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Psychosocial interventions used in the treatment of substance
Abstract: This review evaluates the effectiveness of psychosocial interventions for drug treatment with forensic and non-forensic samples. Online databases and relevant journals cwere searched using keywords. A total of 22 papers were identified as relevant. Five approaches emerged i.e. CBT, MI, ACT, RT, CM and faith-based programmes. All interventions have been found effective, even though there was some contrary evidence as well.
Psychosocial interventions seem to work differently with different samples in different contexts. More research is needed to identify the circumstances where these interventions are most effective in the areas of: studies with female samples; studies with the drugs users including poly-drugs users; a study of how demographic factors interact with the outcomes of different interventions; and a more refined analysis to identify those components of the intervention programmes which are successful and those which are not.
The research designs need to be strengthened as although there are many randomized trials to establish the effectiveness of drug treatment interventions, they need to be randomized and double- blinded. The randomization and allocation procedure need to be explained in detail and also the statistical procedures need to be presented clearly. Moreover, larger and more representative samples need to be used to ensure generality of the findings.
Key words: drug and alcohol addiction, addiction treatment, psychosocial interventions, psychological treatment for drug addiction.
- Introduction
The statistics are overwhelming: four million people use illicit drugs each year in the UK according to the NHS Information Centre study conducted in 2009 (NHS, 2009). Furthermore, in between 2006 and 2007, out of every 1000 people aged between 15 and 64 years in the UK, an estimated 8.1 were heroin users and 5.4 were crack cocaine users (Hay et al., 2006 & 2007).
According to another estimate, for every UK £1 spent on drug treatment, approximately UK £9.5 can be saved on the criminal justice system and health care costs combined (Home Office, 2010), Psychosocial interventions used in the treatment of substance therefore as expensive as it is, addiction treatment is less costly than the direct and indirect costs associated with the addiction itself.
In the UK, there is a vast drug market for commercialised class “A” drugs, especially heroin. The link between drugs consumption and crime has been well established as in 2002, 63% of injecting drug users getting professional help, have reported being in prison (Health Protection Agency, 2003). Moreover, in the US, the number of the citizens incarcerated for drug offenses increased ten-fold between 1980 and 2003 (Mauer, 2003). A similar trend can be found in case of Canada, where drug related offenses reached a 30-year high in 2007 (Dauvergne, 2009).
The US research shows that the drug abuse in prison can be observed at a higher rate than in the community (Fazel et al., 2006) as presented in Roberts et al (2007). Therefore, it can be said that more need of treatment of drug abuse is there for the prisons than for the communities.
An important difference between treatment in prison and treatment in the community is that treatment within the criminal justice system involves some level of coercion meaning thereby that there are elements that are compulsory, while also allowing some limited degree of choice or mandated (totally compulsory). These characteristics lead to a heavy focus placed by these programmes upon the disciplinary actions taken against participants who do not comply with the guidelines (Burdon et al., 2011) and which might impact on the participants’ motivation. This is because some participants might not be taking the programme because they choose to volunteer and neither because they feel they need to; Psychosocial interventions used in the treatment of substance but because there would be negative consequences for them if they do not comply with the programme. Therefore, motivation might become problematic for the forensic samples due to the coercion element imbedded within the treatment. It is also well documented that motivation is a crucial prerequisite for a successful recovery (Madukwe, 2013), a critical factor leading to change (Amrhain et al., 2003) and also related to recruitment, engagement and retention for treatment (McMurran & Theodosi, 2007).
Generally, effectiveness of substance treatment programs has been measured within the existing literature in terms of rate of recidivism, treatment attendance, treatment completion or abstinence rate. Abstinence rate is measured in terms of days of using/ not using drugs. For instance, as in Witkiewitz & Bowen (2010) or by self-reported abstinence as in Bakken et al. (2014) or negative urine specimens as in Amrhein et al. (2003) and Min et al. (2011). The research till date shows quite low abstinence rates for users who complete the treatment and hence, it is no surprise that the tax payers, Psychosocial interventions used in the treatment of substance the policy makers and service providers are disappointed that addiction treatment does not work (McLellan et al., 2005). This disappointment is also owing to the fact that most participants relapse following cessation of treatment (McLellan, 2002), whereas about 50-60% of patients start re-using drugs within six months after completion of the treatment (Simpson et al., 1997). Cooper (2012) also mentions a sense of “failure” in the context of substance user interventions.
Therefore, it can be stated that addiction is costly, while the treatment is costly too but less costly than the addiction itself (Home Office, 2010). Furthermore, the treatment interventions evaluated by the literature do not seem to be successful, as most participants relapse after completing the treatment (McLellan, 2002). In this pessimistic context, it seems important to identify the types of interventions that do work and provide robust and consistent evidence of effectiveness.
Roberts et al. (2007) published a very comprehensive review on drug treatment interventions. Regarding the pharmacological treatment the authors reported plenty of evidence that methadone and buprenorphine treatment assisted towards successful detoxification. Similarly, benzodiazepine and naltrexone were promising in the community in the context of alcohol treatment, while psychosocial interventions produced mixed results. Generally the study has shown promising results, but not alone, only in combination with pharmacological treatment. On the other hand, therapeutic communities offered most promising results. However, as far as the limitations are concerned, there is no precise indication and description of the type of psychosocial interventions tested; the studies with offenders in the UK were scarce and the existing literature has been found based upon poor methodology. The methodology is considered to be poor because some studies relied on self-reports; some did not use randomization procedures; some were using quasi-experimental designs; some used small samples which would diminish the statistical effectiveness of the findings; some did not report data at the baseline, but treatment outcomes only and generally all overrepresented adult and male populations. Overall, Roberts et al. (2007) recommended more research for more conclusive results, while reporting…
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