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Psychosocial interventions for cocaine and psychostimulant amphetamines related disorders

Knapp WP, Soares B, Farrell M, Silva de Lima M
Published Online: 
16 July 2008

Psychostimulants such as amphetamines and cocaine are used, at least in part, because of their effects on mood, cognition and behaviour. People who abuse or are dependent on them often have a long history of repeated periods of intoxication and of withdrawal and after long-term use they can develop a stereotyped behaviour, paranoia, and aggressive behaviour. Substance use disorders are a major public health problem with high costs for society including related health and relationship problems, absenteeism, loss of productivity and the costs of treatment. Yet knowledge about treatment interventions that impact on maintenance of abstinence remains a challenge. Trials on drug treatments for psychostimulants dependence have high levels of dropouts from the trials and psychosocial interventions may be promising treatments as long as they can help to keep patients in treatment and reduce the use of the psychostimulants. In this review, several comparisons were made of psychosocial treatments but most of them did not show statistically significant differences between interventions, so that the evidence currently available does not have data supporting a single psychosocial treatment approach. The review authors identified 27 randomised controlled studies involving 3663 participants who were dependent on cocaine (crack or intravenous) in all but one Australian trial where oral amphetamine was the psychostimulant used. The other trials took place in the US. The trials lasted from 12 weeks to 9 months and the mean age of participants was 33 years old (range 18 to 65 years). Overall, cognitive behavioural interventions reduced dropouts from treatment and use of cocaine when compared with drug counseling. Behavioural interventions also clearly performed better than clinical management (psychotherapy sessions attended), usual care (lower rates of cocaine users at 1 and 3 months), information and referral (non-attendance). A multimodal intensive intervention was more effective than non-intensive delivery and cognitive behavioural treatments with some form of contingency management (involving the incentive of vouchers that are exchangeable for retail items) also showed benefits. Many of the results come from single studies, which limits their generalizability. The interventions used were variable and different types of cognitive behavioural treatments had overlapping but distinct therapeutic approaches. Simple reduction in the
amount of drug used or retention in treatment is not a measure of meaningful changes in lifestyle.

This record should be cited as: 
Knapp WP, Soares B, Farrell M, Silva de Lima M. Psychosocial interventions for cocaine and psychostimulant amphetamines related disorders. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD003023. DOI: 10.1002/14651858.CD003023.pub2
Assessed as up to date: 
21 May 2007
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