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Психосоциальные вмешательства для уменьшения потребления алкоголя при совместной проблеме потребления алкоголя и наркотиков.

Esta versión no es la más reciente

Appendices

Appendix 1. MEDLINE search strategy

MEDLINE (via PubMed)

Monday, June 23, 2014 (564 hits):

Search terms to locate drug abuse:

1. "Substance‐Related Disorders"[MeSH]

2. addict*[tiab] OR overdose[tiab] OR intoxicat*[tiab] OR abstin*[tiab] OR abstain*[tiab] OR withdrawal*[tiab] OR abuse*[tiab] OR use*[tiab] OR misuse[tiab] OR disorder*[tiab] OR dependen*[tiab]

3. #1 or #2

Search terms to identify drugs:

4. ''heroin"[mh] OR heroin[tiab]
5. narcotic*[tiab]
6. drug[tiab] OR polydrug[tiab] OR substance[tiab] OR opioid[tw] OR opiate[tw] OR hallucinogen[tiab] OR cocaine[tw] OR benzodiazepine*[tw] OR amphetamine*[tw] OR "anti‐anxiety‐agents"[tiab] OR barbiturate*[tiab] OR "lysergic acid"[tiab] OR ketamine[tiab] OR cannabis[tiab] OR marihuana[tiab] OR hashish[tiab] OR opium[tiab] OR inhalant*[tiab] OR solvent[tiab] OR steroid*[tiab] OR methadone[tiab] OR morphine[tiab] OR ecstasy[tiab] OR MDMA[tiab]
7. ''Street Drugs"[MeSH]
8. ''Designer Drugs"[MeSH]
9. #4 or #5 or #6 or #7 or #8

Search terms to identify alcohol:

10. alcohol*[tiab]
11. binge[tiab] OR drink*[tiab]
12. alcoholism[MeSH]
13. alcoholic Intoxication [MeSH]
14. ''Drinking behavior''[MeSH]
15. #10 or #11 or #12 or #13 or #14

Search terms to locate interventions:

16. psychotherapy [MeSH]
17. incentive*[tiab] OR voucher[tiab] OR psychotherap*[tiab] OR psychosocial*[tiab] OR ''behaviour therapy'' [tiab] OR ''behavior therapy''[tiab] OR reinforcement[tiab] OR motivation*[tiab] OR contingent*[tiab] OR advice[tiab] OR biofeedback[tiab] OR community[tiab] OR stimulation[tiab] OR education*[tiab]
18. ''brief intervention''[tiab]
19. ''early intervention''[tiab]
20. ''minimal intervention'' [tiab]
21. ''counselling"[MeSH] or counsel*[tiab]
22. ''cognitive therapy'' [tiab]
23. ''family therapy'' [tiab]
24. ''social skill''[tiab]
25. ''stress management training'' [tiab]
26. ''supportive expressive therapy'' [tiab]
27. neurobehavioral* [tiab]
28. ''coping skill''[tiab]
29. ''self‐control training''[tiab]
30. ''social support''[MeSH]
31. ''relaxation techniques''[MeSH]
32. ''case management''[MeSH]
33. #16 or #17 or #18 or #19 or #20 or #21 or #22 or #23 or #24 or #25 or #26 or #27 or #28 or #29 or #30 or #31 or #32

Search terms to locate randomised controlled trials

34. randomised controlled trial [pt]
35. controlled clinical trial [pt]
36. random*[tiab]
37. placebo [tiab]
38. drug therapy [sh]
39. trial [tiab]
40. groups [tiab]
41. #34 or #35 or #36 or #37 or #38 or #39 or #40
42. Animals [mh] NOT Humans [mh]
43. #41 NOT #42
44. #3 AND #9 AND ##15 AND #33 AND #43

Appendix 2. CENTRAL (CLIB) search strategy

The Cochrane Library

Issue 6, June 2014 (372 hits)

#1. MeSH descriptor Substance‐Related Disorders explode all trees

#2. ((stimulant* or polydrug* or drug* or substance) near/3 (abuse* or abusing or depend* or addict* or disorder* or intoxicat* or misus* or use* )):ti,ab

#3. (#1 OR #2)

#4. (abuse* or abusing or depend* or addict* or depend* or overdos* or withdraw* or abstain* or abstinen* or disorder* or intoxicat* or misus*):ti,ab,kw

#5. use*:ti,ab

#6. (#4 OR #5)

