This Discussion Paper was prepared by UNODC in line with relevant international policy documents, such as resolution 59/4 of the Commission on Narcotic Drugs (CND) on the “Development and dissemination of international standards for the treatment of drug use disorders” and CND resolution 64/3 that calls for “Promoting scientific evidence-based, quality, affordable and comprehensive drug prevention, treatment, sustained recovery and related support services”. This Discussion Paper provides the results of a systematic scoping review that mapped the existing literature on person-centred care for substance use disorders and service outcomes. The review has been undertaken as a follow-up to E/CN.7/2023/CRP.9 “The relationship between quality of specialist treatment for substance use disorders and patient outcomes: a scoping review of the literature ”, which identified patient-centred care as one of the dimensions of quality that is most strongly associated to positive patient outcomes. This Discussion Paper delves deeper in the scientific literature by investigating which of the many components of patient-centred care is associated with positive patient outcomes. The Discussion Paper is made available as a Conference Room Paper to the Commission for its information at its sixty-seventh session.

Purpose: Person-centred care (PCC) within substance use disorder (SUD) treatment has been conceptualized as the provision of (i) holistic, integrated services; (ii) individualised care tailored to patients’ needs, goals, and preferences; (iii) opportunities for involvement in treatment decisions; (iv) a strong therapeutic allia nce; (v) trauma-informed care; and (vi) culturally informed care. This systematic scoping review synthesizes evidence on the relationship between these dimensions of PCC and the outcomes of interventions across the SUD treatment continuum.

Method: This review included 129 articles representing 108 unique studies with an aggregate sample of 658,014 participants. All included studies were conducted in high-income countries.

Key findings:
• This review found largely positive associations between each dimension of PCC and the outcomes of SUD services across a broad range of treatment types, settings and populations.
• Therapeutic alliance: (38.8% of included studies). There was strong evidence that patient ratings of the therapeutic alliance had a small direct effect on initial substance use-related treatment outcomes and a larger indirect effect on more distal (>6 months) outcomes by influencing self -efficacy and motivation for change. These findings were evident for a range of populations, treatment types, and settings.
• Choice and involvement in decision-making (17.8% of articles). There was strong evidence that providing patients with treatment options (including medication dosing options) increased SUD treatment initiation, engagement and treatment satisfaction. There was less evidence that this dimension of PCC directly impacted SUD-related outcomes.
• Culturally informed treatment (7.8% of studies). There was moderate evidence, from both adolescent and adult populations, that culturally accommodated outpatient treatments had superior SUD outcomes compared to standard treatments. Culturally accommodated brief treatments appear to offer little additional benefit. brief interventions. There was evidence that patients with a strong er connection to traditional ethnic identity had better outcomes in culturally informed treatments than those who were more acculturated.
• Trauma-informed SUD services (15.5% of articles). Receipt of trauma-informed services was consistently associated with greater reductions in substance use, mental health and trauma-related problem severity than standard SUD treatment. In addition, there was good evidence of better PTSD outcomes for patients who received integrated treatments for SUD and PTSD compared with SUD-only treatment. There was less evidence that integrated PTSD treatment had benefits for SUD-related outcomes.
• Individualised care (9.3% of articles). Despite the evidence base being limited to personalised supports for linkage to speciality SUD treatment after a hospital or ED admission, there was good evidence that these personalised interventions led to higher rates of post-hospital SUD treatment initiation and greater reductions in the use of acute health care services compared to standard care.
• Integrated treatment for SUD and other co-occurring conditions (14.0% of articles). There was moderate evidence that integrating SUD services into primary health or mental health services, and conversely, integrating primary health and mental health services into SUD treatment led to improvements on outcomes beyond their presenting concern. For example, integration of MH or primary health services into SUD  treatment was consistently associated with better mental health and acute health service utilization outcomes than on-integrated SUD treatment.

Conclusions: Given evidence of the importance of these dimensions of PCC for patient outcomes, implementation of PCC across these six dimensions should be monitored as part of routine quality assurance processes for SUD services. Future research should focus on assessing the relative contribution of each component of PCC to patient outcomes and identify patient subgroups that may benefit most from the implementation of specific dimensions of PCC. This information will support evidence-based prioritization of interventions to enhance the delivery of PCC