York

4 Included studies

Study flow

Quality assessment

N=594, - 33% female. Average age was 38.3

• Type of psychosocial intervention and setting:

1) CBT vs. TSF in an outpatient clinic (Carroll et al,1998)

2) BI vs. Treatment as usual in an outpatient clinic with/out opioid substitution treatment (Feldman et al, 2011)

3) MI (single/group) vs. HHP in an opioid substitution clinic (Nyamathi et al, 2010)

4) BMI vs. Assessment only in a Needle exchange programme (Stein et al, 2002)

• Country: 3x USA and 1x Switzerland
• Duration : range from 4 to 12 weeks (plus various follow-ups), mean 7.5 weeks. Between 1-16 sessions were offered to participants, mean 5.5 (from 15 min - 16 hours of treatment time).

Results

Inclusion criteria

Formal meta-analysis not possible

• Results presented separately for each study:

1. Cognitive-behavioural coping skills training versus 12-step facilitation

2. Brief intervention versus treatment as usual

3. Motivational interviewing (group/single) versus hepatitis health promotion

4. Brief motivational intervention versus assessment only

RCT’s of psychosocial interventions:

Inclusion:

• Adults (18+)
• Problem Drug Users as defined by EMCDDA: Injecting/ long-duration/ regular use of opioids, cocaine and/or amphetamines (regular use: 1x week)
• Problem alcohol users

Exclusion:

• Single-drug users
• patients on prescribed medication
• 'soft drugs' e.g. tobacco
• Adolescents

Significant outcomes

Search Methods

Comparison #2: decreased alcohol use at 3 months (RR 0.32; 95% CI 0.19 - 0.54) and 9 months (RR 0.16; 95% CI 0.08 - 0.33) in the Treatment-as-usual group;

Comparison #4: reduced alcohol use in the Brief motivational intervention (RR 1.67; 95% CI 1.08- 2.60).

2 independent reviewers

• 5 databases: Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 11, Nov 2011), PUBMED (1966 to 2011); EMBASE (1974 to 2011); CINAHL (1982 to 2011); PsycINFO (1872 to 2011) and reference list of articles.
• Also: 1) conference proceedings (SSA, IHRA, ICAHR, AATOD); 2) online registers of clinical; 3) contacted authors

Conclusions

Involvement of GPs in managing alcohol problems

More research is needed?

• RCTs
• Populations: adults, who are identified as problem drug users with concurrent problem alcohol use; people in or out of a formal addiction treatment.
• Interventions: psychosocial intervention, that is talking therapy or counselling (e.g. MI, CBT, contingency management, family therapy, BI, etc.).
• Comparisons: treatment as usual, no intervention, waiting list, other psychosocial interventions; pharmacological treatments (alone, or in combination with psychosocial treatments); interventions of different type, length and intensity.
• Outcomes: reduction in/abstinence from alcohol or drug use, or from both. (formal validated instruments, e.g. AUDIT and Objective measures, e.g. breathalysers, urine-analysis).

• 2004: it seems possible to increase rates of SBIs by GPs, but use multi-component (Anderson, Kaner et al)
• 2010: Real world evidence supports SBI theory (McCormick et al)
• 2012: Don’t bother – multi-component int. failed to show effect in Netherlands (Van Beurden, Anderson et al)
• Ireland: 35% of MMT patients in Primary care drink in excess of limits (Ryder et al, 2009)

Background

Acknowledgements

Psychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users

Co-authors:

Catherine-Anne Field, Walter Cullen, Clodagh O'Gorman, Liam Glynn, Eamon Keenan, Jean Saunders, Gerard Bury, Colum Dunne

• '77: The use of an alcoholism screening test to identify the potential for alcoholism in persons on MMT (Cohen et al)
• ‘78: A Behavioral Treatment of Alcoholic Methadone Patients + Disulfiram (Liebson et al)
• ‘83: Is treatment for alcoholism effective in persons on MMT? – RCT (Stimmel, Cohen et al)
• ‘87: The treatment of alcoholic MMT patients: a review (Bickel et al)
• '07: Alcohol and MMT (Ed Day, SSA)

Cochrane review

@JanKlimas

Thank you!

Jan Klimas

“We must become the change we want to see”

Post-doctoral research fellow

jan.klimas@ucd.ie

+353 (0) 1 473 0893

@JanKlimas