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Hi everyone, this is a subject which concerns us all and one which we have also taken up in Australia and New Zealand. I have a systematic review under consideration at the moment with a journal, and thankfully we are beginning to see more studies emerging, as well as a recognition that RCTs are not only not suited to the TC environment but to most health-related interventions that do not rely on medications or other medical interventions. In Australia we have recently held a Research Roundtable and had interest from researchers from 10 universities keen to provide some input into research with TCs. I will be at EFTC and Rowdy will then be with us in Australia for the ATCA conference in October. I would also be very keen to take part in any discussion and to let you know what we are doing 'downunder' in TC work and research. Kind Regards Lynne Assoc Prof Lynne Magor-Blatch MAPS, MCFP Executive Officer Australasian Therapeutic Communities Association (ATCA) Ph: 0422 904 040 PO Box 464 Yass NSW 2582 [log in to unmask] www.atca.com.au The ATCA acknowledges Aboriginal and Torres Strait Islander people as the Traditional Custodians of this country and its waters. We wish to pay our respect to Elders past and present and extend this to all Aboriginal people seeing this message. From: Therapeutic Communities [mailto:[log in to unmask]] On Behalf Of geodeleon Sent: Monday, 10 June 2013 2:41 AM To: [log in to unmask] Subject: Re: [EFTC] EMCDDA: no evidence on effectiveness of drug-free TC? On Jun 9, 2013, at 9:33:35 AM, "Rowdy Yates" <[log in to unmask]> wrote: From: "Rowdy Yates" <[log in to unmask]> Subject: Re: [EFTC] EMCDDA: no evidence on effectiveness of drug-free TC? Date: June 9, 2013 9:33:35 AM EDT To: [log in to unmask] Kenneth The article Rod refers to is a summary of the evidence base for American drug-free TCs in the International Journal of Therapeutic Communities by George De Leon.. Although it only covers US research it can nevertheless be regarded as a seminal 'state-of-the-art' piece. You can find it in the Scottish Addiction Studies online library at: <http://www.dldocs.stir.ac.uk/documents/ijtc281..pdf> MailScanner has detected a possible fraud attempt from "www.dldocs.stir.ac.uk" claiming to be http://www.drugslibrary.stir.ac.uk or you can go straight to the article at: <http://www.dldocs.stir.ac.uk/documents/ijtc281.pdf> http://www.dldocs.stir.ac.uk/documents/31(2).pdf I haven't read the EMCDDA report yet - I'll do that in the next few days. But my assumption would be that it is yet another report which examines the relative paucity of randomised control trials (RCTs) and effectively dismisses a huge number of other sorts of studies. It wouldn't be the first. There's a Cochrane review and a Dutch meta-analysis from about 5 years ago: both of which say something similar. My problem with this is that in general terms the RCT is probably unsuitable for an extremely complex intervention like a TC. And as a researcher I really object to this cavalier dismissal of a huge number of perfectly good outcome studies - which in almost every case suggest significant behavioural and health-related improvements post TC intervention. It's worth noting that Eric Broekaert and Wouter Vanderplasschen are currently working on a new EMCDDA publication on European TCs which is likely to offer a more tempered view of the current evidence base. Overall, I do feel that there is a great deal of cynicism about the whole business of abstinence-based recovery (and not just TCs). I'm not sure why this should be but it's probably significant that it stems mainly from medical researchers. For a more balanced view of the evidence you could check out Best et al's Research for Recovery which was commissioned a couple of years ago. As with the De Leon article you can download it from the SAS online library. Or check out the many reports on recovery in the William White Archive (again you can find a link in the SAS online library). The truth is that despite the strident cynicism, the evidence for long-term methadone maintenance is not at all as robust as many would have us believe. Drop-out rates are not that much better than residential rehabilitation and although results are good in terms of reductions in illicit drug use and offending, unlike abstinent recovery, these behaviours are very rarely eliminated and re-employment rates are very poor in comparison to recovery-oriented treatments. Rowdy Yates Senior Research Fellow Scottish Addiction Studies University of Stirling http://www.dass.stir.ac.uk/sections/showsection.php?id=4 http://www.drugslibrary.stir.ac.uk <http://www.drugslibrary.stir.ac.uk/> http://roryyates.bandcamp.com <http://roryyates.bandcamp.com/> - Wrestling With Demons: Four Songs of Addiction & Recovery On 8 Jun 2013, at 10:52 PM, "Rod Mullen" <[log in to unmask]> wrote: You need to look at the "evidence based" issue of the TC Journal published a couple of years ago-- particularly the first article, which addresses this ________________ Rod Mullen, President & CEO 520.749.7178 . phone 520.844.6718 . fax 520.260.1075 . mobile www.amityfdn.org www.dragonflyvillage.org The information contained in this e-mail message is intended only for the personal and confidential use of the recipient(s) named above. If the reader of this message is not the intended recipient or an agent responsible for delivering it to the intended recipient, you are hereby notified that you have received this document in error and that any review, dissemination, distribution, or copying of this message is strictly prohibited. If you have received this communication in error, please notify us immediately by e-mail, and delete the original message. On Jun 8, 2013, at 2:23 PM, Kenneth Arctander <[log in to unmask]> wrote: Hello everyone! I've been reading the EMCDDAs European Drug Report: http://www.emcdda.europa.eu/publications/edr/trends-developments/2013 The report clearly states that there aren't any conclusive evidence with regards to drug free TC treatment of opiate addicts: "Cognitive behavioural interventions have shown some effectiveness with opioid users, but evidence is not sufficiently robust to allow the identification of which intervention is the most effective. There is no conclusive evidence on the effectiveness of drug-free therapeutic communities." I would very much appreciate some comments on this particular statement in the EMCDDA report. -- Sincerely, Kenneth Arctander Johansen _____ The University of Stirling is ranked in the top 50 in the world in The Times Higher Education 100 Under 50 table, which ranks the world's best 100 universities under 50 years old. The University of Stirling is a charity registered in Scotland, number SC 011159. ROWDY; JUST WANTED TO EXTEND MY GRATITUDE FOR YOUR SENSIBLE RESPONSE AND SUGGESTIONS TO KA JOHANSEN WITH RESPECT TO THE EMCDDA CLAIMS. I HAVE BEEN DEEPLY FRUSTRATED , AS YOU KNOW, AS TO HOW TO COPE WITH THE CHALLENGE TO TC EFFECTIVENESS, BUT THE CURRENT EXCHANGE OF EMAILS INCLUDING ROD'S COMMENTS HAS INSPIRED A PROPOSAL FOR EFTC IN PRAGUE. THE ENTIRE MEMBERSHIP SHOULD BE EDUCATED AS TO THE KNOWLEDGE BASE ON THE EFFECTIVENESS ISSUE. EFTC SHOULD PRODUCE, PACKAGE AND DISTRIBUTE VIDEO AND/OR YOU- TUBE PRODUCTS THAT TELL THE TC EFFECTIVENESS STORY. SUGGESTED EXAMPLE: A SPECIAL PANEL TO REVIEW AND DEBATE THE KEY REPORTS AND CLAIMS; STRENGTHS, WEAKNESSES, AND NEXT STEPS. THIS COULD BE A TWO HOUR + QUESTIONS PLENARY, THAT IS VIDEO TAPED TO INCLUDE 15 MINUTE DIDACTIC PRESENTATIONS ALONG WITH FOCUSED DISCUSSION THAT STRESSES CORRECT CONCLUSIONS ETC. BUT WE COULD EXPLORE OTHER FORMATS. I WILL HELP IN ANY WAY I COULD. GEORGE