best practice

Psychosocial interventions for Amphetamine-type stimulants (ATS - meth/amphetamine and ecstasy) use were found in review of reviews with meta-analysis (Tran et al., 2021) that:

• membership of a psychological intervention group was associated with an important reduction in drug usage (risk ratio (RR) 0.80, 95% CI: 0.75 to 0.85, high-quality evidence)
• the combination of therapies reduced 1.51 day using drugs in the preceding 30 days (95% CI: −2.36 to −0.67) compared to cognitive behavioural therapy intervention alone (high-quality evidence)
• compared to usual care, cognitive behavioural therapy was less likely to be retained at follow-up (RR 0.89, 95% CI: 0.82 to 0.97; high-quality evidence). However, the additional of contingency management strategy can make an important improvement upon retention (RR 1.42, 95%CI: 1.25 to 1.62)

 Psychosocial interventions considered in the analysis were:

1. Cognitive behaviour therapy (CBT)/ Cognitive Behaviour Therapy combined with Text messages/ Computer-based Cognitive Behaviour Therapy intervention; 2. Contingency management (CM); 3. Psychosocial therapies (combined CBT+ MI+ CM+BI + others); Matrix; 4. Motivational interviewing (MI);  5. Brief intervention (BI); 6. Case management;  7. Community-based management, therapeutic community; harm reduction group therapy;  8. Mindfulness;  9. 12 steps facilitation;  10. Family therapy.

Online interventions, web or mobile-based, for young adults (defined as adolescents and young adults from 15 to 30 years), including peer-to-peer contact, patient-to-expert communication, or interactive psychoeducation/therapy to reduce cannabis use was found in a systematic review with meta-analysis (Beneria et al., 2021, 17 RCTs, N= 3 525) to have no effect in:

• reducing cannabis consumption (Hedge's g = -0.061, 95% CI [-0.363] to [-0.242], p = .695)

However, some of the more recent studies out of the 17 used in the analysis, reported positive results. These trials used structured interventions, daily feedback, young adults centred designs, peer support, and specifically targeting cannabis use (as opposed to generic interventions) and showed promise as potentially effective approaches to address cannabis use in this population.

Psychotherapy interventions (individual (CBT, IPSRT, family focused therapy) and group interventions) were found in a systematic review (Crowe et al., 2021, 7 studies) to have no conclusive effects in:

• improving mental health and treatment outcomes (i.e. improving mood outcomes and reducing use)

Multiple health behaviour change interventions target risk factors in combination and are a promising method to improve lifelong health. This approach capitalises on evidence that changing one lifestyle behaviour could increase self-efficacy to improve others. Given that teaching time is often restricted, interventions that simultaneously address multiple risk behaviours are particularly advantageous in school settings. eHealth interventions (delivered via the internet, computers, tablets, mobile technology, or tele-health) offer increased student engagement, fidelity, and scalability, and internet technology is becoming increasingly embedded in school education.
School-based eHealth multiple health behaviour change interventions were found in a systematic review with meta-analysis (Champion et al., 2019, 18 studies, N = 18 873 students) to have no effect in:

• reducing alcohol use or smoking

The interventions significantly increased fruit and vegetable intake (standard mean difference 0·11, 95% CI 0·03 to 0·19; p=0·007) and both accelerometer-measured (0·33, 0·05 to 0·61; p=0·02) and self-reported (0·14, 0·05 to 0·23; p=0·003) physical activity, and reduced screen time (–0·09, –0·17 to –0·01; p=0·03) immediately after the intervention; however, these effects were not sustained at follow-up when data were
available.

Contingency management in psychotic patients with Substance Use Disorders (SUD) was found in a systematic review with meta analysis (Destoop et al., 2021) to be effective compared to standard care in:

• Improving abstinence rates of drug use, measured by:
  • self-reported lower number of days using substance (SMD = −0.52, 95% CI −0.98 to −0.06; p = 0.03
  • tendency to more negative breath or urine samples for substance use (OR 2.13, 95% CI 0.97 to 4.69; p = 0.06)

However no differences among retention in treatment (RR 1.15, 95% CI 0.90 to 1.45; p = 0.26).

Physical exercise (and/or activity) was found in a systematic review (Thompson et al., 2020, 32 studies) to have no conclusive effects in:

• improving substance use outcomes
• reducing the risk of progression to alcohol and other drug use
• supporting individuals to reduce alcohol and other drug use for harm reduction
• promote abstinence and relapse prevention during and after treatment of alcohol and other drug use

A more specific but limited systematic review (Jake-Schoffman et al., 2020, 3 studies) analysed the effects of aerobic exercise interventions as adjunctive treatment for patients in opioid substitution treatment and also found no significant effects on substance use outcomes.

Adding another formal psychotherapy, such as cognitive– behavioural therapy (CBT) or motivational enhancement therapy (MET), to contingency management (CM) was found in a systematic review with meta-analysis (Sheridan et al., 2020, 12 studies, N = 1654) to have no effect in:

• improving both treatment end and at post-treatment follow-up compared with CM only
  • no evidence of a synergistic effect in PPA at treatment end (relative risk (RR) 0.97, 95% CI 0.85 to 1.09; p=0.57)
  • sensitivity analysis of studies featuring CBT/MET also found no evidence of an effect (RR 0.92; 95% CI 0.79 to 1.08; p=0.32)
  • none of the secondary outcomes showed any evidence of benefit.