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Psychosocial interventions in opiate substitution treatment services: Does the evidence provide a case for optimism or nihilism?

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Original languageEnglish
Article numberADD13644
Pages (from-to)1329-1336
Issue number8
Early online date2 Jan 2017
Accepted/In press5 Oct 2016
E-pub ahead of print2 Jan 2017
PublishedAug 2017


King's Authors


BACKGROUND & AIMS: Clinical guidelines from around the world recommend the delivery of psychosocial interventions as part of routine care in opiate substitution treatment (OST) programs. However, although individual studies demonstrate benefit for structured psychosocial interventions, meta-analytic reviews find no benefit for manual-based treatments beyond ‘routine counselling’. ANALYSIS: We consider the question of whether OST medication alone is sufficient to produce the required outcomes, or whether greater efforts should be made to provide high quality psychosocial treatment alongside medication. In doing so, we consider the nuances and limitations of the evidence and the organisational barriers to transferring it into routine practice. CONCLUSION: Steering a path between overly optimistic or nihilistic interpretations of the value of psychosocial treatment in OST programs is the most pragmatic approach. Greater attention should be paid to elements common to all psychological treatments (such as therapeutic alliance), but also to the sequencing and packaging of psychosocial elements and their linkage to peer-led interventions.

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