Peaks in substance use prior to treatment presentation – a re-evaluation

Abstract

Background: Presentation to substance misuse treatment is believed to coincide with extremes of behaviour or function, leading some to suggest that such extreme behaviours can improve over time, in the absence of appropriate, evidence-based treatment. In challenging times for services, it is essential that available evidence on this potential explanation of the treatment effect is summarised and disseminated to policy makers. We combined an analysis of existing data with a rapid literature review.

Methods: We used the UK Drug Treatment Outcomes Research Study (DTORS) baseline cohort (N = 1,794) to examine levels of substance use and offending at treatment presentation, in relation to self-defined norms. A rapid review identified 7 studies (US, 5; UK, 2) examining change in substance use, and 6 studies (Australia, 1; Norway, 3; US, 2) examining change in function, ahead of treatment.

Results: In our sample, users were unlikely (9%) to be using more drugs than self-defined norms at treatment entry, and more likely (39%) to be using less than self-defined norms. A minority (24%) offended at higher levels than self-defined norms; 43% at lower levels. Among studies in the review, none identified increased substance use; 3 identified reduced function (employment, court appearances, and mental health admissions).

Conclusion: Available evidence fails to support the belief that presentation to treatment commonly occurs at extreme points of behaviour. An increase in substance use ahead of treatment was not evident; data on reduced function was ambiguous.

Keywords:

• Treatment
• substance misuse
• function
• behaviour
• review
• data analysis

Disclosure statement

AJ has received grant research funding from the UK Home Office, Public Health England, the UK Department of Health and Change, Grow, Live (CGL), a 3^rd-sector provider of UK substance misuse services. KPH has received grant research funding from CGL. RE has no conflicts of interest to report.

Additional information

Funding

The Drug Treatment Outcomes Research Study (DTORS) was funded by the UK Home Office. Work completed to prepare this paper did not receive any specific grant funding.