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HOT TOPIC 2016 HTM file
Prizes for not using drugs?
‘Hot topics’ offer background and analysis on important issues which sometimes generate heated debate. Contingency management programmes reward patients for complying with treatment or not engaging in undesired substance use. It works, but often only temporarily – and perhaps at the cost of eroding the patient’s confidence and motivation.
This US study found that among people with serious mental illness and a history of criminal justice involvement, an intervention intended to foster citizenship through peer mentoring, education and activities, reduced alcohol and drug use and enhanced quality of life and satisfaction with social, leisure and work activities.
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.
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.
Is regular counselling really essential to the effectiveness of methadone maintenance treatment, or are treatment entry and the power of high-dose methadone enough in themselves for many patients? At least in the first four months, this US study suggests the latter.
From England, findings suggesting the intriguing but for the moment tentative possibility that non-conformist drug workers who value hedonism and stimulation help socially excluded clients improve most because their values match those of their clients.
STUDY 2012 HTM file
Innovation adoption as facilitated by a change-oriented workplace
Message from this large US study is that 'bottom-up' practice improvements in treatment services initiated by counsellors are still strongly influenced by the climate-setting and support offered by an organisation's leadership and ethos, especially how far they foster professional development.
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.
DOCUMENT 2013 HTM file
Sometimes best to break the rules
Motivational interviewing’s ‘Do not dos’ like avoiding confrontation were intended to sidestep the traps which provoke clients to dig in their heels or disengage. Imagine then the upset of discovering that in certain circumstances, the opposite is the case; the explanation appeared to lie in coming across as ‘genuine’.
STUDY 2010 HTM file
Effect of motivational interviewing on reduction of alcohol use
At Californian methadone clinics, group education sessions led by a nurse and focused on the risks of aggravating hepatitis infection led to the same substantial reductions in drinking as one-to-one or group motivational interviewing conducted by highly trained counsellors, offering a cost-effective means to reduce alcohol-related risks.
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