|Titre :||Psychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users (Review) (2012)|
|Auteurs :||J. KLIMAS ; C. A. FIELD ; W. CULLEN ; C. S. M. O'GORMAN ; L. G. GLYNN ; E. KEENAN ; J. SAUNDERS ; G. BURY ; C. DUNNE|
|Type de document :||Article : Périodique|
|Dans :||Cochrane Database of Systematic Reviews (n°11, 2012)|
|Article en page(s) :||CD009269 ; 62 p.|
|Discipline :||TRA (Traitement et prise en charge / Treatment and care)|
Thésaurus TOXIBASEALCOOL ; INTERVENTION ; REDUCTION DE CONSOMMATION ; USAGER ; PRODUIT ILLICITE ; ADULTE ; CONSEIL ; EFFICACITE
BACKGROUND: Problem alcohol use is common among illicit drug users and is associated with adverse health outcomes. It is also an important factor in poor prognosis among drug users with hepatitis C virus (HCV) as it impacts on progression to hepatic cirrhosis or opiate overdose in opioid users.
OBJECTIVES: To assess the effects of psychosocial interventions for problem alcohol use in illicit drug users (principally problem drug users of opiates and stimulants).
SEARCH METHODS: We searched the Cochrane Drugs and Alcohol Group trials register (November 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 11, November 2011), PUBMED (1966 to 2011); EMBASE (1974 to 2011); CINAHL (1982 to 2011); PsycINFO (1872 to 2011) and reference list of articles. We also searched: 1) conference proceedings (online archives only) of the Society for the Study of Addiction (SSA), International Harm Reduction Association (IHRA), International Conference on Alcohol Harm Reduction (ICAHR), and American Association for the Treatment of Opioid Dependence (AATOD); 2) online registers of clinical trials, Current Controlled Trials (CCT), Clinical Trials.org, Center Watch and International Clinical Trials Registry Platform (ICTRP).
SELECTION CRITERIA: Randomised controlled trials comparing psychosocial interventions with another therapy (other psychosocial treatment, including non-pharmacological therapies or placebo) in adult (over the age of 18 years) illicit drug users with concurrent problem alcohol use.
DATA COLLECTION AND ANALYSIS: Two review authors independently assessed risk of bias and extracted data from included trials.
MAIN RESULTS: Four studies, 594 participants, were included. Half of the trials were rated as having high or unclear risk of bias. They considered six different psychosocial interventions grouped into four comparisons: (1) cognitive-behavioural coping skills training versus 12-step facilitation (N = 41), (2) brief intervention versus treatment as usual (N = 110), (3) hepatitis health promotion versus motivational interviewing (N = 256), and (4) brief motivational intervention versus assessment-only group (N = 187). Differences between studies precluded any pooling of data. Findings are described for each trial individually:comparison 1: no significant difference; comparison 2: higher rates of decreased alcohol use at three months (risk ratio (RR) 0.32; 95% confidence interval (CI) 0.19 to 0.54) and nine months (RR 0.16; 95% CI 0.08 to 0.33) in the treatment as usual group; comparison 3 (group and individual format): no significant difference; comparison 4: more people reduced alcohol use (by seven or more days in the past 30 days at 6 months) in the brief motivational intervention compared to controls (RR 1.67; 95% CI 1.08 to 2.60).
AUTHORS' CONCLUSIONS: Very little evidence exists that there is no difference in the effectiveness between different types of interventions and that brief interventions are not superior to assessment only or treatment as usual. No conclusion can be made because of the paucity of the data and the low quality of the retrieved studies.
PLAIN LANGUAGE SUMMARY:
Which talking therapies (counselling) work for drug users with alcohol problems?
What is problem alcohol use and what are psychosocial interventions?
Problematic use of alcohol means drinking above the recommended safe drinking limits. It can lead to serious alcohol problems or dependence. Excessive drinking in people who have problems with other drugs is common and often makes their problems worse as well as having serious health consequences for the person involved.
Psychosocial interventions are talking therapies that aim to identify an alcohol problem and motivate an individual to do something about it. They can be performed by staff with training in these approaches, for example doctor, nurse, counsellor, psychologist, etc.
Talking therapies may help people cut down their drinking but the impact is not known in people who have problems with other drugs.
We wanted to do a review to see whether talking therapies have an impact on alcohol problems in drug users. In this review, we wanted to evaluate information from randomised trials in relation to the impact of talking therapies on alcohol drinking in adult (over the age of 18 years) users of illicit drugs (mainly opiates and stimulants).
This review found the following studies, and came to the following conclusions:
We found four studies that examined 594 people with drug problems. One study looked at cognitive-behavioural coping skills training versus 12-step facilitation. One study looked at brief intervention versus treatment as usual. One study looked at motivational interviewing (group and individual format) versus hepatitis health promotion. The last study looked at brief motivational intervention versus assessment only.
- The studies were so different that we could not combine their results to answer our question.
- It remains uncertain whether talking therapies affect drinking in people who have problems with other drugs because of the low quality of the evidence.
- It remains uncertain whether talking therapies for drinking affect illicit drug use in people who have problems with other drugs. There was not enough information to compare different types of talking therapies.
- Many of the studies did not account for possible sources of bias.
- More high-quality studies, such as randomised controlled trials, are needed to answer our question.
|Domaine :||Alcool / Alcohol ; Drogues illicites / Illicit drugs|
|Sous-type de document :||Revue de la littérature / Literature review|
|Affiliation :||Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland|
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