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NICE guidance on health and social care for substance users with severe mental illness says that rather than creating specialist ‘dual diagnosis’ services, health and social care (including substance misuse) services should adapt to this caseload, and their care should be led by the mental health service.
Naltrexone and acamprosate both modestly curtail drinking among alcohol-dependent patients, but which is best in which circumstances and for which treatment goals? To find out this review compared the medications’ performance when separately benchmarked against a placebo, bringing to bear much more data than is available from the few trials which directly compared the two drugs.
Brief interventions conducted by alcohol treatment specialists reduced alcohol-affected readmission rate by nearly half among patients admitted to a French emergency department when drunk or in need of withdrawal.
Patient interviews provide insight into low levels of engagement and retention in alcohol treatment services, hindering the effective provision of treatment for dependent drinkers. Findings suggest that treatment pathways should better reflect the capacity and capabilities of people with alcohol dependence.
Family interventions were at the heart of the UK government’s ambition to ‘turn round’ the lives of 120,000 troubled families in England. In respect of drink and drug problems, substantial remission was seen, but the featured study could not show whether this was due to the interventions, and a report on a successor programme found no significant impacts.
Amalgamated findings from studies of risky drinkers identified and counselled in primary care settings indicate that compared to screening and assessment only, brief counselling lead to greater reductions in drinking, gains reflected less strongly in some indicators of health. However, it is unclear whether the generally small impacts would be sustained in routine practice.
The first review to evaluate shared decision-making and patient preferences for substance use treatment finds evidence that greater patient involvement in decisions can improve outcomes and has no negative impacts.
HOT TOPIC 2016 HTM file
‘Recovery’: meaning and implications for treatment
One of our selection of hot topics – important issues which sometimes generate heated debate. Since 2008 the “recovery” objective has been at the heart of British drug treatment policy. Where did it come from and what does it mean for treatment services?
REVIEW 2015 HTM file
Risks and benefits of nalmefene in the treatment of adult alcohol dependence: a systematic literature review and meta-analysis of published and unpublished double-blind randomized controlled trials
‘A pill for every ill’ is the gist of the attacks levelled at nalmefene in the form of Selincro, a drug expected to extend the benefits of pharmacotherapy to drinkers not physically dependent or in need of detoxification – or for critics, to medicalise psychosocial dependence on shaky scientific grounds.
HOT TOPIC 2016 HTM file
Treatment staff matter
One of our hot topics offering background and analysis on important issues which sometimes generate heated debate. By focusing on the intervention as if it were a mechanical lever, research has not just ignored but sought to eliminate what now seems a more important factor – the influence of the practitioner and how they relate to the patient.
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