#7. MeSH descriptor Narcotics explode all trees

#8. (heroin or morphine* or diamorphine or diacetylmorphine or morfin* or narcotic* or methadone):ti,ab,kw

#9. MeSH descriptor Methadone explode all trees

#10. (Opioid* or opiate* or opium):ti,ab,kw

#11. MeSH descriptor Amphetamine explode all trees

#12. (amphetamine* or dextroamphetamine* or methamphetamine or Methylamphetamine*):ti,ab,kw

#13. MeSH descriptor Methamphetamine explode all trees

#14. (ecstasy or MDMA or hallucinogen*):ti,ab,kw

#15. MeSH descriptor Hallucinogens explode all trees

#16. MeSH descriptor Street Drugs explode all trees

#17. MeSH descriptor Cocaine explode all trees

#18. (crack or cocaine):ti,ab,kw

#19. MeSH descriptor Cannabis explode all trees

#20. (cannabis or marijuana or marihuana or Hashish):ti,ab,kw

#21. (Lysergic NEXT Acid):ti,ab,kw

#22. (LSD):ti,ab,kw

#23. (benzodiazepine* or barbiturate* or ketamine or solvent or inhalant):ti,ab,kw

#24. (#7 OR #8 OR #9 OR #10 OR #11 OR #12 OR #13 OR #14 OR #15 OR #16 OR #17 OR #18 OR #19 OR #20 OR #21 OR #22 OR #23)

#25. (#6 AND #24)

#26. (#3 OR #25)

#27. (alcohol*):ti,ab,kw

#28. (binge or drink*):ti,ab

#29. MeSH descriptor Drinking Behavior explode all trees

#30. MeSH descriptor Alcoholism explode all trees

#31. MeSH descriptor Alcoholic Intoxication explode all trees

#32. (#27 OR #28 OR #29 OR #30 OR #31)

#33. MeSH descriptor Psychotherapy explode all trees

#34. (psychotherap* or psychosocial or voucher or reinforcement or motivation* or contingent* or biofeedback or community or stimulation or education* or counsel*):ti,ab,kw

#35. (social near/2 skill*):ti,ab

#36. (coping near/2 skill):ti,ab

#37. MeSH descriptor Counseling explode all trees

#38. (behavi* near/2 therap*):ti,ab

#39. MeSH descriptor Reinforcement (Psychology) explode all trees

#40. (brief near intervention):ti,ab

#41. (early near intervention):ti,ab

#42. (minimal near intervention):ti,ab

#43. (cognitive near therapy):ti,ab

#44. (family near therapy):ti,ab

#45. (stress near management near training):ti,ab

#46. (supportive near expressive near therapy):ti,ab

#47. MeSH descriptor Social Support explode all trees

#48. MeSH descriptor Case Management explode all trees

#49. (self near control near training):ti,ab

#50. neurobehavioral*:ab,ti

#51. (#33 OR #34 OR #35 OR #36 OR #37 OR #38 OR #39 OR #40 OR #41 OR #42 OR #43 OR #44 OR #45 OR #46 OR #47 OR #48 OR #49 OR #50)

#52. (#26 AND #32 AND #51)

#53. "(#26 AND #32 AND #51) in Cochrane Central Register of Controlled Trials"

Appendix 3. EMBASE search strategy

EMBASE (via embase.com)

Monday, June 23, 2014 (632 hits)

#1. 'addiction'/exp

#2. dependen*:ab,ti OR addict*:ab,ti OR overdos*:ab,ti OR intoxicat*:ab,ti OR abstin*:ab,ti OR abstain:ab,ti OR withdraw*:ab,ti OR abus*:ab,ti OR use*:ab,ti OR misus*:ab,ti OR disorder*:ab,ti

#3. #1 OR #2

#4. 'diamorphine'/exp

#5. diamorphine:ab,ti OR heroin:ab,ti OR narcotic*:ab,ti OR drug*:ab,ti OR polydrug:ab,ti OR substance:ab,ti OR opioid:ab,ti OR opiate:ab,ti OR hallucinogen:ab,ti OR cocaine:ab,ti OR benzodiazepine:ab,ti OR amphetamine:ab,ti OR 'anti‐anxiety‐agents':ab,ti OR barbiturate:ab,ti OR 'lysergic acid':ab,ti OR ketamine:ab,ti OR cannabis:ab,ti OR marihuana:ab,ti OR marijuana:ab,ti OR hashish:ab,ti OR opium:ab,ti OR inhalant:ab,ti OR solvent:ab,ti OR steroid:ab,ti OR methadone:ab,ti OR morphine:ab,ti OR ecstasy:ab,ti OR mdma:ab,ti

