Drug Treatment Matrix cell B3: Practitioners; Medical treatment

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Practitioners; Medical treatment

Seminal and key research and reviews on the influence of the practitioner in the medical treatment of drug dependence. Investigates the how clinician-patient relationships might be affected by enforcing clinic rules and the potential importance of doctors forming a “whole person’ relationship with patients.


S Seminal studiesK Key studiesR ReviewsG Guidancemore Search for more studies

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S Quasi-randomisation reveals methadone counsellor is an ‘active ingredient’ (1988). Effectively random allocation of patients to different methadone counsellors at the same service revealed that effective counsellors were more diligent and active, helping patients anticipate problems and solutions. Related study below. For discussion click here and scroll down to highlighted heading.

S What makes a methadone counsellor effective? (1985). In US study based in a methadone treatment clinic differences in effectiveness could partly be explained by the personalities of the therapists, particularly their abilities to quickly form warm, supportive relationships with patients.

K Treatment staff matter as much as the drug (1999). Trio of US studies finds methadone patients do better with active counsellors who respond constructively to their problems. One of the three was the study below.

K Quasi-random allocation exposes impact of methadone counsellors (1999). When methadone doses had been tailored to the individual and stable for at least three months – effectively taking them out of the equation – US study found which counsellor the patient had effectively at random been assigned to substantially affected retention and illegal substance use. One of three studies featured in entry above. Related study above. For discussions click here and here and scroll down to highlighted heading.

K Patients more likely to avoid illegal opioid use when relationship good with methadone-prescriber (2014). Of all the assessed variables, whether six months in to treatment patients in France felt they had a good relationship with their doctors was most closely related to the elimination of non-prescribed opioid use six months later, possibly because it meant they were more likely to discuss their dose with their physician and therefore to be prescribed appropriately. For discussion click here and scroll down to highlighted heading.

K Patients do best with GPs who they feel know them as a whole person (2007; free source at time of writing). US patients referred to primary care after detoxification reduced drug use/problems most when they saw GPs who they felt knew them as a whole person and who consistently saw them rather than referring to a colleague or assistant. Related study below. For discussion click here and scroll down to highlighted heading.

K Not just an addict/patient (2007). Free source at the time of writing. Interviews with long-term buprenorphine maintenance patients in France revealed that “the physician’s behaviour may convey to the user that s/he is … a life-long junkie or a repentant junkie, or on the other hand may allow him to see himself as a whole person,” promoting “a positive worthwhile image free of the stigma of the junkie”. Related study above. For discussion click here and scroll down to highlighted heading.

R Clinicians’ impact on treatment quality (2000; free source at the time of writing). Assessed whether retention and substance use outcomes were related to the clinician’s professional status, whether they had been a problem substance user, their adherence to protocols, countertransference, formation of therapeutic relationships with patients, personality, beliefs about treatment, and professional practice issues. Found that clinicians vary greatly in their performance but that “past assumptions that levels of training, experience, or other simple therapist variables could account for such differences does not hold”. For discussion click here and scroll down to highlighted heading.

R Above all, don’t do the wrong thing (2015; free source at the time of writing). Across health care in general, doctor-patient interactions that are invalidating (do not successfully communicate acceptance and understanding) damage relationships more powerfully than positive communications cement them. More on the importance of not doing the wrong things in cell B2.

G What UK doctors should do and be able to do ([UK] Royal College of Psychiatrists and Royal College of General Practitioners, 2012). Guidance from UK professional associations for GPs and for psychiatrists on the competencies, training and qualifications expected of doctors involved in caring for substance users, from generalists such as doctors in emergency departments and general practitioners to addiction specialists.

G What UK specialist addiction doctors should do and be able to do ([UK] Public Health England, Royal College of Psychiatrists and Royal College of General Practitioners, 2014). Guidance from body overseeing addiction treatment in England and from professional associations for GPs and for psychiatrists on the “essential functions which can usually only be carried out by addiction specialist doctors” and the importance of retaining their expertise in the sector.

G Competencies for working with co-occurring substance use and mental health problems (2019). From Clinks, a national charity supporting voluntary organisations in the criminal justice system in England and Wales, and developed through Public Health England based on their related guidance. Advice on the values, knowledge and skills required for effective care of people whose substance use problems are complicated by poor mental health. Informed by patients who emphasised the “importance of workers’ personal qualities and behaviour and how vital the workers’ characteristics were to an individual’s recovery journey”.

G What US specialist addiction doctors should do and be able to do ([US] American Society of Addiction Medicine, 2014). Consensus guidelines from the US professional association for doctors who specialise in treating addiction on what they are expected to do and the standards they should meet throughout treatment from assessment to aftercare.

Search for all relevant Effectiveness Bank analyses or search more specifically at the subject search page. See also hot topic on the influence of treatment staff.

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