Therapeutic communities (TCs) for addictions are drug-free environments in which people with addictive problems live together in an organized and structured way to promote change toward recovery and reinsertion in society. Despite a long research tradition in TCs, the evidence base for the effectiveness of TCs is limited according to available reviews. Since most of these studies applied a selective focus, we made a comprehensive systematic review of all controlled studies that compared the effectiveness of TCs for addictions with that of a control condition. The focus of this paper is on recovery, including attention for various life domains and a longitudinal scope. We searched the following databases: ISI Web of Knowledge (WoS), PubMed, and DrugScope. Our search strategy revealed 997 hits. Eventually, 30 publications were selected for this paper, which were based on 16 original studies. Two out of three studies showed significantly better substance use and legal outcomes among TC participants, and five studies found superior employment and psychological functioning. Length of stay in treatment and participation in subsequent aftercare were consistent predictors of recovery status. We conclude that TCs can promote change regarding various outcome categories. Since recovering addicts often cycle between abstinence and relapse, a continuing care approach is advisable, including assessment of multiple and subjective outcome indicators.

Present-day substance abuse treatment is characterized by a compelling demand for applying evidence-based interventions. Vehement discussions between policymakers, practitioners and researchers illustrate this clash of differing paradigms. The aim of this article is to situate evidence-based practice among the leading paradigms of care and to elucidate its implicit assumptions and potential implications. Evidence-based practice is inherent in the empirical-analytical paradigm of care and science, founded upon randomized and controlled studies. This paradigm is compared with the phenomenological-existential and the critical post-structural paradigm, which focus on elaborating the human potential and exploring individuals' subjective interpretations, and on criticizing social inequalities and striving for compliance with human rights, respectively. Evidencebased practice and the methodological rigidity in each paradigm are analyzed critically. We conclude that through the dialectical integration of these diverse approaches, evidence, existence/humanism and social emancipation can be combined for the benefit of the human prerogative of care.

There are a substantial number of guidelines addressing substance misuse in adolescents. However, only four high-quality guidelines included recommendations specific for adolescents. The current level of evidence that underpins the recommendations in these high-quality guidelines is low.

Background/Aim: Evidence-based guidelines for substance abuse treatment are available in many European countries. In Belgium, no such guidelines have been developed yet at a national level although their need has repeatedly been emphasized. This study aims to assess Belgian practitioners’ attitudes concerning evidence-based guidelines for substance abuse treatment. Methods: A survey was conducted with clinical coordinators in a representative sample of 60 agencies dispensing specialized treatment to alcohol and drug abusers. Results: The study revealed that evidence-based guidelines are rarely used in substance abuse treatment in Belgium, but that many agencies use self-developed guidelines. The attitude concerning evidence-based guidelines is mainly positive. Practitioners’ concerns mostly relate to the risk of disregarding their clients’ needs and the constraining character of using evidence-based guidelines. The study also reveals some barriers concerning the implementation of evidence-based guidelines and suggests some strategies to overcome them. Conclusion: Practitioners appear to be prepared to work with evidence-based guidelines. When developing, adapting and implementing evidence-based guidelines for substance abuse treatment, it is important for policy makers to take into account the state of the art in clinical practice as well as practitioners’ needs and requirements.

De laatste jaren wordt de term 'evidence-based' steeds vaker in de mond genomen en verschijnen er tal van publicaties die het belang van 'evidence-based practice' (EBP) en 'evidence-based'-richtlijnen (EBR) in de verslavingszorg benadrukken. De kloof tussen theorie en praktijk is echter een welbekend probleem en op de werkvloer lijkt men vrij terughoudend te staan tegenover deze nieuwe tendens. In dit artikel wordt daarom bekeken wat de kennis is van praktijkwerkers over EBP en EBR, welke houding zij tegenover deze ontwikkeling aannemen en in welke mate zij de methoden en richtlijnen toepassen. Dit gebeurt aan de hand van de resultaten van een bevraging in de Belgische verslavingszorg, waarbij sleutelfiguren uit zestig verschillende voorzieningen in België geïnterviewd werden. Op basis van de resultaten worden aanbevelingen geformuleerd voor de praktijk. InleidingDe laatste jaren wordt de term 'evidence-based' steeds vaker in de mond genomen en verschijnen er met de regelmaat van de klok publicaties die de noodzaak van het toepassen van 'evidence-based'-methoden en -richtlijnen in de verslavingszorg benadrukken. Deze terminologie is afgeleid van het begrip 'evidence-based medicine' (EBM), dat in 1992 voor het eerst gelanceerd werd door Sackett en collega's in het befaamde tijdschrift