Evidence Based Addiction Treatment. Lessons for Poland

Executive Summary

This policy paper examines Poland's addiction treatment system and recommends evidence-based reforms to address significant gaps in care. Poland faces substantial challenges with approximately 2.8 million people struggling with alcohol dependency and 140,000 engaged in high-risk drug use, yet only 25-30% of those requiring treatment receive it. The current system relies heavily on inpatient, abstinence-only approaches, with chronic underfunding (2.9% of health budget allocated to mental health including addiction services, compared to the EU average of 5.5%) and limited support for harm reduction or medication-assisted treatment (MAT).

International evidence demonstrates the effectiveness of comprehensive, integrated approaches to addiction treatment. Medication-Assisted Treatment has proven particularly effective for opioid and alcohol use disorders, with countries like Germany, Portugal, and the Czech Republic successfully implementing widespread access. Integrated care models that address co-occurring mental health conditions, community-based services, and recovery-oriented systems of care show superior outcomes compared to siloed approaches.

Poland's addiction treatment system exhibits three critical deficiencies requiring urgent reform:

1. Inadequate access to medication-assisted treatment, with only about 3,100 clients receiving opioid agonist treatment in 2021
2. Fragmentation of service delivery, with addiction treatment siloed from mainstream healthcare and social support
3. An imbalanced treatment ecosystem that overemphasizes residential care at the expense of community-based alternatives

Key policy recommendations include:

• Expanding access to MAT by increasing methadone maintenance programs, including buprenorphine and naltrexone in the National Health Fund reimbursement scheme, and developing clear clinical guidelines
• Developing integrated care pathways through formal coordination mechanisms, care coordinators, implementing Screening, Brief Intervention, and Referral to Treatment (SBIRT) protocols, and creating specialized programs for co-occurring disorders
• Strengthening community-based services by reallocating funding to expand outpatient options, developing low-threshold services, supporting peer recovery programs, and implementing Housing First initiatives

Implementation should follow a phased approach over 10 years, beginning with pilot programs and foundation-building (years 1-2), followed by national expansion (years 3-5), and culminating in full system integration (years 6-10). Sustainable financing can be achieved through increased healthcare budget allocation, EU structural funds, public health levies, and value-based funding mechanisms.

Robust monitoring, evaluation, and quality assurance systems are essential to track outcomes and ensure effective implementation. These should include comprehensive outcome monitoring, accreditation systems, and investment in research and innovation, with particular attention to equity considerations and the perspectives of people with lived experience.

By implementing these evidence-based reforms, Poland can significantly improve addiction treatment outcomes, reduce societal costs, and enhance the quality of life for individuals and families affected by substance use disorders.

Current State of Addiction Treatment in Poland

Poland faces significant challenges in addressing substance use disorders (SUDs), with an estimated 2.8 million people struggling with alcohol dependency (Państwowa Agencja Rozwiązywania Problemów Alkoholowych [PARPA], 2022) and approximately 140,000 individuals engaged in high-risk drug use, primarily involving opioids and stimulants (Krajowe Biuro ds. Przeciwdziałania Narkomanii [KBPN], 2023a). These figures likely underestimate the true scope due to stigma and underreporting, issues that plague addiction statistics globally (Room et al., 2005). While cannabis remains Poland's most commonly used illicit substance, emerging concerns center on new psychoactive substances and prescription medication misuse, particularly benzodiazepines and certain opioids (EMCDDA, 2023; KBPN, 2023a).

The Polish addiction treatment landscape is characterized by a heavy reliance on inpatient care and abstinence-only approaches (Moskalewicz & Kocoń, 2021). This narrow focus fails to align with international best practices that advocate for a comprehensive continuum of care including harm reduction strategies and medication-assisted treatment (MAT) (World Health Organization [WHO], 2017). Particularly concerning is the substantial treatment gap—only 25-30% of those requiring addiction treatment actually receive it (KBPN, 2023b). This gap exceeds that of many Western European nations where integrated care models have achieved treatment coverage rates of 40-50% for opioid use disorder in some regions (Rehm et al., 2019; Federal Ministry of Health Germany, 2022). The consequences of this treatment shortfall are severe: increased morbidity and mortality, elevated societal costs from lost productivity, higher healthcare expenditures, and perpetuated cycles of addiction (NIDA, 2020; GUS, 2023).

Chronic underfunding represents a critical barrier to modernizing Poland's addiction treatment system. The Polish healthcare system allocates approximately 2.9% of its total health budget to mental health, including addiction services—significantly below the EU average of 5.5% (OECD/European Union, 2022; Ministerstwo Zdrowia, 2023a). This financial constraint directly contributes to limited service availability, particularly in rural areas where individuals may face waiting periods exceeding three months for residential treatment (Najwyższa Izba Kontroli [NIK], 2022). The National Health Fund (NFZ) primarily finances abstinence-oriented programs, with minimal systematic support for harm reduction strategies or medication-assisted treatments (NFZ, 2023; Moskalewicz et al., 2020). This policy stance diverges sharply from international best practices, where MAT is considered essential for opioid use disorder treatment (FDA, 2024; NIDA, 2020) and harm reduction is recognized as a vital public health strategy (National Harm Reduction Coalition, n.d.; SAMHSA, 2024a).

The current system also suffers from limited standardized outcome data beyond abstinence rates (Sierosławski & Zieliński, 2021). While sobriety represents a valid goal for many, an exclusive focus on abstinence obscures other crucial outcomes such as improvements in physical and mental health, social functioning, quality of life, and reductions in substance-related harm (Neale et al., 2019). Developing and implementing a broader set of quality indicators is essential for comprehensive system improvement.

Non-governmental organizations play a vital role in Poland's addiction response, often filling gaps left by the public system, particularly in harm reduction services, peer support, and advocacy (Fundacja Polityki Społecznej PREKURSOR, 2022; MONAR, 2023). However, these organizations frequently struggle with sustainable funding, coordination with statutory services, and inconsistent local government support (Stowarzyszenie JUMP'93, 2021).

The economic impact of untreated SUDs in Poland is substantial, encompassing direct healthcare costs, criminal justice expenses, and indirect costs such as lost productivity and social welfare burdens, estimated at billions of PLN annually (Centrum Analiz Ekonomicznych Sektora Publicznego [CASE-Poland], 2022). Investment in evidence-based treatment and prevention offers a strong potential return by reducing these societal costs (Sederer, 2019). Furthermore, addiction in Poland frequently intersects with homelessness, unemployment, and incarceration, creating complex cycles of disadvantage that require integrated multi-sectoral policy responses (Instytut Pracy i Spraw Socjalnych, 2021; Służba Więzienna, 2022).

Current prevention strategies largely emphasize school-based programs and public awareness campaigns, but their effectiveness varies considerably. There is an urgent need for wider implementation of evidence-based early intervention models, particularly for at-risk youth and families (KBPN, 2023c; Ośrodek Rozwoju Edukacji, 2022). Specific populations—youth transitioning to adulthood, pregnant women with SUDs, elderly individuals misusing prescription medications, and those within the criminal justice system—have unique needs that current system architecture fails to adequately address (IPiN, 2022a; Fundacja Rodzić po Ludzku, 2021). Policy reforms must prioritize tailored programs and improved access pathways for these vulnerable groups.

Regulatory Framework

Poland's addiction treatment regulatory framework is primarily governed by the Act on Counteracting Drug Addiction of 2005 (Dziennik Ustaw, 2005, Nr. 179, poz. 1485, as amended) and the Act on Upbringing in Sobriety and Counteracting Alcoholism of 1982 (Dziennik Ustaw, 1982, Nr. 35, poz. 230, as amended). While these laws established an initial foundation for treatment services, they have not kept pace with significant advancements in addiction science and evidence-based practices (Helsińska Fundacja Praw Człowieka, 2021). Recent amendments, such as the 2022 revision to the Act on Counteracting Drug Addiction, have focused on improving data collection and monitoring (Dziennik Ustaw, 2022, Nr. X, poz. Y), but more comprehensive reforms are needed to establish widespread access to Medications for Opioid Use Disorder (MOUD) as a standard of care.

The current regulatory environment maintains significant barriers to evidence-based treatment. While methadone maintenance treatment exists in Poland, its accessibility is severely limited by geographical distribution and restrictive admission criteria. Buprenorphine, which can be prescribed in office-based settings in many countries, faces greater restrictions and significant underutilization in Poland (EMCDDA, 2023; KBPN, 2023b). This policy stance directly contradicts overwhelming evidence supporting these medications as effective treatments for opioid use disorder (FDA, 2024; CDC, 2024).

Poland's legal framework also maintains a relatively punitive approach to personal drug possession, which significantly deters individuals from seeking treatment due to fear of legal consequences and social stigma (Polski Instytut Praw Człowieka i Polityki Narkotykowej, 2022). International experience, particularly from Portugal, demonstrates that shifting from punitive measures toward a public health approach yields substantial benefits. Portugal's 2001 decriminalization of personal drug possession redirected resources from criminal justice to public health, including treatment and harm reduction services. This policy shift correlated with increased treatment engagement, reduced problematic drug use, fewer drug-related deaths, and decreased HIV infections among people who inject drugs (Greenwald, 2009; Hughes & Stevens, 2010).

Updating Poland's regulatory framework to align with current scientific understanding of addiction as a chronic health condition (Cleveland Clinic, n.d.; NIDA, 2020) and explicitly supporting a broader range of evidence-based interventions represents an essential policy priority. Regulatory reform should focus on removing barriers to harm reduction services (Johns Hopkins Bloomberg School of Public Health, 2022) and comprehensive MAT programs (OASAS, n.d.; AAC, 2025), while reconsidering punitive approaches to personal drug possession that deter treatment engagement.

Treatment Workforce

Poland faces a critical shortage of addiction specialists, with approximately 650 certified addiction therapy specialists and around 1,200 certified addiction psychotherapy instructors serving a population of nearly 38 million (Polskie Towarzystwo Badań nad Uzależnieniami [PTBU], 2023). This specialist density falls significantly below that of many European countries where addiction professionals are more widely available and integrated into primary care and specialized outpatient services (WHO Regional Office for Europe, 2021). This workforce shortage creates a major bottleneck in service delivery, contributing to long waiting lists and inequitable access to care, particularly in rural and underserved areas (NIK, 2022).

