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Cognitive-behavioural therapies are among the most widespread and influential approaches to substance use, yet this analysis found they conferred just a small advantage over other therapies. Perhaps other features are more important than the therapeutic 'brand'.
Set in Sweden, the first study among psychiatric outpatients to test brief alcohol interventions against screening alone found worthwhile extra drinking reductions after brief motivational advice. Use of a telephone-based intervention was another innovation.
This report on work in England and Wales describes a system creatively grappling with a huge drink problem among offenders, but one undermined by lack of evidence about what works and by under-resourcing linked to a dispute over whether health or probation should bear the core funding burden.
STUDY 2006 PDF file 113Kb
Recently attempting suicide one of the strongest indicators for residential treatment
In this US study most patients benefited to roughly the same degree from residential and non-residential programmes, but those who had recently attempted suicide responded dramatically better to residential programmes, doing even better than the other patients.
STUDY 2006 PDF file 171Kb
Matching resources to needs is key to achieving 'wrap-around' care objectives
Linking treatment intake assessments to a computerised guide to local welfare and medical services transformed the assessments from redundant paperwork into a practical route to the reintegration services being advocated in Britain – and treatment completion rates doubled.
STUDY 2006 PDF file 161Kb
Warning sign aftercare for drinkers improves attendance and avoids relapse
Graduates from a British intensive day programme for alcohol dependence were trained to analyse why they had last relapsed in order to recognise and cope with the warning signs. The result was fewer relapses without significantly increased health and treatment costs.
STUDY 2006 PDF file 169Kb
Soup kitchen turned into therapeutic setting
A successful group therapy programme at a large New York soup kitchen shows that welfare services with high concentrations of problem substance users can be transformed from environments which impede recovery into ones which promote it.
STUDY 2006 PDF file 199Kb
A&E units save health service resources by addressing drinking
This US study estimated that each $ spent screening for and offering advice to heavy drinking emergency patients would save nearly $4 in health care costs due to reduced hospital re-attendance. A British trial suggests similar savings might be found in the UK.
STUDY 2006 PDF file 172Kb
Adjust therapist directiveness to client resistance
Persuasive evidence from the US Project MATCH alcohol treatment trial that a non-directive therapeutic style suits clients prone anger or defensiveness or who like to take control, and more structured and directive approaches suit those who welcome being given a lead.
Better than 'treatment as usual' but not than other specific therapies are the headlines from the most comprehensive synthesis of motivational interviewing studies to date. Along the way are insights in to the equivocal value of manuals and of feeding back assessment results to patients.
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