Home > Evidence review of the outcomes that can be expected of drug misuse treatment in England.

Burkinshaw, Peter and Knight, Jonathan and Anders, Paul and Eastwood, Brian and Musto, Virginia and White, Martin J and Marsden, John (2017) Evidence review of the outcomes that can be expected of drug misuse treatment in England. London: Public Health England.

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What can be expected of drug treatment?


Drug treatment has been evaluated by researchers on a wide range of measures, including drug use, abstinence from drug use, drug injecting, overdose, health and mortality, crime, social functioning including employment, housing, family relations, and the perceptions of service users about their recovery status. The breadth of these measures reflects the broad range of benefits anticipated from drug treatment.


England has a well-established network of locally commissioned and run public systems and services that provide this treatment. There is extensive international research evidence on the interventions provided by these services and how people can be helped to tackle drug misuse and recover. This evidence forms the basis of guidance for local treatment systems.


There is consistent evidence that community-based needle and syringe programmes are associated with reduced rates of HIV and hepatitis C infection in the target population. Opioid substitution treatment (typically using methadone or buprenorphine) is the most widely studied medical intervention for heroin dependence, with consistent reports of reduced drug use, injecting and mortality.


Several types of psychosocial intervention have also been evaluated, with mixed results. Specialist drug treatment services are associated with reductions in offending. The evidence points to opioid substitution treatment as an important driver of crime reduction, with reduced offending proportionate to the time people spend in treatment.


Taken together, the research literature suggests that investment in drug treatment is likely to substantially reduce social costs associated with drug misuse and dependence. Current estimates suggest that the net benefit-cost ratio is approximately 2.5 to 1.


Social factors are important influences on treatment effectiveness. Drug use and misuse tend to be clustered; for example, areas of relatively high social deprivation have a higher prevalence of illicit opiate and crack cocaine use and larger numbers of people in treatment. Unemployment and housing problems have a marked negative impact on treatment outcomes and exacerbate the risk that someone will relapse after treatment. Alongside other benefits, employment support and achieving good employment may lead to improvements in treatment outcomes and reduced relapse.


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