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As this review comments, people treated for substance use often remain precariously balanced between recovery and relapse. Widely seen as valuable if not essential, aftercare is nevertheless more the exception than the rule. How to reverse that ratio is the issue addressed by these leading US analysts.
In three high drug use urban areas in England, treatment staff were placed in job centres to facilitate the referral of unemployed substance users in to treatment. It worked, but not well enough to recommend a national roll out.
Seven years after the first alcohol harm reduction strategy for England, this audit finds treatment access and brief intervention work has progressed in London but funding is often precarious and GP services are surprisingly under-developed.
In the English Midlands, problem-drinking offenders who agreed to be ordered in to alcohol treatment by the courts had a worse prognosis than comparable previous offenders but slightly fewer reoffended; also their drinking was reduced but for many remained excessive.
If alcohol treatment is to compete for scarce healthcare resources, studies must adopt the same yardsticks of success as are used for healthcare interventions contends this team of UK-based health economists; prime amongst these are quality of life measures.
STUDY 2010 HTM file
Planned and unplanned discharge from alcohol services in Scotland, 2004–2008
In the mid-2000s over 50% of terminated alcohol treatment episodes in Scotland ended with the client or patient dropping out. Considerable variation between regions suggests there is room for improvement and with it improvement in the cost effectiveness of services.
In Madrid, unusually a primary care brief alcohol intervention targeted heavy episodic or 'binge' drinking. The result was drinking reductions which probably saved lives due to less drunkenness and less drinking overall – and both screening and intervention were done by the doctors themselves, not specialist staff.
Does it help to add a structured internet-based therapeutic programme to web access to a mutual aid network also geared to moderate drinking? Sustained extra moderation in the form of fewer days drinking was the clearest positive effect; less clear was whether it led to greater reductions in drink-related problems.
DOCUMENT 2010 HTM file
Alcohol in our lives: curbing the harm
Extensive policy report from New Zealand accepts evidence that alcohol-related harm is best reduced by population level measures, including raising prices, licensing reform with harm reduction as its prime objective, and restricting the availability of alcohol through reduced opening hours, age limits and curbs on promotion.
STUDY 2011 HTM file
Shared decision-making: increases autonomy in substance-dependent patients
An innovative Dutch study tested a way of involving substance users as equals in decisions over issues addressed in their treatment. The effect was to give these typically submissive personalities a greater sense of control over their lives. Just as influential was the lead offered by the clinician's personality.
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