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In three years from 2008 Scottish national policy drove delivery of nearly 175,000 brief alcohol interventions, testament to what can be done when policy is backed by funding and infrastructure and incentive payments contingent on implementation. Leverage and acceptance were greatest in primary care, where the vast majority of the work took place.
Until June 2008 Victoria in Canada had a comprehensive extended hours needle exchange at a fixed site in the city. Neighbourhood pressure led to closure, creating a natural experiment in the withdrawal of services. The result seemed to be more sharing of injecting equipment entailing a greater risk of infection.
In the US homeland of competition and private health care, it was cooperation and coordination which led to the introduction of new medications and innovations to promote continuing care – plus the exercise of regulatory and financial muscle and the salutary experience of senior staff who placed themselves in the patient's shoes.
In 2007–08 the US state of Maine introduced a new scheme directly linking funding for outpatient treatment services to performance in terms of waiting times and retention, but financial and service delivery impacts were negligible. Were the incentives too weak, or were services already doing as well as they could?
Improving performance of substance use disorder treatment systems is no easy matter and one prone to unintended consequences. All the more welcome then is guidance from leading US experts with top-level experience in the UK and the USA; their favourite tactic, rewarding services for patient progress during treatment, is featured in UK payment-by-results schemes.
This first major multi-modality test of a treatment engagement indicator widely used as a quality control yardstick in the USA found it was only very weakly related to patient improvement seven months after starting treatment, confirmation that simple measures of what happens during treatment struggle to capture what really makes treatment effective.
STUDY 2011 HTM file
South East Alcohol Innovation Programme: evaluation report
In the south east of England a bidding exercise spawned a spate of short-term innovative projects to reduce alcohol-related harm, from which five models were assessed as most promising and taken forward for further implementation and assessment the following year – a rapid and intensive test bed from which others can learn as well.
STUDY 2012 HTM file
Estimating the crime reduction benefits of drug treatment and recovery
England's National Treatment Agency for Substance Misuse calculates the crime reduction dividend for society arising from effective addiction treatment at billions of pounds, meaning that any cuts in funding would be more than wiped out by the costs of increased crime.
From national and local guidance, commissioners and services, a rounded picture of how much Britain knows about and responds to the needs of the relatives of problem drug users. Increasing recognition of needs has generally yet to be matched by systematic needs assessments or service provision.
DOCUMENT 2012 HTM file
The government's alcohol strategy
The UK government alcohol strategy for England and Wales claims to signal a radical change to turn the tide against irresponsible drinking. After resisting the policy, headline is the commitment to setting a minimum per unit price for alcohol.
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