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Comparative efficacy and acceptability of psychosocial interventions for individuals with cocaine and amphetamine addiction: A systematic review and network meta-analysis

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  • Franco De Crescenzo
  • Marco Ciabattini
  • Gian Loreto D’Alò
  • Riccardo De Giorgi
  • Cinzia Del Giovane
  • Carolina Cassar
  • Luigi Janiri
  • Nicolas Clark
  • Michael Joshua Ostacher
  • Andrea Cipriani

Abstract

Background: Clinical guidelines recommend psychosocial interventions for cocaine and/or amphetamine addiction as first-line treatment, but it is still unclear which intervention, if any, should be offered first. We aimed to estimate the comparative effectiveness of all available psychosocial interventions (alone or in combination) for the short- and long-term treatment of people with cocaine and/or amphetamine addiction. Methods and findings: We searched published and unpublished randomised controlled trials (RCTs) comparing any structured psychosocial intervention against an active control or treatment as usual (TAU) for the treatment of cocaine and/or amphetamine addiction in adults. Primary outcome measures were efficacy (proportion of patients in abstinence, assessed by urinalysis) and acceptability (proportion of patients who dropped out due to any cause) at the end of treatment, but we also measured the acute (12 weeks) and long-term (longest duration of study follow-up) effects of the interventions and the longest duration of abstinence. Odds ratios (ORs) and standardised mean differences were estimated using pairwise and network meta-analysis with random effects. The risk of bias of the included studies was assessed with the Cochrane tool, and the strength of evidence with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. We followed the PRISMA for Network Meta-Analyses (PRISMA-NMA) guidelines, and the protocol was registered in PROSPERO (CRD 42017042900). We included 50 RCTs evaluating 12 psychosocial interventions or TAU in 6,942 participants. The strength of evidence ranged from high to very low. Compared to TAU, contingency management (CM) plus community reinforcement approach was the only intervention that increased the number of abstinent patients at the end of treatment (OR 2.84, 95% CI 1.24–6.51, P = 0.013), and also at 12 weeks (OR 7.60, 95% CI 2.03–28.37, P = 0.002) and at longest follow-up (OR 3.08, 95% CI 1.33–7.17, P = 0.008). At the end of treatment, CM plus community reinforcement approach had the highest number of statistically significant results in head-to-head comparisons, being more efficacious than cognitive behavioural therapy (CBT) (OR 2.44, 95% CI 1.02–5.88, P = 0.045), non-contingent rewards (OR 3.31, 95% CI 1.32–8.28, P = 0.010), and 12-step programme plus non-contingent rewards (OR 4.07, 95% CI 1.13–14.69, P = 0.031). CM plus community reinforcement approach was also associated with fewer dropouts than TAU, both at 12 weeks and the end of treatment (OR 3.92, P

Suggested Citation

  • Franco De Crescenzo & Marco Ciabattini & Gian Loreto D’Alò & Riccardo De Giorgi & Cinzia Del Giovane & Carolina Cassar & Luigi Janiri & Nicolas Clark & Michael Joshua Ostacher & Andrea Cipriani, 2018. "Comparative efficacy and acceptability of psychosocial interventions for individuals with cocaine and amphetamine addiction: A systematic review and network meta-analysis," PLOS Medicine, Public Library of Science, vol. 15(12), pages 1-24, December.
  • Handle: RePEc:plo:pmed00:1002715
    DOI: 10.1371/journal.pmed.1002715
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    Cited by:

    1. Kiffer G. Card & Madison McGuire & Graham W. Berlin & Gordon A. Wells & Karyn Fulcher & Tribesty Nguyen & Trevor A. Hart & Shayna Skakoon Sparling & Nathan J. Lachowsky, 2022. "Does Treatment Readiness Shape Service-Design Preferences of Gay, Bisexual, and Other Men Who Have Sex with Men Who Use Crystal Methamphetamine? A Cross Sectional Study," IJERPH, MDPI, vol. 19(6), pages 1-17, March.
    2. Emma Audrey Adams & Liam Spencer & Michelle Addison & William McGovern & Hayley Alderson & Mark Adley & Ruth McGovern & Eilish Gilvarry & Eileen Kaner & Amy O’Donnell, 2022. "Substance Use, Health, and Adverse Life Events amongst Amphetamine-Type Stimulant Users in North East England: A Cross-Sectional Study," IJERPH, MDPI, vol. 19(12), pages 1-12, June.
    3. Francisco González-Saiz & Esperanza Vergara-Moragues, 2021. "In-Treatment Changes in Quality of Life-Related Variables in Therapeutic Communities for Cocaine Abusers: Are These Changes Associated with Clinical Outcomes?," IJERPH, MDPI, vol. 18(14), pages 1-14, July.
    4. Claire Ronsley & Seonaid Nolan & Rod Knight & Kanna Hayashi & Jano Klimas & Alex Walley & Evan Wood & Nadia Fairbairn, 2020. "Treatment of stimulant use disorder: A systematic review of reviews," PLOS ONE, Public Library of Science, vol. 15(6), pages 1-22, June.

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