Drug misuse in over 16s: psychosocial interventions

Introduction

This guideline makes recommendations for the use of psychosocial interventions in the treatment of people who misuse opioids, stimulants and cannabis in the healthcare and criminal justice systems. The patterns of use vary for these drugs, with cannabis the most likely to be used in the UK. Cocaine is the next most commonly used drug in the UK, followed by other stimulants such as amphetamine. Opioids, although presenting the most significant health problem, are used less commonly. A large proportion of people who misuse drugs are polydrug users and do not limit their use to one particular drug. This guideline will not deal with recreational drug use, although opportunistic brief interventions for people who misuse drugs but who are not in formal drug treatment are included. The guideline also does not specifically address drug misuse in pregnancy.

Opioid misuse is often characterised as a long-term, chronic condition with periods of remission and relapse. Although abstinence may be 1 of the long-term goals of treatment, it is not always achieved. The patterns of cannabis and stimulant misuse vary considerably and are less well understood.

Pharmacological approaches are the primary treatment option for opioid misuse, with psychosocial interventions providing an important element of the overall treatment package. Pharmacological treatments for cannabis and stimulant misuse are not well developed, and therefore psychosocial interventions are the mainstay of effective treatment.

In order to ensure that all people to whom this guidance applies obtain full benefit from the recommendations, it is important that effective keyworking systems are in place. Keyworking is an important element of care and helps to deliver high-quality outcomes for people who misuse drugs. Keyworkers have a central role in coordinating a care plan and building a therapeutic alliance with the service user. The benefits of a number of the recommendations in this guideline will only be fully realised in the context of properly coordinated care.

NICE has also developed a guideline on opioid detoxification for drug misuse, a guideline on drug misuse prevention: targeted interventions, technology appraisal guidance on methadone and buprenorphine for the management of opioid dependence and naltrexone for the management of opioid dependence.

This guideline should be read in conjunction with the Department of Health's Drug misuse and dependence guidelines on clinical management: update 2007, also known as the 'Orange Book', which provides advice to healthcare professionals on the delivery and implementation of a broad range of interventions for drug misuse, including those interventions covered in the present guideline. For more information, see the Office for Health Improvement and Disparities alcohol and drug misuse prevention and treatment guidance.