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Cited by 32Substance Abuse Treatment and OutcomesOpioid Use Disorder TreatmentHIV, Drug Use, Sexual Risk

Psychosocial interventions for stimulant use disorder

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Minozzi, Silvia, Saulle, Rosella, Amato, Laura, Traccis, Francesco, Agabio, Roberta·2024·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd011866.pub3PMC PMC10867898
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Abstract

BACKGROUND: Stimulant use disorder is a continuously growing medical and social burden without approved medications available for its treatment. Psychosocial interventions could be a valid approach to help people reduce or cease stimulant consumption. This is an update of a Cochrane review first published in 2016. OBJECTIVES: To assess the efficacy and safety of psychosocial interventions for stimulant use disorder in adults. SEARCH METHODS: We searched the Cochrane Drugs and Alcohol Group Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, three other databases, and two trials registers in September 2023. All searches included non-English language literature. We handsearched the references of topic-related systematic reviews and the included studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs) comparing any psychosocial intervention with no intervention, treatment as usual (TAU), or a different intervention in adults with stimulant use disorder. DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures expected by Cochrane. MAIN RESULTS: We included a total of 64 RCTs (8241 participants). Seventy-three percent of studies included participants with cocaine or crack cocaine use disorder; 3.1% included participants with amphetamine use disorder; 10.9% included participants with methamphetamine use disorder; and 12.5% included participants with any stimulant use disorder. In 18 studies, all participants were in methadone maintenance treatment. In our primary comparison of any psychosocial treatment to no intervention, we included studies which compared a psychosocial intervention plus TAU to TAU alone. In this comparison, 12 studies evaluated cognitive behavioural therapy (CBT), 27 contingency management, three motivational interviewing, one study looked at psychodynamic therapy, and one study evaluated CBT plus contingency management. We also compared any psychosocial intervention to TAU. In this comparison, seven studies evaluated CBT, two contingency management, two motivational interviewing, and one evaluated a combination of CBT plus motivational interviewing. Seven studies compared contingency management reinforcement related to abstinence versus contingency management not related to abstinence. Finally, seven studies compared two different psychosocial approaches. We judged 65.6% of the studies to be at low risk of bias for random sequence generation and 19% at low risk for allocation concealment. Blinding of personnel and participants was not possible for the type of intervention, so we judged all the studies to be at high risk of performance bias for subjective outcomes but at low risk for objective outcomes. We judged 22% of the studies to be at low risk of detection bias for subjective outcomes. We judged most of the studies (69%) to be at low risk of attrition bias. When compared to no intervention, we found that psychosocial treatments: reduce the dropout rate (risk ratio (RR) 0.82, 95% confidence interval (CI) 0.74 to 0.91; 30 studies, 4078 participants; high-certainty evidence); make little to no difference to point abstinence at the end of treatment (RR 1.15, 95% CI 0.94 to 1.41; 12 studies, 1293 participants; high-certainty evidence); make little to no difference to point abstinence at the longest follow-up (RR 1.22, 95% CI 0.91 to 1.62; 9 studies, 1187 participants; high-certainty evidence); probably increase continuous abstinence at the end of treatment (RR 1.89, 95% CI 1.20 to 2.97; 12 studies, 1770 participants; moderate-certainty evidence); may make little to no difference in continuous abstinence at the longest follow-up (RR 1.14, 95% CI 0.89 to 1.46; 4 studies, 295 participants; low-certainty evidence); reduce the frequency of drug intake at the end of treatment (standardised mean difference (SMD) -0.35, 95% CI -0.50 to -0.19; 10 studies, 1215 participants; high-certainty evidence); and increase the longest period of abstinence (SMD 0.54, 95% CI 0.41 to 0.68; 17 studies, 2118 participants; high-certainty evidence). When compared to TAU, we found that psychosocial treatments reduce the dropout rate (RR 0.79, 95% CI 0.65 to 0.97; 9 studies, 735 participants; high-certainty evidence) and may make little to no difference in point abstinence at the end of treatment (RR 1.67, 95% CI 0.64 to 4.31; 1 study, 128 participants; low-certainty evidence). We are uncertain whether they make any difference in point abstinence at the longest follow-up (RR 1.31, 95% CI 0.86 to 1.99; 2 studies, 124 participants; very low-certainty evidence). Compared to TAU, psychosocial treatments may make little to no difference in continuous abstinence at the end of treatment (RR 1.18, 95% CI 0.92 to 1.53; 1 study, 128 participants; low-certainty evidence); probably make little to no difference in the frequency of drug intake at the end of treatment (SMD -1.17, 95% CI -2.81 to 0.47, 4 studies, 479 participants, moderate-certainty ev

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  1. [5]5. Mimiaga 2019 ? ? -+ ? Mitcheson 2007 ? --+ ? + Parsons 2018 + ? -+ ? Peirce 2006 + -+ ? -? Petitjean 2014 + -+ ? Petry 2005a -+ ? Petry 2005b -Petry 2007 + ? -+ ? 2013 Informed decisions. Better health. Cochrane Database of Systematic Reviews summary of findings tables. Journal of Clinical Epidemiology 2011;64(4):383-94.
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Authors
Minozzi, S., Saulle, R., Amato, L., Traccis, F., & Agabio, R.
Affiliations
  • Regione Lazio (IT)
  • University of Cagliari (IT)
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2024-02-15
Volume
2024
Issue
2
Pages
CD011866-CD011866
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd011866.pub3
PMC
PMC10867898
OpenAlex
W4391840511
Cited by
32
References
280
Citations by year
2026: 6 · 2025: 19 · 2024: 6 · 2019: 1
FWCI
2.04
Type
journal article
Language
en
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • UNICA IRIS Institutional Research Information System (University of Cagliari) (submittedVersion)
Funders
  • National Institutes of Health (AA03510)
  • National Institute on Drug Abuse (DA09241., P50DA009241, P50-DA-0-9241, R01DA013444)
  • National Center for Research Resources (M01RR006192)
Topics
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
  • Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
Keywords
stimulant use disorder, psychosocial interventions, cocaine dependence, crack cocaine, amphetamine use disorder, methamphetamine, cognitive behavioral therapy, contingency management, motivational interviewing, psychodynamic psychotherapy, methadone maintenance treatment, treatment efficacy, treatment safety, relapse, treatment discontinuation, medication adherence, treatment acceptability
MeSH terms
Psychosocial Intervention, Adult, Counseling, Humans, Cognitive Behavioral Therapy, Substance-Related Disorders, Motivational Interviewing

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