hoice have changed. In the past 40 years, much has been learned from the literature on substance abusers treated in federally funded treatment modalities (De Leon, 1993). The considerable knowledge gained has broad implications for psychological science, theory and practice. The work in the field of addictions has generated several paradigms which have affected how psychoanalysts now approach the problem.
Most of the changes have come about from the study of drug abuse (De Leon, 1993). The three modalities tested most were: methadone maintenance programs, drug-free outpatient programs, and residential therapeutic communities. Thirty percent of opiate addicts in these treatment programs have favorable outcomes, which include no use of illicit drugs, and no arrests in one to five years after treatment. Success rates are lower for marijuana and alcohol abusers. However, for clients treated in residential centers, overall drug use and criminality are reduced. The percentage of success for a patient is directly related to their length of stay in rehabilitation centers - 75 percent for five years for those who spend two years in treatment, 50 percent for those who stay for one year, and less than 25 percent for those who stay less than one year.
There has ben an upward trend in heroin use since the mid-1990s, and between 1995 and 1999 it overtook cocaine as the drug of choice among those seen in treatment centers (Clark, 1999). The drug is available purer and cheaper than ever before, and can be snorted or smoked, so the risks of injection and the stigma attached are less. However, nearly all heroin inhalers eventually go on to inject the drug, and with this goes the added increase in the risk of needle-transmitted diseases such as HIV and hepatitis.
Murphy et al (2001) addressed the issue of college drinking. As many as 20 percent of college students are problem drinkers, they say, and binge drinking can often lead to...