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Heroin Addiction and Related Clinical Problems: 2019, 21, N1 (pages: 47 - 56)

How to Improve a Poorly Running Agonist Opioid Treatment (Aot). Part 6: psychosocial Care

Ulmer A., and Meinhold C.

Summary: Introduction: Psychosocial approaches are important, besides what can be achieved by medical treatment alone, in the attempt to optimize a poorly running Agonist Opioid Treatment (AOT). The German system puts pressure on physicians and patients: no payment of AOT expenses is permitted without professional psychosocial care. It's surprising to discover how many patients miss their appointments for such care. Methods: Not much published evidence has been made available on this topic, but we have asked our patients how important psychosocial care is to them. Results: We were impressed by how high a grade of appreciation was displayed by their answers; 65% said that this kind of care was essential to them. We also discussed the view that all forms of care would become much more effective if the treatment were organized in a decentralized manner, so aiming more directly at the integration of patients into normal settings. The number of patients with a job or training post under the widely unregulated, decentralized type of treatment being offered 27 years ago was 85.7%. Currently, in the opposite situation of an organized offer of treatment, that figure has fallen to 31% (including those with a regular job, who account for 29%). Conclusion: The optimum is, therefore, the best possible organization of AOT treatment, which gives normality the top priority, as well as a comprehensive psychosocial offer, with special emphasis dedicated to its psychotherapeutic components.