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Assessment & Treatment

(updated 30.11.10)

Needs assessment & treatment planning: Drug treatment, recovery and reintegration in the community and prisons: Supplementary advice in relation to Tier 4
NTA 2010
This supplementary guidance is designed to be read in conjunction with the wider NTA needs assessment guidance for local drug partnerships.

Pychosocial interventions for drug misuse: a framework and toolkit for implementing NICE-recommended treatment interventions
NTA, British Psychological Society, 2009.
This document is designed to support drug treatment services in the effective delivery of evidence-based psychosocial interventions both for drug misuse and for common co-morbid mental health problems. It focuses on evidence-based treatment interventions recommended by the National Institute for Health and Clinical Excellence (NICE) and provides a range of tools to support effective implementation.

Drug Treatment at the Crossroads
Drugscope 2009
Drug treatment at the crossroads is about making the case for drug treatment and looking ahead to where we go next. It is also about ensuring that – working together – we have the necessary commitment, the tools and the vision, to make drug treatment in this country even better.

Residential drug treatment services: a summary of good practice
NTA, 2009.
This report describes the good practice identified among the best-performing rehabilitation and detoxification centres in a recent joint review with the Healthcare Commission. The report highlights how innovative models of residential treatment are emerging in some parts of the country, including supported housing linked to structured treatment, and services tailored to local recovery communities.

Guidance for the pharmacological management of substance misuse among young people
NTA, 2009.
Until now there has been no formal guidance to help clinicians to manage substance dependence among young people. This has left practitioners concerned that their practice may not accord with the developing evidence base. This guidance document describes good practice on the best ways to manage a clinically complex condition.

Guidance for the pharmacological management of substance misuse among young people in secure environments
DH 2009
Until now there has been no formal guidance to help clinicians to manage substance dependence among young people. This has left practitioners concerned that their practice may not accord with the developing evidence base. This guidance document describes good practice on the best ways to manage a clinically complex condition.

Parliamentary Office for Science and Technology 2009
Some 11.3 million people in Britain have used an illicit drug at least once in their lifetime.4 Cocaine and heroin are the most damaging illicit drugs in terms of health impacts to dependent individuals and the cost of drug related crime. This POSTnote looks at the treatments currently available for heroin and cocaine dependency, assesses the prospects for new treatments, and examines the issues these raise.

This discussion paper aims to encourage Governments and other partners to take concerted action for the implementation of evidence-based drug dependence treatment services, which respond to the needs of their populations.

Undertaking needs assessment: Drug treatment Recovery and reintegration in the community and prisons
NTA 2009
Undertaking needs assessment – Drug Treatment: reintegration and recovery in the community and prisons. Information on undertaking an assessment of need fordrug treatment, recovery and reintegration services for drug users in the community and prisons

ITEP Routes to recovery
NTA, 2009.
This report highlights the influence of organisational factors on the effectiveness of drug treatment, particularly ‘strong leadership, a learning culture and clarity of purpose - the three key elements of organisational health’. Delivered as a key part of psychosocial drug treatment interventions, the ‘mapping’ approach allows drug workers to visually represent their clients’ thinking during the recovery process through a series of personal ‘maps’. The technique is designed to improve clients’ motivation and engagement in treatment services.

Routes to recovery: ITEP & BTEI new approaches to psychosocial interventions: executive summary. (PDF 655KB)
Routes to recovery part 1: ITEP: challenging and changing the ways we think.
Routes to recovery part 2: The ITEP manual: delivering psychosocial interventions Manual. (PDF Warning large file 4Mb)

Improving the quality and provision of Tier 4 interventions as part of client treatment journeys: A best practice guide
NTA, 2008.
This guidance summarises key challenges that currently face the Tier 4 sector. It links the roles that each stakeholder group can play in jointly finding solutions and improvements. This document can be read in tandem with Models of Residential Rehabilitation for Drug and Alcohol Misusers (NTA, 2006), Drug Misuse and Dependence: UK Guidelines on Clinical Management, and Commissioning Tier 4 Drug Treatment (NTA, 2006). Reference should also be made to the World Class Commissioning Programme launched by the Department of Health in December 2007 (Department of Health, 2007). World Class Commissioning will deliver a more strategic and long term approach to commissioning services with a clear focus on delivering improved health outcomes. Many of the principles highlighted in this NTA best practice guidance, notably thorough needs assessments, partnership working and user involvement are reflected in the World Class Commissioning vision.

