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One of 25 cells in the Drug Treatment Matrix
Seminal and key studies on features common to psychosocial therapy/support and medical treatment. Investigates where treatment is aiming to get to in the form of ‘recovery’, where it starts from as depicted in the brain-disease model of addiction, and the politics of the two most important British drug treatment studies.
S Seminal studies K Key studies R Reviews G Guidance more Search for more studies
Links to other documents. Hover over for notes. Click to highlight passage referred to. Unfold extra text
S The ‘miracle’ recovery of the Vietnam veterans (1977). In the 1970s fewer than 1 in 8 of the US soldiers who became dependent on heroin in Vietnam relapsed in the three years after their return. The great majority usually remitted without any treatment. For discussion click here and scroll down to highlighted heading.
S Pioneering insight into common factors in therapy (1991). First published in 1961 and culminating in a third edition in 1991, Jerome D. Frank’s book Persuasion and Healing was a pioneering insight into the important features shared by effective therapies in mental health including the addictions, features now widely acknowledged as more influential than the specific theories and methods of different approaches.
S ‘Pre-recovery’ foundations of recovery orientation (2000). Original article here. Justification for the ‘seminal’ tag is that by many years this study predated the recovery era in British policy, yet laid some of the foundations for its shift in emphasis from the psychological or biochemical grip of addiction, to lifestyle change which forges a positive, non-addict identity as a bolster against relapse.
K Remission is the norm but some take much longer than others (2011). US national population survey found that after ten years two-thirds of people dependent on cannabis were no longer dependent and three-quarters for cocaine. Reanalysis (2013) of same surveys points out that most remit without treatment and calculates that no matter how long ago someone became dependent, their chances of remission remain the same, challenging assumptions that progressive neural, lifestyle or psychological changes increasingly lock-in addiction. Related reviews below. For related discussion click here and scroll down to highlighted heading.
K English treatment services vindicated (1999). NTORS recruited its sample of patients in drug treatment in England in 1995, but remains the most important treatment study in Britain. Conducted when the modalities it studied (inpatient, residential and methadone) were under threat, it found they reaped benefits which greatly outweighed costs. Sampling about 11 years later, DTORS (2009) reached similar conclusions, but nearly three-quarters of the patients could not be followed up. For discussion click here and scroll down to highlighted heading.
K Abstinence rare outcome in Scotland (2006). Recruiting its sample in 2001, the DORIS drug treatment study 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 actually the findings were not so clear cut. See also reports on employment (2008) and crime (2007) outcomes, and an omnibus report (2008) on the project’s findings. For discussion click here and scroll down to highlighted heading.
K Influential treatment process model emerges from US studies (2002). The US national drug treatment study 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 patients were dependent on. For the UK the study’s significance was 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 diagram.
K Validation for English treatment exit outcome measure ([UK] National Treatment Agency for Substance Misuse, 2010). Support for the argument made by England’s National Treatment Agency for Substance Misuse that relapse is less likely if patients leave treatment after having successfully completed the programme rather than dropping out – but staying ([UK] National Treatment Agency for Substance Misuse, 2012) in treatment for at least a few years is in some respects even better.
K Non-residential rehabilitation usually matches residential … but not always (2007). Confirmed that unless there are pressing contraindications, intensive day options deliver outcomes equivalent to residential care. Often of course, there are pressing contraindications. See also this informal Effectiveness Bank review.
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 What is addiction treatment for? (2016). Effectiveness Bank hot topic asks the big question, on the way roving through ‘recovery’ as an answer (the focus of another hot topic 2016), and noting that “though those who later become addicts often start with few personal, social and economic resources, the little they do have will be eroded by criminalisation and social stigma, and by services which explicitly or inadvertently encourage the adoption of an addict identity”. For discussion click here and scroll down to highlighted heading.
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 of ten remitted by becoming abstinent, but among general population samples, six out of ten continued to use. Similar territory covered in another review (2010). Related key study above. For related discussion click here and scroll down to highlighted heading.
R Engaging the treatment-resistant (2010). Shock-tactic confrontation and tough-love disengagement found less likely to persuade dependent users in the family to enter treatment than a ‘community reinforcement’ approach aimed at engaging them in fulfilling activities incompatible with continued substance use.
R Tailor induction to treatment (2005). When considering or starting treatment some patients need motivation bolstered and options explored, for others this is not just unnecessary, but counterproductive.
R Chronic care for chronic conditions (2009). Based on a count of studies which found improvement on at least one substance use outcome, generally the offer of long-term continuing care/aftercare leads to better outcomes, implying that dependence is best treated as a chronic condition. A later review (2014) (free source at time of writing) added 13 studies to the 20 previously identified and aggregated all substance use outcomes reported in the trials. Still the offer of continuing care helped retain treatment effects but more modestly than found by the earlier review. Guidelines based on review below.
G Recovery defined (2008). A national UK drug policy charity 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”. For discussions click here and here and scroll down to highlighted headings.
G Guide for UK clinicians on treating problem drug use ([UK] Department of Health, 2017). There is no more important document for UK clinicians involved in treating problem drug use than the so-called ‘Orange guidelines’. This major update offered detailed guidance on the range of problems, settings and patients clinicians encounter, establishing the foundation for deciding what in Britain constitutes acceptable and unacceptable medical practice.
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 US guidance on matching patients to intensity and type of care (American Society of Addiction Medicine, 2013). From the professional body for US addiction clinicians, world’s most widely used criteria for deciding what kind of treatment to start with or move on to for different kinds of patients.
G Strategies to promote continuing care (2009). Expert US consensus on practical strategies to promote continuing care based on review above.
G Crucial case management role (Association of Alcohol and Other Drugs Agencies Northern Territory, 2015). Australian state ‘peak’ body for non-governmental drug and alcohol services offers guidance on the important and widely implemented (but barely researched) role of the case manager in integrating and coordinating service delivery.
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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, on what treatment is for, and on recovery as a treatment objective.
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