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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.
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.
In Spain offering families of secondary school children a low-value voucher to come to family-based prevention sessions greatly improved attendance even after the vouchers were discontinued.
Review of controlled studies finds that offering therapy and incentives alongside drugs which ameliorate withdrawal symptoms increases the numbers who complete detoxification from heroin and allied drugs and who stay opiate free, but still most do not do either.
REVIEW 2009 HTM file
Efficacy of opiate maintenance therapy and adjunctive interventions for opioid dependence with comorbid cocaine use disorders: a systematic review and meta-analysis of controlled clinical trials
About a third of Britain's heroin dependent patients also have problems with crack cocaine. Can opiate substitute prescribing help with both problems, and which special anti-cocaine therapies are worth adding on? This review trawled the international research for the answers.
Update of Cochrane review of rigorous studies surprisingly finds that adding psychosocial therapy to opiate substitute prescribing makes no difference to retention or substance use – a testament to the power of the routine treatment and a blow (but not a fatal one) to hopes that extra therapy would aid recovery and treatment exit.
REVIEW 2008 HTM file
The search for medications to treat stimulant dependence
Expert and accessible review of the state of play in finding effective and (to the patients) acceptable medications to initiate or sustain abstinence from cocaine or methamphetamine. Though extensive, the results of this US-led search have so far been disappointing.
STUDY 2006 PDF file 169Kb
Soup kitchen turned into therapeutic setting
A successful group therapy programme at a large New York soup kitchen shows that welfare services with high concentrations of problem substance users can be transformed from environments which impede recovery into ones which promote it.
Treatment services do not have to adopt, or ask patients to adopt, the belief system on which 12-step groups are founded in order to effectively encourage patients to tap in to the social support offered by these groups and improve their chances of sustained abstinence.
After trawling the world literature for randomised trials, reviewers found it is less the case that 'nothing works' with methamphetamine users, more the case that, within reason, everything works for some people to some degree and for some time.
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