Audit of drug treatment prescribing services
NTA, 2007.
The National Treatment Agency for Substance Misuse's guidelines on ethical prescribing for UK drug treatment providers. This document also contains information on new monitoring procedures to ensure the guidelines are followed by all doctors.

Essential care: A report on the approach required to maximise opportunity for recovery from problem substance use in Scotland
Scottish Advisory Council on the Misuse of Drugs, 2008.
The majority of the Essential Care report is concerned with support that is needed to address problems in areas of drug service users’ lives other than addiction, such as general health, mental health and social skills and relationships. It lists all the areas which may need attention, together with evidence of their benefits. However the main conclusion is that there needs to be a major change in the philosophy of care for problem substance use in Scotland – focused on the recovery of each individual.

The drug treatment outcomes research study (DTORS): baseline report
Home Office 2007
The Drug Treatment Outcomes Research Study has been designed to update existing knowledge on the effectiveness of drug treatment in England. Within the context of changing patterns of drug use and an expansion in criminal justice referrals, this study aims to measure the outcomes experienced by those seeking drug treatment. The study comprises of three key elements, operated over a three-year period, namely: a quantitative study of outcomes; a qualitative study of treatmentrelated issues; and a cost benefi ts analysis. This report describes the fi ndings from the quantitative study baseline interviews.
Guidelines for the evaluation of treatment in the field of problem drug use
EMCDDA, 2007.
The main objective of the guidelines is to provide a European audience with basic information on the options, elements and procedures of drug-related treatment evaluation. The target readership includes professionals working in treatment services for substance use and dependence, administrators and officials in social and health authorities, researchers dealing with treatment of substance dependence, and those who professionally or politically may have an interest in evidence from treatment evaluation.

The International Treatment Effectiveness Project - Implementing psychosocial interventions for adult drug misusers
NTA 2007.
The International Treatment Effectiveness Project (ITEP) is part of the National Treatment Agency’s Treatment Effectiveness strategy, which identified areas for enhancing the quality of treatment interventions. The project was a collaboration between the NTA, the Institute of Behavioural Research (IBR) in Texas and severalservice providers in the north-west England and London. ITEP utilised a care planning approach (referred to as “mapping”) in the form of a manual, which was used by trained keyworkers with their clients. Previous research had shown that these psychosocial interventions had a number of positive outcomes in terms of clients’ treatment experiences and reductions in illicit drug use.

Drug misuse and dependence: Guidelines on clinical management 2007
DH (September 2007)
The Guidance is intended for all clinicians, especially those providing pharmacological interventions for drug misusers as a component of drug misuse treatment.

Needs assessment guidance for adult drug treatment
NTA, 2007.
Describes the aims and objectives behind needs assessments and the processes involved in conducting one. Includes practical information on conducting research into prevalence, current provision, evaluation, commissioning and monitoring.

Drug misuse: psychosocial interventions
NICE, 2007.
NICE has produced two guidelines on drug misuse – ‘Drug misuse: psychosocial interventions’ (NICE clinical guideline 51) and ‘Drug misuse: opioid detoxification’ (NICE clinical guideline 52). They cover:
* the support and treatment people can expect to be offered if they have a problem with or are dependent on opioids, stimulants or cannabis
* how families and carers may be able to support a person with a drug problem and get help for themselves.
NICE clinical guideline 51 makes recommendations for the use of psychosocial interventions in the treatment of people who misuse opioids, stimulants and cannabis in the healthcare and criminal justice systems.

Best practice guidance for commissioners and providers of pharmaceutical services for drug users
NTA, RPS, 2006.
The aim of this report is to provide commissioners and providers of pharmaceutical services for drug users with information and advice in order to inform commissioning and ensure best practice.

Treating drug misuse problems: evidence of effectiveness
National Addiction Centre, 2006.
This report reviews evidence of the effectiveness of a wide range of drug treatments, including; pharmacotherapies, psychological treatments, twelve step programs, brief interventions, needle exchange schemes and combined treatments.

Responses to drug misuse: treatment
RSA, 2006.
This paper looks at treatment as a response to drug misuse.

Models of residential rehabilitation for drug and alcohol misusers
NTA, 2006.
A review of types of residential treatment currently on offer, clinical standards, and guidance on best practice.

Models of care: Update 2006
NTA, 2006.
This update is intended to build on the framework and concepts in Models of Care 2002 rather than replace them. It requires drug treatment commissioners and providers to have implemented the key tenets previously described in Models of Care 2002.