#6. 'designer drug'/exp

#7. 'street drug'/exp

#8. #5 OR #6 OR #7

#9. alcohol*:ab,ti OR binge:ab,ti OR drink*:ab,ti

#10. 'alcohol intoxication'/exp

#11. drinking behavior'/exp

#12. 'alcohol abuse'/exp

#13. #9 OR #10 OR #11 OR #12

#14. 'psychotherapy'/exp

#15. incentive*:ab,ti OR voucher:ab,ti OR psychotherap*:ab,ti OR psychosocial*:ab,ti OR reinforcement:ab,ti OR motivation*:ab,ti OR contingent*:ab,ti OR advice:ab,ti OR biofeedback:ab,ti OR community:ab,ti OR stimulation:ab,ti OR education*:ab,ti

#16. 'behaviour therapy':ab,ti OR 'behavior therapy':ab,ti

#17. counsel*:ab,ti

#18. 'counseling'/exp 

#19. 'cognitive therapy':ab,ti OR 'family therapy':ab,ti OR 'social skill':ab,ti OR 'stress management training':ab,ti OR 'supportive expressive therapy':ab,ti

#20. 'coping skill':ab,ti OR 'social skill':ab,ti

#21. 'social support'/exp

#22. 'case management'/exp

#23. 'relaxation therapy':ab,ti

#24. 'self‐control training':ab,ti

#25. neurobehavioral*:ab,ti

#26. #9 OR #10 OR #11 OR #12 OR #13 OR #14 OR #15 OR #16 OR #17 OR #18 OR #19 OR #20 OR #21 OR #22 OR #23 OR #24 OR #25

#27. 'crossover procedure'/exp 

#28. 'double blind procedure'/exp

#29. 'single blind procedure'/exp

#30. 'controlled clinical trial'/exp

#31. 'clinical trial'/exp

#32. placebo:ab,ti OR 'double blind':ab,ti OR 'single blind':ab,ti OR assign*:ab,ti OR allocat*:ab,ti OR volunteer*:ab,ti

#33. random*:ab,ti OR factorial*:ab,ti OR crossover:ab,ti OR (cross:ab,ti AND over:ab,ti)

#34. 'randomized controlled trial'/exp

#35. #27 OR #28 OR #29 OR #30 OR #31 OR #32 OR #33 OR #34

#36. #3 AND #8 AND #13 AND #26 AND #35 AND [humans]/lim AND  [embase]/lim

Appendix 4. CINAHL search strategy

CINAHL (via EBSCO)

Monday, June 23, 2014 (56 hits)

S01. MH "Substance Use Disorders"

S02. TX(drug N3 addict*) or TX(drug N3 dependen*) or TX(drug N3 abuse*) or TX(drug N3 misus*) or TX(drug N3 use*)

S03. TX(substance N3 addict*) or TX(substance N3 dependen*) or TX(substance N3 abuse*) or TX(substance N3 misus*)

S04. S1 or S2 or S3

S05. TX(addict* OR overdos* OR intoxicat* OR abstin* OR abstain OR withdraw* OR abus* OR misus* OR disorder* OR dependen* OR use*)

S06. MH "Heroin"

S07. MH "Narcotics"

S08. MH "Designer Drugs"

S09. TX(polydrug or opioid or opiate or opium or hallucinogen or cocaine or benzodiazepine* or amphetamine*or “anti‐anxiety‐agents” or barbiturate* or “lysergic acid” or ketamine or cannabis or marihuana or hashish or inhalant* or solvent or steroid* or methadone or morphine)

S10. TI ecstasy or TI mdma or AB ecstasy or AB mdma

S11. S6 or S7 or S8 or S9 or S10

S12. S5 and S11

S13. S4 or S12

S14. TI alcohol* or AB alcohol*

S15. TI drink* or TI binge or AB drink* or AB binge

S16. MH "Alcoholism"

S17. MH "Alcoholic Intoxication"

S18. (MH "Drinking Behavior+")

S19. S14 or S15 or S16 or S17 or S18

S20. MH "Clinical Trials+"

S21. PT Clinical trial

S22. TI clinic* N1 trial* or AB clinic* N1 trial*

S23. TI ( singl* or doubl* or trebl* or tripl* ) and TI ( blind* or mask* )

S24. AB ( singl* or doubl* or trebl* or tripl* ) and AB ( blind* or mask* )

