|Titre :||Effectiveness of secondary prevention and treatment interventions for crack-cocaine abuse: A comprehensive narrative overview of English-language studies (2015)|
|Auteurs :||B. FISCHER ; P. BLANKEN ; D. DA SILVEIRA ; A. GALLASSI ; E. M. GOLDNER ; J. REHM ; M. TYNDALL ; E. WOOD|
|Type de document :||Article : Périodique|
|Dans :||International Journal of Drug Policy (Vol.26, n°4, April 2015)|
|Article en page(s) :||352-363|
|Discipline :||TRA (Traitement et prise en charge / Treatment and care)|
Thésaurus mots-clésCRACK ; PREVENTION SECONDAIRE ; PREVENTION ; TRAITEMENT ; INTERVENTION ; ABUS ; EFFICACITE ; PHARMACOTHERAPIE ; PSYCHOTHERAPIE ; THERAPIE COMPORTEMENTALE
There are an estimated several million crack-cocaine users globally; use is highest in the Americas. Most crack users are socio-economically marginalized (e.g., homeless), and feature elevated risks for morbidity (e.g., blood-borne viruses), mortality and crime/violence involvement, resulting in extensive burdens. No comprehensive reviews of evidence-based prevention and/or treatment interventions specifically for crack use exist. We conducted a comprehensive narrative overview of English-language studies on the efficacy of secondary prevention and treatment interventions for crack (cocaine) abuse/dependence. Literature searches (1990-2014) using pertinent keywords were conducted in main scientific databases. Titles/abstracts were reviewed for relevance, and full studies were included in the review if involving a primary prevention/treatment intervention study comprising a substantive crack user sample. Intervention outcomes considered included drug use, health risks/status (e.g., HIV or sexual risks) and select social outcome indicators. Targeted (e.g., behavioral/community-based) prevention measures show mixed and short-term effects on crack use/HIV risk outcomes. Material (e.g., safer crack use kit distribution) interventions also document modest efficacy in risk reduction; empirical assessments of environmental (e.g., drug consumption facilities) for crack smokers are not available. Diverse psycho-social treatment (including contingency management) interventions for crack abuse/dependence show some positive but also limited/short-term efficacy, yet likely constitute best currently available treatment options. Ancillary treatments show little effects but are understudied. Despite ample studies, pharmaco-therapeutic/immunotherapy treatment agents have not produced convincing evidence; select agents may hold potential combined with personalized approaches and/or psycho-social strategies. No comprehensively effective 'gold-standard' prevention/treatment interventions for crack abuse exist; concerted research towards improved interventions is urgently needed.
Crack/cocaine abuse is a major global problem with extensive health/social burdens.
Secondary prevention measures show mixed/limited effects on drug use and health.
Psycho-social and pharmaco-therapeutic treatment options are extensively studied.
Psycho-social treatments feature limited but best currently available effectiveness.
Widely effective interventions are absent; improved measures need to be developed.
|Domaine :||Drogues illicites / Illicit drugs|
|Sous-type de document :||Revue de la littérature / Literature review|
|Affiliation :||Social & Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Canada|