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A policy-oriented review of strategies for improving the outcomes of services for substance use disorder patients


  • Authors' note: Earlier versions of this paper were presented at a meeting of the UK Advisory Council on the Misuse of Drugs and at the 2010 Symposium of the Society for the Study of Addiction. This paper is heavily informed by the authors' experience working with/for numerous government agencies in the United Kingdom and United States, but does not necessarily reflect the official views of any of those agencies.

Keith Humphreys, VA Palo Alto HCS (152-MPD), 795 Willow Road, Menlo Park, CA 94025, USA. E-mail:


Aims  To inform policy makers on available options for improving the effectiveness of treatments for substance use disorders and to stimulate debate about treatment improvement strategies among public officials, clinical providers, care managers, service users, families and researchers.

Methods  We draw on the scientific literature and our public policy experiences in two countries (the United Kingdom and the United States) to give an overview of policies which may improve care for individuals with substance use disorders. We divide such policies into ‘process-focused quality improvement strategies’ that attempt to change some aspect of treatment (e.g. increased retention, greater use of evidence-based practices) and ‘patient-focused strategies’ that attempt to reward outcomes directly (e.g. contingency management for patients, payment by results for providers).

Findings  Many policies of both types are poorly developed, have shown poor results, or both. The evidence is clear that process-focused quality improvement strategies can change what providers do and how treatment programs work, but such changes have thus far demonstrated only minimal impact on patient outcomes. Patient-focused strategies face challenges including treatment providers avoiding hard-to-treat patients or spending inordinate time relocating patients after treatment to assess outcome. However, policies that reward in-treatment outcomes and policies that allow the patient to purchase desired recovery support services show more promise. As policy makers go forward in this endeavor, they can do an enormous service to their countries and the field by embedding careful evaluation studies alongside new treatment outcome improvement initiatives.

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