best practice

Work-based interventions were evaluated in a narrative systematic review (Morse et al., 2022, 39 studies) and found no evidence of effect in treating and preventing substance use. More specifically:

• Workplace health promotion interventions could reduce alcohol consumption, but the quality of the evidence is low: out of seven interventions on health promotion, five found statistical significance. However, more research is needed due to the low quality of the studies and the lack of a control group.
• Workplace-based psychosocial and e-health interventions might not be effective. Most studies reported weak statistical evidence.

The authors discussed that the main difficulties of implementing workplace interventions are a lack of engagement in online interventions, male employees' hesitation to seek help, and confidentiality issues.

Psychosocial interventions for family members affected of other members’ substance abuse were found in a systematic review with meta-analysis (Rushton et al., 2023, 19 studies, 10 incl. metanalysis) to have a significant effect on:

• reducing depression (RTCs = 3, SMD= 0.50, 95% CI 0.21 to 0.79) and in non-RTCs (d =0.50, 95% CI 0.17 to 0.82)
• decreasing distress (SMD=0.28, 95% CI 0.03, 0.54) and in non-RTC (d = 0.44, 95% CI 0.13, 0.75)
• improving family functioning (d = 0.51, 95% CI 0.28, 0.73) and coping (d = 0.81, 95% CI 0.29, 1.33).

A systematic review of randomised controlled trials (Soni et al. 2022, 10 studies, N=1431) assessed the effectiveness of deprescribing interventions used to discontinue long-term use of benzodiazepines. The review reported that:

• Non-pharmacological interventions were more effective than routine care in facilitating benzodiazepine withdrawal (n=189; RR 3.26, 95% CI 2.36-4.51, low quality).
• Deprescribing benzodiazepines with a non-pharmacological intervention was more effective than gradual tapering alone both in the short term (n=124; RR 2.02; 95%CI 1.41, 2.89, low quality), and long term (n=123; RR 2.45; 95%CI 1.56, 3.85, low quality).

Interventions to reduce stigma about substance abuse aim to establish contact with vulnerable groups to avoid social isolation, protest and take action against prejudice, and foster education to replace myths with factual knowledge. A systematic review (Gür & Yilmaz, 2023, 10 studies) to assess the effectiveness of interventions reducing substance-related stigma found that:

• interventions did not have a significant impact on reducing stigma (Hedges’ g = 0.301, 95% CI =-0.154 to 0.755, p = 0.195) nor social stigma (g=-0.198, 95% CI=-1.271 to 0.876).
• interventions had a small significant impact on reducing structural stigma [0.360 (95% CI= 0.156-0.564), p = 0.00].

A narrative systematic review (Ramadas et al., 2023, 5 studies) assessed the effectiveness of digital interventions in providing ongoing support for individuals with alcohol use disorders (AUD). The review concluded that:

• smartphone applications might be beneficial to provide continuous support for the treatment of AUD (Out of the 5 studies, 4 found the intervention to be clinically effective).

Due to the limited number of studies, more research is needed to provide robust conclusions.

Culturally sensitive programs integrate positive youth development factors such as future orientation, problem-solving, communication, decision-making, and emotional regulation with specific cultural or ethnic factors related to socialisation, identity, and acculturation. Culturally sensitive prevention programs for substance use were assessed in a systematic review and meta-analysis (Bo et al., 2023, 30 studies) and found a small yet significant effect in:

• Preventing and reducing substance use (Hedges’s g = - 0.20, 95% CI = [-0.24, -0.16])

Reducing cannabis use for patients with comorbidities could improve clinical, cognitive, and psychosocial outcomes. Contingency management (CM) for patients with comorbid diagnoses was assessed in a narrative systematic review (Rodas et al., 2022, 6 studies, 4 focused on Schizophrenia and schizoaffective disorder, while the remaining two involved patients with major depressive disorder) and found to have an effect in:

• decreasing cannabis use.

More research is needed to establish the implications of CM for improving psychiatric symptoms in patients with comorbidities. Several studies in the current review did not find significant results in reducing psychiatric symptom severity.

Contingency management (CM) interventions for people with HIV and substance use disorder were found in a systematic review with meta-analysis (Ribeiro et al. 2023, five studies) to have a more positive effect when compared to control conditions in:

• adherence to antiretroviral therapy during the intervention period (improved patient adherence by 2.69 (95% confidence interval: [0.08, 0.51]; p = .007)).

Adherence to antiretroviral therapy was measured by counting the increase in CD4 (a type of white blood cell).

Brief interventions (Bis) were found in a review with metanalysis (Schweer-Collins et al., 2023, k = 116, N= 12,074) to be more beneficial to treat alcohol use in the following target groups:

• Females: The study found that among females, brief interventions (BIs) led to significant reductions in binge alcohol consumption (g = 0.09, 95% CI [0.03, 0.14]), frequency of alcohol consumption (g = 0.10, 95% CI [0.03, 0.17]), and alcohol-related consequences (g = 0.16, 95% CI [0.08, 0.25]). The study also found that BIs resulted in greater utilisation of substance use treatment (g = 0.25, 95% CI [0.21, 0.30]).
• Individuals with less than a high school level education showed a significant decrease (g = 0.16, 95% CI [0.09, 0.22]) in the frequency of alcohol consumption at the 3-month follow-up.

Brief interventions (BIs) were analyzed analysed in a narrative systematic review and metanalysis for patients with comorbid substance misuse (Ghosh et al., 2023, 8 studies). The review found some positive but not conclusive effects on:

• reducing substance use (Hedges g = 0.752, 95% confidence interval, 0.405–1.099) and alcohol consumption 3 months after the intervention.

More research is needed for robust results, due to the limited number of studies in the review.