Training requirements for addiction specialists in Poland have historically emphasized psychotherapeutic approaches focused primarily on abstinence, often lacking comprehensive, mandatory components on evidence-based pharmacological treatments and newer, empirically supported psychosocial interventions (Centrum Medyczne Kształcenia Podyplomowego [CMKP] Standards, 2020; IPiN, 2022b). While abstinence-focused therapy skills remain valuable, this narrow training focus limits the treatment options specialists may offer, even when patients might benefit significantly from MAT (NIDA, 2020; AAC, 2025) or harm reduction strategies (National Harm Reduction Coalition, n.d.).

Cultural factors in Poland, including a strong historical emphasis on willpower in overcoming addiction and skepticism toward long-term medication use for SUDs, influence both training content and patient/provider preferences (Bielecka & Warzecha, 2021). Furthermore, the prevailing treatment philosophy often fails to adequately integrate systematic screening and treatment for co-occurring mental health conditions or fully embed trauma-informed care principles, despite high comorbidity rates (IPiN, 2022a). As Joe Polish has noted, addiction often represents an attempt to manage underlying pain and trauma (U.S. News & World Report, 2019), underscoring the need for trauma-informed approaches throughout the treatment system.

Poland could benefit from examining workforce development models from other countries. France significantly expanded access to buprenorphine for opioid use disorder in the mid-1990s by allowing general practitioners to prescribe it after brief training—a policy that dramatically increased treatment coverage and reduced overdose deaths (Auriacombe et al., 2004). This model has since been adapted and proven effective in multiple contexts.

Comprehensive workforce policy reform should include: investing in updated training curricula for existing and future specialists; expanding addiction training to primary care physicians and allied health professionals; incentivizing practice in underserved areas; and ensuring education covers the neurobiology of addiction, the full spectrum of evidence-based treatments including MAT and harm reduction, motivational interviewing, and trauma-informed care. Such reforms, already advocated by some Polish addiction experts (PTBU, 2023), would not only increase the quantity of available professionals but also enhance the quality and diversity of care provided, ultimately improving outcomes for individuals struggling with addiction in Poland.

International Best Practices in Addiction Treatment

Evidence from countries with advanced addiction treatment systems, as well as emerging data from diverse global contexts, demonstrates the effectiveness of comprehensive, integrated, and person-centered approaches to addiction treatment. The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) has identified several evidence-based practices that consistently yield positive outcomes across various settings (EMCDDA, 2023a). The global scale of substance use disorders is staggering, with an estimated 296 million people using drugs in 2021 and approximately 39.5 million suffering from drug use disorders—figures that continue to rise at an alarming rate (United Nations Office on Drugs and Crime [UNODC], 2023). This growing crisis underscores the urgent need for effective, evidence-based, and adaptable treatment strategies worldwide.

Medication-Assisted Treatment (MAT)

Medication-Assisted Treatment, increasingly referred to as Medications for Opioid Use Disorder (MOUD) when specific to opioids, combines regulatory agency-approved medications with counseling and behavioral therapies to provide a "whole-patient" approach to treatment (Substance Abuse and Mental Health Services Administration [SAMHSA], 2024a). This integrated approach has demonstrated remarkable effectiveness for a range of substance use disorders, particularly opioid use disorder (OUD) and alcohol use disorder (AUD) (American Addiction Centers [AAC], 2024). The World Health Organization (WHO) recognizes the value of medications like methadone and buprenorphine by including them on its Model List of Essential Medicines and endorsing their use within comprehensive treatment frameworks for opioid dependence (WHO, 2023a).

Several European nations have successfully implemented widespread access to MAT for opioid use disorder. Germany maintains a robust opioid agonist treatment system serving approximately 82,300 individuals as of 2021 (EMCDDA, 2023b). Portugal's health-focused drug policy has significantly expanded MAT access, contributing to improved health outcomes among people who use drugs (EMCDDA, 2022a). The Czech Republic has prioritized scaling up MAT, particularly buprenorphine, often delivering these services through primary care to enhance accessibility (EMCDDA, 2022b). Similar efforts, though varying in scale and implementation, are evident in countries like Canada and Australia (Australian Institute of Health and Welfare, 2023; Canadian Agency for Drugs and Technologies in Health, 2022).

For opioid use disorder, three primary medications have received FDA approval: methadone, buprenorphine, and naltrexone (FDA, 2024). Methadone, typically provided in specialized clinics, has demonstrated high effectiveness in reducing illicit opioid use compared to no opioid replacement therapy, as confirmed by comprehensive meta-analyses (Mattick et al., 2009). Perhaps most significantly, methadone maintenance treatment is associated with a substantial decrease in mortality among individuals with OUD, potentially reducing death rates by over 50% compared to being out of treatment (Sordo et al., 2017; WHO, 2023a). Buprenorphine, often available in office-based settings, also demonstrates strong efficacy in reducing opioid use, improving treatment retention, and enhancing social functioning (Mattick et al., 2014). Its integration into primary care has been a key strategy for expanding access in many high-income countries. Naltrexone, an opioid antagonist that blocks opioid effects, is available in both oral and long-acting injectable forms (SAMHSA, 2024a), with the injectable formulation showing particular promise in improving adherence among patients (Lee et al., 2018).

For alcohol use disorder, acamprosate, disulfiram, and naltrexone are common FDA-approved medications (SAMHSA, 2024a). When incorporated into a comprehensive treatment plan that includes behavioral therapies, these medications effectively reduce relapse rates and support abstinence (Jonas et al., 2014; National Institute on Alcohol Abuse and Alcoholism [NIAAA], 2023).

Despite the strong evidence supporting MAT, access remains a significant global challenge due to regulatory hurdles, persistent stigma, insufficient funding, and workforce shortages (Volkow et al., 2023; WHO, 2023b). Policy reforms addressing these barriers are essential to expand access to these life-saving interventions.

Treatment for Stimulant Use Disorders

The global prevalence of stimulant use, including cocaine and amphetamine-type stimulants (ATS) such as methamphetamine, presents distinct treatment challenges compared to opioid or alcohol use disorders (UNODC, 2023). Unlike OUD or AUD, there are currently no FDA-approved medications specifically for stimulant use disorders (National Institute on Drug Abuse [NIDA], 2023a). However, research has identified several effective behavioral interventions that should be incorporated into comprehensive treatment policies.

Contingency Management (CM), which provides tangible rewards for abstinence, has demonstrated robust efficacy in reducing stimulant use across multiple studies (Petry et al., 2011; De Crescenzo et al., 2018). Cognitive Behavioral Therapy (CBT) helps individuals identify and change maladaptive thought patterns and behaviors related to substance use, offering another evidence-based approach for stimulant use disorders (Lee & Rawson, 2008). The Matrix Model, a multi-component approach combining elements of CBT, family education, individual counseling, and group therapy, has shown particular effectiveness for methamphetamine use disorders (Rawson et al., 2004).

Research into pharmacological treatments for stimulant use disorder continues, with some agents showing modest promise in specific populations, but no definitive breakthroughs have yet translated into widespread clinical approval (Chan et al., 2019; NIDA, 2023a). Policy approaches should support continued research while ensuring access to evidence-based behavioral interventions.

Integrated Care Models

Integrated care, where treatment for mental health and substance use problems is delivered conjointly by collaborating providers, represents a best practice in addiction treatment (SAMHSA & HRSA Center for Integrated Health Solutions, n.d., as cited in SAMHSA, 2022a). This approach is particularly vital given that nearly half of adults with a substance use disorder also have a co-occurring mental illness, and vice-versa (National Institute of Mental Health [NIMH], 2023; Kessler et al., 2005). More recent epidemiological studies confirm these high comorbidity rates continue to be a major concern requiring coordinated policy responses (Grant et al., 2016).

Sweden and the Netherlands exemplify successful integrated care models worth examining for policy adaptation. The "Swedish Model" emphasizes social services and continuity of care via robust case management, aiming for seamless transitions from detoxification to long-term recovery (Socialstyrelsen, 2019; Storbjörk & Room, 2011). While the specific term "Swedish Model" encompasses broad approaches, evaluations of comprehensive, continuous care systems central to its philosophy show improved treatment retention and outcomes (Gotham, 2004; NASEM, 2016). Integrated treatment programs for co-occurring disorders significantly improve outcomes over non-integrated approaches, including better housing stability and reduced substance use (Drake et al., 2001). Specific data from well-designed comparative studies indicates that integrated care leads to higher rates of treatment engagement and retention compared to parallel or sequential care models (Essock et al., 2006; Kelly & FAP, 2011).

The Netherlands employs pragmatic, integrated approaches linking addiction treatment with general health, mental health, and municipal social support, including accessible low-threshold services that reduce barriers to entry (Trimbos Instituut, 2022; EMCDDA, 2022c). This comprehensive approach offers valuable policy lessons for other nations.

Integrating addiction treatment with primary care is crucial for addressing co-occurring physical health issues like HIV, hepatitis C, and chronic diseases that often accompany substance use disorders (NIDA, 2023b; SAMHSA, 2022b). Models like collaborative care, which involves care managers and psychiatric consultants supporting primary care providers, have strong evidence for improving outcomes for co-occurring disorders (Archer et al., 2012; Katon et al., 2010).

Sustaining integrated care faces policy challenges including complex funding mechanisms, differing professional cultures, and workforce development needs that must be addressed through coordinated policy initiatives (SAMHSA, 2022a; Garner et al., 2020).

Harm Reduction Approaches

Harm reduction encompasses practical strategies to reduce negative health, social, and economic consequences of drug use without necessarily requiring abstinence (Harm Reduction International, 2023; SAMHSA, 2024b). As a public health approach prioritizing harm minimization, it forms a key component of comprehensive substance use strategies (NIDA, 2023c) and should be incorporated into balanced policy frameworks.

Switzerland and Portugal stand out for their comprehensive harm reduction policies. Switzerland implemented measures like Needle and Syringe Programs (NSPs), Supervised Consumption Sites (SCSs), and Heroin-Assisted Treatment (HAT) in response to public health crises, leading to significant reductions in HIV/hepatitis C transmission among people who inject drugs (EMCDDA & WHO, 2011; Uchtenhagen, 2009). Supervised Consumption Sites are linked to reduced overdose deaths, decreased public injecting, and increased treatment uptake (EMCDDA, 2018a; Kennedy et al., 2017). Heroin-Assisted Treatment, while sometimes politically controversial, is recognized for engaging individuals with severe, long-term opioid dependence who have not responded to other treatments, leading to improved health and social functioning (Strang et al., 2015; Oviedo-Joekes et al., 2016).

