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Psychosocial treatment for opiate abuse and dependence
1Institute of Psychiatry, 4 Windsor Walk, London, UK. Soraya.Mayet@oxleas.nhs.uk
The Cochrane Database of Systematic Reviews
|March 4, 2005
Summary
Psychosocial interventions for opioid dependence show mixed results, with some approaches like Enhanced Outreach Counselling demonstrating short-term benefits. More research is needed to establish their long-term effectiveness and superiority over standard treatments.
Area of Science:
- Public Health
- Psychiatry
- Addiction Medicine
Background:
- Opioid dependence is a significant public health issue requiring effective treatment strategies.
- While pharmacotherapy for opioid dependence is established, the role of psychosocial interventions alone needs further systematic review.
- Numerous psychosocial interventions exist, but evidence for their standalone efficacy in treating opioid use disorders is limited.
Purpose of the Study:
- To systematically evaluate the efficacy and acceptability of psychosocial interventions when used as standalone treatments for opioid use disorders.
- To synthesize evidence from randomized controlled trials on psychosocial interventions for opioid dependence.
Main Methods:
- Conducted comprehensive electronic searches across major databases (Cochrane Library, EMBASE, MEDLINE, LILACS) and other sources for relevant randomized controlled trials.
- Included studies focusing exclusively on psychosocial interventions for opioid use disorders, excluding those with pharmacotherapy.
- Extracted data using relative risks and weighted mean difference, employing intention-to-treat analysis and sensitivity testing.
Main Results:
- Five studies met the inclusion criteria, analyzing interventions such as Contingency Management and Enhanced Outreach-Counselling.
- Enhanced Outreach Counselling and Brief Reinforcement Based Intensive Outpatient Therapy showed significantly better outcomes than standard care for relapse, re-enrollment, and retention.
- These positive effects were not sustained at follow-up for Brief Reinforcement Based Intensive Outpatient Therapy, and Cue Exposure and Contingency Management alone showed no advantage over standard care.
Conclusions:
- Current evidence for standalone psychosocial interventions in opioid dependence is limited by small sample sizes and heterogeneity.
- Psychosocial treatments alone are not yet adequately proven as superior modalities compared to other treatments.
- Large-scale, randomized trials with longer follow-up periods and robust methodologies are crucial for establishing the evidence base for psychosocial interventions in opioid use disorder treatment.