Drug dependence, a chronic medical illness: implications for treatment, insurance, and outcomes evaluation.

@article{Mclellan2000DrugDA,
  title={Drug dependence, a chronic medical illness: implications for treatment, insurance, and outcomes evaluation.},
  author={A. Thomas Mclellan and David C. Lewis and Charles P O'brien and Herbert D. Kleber},
  journal={JAMA},
  year={2000},
  volume={284 13},
  pages={
          1689-95
        }
}
The effects of drug dependence on social systems has helped shape the generally held view that drug dependence is primarily a social problem, not a health problem. [...] Key Method A literature review compared the diagnoses, heritability, etiology (genetic and environmental factors), pathophysiology, and response to treatments (adherence and relapse) of drug dependence vs type 2 diabetes mellitus, hypertension, and asthma. Genetic heritability, personal choice, and environmental factors are comparably involved…Expand
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References

SHOWING 1-10 OF 137 REFERENCES
Genetic and environmental influences on drug use and abuse/dependence in male and female twins.
Twins were recruited through alcohol and drug treatment programs. With structural equation modeling, genetic and environmental estimates were obtained for use and DSM-III abuse/dependence ofExpand
Drug dependence: stress and dysregulation of brain reward pathways.
TLDR
Genetic factors and early environmental factors may contribute to variations or abnormalities in neurobiologic function which may yield some individuals more vulnerable, both to the initial acquisition of drug addiction, as well as relapse to drug use once achieving the abstinent state. Expand
Pharmacologic Treatment of Heroin-Dependent Patients
TLDR
The treatment of heroin dependence is reviewed and new pharmacologically based treatments show promise for the expansion of treatment options are emphasized. Expand
Alcohol and drug problems among diverse health and social service populations.
TLDR
Health and social service agencies provide significant opportunities for the screening and referral of individuals with problematic alcohol and drug use, and general medical services may be more effective in conducting prevention and early case-finding activities. Expand
Genetic influences on DSM-III-R drug abuse and dependence: a study of 3,372 twin pairs.
TLDR
The application of molecular genetic approaches to elucidate the genetic influence on drug use disorder, as well as the potential efficacy of environmental intervention to reduce risk, are supported. Expand
The long-term course of treated alcoholism: II. Predictors and correlates of 10-year functioning and mortality.
TLDR
The findings support the value of embedding long-term follow-up studies in a theory of the disorder that is the target of the intervention. Expand
Substance Abuse: A Comprehensive Textbook
TLDR
This book discusses the determinants and perpetuators of substance abuse, medical aspects of immunodeficiency virus infections and its treatment in injecting drug users, and management of the psychosocial sequelae of Hiv infection among drug users effects of narcotics on immune function. Expand
Common genetic vulnerability for nicotine and alcohol dependence in men.
TLDR
A common genetic vulnerability to nicotine and alcohol dependence in men is suggested, which may partially explain the clinical and epidemiological observations that alcoholics are often dependent smokers. Expand
Similarity of outcome predictors across opiate, cocaine, and alcohol treatments: role of treatment services.
This study examined the patient and treatment factors associated with 6-month outcome in 649 opiate-, alcohol-, and cocaine-dependent (male and female) adults, treated in inpatient and outpatientExpand
One‐Year Follow‐Up Status of Treatment‐Seeking Cocaine Abusers: Psychopathology and Dependence Severity as Predictors of Outcome
TLDR
The data supported a unidimensional model of outcome for cocaine abuse that emphasized reduction in level of substance use, but abstinence was not strongly associated with improved functioning in all outcome areas. Expand
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