What does the scientific evidence tell us about the effectiveness of treatment and rehabilitation?

First published: 09/05/2019 | Last updated: May 20th, 2019

Health and social services for people with drug disorders is an essential component of public health-oriented drug policy throughout the world.  The official goal of such services may be reducing use (e.g., therapeutic communities) or reducing harm (e.g., syringe exchange, naloxone), although the practical reality is that effective services tend to accomplish both. The most effective services available are pharmacotherapies for opioid use disorder (e.g., methadone maintenance), which have evidence of substantial benefit in many countries and with many populations. There is no comparably effective medication for other drug use disorders, unfortunately. Psychosocial treatments, which may be residential in nature but are usually outpatient, can also make substantial contributions to well-being. Effective models including cognitive-behavioral therapy, contingency management and 12-step facilitation counselling.

Integrating the care of people with drug use disorders into mainstream healthcare remains challenging. Screening and brief intervention models in primary care have rarely been adopted, and have an indifferent track record of effectiveness.  As a result the drug use disorder service system exists outside of the rest of health care in most countries, compromising care coordination and quality and also potentially increasing stigmatisation. Developing and implementing better models of integrated care should be a major goal of clinicians, researchers and drug policy makers.

November 2017

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Professor Keith Humphreys


 

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