Effectiveness Bank bulletin 27 September 2013

The first entry is a rare study of the featherweight end of treatment for drug problems – a quarter of an hour of light-touch counselling. Then we lurch to the heaviest end, prescribing heroin to opiate addicted patients unable to manage on methadone, and to the difficult issues entailed in treating psychotic patients. Finally to prevention, with an intriguing series of US studies which shows once again that you don't always get what you want from media campaigns; sometimes you get the very opposite.

Get up to speed on the 'hot' topics which arouse controversy due to their importance and disputes over the facts or their interpretation:
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Positive but puzzling results from brief intervention trial for drug problems
Well established for drink problems, screening followed by brief counselling is rarely featured in research on illegal drug use, and its effectiveness is unclear. Across four countries, the World Health Organization tried to rectify these gaps with a study of illegal drug use problems identified at front-line health care centres. It did find reductions in use/risks, but they were modest, and there was a puzzling opposition between particularly positive results from Australia and seemingly negative ones from the USA.

Can heroin remedy the problems it helped to create?
Prescribing oral methadone to heroin addicts divides opinions, but prescribing injectable heroin elevates the controversy to another level. Nothing better illustrates the power of the last two pillars of Norman Zinberg's book title, Drug, Set, and Setting, than the same drug taken in the same way being associated with wrecked lives on the street, but rescued and stabilised lives in the clinic. As expertly documented by this European Union review, the evidence of this transformation is there from six randomised trials, but the expense, inconvenience, and risks, are substantial.

UK guidance on services for psychotic substance misusers
Psychosis plus harmful substance use is a toxic mixture which blights the prospects of recovery from mental illness. How should it be dealt with, and what are the respective roles of mental health and substance use services? This UK guideline developed by an expert group has some answers to among the most difficult questions in substance use treatment.

Guilt- or shame-inducing responsible drinking ads backfire
Students already burdened by these emotions reacted to shame or guilt-inducing 'responsible drinking' ads by intending to and actually drinking more, the opposite of what was intended. Piling on shame or guilt led them to feel less of the same emotion and to divorce themselves from the ads' messages. This intriguing series of US studies may reinforce the feeling that the ways anti-substance use media campaigns can backfire are so various, the safest option is not to try them.

Sent by the Drug and Alcohol Findings Effectiveness Bank to alert you to site updates and UK-relevant evaluations and reviews of drug/alcohol interventions. Managed by DrugScope, Alcohol Concern and the National Addiction Centre. Supported by Alcohol Research UK and the J. Paul Getty Jr. Charitable Trust.