effective in stimulant users, and alcoholics (in which it is nearly as effective as benzodiazepines in preventing complications); using clonidine, an alpha-agonist, and loperamide for opioid detoxification, for first-time users or those who wish to attempt an abstinence-based recovery (90% of opioid users relapse to active addiction within eight months or are multiple relapse patients); or replacing an opioid that is interfering with or destructive to a user's life, such as illicitly-obtained heroin, dilaudid, or oxycodone, with an opioid that can be administered legally, reduces or eliminates drug cravings, and does not produce a high, such as methadone or buprenorphine – opioid replacement therapy – which is the gold standard for treatment of opioid dependence in developed countries, reducing the risk and cost to both user and society more effectively than any other treatment modality (for opioid dependence), and shows the best short-term and long-term gains for the user, with the greatest longevity, least risk of fatality, greatest quality of life, and lowest risk of relapse and legal issues including arrest and incarceration. in a survey of treatment providers from three separate institutions, the national association of alcoholism and drug abuse counselors, rational recovery systems and the society of psychologists in addictive behaviors, measuring the treatment provider's responses on the "spiritual belief scale" (a scale measuring belief in the four spiritual characteristics of aa identified by ernest kurtz); the scores were found to explain 41% of the variance in the treatment provider's responses on the "addiction belief scale" (a scale measuring adherence to the disease model or the free-will model of addiction). behavioral programming behavioral programming is considered critical in helping those with addictions achieve abstinence. from the applied behavior analysis literature and the behavioral psychology literature, several evidence based intervention programs have emerged: (1) behavioral marital therapy; (2) community reinforcement approach; (3) cue exposure therapy; and (4) contingency management strategies. in addition, the same author suggests that social skills training adjunctive to inpatient treatment of alcohol dependence is probably efficacious. community reinforcement has both efficacy and effectiveness data. in addition, behavioral treatment such as community reinforcement and family training (craft) have helped family members to get their loved ones into treatment. motivational intervention has also shown to be an effective treatment for substance dependence. alternative therapies alternative therapies, such as acupuncture, are used by some practitioners to alleviate the symptoms of drug addiction. in 1997, the american medical association (ama) adopted, as policy, the following statement after a report on a number of alternative therapies including acupuncture: there is little evidence to confirm the safety or efficacy of most alternative therapies. much of the information currently known about these therapies makes it clear that many have not been shown to be efficacious. well-designed, stringently controlled research should be done to evaluate the efficacy of alternative therapies. treatment and issues medical professionals need to apply many techniques and approaches to help patients with substance related disorders. using a psychodynamic approach is one of the techniques that psychologists use to solve addiction problems. in psychodynamic therapy, psychologists need to understand the conflicts and the needs of the addicted person, and also need to locate the defects of their ego and defense mechanisms. using this approach alone has proven to be ineffective in solving addiction problems. cognitive and behavioral techniques should be integrated with psychodynamic approaches to achieve effective treatment for substance related disorders. cognitive treatment requires psychologists to think deeply about what is happening in the brain of an addicted person. cognitive psychologists should zoom in to neural functions of the brain and understand that drugs have been manipulating the dopamine reward center of the brain. from this particular state of thinking, cognitive psychologists need to find ways to change the thought process of the addicted person. cognitive approach there are two routes typically applied to a cognitive approach to substance abuse: tracking the thoughts that pull patients to addiction and tracking the thoughts that prevent them if so from relapsing. behavioral techniques have the widest application in treating substance related disorders. behavioral psychologists can use the techniques of "aversion therapy", based on the findings of pavlov's classical conditioning. it uses the principle of pairing abused substances with unpleasant stimuli or conditions; for example, pairing pain, electrical shock, or nausea with alcohol consumption. the use of medications may also be used in this approach, such as using disulfiram to pair unpleasant effects with the thought of alcohol use. psychologists tend to use an integration of all these approaches to produce reliable and effective treatment. with the advanced clinical use of medications, biological treatment is now considered to be one of the most efficient interventions that psychologists may use as treatment for those with substance dependence. medicinal approach another approach is to use medicines that interfere with the functions of the drugs in the brain. similarly, one can also substitute the misused substance with a weaker, safer version to slowly taper the patient off of their dependence. such is the case with suboxone in the context of opioid dependence. these approaches are aimed at the process of detoxification. medical professionals weigh the consequences of withdrawal symptoms against the risk of staying dependent on these substances. these withdrawal symptoms can be very difficult and painful times for patients. most will have steps in place to handle severe withdrawal symptoms, either through behavioral therapy or other medications. biological intervention should be combined with behavioral therapy approaches and other non-pharmacological techniques. group therapies including anonymity, teamwork and sharing concerns of daily life among people who also have substance dependence issues can have a great impact on outcomes. however, these programs proved to be more effective and influential on persons who did not reach levels of serious dependence. vaccines ta-cd is an active vaccine developed by the xenova group which is used to negate the effects of cocaine, making it suitable for use in treatment of addiction. it is created by combining norcocaine with inactivated cholera toxin. ta-nic is a proprietary vaccine in development similar to ta-cd but being used to create human