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Cochrane Database of Systematic Reviews

Psychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users

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DOI:
https://doi.org/10.1002/14651858.CD009269.pub3Copy DOI
Database:
  1. Cochrane Database of Systematic Reviews
Version published:
  1. 03 December 2014see what's new
Type:
  1. Intervention
Stage:
  1. Review
Cochrane Editorial Group:
  1. Cochrane Drugs and Alcohol Group

Copyright:
  1. Copyright © 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Authors

  • Jan Klimas

    Correspondence to: Addiction & Urban Health Research Initiative, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada

    [email protected]

    School of Medicine and Medical Science, University College Dublin, Dublin, Ireland

  • Helen Tobin

    School of Medicine and Medical Science, University College Dublin, Dublin, Ireland

  • Catherine‐Anne Field

    National University of Ireland Galway, Galway, Ireland

  • Clodagh SM O'Gorman

    Centre for Interventions in Infection, Inflammation & Immunity (4i), Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland

    Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland

    Department of Paediatrics, Mid‐Western Regional Hospital, Limerick, Ireland

  • Liam G Glynn

    Department of General Practice, National University of Ireland, Galway, Ireland

  • Eamon Keenan

    Addiction Services, Health Service Executive, Dublin, Ireland

  • Jean Saunders

    Statistical Consulting Unit/ Applied Biostatistics Consulting Centre /CSTAR, Graduate Entry Medical School, University of Limerick, Limerick, Ireland

  • Gerard Bury

    School of Medicine and Medical Science, University College Dublin, Dublin, Ireland

  • Colum Dunne

    Centre for Interventions in Infection, Inflammation & Immunity (4i), Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland

    Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland

  • Walter Cullen

    School of Medicine and Medical Science, University College Dublin, Dublin, Ireland

    Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland

    Academic General Practice, UCD School of Medicine and Medical Sciences, Dublin 4, Ireland

Contributions of authors

JK: designed and coordinated the review, wrote and re‐drafted the protocol and full review.
HT: double screened titles, abstracts and full texts, carried out double data extraction and commented on draft updates
WC, CAF, CSMOG: contributed to design of the first version of this review and commented on drafts
LGG, JS: provided methodological advice and commented on review drafts
GB, EK, CD: commented on review drafts

Sources of support

Internal sources

  • No sources of support supplied

External sources

  • Cochrane Training Fellowship (No. CTF/2010/9) from Health Research Board, Ireland.

  • PINTA feasibility study (No. HRA_HSR/2012/14) grant from Health Research Board, Ireland.

  • Medical Emergency Responders: Integration and Training (MERIT) grant from Department of Health, Ireland.

Declarations of interest

The authors declare that they have no competing interests.

Acknowledgements

Health Research Board Ireland funded this project. For the first version of our review, Jennifer Collery and Kathryn Smyth from UCD Health sciences library provided extensive support with the search strategy, in conjunction with the support from the GDAG, especially Suzanna Mitrova (records screening) and Silvia Minozzi (quality advice). We thank the following individuals for retrieving full‐text papers: Cendrine Robinson (Uniformed Services University of the Health Sciences, US); Constance M Pollack (The College of Problems on Drug Dependence, US); Jan R Böhnke (University of Trier, Germany); Maria Jakubekova (helped with German translations); Amy Drahota and Marialena Trivela (UK Cochrane Centre) for excellent training in systematic reviews and answering follow‐up questions; and Adeline Nyamathi and Nelson Feldman for providing additional information/data regarding their trials included in our review.

Version history

Published

Title

Stage

Authors

Version

2018 Dec 05

Psychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users

Review

Jan Klimas, Christopher Fairgrieve, Helen Tobin, Catherine‐Anne Field, Clodagh SM O'Gorman, Liam G Glynn, Eamon Keenan, Jean Saunders, Gerard Bury, Colum Dunne, Walter Cullen

https://doi.org/10.1002/14651858.CD009269.pub4

2014 Dec 03

Psychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users

Review

Jan Klimas, Helen Tobin, Catherine‐Anne Field, Clodagh SM O'Gorman, Liam G Glynn, Eamon Keenan, Jean Saunders, Gerard Bury, Colum Dunne, Walter Cullen

