Meta-review on the efficacy of psychological therapies for the treatment of substance use disorders

Dellazizzo, Laura; Potvin, Stéphane; Giguère, Sabrina; Landry, Clara; Léveillé, Nayla; Dumais, Alexandre

doi:10.1016/j.psychres.2023.115318

Cited by 12 publications

(4 citation statements)

References 59 publications

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“…Psychosocial interventions have demonstrated significant promise in the treatment of individuals with comorbid substance use and psychiatric disorders [37,38]. Several meta-reviews evaluating the efficacy of psychotherapies for SUDs, spanning a range of substances such as alcohol, cannabis, stimulants, opioids, and benzodiazepines, have consistently shown that psychosocial treatments yield small to moderate benefits compared to inactive controls in the short-term [39][40][41][42][43][44].…”

Section: Psychotherapeutic Approachesmentioning

confidence: 99%

Navigating the Complex Intersection of Substance Use and Psychiatric Disorders: A Comprehensive Review

Bahji

2024

JCM

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The co-occurrence of substance use disorders (SUDs) and psychiatric conditions, often referred to as comorbidity or concurrent disorders, presents intricate challenges in both diagnosis and treatment. This comprehensive narrative review aims to synthesize and critically evaluate the existing evidence surrounding the management of individuals with comorbid SUDs and psychiatric disorders. Comorbidity in these domains carries profound implications for clinical practice, research, and policymaking, emphasizing the need for a holistic understanding of the intricate dynamics that arise when these conditions coexist. This review explores recent research findings, evidence-based guidelines, and emerging trends within the field, offering valuable insights for clinicians, researchers, and policymakers seeking to navigate the complex terrain of comorbidity in substance use and psychiatric disorders.

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Section: Psychotherapeutic Approachesmentioning

confidence: 99%

Navigating the Complex Intersection of Substance Use and Psychiatric Disorders: A Comprehensive Review

Bahji

2024

JCM

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“…58,61 Psychosocial approaches to cocaine use disorder, primarily contingency management and cognitive behavioral therapies, are the main modality for treatment in the United States, 62 but the effect sizes of most therapies is small and none are effective for all (or even most) patients. [62][63][64] As of 2023, there are no medications for cocaine use disorder that have been approved by the US Food and Drug Administration (FDA); though a number of pharmacological agents are under investigation, none have been conclusively demonstrated to be more effective than placebo in well controlled trials of sufficient sample size to pass FDA criteria. Approaches combining pharmaceutical (e.g., prescription psychostimulants) and psychosocial treatments are under study, but none have yet been proven superior to others.…”

Section: Challenges Faced With Diagnosis and Treatment Of Cocaine Use...mentioning

confidence: 99%

Use, Effects, and Diagnostic Challenges of Cocaine Use in “Baby Boomers” and Older Adults

Akwe,

Moussa,

Hall

2023

Journal of Brown Hospital Medicine

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Introduction: Substance use disorder (SUD) is frequently recognized in the literature as an epidemic in the United States, but less attention has been paid to the scale of the epidemic among people older than 60 years of age. As the cohort of individuals in this age group grows as a proportion of the population—the so-called aging of the population—the incidence of SUD in older adults will increase numerically as well. While most existing literature on SUD in the elderly has focused on alcohol, opioids, and prescription drugs, the number of users of stimulant drugs like cocaine and methamphetamine is also growing. We review literature on the use, effects, and diagnostic challenges of cocaine in adults in the so-called “Baby Boomer generation” (ages 59-77 in 2023), particularly those ≥65 years. Methods: We performed a literature review of PubMed and Web of Science databases, supplemented by Google Scholar using combinations of “cocaine,” “elderly,” and “older adults.” We searched the reference sections of particularly salient articles and utilized PubMed’s and Google Scholars’ “Cited By” and “Similar Articles” functions to find additional materials to include. We produced an annotated bibliography containing title and author information for each paper along with its abstract to select the papers to include; each author reviewed this bibliography to determine if articles were relevant, and if so, in which section(s) the material should be included. A total of 66 references have been included in this review. Results: Both lifetime and current cocaine use appear to be more prevalent among members of the “Baby Boomer generation” than older cohorts. Though there has been limited research to inform clinical care for older adults who use cocaine, negative physical and psychosocial impacts have been noted in the literature. Cocaine use disorder may negatively affect the elderly more than younger users because of the increased vulnerability of their aging bodies to the physiological and cognitive effects of cocaine. Underdiagnosis of cocaine use in the elderly may be attributable to the assumption that any presenting symptoms are due to pre-existing medical conditions or that older adults are less likely to consume cocaine. Conclusions: There is little information currently in the literature to help clinicians understand patterns and epidemiology of cocaine use, its effects on older adults and their common presentations after experiencing adverse events, and challenges of diagnosing and treating cocaine use in older adults. Additional research is needed to describe use and effects of cocaine on the elderly, particularly on age-related comorbid conditions and interactions with medications.

