Psychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users (Review) (2018)

Review question: We wanted to see whether talking therapies reduce drinking in adult users of illicit drugs (mainly opioids and stimulants). We also wanted to find out whether one type of therapy is more effective than another.
Background: Drinking alcohol above the low-risk drinking limits can lead to serious alcohol use problems or disorders. Drinking above those limits is common in people who also have problems with other drugs. It worsens their physical and mental health. Talking therapies aim to identify an alcohol problem and motivate an individual to do something about it. Talking therapies can be given by trained doctors, nurses, counsellors, psychologists, etc. Talking therapies may help reduce alcohol use but we wanted to find out if they can help people who also have problems with other drugs.
Search date: the evidence is current to August 2017.
Study characteristics:
We found seven studies that examined five talking therapies among 825 people with drug problems.
Cognitive-behavioural coping skills training (CBCST) is a talking therapy that focuses on changing the way people think and act.
The twelve-step programme is based on theories from Alcoholics Anonymous and aims to motivate the person to develop a desire to stop using drugs or alcohol.
Motivational interviewing (MI) helps people to explore and resolve doubts about changing their behaviour. It can be delivered in group, individual and intensive formats.
Brief motivational interviewing (BMI) is a shorter MI that takes 45 minutes to three hours.
Brief interventions are based on MI but they take only five to 30 minutes and are often delivered by a non-specialist.
Six of the studies were funded by the National Institutes for Health or by the Health Research Board; one study did not report its funding source.
Key results:
We found that the talking therapies led to no differences, or only small differences, for the outcomes assessed. These included abstinence, reduced drinking, and substance use.
One study found that there may be no difference between CBCST and the twelve-step programme.
Three studies found that there may be no difference between brief intervention and usual treatment.
Three studies found that there may be no difference between MI and usual treatment or education only.
One study found that BMI is probably better at reducing alcohol use than usual treatment (needle exchange), but found no differences in other outcomes.
One study found that intensive MI may be somewhat better than standard MI at reducing severity of alcohol use disorder among women, but not among men and found no differences in other outcomes.
It remains uncertain whether talking therapies reduce alcohol and drug use in people who also have problems with other drugs. High-quality studies are missing and are needed.
Quality of evidence: The quality of the evidence was moderate for brief and intensive motivational interviewing, but low for brief interventions and standard motivational interviewing, and very low for CBCST versus twelve-step programme.