Effective iSBNT
selected research articles
When what are thought to be effective treatments are compared, it is a common finding that there is no great difference between the two interventions providing that they have been well delivered. The main reason for this is that effective treatments tend to include similar components.
Treatments need to have a flexible structure
Classic paper :: What are the elements of effective treatment?
Moos R (2007) Theory-based active ingredients of effective treatments for substance use disorders. Drug and Alcohol Dependence 88: 109–121 doi:10.1016/j.drugalcdep.2006.10.010
This is a must read article for anybody interested in the theoretical underpinning of effective interventions which at the same time reviews the available evidence. In an overview of what kind of interventions work the author concludes that, consistent with social control theory, effective treatment appears to be characterised by:
❶ cohesion and support between therapist and service user ❷ moderate, ie flexible, structure ❸ goals oriented toward achieving service user’s personal milestones and objectives.
The quality of the alliance or bonding between service user and therapist or overall program has been consistently associated with treatment outcome.
Effectiveness is not the only consideration
It is a prerequisite of any treatment offered to the public that it should be effective, but there are other things to think about: Is it practical - are suitably qualified staff available to deliver it and can it be done within necessary time constraints? is it more or less cost-effective than alternatives? Is it acceptable to all stakeholders? Clinical guidelines usually address these issues.
Important study :: What techniques are suggested in guidelines?
Michie S, Whittington C, Hamoudi Z, Zarnani F, Tober G & West R (2012) Identification of behaviour change techniques to reduce excessive alcohol consumption. Addiction 107: 1431–1440 doi:10.1111/j.1360-0443.2012.03845.x
Behaviour change techniques were identified by trawling through guidelines and treatment manuals and 42 different techniques were agreed upon. The effectiveness of these techniques was then tested against a meta-analysis of RCTs where the target behaviour was heavy rather than dependent drinking. How well the interventions were delivered is not recorded.
The authors conclude that in brief interventions, promoting self-monitoring is associated with improved outcomes. How effective the other promising techniques might be could not be confirmed from the dataset available.
Important study :: What does recovery mean?
Thurgood S, Crosby H, Raistrick D, Tober G (2014) Service user, family and friends' views on the meaning of a 'good outcome' of treatment for an addiction problem. Drugs: Education, Prevention and Policy 21: 324-32
24 people with drug and alcohol problems and 12 of their family and friends were asked in six focus groups what 'being better' meant to them. 20 things seen as important to a stable recovery were identified. These were grouped into seven themes: i) abstinence ii) health iii) daily activities iv) relationships v) social circumstances vi) self awareness and vii) wellbeing of family and friends. This first quote really gets to the heart of what needs to change for successful recovery…
❝ Have you got new friends, you know, have you got a social circle of non-drug users - that was one of the main things why I’ve done so well.❞
❝ First of all you had to lose the craving for drink. And then it progressed to getting away from the mental and physical state that you were in when you were drinking. And then it progressed to staying sober and then it progressed to not wanting a drink. And then it progressed to leading a normal sort of life. ❞
❝ Your feelings come back, your emotions and your goals, you know, even your hygiene gets a lot better and that, you take time in yourself, you know, and you make sure all your clothes are ironed, you know, tidying up around yourself, you know, little things like that, stopping smoking dockers out of the ashtray, ‘cos you’ve got money to buy cigs. ❞
❝ I get paid on a Thursday and by the next day I’ve still got money in my pocket, it was all gone on the same day before. ❞
❝ A good social life is moving on from other drinkers. ❞
❝ I still don’t feel like I’ve recovered because I’m still taking an opiate based drug, like I said, I still feel like a drug addict. ❞
Important study :: What do service users think has helped them to change?
Orford J, Hodgson R, Copello A, Wilton S, Slegg G on behalf of the UKATT Research Team (2009) To what factors do clients attribute change? Content analysis of follow-up interviews with clients of the UK Alcohol Treatment Trial. Journal of Substance Abuse Treatment 36: 49–58
The chart shows how many clients thought each of the 12 factors to be important to change - the more the greater its significance. Beliefs about what caused change may not be the reality, nonetheless, therapists should take note of what service users see as important. The dominance of general factors is one reason why different treatments tend to have similar outcomes. Reasons for change are similar to those given for natural recovery.
The reasons given were grouped into social (S), motivational (M) or general (G) factors: S1= involvement with others S2= alternative activities S3= better communication M1= awareness of consequences M2= feedback M3= priorities in life G1= comfortable talking to others G2= keeping occupied G3= commitment G4= detox/medication G5= personal circumstances G6= other.
practitioner guides to iSBNT…