Portugal's 2001 decriminalization of personal drug possession, implemented alongside expanded prevention, treatment, harm reduction, and social reintegration services, led to increased treatment uptake and notable reductions in new HIV infections among people who inject drugs (Hughes & Stevens, 2010; EMCDDA, 2022a). While drug-related deaths initially decreased, more recent data indicate some fluctuations, highlighting the need for ongoing adaptation and sustained investment in the full spectrum of services (EMCDDA, 2023c; Hughes & Stevens, 2022). It's vital for policymakers to recognize that decriminalization's success is inextricably tied to the broader health-centered strategy implemented concurrently (Hughes & Stevens, 2012).

Harm reduction implementation faces policy challenges, including community opposition (NIMBYism), legal barriers in some jurisdictions, and ensuring equitable access across populations (EMCDDA, 2023d; Ritter & Cameron, 2006). While criticisms sometimes arise regarding perceived condoning of drug use, public health evidence largely supports harm reduction's benefits in reducing negative consequences (Caulkins et al., 2019).

The EMCDDA monitors harm reduction across Europe, noting its inclusion in most national strategies, though implementation varies significantly between countries (EMCDDA, 2023d). Take-home naloxone programs have become increasingly widespread and effective in reversing opioid overdoses, representing a relatively straightforward policy intervention with substantial life-saving potential (McDonald & Strang, 2016).

Abstinence-Based Approaches

While MAT and harm reduction are critical components of comprehensive addiction policy, abstinence-based approaches remain a significant part of the treatment landscape and represent the goal for many individuals seeking recovery (NIDA, 2020). These approaches typically involve detoxification followed by psychosocial therapies aimed at achieving and maintaining complete abstinence from all non-prescribed psychoactive substances.

Therapeutic Communities (TCs) are intensive, long-term residential programs emphasizing resocialization and personal growth within a structured peer-support environment (De Leon, 2000). 12-Step Facilitation (TSF) therapies encourage active involvement in mutual-help groups like Alcoholics Anonymous (AA) or Narcotics Anonymous (NA), which are widely accessible global resources that can complement formal treatment (Kelly et al., 2020; Humphreys et al., 2004).

The effectiveness of these approaches varies across individuals and contexts, and they may be best suited for those with particular recovery goals and support systems (NIDA, 2020). A comprehensive policy framework should integrate various approaches, allowing for tailored treatment plans that respect individual preferences and needs.

Recovery-Oriented Systems of Care (ROSC) and Peer Support

A growing international movement emphasizes Recovery-Oriented Systems of Care (ROSC), which are networks of formal and informal services designed to initiate and sustain long-term recovery (White, 2008; SAMHSA, 2022c). ROSC represents a paradigm shift in addiction policy, moving from acute-care models to sustained recovery management approaches that are person-centered, community-based, and include a full continuum of care from prevention and early intervention to treatment and long-term recovery supports.

Peer support services, delivered by individuals with lived experience of addiction and recovery, are a cornerstone of ROSC. Peer supporters offer mentoring, advocacy, and practical assistance, improving engagement, reducing relapse, and enhancing quality of life (Bassuk et al., 2016; Reif et al., 2014). Policy frameworks should recognize and support the integration of peer recovery specialists into treatment and recovery systems, including addressing credentialing, reimbursement, and workforce development needs.

Digital Health Interventions and Telehealth

The use of digital health interventions and telehealth for addiction treatment has rapidly expanded, particularly accelerated by the COVID-19 pandemic (NIDA, 2023d; SAMHSA, 2022d). This evolution presents both opportunities and challenges for addiction policy.

Telehealth allows for remote consultations, therapy sessions, and even MAT prescribing in some contexts, improving access for rural or underserved populations that have historically faced significant barriers to treatment (Lin et al., 2021). Mobile apps and web-based platforms can deliver psychoeducation, CBT-based exercises, recovery support tools, and monitor cravings or mood, extending the reach of treatment beyond traditional clinical settings (Maresco et al., 2022).

While promising for expanding reach and convenience, digital health interventions face implementation challenges that require policy attention, including the digital divide affecting vulnerable populations, ensuring data privacy and security, clinician training needs, and establishing consistent reimbursement policies (Gordon et al., 2020). The evidence base for the long-term effectiveness of some digital tools is still developing but shows promise for specific applications that can complement traditional treatment approaches (Maresco et al., 2022).

Treatment Considerations for Special Populations

Effective addiction policy requires tailoring interventions to the unique needs of diverse populations. Adolescents require family-centered approaches, developmentally appropriate therapies, and attention to co-occurring educational or mental health issues (NIDA, 2023e; Winters et al., 2018). Policies should support specialized adolescent treatment programs and prevention initiatives that address risk factors specific to youth.

Pregnant women need coordinated care addressing both maternal and fetal health, often involving specialized MAT programs and comprehensive support services to mitigate risks of neonatal abstinence syndrome and support parenting (WHO, 2014; NIDA, 2023f). Policies removing barriers to treatment for pregnant women, including addressing stigma and legal concerns, are essential.

Older adults may face unique challenges related to polypharmacy, age-related cognitive changes, and co-occurring medical conditions, requiring careful assessment and adapted interventions (SAMHSA, 2020a; Kuerbis et al., 2014). As populations age globally, policies must address the growing need for geriatric-specific addiction services.

Justice-involved individuals benefit from continuity of care between correctional settings and the community, including access to MAT and pre-release planning (NIDA, 2022; Chandler et al., 2009). Policies facilitating this continuity, including partnerships between criminal justice and healthcare systems, can reduce relapse and recidivism.

Addiction Treatment in Low- and Middle-Income Countries (LMICs)

While much research originates from high-income countries, the burden of substance use disorders is significant in LMICs, where resources for treatment are often severely limited (Degenhardt et al., 2019; UNODC, 2023). This disparity requires targeted policy attention and international cooperation.

LMICs face extreme shortages of trained professionals, lack of infrastructure, limited availability of essential medications for MAT, high levels of stigma, and competing health priorities that complicate addiction treatment implementation (Saxena et al., 2013; Eaton et al., 2012). Despite these challenges, some LMICs are successfully adapting evidence-based practices to local contexts through innovative approaches.

These adaptations include task-shifting (training non-specialist health workers to deliver basic interventions), integrating addiction care into primary health services, and leveraging community-based resources (WHO, 2010; Patel et al., 2018). For example, initiatives in countries like Vietnam and Indonesia have focused on scaling up MAT and harm reduction in community settings with promising results (Nguyen et al., 2016; EMCDDA & Australian Government, 2019).

Greater international collaboration and investment are crucial to build capacity and expand access to evidence-based care in LMICs (UNODC & WHO, 2020). Policy frameworks should support knowledge transfer, technical assistance, and sustainable funding mechanisms while respecting local contexts and priorities.

Prevention Strategies

A comprehensive addiction policy must include robust prevention strategies targeting different populations and risk levels. Universal prevention targets the general population through school-based programs and public awareness campaigns to prevent or delay the onset of substance use (NIDA, 2023g). Selective prevention focuses on individuals or subgroups at increased risk, such as children from families with substance use problems or youth in underserved communities (SAMHSA, 2020b). Indicated prevention targets individuals already experimenting with substances to prevent progression to disorders (NIDA, 2023g).

Evidence-based prevention programs, such as family skills training and life skills education in schools, can yield significant long-term public health and economic benefits when implemented with fidelity (Spoth et al., 2008; Botvin & Griffin, 2004). Policy frameworks should prioritize sustained funding for prevention, integration of prevention across sectors (education, healthcare, community services), and implementation of programs with demonstrated effectiveness.

Current Challenges in Addiction Policy Implementation

Despite evidence for best practices, widespread effective implementation faces international challenges requiring coordinated policy responses. Pervasive stigma against people who use drugs and those with addiction hinders help-seeking, community support, and policy investment (UNODC, 2023; Volkow et al., 2021; Livingston et al., 2012). Anti-stigma campaigns and language reforms in policy documents and professional training can help address these barriers.

Funding and resource allocation remain critical issues, as comprehensive addiction services require sustained investment. Many regions, especially LMICs, face severe resource limitations for treatment, prevention, and recovery supports (NASEM, 2016; WHO, 2023b). Policies should establish dedicated funding streams and explore innovative financing mechanisms to ensure service sustainability.

Workforce development presents another significant challenge, with shortages of trained addiction specialists (physicians, psychiatrists, psychologists, counselors, social workers) and inadequate training for general healthcare providers (NASEM, 2016; WHO, 2023b). Policies supporting education, training, credentialing, and retention of addiction professionals are essential for system capacity building.

Regulatory and policy barriers, such as outdated or restrictive regulations limiting MAT access or harm reduction services, continue to impede implementation of evidence-based practices (Volkow et al., 2023; International Drug Policy Consortium [IDPC], 2021). Policy reform should address these structural barriers while maintaining appropriate safeguards.

Integration across systems presents complex challenges, as effectively connecting addiction treatment with mental health, primary care, and social services requires inter-agency collaboration, data sharing, and aligned funding mechanisms (SAMHSA, 2022a; Gureje & Alem, 2015). Policies promoting integrated care should address these systemic barriers through coordinated planning and implementation.

Adapting models to diverse contexts is essential, as policies and interventions must be tailored to specific cultural, social, and economic environments. Direct transplantation of models without local adaptation is often ineffective (EMCDDA, 2023e; Khenti, 2014). This includes addressing unique needs in LMICs and for diverse cultural groups within nations through culturally responsive policy development.

Data collection and monitoring systems, like the EMCDDA's Treatment Demand Indicator, are vital for trend monitoring, policy evaluation, and informed adjustments, but such systems are not universally implemented or harmonized (EMCDDA, 2012; UNODC, 2023). Policies should support development of robust monitoring frameworks with standardized indicators to guide evidence-based decision making.

Finally, balancing public health and public safety approaches to substance use remains challenging, as ongoing tension between criminal justice and public health perspectives can undermine effective policy implementation in many jurisdictions (Volkow et al., 2021; Stevens, 2011). Policies promoting cross-sector collaboration and shared goals can help bridge this divide.

Addressing these challenges requires a multi-pronged policy approach: legislative and regulatory reform, increased and sustained investment, public education to combat stigma, workforce training, commitment to evidence-based practices tailored to local needs, and greater international cooperation. By embracing comprehensive, integrated approaches informed by global best practices, policymakers can develop more effective responses to addiction that respect human dignity while improving public health outcomes.

Gaps in Poland's Addiction Treatment System: Policy Implications and Reform Opportunities

Poland's addiction treatment system, despite its evolution since the post-communist transition, continues to exhibit significant structural and operational deficiencies when measured against international standards and evidence-based practices. These shortcomings not only compromise treatment outcomes for individuals with substance use disorders (SUDs) but also represent missed opportunities for more effective public health interventions. A comprehensive policy analysis reveals three critical areas requiring urgent reform: inadequate access to medication-assisted treatment, fragmentation of service delivery, and an imbalanced treatment ecosystem that overemphasizes institutional care at the expense of community-based alternatives.

