HOT TOPICS November/December 2013

The more important an issue, the more likely it is to be contested. These are the hot topics, some new, some perennial, plus some which ought to be hot but have been neglected. For each we give a context-setting introduction plus one-click access to all relevant Effectiveness Bank analyses.

The recovery era has seen a resurgence of interest in 12-step mutual aid groups and a new focus on employment, both perhaps owing as much to austerity as recovery. Treatment itself is also being challenged by programmes which show that sometimes all it takes is to credibly threaten immediate sanctions. After these first three entries, an important trend in prevention – generic initiatives which tackle the developmental precursors of problem behaviours rather than substance use itself.

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See hot topics archive for all 30+ past hot topics
12-step mutual aid promises to plug the recovery resources deficit
Paralleling the rise in abstinence-based recovery in UK national strategies has been a rise in the profile of the best-known programme for achieving this goal – the 12 steps of various mutual aid fellowships and allied treatments. For the UK, these offer a way to reconcile diminished resources with the desire to get more patients safely out of treatment, but is the resurgence of interest matched by evidence of effectiveness?

Promoting recovery through employment
Just about wherever you look among British national drug policies, employment is seen as both a bulwark against relapse and an obligation on drug users who can work and contribute to society rather than living on benefits. But how realistic is competitive paid employment for addicts who have often spent a decade or more not honing their CVs, but chasing drugs and gaining a criminal record?

Will intensive testing and sanctions displace treatment?
Influentially promoted in the USA, programmes which directly mandate abstinence for offenders rather than mandating treatment have in some studies an enviable record. Frequent testing and swift sanctions are the keys. Leverage over the offenders, enforcement resources, and an appropriate legal framework, are needed to turn this in to an approach which would reserve treatment only for the otherwise intractable.

It's magic: prevent drug problems without mentioning drugs
The future for prevention seems more likely to lie with child development and parenting programmes which do not mention substances at all than with drug programmes. These generic approaches have recorded some of the most substantial preventive impacts ever seen – for example, the primary school classroom management technique which it was estimated would later halve drug use disorders among the boys.
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