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Continuing care for addiction: Indications, features, and efficacy

James R McKay, PhD
Section Editors
Richard Saitz, MD, MPH, FACP, DFASAM
Andrew J Saxon, MD
Deputy Editor
Richard Hermann, MD


Addiction is a chronic or relapsing condition for many patients. Yet the traditional treatment model for addiction has emphasized episodic intensive treatment for medically supervised substance withdrawal and/or stabilization, followed by time-limited outpatient care. In recent years, public and private health care systems and clinicians are coming to recognize that chronic or relapsing addiction, like chronic physical conditions such as diabetes or hypertension, typically requires continuing, long-term care.

Continuing care for addiction includes routine assessment and treatment customized to the needs and preferences of the individual patient [1]. The patient’s clinical status and risk of relapse are monitored systematically and longitudinally. The intensiveness of treatment is adjusted as the addiction waxes and wanes over time. Patients receive training in self-management skills and linkage to other sources of professional and community support.

This topic describes indications for continuing care in chronic or relapsing addiction, components of continuing care, and the efficacy of multimodal continuing-care interventions. Other topics describe the implementation of continuing care in addiction, treatment issues specific to individual substance use disorders (SUD), and determining the appropriate level of care for patients with SUDs. (See "Continuing care for addiction: Implementation" and "Pharmacotherapy for opioid use disorder" and "Pharmacotherapy for alcohol use disorder" and "Psychosocial treatment of alcohol use disorder" and "Cannabis use disorder: Treatment, prognosis, and long-term medical effects" and "Cocaine use disorder in adults: Epidemiology, pharmacology, clinical manifestations, medical consequences, and diagnosis" and "Psychosocial interventions for stimulant use disorder in adults" and "Determining appropriate levels of care for treatment of substance use disorders".)


Treatment of addiction has traditionally been short-term and focused on acute episodes of care. After initial medically supervised substance withdrawal and/or stabilization at a higher level of care (eg, inpatient or residential), patients would typically receive a time-limited course of outpatient treatment. A national survey of outpatient SUD treatment programs found that the planned duration of outpatient care was most often 90 days, while the actual duration was less than 30 days [2]. Treatment has largely taken place in specialty addiction programs that employ a single modality of treatment, often without access to medication.

For many patients, however, addiction is a chronic or relapsing condition that lasts many years subsequent to diagnosis [3]. Studies have found that 40 to 60 percent of patients treated for alcohol or other drug dependence return to regular use within a year following treatment [4-6].


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