The Medication Access Crisis: Policy Failures in Evidence-Based Treatment

Poland's approach to medication-assisted treatment (MAT) represents one of the most concerning policy failures in its addiction treatment framework. Despite overwhelming scientific consensus supporting MAT as a first-line intervention for opioid use disorder (OUD), Poland's implementation remains woefully inadequate. In 2021, only approximately 3,100 clients received opioid agonist treatment (OAT), primarily methadone (EMCDDA, 2023). This coverage rate falls dramatically short of World Health Organization recommendations for achieving meaningful public health impact (WHO, 2009).

The policy barriers to effective MAT implementation are multifaceted. While methadone, buprenorphine, and naltrexone are technically approved for OUD treatment (NIDA, 2023), the National Health Fund's (NFZ) reimbursement policies have created significant financial obstacles, particularly for buprenorphine. This medication, often preferred for its superior safety profile and clinical flexibility, has historically not been fully reimbursed for outpatient use (KBPN, 2020). Such reimbursement policies directly contradict international standards, as both methadone and buprenorphine appear on the WHO Model List of Essential Medicines (WHO, 2023).

The contrast with other European nations is stark and instructive for policy reform. Germany has achieved OAT coverage exceeding 50% of high-risk opioid users (EMCDDA, 2023), while France's policy decision to expand buprenorphine access through general practitioners in the 1990s resulted in demonstrable reductions in overdose mortality (Auriacombe et al., 2004). These successful policy models highlight how Poland's current approach not only fails to meet clinical needs but likely contributes to preventable morbidity, mortality, and increased societal costs associated with untreated OUD (Strang et al., 2012).

Effective policy reform must address systemic barriers including the insufficient number of authorized prescribers (particularly in non-urban areas), persistent stigma among healthcare professionals, and the complex funding mechanisms that impede program implementation (EMCDDA, 2019). Recent pilot initiatives for buprenorphine in correctional settings represent positive developments but require comprehensive policy frameworks to achieve meaningful scale (KBPN, 2022).

Service Integration: Addressing Structural Fragmentation Through Policy Reform

The structural fragmentation of Poland's addiction services represents a significant policy challenge that undermines treatment effectiveness. The current system operates with addiction treatment largely siloed from mainstream healthcare and social support networks. This separation, reinforced by distinct funding streams primarily through the National Health Fund with supplementary local government contributions (KBPN, 2020), creates artificial barriers to integrated care delivery.

Perhaps most concerning from a policy perspective is the inadequate coordination between addiction treatment and mental health services. Research from Warsaw's Institute of Psychiatry and Neurology has documented persistent challenges in establishing formal cooperation between these sectors, despite the high prevalence of co-occurring disorders (Moskalewicz & Kocoń, 2019). This policy failure contradicts substantial evidence demonstrating that integrated treatment approaches for co-occurring disorders consistently yield superior outcomes, including reduced substance use and improved psychiatric symptoms (Drake et al., 2001).

The consequences of this fragmentation manifest in disrupted care pathways that compromise treatment continuity. Patients may successfully complete detoxification only to encounter administrative barriers or delays in accessing subsequent psychosocial support or MAT, significantly increasing relapse risk (Hellman et al., 2018). While similar challenges exist throughout Europe, several countries have implemented policy frameworks specifically designed to ensure seamless transitions between care levels (Rehm et al., 2019).

Effective policy solutions must focus on developing standardized referral protocols, implementing shared care frameworks, and incentivizing inter-agency collaboration. The European Commission's frameworks promoting integrated care offer valuable policy templates that could be adapted to the Polish context (European Commission, 2020). The COVID-19 pandemic, while exacerbating existing fragmentation, also catalyzed innovations in remote service delivery that could inform future policy development (EMCDDA, 2021).

Rebalancing the Treatment Ecosystem: Policy Priorities for Community-Based Care

Poland's addiction treatment system exhibits a concerning policy imbalance, with disproportionate resources allocated to residential treatment facilities at the expense of community-based alternatives. While comprehensive national data on exact funding allocations are not consistently published, analyses indicate a persistent pattern of prioritizing inpatient services (KBPN, 2019). This policy orientation contradicts evidence suggesting that well-designed outpatient services can achieve comparable outcomes for many patients, often at lower costs, while better supporting community integration (McCarty & Guydish, 2021).

A balanced policy approach requires developing a comprehensive continuum of care that includes outpatient counseling, intensive outpatient programs, day treatment, and structured aftercare services tailored to individual needs (SAMHSA, 2023b). The current imbalance creates significant access barriers, particularly for individuals unable to disengage from employment, family responsibilities, or education for extended residential treatment episodes.

The policy implications are especially pronounced in rural regions, where geographic distance compounds the scarcity of specialized services (Council of Europe, Pompidou Group, 2017). Furthermore, the underdevelopment of community-based services disrupts continuity of care, as individuals completing inpatient programs often lack adequate step-down support in their communities, undermining long-term recovery outcomes.

While Poland maintains a network of outpatient clinics, policy reforms must address their limited capacity, restricted service offerings (particularly evidence-based psychotherapies and MAT), and insufficient integration with primary care and social services (EMCDDA, 2023). Effective policy must also prioritize workforce development, ensuring adequate training and incentives for addiction specialists, psychologists, and social workers to practice in community settings (WHO Europe, 2021).

Strategic policy investments in accessible, evidence-based community services, including appropriate harm reduction initiatives, would likely improve treatment engagement, support sustained recovery, and align Poland's system with cost-effective models implemented in other European nations that have successfully prioritized deinstitutionalization and community integration (Knapp et al., 2011). Such policy reorientation would simultaneously address the rural-urban disparities in service availability that currently undermine treatment equity.

Evidence-Based Policy Recommendations

Based on international evidence, contemporary best practices, and the specific context of Poland, the following policy recommendations aim to strengthen the addiction treatment system and improve outcomes for individuals with substance use disorders. These recommendations draw upon successful strategies implemented globally, incorporate recent advancements in addiction science, and are tailored to address the multifaceted challenges of addiction, while also considering cost-effectiveness and implementation factors.

Expand Access to Medication-Assisted Treatment (MAT)

Medication-Assisted Treatment represents the gold standard in addressing substance use disorders, particularly for opioid and alcohol dependence. By combining FDA or EMA-approved medications with counseling and behavioral therapies, MAT provides a comprehensive approach that addresses both the neurobiological and psychosocial aspects of addiction (Substance Abuse and Mental Health Services Administration [SAMHSA], 2024a; American Society of Addiction Medicine [ASAM], 2023). The evidence supporting MAT is compelling—studies consistently demonstrate reduced illicit drug use, improved treatment retention, decreased mortality, and enhanced quality of life (National Institute on Drug Abuse [NIDA], 2023a; Sordo et al., 2017). From a fiscal perspective, MAT represents a sound investment, with cost-effectiveness analyses showing significant reductions in healthcare expenditures associated with untreated addiction (Bush et al., 2021).

Poland should prioritize increasing the number of methadone maintenance programs, particularly in underserved regions. Methadone, a long-acting full opioid agonist, has proven highly effective when administered in supervised clinical settings (SAMHSA, 2024b; Connock et al., 2007). These programs should provide not only pharmacological treatment but also comprehensive ancillary services, including counseling and social support, in line with World Health Organization recommendations (World Health Organization [WHO], 2009; Polish National Centre for Addiction Prevention, 2022). While universal coverage targets can be aspirational, a pragmatic approach involves continuous expansion based on local needs assessments and resource availability. Portugal's experience offers valuable insights—their expanded MAT programs contributed significantly to reductions in drug-related deaths and HIV infections (Transform Drug Policy Foundation, 2021; Wiessing et al., 2017). To overcome implementation barriers such as stigma, insufficient funding, and restrictive regulations, Poland should invest in public awareness campaigns, establish dedicated funding streams, reform regulations to facilitate easier establishment of treatment programs, and integrate telehealth where appropriate (SAMHSA, 2022a).

The inclusion of buprenorphine, naltrexone (both oral and long-acting injectable forms), and acamprosate in the National Health Fund reimbursement scheme is essential for comprehensive addiction treatment. These medications have received regulatory approval and demonstrated efficacy for opioid and alcohol use disorders (NIDA, 2023a; SAMHSA, 2024a; Jonas et al., 2014). Buprenorphine offers distinct advantages over methadone, including office-based prescribing and telehealth options, significantly enhancing accessibility (NIDA, 2023a; Monico et al., 2021). Naltrexone, which blocks the euphoric effects of opioids and reduces alcohol cravings, provides an important non-opioid treatment option (NIDA, 2023a; Anton et al., 2006). France's experience with liberalizing buprenorphine prescribing in the mid-1990s contributed to a significant increase in treatment uptake and subsequent reduction in overdose deaths, though this occurred alongside other public health measures (Auriacombe et al., 2004; Carrieri et al., 2006). Full reimbursement by Poland's National Health Fund would eliminate financial barriers, encouraging both uptake and adherence to these life-saving medications (Lee et al., 2018).

The development and regular updating of clear clinical guidelines based on WHO/UNODC international standards is crucial for ensuring quality care. These guidelines should be adapted to the Polish context while maintaining alignment with international best practices (WHO & UNODC, 2020). Clear protocols help standardize treatment, inform prescribing practices, and ensure that MAT is delivered safely and effectively, including for special populations such as pregnant women (SAMHSA, 2021a; Polish Society of Addiction Psychiatry, 2023). Equally important is comprehensive training for a multidisciplinary workforce—physicians, nurses, pharmacists, psychologists, and social workers—covering pharmacology, patient assessment, management of side effects, psychosocial components of MAT, trauma-informed care, and strategies to address stigma (SAMHSA, 2021b; Avery & Kertesz, 2021). Integrating addiction training into standard medical and healthcare education, with ongoing professional development opportunities, will help address the critical shortage of qualified providers (SAMHSA, 2023a; National Center for Addiction Studies Poland, 2023).

