John: Hello, I'm John Hilton, editor of the Cochrane Editorial unit. The misuse of psychostimulants is a growing medical and social problem. A team of Cochrane researchers from Italy have looked at the evidence for psychosocial interventions in a new Cochrane Review from September 2016. One of the authors, Franco De Crescenzo from the Catholic University of the Sacred Heart in Rome tells us more in this Evidence Pod.

Franco: It has been estimated that 1 in 90 people in the world misuse psychostimulants, with the most common being cocaine and amphetamine-type drugs, such as Methamphetamine, amphetamines and ecstasy. However, there is no widely accepted intervention to prevent or reduce psychostimulant misuse.
In recent years, there have been rapid developments in research on psychosocial interventions, as drug treatments have been found relatively ineffective. Therefore, it’s important to bring this evidence together. We did this Cochrane Review to do this and to investigate whether psychosocial interventions increase adherence to treatment, abstinence or, at least, reduce frequency of misuse of the psychostimulants; in the hope of finding those that are most effective. Unfortunately, the existing research wasn’t sufficient to allow us to determine whether some specific types of psychosocial interventions could be considered better than others but, in general, we have found that the interventions do have some benefits.
Psychosocial treatments use various modalities to try to achieve their goals of keeping patients in treatment, achieving abstinence or lower frequency and quantity of misuse, and preventing relapse. We were particularly interested in how well the treatments did in reducing substance use and helping patients to remain in treatment; but the treatments might help in many ways. For example, by giving people the skills to resolve current problems and adjust dysfunctional cognitive and behavioural patterns; or by providing skills training, improving relations, offering employment and vocational counselling, evoking and strengthening personal motivation for change, and helping patients to accomplish their goals.
We looked for studies that had compared standard care without a psychosocial treatment against structured and standardized interventions, as well as direct comparisons of different psychosocial treatments. We were interested in a wide range of treatments, including cognitive therapy, community reinforcement, coping skills training, Contingency management, Motivational interviewing, Interpersonal therapy, Psychodynamic therapy and 12-step approach. However, because case management and counseling are usually provided in standard care, we did not consider them among the experimental interventions.
After screening around 6500 records, we were able to include 52 randomized trials, with a total of nearly 7000 participants. Most of the studies were from the United States, with eleven done in other countries. Four in Spain, three in Australia, two in Switzerland and two in the UK. Overall, we judged the quality of evidence to be moderate to low because so many participants were lost to follow up and many studies reported conflicting results.
However, we are able to draw some conclusions and our bottom line is that, taken as a whole, when compared to standard care, psychosocial interventions probably improve treatment adherence and may increase abstinence at the end of treatment; but this benefit may have disappeared by several months after the end of treatment.

John: If you would like to read more about the variety of interventions that were tested in the more than 50 trials in Franco’s review, you can find it online in the Cochrane Library. Go to Cochrane Library dot com and do a simple search for ’psychostimulant misuse’.