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Conclusions supportive of cognitive-behavioural therapy for problem cannabis use from this authoritative UK assessment seem to conflict with earlier UK guidelines, though both query whether extended cognitive-behavioural therapy offers added value compared to briefer approaches.
Detailed, frank and compelling account of what it takes in the real world (when implementers have to grapple with counsellors and organisations over which they have no control) to introduce a new treatment approach. Key lesson is that each organisation is different; being there, learning about that unique context, and taking it in to account, is what’s needed to give implementation a chance.
In this massive enterprise, analysts dissected 232 treatment-comparison studies to test the validity of the US government’s principles of effective treatment for problems related to illegal drug use. Principles relating to individualising treatment were consistently supported by the North American evidence.
DOCUMENT 2013 HTM file
Can we dispense with counselling, therapy, treatment as we know it, and just punish or deprive patients of rewards when they use substances in undesired ways, and reward them when they behave as we/they would wish? British services are trialling an approach about which many clinicians express major ethical concerns – contingency management.
Transfer of responsibility for monitoring and promoting addiction treatment to Public Health England seems likely to encourage broader health promotion among treatment services, placing smoking cessation higher up the agenda. The US studies reported in this article have paved the way, showing that at least initial non-smoking can be achieved via incentives.
Does implementing evidence-based psychosocial therapies actually lead to the intended practice changes and do these make things better for the clients? From this review, most clearly when the whole organisation is enrolled in the effort and training is bolstered by systematic and expert continuing supervision.
Unusually this US study took a set of patients who had generally already initiated abstinence from cocaine use and then used abstinence incentives and/or cognitive-behavioural therapy to extend and consolidate these gains. There was some evidence that offering the therapy and improving attendance via incentives prolonged the impact of those incentives.
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.
Heroin addicts in Baltimore who still used drugs heavily despite being on methadone were sent to a special clinic for intensified care reinforced by sanctions and incentives and eventual discharge if still they failed to comply. Tough love perhaps, but does it really make sense to intensify compliance requirements on patients already not complying?
Improving performance of substance use disorder treatment systems is no easy matter and one prone to unintended consequences. All the more welcome then is guidance from leading US experts with top-level experience in the UK and the USA; their favourite tactic, rewarding services for patient progress during treatment, is featured in UK payment-by-results schemes.
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