Addictive disorders in context: principles and puzzles of effective treatment and recovery.

To consider key issues in understanding effective treatment and recovery, the author reviews selected principles and unresolved puzzles about the context of addictive disorders and the structure, process, and outcome of treatment. The principles focus on the process of problem resolution, the duration and continuity of care, treatment provided by specialist versus nonspecialist providers, alliance and the goals and structure of treatment, characteristics of effective interventions, and the outcome of treatment versus remaining untreated. The unresolved puzzles involve how to concepualize service episodes and treatment careers, connections between the theory and process of treatment effective patient-treatment matching strategies, integration of treatment and self-help, and the development of unified models to encompass life context factors and treatment within a common framework.