Cognitive-behavioural treatment for amphetamine-type stimulants (ATS)-use disorders
Open accessAbstract
BACKGROUND: Amphetamine-type stimulants (ATS) refer to a group of synthetic stimulants including amphetamine, methamphetamine, 3,4-methylenedioxy-methamphetamine (MDMA) and related substances. ATS are highly addictive and prolonged use may result in a series of mental and physical symptoms including anxiety, confusion, insomnia, mood disturbances, cognitive impairments, paranoia, hallucinations and delusion.Currently there is no widely accepted treatment for ATS-use disorder. However, cognitive-behavioural treatment (CBT) is the first-choice treatment. The effectiveness of CBT for other substance-use disorders (e.g. alcohol-, opioid- and cocaine-use disorders) has been well documented and as such this basic treatment approach has been applied to the ATS-use disorder. OBJECTIVES: To investigate the efficacy of cognitive-behavioural treatment for people with ATS-use disorder for reducing ATS use compared to other types of psychotherapy, pharmacotherapy, 12-step facilitation, no intervention or treatment as usual. SEARCH METHODS: We identified randomised controlled trials (RCT) and quasi-RCTs comparing CBT for ATS-use disorders with other types of psychotherapy, pharmacotherapy, 12 step facilitation or no intervention. We searched the Cochrane Drugs and Alcohol Group Specialised Register, Cochrane Central Register of Controlled Trials, MEDLINE via PubMed, Embase and five other databases up to July 2018. In addition, we examined reference lists of eligible studies and other systematic reviews. We contacted experts in the field. SELECTION CRITERIA: Eligibility criteria consisted of RCTs and quasi-RCTs comparing CBT versus other types of interventions with adult ATS users (aged 18 years or older) diagnosed by any explicit diagnostic system. Primary outcomes included abstinence rate and other indicators of drug-using behaviours. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. MAIN RESULTS: Only two studies met the eligibility criteria. Both studies were at low risk of selection bias and reporting bias. In one study, almost half of participants in the intervention group dropped out and this study was at high risk of attrition bias. The studies compared a single session of brief CBT or a web-based CBT to a waiting-list control (total sample size across studies of 129). Results were mixed across the studies. For the single-session brief CBT study, two out of five measures of drug use produced significant results, percentage of abstinent days in 90 days (odds ratio (OR) 0.22, 95% confidence interval (CI) 0.02 to 2.11) and dependence symptoms (standardised mean difference (SMD) -0.59, 95% CI -1.16 to -0.02). Little confidence could be placed in the results from this study give the small sample size (25 participants per group) and corresponding large CIs around the observed effects. For the web-based CBT, there was no significant difference across different outcomes. Neither study reported adverse effects. The meta-analytic mean across these two trials for drug use was not significant (SMD -0.28, 95% CI -0.69 to 0.14). In summary, overall quality of evidence was low and there was insufficient evidence to conclude that CBT is effective, or ineffective, at treating ATS use. AUTHORS' CONCLUSIONS: Currently, there is not enough evidence to establish the efficacy of CBT for ATS-use disorders because of a paucity of high-quality research in this area.
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Evidence-based strategies including contingency management, cognitive-behavioral therapy, dialectical behavior therapy, motivational interviewing, acceptance and commitment therapy, and family-based interventions have demonstrated effectiveness in reducing substance use and enhancing treatment outcomes.
“Evidence-based strategies, including contingency management (CM), cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT), motivational interviewing (MI), acceptance and commitment therapy (ACT), and family-based interventions, have demonstrated their effectiveness in reducing substance use and enhancing treatment outcomes”
From Navigating the Complex Intersection of Substance Use and Psychiatric Disorders: A Comprehensive Review (2024) · cites this paper as [47]
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredCochrane reviews have consistently highlighted the insufficiency of evidence to establish the effectiveness of certain psychotherapies for various SUDs, whether accompanied by comorbidity or not.
“Cochrane reviews have consistently highlighted the insufficiency of evidence to establish the effectiveness of certain psychotherapies for various SUDs, whether accompanied by comorbidity or not.”
From Navigating the Complex Intersection of Substance Use and Psychiatric Disorders: A Comprehensive Review (2024) · cites this paper as [47]
The Authors’ Conclusions (page unavailable) state that evidence is insufficient to support CBT’s efficacy for amphetamine-type stimulant use disorders. The review does not establish the broader claim about various substance-use disorders, psychotherapies generally, or effectiveness with and without comorbidity; it describes studies of people with co-occurring disorders as excluded. (LLM, conf=0.86)
Experimental — accuracy not yet measuredHigh-quality research regarding the effectiveness of CBT in the treatment of stimulant use disorders is inadequate.
“An example of this shortfall is the inadequacy of high-quality research regarding the effectiveness of CBT in the treatment of stimulant use disorders [47,48,58].”
From Navigating the Complex Intersection of Substance Use and Psychiatric Disorders: A Comprehensive Review (2024) · cites this paper as [47]
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- Authors
- Harada, T., Tsutomi, H., Mori, R., & Wilson, D. B.
- Affiliations
- Mejiro University (JP)
- Shizuoka University (JP)
- National Center For Child Health and Development (JP)
- George Mason University (US)
- Venue
- Cochrane Database of Systematic Reviews
- Publisher
- Wiley
- Published
- 2018-12-22
- Volume
- 2018
- Issue
- 12
- Pages
- CD011315-CD011315
- ISSN
- 1361-6137 (ISSN-L)
- 1465-1858
- PMC
- PMC6516990
- OpenAlex
- W1816695864
- Cited by
- 76
- References
- 81
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 7 · 2023: 18 · 2022: 7 · 2021: 15 · 2020: 14 · 2019: 4 · 2017: 2 · 2016: 2 · 2015: 1
- FWCI
- 1.18
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Cochrane Database of Systematic Reviews (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Japan Agency for Medical Research and Development
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Forensic Toxicology and Drug Analysis
- Keywords
- cognitive-behavioral intervention, amphetamine-type stimulants, stimulant use disorder, methamphetamine, MDMA, abstinence, treatment efficacy, psychotherapy comparison, pharmacotherapy, 12-step facilitation, substance use disorders, attrition bias, dropout, medication adherence, relapse, treatment acceptability
- MeSH terms
- Adult, Amphetamines, Female, Humans, Male, Patient Dropouts, Waiting Lists, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Sample Size, Amphetamine-Related Disorders
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