**3. Treatments**

The treatments for drug dependence can be classified into three categories, conventional treatments (non-emergency), emergency (overdose) treatments, and novel treatments. Psychosocial interventions and medication managing are the most common techniques in conventional treatments. Patients need pharmacological intervention to reverse death when they are in overdose. In addition, physical activities, brain stimulation, virtual reality (VR), and mindfulness are considered as novel treatments for drug dependence. The drug dependences may need a combined treatment to make the therapeutic process more effective.

### **3.1 Conventional treatments**

WHO and The United Nations Office on Drugs and Crime gave the standards of the treatments for drug use disorders (Standards). In order to screen out unqualified (ineffective, even harmful) treatments, Standards required the treatments of drug disorders to meet: (1) stopping or dropping drug use; (2) improving health, wellbeing, and social functioning of the affected individuals; (3) preventing future harms by reducing the risk of complications and relapse [4]. According to Standards, the traditional treatments can be categorized into psychosocial interventions, medication managing treatments and overdose or emergency treatments.

### *3.1.1 Psychosocial interventions*

Psychosocial interventions are to address psychological and psychosocial issues related to drug use disorders. Cognitive-behavioral therapy (CBT) helps patients identify self-defeating thoughts and behaviors. It can contribute to address mental illnesses caused or related to drug use [4, 56]. Previous studies provided data-based evidence to support the effectiveness of CBT in drug dependence [57–59]. Contingency management (CM) is to reinforce patients' positive behaviors, such as keeping abstinence, treatment attendance, and compliance with medication, by providing them rewards. Different from other treatments, the effect of CM may be not directly shown in drug use reduction, but shown in combined treatments [4, 60].

Moreover, building connection with other individuals and obtaining supports from others are crucial in psychological therapy. Family-orientated treatment approaches (FOTAs) are to realize the importance of family relationships and cultures. FOTA has been proved that it can be an effective and promising method for drug use disorders [61]. Mutual-help groups (MHP) are frequently used in drug rehabilitation centers, and there are famous drug-focused mutual-help groups, such as Narcotics Anonymous and Cocaine Anonymous. Twelve-step oriented MHP is a nonprofessional, mental support, emphasizing "sharing" and peer-led treatment [4, 62]. Evidence from different types of studies, meta-analysis, randomized controlled trials, and observational studies illustrated the effects of MHP, including reducing drug use, improving mental health, and decreasing relapse rate [63–65]. There are also some other psychosocial interventions, such as contingency management, the community reinforcement approach, and motivational interviewing and motivational enhancement therapy.

### *3.1.2 Medication managing treatments*

Medication managing, also called substitution therapy, is useful and effective in managing and treating drug-related disorders. Pharmacological techniques treat drug disorders, usually through agonist approaches, antagonist approaches, targeting negative reinforcement of drugs, and targeting psychiatric and cognitive disorders [66]. Different drugs have different targeted medicines. For opioid dependence, WHO suggests two main pharmacological treatments: (1) opioid agonist maintenance treatment with long-acting opioids (extended-release opioids), methadone and buprenorphine, this method should be combined with psychosocial treatments; (2) detoxification, with naltrexone, an opioid antagonist [67]. Some other synthetic oral opioids such as L-alpha-acetyl-methadol and slow-release morphine are also considered as effective agents for opioids withdrawal [68]. Long-acting

*Quantitative Assessment Methods for the Severity of Drug Dependences… DOI: http://dx.doi.org/10.5772/intechopen.105582*

benzodiazepine is a helpful medicine for sedative, hypnotic, or anxiolytic withdrawal. In addition, for methamphetamine and cocaine withdrawal, Provigil and immunotherapies would be the most useful agents, respectively [68–71]. These medicines will reduce withdrawal symptoms and reduce drug use, rather than being an alternative addiction for another [72].

