Psychosocial combined with agonist maintenance treatments versus agonist maintenance treatments alone for treatment of opioid dependence

Laura Amato; Silvia Minozzi; Marina Davoli; Simona Vecchi

doi:10.1002/14651858.CD004147.pub4

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Figure 1

Study flow diagram.

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Figure 2

Methodological quality graph: review authors' judgments about each methodological quality item presented as percentages across all included studies.

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Figure 3

Methodological quality summary: review authors' judgments about each methodological quality item for each included study.

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Figure 4

Forest plot of comparison: 1 Any Psychosocial intervention plus pharm versus pharm standard, outcome: 1.1 Retention in treatment.

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Analysis 1.1

Comparison 1 Any Psychosocial intervention plus pharm versus pharm standard, Outcome 1 Retention in treatment.

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Analysis 1.2

Comparison 1 Any Psychosocial intervention plus pharm versus pharm standard, Outcome 2 Opioid abstinence.

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Analysis 1.3

Comparison 1 Any Psychosocial intervention plus pharm versus pharm standard, Outcome 3 Number of participants still in treatment at the end of follow‐up.

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Analysis 1.4

Comparison 1 Any Psychosocial intervention plus pharm versus pharm standard, Outcome 4 Number of participants abstinent at the end of follow‐up.

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Analysis 1.5

Comparison 1 Any Psychosocial intervention plus pharm versus pharm standard, Outcome 5 Compliance.

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Analysis 1.6

Comparison 1 Any Psychosocial intervention plus pharm versus pharm standard, Outcome 6 Psychiatric symptoms SCL‐90.

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Analysis 1.7

Comparison 1 Any Psychosocial intervention plus pharm versus pharm standard, Outcome 7 Depression (BDI).

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Analysis 2.1

Comparison 2 Any Behavioural interventions plus pharm versus pharm standard, Outcome 1 Retention in treatment.

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Analysis 2.2

Comparison 2 Any Behavioural interventions plus pharm versus pharm standard, Outcome 2 Opioid abstinence.

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Analysis 2.3

Comparison 2 Any Behavioural interventions plus pharm versus pharm standard, Outcome 3 Continuous weeks of abstinence.

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Analysis 2.4

Comparison 2 Any Behavioural interventions plus pharm versus pharm standard, Outcome 4 Number of participants still in treatment at the end of follow‐up.

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Analysis 2.5

Comparison 2 Any Behavioural interventions plus pharm versus pharm standard, Outcome 5 Number of participants abstinent at the end of follow‐up.

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Analysis 3.1

Comparison 3 Psychoanalytic oriented treatments plus pharm versus pharm standard, Outcome 1 Retention in treatment.

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Analysis 3.2

Comparison 3 Psychoanalytic oriented treatments plus pharm versus pharm standard, Outcome 2 Opioid abstinence.

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Analysis 4.1

Comparison 4 Counselling plus pharm versus pharm standard, Outcome 1 retention in treatment.

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Analysis 4.2

Comparison 4 Counselling plus pharm versus pharm standard, Outcome 2 opioid abstinence.

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Summary of findings for the main comparison. Any Psychosocial intervention plus pharm versus pharm standard for treatment of opioid dependence

Any Psychosocial intervention plus pharm versus pharm standard for treatment of opioid dependence
Patient or population: patients with treatment of opioid dependence Settings: Intervention: Any Psychosocial intervention plus pharm versus pharm standard
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	Any Psychosocial intervention plus pharm versus pharm standard
Retention in treatment Objective Follow‐up: mean 17 weeks	Study population		RR 1.02 (0.97 to 1.07)	2582 (26 studies)	⊕⊕⊕⊕ high
	683 per 1000	696 per 1000 (662 to 730)
	Moderate
	738 per 1000	753 per 1000 (716 to 790)
Opioid abstinence objective Follow‐up: mean 17 weeks	Study population		RR 1.19 (0.91 to 1.56)	667 (7 studies)	⊕⊕⊕⊕ high
	502 per 1000	597 per 1000 (456 to 782)
	Moderate
	527 per 1000	627 per 1000 (480 to 822)
Number of participants still in treatment at the end of follow‐up objective Follow‐up: mean 3 months	Study population		RR 0.9 (0.77 to 1.07)	250 (3 studies)	⊕⊕⊕⊕ high
	713 per 1000	641 per 1000 (549 to 763)
	Moderate
	771 per 1000	694 per 1000 (594 to 825)
Number of participants abstinent at the end of follow‐up objective Follow‐up: mean 3 months	Study population		RR 1.15 (0.98 to 1.36)	181 (3 studies)	⊕⊕⊕⊕ high
	724 per 1000	833 per 1000 (710 to 985)
	Moderate
	429 per 1000	493 per 1000 (420 to 583)
Compliance objective Follow‐up: mean 17 weeks		The mean compliance in the intervention groups was 0.43 higher (0.05 lower to 0.92 higher)		685 (3 studies)	⊕⊕⊕⊝ moderate¹
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% confidence interval) 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 studies were judged at unclear risk of detection bias.

