EMCDDA Best practice portal update

Pharmacotherapies for the treatment of cocaine use disorders

There are signs that increased cocaine availability in Europe is resulting in growing health costs. Since 2014, the number of new clients entering treatment for cocaine problems, although still relatively low, has increased by over 35% in Europe. Yet, evidence available to support what constitutes effective services for cocaine users remains relatively weak, and targeted programmes for cocaine users are currently limited in Europe.

Psychosocial interventions remain the most common line of action in the treatment of cocaine use disorders. Some neurostimulation techniques have shown encouraging results, but no decisive evidence, in reducing cocaine craving.

In the new round of updates to the Best practice portal we found that antipsychotics are likely to be effective in retaining patients in treatment and some promising but not yet conclusive evidence that psychostimulants may be effective in reducing cocaine use.

Evidence summaries are available at the Best practice portal.

Brief interventions for cannabis use

In the previous round of updates to the Best practice portal, we found insufficient data to conclude that brief interventions (BIs) for cannabis use in post-secondary school settings are either effective or ineffective. Yet, new evidence found that BIs may be effective in improving short-term abstinence and in reducing the risk of cannabis use disorders among young adults. Brief interventions (BIs) are short interventions consisting of one of several sessions, each taking between 5 to 60 minutes, usually conducted individually and in-person.

Comorbid bipolar and substance use disorders

Mental health problems, such as bipolar disorder (BD) are very common in those with a substance use disorder (SUD); they increase the difficulty of treating SUD and lead to poorer prognoses for both disorders. While there are effective pharmacotherapies for BD and for SUD separately, less in known about treating their comorbidity. A recent systematic review found promising but inconclusive evidence of effectiveness of mood stabilizers in improving treatment outcomes for comorbid BD-SUD.

Technology-based interventions for women

Technology-based interventions (TBIs) are brief interventions delivered by computer, mobile phones, and other emerging technologies; they may be modelled after the motivational interviewing approach or consist of text messages periodically sent to participants to provide educational information. In the last round of updates to the Best practice portal we found that TBIs are likely to be beneficial in reducing alcohol and illicit drug use among women of childbearing age (18 to 44 years old).

Xchange registry — environmental interventions in 2020

Xchange is an online registry of evidence-based prevention programmes. In its first phase, the registry made available manualised interventions for which good European evaluation studies showed beneficial outcomes relating to substance use. Now it also contains programmes for delinquency and violence prevention in youth. From 2020 on, we will gradually be adding non-manualised interventions, starting with local environmental prevention strategies.

This content was published in the Best pratice portal update briefing on 18.12.2019

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