complex care

Topics: Drug addiction, Addiction, Heroin Pages: 10 (2660 words) Published: April 4, 2014
Background
Problem alcohol use is common among illicit drug users and is associated with adverse health outcomes. It is also an important factor in poor prognosis among drug users with hepatitis C virus (HCV) as it impacts progression to hepatic cirrhosis or opiate overdose in opioid users. The aim of this systematic review was to assess the effects of psychosocial interventions for problem alcohol use in adult illicit drug users with concurrent problem alcohol use (principally, problem drug users of opiates and stimulants).

Methods
We searched the following databases (November 2011): Cochrane Library, PUBMED, EMBASE, CINAHL, PsycINFO and reference list of articles. We also searched conference proceedings and online registers of clinical trials. Two reviewers independently assessed risk of bias and extracted data from included randomized controlled trials.

Results
Four studies (594 participants) were included in this review. Half of the trials were rated as having a high or unclear risk of bias. The four studies considered six different psychosocial interventions grouped into four comparisons: 1) cognitive-behavioral coping skills training versus 12-step facilitation (N = 41), 2) brief intervention versus treatment as usual (N = 110), 3) hepatitis health promotion versus motivational interviewing (N = 256), and 4) brief motivational intervention versus assessment-only group (N = 187). Differences between studies precluded any pooling of data. Findings are described for each trial individually. Most findings were not statistically significant except for comparison 2: decreased alcohol use at three months (risk ratio (RR) 0.32; 95% confidence interval (CI) 0.19 to 0.54) and nine months (RR 0.16; 95% CI 0.08 to 0.33) in the treatment-as-usual group and comparison 4: reduced alcohol use in the brief motivational intervention (RR 1.67; 95% CI 1.08 to 2.60).

Conclusions
No conclusion can be made because of the paucity of the data and the low quality of the retrieved studies.

Keywords: Alcohol; Brief intervention; Illicit drugs; Opioids; Systematic review; Screening; Methadone Background
Problem alcohol use is common among illicit drug users and is associated with adverse health outcomes, which include physical, psychological and social implications [1-4]. Recent NIDA (National Institute on Drug Abuse) meta-analyses of US clinical trials found alcohol use disorders (AUDs) in 38% and 45% of opiate- and stimulant-using treatment seekers, respectively [5,6].

Problem drug users are at high risk of liver disease resulting from hepatitis C virus (HCV) infection because of its high prevalence in this population [7]. Problem alcohol use is an important factor in determining poor prognosis among people with HCV as it impacts progression to hepatic cirrhosis, increased HCV-ribonucleic acid (RNA) levels or fatal opiate overdose in opiate users [8,9].

Psychosocial interventions are best described as ‘psychologically-based interventions aimed at reducing consumption behavior or alcohol-related problems’ [10], which exclude any pharmacological treatments. The most frequently used interventions include motivational interviewing (MI), cognitive-behavioral therapy (CBT), psychodynamic approaches, screening and brief interventions (SBI), family therapy, drug counseling, 12-step programs, therapeutic communities (TC) and vocational rehabilitation (VR). For descriptions, see the review by Amato et al. [11].

Substantial evidence has described the value of psychosocial interventions in treating problem alcohol use [12-15]. Even in their brief version, psychosocial interventions are feasible and potentially highly effective components of an overall public health approach to reducing problem alcohol use, although considerable variation in effectiveness trials exists and problem drug users from non-specialist settings (for example, primary care) are under-represented in these trials [10,16].

Two previous narrative reviews of...
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