Improving drug abuse treatment.

Multiple drug abuse may involve the whole range of abused drugs, but the most critical problems exist with cocaine, alcohol, opioids, and benzodiazepines. The medical and psychosocial consequences of abusing these drugs in various combinations are often more severe than abusing each drug alone, and specific combinations of treatment options may be needed for many of these drugs. These combination treatments may include relapse prevention psychotherapies targeted toward drug-related cues that are specific to each type of drug as well as pharmacotherapies targeted toward specific drugs of abuse, such as naltrexone for opioid abuse and disulfiram for alcohol abuse. Few controlled clinical trials are available with multiple drug abusers, but successful treatments using pharmacological adjuncts such as disulfiram and amantadine have been described with cocaine-abusing or alcoholic methadone-maintained patients. CONTEXT OF MULTIPLE DRUG ABUSE Multiple drug abuse has become an increasing problem among opioid and cocaine abusers, the two major risk groups for infection with acquired immunodeficiency syndrome (AIDS). The management of multiple drug abuse is particularly important among the abusers of these two drugs because a key means for controlling the AIDS epidemic among drug abusers is the successful treatment of intravenous (IV) drug abuse (Battjes and Pickens 1988). Among those patients who abuse both opioids and cocaine together (“speedballs”), the IV route of administration is quite common, and the direct relationship to the spread of AIDS is quite clear. The other two substances that are substantially abused by opioid and cocaine abusers are alcohol and sedatives, particularly benzodiazepines. Although alcohol and benzodiazepines are not abused intravenously in the United States, abuse of these two substances is associated with complications in the management of both opioid and cocaine abusers. These complications include difficulties in detoxification as well as in