https://doi.org/10.1002/14651858.CD009269.pub3

2012 Nov 14

Psychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users

Review

Jan Klimas, Catherine‐Anne Field, Walter Cullen, Clodagh SM O'Gorman, Liam G Glynn, Eamon Keenan, Jean Saunders, Gerard Bury, Colum Dunne

https://doi.org/10.1002/14651858.CD009269.pub2

2011 Aug 10

Psychosocial interventions for problem alcohol use in illicit drug users

Protocol

Jan Klimas, Catherine‐Anne Field, Walter Cullen, Clodagh SM O'Gorman, Liam G Glynn, Eamon Keenan, Jean Saunders, Gerard Bury, Colum Dunne

https://doi.org/10.1002/14651858.CD009269

Differences between protocol and review

According to the protocol we intended to exclude studies comparing psychosocial with pharmacological treatments. However, we exempted trials with two psychosocial arms in addition to pharmacological arms from this rule in the review. We did not conduct the subgroup/sensitivity analyses planned in the protocol owing to the lack of studies identified. We simplified the wording of the primary and secondary outcome measures from those in the protocol for ease of presentation, as follows:

  1. reduction and/or stabilisation of alcohol use = alcohol use or abstinence;

  2. illicit drug use outcomes (changes in illicit drug use) = illicit drug use or abstinence.

We have added new references to the Background sections 'Description of the condition' and 'Why is it important to do this review', to reflect recent developments in the field. We reduced the text in the sections 'Experimental interventions' and 'Types of participants' so as to exclude examples. We removed mention of the Newcastle‐Ottawa scale for assessing the quality of non‐randomised studies from the review as it was not used in any of the studies (observational studies were not included in the review).

Keywords

MeSH

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Study flow diagram from first publication of this review in 2012.
Figures and Tables -
Figure 1

Study flow diagram from first publication of this review in 2012.

Study flow diagram for a review update: previous studies incorporated into results of new literature search
Figures and Tables -
Figure 2

Study flow diagram for a review update: previous studies incorporated into results of new literature search

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figures and Tables -
Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figures and Tables -
Figure 4

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Comparison 1 Cognitive‐behavioural coping skills training (CBT) versus 12‐step facilitation (TSF), Outcome 1 Continuous outcomes.
Figures and Tables -
Analysis 1.1

Comparison 1 Cognitive‐behavioural coping skills training (CBT) versus 12‐step facilitation (TSF), Outcome 1 Continuous outcomes.

Comparison 1 Cognitive‐behavioural coping skills training (CBT) versus 12‐step facilitation (TSF), Outcome 2 Dichotomous outcomes.
Figures and Tables -
Analysis 1.2

Comparison 1 Cognitive‐behavioural coping skills training (CBT) versus 12‐step facilitation (TSF), Outcome 2 Dichotomous outcomes.

Comparison 2 Brief intervention (BI) versus treatment as usual, Outcome 1 Continuous outcomes.
Figures and Tables -
Analysis 2.1

Comparison 2 Brief intervention (BI) versus treatment as usual, Outcome 1 Continuous outcomes.

Comparison 2 Brief intervention (BI) versus treatment as usual, Outcome 2 Dichotomous outcomes.
Figures and Tables -
Analysis 2.2

Comparison 2 Brief intervention (BI) versus treatment as usual, Outcome 2 Dichotomous outcomes.

Comparison 3 Motivational interviewing (group) (MI‐G) versus hepatitis health promotion (HHP), Outcome 1 Continuous outcomes.
Figures and Tables -
Analysis 3.1

Comparison 3 Motivational interviewing (group) (MI‐G) versus hepatitis health promotion (HHP), Outcome 1 Continuous outcomes.

Comparison 3 Motivational interviewing (group) (MI‐G) versus hepatitis health promotion (HHP), Outcome 2 Dichotomous outcomes.
Figures and Tables -
Analysis 3.2

Comparison 3 Motivational interviewing (group) (MI‐G) versus hepatitis health promotion (HHP), Outcome 2 Dichotomous outcomes.

Comparison 4 Motivational interviewing (single) (MI‐S) versus hepatitis health promotion (HHP), Outcome 1 Continuous outcomes.
Figures and Tables -
Analysis 4.1

Comparison 4 Motivational interviewing (single) (MI‐S) versus hepatitis health promotion (HHP), Outcome 1 Continuous outcomes.