anti-nicotine antibodies in a person to destroy nicotine in the human body so that it is no longer effective. history the phenomenon of drug addiction has occurred to some degree throughout recorded history (see "opium"). modern agricultural practices, improvements in access to drugs, advancements in biochemistry, and dramatic increases in the recommendation of drug usage by clinical practitioners have exacerbated the problem significantly in the 20th century. improved means of active biological agent manufacture and the introduction of synthetic compounds, such as fentanyl and methamphetamine, are also factors contributing to drug addiction. for the entirety of us history, drugs have been used by some members of the population. in the country's early years, most drug use by the settlers was of alcohol or tobacco. the 19th century saw opium usage in the us become much more common and popular. morphine was isolated in the early 19th century, and came to be prescribed commonly by doctors, both as a painkiller and as an intended cure for opium addiction. at the time, the prevailing medical opinion was that the addiction process occurred in the stomach, and thus it was hypothesized that patients would not become addicted to morphine if it was injected into them via a hypodermic needle, and it was further hypothesized that this might potentially be able to cure opium addiction. however, many people did become addicted to morphine. in particular, addiction to opium became widespread among soldiers fighting in the civil war, who very often required painkillers and thus were very often prescribed morphine. women were also very frequently prescribed opiates, and opiates were advertised as being able to relieve "female troubles". many soldiers in the vietnam war were introduced to heroin and developed a dependency on the substance which survived even when they returned to the us. technological advances in travel meant that this increased demand for heroin in the us could now be met. furthermore, as technology advanced, more drugs were synthesized and discovered, opening up new avenues to substance dependency. society and culture demographics internationally, the u.s. and eastern europe contain the countries with the highest substance abuse disorder occurrence (5-6%). africa, asia, and the middle east contain countries with the lowest worldwide occurrence (1-2%). across the globe, those that tended to have a higher prevalence of substance dependence were in their twenties, unemployed, and men. the national survey on drug use and health (nsduh) reports on substance dependence/abuse rates in various population demographics across the u.s. when surveying populations based on race and ethnicity in those ages 12 and older, it was observed that american indian/alaskan natives were among the highest rates and asians were among the lowest rates in comparison to other racial/ethnic groups. substance use in racial/ethnic groups race/ethnicity dependence/abuse rate asian 4.6% black 7.4% white 8.4% hispanic 8.6% mixed race 10.9% native hawaiian/ pacific islander 11.3% american indian/ alaskan native 14.9% when surveying populations based on gender in those ages 12 and older, it was observed that males had a higher substance dependence rate than females. however, the difference in the rates are not apparent until after age 17.drug and alcohol dependence reports that older adults abuse drugs including alcohol at a rate of 15-20%. it's estimated that 52 million americans beyond 12 years old have abused a substance. substance use in different genders w/ respect to age age male female 12 and older 10.8% 5.8% 12-17 5.3% 5.2% 18 or older 11.4% 5.8% alcohol dependence or abuse rates were shown to have no correspondence with any person's education level when populations were surveyed in varying degrees of education from ages 26 and older. however, when it came to illicit drug use there was a correlation, in which those that graduated from college had the lowest rates. furthermore, dependence rates were greater in unemployed populations ages 18 and older and in metropolitan-residing populations ages 12 and older. illicit drug dependence demographics (education, employment, and regional) education level rates employment status rates region rates high school 2.5% un-employed 15.2% large metropolitan 8.6% no-degree, college 2.1% part-time 9.3% small metropolitan 8.4% college graduate 0.9% full-time 9.5% non-metropolitan 6.6% the national opinion research center at the university of chicago reported an analysis on disparities within admissions for substance abuse treatment in the appalachian region, which comprises 13 states and 410 counties in the eastern part of the u.s. while their findings for most demographic categories were similar to the national findings by nsduh, they had different results for racial/ethnic groups which varied by sub-regions. overall, whites were the demographic with the largest admission rate (83%), while alaskan native, american indian, pacific islander, and asian populations had the lowest admissions (1.8%). legislation depending on the jurisdiction, addictive drugs may be legal, legal only as part of a government sponsored study, illegal to use for any purpose, illegal to sell, or even illegal to merely possess. most countries have legislation which brings various drugs and drug-like substances under the control of licensing systems. typically this legislation covers any or all of the opiates, amphetamines, cannabinoids, cocaine, barbiturates, benzodiazepines, anesthetics, hallucinogenics, derivatives and a variety of more modern synthetic drugs. unlicensed production, supply or possession is a criminal offence. usually, however, drug classification under such legislation is not related simply to addictiveness. the substances covered often have very different addictive properties. some are highly prone to cause physical dependency, while others rarely cause any form of compulsive need whatsoever. also, under legislation specifically about drugs, alcohol and nicotine are not usually included. although the legislation may be justifiable on moral or public health grounds, it can make addiction or dependency a much more serious issue for the individual: reliable supplies of a drug become difficult to secure, and the individual becomes vulnerable to both criminal abuse and legal punishment. it is unclear whether laws against illegal drug use do anything to stem usage and dependency. in jurisdictions where addictive drugs are illegal, they are generally supplied by drug dealers, who are often involved with organized crime. even though the cost of producing most illegal addictive substances is very low, their illegality combined with the addict's need permits the seller to command a premium price, often hundreds of times the production cost. as a result, addicts sometimes turn to crime