Background briefing | Professor David Clark What the science shows, and what we should do about it (Part 5) Professor David Clark completes the main recommendations from a major new book based on the views of America’s leading clinicians and researchers of how treatment would look like if it were based on the best science possible. Professor David Clark completes the main recommendations from a major new book based on the views of America’s leading clinicians and researchers of how treatment would look like if it were based on the best science possible. On the basis of discussions at a ‘think-tank’
address the client’s own goals, needs, priorities, and
conference, leading US addiction experts proposed a
values. Offer a menu of alternative services and goals
set of ten recommendations for ‘designing programs,
from which people can choose what best meets their
systems, and social policy to reduce drug and
needs and preferences. Express clearly that there is no
associated suffering, societal harms and costs’. We
one effective approach for all affected individuals and
look at the last four of these recommendations.
make a commitment to keep working with the personuntil you find what works and his or her goals are
Recommendation 7: Enhance positive reinforcement
met. An unsuccessful outcome is a failure of
for non-use and enrich alternative sources of positive
treatment, not the person, and warrants trying a
Stopping the use of substances removes one
source of reinforcement. If the person giving up
Recommendation 10: Use evidence-based
substances does not have alternative sources of
positive reinforcement, they are likely to start using or
There are large differences in outcomes depending
‘An unsuccessful outcome
drinking again. It is important to organise treatment
on the services provided. Some forms of treatment
efforts around helping people to develop meaningful
is a failure of treatment,
are ineffective or harmful. Treatment services should
concentrate on those approaches with the best
not the person, and
People with substance use problems are often cut
evidence of efficacy. ‘It is long overdue for science,
off from alternative sources of reinforcement. A
warrants trying a
rather than opinion and ideology, to shape
significant task for them is to establish or re-establish
interventions for drug [substance use] problems.’
different approach.’
contact with social networks that favour abstinence,
Learning a new treatment approach involves more
and to sample and gain access to sources of non-drug
than reading a book or attending a workshop. It
requires training involving supervision and coaching,
substance use, and most of the time can engage an
as well as support from administrative officials and
responsibilities can be important sources of
initially unmotivated loved one in treatment.
funding sources. Learning a new complex skill rarely
reinforcement that are incompatible with substance
Conditions that protect people from the natural
occurs without feedback on actual practice, but this
negative consequences of their own substance use can
rarely happens in the treatment system.
spiritual/religious organisations, or involvement in 12-
Attention should be given in hiring to the qualities
of the practitioner (eg accurate empathy) that are
‘In essence, the goal is to develop a rewarding
Recommendation 9: Make services easily accessible,
associated with better outcomes. ‘One of the largest
drug-free life that competes successfully with the
affordable, welcoming, helpful, potent, rapid, and
determinants of how clients will fare in treatment is
allure of positive and negative reinforcement that
the clinician to whom they are entrusted.’
‘Common obstacles include waiting lists, stigma,
It is important to have ‘a system that monitors the
geographic inaccessibility, cost, restricted hours, and
ongoing outcome of treatment services, providing
Recommendation 8: Diminish the rewarding aspects
limited program goals that do not match the
timely, accurate, and reliable feedback to treatment
individual’s priorities. All of these obstacles can be
providers, managers, and funding sources as well as
Pharmacotherapies represent one effective means
addressed in redesigning service systems.’
to affected individuals and their families’.
of doing this. Various medications (eg methadone,
Intake systems should be welcoming and attractive.
The experts do not recommend reducing practice
A professional should be seen from the outset, and
into a list of ‘approved’ evidence-based treatments,
pharmacological incentives for taking drugs by
questions in the initial consultation should be kept to a
since this would stifle creativity and limit services to
blocking, replacing, or offsetting drug effects. A
minimum. ‘Half an hour of listening, letting people tell
the practices of the past. ‘While interventions with a
principal problem in their therapeutic use has been
their story and express their concerns and goals, is a
good evidence base are a good starting point, a
medication compliance. Drug use is also responsive to
good start before asking questions and completing the
creative system will also encourage innovation to
forms needed for administrative purposes.’
accomplish specified goals and to monitor outcomes
In treating an individual, it is important to
Programs and practitioners are there to meet the
to know which practices do, in fact, promote the
consider what reinforcement the person is receiving
needs of the client, not vice versa. Drop-out in early
for drug use, beyond the pharmacological incentives
stages of treatment often occurs because the person
sees a mismatch between what is on offer and their
Rethinking Substance Abuse: What the science shows,
With proper support and coaching, families can
and what we should do about it, edited by William R.
learn to reinforce behaviour incompatible with
‘Services should take into account, respect, and
Miller and Kathleen M. Carroll, Guilford Press, 2006www.drinkanddrugs.net 18 June 2007 | drinkanddrugsnews | 15
Lipitor, Zocor, Pravachol: Cholesterol Lowering Drugs Cause Cancer? - Health Supreme Networking For A Better Future - News and perspectives you may not find in the media Lipitor, Zocor, Pravachol: Cholesterol Lowering Drugs Cause Cancer? Lipitor has been known to cause very painful and potentially fatal muscle wasting also known as rhabdomyolysis as detailed and confirmed by numerous persona
A. CLEANING THE SITE: It might be red and tender and may have dry, yellow crust. IMPORTANT—Keep tension off the site and tape the catheter to the abdomen. THREE STEPS TO CLEAN—1. Wash hands. 2. Prepare mixture of half water and half hydrogen peroxide. 3. Use solution to clean around the site With a Q-tip (gently loosen crust or drainage) and then dry gently. Will see normal
Background briefing | Professor David Clark