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Cited by 12Substance Abuse Treatment and OutcomesMental Health Treatment and AccessOpioid Use Disorder Treatment

Systematic review of the efficacy, effectiveness, and cost-effectiveness of stepped-care interventions for the prevention and treatment of problematic substance use

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Morse, Ashleigh K., Sercombe, Jayden, Askovic, Mina, Fisher, Alana, Marel, Christina, Chatterton, Mary-Lou, Kay-Lambkin, Frances, Barrett, Emma +5 more·2023·Journal of Substance Abuse Treatment
DOI 10.1016/j.jsat.2022.108928
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Abstract

BACKGROUND: Stepped-care is a commonly recommended and implemented care model across health care domains, including substance use. Despite their presumed efficient allocation of treatment resources, a current and robust evidence synthesis is needed on the efficacy, effectiveness and cost-effectiveness of stepped-care for substance use. METHODS: This systematic review analyzed articles describing evaluations of stepped-care models that measured the use of acutely psychoactive substances (i.e., alcohol, cannabis, hallucinogens, inhalants, opioids, sedatives, hypnotics, anxiolytics, and stimulants) as a primary or secondary outcome, in participants over 18 years old. The analysis investigated model and participant characteristics associated with treatment outcomes. RESULTS: The study team conducted a search of five databases of literature (PsychINFO, MEDLINE, Embase, Cochrane Library and Scopus) published between January 1, 2010, and November 1, 2020. The search yielded 1051 unique articles, 19 of which were included in the analysis. The studies had considerable variability in sample sizes (n = 18-2310), time to follow-up (4.5 months to 3 years), and retention rates (35.1-100 %). Studies examined outcomes for either alcohol alone (n = 9), alcohol and other drug use (n = 9), or drug use alone (n = 1). Most studies (n = 13;) were rated as good quality. Three (15.8 %) were rated as fair and three (15.8 %) were rated as poor quality. The evidence regarding the efficacy, effectiveness and cost-effectiveness of stepped-care approaches is limited, but four of seven studies found that adaptive-care interventions delivered in the context of other systemic interventions produced greater benefit than control conditions in relation to at least one alcohol-related outcome. We have insufficient evidence to determine whether the modes or intensity of interventions included in the models, or decision rules used to step people up or down to differing levels of care, have an impact on outcome. CONCLUSION: Heterogeneity between studies with regard to model and evaluation design limited the degree to which the analysis could draw robust conclusions. Sample recruitment and statistical power are particular challenges, and the field needs more innovative evaluation designs to assess the efficacy, effectiveness, and cost-effectiveness of stepped-care models.

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Authors
Morse, A. K., Sercombe, J., Askovic, M., Fisher, A., Marel, C., Chatterton, M.-L., Kay-Lambkin, F., Barrett, E., Sunderland, M., Harvey, L., Peach, N., Teesson, M., & Mills, K. L.
Affiliations
  • The University of Sydney (AU)
  • Deakin University (AU)
ORCID
Venue
Journal of Substance Abuse Treatment
Publisher
Elsevier BV
Published
2023-01
Volume
144
Pages
108928
ISSN
0740-5472 (ISSN-L)
DOI
10.1016/j.jsat.2022.108928
OpenAlex
W4308079517
Cited by
12
References
59
Citations by year
2026: 1 · 2025: 3 · 2024: 5 · 2023: 3
FWCI
0.44
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Substance Abuse Treatment (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • NOVA (University of Newcastle Australia) (submittedVersion, cc-by-nc-nd)
  • Figshare (submittedVersion, cc-by-nc-nd)
  • Deakin Research Online (Deakin University)
Funders
  • icare
  • National Health and Medical Research Council
Topics
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
Keywords
stepped care, substance use disorders, alcohol consumption, drug use, cost-effectiveness, treatment efficacy, alcohol and other drug use
MeSH terms
Adolescent, Cost-Benefit Analysis, Humans, Treatment Outcome, Substance-Related Disorders

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