Evidence based medicine is familiar to all physicians and is seen as the appropriate process for rational decision making. NIABY is a strong believer in the principles of evidence based medicine.
The current proposed supportive drug addict housing model for Vancouver neighbourhoods is based on the Fraser St. drug addict housing project:
- Admission upon completion of a 60 day detoxification program.
- Out patient Treatment.
- Transitional Housing in Vancouver neighbourhoods. From 6 up to 18 months, perhaps more.1
True and meaningful goals of drug rehabilitation programs including housing are:
- Sustained long term abstinence.
- Gaining and retaining competitive employment.
- No increased risks to host community's safety and security.2
Unfortunately, there are few studies which demonstrate that current drug rehabilitation housing programs are effective in terms of the above outcomes.
Results from clinical trials, (long term abstinence, getting and retaining competitive employment and no impact on the security and safety of host community) are disappointing for the patient population proposed for these large drug rehabilitation housing projects.
Based on the medical evidence, the vast majority of the proposed population (62 to 92%) will experience relapses, lapses and "slips" into recurrent drug useage and possibly crime.3
Currently researchers have difficulty completing most clinical trials because of high drop out rates.
City Hall is proposing to manage large groups of very complex patients in many of Vancouver's neighbourhoods. Based on the current medical evidence, we believe that City Hall's proposed abstinent based housing for drug addicts will not work and therefore these large drug addict apartments spread throughout Vancouver's neighbourhoods will be become "wet" housing, tolerant of drug use.
We require convincing evidence with meaningful outcomes and proven with peer reviewed clinical trials. A proven workable plan not only ensures a positive outcome for the inhabitants of such housing projects but also guarantees to the residents of the host communities that their safety and security will not be negatively impacted.
Brunette MF, Meuser KT, A review of research on residential programs for people with severe mental illness and co-occurring substance use disorders. Drug and Alcohol Review 2004;23:471-481.
"... and an increasing number of such programs are becoming available their effectiveness remains uncertain." P 472.
"Despite clinical enthusiasm and the promise of initial studies, this field is only beginning to develop clinical guidelines and data on outcomes. A number of issues need to be clarified by further research. First and foremost is the question of effectiveness" P 477.
"Even one small, tightly controlled study under effectiveness conditions (routine clients, clinicians and programs) would be a tremendous step forward." P 478.
"What little research that has been conducted to establish client factors predicting treatment retention has not been able to establish predictors…" P 478.
Drake RE, Mueser KT, A Review of Treatments for People With Severe Mental Illnesses and Co-Occurring Substance Use Disorders. Psychiatric Rehabilitation Journal 2004; 27:360-374
"Although several interventions are under study, only residential treatments have thus far been examined by controlled trials." P 362.
"The net result is that there are as yet few replications of effective integrated programs." P 362.
Brunette MF, Drake RE, A Comparison of Long-Term and Short Term Residential Treatment Programs For Dual Diagnosis Patients Psychiatric Services 2001;52,4:526-528.
Table 1. P 527 Short term residential treatment (3 to 6 months) at 6 month follow up 8% were abstinent from substance abuse.
Bellack AS, Bennett ME, A Randomized Clinical Trial of a New Behavioral Treatment For Drug Abuse in People With Severe and Persistent Mental Illness, Arch Gen Psychiatry 2006;63:426-432.
"... there is a dearth of empirical data on effective techniques for producing change." P 427.
"... overall the data do not identify predictors of treatment participation or retention." P 429.
"However these self-report data must be viewed cautiously because there were often in conflict with other sources of data on drug use." P 430.
Published October 10, 2006. Revised March 5, 2008.