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HOT TOPIC 2016 HTM file
Is it futile to match alcohol treatments to the patient?
‘Hot topics’ offer background and analysis on important issues which sometimes generate heated debate. Even if overall one type of therapy for problem drinking is no better than another, surely this is just because certain therapies worked best with certain patients? Expectations that ‘matching’ would lead to improved outcomes were dashed in what was intended to be the definitive test, but it would be premature entirely to dismiss the idea.
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.
STUDY 2011 HTM file
Recovery innovations in Yorkshire and Humberside
The enthusiastic shoots of a recovery orientation emerging in treatment systems and services in northern England faced considerable challenges in gaining sufficient coverage to transform the established landscape – literally in the case of a plan to communally build an Iron Age roundhouse village.
Reanalysis of the largest US study of medication-based alcoholism treatment confirms that either naltrexone or psychological therapy improved outcomes more than medical care and placebos, while the two in combination or acamprosate added little. It also revealed previously invisible benefits when certain types of patients received certain treatments.
Detailed examination of how differing welfare and treatment systems and understandings of dependence affect the alcohol caseloads of substance use treatment services in Sweden and the USA and how they fare in the year after starting treatment; reveals differences and similarities in what 'success' consists of and what seems to promote it.
REVIEW 2012 HTM file
Drug policy and the public good: evidence for effective interventions
Review of relevant research by an international team of leading researchers offers policymakers guidance on the interventions most likely on the evidence to achieve national policy aims in respect of illegal drug use.
Computer simulation suggests that health would improve and/or costs be reduced if on-line brief interventions and therapy were added to or replaced conventional alcohol-related health care; these results for the Netherlands are based on a simulation model applicable as an aid to national policymaking in other countries.
Advanced statistical techniques applied to data from a landmark US cocaine therapy study revealed three typical recovery trajectories; at the extremes patients who fared best and worst did so whatever the therapy, but in the middle a consistent approach (in this case, 12-step) which matched cultural expectations worked best.
Confirmation from the US Project MATCH alcohol treatment trial that too explicitly imposing structure on therapy risks relatively poor outcomes among patients reluctant to relinquish control and who react against direction – and a further indication that this pattern is not universal, but depends on the context.
As this review comments, people treated for substance use often remain precariously balanced between recovery and relapse. Widely seen as valuable if not essential, aftercare is nevertheless more the exception than the rule. How to reverse that ratio is the issue addressed by these leading US analysts.
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