Comparison 4 Motivational interviewing (single) (MI‐S) versus hepatitis health promotion (HHP), Outcome 2 Dichotomous outcomes.
Figures and Tables -
Analysis 4.2

Comparison 4 Motivational interviewing (single) (MI‐S) versus hepatitis health promotion (HHP), Outcome 2 Dichotomous outcomes.

Comparison 5 Brief motivational intervention (BMI) versus assessment‐only, Outcome 1 Continuous outcomes.
Figures and Tables -
Analysis 5.1

Comparison 5 Brief motivational intervention (BMI) versus assessment‐only, Outcome 1 Continuous outcomes.

Comparison 5 Brief motivational intervention (BMI) versus assessment‐only, Outcome 2 Dichotomous outcomes.
Figures and Tables -
Analysis 5.2

Comparison 5 Brief motivational intervention (BMI) versus assessment‐only, Outcome 2 Dichotomous outcomes.

Summary of findings for the main comparison. Cognitive‐behavioural coping skills training (CBT) versus 12‐step facilitation (TSF) for alcohol use in concurrent problem alcohol and illicit drug users

Population: participants with alcohol use in concurrent problem alcohol and illicit drug users
Settings: substance abuse treatment centre
Intervention: CBT versus TSF

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No. of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

CBT versus TSF

Maximum number of weeks of consecutive alcohol abstinence during treatment
Substance abuse calendar and breathalyser. Scale from: 0 to 12.
Follow up: 12 weeks

The mean maximum number of weeks of consecutive alcohol abstinence during treatment in the control groups was
1.8 weeks

The mean maximum number of weeks of consecutive alcohol abstinence during treatment in the intervention group was
0.4 higher
(1.14 lower to 1.94 higher)

41
(1 study)

⊕⊕⊝⊝
low1,2

Maximum number of weeks of consecutive abstinence from cocaine during treatment
Substance abuse calendar and urinalysis. Scale from: 0 to 12.
Follow up: 12 weeks

The mean maximum number of weeks of consecutive abstinence from cocaine during treatment in the control groups was
1.3 weeks

The mean maximum number of weeks of consecutive abstinence from cocaine during treatment in the intervention group was
0.8 higher
(0.7 lower to 2.3 higher)

41
(1 study)

⊕⊕⊝⊝
low1,2

Number of people achieving 3 or more weeks of consecutive alcohol abstinence during treatment
Substance abuse calendar and breathalyser
Follow up: 12 weeks

Study population

RR 1.96
(0.43 to 8.94)

41
(1 study)

⊕⊕⊝⊝
low1,2

111 per 1000

218 per 1000
(48 to 993)

Moderate

111 per 1000

218 per 1000
(48 to 992)

Alcohol abstinence
Substance abuse calendar and breathalyser
Follow up: 1 year

Study population

RR 2.38
(0.1 to 55.06)

41
(1 study)

⊕⊕⊝⊝
low1,2

0 per 1000

0 per 1000
(0 to 0)

Moderate

0 per 1000

0 per 1000
(0 to 0)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Incomplete outcome data
2 Sparse data: only 1 study with relatively few participants included in comparison

Figures and Tables -
Summary of findings for the main comparison. Cognitive‐behavioural coping skills training (CBT) versus 12‐step facilitation (TSF) for alcohol use in concurrent problem alcohol and illicit drug users
Summary of findings 2. Brief intervention (BI) versus treatment as usual for alcohol use in concurrent problem alcohol and illicit drug users

Population: participants with alcohol use in concurrent problem alcohol and illicit drug users
Settings:
Intervention: BI versus treatment as usual

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No. of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

BI versus treatment as usual

Number of standard drinks per week
unreported
Follow up: 3 months

The mean number of standard drinks per week in the control groups was
16.3 standard drinks

The mean number of standard drinks per week in the intervention groups was
0.7 higher
(3.85 lower to 5.25 higher)

110
(1 study)

⊕⊕⊝⊝
low1,2

Number of standard drinks per week
unreported
Follow up: 9 months

The mean number of standard drinks per week in the control groups was
18.7 standard drinks

The mean number of standard drinks per week in the intervention groups was
0.3 lower
(4.79 lower to 4.19 higher)

110
(1 study)

⊕⊕⊝⊝
low1,2

Decreased alcohol use
1st question from the Alcohol Use Disorders Identification Test: How often do you have a drink containing alcohol?
Follow up: 3 months

Study population

RR 1.13
(0.67 to 1.93)