S25. TI randomi?ed control* trial* or AB randomi?ed control* trial*

S26. MH "Random Assignment"

S27. TI random* allocat* or AB random* allocat*

S28. MH "Placebos"

S29. TI placebo* or AB placebo*

S30. MH "Quantitative Studies"

S31. S20 or S21 or S22 or S23 or S24 or S25 or S26 or S27 or S28 or S29 or S30

S32. S13 and S19 and S31

S33. S13 and S19 and S31

Limiters ‐ Exclude MEDLINE records; Human

Appendix 5. PsycINFO search strategy

PsycINFO (via EBSCO)

Friday, March 14, 2014 (212 hits)

1. (((psychotherap*) OR TI(psychosocial*) OR TI("behaviour therapy") OR TI("behavior therapy") OR TI(reinforcement) OR TI(motivation*) OR TI(contingent*) OR TI(advice) OR TI(biofeedback) OR TI(community) OR TI(stimulation) OR TI(education*) OR TI(incentive*) OR TI(voucher)) OR ((psychotherap*) OR AB(psychosocial*) OR AB("behaviour therapy") OR AB("behavior therapy") OR AB(reinforcement) OR AB(motivation*) OR AB(contingent*) OR AB(advice) OR AB(biofeedback) OR AB(community) OR AB(stimulation) OR AB(education*) OR MJ("psychotherapy") OR AB(incentive*) OR AB(voucher)))

2. ((TI(alcohol*) OR TI(binge) OR TI(drink*)) OR (AB(alcohol*) OR AB(binge) OR AB(drink*)) OR (KW(alcohol*) OR KW(binge) OR KW(drink*)) OR DE(Alcoholism) OR DE("Alcohol intoxication") OR DE("Alcohol drinking patterns"))

3. ((KW(''heroin'') OR KW(''morphine'')) OR KW(''narcotics'') OR (TI(drug) OR AB(drug) OR TI(polydrug) OR AB(polydrug) OR TI(substance) OR AB(substance) OR TI(opioid) OR AB(opioid) OR TI(opiate) OR AB(opiate) OR TI(''hallucinogenic drugs'') OR AB(''hallucinogenic drugs'') OR KW(''psychedelic drugs'') OR KW(''Lysergic Acid Diethylamide'') OR TI(LSD) OR AB(LSD) OR TI(cocaine) OR AB(cocaine) OR TI(benzodiazepine*) OR AB(benzodiazepine*) OR TI(''amphetamine'') OR AB(''amphetamine'') OR TI(''anti‐anxiety‐agents'') OR AB(''anti‐anxiety‐agents'') OR TI(barbiturate*) OR AB(barbiturate*) OR TI(ketamine) OR AB(ketamine) OR TI(''cannabis'') OR AB(''cannabis'') OR TI(''marihuana'') OR AB(''marihuana'') OR TI(hashish) OR AB(hashish) OR TI(opium) OR AB(opium) OR TI(''inhalant abuse'') OR AB(''inhalant abuse'') OR TI(solvent) OR AB(solvent) OR TI(steroid*) OR AB(steroid*) OR TI(''methadone'') OR AB(''methadone'') OR TI(ecstasy) OR AB(ecstasy) OR TI(''methylenedioxyamphetamine'') OR AB(''methylenedioxyamphetamine'')) OR (KW(street drug*) OR KW(designer drug*)))

4. (SU("drug abuse") OR (KW(addict* OR abus* OR dependen*)) OR TX(overdose) OR TX(intoxicat*) OR TX(abstin*) OR TX(abstain) OR TX(withdrawal) OR TX(abuse) OR TX(use) OR TX(misuse) OR TX(disorder*) OR KW(''drug addiction''))

5. DE(treatment effectiveness evaluation)

6. DE(clinical trials)

7. DE(mental health program evaluation)

8. DE(placebo)

9. TI(placebo*) OR AB(placebo*)

10. AB(randomly)

11. TI(randomi*ed) OR AB(randomi*ed)

12. TI(trial) OR AB(trial)

13. TI((singl* OR doubl* OR trebl* OR tripl*) W3 (blind* OR mask* OR dummy)) OR AB((singl* OR doubl* OR trebl* OR tripl*) W3 (blind* OR mask* OR dummy))

