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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.
The title speaks of long-term effects but in fact there were none from sending young US substance users to a youth therapeutic community specialising in substance use problems compared to non-specialist group homes; early gains had all eroded, an instance of the general difficulty of sustaining youth treatment outcomes.
Unequivocal backing from UN agencies for methadone and other forms of long term maintenance treatments as the prime modality for the treatment of dependence on heroin and allied drugs. In contrast say the experts, detoxification results in poor long term outcomes.
What happens when opiate-addicted patients are suddenly no longer required to take their methadone under supervision but can take it away from the pharmacy? In Scotland this was tried in the first UK randomised trial; patients stayed longer in treatment and there was no dramatic escalation in heroin use.
Heroin addicts in Baltimore who still used drugs heavily despite being on methadone were sent to a special clinic for intensified care reinforced by sanctions and incentives and eventual discharge if still they failed to comply. Tough love perhaps, but does it really make sense to intensify compliance requirements on patients already not complying?
From the USA a rare randomised controlled trial of prison-based substance use treatment for women finds substantial benefits from replacing a standard prison therapeutic community programme with one based on extensive trauma-informed and gender-responsive elements delivered in an entirely woman-only environment.
This wide-ranging review uniquely draws together findings from authoritative reviews of rigorous research conducted for the Cochrane collaboration and later studies concerned with the pharmacological and psychosocial treatment of dependence on opiate-type drugs like heroin, concluding that retention is the common key to success.
Update of Cochrane review of rigorous studies surprisingly finds that adding psychosocial therapy to opiate substitute prescribing makes no difference to retention or substance use – a testament to the power of the routine treatment and a blow (but not a fatal one) to hopes that extra therapy would aid recovery and treatment exit.
From the Netherlands, the first randomised controlled trial to evaluate internet-based therapy for problem drinking via text-chat conversations with a real therapist found this improved on an automated self-help option; on average alcohol intake was cut by nearly two-thirds.
Despite being motivated to sustain abstinence and implanted with a drug which should have blocked the effects of opiates, in Norwegian studies most opiate-dependent patients used opiates and about a quarter did so repeatedly.
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