Objective: The article offers an inventory of controversial basic issues related to treatment responses and their sociocultural political context, highlighting policy failures and successes, with a focus on Europe. As a reference point for this assessment, serves a conceptual framework of an “ideal type of treatment system”, which is built upon the following normative assumptions: the objective of harm minimisation or preventing substance-use-related consequences, evidence-based decision making, securing equity and accessibility also from a user perspective as well as efficiency in terms of the diversity and choice of treatment options. Method: Five major issues of addiction treatment systems, as identified and exemplified by an expert survey among 14 countries conducted in 2014, served as a reference for discussing fundamental gaps between an assumed ideal type of treatment system and the treatment response in practice: (1) Resistance to change, consensus building and innovation, (2) Political influence and target group bias beyond evidence, (3) Assumptions about rationality and universal evidence, (4) Myths of addiction and ethical deficits and (5) The treatment gap and user perspectives. Results/conclusions: Recommendations relevant for politicians, system planners, and clinicians are formulated for each of the five issues, specifically focusing on embeddedness of treatment systems in macro-societal conditions, the abstinence paradigm and outcome diversity, ethnocentric biases of the “evidence credo”, learning from self-change as the major road to recovery, and questioning implicit conceptions of the “addict as a human being”. Furthermore, it is concluded that theories regarding the diffusion of innovation and knowledge exchange can inform future research.

中文翻译：

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药物滥用治疗的成功与失败：治疗系统的观点和来自欧洲大陆的经验教训

目的：本文提供了与治疗反应及其社会文化政治背景相关的有争议的基本问题的清单，突出了政策的失败和成功，重点是欧洲。作为该评估的参考点，服务于“理想类型的治疗系统”的概念框架，该框架建立在以下规范假设之上：危害最小化或预防与物质使用相关的后果的目标，基于证据的决策，从用户的角度确保公平和可及性，以及在治疗方案的多样性和选择方面的效率。方法：2014 年对 14 个国家进行的专家调查确定并举例说明了成瘾治疗系统的五个主要问题，作为讨论假定的理想治疗系统类型与实践中的治疗反应之间的基本差距的参考：（1）抵制变革、建立共识和创新，（2）无证据的政治影响和目标群体偏见，（3）关于理性和普遍证据的假设，（4）成瘾和道德缺陷的神话和（5）治疗差距和用户观点。结果/结论：针对这五个问题中的每一个都制定了与政治家、系统规划者和临床医生相关的建议，特别关注治疗系统在宏观社会条件下的嵌入性、禁欲范式和结果多样性、“证据信条”的种族中心主义偏见”，从自我改变中学习是恢复的主要途径，并质疑“吸毒者作为人类”的隐含概念。此外，得出的结论是，有关创新扩散和知识交流的理论可以为未来的研究提供信息。