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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.
Synthesising the results of 154 studies, the most thorough and extensive investigation of the crime-reduction credentials of drug courts finds the evidence bulky but lacking quality, yet sufficient to support courts for adult illegal drug users if not (or not yet) teenagers or drink-drivers.
How do drug recovery wings in women’s prisons compare with best practice in Baroness Corston’s 2007 report to the Home Office?
STUDY 2000 PDF file 154Kb
Assertive outreach for mentally ill problem substance users: follow the manual
Major US study finds that the impact of assertive outreach to engage and deliver services to people with serious mental health and substance use problems is crucially dependent on whether the key features of the approach are faithfully implemented.
Latest update from the respected Cochrane review process still finds no reason to advocate replacing conventional care with specialised therapeutic approaches/teams when severe mental illness is complicated by substance use.
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 159Kb
Integrated care for dual diagnosis patients betters parallel provision
This rare test of truly integrated substance use and mental health care for severely mentally ill patients found it cut subsequent psychiatric and legal crises. Even where full integration is not possible, the same principles could improve the work of mental health and addiction services.
Seeking Safety is a prominent therapy for the common combination of substance dependence and post-traumatic stress disorder, yet in this study of imprisoned women in the USA it did not significantly augment outcomes from the prison's own substance use treatment. Asking 'Why not?' generates interesting explanations.
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.
People with co-occurring mental health and substance use problems are often unable to access the care they need. This 2017 guide from Public Health England describes what better care would look like, underpinned by the principles that there is ‘no wrong door’ for accessing support, and it is ‘everyone’s job’ the other side of the door to help.
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