Mieke Autrique

Therapeutic communities for addictions: a review of their effectiveness from a recovery-oriented perspective.

Therapeutic communities (TCs) for addictions are drug-free environments in which people with addictive problems live together in an organized and structured way to promote change toward recovery and reinsertion in society. Despite a long research tradition in TCs, the evidence base for the effectiveness of TCs is limited according to available reviews. Since most of these studies applied a selective focus, we made a comprehensive systematic review of all controlled studies that compared the effectiveness of TCs for addictions with that of a control condition. The focus of this paper is on recovery, including attention for various life domains and a longitudinal scope. We searched the following databases: ISI Web of Knowledge (WoS), PubMed, and DrugScope. Our search strategy revealed 997 hits. Eventually, 30 publications were selected for this paper, which were based on 16 original studies. Two out of three studies showed significantly better substance use and legal outcomes among TC participants, and five studies found superior employment and psychological functioning. Length of stay in treatment and participation in subsequent aftercare were consistent predictors of recovery status. We conclude that TCs can promote change regarding various outcome categories. Since recovering addicts often cycle between abstinence and relapse, a continuing care approach is advisable, including assessment of multiple and subjective outcome indicators.

‘The Human Prerogative’: A Critical Analysis of Evidence-Based and Other Paradigms of Care in Substance Abuse Treatment

Present-day substance abuse treatment is characterized by a compelling demand for applying evidence-based interventions. Vehement discussions between policymakers, practitioners and researchers illustrate this clash of differing paradigms. The aim of this article is to situate evidence-based practice among the leading paradigms of care and to elucidate its implicit assumptions and potential implications. Evidence-based practice is inherent in the empirical-analytical paradigm of care and science, founded upon randomized and controlled studies. This paradigm is compared with the phenomenological-existential and the critical post-structural paradigm, which focus on elaborating the human potential and exploring individuals’ subjective interpretations, and on criticizing social inequalities and striving for compliance with human rights, respectively. Evidence-based practice and the methodological rigidity in each paradigm are analyzed critically. We conclude that through the dialectical integration of these diverse approaches, evidence, existence/humanism and social emancipation can be combined for the benefit of the human prerogative of care.

Practitioner Review: Evidence-based practice guidelines on alcohol and drug misuse among adolescents: a systematic review

BACKGROUND Context-specific evidence-based guidelines on how to prevent and treat substance misuse among adolescents are currently lacking in many countries. Due to the time consuming nature of de novo guideline development, the ADAPTE collaboration introduced a methodology to adapt existing guidelines to a local context. An important step in this method is a systematic review to identify relevant high-quality evidence-based guidelines. This study describes the results of this step for the development of guidelines on adolescent alcohol and drug misuse in Belgium. METHODS Rigorous systematic review methodology was used. This included searches of electronic databases (Medline, Embase, Cinahl, PsychInfo, and ERIC in June 2011), websites of relevant organizations, and reference lists of key publications. Experts in the field were also contacted. Included were Dutch, English, French, or German evidence-based practice guidelines from 2006 or later on the prevention, screening, assessment, or treatment of alcohol or illicit drug misuse in persons aged 12-18 years. Two independent reviewers assessed the quality of the guidelines using the AGREE II (Appraisal of Guidelines for Research and Evaluation) instrument. SCOPE This overview provides a framework of current knowledge in adolescent alcohol and drug misuse prevention and treatment. RESULTS This systematic review identified 32 relevant evidence-based guidelines on substance misuse among adolescents. Nine guidelines were judged to be of high quality; of which four had recommendations specifically on adolescents: one on school-based prevention, one on substance misuse prevention in vulnerable young people and two on alcohol misuse with specific sections for the adolescent population. There were few commonalities as guidelines focused on different target groups, professional disciplines and type and level of substance misuse. Evidence to support the recommendations was sparse, and many recommendations were based on expert consensus or on studies among adults. Also, the link between evidence and recommendations was often unclear. CONCLUSIONS There are a substantial number of guidelines addressing substance misuse in adolescents. However, only four high-quality guidelines included recommendations specific for adolescents. The current level of evidence that underpins the recommendations in these high-quality guidelines is low.

Practitioners' attitudes concerning evidence-based guidelines in Belgian substance abuse treatment

Background/Aim: Evidence-based guidelines for substance abuse treatment are available in many European countries. In Belgium, no such guidelines have been developed yet at a national level although their need has repeatedly been emphasized. This study aims to assess Belgian practitioners’ attitudes concerning evidence-based guidelines for substance abuse treatment. Methods: A survey was conducted with clinical coordinators in a representative sample of 60 agencies dispensing specialized treatment to alcohol and drug abusers. Results: The study revealed that evidence-based guidelines are rarely used in substance abuse treatment in Belgium, but that many agencies use self-developed guidelines. The attitude concerning evidence-based guidelines is mainly positive. Practitioners’ concerns mostly relate to the risk of disregarding their clients’ needs and the constraining character of using evidence-based guidelines. The study also reveals some barriers concerning the implementation of evidence-based guidelines and suggests some strategies to overcome them. Conclusion: Practitioners appear to be prepared to work with evidence-based guidelines. When developing, adapting and implementing evidence-based guidelines for substance abuse treatment, it is important for policy makers to take into account the state of the art in clinical practice as well as practitioners’ needs and requirements.

The impact of a randomised trial on TC environments

Purpose – The purpose of this paper is to investigate the possible impact of a randomised controlled trial on the therapeutic environment of participating therapeutic communities (TCs). Design/methodology/approach – The authors compared the environment in four democratic day TCs involved in a randomised trial (experimental TCs) with a similar democratic day TC not involved in the trial (the control TC) by administering the Community Oriented Environment Scale (COPES) to 28 TC members. Findings – TC members’ views of the real psychosocial environment at the experimental TC and control TC showed similar high levels for spontaneity, autonomy and personal problem orientation and similar intermediate levels for practical orientation and staff control. The TC members at the experimental TC rated significantly higher levels for order and organisation and clarity, while members at the control TC rated a significantly higher level for involvement. Originality/value – The study provided no evidence of a significant...

‘Evidence-based’-werken in de verslavingszorg: geen evidentie?

SamenvattingDe laatste jaren wordt de term ‘evidence-based’ steeds vaker in de mond genomen en verschijnen er tal van publicaties die het belang van ‘evidence-based practice’ (EBP) en ‘evidence-based’-richtlijnen (EBR) in de verslavingszorg benadrukken. De kloof tussen theorie en praktijk is echter een welbekend probleem en op de werkvloer lijkt men vrij terughoudend te staan tegenover deze nieuwe tendens. In dit artikel wordt daarom bekeken wat de kennis is van praktijkwerkers over EBP en EBR, welke houding zij tegenover deze ontwikkeling aannemen en in welke mate zij de methoden en richtlijnen toepassen. Dit gebeurt aan de hand van de resultaten van een bevraging in de Belgische verslavingszorg, waarbij sleutelfiguren uit zestig verschillende voorzieningen in België geïnterviewd werden. Op basis van de resultaten worden aanbevelingen geformuleerd voor de praktijk.