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Major Studies of Drugs and Drug Policy | ||||
Canadian Senate Special Committee on Illegal Drugs | ||||
Volume 2 - Policies and Practices In Canada |
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Chapter 17 - Treatment practicesEffectiveness of treatment
Once
again we should stress the fact that we are not able to discuss specific
treatments for cannabis dependency. To our knowledge, no study assessing the
effectiveness of these treatments has been completed. Furthermore, of all the
treatment and rehabilitation programs that exist in Canada, approximately 14%
have been the subject of independent assessments.[1][24] Despite
the lack of systematic data, it may be possible to state that approaches to
treatments for drug dependency are primarily cognitivist and behaviourist in
nature. In the cognitivist approaches, an attempt is made primarily to increase
the awareness of the fact that a dependency problem exists: objective
information and mechanisms of introspection are used to facilitate this
awareness. In the behaviourist approaches, the treatments are designed to
facilitate changes in lifestyle. It is known, in fact, that drug taking is part
of a way of life revolving around a group of acquaintances and involving the
frequentation of specific locations. Changing these patterns will help to
create a lifestyle in which these drugs are not used. How
effective is this approach? Most of the authors who have examined dependency
treatment programs agree in saying that, beyond the humanistic dimensions of
the treatment, there is a pool of knowledge indicating that they are relatively
effective. More
specifically, most of the studies including those conducted in Quebec show that
people who seek assistance in rehabilitation centres show improvement. [Translation] … the people who undertake a
rehabilitative approach as part of the services offered in Quebec improve their
situation … this improvement is maintained for a period of six months to one
year following the treatment. That is a positive and reassuring result. These
results are to the same effect as a very large number of other studies
conducted for the most part over the last twenty years. [2][25] In
technical terms, the studies do not permit the conclusion that one approach is
any more effective than another. The report prepared for Canada’s Drug Strategy
describes two mega-summaries of assessments of 24 different methods of
treatment conducted in the United States and shows that, while the two groups
of researchers agree on the effectiveness of a number of forms of treatment,
they do not, on the other hand, agree entirely on the order in which they
should be placed. We reproduce below the part of the table that shows the most
effective approaches.[3][26] Classification of effective
methods of treatment according to two groups of authors
The
studies do not permit us to conclude that the treatment as such makes a
difference and, for some of the authors, the decision to register in a
treatment program, no matter what form of treatment, would be more conclusive.
The studies do not enable us to determine the ideal duration of treatment, but
it would appear that the effects of treatment level off after 9 to 12 months.
In addition, it is difficult to determine the impact of the intensity of the
treatment (how many hours per day, days per week). Finally
and most importantly, the positive impacts relate primarily to consumption
habits and to the person’s general psychological state. However, the treatments
apparently have little effect on the reintegration of the individuals into
society, which is a particularly important factor in the case of offenders. As a final point, treatment is more effective and certainly less expensive than incarceration. In Canada, it is estimated that the cost of applying the drug court process is approximately $4,500 per person whereas imprisonment costs an average of $47,000. Even with a success rate of 15%, there can be no doubt that treatment both benefits society and better reflects the real needs of offenders who have problems of dependency. Speaking
more generally, cost-benefit ratio of the treatment has been recog ized: Evidence for the economic benefits of treatment for problems with drugs
other than alcohol comes from a large study of drug treatment in the United
States (Hubbard et al., 1989). This study involved more than 10,000 drug users
and 37 treatment programs that represented three main treatment modalities:
methadone maintenance treatment, drug-free outpatient counselling and therapeutic
community. … Two summary measures of these costs were developed: costs to
law-abiding citizens, and costs to society. The cost to law-abiding citizens
included those associated with crime-related property loss or damage, reduced
productivity because of injury or inconvenience occasioned by drug-related
crime, and the costs of criminal justice proceedings. Costs to society included
cost to victims of drug-related crime, criminal justice costs and
“crime/career/productivity costs” incurred when drug users are not involved in
earning a legitimate income. The results showed that, in the population
studied, both types of costs were lower after treatment than before and that
pre-post differences in costs exceeded the costs of treatment. [4][27] [1][24] Ibid., page 15. [2][25]
Michel Landry, The impact on
addicts of the treatments offered in Quebec. Brief submitted to the Senate Special Committee on Illegal Drugs,
November 2001. [3][26]
Roberts and Ogborne (1999) op.
cit, page 9. Note that these
treatments apply to all forms of dependency while most assessment studies
relate to alcoholism. [4][27]
Roberts and Ogborne, (1999) op.
cit., page 68. |