Successes and failures in treatment of substance abuse: Treatment system perspectives and lessons from the European continent

Abstract

Objective: The article offers an inventory of controversial basic issues related to treatment responses and their sociocultural political context, highlighting policy failures and successes, with a focus on Europe. As a reference point for this assessment, serves a conceptual framework of an “ideal type of treatment system”, which is built upon the following normative assumptions: the objective of harm minimisation or preventing substance-use-related consequences, evidence-based decision making, securing equity and accessibility also from a user perspective as well as efficiency in terms of the diversity and choice of treatment options. Method: Five major issues of addiction treatment systems, as identified and exemplified by an expert survey among 14 countries conducted in 2014, served as a reference for discussing fundamental gaps between an assumed ideal type of treatment system and the treatment response in practice: (1) Resistance to change, consensus building and innovation, (2) Political influence and target group bias beyond evidence, (3) Assumptions about rationality and universal evidence, (4) Myths of addiction and ethical deficits and (5) The treatment gap and user perspectives. Results/conclusions: Recommendations relevant for politicians, system planners, and clinicians are formulated for each of the five issues, specifically focusing on embeddedness of treatment systems in macro-societal conditions, the abstinence paradigm and outcome diversity, ethnocentric biases of the “evidence credo”, learning from self-change as the major road to recovery, and questioning implicit conceptions of the “addict as a human being”. Furthermore, it is concluded that theories regarding the diffusion of innovation and knowledge exchange can inform future research.

Substance use treatment completion and criminal justice system contact in Chile: A retrospective, linked data cohort study

“…cost-benefit) to consider the long-term benefits of SUT on the prevention CJS contact. Another advantage of the current research is that it provides insights outside the Global North context [34,35] into the outcomes associated with SUT at a system level (including data from multiple centres and programmes).…”

“…While all cited studies have significantly contributed to our knowledge, most of them come from western contexts (e.g. the United States and western Europe), and other contexts are relatively underexplored [34,35]. The Chilean SUT policy is an interesting case study, as it has one of Latin America's oldest and most developed SUT systems.…”

Obstacles to successful rehabilitation and resettlement of drug use offenders

“…Nevertheless, difficulties in managing users due to their own specific individual needs can limit the effectiveness of these strategies and so, without regular reviewing, possible modifications that would improve an individual's rehabilitation success is ignored (Leukefeld and Tims, 1993). The allocation of resources and stigma can also have a negative impact (Klingemann, 2020). Sondhi and Day (2012) found that while male prisoners did havehad high expectations of the IDTS, they felt their treatment they received did not match their prior assumptions.…”

Effectiveness of Addiction Treatment Programs in Iran in Terms of Social, Psychological, Economic, and Therapeutic Outcomes: An Appraisal

“…Unsuccessful treatment can have very negative consequences for the individual and society. Some of the outcomes of unsuccessful treatment include relapse and recidivism after treatment [12][13][14], negative psychological and social performance, poor educational or occupational status [15], participation in criminal behavior [16,17], and social costs, for example, pressure on family and society [7].…”