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The largest recent US national survey of drink and drug problems shows that outside the addiction treatment clinic, remission is the norm and recovery common. After 14 years half the people at some time dependent on alcohol were in remission, a milestone reached for cannabis after six years, and for cocaine after just five.
Orchestrated by WHO, across all four countries this rare attempt at screening and brief intervention for problems arising from illegal drug use identified at front-line health care centres found modest reductions in use/risks, but there was a puzzling opposition between particularly positive results from Australia and seemingly negative ones from the USA.
Rare attempt at screening and brief intervention for actual or potential problems arising from illegal drug use among primary care patients suggests that screening itself reduces use levels and that further intervention might be worthwhile among high-risk populations.
STUDY 2011 HTM file
Interim methadone treatment compared to standard methadone treatment: 4-month findings
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.
STUDY 2013 HTM file
Criminal justice responses to drug related crime in Scotland
In one expert package, the recent history, results, achievements and possible drawbacks of Scotland's concerted attempt to engage drug-driven offenders in treatment at nearly every stage of the criminal justice system. Widening treatment access may have been the main plus, also widening entanglement in the criminal justice system the main minus.
REVIEW 2012 HTM file
Effect of buprenorphine dose on treatment outcome
How much buprenorphine does it take to keep patients in treatment and suppress illicit use of heroin or other opiate-type drugs? This review concludes that on average higher is better than lower, but that individualising dose and a preparedness to go high if needed are the keys to effective treatment.
DOCUMENT 2013 HTM file
Community loses from failure to offer maintenance prescribing in prisons
An international team of experts has argued that failure to implement effective opioid maintenance programmes in prison represents an important missed opportunity to engage high-risk drug users in treatment, at possibly substantial costs to the individuals and to the community. Is Britain too losing out, and how does the future look?
STUDY 2009 HTM file
The alliance in motivational enhancement therapy and counseling as usual for substance use problems
Rarely has counselling been so deeply analysed as in this US study of mainly alcohol and cocaine dependent patients. The far-reaching implications are that some counsellors generate relationships with clients which feed through to better outcomes – but also that the 'best' relationship builders are not on average the most effective.
STUDY 2012 HTM file
Four-year outcomes from the Early Re-Intervention (ERI) experiment using recovery management checkups (RMCs)
Chicago studies have shown that quarterly check-ups on former patients can identify need and pave the way for treatment re-entry. Though extra substance use/problem reductions were modest, these remained significant four years after the patients started treatment. Issue for the UK: how does this square with the stress on lasting treatment exit?
STUDY 2010 HTM file
Randomized trial of continuing care enhancements for cocaine-dependent patients following initial engagement
Unusually this US study took a set of patients who had generally already initiated abstinence from cocaine use and then used abstinence incentives and/or cognitive-behavioural therapy to extend and consolidate these gains. There was some evidence that offering the therapy and improving attendance via incentives prolonged the impact of those incentives.
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