110
(1 study)

⊕⊕⊝⊝
low1,2

314 per 1000

355 per 1000
(210 to 605)

Moderate

314 per 1000

355 per 1000
(210 to 606)

Decreased alcohol use
1st question from the Alcohol Use Disorders Identification Test: How often do you have a drink containing alcohol?
Follow up: 9 months

Study population

RR 1.34
(0.69 to 2.58)

110
(1 study)

⊕⊕⊝⊝
low1,2

216 per 1000

289 per 1000
(149 to 556)

Moderate

216 per 1000

289 per 1000
(149 to 557)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Allocation and assessment of outcomes weren't blinded
2 Sparse data: only 1 study with relatively few participants included in comparison

Figures and Tables -
Summary of findings 2. Brief intervention (BI) versus treatment as usual for alcohol use in concurrent problem alcohol and illicit drug users
Summary of findings 3. Motivational interviewing (group) (MI‐G) versus hepatitis health promotion (HHP) for alcohol use in concurrent problem alcohol and illicit drug users

Population: participants with alcohol use in concurrent problem alcohol and illicit drug users
Settings: methadone outpatient clinics
Intervention: MI‐G versus HHP

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No. of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

MI‐G versus HHP

Number of standard drinks per day
counts
Follow up: 6 months

The mean number of standard drinks per day in the control groups was
3.9 standard drinks

The mean number of standard drinks per day in the intervention groups was
0.4 lower
(2.03 lower to 1.23 higher)

147
(1 study)

⊕⊕⊝⊝
low1,2

Over 50% less standard drinks per day
Timeline follow back
Follow up: 6 months

Study population

RR 1.1
(0.82 to 1.48)

166
(1 study)

⊕⊕⊝⊝
low1,2

494 per 1000

544 per 1000
(405 to 731)

Moderate

494 per 1000

543 per 1000
(405 to 731)

Alcohol abstinence
Timeline follow back
Follow up: 6 months

Study population

RR 0.88
(0.49 to 1.58)

166
(1 study)

⊕⊕⊝⊝
low1,2

230 per 1000

202 per 1000
(113 to 363)

Moderate

230 per 1000

202 per 1000
(113 to 363)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Masking: open label. Allocation and assessment of outcomes weren't blinded
2 Sparse data: only 1 study with relatively few participants included in comparison

Figures and Tables -
Summary of findings 3. Motivational interviewing (group) (MI‐G) versus hepatitis health promotion (HHP) for alcohol use in concurrent problem alcohol and illicit drug users
Summary of findings 4. Motivational interviewing (single) (MI‐S) versus hepatitis health promotion (HHP) for alcohol use in concurrent problem alcohol and illicit drug users

Population: participants with alcohol use in concurrent problem alcohol and illicit drug users
Settings:
Intervention: MI‐S versus HHP

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No. of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

MI‐S versus hepatitis HHP

Number of standard drinks consumed per day
counts
Follow up: 6 months

The mean number of standard drinks consumed per day in the control groups was
3.9 standard drinks

The mean number of standard drinks consumed per day in the intervention groups was
0.1 lower
(1.89 lower to 1.69 higher)

155
(1 study)

⊕⊕⊝⊝
low1,2

Over 50% less standard drinks per day
Timeline follow back
Follow up: 6 months

Study population

RR 0.92
(0.68 to 1.26)

177
(1 study)

⊕⊕⊝⊝
low1,2

494 per 1000

455 per 1000
(336 to 623)

Moderate

494 per 1000

454 per 1000
(336 to 622)

Alcohol abstinence
Timeline follow back
Follow‐up: 6 months

Study population

RR 0.97
(0.56 to 1.67)

177
(1 study)

⊕⊕⊝⊝
low1,2

230 per 1000

223 per 1000
(129 to 384)

Moderate

230 per 1000

223 per 1000
(129 to 384)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Masking: open label. Allocation and assessment of outcomes weren't blinded
2 Sparse data: only 1 study with relatively few participants included in comparison

Figures and Tables -
Summary of findings 4. Motivational interviewing (single) (MI‐S) versus hepatitis health promotion (HHP) for alcohol use in concurrent problem alcohol and illicit drug users
Summary of findings 5. Brief motivational intervention (BMI) versus assessment‐only for alcohol use in concurrent problem alcohol and illicit drug users