A robust national monitoring system is essential for tracking treatment access, quality, outcomes, and cost-effectiveness. Such a system should collect data on key indicators including treatment demand, retention rates, medication adherence, substance use reductions, improvements in health and social functioning, relapse rates, and overdose incidents (McLellan et al., 2000; EMCDDA, 2023b). Data should be systematically collected, disaggregated by demographic factors, and analyzed to identify disparities. The United Kingdom's National Drug Treatment Monitoring System offers a valuable model for service planning and quality improvement (Office for Health Improvement and Disparities, 2023). A similar system in Poland, aligned with European Monitoring Centre for Drugs and Drug Addiction indicators, would enable continuous quality improvement, demonstrate public health impact, and assess cost-effectiveness of investments (Zajac et al., 2021).

Develop Integrated Care Pathways (ICPs)

Integrated Care Pathways represent a structured approach to coordinating care across multiple services and providers. These multidisciplinary care plans detail essential steps in patient treatment, improving quality, efficiency, and coordination (Vanhaecht et al., 2006; Rotter et al., 2019). Research consistently demonstrates that ICPs improve outcomes for complex conditions like substance use disorders, particularly for individuals with co-occurring mental health disorders (Velasquez et al., 2015; NICE, 2016; Bartels et al., 2014).

Establishing formal coordination mechanisms between addiction services, mental health care, primary care, social services, and justice systems is fundamental to effective treatment. Individuals with substance use disorders typically present with complex needs spanning multiple domains (NIDA, 2023b). Formal mechanisms such as inter-agency agreements, shared care protocols, and integrated electronic health records—with robust privacy safeguards compliant with GDPR—facilitate communication and collaboration (SAMHSA, 2021c; WHO, 2018a). Models like Assertive Community Treatment demonstrate the benefits of integrated teams for individuals with severe mental illness (National Alliance on Mental Illness [NAMI], 2021). Countries such as Canada and Scotland have made significant progress in integrating mental health and addiction care (Ontario Health, 2022; Scottish Government, 2021). Co-locating services where feasible can further reduce access barriers and improve treatment engagement (SAMHSA, 2021c).

Care coordinators or patient navigators play a vital role in helping individuals navigate complex treatment systems. For people with substance use disorders, who often face multiple barriers to care, these professionals provide crucial support with appointments, transportation, benefits applications, inter-provider communication, and ongoing recovery support (Bradford et al., 2017). Research indicates that care coordination can improve treatment engagement, retention, and outcomes by 15-25% in some studies (Huskamp et al., 2018; Kilmer et al., 2020). The U.S. Department of Veterans Affairs has successfully implemented care coordination for veterans with substance use disorders (VA.gov, 2022). Funding these positions within the Polish healthcare system, potentially through the National Health Fund, would represent a strategic investment in improving treatment outcomes and system efficiency.

Implementing Screening, Brief Intervention, and Referral to Treatment (SBIRT) protocols across multiple settings offers a powerful opportunity for early identification and intervention. This evidence-based approach can identify problematic substance use before it progresses to severe addiction (SAMHSA, 2023b; Babor et al., 2007). The U.S. Preventive Services Task Force recommends screening for unhealthy alcohol use and providing brief interventions in primary care settings (USPSTF, 2018; USPSTF, 2020). Widespread implementation of SBIRT in Polish primary care, emergency departments, schools, and workplaces—supported by adequate funding, training, and clear referral pathways—could significantly increase early detection, prevent progression to severe substance use disorders, and reduce healthcare costs (Estee et al., 2010; Polish Primary Care Association, 2023). This approach serves as both a primary and secondary prevention strategy, potentially reducing the overall burden of addiction.

Specialized, integrated programs for patients with co-occurring mental health and substance use disorders are essential given the high prevalence of these conditions. Over 50% of individuals with severe mental illness also have a substance use disorder, and vice versa (NIDA, 2023b; NIMH, 2022; Kessler et al., 2005). SAMHSA's Treatment Improvement Protocols emphasize that integrated treatment is superior to sequential or parallel approaches (SAMHSA, 2020). Effective programs offer integrated assessment, treatment planning, and interventions delivered by clinicians trained in both mental health and addiction. This includes co-located services, multidisciplinary teams, and evidence-based therapies like Cognitive Behavioral Therapy or Dialectical Behavior Therapy adapted for co-occurring disorders (Drake et al., 2001; Kelly & Daley, 2013). Australia's national drug strategy explicitly supports integrated care for these complex conditions (Australian Government Department of Health and Aged Care, 2017). Significant investment in workforce development is necessary to build dual diagnosis capabilities throughout the treatment system (Minkoff & Cline, 2004).

Strengthen Community-Based Services and Recovery Support

A comprehensive addiction treatment system must balance institutional care with robust community-based services and recovery support. This approach improves accessibility, reduces stigma, facilitates long-term recovery, and enhances social reintegration.

Strategic reallocation of funding to expand outpatient treatment options is essential for creating a balanced service continuum. While inpatient treatment remains vital for certain patients, particularly those with severe addiction, medical complications, or unstable living situations, many individuals can be effectively treated in less intensive settings (McKay, 2009; Mayo-Wilson et al., 2014). Countries like the Netherlands and the United Kingdom have developed strong community-based addiction care systems that demonstrate the effectiveness of this approach (Trimbos Institute, 2022; Office for Health Improvement and Disparities, 2023). Poland should invest in a range of outpatient modalities, including intensive outpatient programs, regular outpatient counseling, day treatment, and telehealth services—which expanded significantly during the COVID-19 pandemic (SAMHSA, 2022a; Polish Telemedicine Society, 2023). A comprehensive needs assessment should guide this reallocation to ensure appropriate levels of care are available throughout the country.

Low-threshold services represent a critical entry point for individuals not yet ready or able to commit to abstinence-based treatment. These services embrace harm reduction principles while providing basic healthcare, psychosocial support, and pathways to more intensive treatment when appropriate (Harm Reduction International, 2022; Paquette et al., 2021). By meeting individuals "where they are" in their recovery journey, low-threshold services build trust and engagement with marginalized populations (Integration Academy AHRQ, 2023). New York State's funding of low-threshold buprenorphine services exemplifies this approach (OASAS NY, 2023). Switzerland's four-pillar policy successfully integrated low-threshold services into their comprehensive strategy, leading to significant public health improvements (Klingemann & Schmid, 2015; Federal Office of Public Health Switzerland, 2021). The cost-effectiveness of harm reduction in preventing infectious diseases and overdose deaths is well-established (Wilson et al., 2015).

Recovery community organizations and certified peer support programs provide invaluable complements to professional services. These independent, non-profit organizations led by people in recovery offer peer support, advocacy, and education that professional services alone cannot provide (SAMHSA, 2021d; White, 2009). Peer support specialists, drawing on their lived experience, offer unique empathy, hope, and practical guidance that improves engagement, reduces relapse, and enhances overall well-being (Bassuk et al., 2016; Reif et al., 2014; Pittman et al., 2021). Government support can include funding, technical assistance, establishing certification standards for peer workers, and creating policy frameworks that recognize their essential role in the treatment ecosystem (Association of Recovery Community Organizations, 2022). Incorporating perspectives from people with lived experience in service design and policy development ensures that systems are responsive to actual needs (NCDAS, 2023).

Housing First programs address the critical intersection between homelessness and substance use disorders. These conditions frequently co-occur and create significant barriers to recovery (NIDA, 2023b; Fazel et al., 2014). Housing First provides immediate access to permanent housing without requiring sobriety or treatment participation as preconditions, based on the principle that stable housing provides a foundation for addressing other issues (National Alliance to End Homelessness, 2021; Tsemberis, 2010). Numerous studies, including systematic reviews, demonstrate the effectiveness of Housing First in improving housing retention, reducing emergency service utilization, and enhancing health outcomes for individuals with substance use disorders and co-occurring conditions (Tsemberis et al., 2004; Padgett et al., 2016; Aubry et al., 2016). Finland's national Housing First strategy has achieved remarkable success in reducing homelessness (Yle News, 2022; Pleace & Culhane, 2021). Implementing similar programs in Poland, with integrated support services, could significantly improve outcomes for this vulnerable population.

Cross-Cutting Considerations

While treatment represents a critical component of addiction policy, prevention and early intervention must receive equal attention and investment. Evidence-based prevention strategies should target various age groups and risk factors, from universal prevention in schools to selective prevention for at-risk youth and indicated prevention for those showing early signs of substance use (NIDA, 2020; EMCDDA, 2021). These upstream interventions offer the greatest potential return on investment by preventing addiction before it develops.

Workforce development remains a fundamental challenge across addiction services. Beyond training in specific interventions, comprehensive strategies are needed for recruitment, retention, and ongoing professional development of addiction specialists, mental health professionals, primary care providers, and peer support workers (SAMHSA, 2022b; Polish Association of Addiction Therapists, 2023). Without adequate human resources, even the most well-designed policies cannot be effectively implemented.

Special populations require tailored approaches that address their unique needs and circumstances. Pregnant and parenting women (NIDA, 2022), adolescents (SAMHSA, 2023c), older adults (Kuerbis et al., 2014), LGBTQ+ individuals (Operario et al., 2015), and ethnic minorities or migrant populations all face distinct challenges in accessing and engaging with treatment. Culturally competent and accessible services must be developed to ensure equitable care for all populations (Polish Ministry of Health, 2024).

Legal and regulatory frameworks significantly impact access to care and recovery outcomes. While not the primary focus of these recommendations, addiction policy must consider how drug laws, employment protections for those in treatment, and other legal factors influence treatment-seeking behavior and recovery success. Some jurisdictions are exploring decriminalization or alternatives to incarceration for drug offenses, alongside investments in treatment (Hughes & Stevens, 2010; EMCDDA, 2023c).

Cost-effectiveness and sustainable funding underpin all policy recommendations. Each proposed intervention should be evaluated for its economic impact, with sustainable funding models established to ensure long-term success. This may involve diversified funding streams and demonstration of return on investment through reduced healthcare and social costs (Popovici et al., 2020; National Institute for Health and Care Excellence [NICE], 2011). By framing addiction treatment as an investment rather than merely an expense, policymakers can build broader support for comprehensive approaches.

Implementation Strategies and Financing

Successful implementation of evidence-based addiction treatment in Poland requires strategic planning, adequate financing, sustained political commitment, and careful consideration of the national context. The transition from current practices to a system rooted in scientific evidence is a complex undertaking, but one that promises significantly improved public health outcomes, reduced societal costs associated with addiction, and enhanced quality of life for individuals and families affected by substance use disorders (SUDs) (National Institute on Drug Abuse [NIDA], 2020).

