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Best practice portal:
Treatment options for substance use disorders (not drug-specific)

This page refers to the current evidence on the effectiveness of the available treatment options applicable to patients with substance use disorder(s) and not targeting a specific drug. Information on the methodology used and the definition of terms can be found on the methodology page.

Date of last update: 12.2016     Next update: 04.2017

Effects of available treatments for drug disorders

Beneficial

Ecological family-based treatments to reduce adolescent substance use

Ecological family-based treatments (including multidimensional family therapy) delivered in community settings were found in a systematic review without meta-analysis (Hogue et al., 2014, 8 RCTs) to have significant effect in:

  • reducing adolescent drug use (mainly cannabis and alcohol)

Likely to be beneficial

Behavioural therapies to reduce use in adolescents

Behavioural therapies targeting specifically adolescents were analysed in a systematic review without meta-analysis (Hogue et al., 2014, 8 RCTs) and found that:

  • cognitive behavioural therapies (CBT) are well established but were outperformed  by family-based treatments in several trials
  • cognitive behavioural therapies (CBT)  at group level or at individual level are equally effective
  • integrated models uniformly performed well

Continuing care to improve recovery

Continuing care, i.e. interventions following the initial period of more intensive care aimed at manage and sustain recovery (including cognitive behavioural therapies (CBT), recovery management check-ups, 12-step or self-help and technology based interventions) was found in a systematic review with meta-analysis (Blodgett  et al., 2014, 19 studies, N=3542) to be more effective than control conditions on:

  • at least one substance use outcome (Hedges’ g = 0.187,  p< 0.001)

The same meta-analysis also found that

  • longer planned treatments did not have larger effects sizes than studies with shorter prescribed periods of treatment
  • there was no significant difference between treatments with protocol-specified intervention sessions and those without planned sessions per week

These results were confirmed by another systematic review without meta-analysis (Dennis et al., 2014) that looked specifically at the effects of different types of continuing care on use and retention in treatment outcomes:  

  • behavioural therapies showed promising results results , especially for moderate severity clients
  • recovery managements check-ups are primarily effective in linking people back to treatment
  • more robust evidence is still needed for self-help groups and technology-based interventions

Trade-off between benefits and harms

No interventions met the criteria for this category.

Unknown effectiveness

Emergency department-based brief interventions to reduce use and harms

Brief interventions in emergency settings were found in a systematic review without meta-analysis (EMCDDA, 2016, 16 studies, N=8 875) to have no effect in:

  • significantly decreasing substance use (mainly alcohol) and related harms 

Motivational interviewing to reduce illicit drug use in adolescents

Motivational interviewing was found in a systematic review with meta-analysis (Li et al., 2016, 10 RCT, N=1 466) to have no statistically significant effect in:

  • changing drug use behaviours (d=0.05, 95% CI 0.06 - 0.17, p=0.36)

Residential treatment to improve treatment outcomes

Residential treatment was found in a systematic review without meta-analysis (Reif  et al., 2014, 8 review and 21 studies) mixed results when compared to other interventions in:

  • improving treatment outcomes

Shared decision-making tools to reduce substance use

Shared decision-making (SDM) as means to involve patients in medical decision- making and matching patients’ preferences to treatments were found in a systematic review without meta-analysis (Friedrichs et al., 2016, 25 studies, N=8 729) to have no effect in:

  • decreasing substance use

Evidence of ineffectiveness

Compulsory drug treatment to improve treatment outcomes

Compulsory drug treatment (including drug detention facilities, short (i.e. 21-day) and long-term (i.e. 6 months) inpatient treatment, community-based treatment, group-based outpatient treatment, and prison-based treatment) was found in a systematic review without meta-analysis (Werb et al., 2016, 9 studies, N=10 699) was found to have no effect on:

  • drug use or criminal recidivism over other approaches (78% of the studies)
  • two studies (22 %) detected negative impacts of compulsory treatment on criminal recidivism compared with control arms
  • only two studies (22 %) observed a significant impact of long-term compulsory patient treatment on criminal recidivism: one reported a small effect size on recidivism after two years, and one found a lower risk of drug use within one week of release from compulsory treatment

References and definitions

References

 Explanation of terms used

Below you can find definitions and further explanation for some of the terms used in this section of the Best practice portal. A more general glossary for the best practice portal is also available.

