Volume 17, Issue 2


Aims: (1) To summarize current knowledge about change, efficacious treatments, and the current alcohol and drug treatment delivery system in the United States; (2) To recommend changes in the treatment delivery system based on current scientific findings. Method: Selective review of current scientific literature. Results: Conclusions from the literature: (1) change is common and does not require treatment; (2) change is a process; (3) many factors contribute to and support change; (4) the course of substance use disorders is variable; (5) clinical populations have complex problems; (6) treatment contributes to success; (7) several treatments have strong evidence for effectiveness; (8) decisions about levels of care are a factor in the effectiveness of treatment; (9) the majority of patients are mandated to treatment; and (10) staffing of SUD treatment facilities is incompatible with evidence-based practice. Based on these findings 7 recommendations are made: (1) information about effective methods of change should be widely available to the community (2) screening and brief interventions should be integrated into primary health care settings and appropriately funded; (3) licensure standards for SUD treatment facilities should require the use of evidence-based practices; (4) programs need ways to provide incentives for abstinence without additional cost to the program; (5) effective, attractive, and useful training in evidence-based practices and empirically support treatments is needed for front-line addictions counselors; (6) the structure and financing of treatment services should be organized to recognize the chronic, relapsing nature of some SUDs; (7) there is a need to develop and finance on-going, evidence-based services for families.

Substance abuse, change, effective treatments

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