Final guidance - Safer management of controlled drugs (CDs)
DoH (October 2006)
The purpose of this guidance is to inform and support relevant healthcare professionals and organisations in implementing changes to the record keeping requirements for controlled drugs required by recent changes to the Misuse of Drugs Regulations 2001 : 8pp PDF

Roles and responsibilities of doctors in the provision of treatment for drug and alcohol misusers
RCP + RCGP, 2005
This document reflects the development and evolution of the process of providing improved treatments, delivered by both general practitioners and psychiatrists.

NTA/Home Office guidance for commissioning drug treatment Services from voluntary and community sector Organisations
NTA, 2005.
This guidance aims to provide the framework for a positive relationship between the purchaser and the service provider. A positive relationship will enable the maximum possible resources to reach the frontline, resulting in the best quality of service to be delivered.

Nurse prescribing in substance misuse
NTA , 2005.
This briefing aims to clarify the current situation in relation to nurse prescribing in the substance misuse sector. It provides information to commissioners, treatment providers and health professionals on the potential role of nurse prescribing in service development. It will form part of a series of briefings, designed to provide updates on changes in regulations/legislation in relation to nurse prescribing and inform colleagues of the work of the National Treatment Agency (NTA), in supporting the development of clinical practice in this area.

Prevention and treatment of substance misuse: delivering the right medicine: a strategy for pharmaceutical care in Scotland
Scottish Executive. National Pharmaceutical Forum, UK. Scotland. Scottish Executive. Scottish Medical and Scientific Advisory Committee, 2005.
This report sets out the present and future role of pharmacy in the provision of services to substance misusers. Two of the main recommendations relate to the inclusion of senior pharmacy representation on Drug and Alcohol Action Teams and access to specialist pharmacist advice on all areas of substance misuse.

Roles and responsibilities of doctors in the provision of treatment for drug and alcohol misusers
Royal College of General Practitioners, Royal College of Psychiatrists, 2005.
All organisations employing doctors need a robust clinical governance structure that addresses issues of education and supervision. This report recommends that appraisal must be carried out by a trained appraiser with experience of the clinical area. Supervision could be carried across different employing and specialty areas, so for example a consultant addiction psychiatrist could supervise a GP with special clinical interest working in their geographical area.

Guidance for the use of methadone for the treatment of opioid dependence in primary care
SMMGP, 2005.
This document sets out guidelines for GPs in the care of patients receiving methadone maintenance treatment. It covers topics such as titration, stabilisation, interactions, loss of tolerance and shared care.

Treatment outcomes: what we know and what we need to know
NTA 2005.
(Treatment effectiveness 2). This paper reviews what has been learned from the following major national drug treatment outcome studies: NTORS (National Treatment Outcome Research Study); DARP (the Drag Abuse Reporting Programme); TOPS (Treatment Outcome Prospective Study) and DATOS (Drug Abuse Treatment Outcome Study).

Substitution maintenance therapy in the management of opioid dependence and HIV/AIDS prevention
WHO, 2004.
The World Health Organization (WHO), the United Nations Office on Drugs and Crime (UNODC) and the Joint United Nations Programme on HIV/AIDS (UNAIDS), have developed a joint position on substitution maintenance therapy for opioid dependence. Based on a review of scientific evidence and oriented towards policymakers, the WHO/UNODC/UNAIDS position paper covers a wide range of issues, from the rationale for this treatment modality, to the specific considerations regarding its provision for people with HIV/AIDS.

An exploration of the role of substance misuse nurses in scotland
Effective Interventions Unit (November 2004)
With the increase of drug misuse over the past two decades, the role of the substance misuse nurse has increased dramatically. Research on the role of nurses working in this field is minimal and there is little known about what they do, what they think about their clients and their role, and how they approach treatment. A pilot study on substance misuse nurses in Grampian indicated that nurses may be key gatekeepers to specialist services and some nurses appeared to have an important role in clinical decision making. However, clinical decision making and other key aspects of nurse practice may vary across services in different geographical areas. This research was designed to gain a better understanding of the role of the substance misuse nurse in Scotland.

Needs Assessment: A Practical Guide to Assessing Local Needs for Services for Drug Users
Drug Misuse Information Scotland
This guide describes the needs assessment process step-by-step, and gives examples of how to do a needs assessment for specific areas of work

Integrated Care for Drug Users
Scottish Effective Interventions Unit (October 2002)
"The rationale for integrated care and its wider context. Definitions and concepts of integrated care and its key elements: accessibility, assessment, planning and delivery of care, information sharing, monitoring and evaluation."

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