Psychosocial interventions in opiate substitution treatment services: does the evidence provide a case for optimism or nihilism?

Research output: Contribution to journalReview article

Authors

Colleges, School and Institutes

External organisations

  • South London and Maudsley NHS Foundation Trust

Abstract

Background and Aims: Clinical guidelines from around the world recommend the delivery of psychosocial interventions as part of routine care in opiate substitution treatment (OST) programmes. However, although individual studies demonstrate benefit for structured psychosocial interventions, meta‐analytical reviews find no benefit for manual‐based treatments beyond ‘routine counselling’.

Analysis: We consider the question of whether OST medication alone is sufficient to produce the required outcomes, or whether greater efforts should be made to provide high‐quality psychosocial treatment alongside medication. In so doing, we consider the nuances and limitations of the evidence and the organizational barriers to transferring it into routine practice.


Conclusion: The evidence base for psychosocial interventions in opiate substitution treatment (OST) services can be interpreted both positively and negatively. Steering a path between overly optimistic or nihilistic interpretations of the value of psychosocial treatment in OST programmes is the most pragmatic approach. Greater attention should be paid to elements common to all psychological treatments (such as therapeutic alliance), but also to the sequencing and packaging of psychosocial elements and their linkage to peer‐led interventions.

Details

Original languageEnglish
Pages (from-to)1329-1336
Number of pages8
JournalAddiction
Volume112
Issue number8
Early online date2 Jan 2017
Publication statusPublished - Aug 2017

Keywords

  • Evidence‐based practice, opiate, opiate substitution treatment, psychosocial intervention, training, treatment