Treating patients with multiple substance use in accordance with their personal treatment goals: a new paradigm for addiction treatment

Abstract

Purpose This paper aims to present the theoretical foundation and practical approach of “open-target addiction treatment” (OTAT). Traditional treatment programmes are usually-oriented towards fixed predefined goals (abstinence, reduced consumption and harm reduction) and often focus on one substance only (e.g. alcohol). However, as a rule, people who use drugs consume several substances and sometimes additionally exhibit behavioural addictions. For many of these addictions, there is more or less motivation for change, but commonly it is not abstinence as a consistent goal. The paradigm of OTAT systematically considers multi-substance use, expects high readiness to change and is aware that commonly clients lack the willingness to abstain permanently. Design/methodology/approach The theory and practice of OTAT involve three components, namely, first, to create a systematic inventory of all psychoactive substances consumed and addictive behaviours performed, second, to clarify, which substance-related change goals clients pursue and third, to choose adequate treatment options matching the substance-specific goals of the clients. Furthermore, OTAT includes didactic tools to support working along with these three steps (e.g. a set of cards to gain an overview over the psychoactive substances used and addictive behaviours performed). Findings The systematic implementation of OTAT requires fundamentally different concepts about addiction and its treatment, specific competencies of the staff and a corresponding portfolio of interventions within the treatment facilities. Research limitations/implications Future research should focus more on patients’ goal preferences and their impact on their willingness to take up treatment and its outcomes. Practical implications To implement OTAT treatment, institutions have to undergo a systematic process of team and organizational development. Social implications OTAT has the potential to reduce the treatment gap and to serve severely addicted individuals in a more comprehensive way. Originality/value The OTAT approach has not been described in the addiction treatment literature so far.

Monitoring of phosphatidylethanol in dried blood spots and of ethyl glucuronide in hair over 6 months of alcohol consumption

“…CD currently appears to be a viable option where an abstinence‐oriented approach is not mandatory. In Germany, it is based on an approach by Körkel or Körkel and Wagner including three phases 43–45 . The first phase comprises at least 3 months of an analytically verified alcohol abstinence, followed by an implementation period of 3 to 4 months, where a moderate alcohol consumption is accepted.…”

“…In Germany, it is based on an approach by Körkel or Körkel and Wagner including three phases. [43][44][45] The first phase comprises at least 3 months of an analytically verified alcohol abstinence, followed by an implementation period of 3 to 4 months, where a moderate alcohol consumption is accepted. Afterwards, PEth 16:0/18:1 is determined at the end of this second phase and should lie below 100 ng/mL for PEth 16:0/18:1, which includes a safety margin of 20 ng/mL.…”