Treatment and social reintegration

Section title

Treatment and social reintegration

Brief definition of policy approach

Intervention in populations that are treatment-seeking or meet diagnostic criteria for dependence. Social reintegration interventions are those that aim to integrate former or current problem drug users into the community

Description of policy approaches

Intervention in populations that are treatment-seeking or meet diagnostic criteria for dependence. Social reintegration interventions are those that aim to integrate former or current problem drug users into the community. Approaches include psychosocial treatment as well as pharmacological treatment, including substitution treatment. It is not always possible to distinguish clearly between indicated prevention and treatment along the continuum of care. As a general rule, we considered an intervention to be treatment if it was carried out with a population that was treatment-seeking or met diagnostic criteria for dependence, and prevention if it was carried out with an unselected/’at risk’ population. Where interventions may be carried out with either population, these are listed in both sections (i.e., prevention and treatment).

Typical measures included under this approach

  1. Psychosocial treatment
    • Multiple behaviours – Counselling services covering a range of health behaviours
    • Alcohol – helplines; brief interventions; motivational interviewing; cognitive therapies; peer support and self-help programmes; family therapy, mutual aid; computer and web-based interventions
    • Tobacco – individual counselling services; group counselling; brief interventions; motivational interviewing; cognitive therapies; computer and web-based interventions; quit and win contests; relapse prevention
    • Illegal drugs – counselling; brief intervention; motivational interviewing; cognitive therapies; psychodynamic psychotherapy; peer self-help programme; family therapy; therapeutic communities; computer and web-based interventions; contingency management; relapse prevention; case management
    • Gambling – counselling; brief interventions; motivational interviewing; cognitive therapies; peer self-help programmes
  2. Pharmacological treatment
    • Alcohol – pharmacological treatment; pharmacological management of withdrawal
    • Tobacco – pharmacological treatment
    • Illegal drugs – pharmacological treatment; pharmacological treatment of withdrawal; pharmacological detoxification; substitution/maintenance treatment
    • Gambling – pharmacological treatment
  3. Other forms of treatment
    • Alcohol – No approaches identified
    • Tobacco – Mass media campaigns; self-help materials
    • Illegal drugs – Non-pharmacological treatment of withdrawal
    • Gambling – No approaches identified
  4. Interventions for high risk populations
    • Alcohol – Specialised/tailored treatment for young people; Dual diagnosis programmes / Programmes for those affected by co-morbidity
    • Tobacco – Interventions for waterpipe smoking
    • Illegal drugs – Specialised/tailored treatment for young people; interventions for inhalant use; Dual diagnosis programmes / Programmes for those affected by co-morbidity
    • Gambling – No approaches identified
  5. Criminal justice interventions
    • Alcohol – Diversion to (voluntary or mandated) education or treatment, arrest referral schemes
    • Tobacco – No approaches identified
    • Illegal drugs – Diversion to (voluntary or mandated) education or treatment, arrest referral schemes; drug courts; prison treatment programmes; parole programmes; post-release programmes
    • Gambling – No approaches identified
  6. Social reintegration
    • Alcohol – Services to assist clients with a common employability barrier (e.g., history of drug/alcohol misuse, homelessness and ex-prisoners/ex-offenders) to enter employment
    • Tobacco – No approaches identified
    • Illegal drugs – Social rehabilitation programmes for young people; education and employment related programmes; supported housing
    • Gambling – No approaches identified
  7. Delivery structures and quality assurance mechanisms
    • Multiple behaviours – Delivery structures covering a range of addictions
    • Alcohol – ring fenced budgets for treatment; alcohol liaison nurses
    • Tobacco – smoking cessation support networks; reimbursement of medications cost; interventions targeting healthcare providers
    • Illegal drugs – establishment of treatment facilities; workforce development
    • Gambling – ring fenced budgets for treatment

Summary of available evidence for interventions and policies

  1. Beneficial
    • Group cognitive behavioural therapy (CBT) and multi-dimensional family therapy for reducing adolescent alcohol and illegal drug use in the long-term
    • Behavioural therapy, combined CBT and functional family therapy, family systems therapy, functional family therapy, multisystemic treatment, psychoeducational therapy and Botvin Life Skills Training combined with an anti-violence programme and values clarification programme for reducing adolescent alcohol and illegal drug use in the short to medium term
    • CBT for the short-term reduction of problematic gambling in adults
  2. Likely to be beneficial
    • Complex interventions, motivational enhancement therapy or CBT, for tobacco cessation among young people including at long-term follow up
  3. Mixed evidence
    • Computer or web based interventions for tobacco cessation
  4. Unknown effectiveness
    • Pharmacological treatment of alcohol use with 5-HT3 receptor antagonists
    • Treatment approaches for waterpipe smokers
    • Use of levo-α-acetylmethadol (LAAM) maintenance for treatment of heroin dependence
    • Treatment approaches for homeless youth who use illegal drugs
    • Treatment approaches for inhalant abuse
    • Motivational interviewing for problematic gambling
    • CBT for the medium or long term reduction of problematic gambling
  5. Ineffective
    • Individual counselling, family education, adolescent group treatment and individual CBT on multiple substance use
    • Nicotine replacement therapy for tobacco cessation
    • Pharmacological treatment for tobacco cessation

Key Reviews

Vaughn & Howard 2004; Coren et al., 2013; Grimshaw et al., 2006; Maziak et al., 2007; Villanti et al., 2010; Hettema & Hendricks, 2010; Myung et al., 2010; Cowlishaw et al., 2012; Clark et al., 2002; Minozzi et al., 2002Full set of evidence tables (PDF)