best practice

Psychosocial interventions delivered to people affected by someone else's addiction (problematic alcohol use, substance use, gambling or gaming) were assessed in a systematic review with meta-analysis ((Merkouris et al., 2022). Interventions included therapist interventions, delivered individually, in group and/or self-directed; cognitive–behavioural programmes based on CRAFT methodology that helps affected others to engage treatment-resistant addicted individuals into treatment and improve the affected other’s quality of life; coping skills training and other type of interventions. The results found beneficial intervention effects over control groups at post-intervention:

• on some affected other
  • depressive symptomatology (SMD = -0.48, 95% CI = -0.67, -0.29),
  • life satisfaction (SMD = -0.37, 95% CI = -0.71, -0.03)
  • and coping style (SMD = -1.33, 95% CI = -1.87, -0.79)
• on the addicted person
  • treatment entry (RR = 0.86, 95% CI = 0.75-0.98)
• on relationship functioning outcomes
  • marital discord, SMD = -0.40, 95% CI = -0.61, -0.18) 

No beneficial intervention effects were identified at short-term follow-up (4-11 months post-treatment). The beneficial intervention effects identified at post-treatment remained when limiting to studies of alcohol use and therapist-delivered interventions.

A systematic review with meta-analysis (Tinner et al., 2022, 66 studies) assessed the effects of individual-, family- and school-based interventions to prevent multiple risk behaviours relating to alcohol, tobacco and drug use in young people aged 8-25 years.

• There were too few family-level (n=4), individual-level (n=2) and combination level (n=5) studies to draw confident conclusions.

A systematic review with meta-analysis (Tinner et al., 2022, 66 studies) assessed the effects of individual-, family- and school-based interventions to prevent multiple risk behaviours relating to alcohol, tobacco and drug use in young people aged 8-25 years. Results found that:

• for targeted school-level interventions, there was low quality evidence of no or a small short-term benefit: alcohol use (OR 0.90, 95% CI: 0.74-1.09), tobacco use (OR 0.86, 95% CI: 0.66, 1.11), cannabis use (OR 0.84, 95% CI: 0.66-1.07) and other illicit drug use (OR 0.79, 95% CI 0.62-1.02).

A systematic review with meta-analysis (Tinner et al., 2022, 66 studies) assessed the effects of individual-, family- and school-based interventions to prevent multiple risk behaviours relating to alcohol, tobacco and drug use in young people aged 8-25 years. Results show that:

• universal school-based interventions are likely to have little or no short-term benefit (up to 12 months) in relation to alcohol use (OR 0.94, 95% CI: 0.84, 1.04), tobacco use (OR 0.98, 95% CI: 0.83, 1.15), cannabis use (OR 1.06, 95% CI: 0.86, 1.31) and other illicit drug use (OR 1.09, 95% CI: 0.85, 1.39)

Heroin-assisted-treatment (HAT) effects on criminal activity were evaluated in a systematic review with meta-analysis (Smart and Reuter, 2022, 10 RCTs, N= 2 427). Results found:

• significantly reduced criminal activity among HAT participants,
• four trials found significantly larger reductions for HAT compared to control condition [median odds ratios (ORs) = 0.45].
• Reductions in crime are concentrated in drug-related and property offenses (ORs range from 0.14 to 0.90 and from 0.12 to 1.89, respectively).

Interventions aimed at improving engagement of PWID at any (or combination) of the following stages along the chronic HCV care cascade: a) linkage to care, defined as the clinical assessment of HCV infection or liver disease following diagnosis of HCV infection b) adherence to treatment, with regimens combining inter- feron/DAA or solely DAA were evaluated in a systematic review with meta-analysis (Schwarz et al., 2022, 14 studies).

Integrated care structures, where a variety of services are brought together, and nurse case management approaches that facilitate referral for HCV assessment and scheduling of specialist appointments for clients were found to be the most effective in:

• improving engagement throughout the continuum of HCV care among people who inject drugs and people receiving OST

Psychosocial interventions involving information, education, counselling and/or skills training (IECS) were found in a systematic review (Palmateer et al., 2022, 27 systematic review, 61 studies) to have sufficient evidence in:

• the prevention of injecting risk behaviours and injecting frequency among PWID.

Permanent supportive housing was found in a narrative systematic review (Onapa et al., 2021, 3 systematic reviews, 24 studies) mixed results:

• in improving general physical and mental health outcomes

Similar conclusions were also found in a systematic review of reviews (Miler et al., 2021).

Motivational interviewing was found in a narrative systematic review (Orciari et al., 2022, 11 studies) to have mixed results in:

• improving treatment outcomes (treatment engagement, retention, and completion) in homeless populations

Employment-based interventions (including substance use and vocational skills interventions (7 studies), supported employment (6 studies), and integrated supports including an employment component (6 studies)) were found to have mixed results in:

• improving community reintegration
• improving well-being outcomes
• reducing substance use

Specifically:

• Employment participation: only two out of the 12 studies reported a statistically significant increase in employment participation. The statistically significant studies involved interventions for individuals with substance use and/or concurrent disorders. Thus, interventions targeting substance use disorder or mental illnesses and housing interventions might lead to larger benefits.
• Improvement of housing: Four studies in this review reported improved housing after the intervention. Determining the interventions’ impact on housing was complicated due to only half of the studies measuring housing outcomes.