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Promising signs – but from a single study at a single treatment agency – that integrating Buddhism-inspired mindfulness-based elements creates a more effective supplement to usual (in the US context) 12-step based aftercare than a purely cognitive behavioural approach, helping patients sustain gains from initial intensive treatment.
Evidence that in 2012 Scotland’s alcohol treatment caseload equated to about 1 in 4 of the country’s alcohol-dependent adults, over three times the 1 in 14 ratio in England, partly a consequence of extra funding accompanying Scotland’s 2009 national alcohol strategy. Evidence too of a peer-based recovery orientation taking root.
STUDY 2014 HTM file
Alcohol treatment in England 2013–14
In England a record 114,920 adults were in specialist alcohol treatment in 2013/14 and nearly 4 in 10 left as planned free of dependence. A good record, but probably still most dependent drinkers who might have benefited from treatment did without it, partly because relatively few found their way there via GPs and emergency departments.
For such a widely implemented and widely supported adjunct to formal treatment, the revelation from this review is how little evidence there is for involving former problem substance users in promoting recovery from similar problems – a lack which may simply reflect the paucity of adequate research.
‘Do just the minimum’ seems the message of the emergency department arm of the largest alcohol screening and brief intervention study yet conducted in Britain; the proportion of risky drinkers fell no less after a brief warning than after more sophisticated and longer interventions.
US trauma centres dealing with serious and often alcohol-related injuries ought to offer an environment conducive to brief alcohol interventions, but this first multi-site trial found motivational counselling more effective than minimal advice only when combined with a follow-up ‘booster’ phone call.
Swiss study of brief alcohol interventions with a representative sample of heavy drinking young men exposed the determining influence on later drinking of the practitioner’s competence in motivational interviewing and how they behave in the session.
12-step fellowships offer a way to reconcile shrunken resources with the desire to get more patients safely out of treatment. Accounting for the self-selection bias which has obscured AA’s impacts, this synthesis of US trials finds that attending more meetings after treatment boosts abstinence. Why then is research equivocal on whether promoting attendance improves drink-related outcomes?
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.
STUDY 2014 HTM file
A ‘symptom-triggered’ approach to alcohol withdrawal management
Providing medication in response to symptoms of alcohol withdrawal instead of routinely improved the outcomes of patients in acute hospital settings – reducing the duration of treatment and the amount of medication used.
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