Population: participants with alcohol use in concurrent problem alcohol and illicit drug users
Settings: addiction clinic
Intervention: BMI versus assessment‐only

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No. of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

BMI) versus assessment‐only

Number of days with alcohol use at 6 months
Timeline follow back. Scale from: 0 to 31.
Follow up: 6 months

The mean number of days with alcohol use at 6 months in the control groups was
9.1 days

The mean number of days with alcohol use at 6 months in the intervention groups was
1.5 lower
(4.56 lower to 1.56 higher)

187
(1 study)

⊕⊕⊕⊝
moderate1

25% reduction of drinking days in the past 30 days
Timeline follow back
Follow up: 6 months

Study population

RR 1.23
(0.96 to 1.57)

187
(1 study)

⊕⊕⊕⊝
moderate1

522 per 1000

642 per 1000
(501 to 819)

Moderate

522 per 1000

642 per 1000
(501 to 820)

50% reduction of drinking days in the past 30 days
Timeline follow back
Follow up: 6 months

Study population

RR 1.27
(0.96 to 1.68)

187
(1 study)

⊕⊕⊕⊝
moderate1

457 per 1000

580 per 1000
(438 to 767)

Moderate

457 per 1000

580 per 1000
(439 to 768)

Seven or more drinking days' reduction in the past 30 days
Timeline follow back
Follow up: 6 months

Study population

RR 1.67
(1.08 to 2.6)

187
(1 study)

⊕⊕⊕⊝
moderate1

239 per 1000

399 per 1000
(258 to 622)

Moderate

239 per 1000

399 per 1000
(258 to 621)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Sparse data: only 1 study with relatively few participants included in comparison

Figures and Tables -
Summary of findings 5. Brief motivational intervention (BMI) versus assessment‐only for alcohol use in concurrent problem alcohol and illicit drug users
Comparison 1. Cognitive‐behavioural coping skills training (CBT) versus 12‐step facilitation (TSF)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Continuous outcomes Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

1.1 Alcohol abstinence as maximum number of weeks of consecutive alcohol abstinence during treatment

1

41

Mean Difference (IV, Fixed, 95% CI)

0.40 [‐1.14, 1.94]

1.2 Illicit drug abstinence as maximum number of weeks of consecutive abstinence from cocaine during treatment

1

41

Mean Difference (IV, Fixed, 95% CI)

0.8 [‐0.70, 2.30]

2 Dichotomous outcomes Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 Alcohol abstinence as number achieving 3 or more weeks of consecutive alcohol abstinence during treatment

1

41

Risk Ratio (M‐H, Fixed, 95% CI)

1.96 [0.43, 8.94]

2.2 Illicit drug abstinence as number achieving 3 or more weeks of consecutive abstinence from cocaine during treatment

1

41

Risk Ratio (M‐H, Fixed, 95% CI)

1.10 [0.42, 2.88]

2.3 Alcohol abstinence during follow‐up year

1

41

Risk Ratio (M‐H, Fixed, 95% CI)

2.38 [0.10, 55.06]

2.4 Illicit drug abstinence as abstinence from cocaine during follow‐up year

1

41

Risk Ratio (M‐H, Fixed, 95% CI)

0.39 [0.04, 3.98]

Figures and Tables -
Comparison 1. Cognitive‐behavioural coping skills training (CBT) versus 12‐step facilitation (TSF)
Comparison 2. Brief intervention (BI) versus treatment as usual

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Continuous outcomes Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

1.1 Alcohol use as AUDIT scores at 3 months

1

110

Mean Difference (IV, Fixed, 95% CI)

0.80 [‐1.80, 3.40]

1.2 Alcohol use as AUDIT Scores at 9 months

1

110

Mean Difference (IV, Fixed, 95% CI)

2.30 [‐0.58, 5.18]

1.3 Alcohol use as number of drinks per week at 3 months

1

110

Mean Difference (IV, Fixed, 95% CI)

0.70 [‐3.85, 5.25]

1.4 Alcohol use as number of drinks per week at 9 months

1

110

Mean Difference (IV, Fixed, 95% CI)

‐0.30 [‐4.79, 4.19]

2 Dichotomous outcomes Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 Alcohol use as decreased alcohol use at 3 months

1

110

Risk Ratio (M‐H, Fixed, 95% CI)

1.13 [0.67, 1.93]