The current landscape of addiction in Poland underscores the urgency for reform. According to the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), in 2021, Poland reported 281 drug-induced deaths (EMCDDA, 2023a). While this figure may appear modest compared to some European neighbors, each death represents a preventable tragedy and highlights the severe consequences of untreated or inadequately treated addiction. The EMCDDA (2023b) also notes that high-risk drug use, particularly involving opioids and stimulants, remains a significant public health concern across Europe, including Poland. Treatment outcomes are significantly improved when evidence-based practices are consistently applied (NIDA, 2020), and investing in such practices can lead to substantial returns, not only in health gains but also in economic terms (WHO Regional Office for Europe, 2022).

Understanding the Polish Context

Before detailing implementation strategies, it's crucial to acknowledge Poland's specific context. The Polish addiction treatment system has historically relied heavily on long-term residential, abstinence-based therapeutic community models, often with significant involvement from non-governmental and religious organizations (Room et al., 2010; Okulicz-Kozaryn & Sierosławski, 2019). While these approaches have provided valuable support for many individuals, there's a pressing need to integrate a broader range of evidence-based interventions, including harm reduction and Medication-Assisted Treatment (MAT), which have faced slower adoption due to philosophical and cultural factors (Krajowe Centrum Przeciwdziałania Uzależnieniom [KCPU], n.d.; Giza & Baranowska, 2021).

The Catholic Church and associated organizations play a substantial role in social services, including addiction support, and their perspectives and engagement are vital for any systemic reform (Pasek, 2018). Governance of addiction services primarily falls under the Ministry of Health, with the KCPU (formerly KBPN) playing a key coordinating and expert role. Funding has traditionally been a challenge, with a need for increased and more strategically allocated resources to support comprehensive, evidence-based approaches to addiction treatment and prevention.

Phased Implementation Approach

A phased implementation approach is crucial for managing the complexity of systemic change in addiction services. This approach allows for iterative learning, capacity building, stakeholder buy-in, and adaptation to the Polish context, mitigating risks associated with large-scale, rapid overhauls and ensuring that interventions are culturally adapted and contextually appropriate.

Phase 1 (Years 1-2): Foundation Building

The initial phase should focus on piloting evidence-based programs in selected regions that represent Poland's diverse demographics and existing service landscapes. These pilots would test the feasibility and effectiveness of specific evidence-based practices such as Medication-Assisted Treatment for opioid use disorder, Cognitive Behavioral Therapy, Motivational Interviewing, and community-based harm reduction services. Portugal's approach after decriminalizing drug use in 2001 provides an instructive model, as they initiated pilot "Commissions for the Dissuasion of Drug Addiction" which evolved based on early experiences and continuous evaluation (Transform Drug Policy Foundation, 2023).

Simultaneously, Poland should develop and disseminate national clinical guidelines based on international standards (e.g., World Health Organization [WHO], 2009; Substance Abuse and Mental Health Services Administration [SAMHSA], 2021) but meticulously adapted to the Polish healthcare system, cultural norms, and existing legal framework. The UK's National Institute for Health and Care Excellence (NICE) provides a strong model for developing evidence-based guidelines that could be emulated in the Polish context.

This phase must also include intensive training programs for healthcare professionals in pilot regions, covering both theoretical underpinnings and practical application of selected evidence-based practices, while addressing potential biases against certain treatments like MAT (Wakeman & Barnett, 2018). Extensive consultation with all stakeholders, including existing service providers, patient advocacy groups, policymakers, and community leaders is essential to identify potential barriers, foster collaboration, and ensure buy-in for the reform process (Aarons et al., 2011).

Phase 2 (Years 3-5): National Expansion

Based on rigorous evaluation of Phase 1 pilots, the second phase should systematically expand successful and culturally adapted evidence-based practice models across the country. This requires careful planning for resource allocation, infrastructure development (including outpatient facilities), and workforce expansion. Australia's national drug strategy, which involves coordinated efforts between federal and state governments and emphasizes partnership, provides a model for scaling up interventions effectively (Australian Government Department of Health and Aged Care, 2017).

A national, integrated data collection and monitoring system should be implemented to track key performance indicators such as treatment access, waiting times, treatment modality utilization, retention rates, relapse rates, patient-reported outcomes, and overdose incidents. This system should be capable of disaggregating data by region, demographic group, and treatment type to identify disparities and areas for improvement. The EMCDDA's framework for collecting standardized data across EU member states offers a valuable reference for key indicators that Poland could adopt and adapt.

This phase should also begin the gradual reallocation of resources to support comprehensive, integrated community-based services, including outpatient clinics, day programs, and services integrated with primary healthcare, mental health services, and social support systems. Countries like Canada have increasingly emphasized community-based mental health and addiction services to improve accessibility, reduce stigma, and provide holistic care (Mental Health Commission of Canada, 2022), an approach that aligns with SAMHSA's commitment to improving prevention, treatment, and recovery support services within community settings (SAMHSA, n.d.-a).

Phase 3 (Years 6-10): System Integration and Sustainability

The final phase should focus on fully integrating evidence-based practices into the national healthcare and social welfare systems, ensuring that they become standard practice across all addiction treatment settings. This integration must be supported by sustainable funding mechanisms, robust quality assurance processes, and continuous professional development for the addiction workforce.

Comprehensive evaluations of the long-term impact of the reforms on public health indicators (e.g., addiction prevalence, overdose deaths, HIV/HCV transmission rates related to drug use) and socio-economic factors (e.g., employment rates among individuals in recovery, healthcare cost savings, reduction in crime) should be conducted regularly. This continuous evaluation and quality improvement loop, informed by Polish-specific research, is critical for refining policies and practices over time (Proctor et al., 2009).

Financing Mechanisms

Sustainable financing is the bedrock of effective addiction policy. Without adequate and strategically allocated resources, even the best-laid implementation plans will falter. Poland must consider multiple approaches to ensure sufficient and sustainable funding for addiction services.

Poland's expenditure on "mental health and substance use disorders" as a share of current health expenditure was 3.4% in 2019 (OECD, 2021), with the specific SUD portion likely considerably lower. While precise, directly comparable EU averages for SUD-specific spending are difficult to obtain due to varying national accounting practices, several Western European countries with well-developed addiction services invest a more substantial portion of their health budgets in this area. For instance, specialized addiction care expenditure in the Netherlands was approximately €975 million in 2017 (Van Gils et al., 2019). Poland should commit to progressively increasing addiction-specific funding to a level commensurate with the burden of disease, potentially aiming for a dedicated 1-2% of the total healthcare budget specifically for SUDs, distinct from broader mental health allocations.

EU structural funds and programs like EU4Health and the European Social Fund Plus (ESF+) represent significant opportunities for financing the transition to evidence-based addiction services. The ESF+ aims to support Member States in tackling poverty, promoting social inclusion, and investing in education, skills, and lifelong learning (European Commission, n.d.-a), while the EU4Health programme (2021-2027) offers funding for improving health systems and addressing cross-border health threats, including those related to substance use (European Commission, n.d.-b). These funds could be strategically leveraged for training healthcare professionals, developing new community-based treatment facilities, supporting employment and social reintegration programs for individuals in recovery, and funding implementation research.

A public health levy on alcohol and potentially other unhealthy products, with a portion of revenues earmarked for addiction prevention and treatment, could generate a sustainable revenue stream independent of general budget fluctuations. Many jurisdictions use such hypothecated taxes to fund health initiatives. For example, several U.S. states earmark a portion of alcohol or tobacco taxes for substance abuse prevention and treatment programs (Campaign for Tobacco-Free Kids, 2023), and in the Philippines, the Sin Tax Reform Law of 2012 increased taxes on tobacco and alcohol, with a significant portion of the revenue allocated to universal healthcare (WHO, 2019). Such a levy in Poland could serve a dual purpose by potentially reducing consumption of these substances due to increased prices, a well-documented public health benefit (Chaloupka et al., 2019).

Value-based or performance-informed funding mechanisms that incentivize providers to implement evidence-based practices and achieve positive, patient-centered outcomes should also be explored. Performance-based contracting or value-based payment models can link financial incentives to the achievement of specific, measurable outcomes or the adoption of desired practices. Research suggests that such models can incentivize providers of substance abuse treatment to focus on client outcomes and quality of care, though careful design is crucial to avoid unintended consequences like "cream-skimming" or neglecting unmeasured aspects of care (Garnick et al., 2009; Conrad & Perry, 2019). The New Jersey Department of Human Services utilizes performance-based contracts for some treatment services (New Jersey Department of Human Services, n.d.-a), providing a potential model for adaptation in Poland.

Workforce Development

A skilled, motivated, and adequately sized workforce is essential for delivering high-quality, evidence-based addiction treatment. Current challenges in Poland often include shortages of specialized professionals, a need for updated training in modern evidence-based practices, and varying levels of recognition for addiction medicine and therapy as specialized fields.

Training curricula for all relevant health and social care professionals should be updated to include comprehensive, evidence-based addiction science and treatment modalities. Medical schools, nursing programs, psychology, social work, and specialized addiction counseling programs should integrate modules on addiction neuroscience, screening, brief intervention, and referral to treatment (SBIRT), as well as specific evidence-based practices. This includes in-depth training in MAT (methadone, buprenorphine, naltrexone), which is highly effective for opioid use disorders (WHO, 2009; SAMHSA, 2021), and psychosocial therapies like CBT, Motivational Interviewing, contingency management, and behavioral couples therapy (NIDA, 2020; Fals-Stewart et al., 2005). Training should also address stigma and promote person-centered care.

A tiered and integrated workforce model that includes peer support specialists, certified addiction counselors, and clinical specialists would address workforce needs and improve service accessibility. Peer support specialists—individuals with lived experience of addiction and recovery—can provide invaluable support, engagement, hope, and navigation assistance. Formalizing their roles, training, certification, and integration into treatment teams is a growing international best practice (SAMHSA, 2017; Davidson et al., 2012). Certified addiction counselors and therapists with specific addiction counseling certifications can deliver many psychosocial interventions, case management, and group therapy, often under clinical supervision. Clinical specialists, including physicians, clinical psychologists, and advanced practice nurses with specialized training in addiction medicine, are needed for diagnosis, complex case management, prescribing MAT, managing co-occurring disorders, and providing clinical leadership.

Financial and professional incentives for healthcare and social care professionals to specialize and work in addiction services, particularly in underserved areas, are essential for building and maintaining the workforce. These incentives could include loan repayment programs or scholarships for those who commit to working in addiction services or underserved regions, stipends for specialized training, enhanced remuneration or career development pathways for addiction specialists, and support for supervision and continuous professional development. Some European countries have successfully used financial incentives to encourage doctors to practice in underserved areas, a model adaptable for addiction specialists (Sagan et al., 2021).