### *3.1.3 Conventional treatments selecting*

The conventional treatments do not have a specific program for patients in different levels of severity. Taking cocaine dependence as example, Hser et al. claim that different treatments, including outpatient methadone maintenance, outpatient drugfree, long-term residential and short-term inpatient, did not have significant difference on different severity of cocaine [73]. In general, a combined treatment is more effective. Drug-free treatments are more suitable for less severe drug dependence, and high level of drug dependence is challenge for any treatments.

Different groups may need different treatments. For pregnant women, almost all pharmacological treatments, except methadone, are unavailable, and stimulants and cannabis substitution drug is very limited, even nonexistent [74, 75]. Psychosocial intervention might be a better method [75]. Moreover, the treatments should be changed based on different ages. Treatment Improvement Protocol suggests that the elderly with drug addiction should accept age-specific treatments and combined pharmacological and psychosocial treatment is necessary. Building and rebuilding of self-esteem and social support network are important [76]. Adolescents with drug addiction may confront worse psychiatric comorbidity, and this issue is more common in family having alcohol and drug problems and mental health problems [77, 78]. Family dysfunction and mental health problems are more common and worse in girls, compared with boys [79, 80]. Therefore, the treatments for adolescents may focus more on psychiatric issues, and solving family issues would benefit the treatment outcomes, especially for female adolescents.

Treatments also need to consider about ethical issues. A large proportion of dependences are not willing to accept or seek treatments [45, 81]. Compulsory drug treatment is not legal in some nations, and how to convince drug dependences to receive treatments is a challenge. Johnson intervention, which is an organized and rehearsed meeting to let the drug dependence understand the treatment benefits and nontreatment risks, can be a choice [82]. In addition, patients should choose the treatments they prefer. For example, according to Drug Abuse Treatment Outcome Study, cocaine dependent did not like methadone maintenance. Patients who have used but are not dependent on heroin and cocaine like drug-free treatments more. Heroin dependence, or cocaine and heroin dependence, tends to be treated in methadone maintenance program [73].

### **3.2 Overdose or emergency treatments**

Opioids and stimulants overdose can cause irreversible damage, even death. Opioid dependences are more likely to experience overdose, especially using it by injection [4]. WHO suggests that naloxone, a life-saving drug, can be timely administrated to reserve the opioid overdose [83]. For stimulants overdose, WHO recommends using benzodiazepines and sometimes antipsychotic medications to manage syndromes and ameliorate symptoms [4]. Gorelick claim that pharmacokinetic, which is to maintain the target drug under its minimum effective concentration at the site of

action, treatment can be effective for acute drug overdose [84]. The immunotherapies are antagonizing the effects of drug through pharmacokinetic mechanisms. This approach involves the use of nicotine-specific antibodies that bind nicotine in serum, resulting in a decrease in nicotine distribution to the brain and an increase in nicotine's elimination half-life [85].

### **3.3 Novel treatments**

Psychosocial and pharmacological interventions are treating drug disorders through reducing negative symptoms, decreasing craving, or managing the effect of target drugs. New treatment methods bring prospects for the cure of addiction, and it is helpful for developing personalized and comprehensive treatment.

Recent studies have highlighted the potential of brain stimulation as an innovative, safe, and cost-effective treatment for some SUDs. These include: (i) transcranial electrical stimulation; (ii) transcranial magnetic stimulation (TMS); (iii) transcranial direct current stimulation (tDCS); and (iv) deep brain stimulation (DBS). Stimulation therapies may achieve their effect through direct or indirect modulation of brain regions involved in addiction, either acutely or through plastic changes in neuronal transmission. Although these mechanisms are not well understood, further identification of the underlying neurobiology of addiction and rigorous evaluation of brain stimulation methods has the potential for unlocking an effective, long-term treatment of addiction.

