There are a wide range of interventions used to tackle substance misuse, often provided in combination. These include various therapy-based approaches, case management, drug treatment and supported housing.
The primary goal of these programmes is to ensure either adherence to abstinence programmes or reduce substance misuse. Depending on the programme, goals may also include housing stability, improved employment, income and wellbeing, better health and reduced incarceration.
Substance misuse reduces a person’s likelihood of retaining stable accommodation and employment, can have adverse health effects and induce criminal behaviour. Reducing substance misuse may improve outcomes across all these domains.
Substance abuse programmes are generally successful in improving adherence to abstinence programmes and reducing substance abuse. Where it has been measured, these effects are often sustained.
Most studies find that substance abuse programmes also improve housing stability, employment and health.
Fewer studies have measured the effects on incarceration and wellbeing, but those which have generally find positive effects.
Most studies are from North America, mainly the United States.
The studies reviewed all treat those with substance use issues, sometimes exclusively and sometimes as a sub-population.
Nearly all studies consider substance misues as an outcome with nearly all finding a positive impact. The notable exception is the use of extended-release naltrexone which has proven efficacy in reducing heavy drinking but had very low acceptability amongst the target population. Fewer studies assessed health (other than substance abuse), economic outcomes, incarceration and wellbeing. In general positive effects are also reported on these outcomes.
Many studies also assessed housing stability, with nearly all finding positive effects.
If you are implementing a substance misuse support service, consider how best to link the service with other support services. Secure housing and mental health support are particularly beneficial. Establish personalised support programmes to provide help with transportation, health appointment, and advocacy to claim welfare benefits. This support will help service users find stability, engage more effectively and value substance misuse treatment.
Ensure that your team has the technical and interpersonal skills to work effectively with service users. All staff should have at least a basic understanding of the key principles of counselling and psychotherapy. Strong communication skills and a non-judgemental culture help build trust with service users. Low caseloads lead to better outcomes, given the high support needs of service users.
Partnerships are vital. Ensure participating agencies share clear statements of aims, leadership, and values. Facilitate collaboration by establishing formalised roles in contracting arrangements. Inter-agency meetings can be helpful in organising service users’ care and ensuring good relations between partners.
Service users’ care needs will vary depending on their age, gender and cultural background, e.g. young people may need a more intensive support package and certain ethnicities may value more spiritual and holistic approaches. Ensure the service and staff are able to plan and respond accordingly.
Ensure referral routes and criteria are clear to all parties and appropriate to the resources available.