EMCDDA Best practice portal update (3/2021)

Contingency Management – evidence continues to build-up, time to start talking about implementation?

According to the just published EMCDDA European Drug Report cocaine is the second most commonly used illicit drug in Europe and the number of people entering treatment for the first time has risen over the last 5 years.

Treatments for cocaine use disorders are limited and no pharmacotherapy has been approved in Europe. Current treatment options rely mainly on psychosocial interventions.

Numerous meta-analyses have attempted to search for positive treatment outcomes however, none reported improvements among pharmacotherapies, while meta-analyses of psychosocial interventions have reported variable effect sizes.

Contingency management (CM) programmes, which comprise positive reinforcement of drug abstinence, have repetitively shown treatment benefits in counter-tendency with the trends above. In our latest update round of the Best Practice Portal (BPP), a very recent review adds yet another confirmation. The study performed a comprehensive meta-analysis of all treatments for cocaine use disorders published over 22 years to examine which treatment approaches, if any, were associated with a reduction in cocaine use. Only contingency management programmes were consistently associated with a significant reduction in urinalysis-confirmed cocaine use.

In addition, the results of another meta-analysis found no evidence that adding another formal psychotherapy, such as cognitive-behavioural therapy or motivational enhancement therapy, to contingency management improves the short-term or long-term effects of CM treatment.

Contingency management (CM) programmes are also showing positive results with specific target populations such as psychiatric patients. A recent review included in the EMCDDA BPP found a potentially positive effect of CM in psychotic patients with substance use disorders.

While evidence is growing, we do not know enough about the implementation of CM interventions: what approaches are being used? How is it funded? What are the obstacles?

Time to kick-off research and discussions at the European level!

Comorbidity of substance use and mental health disorders

New BPP updates highlight the difficulty of finding effective interventions to treat the comorbidity of substance use and mental health disorders.

A recent review investigated the effects of psychotherapy to improve mental health and treatment outcomes in patients with comorbid bipolar and substance use disorders without definite conclusions.
More promising results were found by another meta-analysis that looked into the pharmacological treatment of attention deficit hyperactivity disorder (ADHD) and substance use disorders. Medications had a small but positive effect in reducing substance use and improving ADHD symptoms.

An interesting European initiative on the subject is the SABAA project that is looking at the overlap between autism and addiction. The project aims to identify research gaps and priorities as well as to provide guidance for future work.

Party drugs and crime prevention toolkit

The European Crime Prevention Network aims to connect at local, national and European level and to promote crime prevention knowledge and practices among the EU Member States.

They have recently published a Toolbox on Party drugs and crime that extensively refers to the EMCDDA BPP and provides excellent examples of effective approaches and real-life cases.