best practice

Last updated : 01.04.2020
Rating
  • Unknown effectiveness

Therapeutic communities were analysed in a narrative systematic review (Vanderplasschen et al., 2013). While the review found some positive impact of TC on legal outcomes, overall it did not find any significant effects in:

  • improving patients' treatment outcomes
Name of response option
  • psychosocial interventions
Desired outcome(s)
  • improve treatment outcomes
Area(s)
  • Treatment
Specific substance or pattern of use
  • not-drug specific

References

Vanderplasschen, W., Colpaert, K., Autrique, M., Rapp, R. C., Pearce, S., Broekaert, E., & Vandevelde, S. (2013). Therapeutic communities for addictions: a review of their effectiveness from a recovery-oriented perspective. The Scientific World Journal, 2013.
Last updated : 31.10.2022
Rating
  • Beneficial

Opioid substitution treatment (OST) was found in a narrative systematic review (Magwood et al., 2020) to be effective in:

  • reducing mortality, morbidity, and substance use in homeless populations

The same results were confirmed by a narrative systematic review of reviews (Miler et al., 2021).

Name of response option
  • Pharmacological treatment
Desired outcome(s)
  • reduce harms
  • reduce mortality
Area(s)
  • Harm reduction
Specific substance or pattern of use
  • opioids
Target group(s) or setting(s)
  • PWID – people who inject drugs

References

Magwood O, Salvalaggio G, Beder M, Kendall C, Kpade V, Daghmach W, et al. (2020) The effectiveness of substance use interventions for homeless and vulnerably housed persons: A systematic review of systematic reviews on supervised consumption facilities, managed alcohol programs, and pharmacological agents for opioid use disorder. PLoS ONE 15(1): e0227298
Miler JA, Carver H, Masterton W, Parkes T, Maden M, Jones L, Sumnall H. What treatment and services are effective for people who are homeless and use drugs? A systematic \'review of reviews\'. PLoS One. 2021 Jul 14;16(7):e0254729. doi: 10.1371/journal.pone.0254729. PMID: 34260656; PMCID: PMC8279330.
Last updated : 09.12.2021
Rating
  • Unknown effectiveness

Drug consumption rooms (or supervised consumption facilities) were found in a narrative systematic review (Magwood et al., 2020) to be effective in:

  • reducing lethal overdoses and other high risk behaviours without any significant harm
  • improving access to care in homeless populations
Name of response option
  • Drug consumption rooms (DCRs)
Desired outcome(s)
  • reach marginalised PWID
  • reduce harms
  • reduce mortality
Area(s)
  • Harm reduction
Specific substance or pattern of use
  • amphetamines
  • opioids
Target group(s) or setting(s)
  • PWID – people who inject drugs

References

Magwood O, Salvalaggio G, Beder M, Kendall C, Kpade V, Daghmach W, et al. (2020) The effectiveness of substance use interventions for homeless and vulnerably housed persons: A systematic review of systematic reviews on supervised consumption facilities, managed alcohol programs, and pharmacological agents for opioid use disorder. PLoS ONE 15(1): e0227298
Last updated : 01.04.2020
Rating
  • Likely to be beneficial

Multi-substance interventions targeting both tobacco and cannabis were found in a systematic review with Bayesian meta-analysis (Walsh et al., 2020, 11 RCTs, N = 1117) to have a significant effect on:

  • cannabis cessation, (RR=1.48 [0.92,2.49], studies=8) and no clear effect on tobacco cessation (RR=1.10 [0.68,1.87], studies=9)
  • Subgroup analysis suggested multi-substance interventions might be more effective than cannabis targeted interventions on cannabis cessation (RR= 2.19 [1.10, 4.36] versus RR=1.39 [0.75,2.74]).

Interventions eamined consisted of nicotine replacement therapies alongside a behavioural component for tobacco and of mainly behavioural interventions for cannabis

Name of response option
  • psychosocial interventions
Desired outcome(s)
  • reduce substance use
Area(s)
  • Treatment
Specific substance or pattern of use
  • cannabis
  • tobacco

References

Walsh, H., McNeill, A., Purssell, E., and Duaso, M. ( 2020) A systematic review and Bayesian meta‐analysis of interventions which target or assess co‐use of tobacco and cannabis in single or multi‐substance interventions. Addiction,
Last updated : 01.04.2020
Rating
  • Likely to be beneficial

Computer-based interventions (CBIs) were found in a narrative systematic review (Dudgale et al., 2020, N = 14 279) to be effective in:

