15 April 2003

UN Publications Identify "Best Practices" in Drug-Abuse Treatment and Rehabilitation

VIENNA, 15 April (UN Information Service) -- Good news for all those involved in drug-abuse treatment and rehabilitation efforts worldwide: the United Nations Office on Drugs and Crime in Vienna (UNODC) has recently released the first two publications of a Drug-Abuse Treatment Toolkit aimed at disseminating "best practices." By drawing on basic research, evaluation reports and field expertise, these publications offer the best current thinking about policy, programme and methodology development.

"Even though international drug demand reduction standards are a relatively new concept -- set by the UN General Assembly Special Session on the world drug problem five years ago -- there is already a substantial body of evidence that prevention, treatment and rehabilitation work," Mr. Antonio Maria Costa, the Executive Director of the UN Office on Drugs and Crime, said in his report to the Commission on Narcotic Drugs meeting in Vienna taking place until 17 April.

What are the best ways to treat the increasing number of drug addicts? The response is important both for the individual and for societies affected by substance dependence.

The first publication, "Investing in Drug-Abuse Treatment: A Discussion Paper for Policy Makers," compares treatment of drug-addiction with treatment of other chronic medical conditions -- such as diabetes, hypertension and asthma -- for which compliance with prescribed behavioural changes is equally critical.

The paper deals with issues such as "What brings substance abusers to treatment?" and "What outcomes are expected from treatment?" These questions are considered from several perspectives of interest not only to policy makers, but also to service planners and treatment practitioners as well.

This discussion paper is based on the premise that drug-abuse treatment should improve not only the individual problems of drug-users, but also public health and social problems. It focuses on key aspects of treatment that are "of worth" to society by identifying addiction-related conditions that most affect society.

The costs of drug-abuse are devastating to society ("…[a 2002 study estimates that] there are 280,000 problem drug-users in the U.K., each [costing] about US$45,000 a year"). In light of this issue, the current paper emphasizes how effective treatment can contribute to substantial reductions in social problems and costs to society ("…every US$1 invested in treatment reduces the costs of drug-related crime, criminal justice costs and theft by US$4-7".

What does the available research say about how best to design treatment strategies in order to maximize return on investment? As Dr. Thomas McLellan, the publication's author, points out "…[we cannot] account fully for the physiological and psychological processes that transform controlled, voluntary 'use' of alcohol and/or other drugs into uncontrolled, involuntary 'dependence' on those substances…[ however] what can be done is to treat use 'effectively' and to provide an attractive return on societal investment in treatment."

The second published paper, "Contemporary Drug-Abuse Treatment," briefly reviews the substance-abuse treatment research literature by looking at it from the perspective of the two key phases of treatment: detoxification/stabilization and rehabilitation/relapse prevention phase. It also identifies drug-abuse treatment elements that are linked to treatment outcome. Namely, "patient-related" factors, such as severity of substance abuse and co-morbid psychiatric conditions, as well as "treatment-related" factors, which include treatment setting and retention.

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