Remarks y The term “drug dependence” refers to diagnosis according to the ICD-10 or DSM-IV criteria or equivalent ICD-11 and DSM-5 diagnosis. y Recovery is “a continuum process and experience through which individuals, families, and communities utilize internal and external resources to address substance use disorders, actively manage their continued vulnerability to such disorders, and develop a healthy, productive and meaningful life”, according to the WHO and UNODC International standards for the treatment of drug use disorders (147). y Recovery-oriented interventions considered in current review included: digital recovery support, user-involvement/oriented care models (spiritual/religious interventions, role of self-care, mindfulness-based therapies, physical exercise, occupational therapy), employment (individual placement and support [IPS]), recovery-oriented systems of care (peer recovery support services [PRSS], case management, assertive community treatment [ACT]), long-term approaches, housing and family support. y Case management refers to a client-centred approach to improve the coordination and continuity of service delivery for people with substance use disorders. This approach supports individuals by helping them identify needed services, facilitate linkage with services and promote participation and retention in services. Long-term continuing community care approaches (also called “aftercare”, “recovery management”) refer to services supporting people with drug use disorders in the process of gradually increasing health and wellness, as well as assisting them in recovery, reducing the risk of relapse to substance use by comprehensively supporting social functioning and well-being, as well as social reintegration into the community and society. This might include, but is not limited to, recovery management checkups, help with management of stressful situations and engagement in the community, peer recovery support and other interventions that gradually increase social reintegration and improve chances of stable remission and recovery, according to the WHO and UNODC International standards for the treatment of drug use disorders (147). y Long-term residential approaches refer to services for individuals with drug use disorders living in a communal environment with others and participating in an intensive daily programme. The programmes provide a diverse range of interventions such as: community meetings and group work; individual psychosocial interventions; family psychosocial interventions; mutual aid and self-help; active participation in community life; and gaining life skills and vocational training. Long-term residential programmes, especially therapeutic communities, use the programme’s entire community, including other residents and staff, as active components of treatment and recovery management, according to the WHO and UNODC International standards for the treatment of drug use disorders (147). y Occupation-based therapies refer to those interventions in which an occupation or activity is performed with the aim of structuring time and creating meaning in one’s life, for example in areas of education, work, leisure and social participation. Occupational therapies help to develop skills necessary to address deficits in occupational performance, promote development of healthy performance patterns and environmental contexts that support abstinence or the reduction of alcohol and drug use. y Any treatment or support for people using drugs or with drug use disorders should ensure ethical standards – including respect for human rights and the individual’s dignity, and never using humiliating or degrading interventions – in line with the WHO and UNODC International standards for the treatment of drug use disorders (147) (see Box 3.1).

Implementation considerations y Although identifying evidence on the costs of implementation was beyond the scope of the systematic reviews conducted for this update, face-to-face psychosocial interventions delivered by service providers are human resource-intensive as these require substantial provider time, training and supervision. y The costs of long-term treatment are likely greater than for short-term approaches, but no data on this topic were available in the reviews. y Though there are not enough studies in primary care, many interventions can be delivered effectively in non-specialized health-care settings but also in other settings including specialized mental health care and social care with a role of trained peers. Integrating the provision of interventions into primary care provides many advantages, including more holistic health care, increased accessibility of mental health services for people in need of care, opportunities for reducing the stigma of mental health problems and reduced costs. y Decision on the choice and implementation of recovery-oriented services should be based on individual characteristics of a person and be adjusted to the complexity of each person’s needs. Service providers should help the person navigate through the system and make informed decisions about engagement into various activities on a caseby-case basis. Country adaptation and translation of training materials and tools for the provision of psychosocial interventions is essential. y There is no identifiable conflict regarding sociocultural differences in most interventions, however, some spiritually oriented interventions can be culture-sensitive. y Peer support integrates treatment approaches with the cultural context of each population, integrating the community and reducing the gap between people affected by the condition and those who have already managed to overcome it, thus reducing the stigma. The fact that people from the community are involved in peer support leads to a more culturally appropriate approach.