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Background: In the last decade, the clinician-patient relationship has become more of a partnership. There is growing interest in shared decision-making (SDM) in which the clinician and patient go through all phases of the decision-making process together, share treatment preferences, and reach an agreement on treatment choice. The purpose of this review is to determine the extent, quality, and consistency of the evidence about the effectiveness of SDM. Method: This is a systematic review of randomised controlled trials (RCTs) comparing SDM interventions with non-SDM interventions. Eleven RCTs met the required criteria, and were included in this review. Results: The methodological quality of the studies included in this review was high overall. Five RCTs showed no difference between SDM and control, one RCT showed no short-term effects but showed positive longer-term effects, and five RCTs reported a positive effect of SDM on outcome measures. The two studies included of people with mental healthcare problems reported a positive effect of SDM. Conclusions: Despite the considerable interest in applying SDM clinically, little research regarding its effectiveness has been done to date. It has been argued that SDM is particularly suitable for long-term decisions, especially in the context of a chronic illness, and when the intervention contains more than one session. Our results show that under such circumstances, SDM can be an effective method of reaching a treatment agreement. Evidence for the effectiveness of SDM in the context of other types of decisions, or in general, is still inconclusive. Future studies of SDM should probably focus on long-term decisions.

Background: In the last decades, shared decision-making (SDM) models have been developed to increase patient involvement in treatment decisions. The purpose of this study was to evaluate a SDM intervention (SDMI) for patients dependent on psychoactive substances in addiction health care programs. The intervention consisted of a structured procedure to reach a treatment agreement and comprised 5 sessions. Methods: Clinicians in 3 treatment centres in the Netherlands were randomly assigned to the SDMI or a standard procedure to reach a treatment agreement. Results: A total of 220 substance-dependent patients receiving inpatient treatment were randomised either to the intervention (n = 111) or control (n = 109) conditions. Reductions in primary substance use (F (1, 124) = 248.38, p < 0.01) and addiction severity (F (8) = 27.76, p < 0.01) were found in the total population. Significant change was found in the total population regarding patients’ quality of life measured at baseline, exit and follow-up (F (2, 146) = 5.66, p < 0.01). On the European Addiction Severity Index, SDMI showed significantly better improvements than standard decision-making regarding drug use (F (1, 164) = 7.40, p < 0.01) and psychiatric problems (F (1, 164) = 5.91, p = 0.02) at 3-month follow-up. Conclusion: SDMI showed a significant add-on effect on top of a well-established 3-month inpatient intervention. SDMI offers an effective, structured, frequent and well-balanced intervention to carry out and evaluate a treatment agreement.

Background: Persistent attention deficit hyperactivity disorder (ADHD) and a history of conduct disorder (CD) are highly prevalent among patients with substance use disorders (SUD). We examined the influence of both diagnoses on problem severity, psychiatric comorbidity, and quality of life in methadone-maintained patients. Methods: 193 patients in long-term methadone maintenance treatment (MMT) were assessed for ADHD through a semi-structured interview. Psychiatric disorders and SUD were assessed with the MINI, the CIDI-SAM, and the SIDP-IV. Results: Childhood ADHD was diagnosed in 68 (35.2%) patients; 48 (24.9%) had persisting ADHD; a CD history was present in 116 (60.1%). Patients with adult ADHD had significantly higher problem severity scores, lower quality of life scores, more comorbid SUD and more psychiatric comorbidity. Although both ADHD and CD contributed to problem severity, addictive pathology and psychopathology, ADHD was found to substantially increase the risk of psychiatric comorbidity, independent of CD. Conclusion: ADHD in MMT patients is characterised by greater addiction severity and more comorbid psychopathology, only partly explained by the influence of a coexisting CD. The presence of ADHD in a substantial minority of patients accentuates the need for early detection and treatment of this complicating disorder.

The 14-item Obsessive Compulsive Drinking Scale (OCDS) is a quick and reliable self-rating instrument developed to measure cognitive aspects of craving for alcohol. The aim of this study was to translate the OCDS into Dutch (OCDS-Dutch). In addition, as a secondary exploratory exercise eight questions were added: three items referring to drinking intention, as potential substitutes for the OCDS items referring to drinking behavior, and five affective items. Three visual analogue scales were also added for comparison. The translated scale and the additional items were administered to 39 Dutch and Belgian alcohol-dependent patients. Translated and substituted scale scores were highly comparable with the OCDS. The internal consistency was good (alpha OCDS: 0.86, OCDS-Dutch: 0.85, and substituted scale: 0.89). The intercorrelations between scale and subscale scores ranged from 0.62 to 0.93 in all three versions of the scale. The relation with analogue craving measures of the OCDS-Dutch (r = 0.71) and substituted scale (r = 0.70) was higher than that of the OCDS (r = 0.40). The affective items did not improve reliability or validity of the scale in any way. The translated scale seems to be psychometrically as valid as the original scale. Substitution of the drinking behavior items by drinking intention items to predict alcohol use seems useful and further research with the proposed questions is suggested.

No abstract available Copyright © 2010 S. Karger AG, Basel [PUBLICATION ABSTRACT]

This paper focuses on exploring the association between the patient’s perception of his own interpersonal behaviour on the one hand, and that of the therapist’s behaviour and of helping alliance on the other hand. A cross-sectional study was conducted, including 83 patients from substance dependence programs in The Netherlands. They completed the Helping Alliance Questionnaire (HAQ) and the Interpersonal Check List (ICL). Results indicate that the patient’s perception of the therapeutic alliance, and his perception of his own and of the therapist’s interpersonal behaviour are three separate domains, each playing their role in the context of the therapeutic relationship. Helping Alliance scores are predicted by both the patient’s (complaisance) and the therapist’s interpersonal behaviour (dominance). We conclude that patient’s cognitions about himself and about his therapist do contribute significantly to the perception of the therapeutic relationship. Limitations to the study are discussed, as well as some clinical implications.