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Treatment efforts include both psychological and pharmacological approaches. A number of psychological therapies are effective in the treatment of Substance Abuse or Dependence. Brief, motivationally focused interventions are effective for individuals with milder problems, and they also may enhance treatment outcomes when combined with ongoing treatments (Bien, Miller, & Tonigan, 1993). Cognitive-behavioral therapies, including community reinforcement treatment, relapse prevention, social skills training, and behavioral couples therapy, have good support for their effectiveness in treating Alcohol Dependence (McCrady &

Langenbucher, 1996). Community reinforcement combined with the use of vouchers (Higgins et al., 1994), and family therapy (Liddle & Dakof, 1995) are effective in treating drug dependence. Outcomes for those who complete long-term treatment in therapeutic communities are good, but dropout rates are high (Simpson & Curry, 1997). Treatments to facilitate involvement with self-help groups such as Alcoholics Anonymous or Narcotics Anonymous also are effective (Project MATCH Research Group, 1997), and continued active participation in self-help groups is correlated with better outcomes.

Separate from medications for withdrawal, effective pharmacotherapies to treat substance use disorders are somewhat limited in number. Naltrexone, acamprosate, and disulfiram have evidence supporting their use in the treatment of alcohol dependence. Methadone, LAAM (1-a-acetylmethadol), and buprenorphine have strong evidence of effectiveness in the treatment of opioid dependence. Nicotine replacement products are effective in the initial phases of treatment for nicotine dependence, and bupro-pion appears to be effective for longer-term pharmacother-apy (Barber & O'Brien, 1999).

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