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For the first time in a prison setting a randomised trial rigorously compared intensive residential therapeutic community treatment to outpatient counselling. Confounding expectations, the US prison for problem drug users which hosted the study gained nothing in terms of preventing recidivism by allocating even high-risk prisoners to the more intensive treatment.
REVIEW 2010 HTM file
Assessment and management of cannabis use disorders in primary care
A brief clinical review outlining the harms associated with cannabis use, and the optimal approaches for assessing and managing problem cannabis use in UK primary care.
The diminishing youth treatment caseload in England is increasingly dominated by under-18s primarily being treated for cannabis use problems as the numbers of primary problem drinkers falls away to just 15% of the caseload.
For the second time the annual accounting of the treatment caseload in England combines records of drug and alcohol use treatment, registering a continuing fall in total numbers and decreasing success with opiate users, while the treatment of drinkers appears to be improving.
Multi-prong therapies centred on the family emerge as probably the most effective in this comprehensive and careful synthesis of the results of trials of non-residential programmes for substance using teenagers – but do the outcomes warrant the extra costs?
English treatment systems perform at least as well as other countries on a number of measures, but have a considerably higher rate of drug-related deaths than elsewhere in Europe. As well as pursuing harm reduction and recovery, this report stresses the importance of social integration as an objective.
For the first time the annual accounting of the treatment caseload in England combines both drug and alcohol use patient records, registering a continuing trend down in total numbers due mainly to falls in users of heroin and other opiate-type drugs.
Systematically giving substance use patients a chance to win valuable prizes if they test abstinent offers a lower-cost alternative to ‘contingency management’ systems which provide rewards each time, but does it work? Across 18 studies the answer was ‘Yes,’ though effects soon faded.
HOT TOPIC 2016 HTM file
Prizes for not using drugs?
‘Hot topics’ offer background and analysis on important issues which sometimes generate heated debate. Contingency management programmes reward patients for complying with treatment or not engaging in undesired substance use. It works, but often only temporarily – and perhaps at the cost of eroding the patient’s confidence and motivation.
Conclusions supportive of cognitive-behavioural therapy for problem cannabis use from this authoritative UK assessment seem to conflict with earlier UK guidelines, though both query whether extended cognitive-behavioural therapy offers added value compared to briefer approaches.
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