Principles of Effective Treatment in Substance Abuse

Principles of Effective Treatment

• Effective treatment attends to individual needs, is available, and continually assessed for effectiveness.
• No single treatment is appropriate for all individuals.
• Treatment must be readily available and attend to multiple needs of the individual, not just their drug use.
• An individual's treatment plan must be assessed continually and modified as necessary to ensure the plan meets the person's changing needs.
• Remaining in treatment for an adequate period of time is crucial for treatment effectiveness.
• Counselling and other behavioural therapies are critical components of effective treatment for addiction.
• Medications are an important element of treatment, especially when combined with counselling and other behavioural therapies.
• Clients presenting with coexisting mental health and substance abuse should have both disorders treated in an integrated way.
• Medical detoxification is only the first stage of treatment and by itself does little to change long-term drug use.
• Treatment does not need to be voluntary to be effective.
• Possible drug use during treatment must be monitored continuously.
• Treatment programs should provide assessment for blood-borne viruses and other infectious diseases, and counselling to help modify or change behaviours that place the person or others at risk of infection.
• Recovery can be a long-term process and frequently requires multiple episodes of treatment.

Miller & Hester Informed Eclecticism

• Informed eclecticism involves an openness to a variety of approaches guided by scientific evidence.
• Four assumptions of informed eclecticism:
  • There is no single superior approach to treatment for all individuals.
  • Treatment programs should be constructed with a variety of approaches that have been shown to be effective.
  • Different individuals respond best to different treatment approaches.
  • It is possible to match clients to optimal treatment, therefore increasing treatment effectiveness and efficiency.

Effectiveness of Treatment

• Australian Treatment Outcomes Study (ATOS):
  • Heroin users were studied, with a treatment sample that differed from the general population.
  • The treatment sample had more PTSD, Depression, Borderline Personality Disorder, and disability.
  • High suicide and overdose rates, and criminality were observed.
• ATOS Outcomes:
  • General functioning improved.
  • The majority of participants were abstinent for the 1 month prior to 12-month follow-up.
  • Noticeable reduction in criminal behaviours, improved injection-related health, and decline in depression.
  • 65% of participants in the replacement group, 63% in the residential rehabilitation group, 52% in the withdrawal group, and 25% in the non-treatment control group were abstinent at 12-month follow-up.
• Many people recover from harmful substance use without psychological therapy.
• There is no single superior approach to treatment for all individuals, and it is important to match clients to their stage of change to maximise treatment effectiveness and efficiency.
• Comprehensive assessment, including mental health assessment, is essential as substance use and mental health problems often occur together.