Lesson 8: Effectiveness of Interventions Used in the Treatment of Substance Use Disorders

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This lesson continues to explore established and innovative approaches for the treatment of substance use and substance use disorders. In the last lesson, we considered some of the larger challenges faced by members of Canada’s substance abuse workforce, and learned about contrasting philosophies for treatment and prevention approaches. In this lesson, we take a serious look at what works and what doesn’t in treatment, and consider the methods used to make such determinations.

In this lesson, we have a number of items to consider. The majority of the readings are either systematic reviews (with meta-analysis) or reviews of recent systematic reviews. You will remember from the Forrest and Miller (2009) articles that systematic reviews are the highest level of evidence (on the hierarchy) used to inform our clinical practice.

Topics

Lesson 8 addresses the following three topics:

  • The evidence basis for pharmacology and psycho-social interventions
  • The evidence basis for treatment intervention with youths
  • Programs/Interventions that have been discredited

Learning Outcomes

After you complete this lesson, you should be able to:

  • Apply EBDM skills to evaluate the evidence in support of long–standing and innovative practices for the treatment of substance use disorders.
  • Recognize that many effective treatments have been developed and proven through scientific investigation.
  • Compare relapse rates in substance use disorders to those of other chronic diseases, such as diabetes, hypertension, and asthma.
  • Assess the evidence supporting the effectiveness of treatment interventions for substance use disorders.
  • Assess the evidence that demonstrates the ineffectiveness of commonly used treatments.
  • Recognize the important role that therapeutic relationships have on treatment outcome.

Resources

Carroll, K., & Rounsaville, B. (2006). Behavioural therapies: The glass would be half full if only we had a glass. In W. Miller & K. Carroll (Eds.), Rethinking substance abuse: What the science shows, and what we should do about it (pp. 223–239). New York, NY: Guildford Press.

McCrady, B. (2006). Family and other close relationships. In W. Miller & K. Carroll (Eds.), Rethinking substance abuse: What the science shows, and what we should do about it (pp. 166–181). New York, NY: Guildford Press.

Norcross, J. C., Koocher, G. P., Fala, N. C., & Wexler, H. K. (2010). What does not work? Expert consensus on discredited treatments in the addictions. Journal Addictive Medicine, 4, 174–80.

O’Malley, S., & Kosten, T. (2006). Pharmacotherapy of addictive disorders. In W. Miller & K. Carroll (Eds.), Rethinking substance abuse: What the science shows, and what we should do about it (pp. 240–256). New York, NY: Guildford Press.

Available Through TRU library

Lev-Ran S., Balchand, K., Lefebvre, L., Araki, K, LeFoll, B. (2012). Pharmacotherapy of alcohol use disorders and concurrent psychiatric disorders: A review. Canadian Journal Psychiatry, 57, 342–349.

Martin, G., & Rehm, J. (2012). The effectiveness of psychosocial modalities in the treatment of alcohol problems in adults: A review of the evidence. Canadian Journal Psychiatry, 57, 350–358.

Rush, B. (2012). A perspective on the effectiveness of interventions for alcohol and other substance use disorders. Canadian Journal Psychiatry, 57, 339–341.

Tanner-Smith, E. E., Wilson, S. J., Lipsey, M. W. (2013). The comparative effectiveness of outpatient treatment for adolescent substance abuse: A meta-analysis. Journal of Substance Abuse Treatment, 44, 145–158.

Activity Checklist

Following is a checklist of the learning activities you will be completing in Lesson 8. You may find it useful for planning your work.

✔ Activity

☐ Activity 1: Examining the evidence for pharmacological and psychosocial interventions

☐ Activity 2: Effectiveness of substance use treatment for youth—The role of family

☐ Activity 3: What doesn’t work?