Why can’t patients last the wait?

One million people in North America are currently waiting for publicly funded substance use treatment. Unfortunately, long waiting times have been listed as the number one reason for not seeking treatment for substance use problems. While it is possible that successful abstinence during the waiting period convinces patients that they do not need treatment at all, more emphasis must be placed on interventions that can bridge the gap between initial contact by patients for substance use treatment and treatment intake. Recommendations in this review include: (1) decreasing the length of time between a patient’s initial contact for treatment and the pre-intake interview, (2) initiating regular phone contact with patients, and (3) decreasing resentful demoralization in patients who are ready for change but who are forced to wait for treatment.

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Integrated Treatment Programmes for Mothers with Substance Use Problems: A Systematic Review and Meta-analysis of Interventions to Prevent Out-of-home Child Placements

Journal of Child and Family Studies ◽

10.1007/s10826-021-02099-8 ◽

2021 ◽

Author(s):

Samantha H. F. Neo ◽

Sam Norton ◽

Despoina Kavallari ◽

Martha Canfield

Keyword(s):

Substance Use ◽

Meta Analysis ◽

Integrated Treatment ◽

Substance Use Treatment ◽

Substance Use Problems ◽

Child Abuse Risk ◽

Randomised Controlled ◽

Home Placement ◽

Abuse Risk ◽

Pooled Sample

AbstractApproximately half of mothers receiving substance use treatment are involved with childcare proceedings. This review aims to determine whether integrated treatment programmes for mothers with substance use problems are effective in preventing out-of-home placement (temporally/permanent) and influencing other maternal factors such as patterns of substance use, treatment completion and parenting behaviours. Six trials were identified—two randomised controlled trials and four non-randomised controlled studies. The pooled sample of participants was 1717. The results showed that mothers who participated in integrated treatment programmes were significantly less likely to have the children removed from their care (Odds Ratio (OR) = 0.40, 95% CI = 0.27, 0.61), more likely to complete substance use treatment (OR = 3.01, 95% CI = 1.79, 5.06), and more likely to reduce their alcohol consumption (Standardised Mean Difference (SMD) = −0.40, 95% Cl = −0.78, −0.01) and drug use (SMD = −0.30, 95% CI = −0.53, −0.07). However, non-significant reductions were observed for parent–child conflict (SMD = −0.35, 95% CI = −0.72, 0.03) and child abuse risk (SMD = −0.03, 95% CI = −0.36, 0.31). While the findings from this review suggest that mothers involved in integrated treatment programmes could potentially be less likely to experience out-of-home child placements and more likely to improve substance use treatment outcomes, little evidence exists for the effectiveness of these interventions. Further research, particularly high-quality RCTs, is required to demonstrate and persuade health and public policy on the far-reaching value of the integrated approaches.

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