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

Abstract

PurposeThis 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/approachThe 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).FindingsThe 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/implicationsFuture research should focus more on patients’ goal preferences and their impact on their willingness to take up treatment and its outcomes.Practical implicationsTo implement OTAT treatment, institutions have to undergo a systematic process of team and organizational development.Social implicationsOTAT has the potential to reduce the treatment gap and to serve severely addicted individuals in a more comprehensive way.Originality/valueThe OTAT approach has not been described in the addiction treatment literature so far.