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From the comprehensive treatment process data collected by a major national US study emerges the important lesson that retention in itself is not an active ingredient in post-treatment outcomes but reflects influences such having one's needs met (especially important for women) and developing a good relationship with the service and your key worker.
DOCUMENT 2012 HTM file
Substance misuse among young people 2011–12
Documents trends towards more successful specialist treatment of children with alcohol and drug problems in England. Patient numbers have fallen in line with trends among young adult patients and the general population, a sign of fewer drug problems generally, though cannabis bucked the downward trend.
DOCUMENT 2011 HTM file
Substance misuse among young people: 2010–11
England's National Treatment Agency for Substance Misuse documents trends in England towards quicker and more often successful treatment of children aged under 18 with alcohol or drug problems, while numbers have fallen in line with developments among the general population and among young adults in treatment.
In the US homeland of competition and private health care, it was cooperation and coordination which led to the introduction of new medications and innovations to promote continuing care – plus the exercise of regulatory and financial muscle and the salutary experience of senior staff who placed themselves in the patient's shoes.
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.
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.
This review encapsulates the range of treatment assessment and improvement tools developed over decades by the Texas Christian University, widely recognised as the most comprehensive and systematic attempt to map the processes involved in treatment and to link these to interventions to improve outcomes for the client.
Opiate dependent methadone patients in Belgium give their own accounts of what for them constitutes a good quality of life. Generally they want what other people want: a meaningful, independent life and supportive relationships. Methadone creates the preconditions for such a life at the same time as it limits its achievement.
STUDY 2011 HTM file
Therapist effectiveness: implications for accountability and patient care
1 in 6 US therapists (mainly not specialising in substance use) typically ended up with clients whose substance use problems were significantly worse than when they started therapy, an indication perhaps that social workers and mental health counsellors find these issues especially hard to deal with.
STUDY 2011 HTM file
Shared decision-making: increases autonomy in substance-dependent patients
An innovative Dutch study tested a way of involving substance users as equals in decisions over issues addressed in their treatment. The effect was to give these typically submissive personalities a greater sense of control over their lives. Just as influential was the lead offered by the clinician's personality.
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