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Is regular counselling really essential to the effectiveness of methadone maintenance treatment, or are treatment entry and the power of high-dose methadone enough in themselves for many patients? At least in the first four months, this US study suggests the latter.
The first systematic review of whether integrated substance use/parenting programmes improve the parenting of problem substance using mothers found remarkably few quality studies, but enough to suggest that such programmes can improve the prospects of often highly at-risk children.
DOCUMENT 2009 HTM file
Management of cannabis use disorder and related issues: a clinician’s guide
Guidance funded by the Australian government and systematically based on the evidence. Covers the range of cannabis use interventions from brief advice for users identified by screening through to managing withdrawal and treating dependence.
STUDY 1970 HTM file
Frontiers of alcoholism
Later to become founding director of the US National Institute on Alcohol Abuse and Alcoholism, in the late 1950s Dr Morris Chafetz of the Massachusetts General Hospital conducted a remarkable series of studies which proved that an alcohol clinic's intake and performance can be transformed by the simple application of empathy and organisation.
This US randomised trial in Rhode Island among formerly opiate dependent prisoners found that starting methadone treatment in prison radically improved treatment uptake on release and reduced heroin and cocaine use over the following six months, confirming results from Baltimore.
Seminal English study which turned the spotlight on organisational factors in the development of a positive attitude to working with problem drinkers, in particular the availability of experience in working with these patients and the support of experienced colleagues. Without these the effects of training are less and less well sustained.
STUDY 2010 HTM file
Effect of motivational interviewing on reduction of alcohol use
At Californian methadone clinics, group education sessions led by a nurse and focused on the risks of aggravating hepatitis infection led to the same substantial reductions in drinking as one-to-one or group motivational interviewing conducted by highly trained counsellors, offering a cost-effective means to reduce alcohol-related risks.
From the comprehensive treatment process data collected by a major national US study emerges the important lesson that retention in itself is not an active ingredient in post-treatment outcomes but reflects influences such having one's needs met (especially important for women) and developing a good relationship with the service and your key worker.
From Canada the first study to show that among long-term, severely opiate dependent patients who have not responded well to prior treatment, women as well as men benefit more from being prescribed injectable heroin than oral methadone.
Slow-release capsules of morphine – the closest drug to heroin – might offer acceptable and effective treatment to addicts who cannot settle on methadone. In England a dozen also being prescribed heroin switched their supplementary methadone to morphine, generally experiencing the benefits they expected and cutting their average dose of heroin.
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