Regional centers of excellence or academic partnerships could provide advanced training, consultation, implementation support, and promote research for providers implementing evidence-based practices. These centers would serve as hubs for advanced training programs, dissemination of best practices and research findings, consultation and mentorship for clinicians and programs, and conducting Polish-specific implementation research. This concept is similar to SAMHSA's Addiction Technology Transfer Centers in the U.S., which provide training and technical assistance on evidence-based practices (SAMHSA, n.d.-b).

Addressing Current and Emerging Challenges

Beyond the strategies outlined, successful implementation in Poland will require proactively addressing several key challenges. Deep-seated social stigma against people with SUDs can deter help-seeking, hinder recovery, and limit political will for robust investment and progressive policies (Livingston et al., 2012; Crapuchet et al., 2017). Public awareness campaigns and anti-stigma initiatives co-designed with people with lived experience are essential components of any comprehensive reform strategy.

While improving, there's a need for more comprehensive, real-time national data on SUD prevalence, treatment needs, service utilization, and outcomes to inform effective planning, resource allocation, and quality improvement (EMCDDA, 2023b). Strengthening Polish-led research in addiction is also vital for developing contextually appropriate interventions and policies.

SUDs frequently co-occur with other mental health conditions, and physical health comorbidities are common among people with addiction. Effective policy requires much better integration of addiction services with mental health care and general primary care systems, a global challenge that requires dedicated strategies and funding (WHO, 2018; Drake et al., 2001).

Policy changes of this magnitude require sustained political commitment across electoral cycles to ensure long-term funding, support for reforms, and adaptation based on evidence. Building broad cross-party and societal consensus is key to maintaining momentum for reform, regardless of political shifts.

Shifting from established treatment paradigms to a broader range of evidence-based practices, particularly those like MAT or harm reduction, may face resistance from some existing providers, policymakers, or segments of the public (Giza & Baranowska, 2021). Open dialogue, education, evidence-sharing, and involvement of champions from within the existing treatment community are crucial to navigate this potential resistance.

Finally, implementation plans must be resilient and adaptable to crises such as the COVID-19 pandemic, which disrupted addiction services globally while sometimes increasing substance use and mental health issues (SAMHSA, 2020; Marsden et al., 2020), or large-scale refugee influxes, such as that experienced by Poland from Ukraine, which can place additional strain on health and social services and may bring unique needs (Roberts et al., 2022).

By addressing these implementation strategies, financing mechanisms, and contextual challenges comprehensively, and by fostering a culture of continuous learning and adaptation informed by both international evidence and local expertise, Poland can significantly enhance its response to addiction, fostering a healthier and more productive society. A risk assessment and mitigation strategy should be integral to each phase of implementation, identifying potential obstacles and developing proactive solutions to ensure the successful transformation of addiction services across the country.

Monitoring, Evaluation, and Quality Assurance in Addiction Treatment

Implementing evidence-based addiction treatment requires robust systems for monitoring outcomes, evaluating program effectiveness, and ensuring quality of care. Without these mechanisms, it becomes virtually impossible to determine whether interventions achieve their intended goals, resources are being used efficiently, or how services can be improved. The global burden of substance use disorders underscores the urgency of establishing such systems. According to the United Nations Office on Drugs and Crime (UNODC), approximately 296 million people worldwide used drugs in 2021, with around 39.5 million suffering from drug use disorders (UNODC, 2023, p. 8). Effective Monitoring and Evaluation (M&E) and Quality Assurance (QA) are vital to addressing this challenge, particularly as the landscape continues to evolve due to factors like the COVID-19 pandemic and advancements in digital health technologies (Oprescu et al., 2020).

Outcome Monitoring Systems: The Foundation of Evidence-Based Practice

A comprehensive outcome monitoring system serves as the cornerstone for tracking individual progress in treatment, assessing service effectiveness, and identifying improvement opportunities. Such systems must move beyond simple output measures, such as the number of clients served, to focus on meaningful changes in clients' lives. To ensure relevance and utility, these systems should be designed with input from diverse stakeholders, including individuals with lived experience of addiction and recovery (Rush & Stevens, 2012).

National addiction treatment outcomes monitoring systems should track several key indicators. Treatment retention rates represent a critical metric, as longer retention consistently correlates with better long-term outcomes—a finding established in earlier research (Simpson et al., 1997) and supported by more recent systematic reviews (Brorson et al., 2013). For example, studies indicate that retention in opioid agonist treatment for at least 12 months significantly improves outcomes (WHO, 2009), with more recent evidence continuing to affirm the critical role of retention across various treatment modalities (Timko et al., 2016).

Reduction in substance use constitutes another primary goal of treatment. Systems like the Partners for Change Outcome Management System (PCOMS), which employs ultra-brief scales, can routinely measure treatment response, including substance use patterns (Miller et al., 2005; Duncan et al., 2010). While PCOMS was developed some time ago, its principles of routine outcome monitoring and feedback remain highly relevant (Recovery Answers, n.d.). Telephone-based recovery management can also provide a simplified method for routine outcome monitoring post-treatment (McKay et al., 2014).

Improvements in physical and mental health represent essential indicators given the high prevalence of co-occurring conditions. SAMHSA's National Survey on Drug Use and Health for 2022 found that 48.5 million adults had both any mental illness and a substance use disorder in the past year, while 19.4 million adults had a serious mental illness and an SUD (SAMHSA, 2023a, p. 45, p.48). Monitoring improvements in both domains is therefore critical to comprehensive care.

Social functioning and quality of life indicators—including employment, housing stability, family relationships, and legal involvement—provide crucial insights into recovery progress. Improved social functioning serves as a key indicator of recovery and is often included in comprehensive outcome monitoring (Neale & Strang, 2015). Patient-Reported Outcome Measures (PROMs) are increasingly recognized as vital for capturing these broader aspects of recovery beyond abstinence (Carlier et al., 2012).

Cost-effectiveness of interventions must also be tracked to demonstrate value for money and secure ongoing public and private investment in addiction treatment. Research has consistently shown that addiction treatment can be highly cost-effective, with every dollar invested potentially saving society significantly more in drug-related crime, criminal justice costs, and theft (National Institute on Drug Abuse [NIDA], 2020). More recent analyses continue to support the economic benefits of investing in SUD treatment (Gorry, 2021).

Different countries have implemented varying approaches to outcome monitoring. While the United States lacks a single, unified national system, SAMHSA collects data through the Treatment Episode Data Set (TEDS) and NSDUH, providing valuable insights. Some states have developed more comprehensive outcome monitoring systems, though the widespread adoption of systems like PCOMS is encouraged but not universally mandated (Recovery Answers, n.d.). The United Kingdom's National Drug Treatment Monitoring System collects detailed data from individuals in treatment, including substance use, health, and social functioning indicators, allowing for robust national-level analysis (Office for Health Improvement and Disparities, 2023). Australia funds the National Minimum Data Set for Alcohol and Other Drug Treatment Services, which collects core data items from publicly funded treatment services, enabling national reporting on client characteristics and treatment episodes (Australian Institute of Health and Welfare [AIHW], 2023).

Low and Middle-Income Countries (LMICs) face significant challenges in establishing comprehensive M&E systems due to resource constraints, lack of trained personnel, and underdeveloped health information infrastructure (Saxena et al., 2007; Eaton et al., 2011). However, initiatives by organizations like the UNODC and WHO aim to support capacity building for data collection and M&E in these regions, sometimes adapting simplified tools and leveraging mobile technology (UNODC, n.d.; WHO, 2017). Vietnam, for example, has worked on strengthening its drug treatment monitoring with international support (UNODC, 2019).

To ensure comprehensive data collection, all publicly funded treatment providers should be required to participate in outcomes monitoring systems as a condition of funding. Such mandates create strong incentives for adoption and are increasingly being applied to addiction treatment. In England, participation in the National Drug Treatment Monitoring System is effectively a requirement for services receiving public funds (Office for Health Improvement and Disparities, 2023). This approach helps standardize data collection and allows for meaningful comparisons across providers, though care must be taken to ensure data quality and avoid perverse incentives (Bird et al., 2005).

Annual reports on system performance should be published to promote transparency and continuous improvement. Public reporting drives quality improvement by allowing providers to benchmark their performance, enabling policymakers to make informed decisions, and empowering service users to choose providers. This aligns with principles of accountability in healthcare (Greener et al., 2021). The Australian Institute of Health and Welfare regularly publishes reports based on National Minimum Data Set data, providing transparency on treatment service activity (AIHW, 2023).

Digital Health Technologies and Equity Considerations

The integration of digital health technologies and Electronic Health Records (EHRs) offers significant potential for enhancing outcome monitoring. EHRs can facilitate standardized data collection, real-time tracking of patient progress, and improved care coordination (Kim et al., 2017). However, several challenges must be addressed, including interoperability between different systems, data security concerns, the digital divide limiting access for vulnerable populations, and implementation costs (Quanbeck, 2019).

Patient-Reported Outcome Measures are crucial for capturing the patient's perspective on their health, quality of life, and treatment effectiveness (Carlier et al., 2012). Integrating PROMs into routine care and M&E systems ensures that treatment goals align with patient priorities and that a broader range of recovery indicators are tracked beyond abstinence alone (Neale & Strang, 2015). The COVID-19 pandemic accelerated the use of telehealth and other digital tools, which can also facilitate remote PROM collection (Oprescu et al., 2020; Rodriguez-Villa et al., 2021).

M&E systems must be designed and implemented with a strong focus on equity. This involves collecting data on key demographic and social determinants of health to identify disparities in access, treatment quality, and outcomes among different population groups based on race, ethnicity, gender, socioeconomic status, and geographic location (SAMHSA, 2020). Systems should not only identify these disparities but also provide data to inform targeted interventions to address them. Without careful design, M&E systems risk perpetuating existing inequities or masking the needs of marginalized communities (Purtle et al., 2020).

The collection, storage, and use of sensitive personal health information in addiction treatment monitoring systems raise significant privacy, confidentiality, and ethical concerns. Robust data governance frameworks, compliant with regulations such as HIPAA in the U.S. or GDPR in Europe, are essential (U.S. Department of Health & Human Services, n.d.; European Commission, n.d.). This includes ensuring informed consent for data collection, employing strong data security measures, using de-identified data for research and reporting where possible, and establishing clear protocols for data access and sharing to prevent misuse and build trust among service users (Gostin & Hodge, 2002).

