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Title and link for copying Comment/query to editor Drug Matrix Alcohol Matrix

S Seminal studiesK Key studiesR ReviewsG Guidancemore Search for more studies

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Drug Matrix cell A2: Interventions; Generic and cross-cutting issues

S Everything you believed about heroin addiction is wrong (1977). Or biased to an extreme degree by a vision usually restricted to the atypical users who enter treatment in societies where the drug is illegal, hard to obtain and demonised. In the 1970s a high proportion of US soldiers became addicted in Vietnam but (even if they still dabbled) ‘recovered’ without treatment on return to the USA, highlighting the importance of environment and the rewards of a ‘normal’ life; those for whom this is not enough or who cannot access these rewards face problems other than their substance use.

S ‘Pre-recovery’ foundations of recovery orientation (2000). Though relatively recent, justification for the ‘seminal’ tag is that this study predated by many years the recovery era in British policy, but laid some of the foundations for its shift in emphasis from the psychological or biochemical grip of addiction to lifestyle change which breaks with the past satisfyingly enough to forge a positive, non-addict identity and prevent relapse.

K Remission is the norm but some take much longer than others (2011). US national population survey found that ten years after meeting criteria for dependence, in respect of cannabis two thirds were no longer dependent and three quarters for cocaine. Reanalysis (2013) of data from the same series of surveys points out most remit without treatment and that since onset is typically around age 20, by age 30 most people formerly dependent on cannabis or cocaine are no longer dependent.

K English treatment services vindicated (1999). NTORS which recruited its sample in 1995 remains the most important treatment study in Britain. Conducted when all the treatment modalities it studied (inpatient, residential and methadone) were under political and/or financial threat, it seemed to show they reaped benefits which greatly outweighed their costs. Recruiting its sample about eleven years later, DTORS (2009) reached similar conclusions, but nearly three quarters of the sample could not be followed up.

K Abstinence rare outcome in Scotland (2006). Recruiting its sample in 2001, DORIS was the Scottish equivalent to the English NTORS and DTORS. The apparent mismatch between the abstinence ambitions of the patients and the lack of abstinence outcomes was the main theme, but the findings were not so clear cut. See also these reports from DORIS on employment (2008) and crime (2007) outcomes, and an omnibus report (2008) on the project’s findings.

K Influential treatment process model emerges from US studies (2002). DATOS was one of the US equivalents to the Scottish DORIS and the English NTORS and DTORS studies. Instead of heroin, cocaine was the main drug. For the UK the study’s significance lay less in its outcomes, than in the highly influential model of how treatment works and therefore how it can be improved which emerged from this and other studies by the same US research institute.

K Motivating aftercare (2007). US inpatient treatment centre systematically applied simple prompts and motivators to substantially improve aftercare attendance and sustain recovery. See also later report from same study.

R Substantial annual rate of remission from dependence on illegal drugs (2010). Synthesis of treatment and general population studies helps fill the gap in the key study above relating to dependence on opiate-type drugs; each year one or two patients out of every ten overcome their dependence. For amphetamines corresponding figure was from one in two to one in six, and for cocaine from one in eight to one in twenty.

R Remission is the norm (2010). In the general population and in treatment samples, on average studies have found half (or more in recent studies) of all problem substance users were later in remission. After treatment, six out ten remitted by becoming abstinent, but among general population samples, six out of ten continued to use.

R Engaging the treatment-resistant (2010). Confrontation and tough love are not the best ways for families to persuade their problem drug users to get help.

R Tailor induction (2005). Some patients need motivation bolstered and options explored, for others this is not just unnecessary but counterproductive.

R Chronic care for chronic conditions (2009). Generally the offer of long-term continuing care or ‘aftercare’ leads to better outcomes; the implication for this US expert reviewer is that dependence is best treated as a chronic condition. A later review (2014) built on his work, adding 13 studies to the 20 previously identified and aggregating all substance use outcomes reported in the trials. The result was a less positive picture than the previous review’s count of studies which found at least one measure enhanced by continuing care.

G Recovery defined (2008). In 2008 a national UK charity aiming to foster evidence-based debate about drug policy brought together 16 experts to (if they could) agree an understanding of ‘recovery’ from problem substance use. Remarkably, they did agree, characterising it as “voluntarily-sustained control over substance use which maximises health and wellbeing and participation in the rights, roles and responsibilities of society”.

G Treatment principles ([US] National Institute on Drug Abuse, 2012). Presents 13 research-based principles of addiction treatment, seven of which have been tested against the North American evidence. Principles relating to individualising treatment were consistently supported.

G Strategies to promote continuing care (2009). Expert US consensus on practical strategies to promote continuing care based on review above.

more This search retrieves all relevant analyses.
For subtopics go to the subject search page or hot topics on promoting recovery through employment, on mutual aid and user-involvement, the need for residential care, on individualising treatment, and on recovery as a treatment objective.

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