Level of research support: Strong evidence of effectiveness
What is it?
Treatment typically refers to a set of services that provides direct supportive care to a person and family members experiencing problems associated with the use of alcohol and other drugs. Treatment services may address physical health problems or help a person deal with psychosocial issues that have led to drug use problems. They may also address the drug use itself.
Treatment may be provided through a range of loosely connected health and social service systems. Or it could be delivered through primary care or other health and social service systems. It could also be delivered by specialized drug use treatment services. In other words, treatment may happen anywhere—in a counsellor’s office, a coffee shop, a hospital, a rehab centre, or even on the street.
People experiencing drug-related harms can benefit from a variety of services and supports, not all of which would be traditionally classified as treatment. Housing or employment services, for example, address basic needs that support general health and wellness. Other services seek to promote health by improving the physical or social environment within the community. Still others may seek to enhance the personal sense of hope that increases motivation and action. But whether or not these services are called treatment, they all contribute to creating healthy communities and individuals.
In BC, the guiding principle of our treatment supports and services system is harm reduction. This means that services are guided by the aim of minimizing drug-related harm to both individuals and communities. One advantage of this approach is that degrees of success can be measured in terms of the harms that have diminished. On a similar note, the system recognizes that a single approach to treatment cannot fit the needs of all individuals. The same applies to communities that are impacted by excessive use of alcohol and other drugs.
No matter what aspect of the problem they address or what system they are delivered through, treatment services should be designed to help people reduce harm, manage their recovery and achieve lasting health and wellness.
Why do it?
Decades of research have established that a diverse array of community and treatment settings allows people to be supported based on their health and social needs. A wide range of services and supports ensures flexibility that considers age, gender, culture and community strengths and needs.
Evidence shows that early identification of substance use problems improves outcomes related to treatment and self-management, and mitigates future problems related to substance use (Roberts & Ogborne, 1999). Different types of people require different types of treatment. Recent research findings support tailoring therapeutic approaches to specific characteristics of the person such as personality, culture, and religion or spirituality (Norcross et al., 2011).
And, research clearly demonstrates the importance of the relationship between therapists and clients. A task force recently convened by the American Psychological Association sought to identify elements of effective therapy relationships (Norcross & Lambert, 2011). The findings reveal that the feelings and attitudes the therapist and client have for one another and the manner in which these are expressed are consistent indicators of positive treatment outcomes.
Research also shows that harm reduction and low-threshold initiatives, such as outreach and needle exchange programs, are effective in both reducing harms related to substance use and providing an entry point for substance users to access health and social services, including referrals to detoxification and treatment services (BC Ministry of Health, 2005).
Who is it for?
Who can facilitate it?
How can we implement it?
The BC Ministry of Health Services has developed a framework to support community and health authority efforts to address problems related to drug use. Called Every Door is the Right Door: A British Columbia Planning Framework to Address Problematic Substance Use and Addiction, the Framework acknowledges that responding effectively to drug use problems requires a collaborative, multi-system response from the entire community.
In keeping with this approach the Framework defines roles for individuals, communities, health authorities and government. Community roles include:
Communities can promote initiatives that offer information about
Organizations and individuals in first contact with people struggling with drug use play a crucial role in whether or not they get help or lose hope. “First responders” can serve as ambassadors to the service system by ensuring that those who are struggling know “every door is the right door” when it comes to accessing help and support. These first responders include families, friends, schools, police, corrections workers, family physicians, public health workers, social workers and community service providers.
Harm reduction and low-threshold services refer to all interventions that are directed at reducing drug-related harm to individuals who are not yet ready to engage with the treatment system. Low-threshold services help to prevent harms such as infections, blood-borne pathogens and other health problems, and to prevent the adoption of higher-risk drug use and other behaviours. Some examples include street nurse outreach programs and needle exchange programs.
Specialized services (e.g. withdrawal management, individual counselling, residential treatment) are defined in the Framework as primarily the responsibility of health authorities, in collaboration with communities. This means communities have a critical role to play in long-term rehabilitation and supports, such as access to housing services, life skills and occupational training, and supportive employment programs.
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