Do treatments and other interventions work? Some critical issues

A variety of interventions, both therapeutic and preventive, have been used to control, reduce or eliminate substance use and misuse and their attendant problems. Yet, despite years of ever more sophisticated and expensive ways of responding to the use and misuse of a variety of legal and illegal substances, addiction continues to be experienced as a major social problem that plagues users, their families and communities, therapists and clinicians, policymakers, and the public. In view of a recidivist treatment population and finite resources, this paper considers whether and to what extent treatments and other interventions used for planned interventions with alcohol- and drug-use related problems work. It examines both clinical treatment outcomes and broad-based population prevention interventions, and reviews their underlying rationales. Finally, it identifies a number of areas that must be addressed if we are to improve the situation. These areas include a lack of agreement on what is meant by the problem of "addictions," how successful interventions are to be defined and measured so that better interventions can be applied in the future, as well as integrating the processes of quality and appropriateness into the planning, implementation and assessment of effective, needed substance use intervention.