title: Psychosocial interventions in opiate substitution treatment services: does the evidence provide a case for optimism or nihilism?
abstract: OBJECTIVE
  Clinical guidelines from around the world recommend the delivery of psychosocial interventions as part of routine care in opiate substitution treatment (OST) programmes. However, although individual studies demonstrate benefit for structured psychosocial interventions, meta-analytical reviews find no benefit for manual-based treatments beyond 'routine counselling'.
  
  
  METHODS
  We consider the question of whether OST medication alone is sufficient to produce the required outcomes, or whether greater efforts should be made to provide high-quality psychosocial treatment alongside medication. In so doing, we consider the nuances and limitations of the evidence and the organizational barriers to transferring it into routine practice.
  
  
  CONCLUSIONS
  The evidence base for psychosocial interventions in opiate substitution treatment (OST) services can be interpreted both positively and negatively. Steering a path between overly optimistic or nihilistic interpretations of the value of psychosocial treatment in OST programmes is the most pragmatic approach. Greater attention should be paid to elements common to all psychological treatments (such as therapeutic alliance), but also to the sequencing and packaging of psychosocial elements and their linkage to peer-led interventions.
authors.affiliation: Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.|Solihull Integrated Addiction Service, Solihull, UK.
authors.forename: Ed
authors.identifier: http://orcid.org/0000-0002-7106-7013
authors.initials: E
authors.lastname: Day
authors.affiliation: South London and Maudsley NHS Foundation Trust, London, UK.
authors.forename: Luke
authors.initials: L
authors.lastname: Mitcheson
mesh_terms: D006801:Humans; D058850:Opiate Substitution Treatment / Q000379:methods* / Q000523:psychology*; D009293:Opioid-Related Disorders / Q000523:psychology* / Q000628:therapy*; D000072858:Psychosocial Support Systems
keywords: Evidence-based practice; opiate; opiate substitution treatment; psychosocial intervention; training; treatment