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Can a limited period of being prescribed opiate-type medications generate longer term reductions in the criminal behaviour of patients dependent on illegal opiates like heroin? And of the two main medications – buprenorphine and methadone – which performs best? It seems a key factor is how well they retain patients in treatment.
REVIEW 2018 HTM file
A review of brain stimulation methods to treat substance use disorders
Already used to treat various neurological and psychiatric disorders, a review investigates the utility of brain stimulation techniques for drug and alcohol problems.
STUDY 2019 HTM file
Efficacy and cost-effectiveness of an adjunctive personalised psychosocial intervention in treatment-resistant maintenance opioid agonist therapy: a pragmatic, open-label, randomised controlled trial
Instead of a set programme, a clinic in London tried offering methadone or buprenorphine patients still using heroin or cocaine a selection from a suite of well-supported psychological interventions tailored to the patient and then systematically re-tailored in the light of how they responded. It worked – but did it work well enough, and would the findings be replicated in more typical circumstances?
Modafinil is a mild stimulant which it is hoped might plug the gap in effective pharmacotherapies for dependence on cocaine. Though this trial found that it promoted abstinence from cocaine, others have not, and its inconsistent benefits have been seen as failing to outweigh the drug’s side effects.
Rewarding people dependent on illegal drugs for not using those drugs is a controversial tactic, one this review from the EU’s drug misuse centre found patchily effective in extending retention and reducing substance use as a supplement to medication-based treatments.
The annual accounting of the treatment caseload in England registers a continuing fall in total numbers and decreasing success with opiate users, while success with drinkers has increased and has for the last few years remained relatively high and stable. An ageing population of opiate users is the proposed explanation for the former trend – but why hasn’t a similarly ageing alcohol caseload also eroded success rates?
DOCUMENT 2007 HTM file
Drug misuse in over 16s: psychosocial interventions
After examining the evidence for psychosocial therapies for problem drug use, the UK’s official health advisers recommend behavioural couples therapy and contingency management, argue against cognitive-behavioural therapies, and pose residential rehabilitation as a last resort – in some respects surprising and controversial recommendations.
REVIEW 2016 HTM file
Psychosocial interventions for psychostimulant misuse (Review)
A review revealing contingency management may be a promising treatment option for problem cocaine and amphetamine use, but unable to answer the big question – ‘is one psychosocial approach more effective than the others and in what circumstances?’
HOT TOPIC 2017 HTM file
The ‘explosion’ that never happened; crack and cocaine use in Britain
One of our hot topics – essays on important issues which sometimes generate heated debate. In 1989 a whirlwind of concern was stirred up by a US drug enforcement officer who foresaw a US-style “explosion” of violence associated with the ‘almost instantly addictive’ crack version of cocaine in Britain. That did not happen – but what did, where do those claims stand today, and what of cocaine powder, for decades seen as the ‘champagne set’s’ favourite drug?
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.
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