14. TI((control*) W3 (trial* OR study OR studies OR group*)) OR AB((control*) W3 (trial* OR study OR studies OR group*))

15. TI(factorial*) OR AB(factorial*)

16. TI(allocat*) OR AB(allocat*)

17. TI(assign*) OR AB(assign*)

18. TI(volunteer*) OR AB(volunteer*)

19. 5 AND 6 AND 7 AND 8 AND 9 AND 10 AND 11 AND 12 AND 13 AND 14 AND 15 AND 16 AND 17 AND 18

20. 1 AND 2 AND 3 AND 4 AND 19

21. 20 AND (Population Group: Human)

Appendix 6. Criteria for risk of bias in RCTs and CCTs

 Item

 Judgement

 Description

1. Random sequence generation (selection bias)

Low risk

The investigators describe a random component in the sequence generation process such as: random number table; computer random number generator; coin tossing; shuffling cards or envelopes; throwing dice; drawing of lots; minimisation

 

High risk

The investigators describe a non‐random component in the sequence generation process such as: odd or even date of birth; date (or day) of admission; hospital or clinic record number; alternation; judgement of the clinician; results of a laboratory test or a series of tests; availability of the intervention

 

Unclear risk

Insufficient information about the sequence generation process to permit judgement of low or high risk

2. Allocation concealment (selection bias)

Low risk

Investigators enrolling participants could not foresee assignment because one of the following, or an equivalent method, was used to conceal allocation: central allocation (including telephone, web‐based, and pharmacy‐controlled, randomisation); sequentially numbered drug containers of identical appearance; sequentially numbered, opaque, sealed envelopes

 

High risk

Investigators enrolling participants could possibly foresee assignments because one of the following method was used: open random allocation schedule (e.g. a list of random numbers); assignment envelopes without appropriate safeguards (e.g. if envelopes were unsealed or non­opaque or not sequentially numbered); alternation or rotation; date of birth; case record number; any other explicitly unconcealed procedure

 

Unclear risk

Insufficient information to permit judgement of low or high risk This is usually the case if the method of concealment is not described or not described in sufficient detail to allow a definite judgement

3. and 4. Blinding of outcome assessor (detection bias).

Objective outcomes.

Subjective outcomes.

Low risk

 

 

No blinding of outcome assessment, but the review authors judge that the outcome measurement is not likely to be influenced by lack of blinding

Blinding of outcome assessment ensured, and unlikely that the blinding could have been broken

 

High risk

No blinding of outcome assessment, and the outcome measurement is likely to be influenced by lack of blinding

Blinding of outcome assessment, but likely that the blinding could have been broken, and the outcome measurement is likely to be influenced by lack of blinding

 

Unclear risk

Insufficient information to permit judgement of low or high risk

5. Incomplete outcome data (attrition bias)

For all outcomes except retention in treatment or drop‐out

Low risk

 

 

 

No missing outcome data

Reasons for missing outcome data unlikely to be related to true outcome (for survival data, censoring unlikely to be introducing bias)

Missing outcome data balanced in numbers across intervention groups, with similar reasons for missing data across groups

For dichotomous outcome data, the proportion of missing outcomes compared with observed event risk not enough to have a clinically relevant impact on the intervention effect estimate

For continuous outcome data, plausible effect size (difference in means or standardised difference in means) among missing outcomes not enough to have a clinically relevant impact on observed effect size

Missing data have been imputed using appropriate methods

All randomised participants are reported/analysed in the group they were allocated to by randomisation irrespective of non‐compliance and co‐interventions (intention to treat)

 

High risk

Reason for missing outcome data likely to be related to true outcome, with either imbalance in numbers or reasons for missing data across intervention groups

For dichotomous outcome data, the proportion of missing outcomes compared with observed event risk enough to induce clinically relevant bias in intervention effect estimate

For continuous outcome data, plausible effect size (difference in means or standardised difference in means) among missing outcomes enough to induce clinically relevant bias in observed effect size

'As‐treated' analysis done with substantial departure of the intervention received from that assigned at randomisation

 

Unclear risk

Insufficient information to permit judgement of low or high risk (e.g. number randomised not stated, no reasons for missing data provided; number of drop‐out not reported for each group)

Study flow diagram from first publication of this review in 2012.
Figuras y tablas -
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
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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

Figuras y tablas -
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

Figuras y tablas -
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

Figuras y tablas -
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

Figuras y tablas -
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

Figuras y tablas -
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]

Figuras y tablas -
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]

Figuras y tablas -
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]

Figuras y tablas -
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]

Figuras y tablas -
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]

Figuras y tablas -
Comparison 5. Brief motivational intervention (BMI) versus assessment‐only