Exercise may also provide a new treatment idea. In recent years, exercises are considered as a novel treatment for drug addiction. Lynch et al. concluded that exercises can reduce the reinforcing effects of drugs and may prevent the relapse [86]. Exercise can increase dopamine level in several parts of brain [87], bring happiness [88], and improve mental health and self-esteem [89]. More importantly, some studies found that exercises can affect dopamine in the reward pathway, even repair the decreased dopamine receptors [86, 90–92]. Furthermore, the side effects that resulted by drug use are not only psychiatric disorders and brain damage, but also the physical impairment, such as impaired respiratory system and bone loss [93, 94]. Exercise can benefit the physical health is well known. Drug dependences should accept the risk evaluation of exercise before having physical activities. The effects of exercises on drug use disorders still need more clinical studies, especially on the dopamine system. Besides, depending on the age, type of drug, age of onset, it is necessary to design appropriate exercise plans according to individual health characteristics [95]. It reported a significant increase in glutamate and GABA signaling in the visual cortex following exercise, as well as an increase in glutamate in the ACC after exercise in adult rats, and exercise-induced expansion of cortical pools can be seen for both glutamate and GABA neurons [96]. Additional, high-intensity interval training has been noted to possess benefits even greater than those of standard moderate exercise [97]. However, appropriate exercise intensity and exercise mode for patient with different age, gender, type of drug still need more in-depth research.

Besides, VR technology has emerged as a powerful tool for the research and intervention of addiction [98]. It's a tool to study how proximal multi-sensorial cues, contextual environmental cues, as well as their interaction (complex cues), modulate addictive behaviors. Moreover, VR simulations can be personalized. They are currently refined for psychotherapeutic interventions. Embodiment, eye-tracking, and neurobiological factors represent novel future directions. The progress of VR

*Quantitative Assessment Methods for the Severity of Drug Dependences… DOI: http://dx.doi.org/10.5772/intechopen.105582*

applications has bred auspicious ways to advance the understanding of treatment mechanisms underlying addictions.

Last but not least, mindfulness-based relapse prevention (MBRP) has been shown as effective in treating substance use disorders [99]. Study results suggest that mindfulness meditation practice may produce endogenous theta stimulation in the prefrontal cortex, thereby enhancing inhibitory control over opioid dose escalation behaviors [100]. However, it necessary to examine the following mediators of intervention outcome: mindfulness skills, emotion regulation skills, executive functioning skills, savoring, and positive and negative affect.

## **4. Conclusion and outlook**

For more than 40 years, the instruments to assess the severity of drug dependence have been developed well, and different quantitative methods can cover almost every field of the symptoms in different periods and stages of drug addiction. Patients, medical workers, or researchers can choose suitable assessments, based on their conditions. The comprehensive and convenient techniques might leave one problem that is how to convince the dependences to do the screening or diagnosis tests. As mentioned in Treatments section, most drug dependences do not want to accept treatments. This needs efforts from drug dependences themselves, their family, the community, and whole society.

Drug addiction is a chronic disease [101], it needs chronic treatments. The interventions or treatments for drug dependence might be in a dilemma caused by medical development. Existing treatments are focusing on addressing the symptoms of drug use–related disorders, rather than the root of addiction. Drug addiction, also called drug use disorders, is defined as a complex, but treatable, disease that affects brain functions modulated by genetic, developmental, and environmental factors. People with addiction use drugs often tend to continue despite harmful consequences [101, 102]. The brain function damage caused by drug use has been proved. For example, chronic methamphetamine use can result in hippocampal volumes decrease and severe gray-matter deficits [103]. Moreover, dopamine receptors and transporters deficits are the consequence of drug use [104, 105]. Conventional treatments, psychosocial interventions, and medicines can only ameliorate withdrawal symptoms, reduce craving or improve psychological health, but not repair the brain or dopamine functions. Exercise or brain stimulation might be a supportive method to contribute to brain system recovering. So far, it is far more from the real rehabilitation. We need more novel treatments to contribute to the functional recovery. Furthermore, existing treatments do not subdivide patients of different level of severity or different groups of patients. Future work can design treatments based on the characteristics of the patients.