Affective-focused prevention intervention

A type of prevention intervention which aims to they aim to modify inner qualities (personality traits such as self-esteem and self-efficacy, and motivational aspects such as the intention to use drugs).

BA

Before-after (BA) study design

BAL

Blood alcohol level (BAL)

Beneficial

Interventions for which precise measures of the effects in favour of the type of intervention were found in systematic reviews of relevant studies. An intervention ranked as ‘beneficial’ is suitable for most patients/contexts. See the relevant module methodology page for further information.

CBA

Controlled before-after (CBA) study design. UCBA stands for Uncontrolled before-after study design.

CBT

Cognitive behavioral therapy is an individual based intervention occurring in three stages. Phase 1 is aimed at determining and prioritizing the patient’s problems and constructing the treatment contract. Phase 2 is aimed at increasing coping competence and reducing risky behaviors. Phase 3 focuses on relapse prevention. Each session is administered once per week over a period of 4-6 months with 60- to 90-minute sessions (Beck AT, Wright FW, Newman CF, Liese B. Cognitive Therapy of substance abuse. New York: Guilford Press, 1993).

CCT

Controlled clinical trials (CCT)

Cohort study

A cohort study is a type of observational study that follows a group of people (i.e. a cohort) over time. In a prospective cohort study, the cohort is formed and then followed over time. In a retrospective cohort study, data is gathered for a cohort that was formed sometime in the past.

Confidence Interval (CI)

The Confidence Interval (CI) is a measure of the precision (or uncertainty) of study results. It is the interval that most likely includes the true value of the parameter we are calculating, where 'most likely' is taken by common usage to be a 95% probability. Thus the current expression of '95 % CI'. A wide CI indicates less precise estimates of effect and vice versa.

Practical interpretation

  • If the RR (the relative risk) = 1, or the CI (the confidence interval) = 1, then there is no significant difference between treatment and control groups
  • If the RR > 1, and the CI does not include 1, events are significantly more likely in the treatment than the control group
  • If the RR < 1, and the CI does not include 1, events are significantly less likely in the treatment than the control group
CPS

Current population survey (CPS)

Cross-sectional study

A cross-sectional study is a study employing a single point of data collection for each participant or system being studied.They are usually conducted to estimate the prevalence of the outcome of interest for a given population at a given point in time.

Evidence of ineffectiveness

Interventions that gave negative results if compared with a standard intervention or no intervention, for example. See the relevant module methodology page for further information.

Additional information for prevention
For ethical reasons this category in prevention should be considered as interventions with negative and undesired (iatrogenic) effect.

IP

Individual psychotherapy is a standard individual treatment based on counseling and motivational interviewing and focused on substance use triggers and strategies for relapse prevention. It includes elements of cognitive-behavioral therapy (CBT).

IQR

Interquartile range (IQR) - also called the midspread or middle fifty - is a measure of statistical dispersion. It is a trimmed estimator, defined as the 25% trimmed mid-range, and is the most significant basic robust measure of scale.

ITS

Intermittent time series design (ITS)

Knowledge-focused prevention intervention

A type of prevention intervention which aims to to enhance knowledge of drugs, and drug effects, and consequences.

Likely to be beneficial

Interventions that were shown to have limited measures of effect, that are likely to be effective but for which evidence is limited. An intervention ranked as ‘likely to be beneficial’ is suitable for most contexts/patients, with some discretion. See the relevant module methodology page for further information.

Number Needed to Treat (NNT)

The Number Needed to Treat (NNT)indicates the number of patients that needs to be treated to obtain one respondent patient. Numerically the NNT is the reciprocal of the difference between the proportion of events in the experimental and the comparison group (absolute risk reduction). Taking into consideration that the ideal NNT would be 1 (the unreal situation in which every single patient succeeded) it is easily understood that a NNT value close to 3 or 4 would be very good.

