Psychosocial treatment for opiate abuse and dependence
Abstract
Background
Substance dependence is a social and public health problem; therefore it is a priority to develop effective treatments. Previous Cochrane reviews have explored the efficacy of pharmacotherapy for opiate dependence. This current review focuses on the role of psychosocial interventions alone for the treatment of opiate dependence. There is some evidence for the effectiveness of psychosocial interventions, but no systematic review has even been carried out.
Objectives
To assess the efficacy and acceptability of psychosocial interventions alone for treating opiate use disorders.
Search methods
Electronic searches of databases: Cochrane drugs and Alcohol Group Register of Trials (21 January 2004); Cochrane Central Register of Controlled Trials (CENTRAL‐The Cochrane Library, Issue 1, 2004); MEDLINE (1966‐2003), LILACS (1982‐2003), EMBASE (1980‐2003), PsycINFO (1872‐2003). In addition reference searching, personal communication, conference abstracts, unpublished trials, book chapters on treatment of opioid dependence.
Selection criteria
Randomised controlled trials comparing psychosocial interventions alone versus pharmacological interventions or placebo or non‐intervention for treating opioid use disorders.
Data collection and analysis
Two reviewers independently assessed trial quality and extracted data.
Main results
Five trials involving 389 participants were included. These analysed Contingency Management, Brief Reinforcement Based Intensive Outpatient Therapy coupled with Contingency Management, Cue Exposure therapy, Alternative Program for Methadone Maintenance Treatment Program Drop‐outs (MMTP) and Enhanced Outreach‐Counselling Program. All the treatments were studied against the control (standard) treatment; therefore it was not possible to identify which type of psychosocial therapy was most effective.
The main findings were that both Enhanced Outreach Counselling and Brief Reinforcement Based Intensive Outpatient Therapy coupled with Contingency Management had significantly better outcomes than standard therapy regarding relapse to opioid use, re‐enrolment in treatment and retention in treatment. At 1‐month and 3‐ month follow up the effects of Reinforcement Based Intensive Outpatient Therapy were not sustained. There was no further follow up of the Enhanced Outreach Counselling group. The Alternative Program for MMTP Drop‐outs and the behavioural therapies of Cue Exposure and Contingency Management alone were no better than the control. As the studies were heterogeneous, it was not possible to pool the results and perform a meta‐analysis.
Authors' conclusions
The available evidence has low numbers and is heterogeneous. At present psychosocial treatments alone are not adequately proved treatment modalities or superior to any other type of treatment.
It is important to develop a better evidence base for psychosocial interventions to assist in future rationale planning of opioid use drug treatment services.
PICOs
Plain language summary
Currently there is not enough evidence to conclude that psychosocial treatments alone are adequate to treat people with opiate abuse and dependence.
Psychosocial interventions alone are offered to people with opiate use disorders indiscriminately across countries; sometimes representing the most prevalent treatment after substitution therapy. Despite its wide use in clinical practice, no systematic review of effectiveness has ever been carried out. This review demonstrated that there was inadequate evidence available to prove the effectiveness of psychosocial interventions alone for the treatment of opiate dependence or that they are superior to any other type of treatment.