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“…Thus, psychological treatments remain a necessary therapeutic avenue for SUDs and may be particularly promising for those with multiple substance use concerns. Although psychological treatments vary greatly in their approach and theoretical framework, they tend to produce moderate effect size reductions in substance dependence [ 10 , 11 ]. To date, the greatest evidence supports cognitive behavioral and motivational enhancement approaches for treating SUDs.…”

Section: Introductionmentioning

confidence: 99%

Feasibility, Acceptability, and Potential Efficacy of a Self-Guided Internet-Delivered Dialectical Behavior Therapy Intervention for Substance Use Disorders: Randomized Controlled Trial

Daros,

Guimond,

Yager

et al. 2024

JMIR Ment Health

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Background People with alcohol and substance use disorders (SUDs) often have underlying difficulties in regulating emotions. Although dialectical behavioral therapy is effective for SUDs, it is often difficult to access. Self-guided, internet-delivered dialectical behavioral therapy (iDBT) allows for expanded availability, but few studies have rigorously evaluated it in individuals with SUDs. Objective This study examines the feasibility, acceptability, and potential efficacy of an iDBT intervention in treatment-seeking adults with SUDs. We hypothesized that iDBT would be feasible, credible, acceptable, and engaging to people with SUDs. We also hypothesized that the immediate versus delayed iDBT group would show comparatively greater improvements and that both groups would show significant improvements over time. Methods A 12-week, single-blinded, parallel-arm, randomized controlled trial was implemented, with assessments at baseline and at 4 (acute), 8, and 12 weeks (follow-up). A total of 72 community adults aged 18 to 64 years were randomized. The immediate group (n=38) received access to iDBT at baseline, and the delayed group (n=34) received access after 4 weeks. The intervention (Pocket Skills 2.0) was a self-guided iDBT via a website, with immediate access to all content, additional text and email reminders, and additional support meetings as requested. Our primary outcome was substance dependence, with secondary outcomes pertaining to feasibility, clinical outcomes, functional disability, and emotion dysregulation, among other measures. All outcomes were assessed using self-report questionnaires. Results iDBT was perceived as a credible and acceptable treatment. In terms of feasibility, 94% (68/72) of the participants started iDBT, 13% (9/68) were early dropouts, 35% (24/68) used it for the recommended 8 days in the first month, and 50% (34/68) were still active 4 weeks later. On average, the participants used iDBT for 2 hours and 24 minutes across 10 separate days. In the acute period, no greater benefit was found for the immediate group on substance dependence, although we did find lower depression (b=−2.46; P=.02) and anxiety (b=−2.22; P=.02). At follow-up, there were greater benefits in terms of reduced alcohol (b=−2.00; P=.02) and nonalcoholic substance (b=−3.74; P=.01) consumption in the immediate access group. Both groups demonstrated improvements in substance dependence in the acute (b=−1.73; P<.001) and follow-up period (b=−2.09; P<.001). At follow-up, both groups reported reduced depression, anxiety, suicidal behaviors, emotional dysregulation, and functional disability. Conclusions iDBT is a feasible and acceptable intervention for patients with SUDs, although methods for improving engagement are warranted. Although results did not support efficacy for the primary outcome at 4 weeks, findings support reductions in substance dependence and other mental health concerns at 12 weeks. Notwithstanding the limitations of this study, the results suggest the potential value of iDBT in the treatment of SUDs and other mental health conditions. Trial Registration ClinicalTrials.gov NCT05094440; https://clinicaltrials.gov/show/NCT05094440

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Meta-review on the efficacy of psychological therapies for the treatment of substance use disorders

Cited by 12 publications

References 59 publications

Navigating the Complex Intersection of Substance Use and Psychiatric Disorders: A Comprehensive Review

Navigating the Complex Intersection of Substance Use and Psychiatric Disorders: A Comprehensive Review

Use, Effects, and Diagnostic Challenges of Cocaine Use in “Baby Boomers” and Older Adults

Feasibility, Acceptability, and Potential Efficacy of a Self-Guided Internet-Delivered Dialectical Behavior Therapy Intervention for Substance Use Disorders: Randomized Controlled Trial

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