Key future research questions on mediators and moderators of behaviour change processes for substance abuse

The effectiveness of psychosocial modalities in the treatment of alcohol problems in adults: a review of the evidence

Our objectives were to review the effectiveness of psychosocial modalities in the treatment of alcohol use disorders and problems, and to examine the impact of therapists on treatment outcome, the evidence on best practices for comorbid conditions, and the evidence on treatment matching. We based our review on published systematic reviews of this topic after 2000. There is strong evidence that some, but not all, psychosocial treatments are effective in treating alcohol problems. Those with the strongest empirical support are motivational enhancement therapy, various cognitive-behavioural interventions, and brief interventions. Meta-analyses for several of these modalities suggest typical effect sizes in the low-to-moderate range. When these modalities have been compared with one another in well-designed clinical trials, they have been shown to be of comparable effectiveness. There is little basis on which to recommend one of these modalities over another but good reason to select from among them.

Tiered Frameworks for Planning Substance Use Service Delivery Systems: Origins and Key Principles

It is well known that only a relatively small proportion of people in the community who experience substance use problems seek assistance from the specialized sector of services that have been commissioned to provide treatment and support for these problems. Going back to seminal reports from the early 1990s there has been a call for a systems approach to “broaden the base of treatment” in order to achieve wider coverage and yield positive outcomes at a population level. In some jurisdictions conceptual models referred to as “tiered models” have been advanced to support planning, system design and performance monitoring. This paper traces the evolution of such tiered models for substance use services and describes a recent model advanced in Ontario Canada for design of an integrated system of mental health, substance use and problem gambling services and supports. The paper concludes by highlighting key features and principles of the tiered approach that are critical for its actual operationalization. Some challenges operationalizing such a comprehensive system design framework are also noted.

Alcohol and drug treatment systems in public health perspective: mediators and moderators of population effects

This article describes a public health approach to the study of service systems for people with substance use disorders. Such an approach is broadly conceived to include the consideration not only of specialized services for alcohol and drug dependence, but also of medical care and social welfare services that interact with and complement specialized drug and alcohol services. After describing a conceptual model of the substance abuse service system, we discuss how systems of care may contribute to population health and social welfare by reducing the societal burden of substance use disorders. The article then summarizes key systems issues pertaining to mediators and moderators of effective treatment systems. The potential benefits of systems thinking in relation to the management of substance use disorders are described. It is suggested that systems concepts and research may help to improve access, efficiency, economy, continuity of care, and effectiveness, thereby improving the population impact of treatment services.

Understanding addiction--mediators and moderators of behaviour change processes: an introduction

We provide an introduction into a highly important research area for the improvement of preventive and therapeutic measures in the field of substance use disorders: a better understanding of core mediators and moderators of change processes, especially during critical phases like onset, progression, cessation and relapse. Based on a brief description of 12 papers on related projects we detail relevant research issues like the role of impaired cognitive control functions or the narrow "window of opportunity" for early interventions during adolescence.