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Polydrug using persons pose particular challenges in mental health practice that result from the complexity of cumulative intertwined effects of the addictive course on their cognitive, affective and neurobiological functioning.
At a diagnostic level, practice systematization using a thorough, multidimensional, evidence-based anamnestic protocol appears mandatory to provide the internationally recommended assessment data relevant to designing informed care pathways (cf. World Health Organization, France's ‘Haute Autorité de Santé’, Belgium's ‘Conseil Supérieur de la Santé’). At a treatment level, this protocol reveals beneficial to the practitioner–client relationship, facilitating initiation of a therapeutic contract. Further “assessment to treatment” tools, including monitoring of polydrug use through structured observational agendas and time-line analyses, respond to multiple care challenges by providing both diagnostic and follow-up data. Early treatment course application of psycho-education sessions into self-observational “homework” strategies further benefits comprehension and control of the addiction course by clients.
Evidence-based, structured “assessment to treatment” tools appear to provide valuable insights regarding polydrug use severity, dynamics and contingencies, relevant to initial multidisciplinary assessment and treatment course evaluation. Significantly, these are also found to ameliorate addiction insight along with facilitating cognitive-emotional regulation by the client. Further research and practice implications are advocated.
Recent developments in the field of polydrug use along with alcoholism provide growing insights into how cognitive, affective, motivational and neurobiological pathways are altered in addictive persons. Few of these insights have as yet been implemented in everyday care.
In as few as seven weeks, dramatic therapeutic improvements come forward. All polydrug patients referred due to long-term treatment refusal, are found to comply with the structured scientist-practitioner model approach. Multidisciplinary practitioner-observed benefits include increased or first-time therapy adherence and drug treatment compliance. Patient self-reported benefits moreover include increased addiction insight and mastery, along with enhanced cognitive-emotional regulation to gain control over addictive craving versus pleasure-seeking behaviours.
Applying an integrative model that focuses on the cognitive–emotional dynamics at hand in the addictive course with the polydrug using patient, and rigorously implementing related assessment and therapeutic methods manifestly bears immediate and middle-term benefits. Evaluation of longer term benefits is recommended, along with larger scale quantitative outcome analyses. Further research and practice implications are discussed to this respect.
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