Drug treatment services

A decision to temporarily or permanently exclude a patient from a drug treatment service or provide coerced detoxification should not be taken lightly. Such a course of action can put the patient at an increased risk of overdose death, contracting a blood-borne virus or offending. It may also increase the level of risk to children and vulnerable adults in the home. If at all possible, patients excluded from a service should be offered treatment at another local service or setting in a way that minimizes risks and maximizes opportunities for patients to be retained in treatment. 

Farrell M, Battersby M Strang J (1990). Screening for hepatitis B and vaccination of injecting drug users in NHS drug treatment services. British Journal of Addiction, 85, 1657-9... 

Further detailed analyses of the ECA data have been extrapolated to USA national costs (Rice and Miller, 1998). It was calculated that the economic costs of mental disorders in 1990 in the USA totalled US 147.8 billion. Anxiety disorders were the most cosdy, amounting to 46.6 billion, just under a third of the total. Direct costs spent on mental health care totalled 67 billion, of which anxiety disorders accounted for only 11 billion (16.5%). Drug costs were 2191 million, of which anxiety disorders accounted for 1167 million—over half Morbidity costs—the value of goods and services not produced because of mental disorders — amounted to 63.1 billion, with anxiety disorders accounting for 34.2 billion, 54.2% of the total. This reflects the high prevalence of anxiety disorders in the community and the high associated rate of lost productivity. In contrast, patients with affective disorders appeared better able to function (Rice and Miller, 1995). In summary, anxiety disorders are common, disruptive and costly to society drug treatment is a substantial element of treatment costs (11%) compared with, say, schizophrenia (2.2%). 

The greatest hope for intervening upon a drug problem is treating the factors we know how to change at the present, which are mainly psychological and environmental. Because drug problems may look different from one person to the next, therapists and counselors must individualize treatment services to serve... 

As previously mentioned, the actual acquisition cost of a drug or service should not be used in isolation to determine the value of a drug. Value should be assessed in an analysis that takes into account all consequences (both positive and negative) that result from use of the therapy. For example, if a therapy eliminates the need for surgery, the cost of the surgery would be eliminated from the overall treatment pathway. However, if the same therapy results in an adverse event that requires specific laboratory monitoring, the cost of the laboratory tests would be added into the treatment pathway. The accurate identification and valuation of resource items that result from the use of that therapy are extremely important components of economic analysis. 

Once the validity of an analysis has been determined, it is up to the reader to decide whether or not the drug or service is a cost-effective treatment option in their setting. The fact that the majority of economic analyses (especially those found in the published literature) are performed in a setting that is different from that of the reader emphasises the need for transparency in reporting. Readers need to be able to assess whether the treatment patterns, the... 

Muller and Schoneich (1992) also reported on favorable experience with intensive outpatient psychotherapy combined with antipsychotic drug treatment. On the basis of a before-and-after comparison over 2x5 years in a university outpatient clinic, they were able to show that the duration of rehospitalizations required by 89 patients could be reduced from a mean of 10 weeks to 2 weeks per year when a special schizophrenia outpatient service offering individualized psychotherapy and psychosocial treatment was available to the patients instead of the routine psychiatric outpatient service. A beneficial effect of psychotherapy was demonstrated both in those patients taking antipsvchotics continuously for long-term prophylaxis and in those taking the drugs intermittently when prodromal symptoms appeared in order to prevent relapse. 

Reviewing her history, it appeared that she had used heroin by injection for five years before being first prescribed methadone. She was from a relatively isolated small town where the limited network of users had few links with treatment services. She used heroin with her then husband, and both were eventually referred to the clinic after he had been charged with supplying the drug. They separated soon afterwards, and while he remained in treatment for only a short period before leaving the area, Amanda has been receiving prescribed medication since that time. 

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