Group treatment for substance use disorder in adults: A systematic review and meta-analysis of randomized-controlled trials

Coco, Gianluca Lo; Melchiori, Francesco Maria; Oieni, Veronica; Infurna, Maria Rita; Strauß, Bernhard; Schwartze, D; Rosendahl, Jenny; Gullo, Salvatore

doi:10.1016/j.jsat.2019.01.016

Cited by 67 publications

(55 citation statements)

References 92 publications

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“…A systematic review on the topic of residential rehabilitation concluded that best practice residential care for any substance use disorder should include continuity of care postdischarge. 36 A review on group treatment for substance use disorders found that group treatment compared to no treatment had a small effect on abstinence however group treatment did not have a significant effect on the frequency of substance use or substance use disorder symptoms 37 . Additionally, with regard to opioid use disorder, it has been reported that…”

Section: Discussionmentioning

confidence: 99%

<p>An Inverse Relationship Between Alcohol and Heroin Use in Heroin Users Post Detoxification</p>

Morgan¹,

Daniels²,

Subramaney³

2020

SAR

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Background: Given that fewer than 50% of countries provide Opioid Agonist Maintenance Therapies (OAMT), it is important to assess whether other substances act as a substitute for heroin in recovering heroin users who receive detoxification models of treatment. There is a dearth of prospective studies from low-and-middle-income countries evaluating these patterns of substance use. Methods: 300 heroin users from the Gauteng province of South Africa were assessed on entry into inpatient detoxification and then followed-up 3 and 9 months after leaving treatment. Treatment consisted of 1 week of detoxification followed by 6-8 weeks of psychosocial therapy. We measured the overall changes in the prevalence of heroin, alcohol and other drug use at baseline and postrehabilitation. Comparison of these outcomes at enrolment, 3 months and 9 months was performed by a Generalised Estimating Equation (GEE) with the outcome as the dependent variable, observation point as the independent variable, and participant as the repeated measure. Injecting status and treatment completion were included as covariates. We also measured the individual pathways between heroin and alcohol use in the 210 participants that were seen at all three timepoints. Results: Of the original cohort, 252 (84.0%) were re-interviewed at 3 months and 225 (75.0%) at 9 months. From baseline to 3 months, the proportion of past month heroin users decreased significantly to 65.5%; however, during this time, the proportion of past month alcohol users increased from 16.3% to 55.2% (p<0.0001). When assessing the pathways between heroin and alcohol use at an individual level, 55.4% (n-97) of those who were past month alcohol abstinent prior to rehabilitation were using alcohol at 3 months. From 3 to 9 months the proportion of heroin users increased to 72.4% (p<0.0001), and during this time, the proportion of alcohol users decreased. Conclusion: After detoxification, a significant reduction in heroin use was observed with a concomitant increase in alcohol consumption. Under these circumstances, alcohol may have acted as a substitute for heroin in the short term. The initial reduction in heroin use 3 months postrehabilitation was followed by increased consumption 6 months later. This observation supports the need for interventions to prevent, monitor and treat high levels of alcohol use in heroin users post detoxification. The provision of OAMT is a necessary consideration to address both the risk of increased alcohol intake as well as the decline in heroin abstinence rates.

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Section: Discussionmentioning

confidence: 99%

<p>An Inverse Relationship Between Alcohol and Heroin Use in Heroin Users Post Detoxification</p>

Morgan¹,

Daniels²,

Subramaney³

2020

SAR

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“…Also, a large observational study that examined treatment results from 7800 patients [ 10 ] concluded that a larger proportion of patients in group therapy had increased likelihood for improved measures of treatment performance compared to patients in individual therapy. In a recent meta analytical review of group therapy for substance abuse disorder in adults [ 11 ], thirty-three studies with measures of group therapy outcomes were included. Significant, but small, effects of group therapy were found on abstinence compared to individual therapy, indicating that group therapy may be a little more effective than individual therapy in relation to abstinence.…”

Section: Introductionmentioning

confidence: 99%

“…Overall, research on outcomes in specific patient groups is still very limited and this lack of research is even more pronounced in relation to combined groups (i.e. groups that include both patients with drug use disorders and patients with alcohol use disorders), since the majority of group treatment studies only include patients with one of the disorders [ 11 ]. Specifically, there is a need for RCT studies that examine the relative usefulness of group and individual treatment formats.…”

