How good is....
❝ some treatments are better than others ❞
- CBT :: Cognitive behaviour therapy is probably the most researched and effective treatment. CBT works by i) identifying risks of drinking or taking drugs ii) working out ways of dealing with these situations - developing 'coping skills' iii) practising these 'coping skills'.
- CM :: Contingency management, which works by rewarding abstinence or some other goal (typically with vouchers, medication take away privileges, prizes).
- RP :: Relapse prevention, which is the same as CBT but with a relapse prevention focus.
- MI :: Motivational interviewing is more of a technique than an intervention. It works by helping service users to become aware of what they most want to change in their behaviour.
- NT :: Network therapy works by recruiting family and friends willing to give practical and emotional support to help people make changes to their substance use.
- CN :: Counselling is something of an umbrella concept but typically means allowing a person to talk about their problems and feelings in a confidential and safe environment.
- Social :: Includes help with housing, employment, leisure activities, relationships and so forth.
- Substitution :: Some drugs of misuse can be 'substituted' with a safer prescribed medication. This is most commonly the case for heroin (and other opiates).
- Detoxification :: Medication can help relieve the cravings and withdrawal symptoms that occur when people addicted to alcohol or a drug either stop suddenly or rapidly reduce their intake.
- Relapse Prevention :: For some addictions, notably alcohol, there are medications that help prevent slipping back into drinking or drug use.
The outcomes of the best treatments improve over time because people become more and more confident in the 'coping strategies' they have learned for dealing with problems and situations where they would previously have been drinking or taking drugs.
FAQs on this page...
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Is there a best psychological treatment?
This benchmark combines a number of studies to compare CBT with some other effective treatments. Chart 1 shows that CBT is much more effective than no treatment but not much better than other active treatment :: Chart 2 shows that CBT, CM, RP treatments all deliver similar and moderate effects when compared with each other but CBT plus CM gets the biggest effect (best outcome).
Is contingency management effective?
This benchmark combines a number of studies and in Chart 3 shows how the CM effect decays over time :: Chart 4 shows CBT is better combined with social and pharmacological treatments.
In our opinion...
❝ structured treatments such as CBT are very effective ❞
❝ CBT is best combined with social networking and medication (where needed) ❞
❝ successful treatment is hard work ❞
❝ CM is best suited for goals with a clear end point eg hepatitis immunisation ❞
Is there a 'gold standard' outcome measure?
This benchmark looks at applying some sophisticated but readily understandable statistics to key elements of addiction. The charts show the outcomes for dependence, psychological and social wellbeing for different substances after treatment at a specialist addiction unit. Note that change occurs first for dependence, then psychological, then social wellbeing.
In our opinion...
❝ clinically significant change should be the 'gold standard' ❞
❝ clinically significant change paints a meaningful picture of outcome ❞
❝ clinically significant change is an exacting standard to adopt❞
❝ the Social Behaviour and Network Therapy (as used here) demonstrates the standard ❞