What does the scientific evidence tell us about the effectiveness of treatment and rehabilitation?

Professor Keith Humphreys

Keith Humphreys is a Professor and the Section Director for Mental Health Policy in the Department of Psychiatry and Behavioral Sciences at Stanford University. He is also a Senior Research Career Scientist at the VA Health Services Research Center in Palo Alto and an Honorary Professor of Psychiatry at the Institute of Psychiatry, King’s College, London. His research addresses the prevention and treatment of addictive disorders, the formation of public policy and the extent to which subjects in medical research differ from patients seen in everyday clinical practice.

His work has won him the 2009 American Psychological Association Award for Distinguished Contribution to the Public Interest, and the 2010 British Medical Association’s Award for Public Health Book of the Year.

Dr Humphreys during the Obama Administration spent a sabbatical year as Senior Policy Advisor at the White House Office of National Drug Control Policy, where he was involved in the formation of public policy. He has also testified on numerous occasions in Parliament and advises multiple government agencies in the UK.

What does the scientific evidence tell us about the effectiveness of treatment and rehabilitation?

Health and social services for people with drug disorders is an essential component of public health-oriented drug policy throughout the world. The official goal of such services may be reducing use (e.g., therapeutic communities) or reducing harm (e.g., syringe exchange, naloxone), although the practical reality is that effective services tend to accomplish both. The most effective services available are pharmacotherapies for opioid use disorder (e.g., methadone maintenance), which have evidence of substantial benefit in many countries and with many populations. There is no comparably effective medication for other drug use disorders, unfortunately. Psychosocial treatments, which may be residential in nature but are usually outpatient, can also make substantial contributions to well-being. Effective models including cognitive-behavioral therapy, contingency management and 12-step facilitation counselling.

Integrating the care of people with drug use disorders into mainstream healthcare remains challenging. Screening and brief intervention models in primary care have rarely been adopted, and have an indifferent track record of effectiveness. As a result the drug use disorder service system exists outside of the rest of health care in most countries, compromising care coordination and quality and also potentially increasing stigmatisation. Developing and implementing better models of integrated care should be a major goal of clinicians, researchers and drug policy makers.