Adjusted Odds Ratio (AOR)

The Adjusted Odds Ratio is a way of comparing whether the probability of a certain event is the same between two groups, yet they are calculated adjusting for or controlling for other possible contributions from other variables (tipically demographic variables) in the model. An AOR equal to 1 implies that the the event is equally probable in both groups. An AOR greater than 1 implies that the event is more likely in the first group. An AOR less than 1 implies that the event is less likely in the first group.

Odds Ratio (OR)

The Odds Ratio is a way of comparing whether the probability of a certain event is the same between two groups. Like the Relative Risk, an OR equal to 1 implies that the the event is equally probable in both groups. A OR greater than 1 implies that the event is more likely in the first group. A OR less than 1 implies that the event is less likely in the first group. In medical research, the odds ratio is commonly used for case-control studies, as odds, but not probabilities, are usually estimated. Relative risk is used in randomized controlled trials and cohort studies.

p value

A p-value is a measure of how much evidence we have against the null hypothesis. The null hypothesis represents the hypothesis of no change or no effect. The smaller the p-value, the more evidence we have against the null hypothesis thus it is more likely that our sample result is true. Traditionally, researchers will reject a null hypothesis if the p-value is less than 0.05.

RBS

Responsible beverage service (RBS)

RCT

Randomised controlled trial (RCT)

Relative Risk (RR)

The Relative Risk (RR) is used to compare the risk in the two different groups of people, i.e. treated and control groups to see if belonging to one group or another increases or decreases the risk of developing certain outcomes. This measure of effect will tell us the number of times an outcome is more likely (RR > 1) or less likely (RR < 1) to happen in the treatment group compared with the control group.

Practical interpretation

  • If the RR (the relative risk) = 1, or the CI (the confidence interval) = 1, then there is no significant difference between treatment and control groups
  • If the RR > 1, and the CI does not include 1, events are significantly more likely in the treatment than the control group
  • If the RR < 1, and the CI does not include 1, events are significantly less likely in the treatment than the control group
Trade-off between benefits and harms

Interventions that obtained measures of effects in favour of the intervention, but that showed some limitations or unintended effects that need to be assessed before providing them. See the relevant module methodology page for further information.

 
Unknown effectiveness

Interventions for which there are not enough studies or where available studies are of low quality (with few patients or with uncertain methodological rigour), making it difficult to assess if they are effective or not. Interventions for which more research should be undertaken are also grouped in this category.

Additional information for prevention
For prevention interventions,  this  is also known as 'zero effect'.

Skill-focused prevention intervention

A type of prevention intervention which aims to enhance students’ abilities in generic skills, refusal skills and safety skills.

Standardised Mean Difference (SMD)

The Standardised Mean Difference (SMD) is the difference in means divided by a standard deviation. Note that it is not the standard error of the difference in means (a common confusion). The standardized mean difference has the important property that its value does not depend on the measurement scale. It may be useful if there are several trials assessing the same outcome, but using different scales.

z score (Standard Score)

The z-score (aka, a standard score) indicates how many standard deviations an element is from the mean of the population.

 

 

 

 

 

 

 

 

About substance use disorders

Case definition

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), substance use disorders occur when the recurrent use of alcohol and/or drugs causes clinically and functionally significant impairment, such as health problems, disability, and failure to meet major responsibilities at work, school, or home. According to the DSM-5, a diagnosis of substance use disorder is based on evidence of impaired control, social impairment, risky use, and pharmacological criteria. Substance use disorders are defined as mild, moderate, or severe to indicate the level of severity, which is determined by the number of diagnostic criteria met by an individual.

Interventions

Mainly psychosocial treatment options since pharmacotherapies are tipically associated to the type of drug used by the patient.

Outcomes

  • Retention in treatment
  • Relapse to use
  • Mortality
  • Criminal activity

About the EMCDDA

The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) is the reference point on drugs and drug addiction information in Europe. Inaugurated in Lisbon in 1995, it is one of the EU's decentralised agencies. Read more >>

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Page last updated: Friday, 16 December 2016