Nav: Home

Seven core principles can help substance use treatment systems focus on high-level goals

January 28, 2019

PISCATAWAY, NJ - Building on reviews of existing studies, researchers in Canada have identified the principles that may help improve substance use treatment systems. They have published these seven core principles in an article in the current supplemental of the Journal of Studies on Alcohol and Drugs.

Lead study author Brian Rush, Ph.D., Scientist Emeritus at the Centre for Addiction and Mental Health in Toronto, says that, over the last 10 to 15 years, he has often been invited to do a system-wide review and to let those responsible for the overall network of services know how it is performing with respect to substance abuse: Is the system meeting the needs of the population? Are there gaps in the programs being offered? Are they evidence based?

"It's obviously different from a program review, which is for one particular organization," says Rush. "We're looking at the whole community network of services."

The seven principles are meant to serve as a template for system analysis, and they provide such recommendations as "a range of systems supports are needed to support and facilitate the effective delivery of services" and "attention to diversity and social-structural disadvantages is crucial to ensuring effective and equitable system design and service delivery."

Rush highlights two principles that stand out to him as most crucial. The first is the need for collaboration between the different sectors that are stakeholders in the process, including mental health services, addiction medicine doctors, primary care physicians, corrections, education -- all under the umbrella term of "a whole government response" or "whole of society."

"The biggest takeaway here is that the need in the population for alcohol and drug services is so high that the specialized alcohol and drug services alone cannot meet that need," says Rush. "They need a strong collaborative partnership with the other sectors."

He also points to the principle of the population-level approach.

"Many people with alcohol and drug problems have very serious problems, such as opioid or substance abuse combined with schizophrenia or depression, and this is a segment of the population that experiences quite serious challenges," says Rush. "But there's a larger percentage of the population who are just beginning to experience these challenges. If we don't also provide some services to these people, then they may be on a trajectory that's a far more serious and more expensive problem to help resolve. Policymakers funding programs are often responding to a crisis: Who's in the emergency room? Who's taking up hospital beds? But the fewest people at the top of the population health pyramid are the ones who cost the most. They came from somewhere, and they didn't wake up overnight as an addict in the hospital."

Rush says that although treatment system planners and funders are often looking to improve, sometimes it's hard for them to make the big decisions.

"The addiction field, more so than many other areas of health, is dominated by very strong opinions," says Rush. "It's also a marketplace for private enterprise versus public services, as well as a place where people have very strong personal experience with addiction. Depending on who that person is, they can have a very strong influence on policymakers. A principles-based methodology levels the playing field for people advocating for resources and asks them to take a very evidence-based approach in reviewing systems and making recommendations."

Rush says that although the researchers and some of the reviews are based in Canada, the findings are universal.

"We have a lot of experience with the World Health Organization and other important organizations involved in setting substance abuse treatment standards and guidelines, and a large percentage of the research we have drawn upon has been published by U.S. researchers," says Rush. "The principles draw upon our experience in consultation around the world."
To arrange an interview with Brian Rush, Ph.D., please contact him directly at

Rush, B., & Urbanoski, K. (2019). Seven core principles of substance use treatment system design to aid in identifying strengths, gaps and required enhancements. Journal of Studies on Alcohol and Drugs, Supplement 18, 9-21. doi:10.15288/jsads.2019.s18.9

The Journal of Studies on Alcohol and Drugs is published by the Center of Alcohol Studies at Rutgers, The State University of New Jersey. It is the oldest substance-related journal published in the United States.

To learn about education and training opportunities for addiction counselors and others at the Rutgers Center of Alcohol Studies, please visit

Journal of Studies on Alcohol and Drugs

Related Mental Health Articles:

The Lancet Child & Adolescent Health: Mental health harms related to very frequent social media use in girls might be due to exposure to cyberbullying, loss of sleep or reduced physical activity
Very frequent use of social media may compromise teenage girls' mental health by increasing exposure to bullying and reducing sleep and physical exercise, according to an observational study of almost 10,000 adolescents aged 13-16 years studied over three years in England between 2013-2015, published in The Lancet Child & Adolescent Health journal.
Can Facebook improve your mental health?
Contrary to popular belief, using social media and the internet regularly could improve mental health among adults and help fend off serious psychological distress, such as depression and anxiety, finds a new Michigan State University study.
A gut feeling for mental health
The first population-level study on the link between gut bacteria and mental health identifies specific gut bacteria linked to depression and provides evidence that a wide range of gut bacteria can produce neuroactive compounds.
Mental health care increasing most among those with less distress
A new study shows that more Americans are getting outpatient mental health care and the rate of serious psychological distress is decreasing.
On-again, off-again relationships might be toxic for mental health
A researcher from the University of Missouri says that the pattern of breaking up and getting back together can impact an individual's mental health and not for the better.
More Mental Health News and Mental Health Current Events

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Rethinking Anger
Anger is universal and complex: it can be quiet, festering, justified, vengeful, and destructive. This hour, TED speakers explore the many sides of anger, why we need it, and who's allowed to feel it. Guests include psychologists Ryan Martin and Russell Kolts, writer Soraya Chemaly, former talk radio host Lisa Fritsch, and business professor Dan Moshavi.
Now Playing: Science for the People

#537 Science Journalism, Hold the Hype
Everyone's seen a piece of science getting over-exaggerated in the media. Most people would be quick to blame journalists and big media for getting in wrong. In many cases, you'd be right. But there's other sources of hype in science journalism. and one of them can be found in the humble, and little-known press release. We're talking with Chris Chambers about doing science about science journalism, and where the hype creeps in. Related links: The association between exaggeration in health related science news and academic press releases: retrospective observational study Claims of causality in health news: a randomised trial This...