Activity 1: Examining the evidence for pharmacological and psychosocial interventions

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Topic Progress:

Introduction

You will begin this activity by reading the “guest editorial” by Dr. Brian Rush (a leader in addictions treatment and research in Canada). It is important to start here because he sets the stage for the next two papers that follow. He makes a few interesting points that include: 1) the therapeutic alliance (the relationship between the client and therapist) may account for as much as 30% of the variance in treatment outcome, 2) the importance of an interprofessional and population health perspective, 3) the significant evidence-to-practice gap in Canada, 4) the need to think about and measure outcomes, and 5) that treatment for adolescents can work.

The two major areas of evidence-based treatment efficacy reviewed in this activity are pharmacology and psycho-social interventions. We begin by looking at pharmacology. Prior to reading the Lev-Ran et al. (2012) article read Chapter 15 in your textbook—“Pharmacotherapy of addictive disorders”—which focuses solely on the use of pharmacotherapy in substance use disorders. Lev-Ran’s article builds on this information and integrates the use of pharmacology for concurrent disorders. Both articles identify that pharmacology is primarily used for 1) the management of acute withdrawal symptoms and 2) in combination with psychosocial therapy for the prevention of relapse.

Chapter 14 in your textbook—“Behavioural Therapies: The Glass Would Be Half Full If Only We Had a Glass”—and the Martin & Rehm (2012) article that reviews the published systematic reviews of psychosocial interventions both identify strong evidence supporting the use of psychosocial (behavioural) interventions for substance use disorders. One type of intervention is not considered superior, and motivational enhancement therapies, cognitive-behavioural therapies, and brief interventions all have shown comparable effectiveness. These interventions also seem to show efficacy when working with people with concurrent disorders. In Chapter 14, Carroll and Rounsaville (2006) make the point that generally, better outcomes for people with less severe or chronic substance use disorders have been achieved through the use of psychosocial interventions.

The articles that you will read reflect Canadian content and are written by Canadian practitioners and researchers. Jurgen Rehm is the Director of the Center for Addiction and Mental Health (CAMH) in Toronto. Canada is showing strong leadership in this area.

It should be noted that Rush, along with the other authors, argue that substance use treatment works, but also acknowledge the limited attention given to subpopulations such as youth, women, older adults, and diverse communities, including First Nations people. In some cases, this situation was due to the paucity of research and literature (e.g., for First Nations people), and in other cases, it was due to space limitations (e.g., for youth). This issue notwithstanding, these articles are a comprehensive synthesis of the literature of effective treatments for substance use disorders, at least among the general population.

Instructions

  1. Read the following articles or chapters:
    • Rush, B. (2012). A perspective on the effectiveness of interventions for alcohol and other substance use disorders. Canadian Journal Psychiatry, 57, 339–341.
    • Chapter 15 textbook: O’Malley and Kosten’s “Pharmacotherapy of Addictive Disorders.”
    • 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.
    • Chapter 14 textbook: Carroll and Rounsaville’s “Behavioural Therapies: The Glass Would Be Half Full If Only We Had a Glass”
    • 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.
  2. As you complete these readings, consider the effect this information has on your own practice and existing knowledge:
    1. Have your practices been confirmed and supported by the readings?
    2. Do you want to reduce or eliminate any of your current practices?
  3. If you were asked for the evidence-base for the work you do now, could you provide this information?