Chapter 17 - Treatment practices

Effectiveness 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]