Quality Standards and Accreditation: Ensuring Excellence in Care

Establishing and enforcing quality standards through accreditation ensures that addiction treatment services are safe, effective, and evidence-based. National quality standards should be developed based on international best practices and scientific evidence, covering aspects such as assessment, treatment planning, use of evidence-based practices, staff qualifications and training, patient rights, facility safety, and continuity of care. Organizations like SAMHSA provide resources and guidelines that can inform such standards. Internationally, the World Health Organization and UNODC have published "International Standards for the Treatment of Drug Use Disorders" which provide a framework for quality services (WHO & UNODC, 2020). These standards should be developed with input from all stakeholders, including service users and families, to ensure they are relevant and comprehensive.

An accreditation system for treatment providers assesses adherence to quality standards. Accreditation bodies like CARF International (CARF, n.d.-a) and The Joint Commission (The Joint Commission, n.d.-a) offer specialized accreditation for addiction treatment facilities. According to SAMHSA's 2022 National Survey of Substance Abuse Treatment Services, 31.1% of substance use treatment facilities in the U.S. reported having no accreditation (SAMHSA, 2023b, p. 19), highlighting a significant portion of services where quality may not be externally verified against national benchmarks.

Accreditation approaches vary significantly across countries. In the United States, accreditation by CARF or The Joint Commission is common but not universally mandated for all types of funding or licensure in every state. In Canada, accreditation is largely voluntary, though often encouraged or required for certain funding streams, with Accreditation Canada providing standards for addiction services (Accreditation Canada, n.d.). The European Union lacks a unified EU-wide accreditation system for addiction treatment; approaches vary significantly by member state, with some countries having well-developed national systems while others have less formal oversight. Formal accreditation systems for addiction treatment are less common in LMICs, where efforts often focus on developing basic quality standards and building capacity for their implementation, sometimes with support from international organizations (WHO & UNODC, 2020).

Linking accreditation status to funding eligibility can incentivize quality improvement. Making accreditation a prerequisite for receiving public funds or insurance reimbursement can significantly drive uptake of quality standards. Evidence from other healthcare sectors suggests that such financial incentives can influence provider behavior (Conrad & Perry, 2009), although careful design is needed to avoid unintended consequences, such as providers avoiding complex cases to meet performance targets.

Regular site visits and audits are necessary to ensure ongoing compliance with standards and to identify areas where providers may need support or corrective action (The Joint Commission, n.d.-b). This helps maintain the integrity of the accreditation system and fosters a culture of continuous quality improvement.

While accreditation aims to improve quality, it is not without criticism. Concerns include the significant administrative burden and cost associated with achieving and maintaining accreditation, which can be particularly challenging for smaller or less-resourced providers (Greenfield & Greener, 2019). There is also debate about whether accreditation always leads to meaningful improvements in patient outcomes or if it sometimes results in a focus on documentation rather than substantive quality enhancement (Nicklin et al., 2017). Ensuring that standards are evidence-based, regularly updated, and genuinely reflect best practices is crucial.

Incorporating the perspectives of people with lived and living experience of substance use and recovery is essential in developing, implementing, and evaluating quality standards (NCDHHS, 2022). Their insights can ensure that standards address what truly matters to service users, promote person-centered care, and foster environments that are respectful, empowering, and conducive to recovery.

Research and Innovation: Advancing the Field

A commitment to research and innovation is vital for the addiction treatment field to evolve, adapt to new challenges, and improve outcomes. Allocating a dedicated portion of the addiction treatment budget to research and innovation ensures that research is an integral part of the treatment system. Such investment can support studies on new interventions, implementation strategies, and understanding the neurobiology of addiction. Countries with strong research outputs often have dedicated national funding mechanisms, like NIDA in the US (NIDA, n.d.-a).

Establishing partnerships between treatment providers and academic institutions facilitates implementation research. There is often a significant gap between what is known from research (evidence-based practices) and what is delivered in routine care. Implementation research focuses on how to best adopt and sustain EBPs in real-world settings (Proctor et al., 2011). A systematic review found that only a minority of providers may offer certain evidence-based treatments, such as addiction medications or specific psychosocial therapies (Garner, 2013). Partnerships can help bridge this gap, as highlighted by the Journal of Substance Use and Addiction Treatment's emphasis on the importance of addiction treatment implementation research (Elsevier, 2024).

Creating a national addiction research network can coordinate studies and disseminate findings, preventing duplication of effort, facilitating larger multi-site trials, and ensuring that research questions are relevant to the needs of providers and policymakers. NIDA's Clinical Trials Network in the U.S. exemplifies such a network, bringing together researchers, treatment providers, and patients to develop and test interventions in community settings (NIDA, n.d.-b).

Developing mechanisms for rapidly translating research findings into practice requires active dissemination strategies, development of user-friendly clinical guidelines, and ongoing training and technical assistance for treatment providers. The call for papers by JSAT on Implementation Science in Addiction Treatment underscores the need for research in this area (CTN Library, 2023). Telehealth represents an innovation where research rapidly evolved during and after the COVID-19 pandemic, leading to updated best practices for its implementation in addiction treatment (Oprescu et al., 2020; Rodriguez-Villa et al., 2021; Gordon et al., 2023).

While evidence-based practices form the cornerstone of quality treatment, their effectiveness can be enhanced through cultural adaptation for diverse populations (Laird, 2023). Research is needed to understand how to best adapt interventions to meet the unique needs of various cultural, ethnic, and demographic groups, ensuring that treatments are not only evidence-based but also culturally sensitive and relevant.

The COVID-19 pandemic significantly impacted addiction treatment research and innovation. It disrupted traditional research activities but also catalyzed rapid innovation, particularly in telehealth and digital health interventions (NIDA, 2021). The pandemic underscored the need for agile research systems capable of responding quickly to emerging crises and for innovative approaches to treatment delivery and monitoring.

Current Challenges in Addiction Policy Implementation

Several significant challenges impede effective implementation of monitoring, evaluation, and quality assurance in addiction treatment. Many countries face substantial underfunding for addiction treatment, limiting access and the ability to implement comprehensive M&E and QA systems (Volkow et al., 2021). Workforce shortages and training gaps persist globally, despite the fact that a well-trained workforce is essential for delivering evidence-based practices and participating in M&E activities (SAMHSA, 2021).

Stigma surrounding addiction continues to deter individuals from seeking treatment and affects policy priorities, funding allocation, and willingness to participate in monitoring efforts (Livingston et al., 2012). Data fragmentation and interoperability issues, including lack of standardized data collection methods and interoperable IT systems, hinder effective national outcome monitoring and the utility of electronic health records (Kim et al., 2017; Quanbeck, 2019).

The implementation gap between research findings and routine clinical practice remains a persistent challenge (Garner, 2013; Proctor et al., 2011). The complexity of substance use disorders, which often co-occur with mental and physical health issues, requires integrated care approaches that can be complex to monitor and evaluate (SAMHSA, 2023a). Research evaluating treatment effectiveness can be affected by survival bias, where patients who remain in treatment longer may inherently have better prognoses, potentially overstating treatment effects if not properly accounted for (Vielot et al., 2005).

Historically, M&E systems and quality standards have often been designed without adequate input from people with lived and living experience, potentially leading to a mismatch between what is measured and what truly matters for recovery (Rush & Stevens, 2012). Balancing the need for standardized data for national comparisons and accountability with the need for flexibility to adapt to local contexts and diverse populations represents an ongoing challenge (Forman-Hoffman et al., 2017). Public health emergencies like COVID-19 can disrupt service delivery, data collection, and M&E processes, requiring systems to be resilient and adaptable (NIDA, 2021).

By addressing these challenges and investing in robust monitoring, evaluation, quality assurance, research, and innovation—with a commitment to equity, patient-centeredness, and ethical practice—addiction policy can lead to more effective, efficient, and equitable treatment systems. This comprehensive approach ultimately improves outcomes for individuals, families, and communities affected by substance use disorders, transforming lives and strengthening public health systems worldwide.

Conclusion

Poland stands at a critical juncture in addressing its substantial burden of substance use disorders. The current system, characterized by an overreliance on abstinence-only approaches, limited access to medication-assisted treatment, fragmented service delivery, and insufficient community-based options, fails to meet the needs of most individuals requiring addiction treatment. This policy analysis has demonstrated that evidence-based reforms could dramatically improve outcomes while potentially reducing long-term societal costs.

The international evidence is clear: comprehensive approaches that integrate medication-assisted treatment, psychosocial interventions, harm reduction strategies, and recovery support services yield superior results compared to narrower treatment paradigms. Countries that have embraced this evidence-based approach, including Germany, Portugal, and the Czech Republic, have achieved significant improvements in treatment engagement, reduced overdose deaths, and better social outcomes.

Reforming Poland's addiction treatment system requires a multifaceted approach that addresses structural, financial, and cultural barriers to evidence-based care. Expanding access to medications for opioid and alcohol use disorders represents an urgent priority, as these interventions have consistently demonstrated effectiveness in reducing substance use, improving treatment retention, and preventing overdose deaths. Equally important is developing integrated care pathways that address the complex needs of individuals with substance use disorders, particularly those with co-occurring mental health conditions. Strengthening community-based services and recovery support will improve accessibility, reduce stigma, and support long-term recovery.

Implementation must be strategic and phased, beginning with pilot programs in selected regions and gradually expanding successful models nationwide. Sustainable financing mechanisms, including increased healthcare budget allocation, EU structural funds, and innovative funding approaches, will be essential for long-term success. Workforce development must address both the quantity and quality of addiction specialists through updated training curricula, a tiered workforce model, and incentives for practice in underserved areas.

Throughout implementation, robust monitoring and evaluation systems must track outcomes, identify disparities, and drive continuous quality improvement. Quality standards and accreditation processes will ensure that services meet international best practices while being adapted to the Polish context. Ongoing research and innovation will help the system evolve in response to emerging challenges and opportunities.

Perhaps most importantly, these reforms must center the experiences and perspectives of people affected by substance use disorders. Their involvement in service design, policy development, and evaluation is essential for creating a system that truly meets their needs and supports their recovery journeys.

The path forward will not be without challenges. Stigma, resource constraints, workforce limitations, and resistance to change will require persistent effort to overcome. However, the potential benefits—improved health outcomes, reduced social costs, and enhanced quality of life for individuals and families affected by addiction—make this transformation both necessary and worthwhile.

By embracing evidence-based approaches, strengthening community-based services, and investing in a comprehensive continuum of care, Poland can build an addiction treatment system that effectively addresses the complex nature of substance use disorders and supports individuals throughout their recovery journey. The time for reform is now, and the roadmap provided in this policy paper offers a clear path toward a more effective, compassionate, and evidence-based response to addiction in Poland.

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