2.2 Alcohol use as decreased alcohol use at 9 months

1

110

Risk Ratio (M‐H, Fixed, 95% CI)

1.34 [0.69, 2.58]

Figures and Tables -
Comparison 2. Brief intervention (BI) versus treatment as usual
Comparison 3. Motivational interviewing (group) (MI‐G) versus hepatitis health promotion (HHP)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Continuous outcomes Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

1.1 Alcohol use as number of standard drinks consumed per day over the last 30 days 

1

147

Mean Difference (IV, Fixed, 95% CI)

‐0.40 [‐2.03, 1.23]

1.2 Illicit drug use as frequency of drug use (as measured by Addiction Severity Index ‐ ASI drug)

1

147

Mean Difference (IV, Fixed, 95% CI)

0.0 [‐0.03, 0.03]

1.3 Illicit drug use as a composite drug score (frequency*severity for all drugs taken)

1

151

Mean Difference (IV, Fixed, 95% CI)

0.0 [‐0.42, 0.42]

2 Dichotomous outcomes Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 Alcohol use as greater than 50% reduction in number of standard drinks consumed per day over the last 30 days

1

166

Risk Ratio (M‐H, Fixed, 95% CI)

1.10 [0.82, 1.48]

2.2 Alcohol abstinence as abstinence from alcohol over the last 30 days

1

166

Risk Ratio (M‐H, Fixed, 95% CI)

0.88 [0.49, 1.58]

Figures and Tables -
Comparison 3. Motivational interviewing (group) (MI‐G) versus hepatitis health promotion (HHP)
Comparison 4. Motivational interviewing (single) (MI‐S) versus hepatitis health promotion (HHP)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Continuous outcomes Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

1.1 Alcohol use as number of standard drinks consumed per day over the last 30 days 

1

155

Mean Difference (IV, Fixed, 95% CI)

‐0.10 [‐1.89, 1.69]

1.2 Illicit drug use as frequency of drug use (as measured by Addiction Severity Index ‐ ASI drug)

1

155

Mean Difference (IV, Fixed, 95% CI)

0.0 [‐0.03, 0.03]

1.3 Illicit drug use as a composite drug score (frequency*severity for all drugs taken)

1

157

Mean Difference (IV, Fixed, 95% CI)

‐0.10 [‐0.46, 0.26]

2 Dichotomous outcomes Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 Alcohol use as greater than 50% reduction in number of standard drinks consumed per day over the last 30 days

1

177

Risk Ratio (M‐H, Fixed, 95% CI)

0.92 [0.68, 1.26]

2.2 Alcohol abstinence as abstinence from alcohol over the last 30 days

1

177

Risk Ratio (M‐H, Fixed, 95% CI)

0.97 [0.56, 1.67]

Figures and Tables -
Comparison 4. Motivational interviewing (single) (MI‐S) versus hepatitis health promotion (HHP)
Comparison 5. Brief motivational intervention (BMI) versus assessment‐only

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Continuous outcomes Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

1.1 Alcohol use as number of days in the past 30 days with alcohol use at 1 month

1

187

Mean Difference (IV, Fixed, 95% CI)

‐0.30 [‐3.38, 2.78]

1.2 Alcohol use as number of days in the past 30 days with alcohol use at 6 months

1

187

Mean Difference (IV, Fixed, 95% CI)

‐1.5 [‐4.56, 1.56]

2 Dichotomous outcomes Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 Alcohol use as 25% reduction of drinking days in the past 30 days

1

187

Risk Ratio (M‐H, Fixed, 95% CI)

1.23 [0.96, 1.57]

2.2 Alcohol use as 50% reduction of drinking days in the past 30 days

1

187

Risk Ratio (M‐H, Fixed, 95% CI)

1.27 [0.96, 1.68]

2.3 Alcohol use as 75% reduction of drinking days in the past 30 days

1

187

Risk Ratio (M‐H, Fixed, 95% CI)

1.21 [0.84, 1.75]

2.4 Alcohol use as 1 or more drinking days' reduction in the past 30 days

1

187

Risk Ratio (M‐H, Fixed, 95% CI)

1.12 [0.91, 1.38]

2.5 Alcohol use as 7 or more drinking days' reduction in the past 30 days

1

187

Risk Ratio (M‐H, Fixed, 95% CI)

1.67 [1.08, 2.60]

Figures and Tables -
Comparison 5. Brief motivational intervention (BMI) versus assessment‐only