Section: Introductionmentioning

confidence: 99%

Group versus individual treatment for substance use disorders: a study protocol for the COMDAT trial

Karsberg¹,

Pedersen²,

Hesse³

et al. 2021

BMC Public Health

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Background Alcohol and other drug use disorders contribute substantially to the global burden of illness. The majority of people with substance use disorders do not receive any treatment for their problems, and developing treatments that are attractive and effective to patients should be a priority. However, whether treatment is best delivered in a group format or an individual format has only been studied to a very limited degree. The COMDAT (Combined Drug and Alcohol Treatment) trial evaluates the feasibility, acceptability, and cost effectiveness of MOVE group (MOVE-G) treatment versus MOVE individual (MOVE-I) treatment in four community-based outpatient treatment centres in Denmark. Methods A two-arm non-inferiority trial comparing MOVE-I (Pedersen et al., Drug Alcohol Depend 218:108363, 2020) with MOVE-G a combined group treatment for both alcohol use disorder and drug use disorder. The primary objective is to examine whether MOVE-G is non-inferior to MOVE-I in relation to abstinence from drug and/or alcohol, number of sessions received, and completion of treatment as planned. All participants will receive treatment based on cognitive behavioral therapy and motivational interviewing, vouchers for attendance and text reminders, as well as medication as needed (MOVE). Participants (n = 300) will be recruited over a one-year period at four public treatment centers in four Danish municipalities. A short screening will determine eligibility and randomization status. Hereafter, participants will be randomized to the two treatment arms. A thorough baseline assessment will be conducted approximately 1 week after randomization. Follow-up assessments will be conducted at 9 months post-randomization. In addition, patients’ use of drugs and alcohol, and patients’ wellbeing will be measured in all sessions. The main outcome measures are drug and alcohol intake at 9 months follow-up, number of sessions attended, and dropout from treatment. Discussion The present study will examine the potential and efficacy of combined groups (patients with alcohol and drug disorders in the same group) versus individually based treatment both based on the treatment method MOVE (Pedersen et al., Drug Alcohol Depend 218:108363, 2020). Trial registration ISRCTN88025085, registration date 30/06/2020.

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“…Group treatment has been established as evidence-based care for the management of substance use disorders (SUD) [ 12 ]. The group modality unlike individual therapy, specifically assists with the development of interpersonal connections, provides positive social support and pressure to change, decreases stigma, and promotes the development of interpersonal skills as well as the practice of those skills in vivo, all of which are beneficial to individuals in SUD treatment ([ 31 ]; TIP 412005; [ 11 , 28 , 34 ]).…”

Section: Introductionmentioning

confidence: 99%

Long-term treatment retention in West Virginia's comprehensive opioid addiction treatment (COAT) program

Lander

Wang

Hustead

et al. 2020

Journal of the Neurological Sciences

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Background: The United States continues to experience an opioid epidemic of unprecedented proportions despite FDA approval of life saving medications, such as buprenorphine. This paper describes a novel group-based buprenorphine treatment model and summarizes patient characteristics and treatment retention. This model, known as the Comprehensive Opioid Addiction Treatment (COAT) program, was developed in West Virginia, the epicenter of the opioid epidemic. Methods: Data on 454 patients actively enrolled in the COAT program were extracted from an administrative clinical data set and electronic medical records and analyzed using descriptive and quantitative analysis to determine long-term retention in treatment using frequencies and means. Results: The characteristics of the 454 patients are as follows: average age of 39, 53% female, predominantly white (94%) and Medicaid was the primary insurance provider (68%). Analysis of retention showed 37.8% of patents were retained less than one year and 14.7% were retained 10 or more years. Initiating treatment at a younger age was associated with long-term retention. Conclusion: Opioid use disorder is a chronic relapsing disease and treatment models that retain patients long-term have the greatest benefit. The COAT model has been successful in retaining patients long-term in a rural setting where barriers to treatment are many.

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Group treatment for substance use disorder in adults: A systematic review and meta-analysis of randomized-controlled trials

Cited by 67 publications

References 92 publications

<p>An Inverse Relationship Between Alcohol and Heroin Use in Heroin Users Post Detoxification</p>

<p>An Inverse Relationship Between Alcohol and Heroin Use in Heroin Users Post Detoxification</p>

Group versus individual treatment for substance use disorders: a study protocol for the COMDAT trial

Long-term treatment retention in West Virginia's comprehensive opioid addiction treatment (COAT) program

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