Models of care for treatment of adult drug misusers: Update 2006
developed and delivered through use of protocols to improve consistency and ease of delivery.
Evidence-based psychosocial interventions include:
Cognitive-behaviour therapy (CBT)
Coping skills training
Relapse prevention therapy
Community reinforcement approaches
Some family approaches.
Psychosocial treatment skills (e.g. particular relapse prevention techniques) may be used in face-to face sessions (e.g. by a keyworker), but this would not reach the threshold to be considered a “structured psychosocial intervention”. If such a skill were used as part of a clearly defined, consistent and evidence- based package of psychological treatment, especially when delivered by a demonstrably competent practitioner, it would then be part of a “structured psychosocial intervention”. Examples of structured psychosocial interventions could include four sessions of family therapy, or a manualised relapse prevention package.
In this definition, psychosocial interventions are to be differentiated from a number of other interventions:
While psychosocial interventions may be delivered by a keyworker, this activity is not part of the keyworking process per se. The keyworker may provide a level of ongoing face-to- face therapeutic support involving the use of some psychological techniques. If keyworkers do not deliver complete and consistent psychological treatment packages as part of their work with individual clients, it does not constitute a “structured psychosocial treatment”. For example, a keyworker helping a client draw up a list of pros and cons is not delivering a full motivational interviewing intervention, merely using one technique commonly associated with the approach. Where keyworkers do deliver a planned, structured and coherent evidence-based psychosocial intervention (for which they have received training and supervision) this is likely to comprise a number of sessions and this constitutes a structured psychosocial intervention.
The difference between psychosocial interventions for problem substance misuse and formal psychological therapies targeting a client’s co-morbid mental health problems is that the latter interventions are specialist psychological treatments (such as cognitive-behaviour therapy for depression or anxiety, cognitive-analytic therapy, dialectical behaviour therapy, or schema-focused therapy for personality disorders) aimed primarily at the non-drug psychological problem. Such interventions should only be delivered by specialist practitioners such as clinical and counselling psychologists,
suitably trained psychiatric staff or other specialist therapists with relevant training, qualifications and supervision in the therapy model being offered. This would be delivered as part of the care plan but would not constitute a “structured psychosocial intervention” for problem drug use itself
Psychosocial interventions also differ from advice, information, simple psycho-education or other low-threshold support, which may be provided by a range of practitioners in a range of treatment settings.
Settings: A range of community and residential services. Some structured psychosocial interventions may be delivered as part of the process of engaging and preparing clients for change and during the “delivery” phase of the client’s treatment journey. Therefore, they may be delivered in different settings for individuals at different stages of their treatment journey. In prisons, structured psychosocial interventions would generally be provided through CARATs.
“Other structured treatment”
“Other structured treatment” describes a package of interventions set out in a client’s care plan which includes as a minimum regular planned therapeutic sessions with the keyworker or other drugs worker. The care plan should address drug and alcohol misuse, health needs, offending behaviour and social functioning. “Other structured treatment” describes structured therapeutic activity not covered under the alternative specific intervention categories set out in Models of Care: Update 2006.
The creation of this “other” category of intervention reflects the evidence base that drug treatment consisting of individually tailored packages of care, in the context of a therapeutic relationship, is beneficial. This intervention may be particularly relevant for non-opiate drug misusers and clients who are receiving criminal justice treatment interventions.
Clients in receipt of community prescribing interventions, residential rehabilitation, inpatient treatment, structured day programmes or structured psychosocial interventions should not be additionally recorded as receiving “other structured treatment”. Care-planned support usually provided by the keyworker is integral to all such interventions anyway.
Most clients receiving “other structured treatment” will receive a range of interventions to meet needs identified in their care plan. These will involve a range of interventions to address their drug misuse and support to address needs in other domains. Examples of these may include:
A crack user who is receiving regular sessions with a keyworker and attending “day care” sessions to address a range of social and health-related needs
An opiate user who has been through community detoxification and is receiving ongoing support to maintain