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In the USA two studies have shown that quarterly check-ups on former patients help identify the need for and motivate further treatment, but gains in substance use/problem reductions only became evident when improved procedures were introduced, and even then remained modest.
One of the few 'matches' found by the huge US Project MATCH alcohol treatment trial was that motivational therapy bettered CBT for clients prone to anger. One of the clinics has shown why – because motivational therapists were less directive.
Instead of telling addiction treatment providers what to do to qualify for funding, the US state of Delaware set recruitment and engagement targets and largely left the methods up to the services. Result: more and more engaging treatment without stifling innovation.
Motivational interviews are not universally beneficial or at worst neutral – sometimes they make things worse. In this US study they helped ambivalent patients make the most of their treatment but impeded the recovery of those already committed to change.
Restructuring the nursing involved in British home detoxification programmes meant that a year later a third more patients were no longer drinking heavily, creating a highly cost-effective intervention.
Combining results from the few available evaluations of emergency department-based alcohol interventions suggests these substantially reduce alcohol-related injuries, but the estimate may not be applicable outside the USA or to all emergency patients.
Rare glimpse 'under the hood' of contingency management suggests that unless the patient sees themselves
as having actively mastered their dependence and has developed anti-relapse strategies, effects of rewarding
abstinence will be short-lived.
Brief interventions based on motivational interviewing typically incorporate feedback on the individual's risk and use level compared to the norm, but does this really help? A US college study found it did, the combination leading to greater drinking reductions than either on its own.
This German study saved valuable counselling time by only offering further advice to primary care patients who had not yet responded to brief computerised feedback on their risky drinking.
Using teachers' ratings to target the families of high-risk pupils, a US study has shown that a few hours spent improving parental monitoring and response to childrens' behaviour can lead two years later to reductions in substance use.
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