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Riv Psichiatr. 2018 Sep-Oct;53(5):233-255. doi: 10.1708/3000.30003.

Psychosocial interventions in stimulant use disorders: a systematic review and qualitative synthesis of randomized controlled trials.

Author information

1
Department of Psychiatry, University of Oxford, Oxford, UK - Oxford Health NHS Foundation Trust, Oxford, UK.
2
Department of Dynamic and Clinical Psychology, Sapienza University, Rome, Italy.
3
School of Hygiene and Preventive Medicine, University Tor Vergata, Rome, Italy.
4
Department of Epidemiology, Lazio Regional Health Service, Rome, Italy.
5
Oxford Health NHS Foundation Trust, Oxford, UK.
6
Institute of Psychiatry and Psychology, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
7
Department of Psychiatry, University of Oxford, Oxford, UK - Institute of Psychiatry and Psychology, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.

Abstract

Stimulant use disorders are highly prevalent with a large burden of disease. Most clinical guidelines recommend psychosocial interventions, but there are no clear hierarchies or indications. Moreover, these interventions have been reported unevenly in the literature. Identifying the most suitable treatment for each patient therefore represents a major challenge. In this review, we describe all psychosocial interventions for stimulant use disorders investigated in randomized controlled trials - including contingency management, cognitive behavioral interventions, community reinforcement approach, 12-step program, meditation-based interventions and physical exercise, supportive expressive psychodynamic therapy, interpersonal psychotherapy, family therapy, motivational interviewing, drug counseling -, and we synthesize the main findings of these studies. Similarities and differences between treatments are highlighted, suggesting that distinct psychosocial interventions can be relevant for certain patients' groups but not for others. Conversely, several interventions can be equally effective in similar clinical contexts, suggesting that a shared element such as therapeutic alliance is key. Finally, combined approaches emerge as a viable option for people with complex needs. Future studies will need to benchmark psychosocial interventions in stimulant use disorders and ascertain markers of response with a view to individualized treatment.

PMID:
30353199
DOI:
10.1708/3000.30003
[Indexed for MEDLINE]

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