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[Consultation draft subject to amendment and correction.] How does an intervention designed to enhance coordination and continuity of services, known as ‘case management’, compare to treatment as usual? Is there any evidence to suggest that it can directly or indirectly improve recovery outcomes?
MATRIX CELL 2020 HTM file
Alcohol Treatment Matrix cell E2: Treatment systems; Generic and cross-cutting issues
Seminal and key studies on local, regional and national systems for effectively and cost-effectively providing treatment. Explores whether payment by results stifles patient-centred practice or stretches services beyond comfort zones, the surprising results of a randomised trial of service-improvement mechanisms, and the multiple answers to how many drinkers should be in treatment. See the remaining four cells in row 2 of the matrix for more on generic features of medical and psychosocial therapies.
A flagship drug treatment policy initiative appears to have backfired in England, where the government’s pilot payment-by-results schemes seem to have led to fewer successful completions of treatment and more prospective patients declining treatment.
STUDY 1962 HTM file
The abstinent alcoholic
Classic description of the patient who has sustained abstinence after treatment but is still unhappy, unfulfilled and/or nervously hanging on – in other words, not really ‘recovered’. They formed the majority of patients seen at Connecticut’s alcohol clinics in the 1950s who were not drinking at follow-up.
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.
While drug recovery wings were specifically designed to facilitate recovery from drug and alcohol problems among prisoners, this small study found that the sharp drop-off in support when they returned to the community ended many recovery journeys prematurely.
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?
On the important national indicator of completing treatment and not returning for treatment in the following six months, inpatient and residential treatments for alcohol use disorders in England appeared to be effective half the time. Longer duration of treatment and ongoing care were associated with a greater likelihood of successfully completing treatment.
MATRIX CELL 2018 HTM file
Drug Treatment Matrix cell E4: Treatment systems; Psychosocial therapies
Seminal and key studies on local, regional and national systems for effectively and cost-effectively providing psychosocial therapies and the place of those therapies within these systems. Asks whether mutual aid groups can bridge the widening gap between resources and recovery ambitions, whether residential rehabilitation should be a last resort, and how tightly commissioners should specify services.
MATRIX CELL 2018 HTM file
Drug Treatment Matrix cell E3: Treatment systems; Medical treatment
Seminal and key studies relating to local, regional and national systems for effectively and cost-effectively providing medical interventions and treatment in medical settings. Highlights a simple innovation which transformed detoxification recyclers into typical patients, asks if you agree with an expert group’s vision of what a good quality service looks like, and questions whether Britain is making progress on organising care for mentally ill problem drug users.
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