On the Specific Effectiveness, and Under-Valuing, of Pharmacological Treatments for Addiction: A Comparison of Methadone, Naltrexone and Disulfiram with Psychosocial Interventions

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Abstract
For a mixture of moral, ideological and educational reasons and financial self-interest, some of the most effective and cost-effective treatments for alcohol and heroin abuse are under-used, under-valued, or actively denigrated by health professionals, or used with less than optimal efficiency. Methadone, disulfiram and naltrexone have specific therapeutic effects which generally exceed the specific effects of most psychosocial interventions. In contrast to the consistent pharmacological effects of these drugs, both the specific and non-specific effects of psychological treatments may be greatly reduced by therapist variables. Methadone maintenance, in particular, has an ability to attract opiate abusers and retain them in treatment which makes it much more effective, overall, than residential treatment. Supervised administration is a crucial factor in the treatment of opiate abuse with naltrexone and of alcohol abuse with disulfiram. With all pharmacological components of treatment, adequate dosage is important.