Summary of findings for the main comparison. Any Psychosocial intervention plus pharm versus pharm standard for treatment of opioid dependence

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Comparison 1. Any Psychosocial intervention plus pharm versus pharm standard

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Retention in treatment Show forest plot	27	3124	Risk Ratio (M‐H, Fixed, 95% CI)	1.03 [0.98, 1.07]

2 Opioid abstinence Show forest plot	8	1002	Risk Ratio (M‐H, Random, 95% CI)	1.12 [0.92, 1.37]

3 Number of participants still in treatment at the end of follow‐up Show forest plot	3	250	Risk Ratio (M‐H, Random, 95% CI)	0.90 [0.77, 1.07]

4 Number of participants abstinent at the end of follow‐up Show forest plot	3	181	Risk Ratio (M‐H, Fixed, 95% CI)	1.15 [0.98, 1.36]

5 Compliance Show forest plot	3	685	Mean Difference (IV, Random, 95% CI)	0.43 [‐0.05, 0.92]

6 Psychiatric symptoms SCL‐90 Show forest plot	3	279	Mean Difference (IV, Fixed, 95% CI)	0.02 [‐0.28, 0.31]

7 Depression (BDI) Show forest plot	3	279	Mean Difference (IV, Fixed, 95% CI)	‐1.70 [‐3.91, 0.51]

Comparison 1. Any Psychosocial intervention plus pharm versus pharm standard

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Comparison 2. Any Behavioural interventions plus pharm versus pharm standard

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Retention in treatment Show forest plot	19		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

1.1 Any behavioural plus pharm versus pharm standard	19	2065	Risk Ratio (M‐H, Fixed, 95% CI)	1.01 [0.95, 1.06]
1.2 Contingency management plus pharm versus pharm standard	14	1616	Risk Ratio (M‐H, Fixed, 95% CI)	1.02 [0.96, 1.08]
2 Opioid abstinence Show forest plot	4	448	Risk Ratio (M‐H, Fixed, 95% CI)	1.04 [0.89, 1.21]

3 Continuous weeks of abstinence Show forest plot	2	138	Mean Difference (IV, Fixed, 95% CI)	1.91 [0.20, 3.62]

4 Number of participants still in treatment at the end of follow‐up Show forest plot	3	218	Risk Ratio (M‐H, Fixed, 95% CI)	0.95 [0.80, 1.13]

5 Number of participants abstinent at the end of follow‐up Show forest plot	3	123	Risk Ratio (M‐H, Fixed, 95% CI)	1.18 [0.98, 1.41]

Comparison 2. Any Behavioural interventions plus pharm versus pharm standard

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Comparison 3. Psychoanalytic oriented treatments plus pharm versus pharm standard

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Retention in treatment Show forest plot	3	212	Risk Ratio (M‐H, Fixed, 95% CI)	0.90 [0.75, 1.07]

2 Opioid abstinence Show forest plot	2	127	Risk Ratio (M‐H, Fixed, 95% CI)	1.21 [0.82, 1.78]

Comparison 3. Psychoanalytic oriented treatments plus pharm versus pharm standard

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Comparison 4. Counselling plus pharm versus pharm standard

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 retention in treatment Show forest plot	4	769	Risk Ratio (M‐H, Fixed, 95% CI)	1.07 [0.98, 1.15]

2 opioid abstinence Show forest plot	1	335	Risk Ratio (M‐H, Fixed, 95% CI)	0.98 [0.85, 1.14]

Comparison 4. Counselling plus pharm versus pharm standard

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