  • improving substance misuse and mental health outcomes for those completing CBIs from baseline to postintervention and to follow-up at 6 months
Name of response option
  • digital interventions
Desired outcome(s)
  • improve mental health outcomes
  • reduce substance use
Area(s)
  • Treatment
Specific substance or pattern of use
  • co-morbidity
Target group(s) or setting(s)
  • dual-diagnosis patients

References

Stephanie Dugdale, Sarah Elison-Davies, Heather Semper, Jonathan Ward & Glyn Davies (2019): Are Computer-Based Treatment Programs Effective at Reducing Symptoms of Substance Misuse and Mental Health Difficulties Within Adults? A Systematic Review, Journal of Dual Diagnosis, DOI: 10.1080/15504263.2019.1652381
Last updated : 16.10.2020
Rating
  • Beneficial

Individual Placement and Support (IPS) is based on eight principles aimed at helping individuals  tofind and work in competitive jobs of their choosing. These principles are: competitive employment, systematic job development, rapid job search, integrated services, benefits planning, no client exclusion, worker preferences, and time-unlimited supports. IPS has been shown to be effective in improving employment of persons with serious mental disorders.

Individual Placement and Support interventions were found in a narrative systematic review (Harrison et al., 2019, 5 RCTs, 2 Cohort) to be effective in:

  • improving employment outcomes (employment rates, hours worked, wages earned) in individuals with substance use disorders.

IPS is one of the interventions/programmes aimed at improving employment outcomes evaluated in another narrative review (Magura et Marshall, 2020, 14 studies). The other interventions were: Customized Employment Supports (CES), Therapeutic Workplace (TW), Drug court employement intervention, Job Seekers Workshop (JSW).

The review concluded that IPS had significant effect on:

  • improving employment outcomes
Name of response option
  • Employment-focus interventions
Desired outcome(s)
  • improve employability
Area(s)
  • Social reintegration
Specific substance or pattern of use
  • not-drug specific

References

Jennifer Harrison, Matthew J. Krieger & Hillary A. Johnson (2019): Review of Individual Placement and Support Employment Intervention for Persons with Substance Use Disorder, Substance Use & Misuse, DOI: 10.1080/10826084.2019.1692035
Stephen Magura & Tina Marshall (2020) The Effectiveness of Interventions Intended to Improve Employment Outcomes for Persons with Substance Use Disorder: An Updated Systematic Review, Substance Use & Misuse, 55:13, 2230-2236, DOI: 10.1080/10826084.2020.1797810
Depression in Adults - Patient Health Questionnaire (PHQ)
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Depression in Adults - Patient Health Questionnaire

The Patient Health Questionnaire is a self-report version of the Primary Care Evaluation of Mental Disorders (PRIME-MD), which was designed for the screening of psychiatric disorders in an adult primary practice setting.
This is a flowchart showing the Xchange registry process
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Xchange Prevention registry process flowchart

Xchange is an online registry of evidence-based prevention programmes. In addition to providing information on the effectiveness of interventions, the registry also offers information on the experiences of professionals who have implemented...
Last updated : 13.03.2020

Country of origin

Spain

Last reviewed:

Age group

6-10 years

Target group

Children 5-10 years and their parents

Programme setting(s)

School

Level(s) of intervention

Indicated prevention

Empecemos is a multi-component programme, addressing the child itself, its parents and its teachers with the aim of reducing the further development of behavioural problems. It addresses the reciprocal, influential links between family problems, rejection by peers, maladjustment at school, and limited self-control and emotional processing skills, which usually generate a snowball effect, by which the opportunities for healthy development are increasingly reduced. Without proper intervention, conduct disorders become more chronic, and a maladjusted lifestyle becomes increasingly consolidated, resulting in problem substance use, together with antisocial, impulsive and emotional disorders.

Empecemos has been implemented in Galicia (northern Spain) and is ready to be implemented elsewhere. 

Links to this programme in other registries

No link

Contact details

Estrella Romero.
Facultad de Psicología, Santiago de Compostela.
E.mail: estrella.romero[a]usc.es

Evidence rating

Additional studies recommended

Studies overview

In the Romero et al 2017 study, a screening process identified children with significant conduct problems both at home with their family and at school, and the programme was implemented in eight schools. It included a long-term follow-up of 56 children for seven years. Multivariate analysis showed significant differences in attitudes (higher in the control group) and in the intention of using tobacco or alcohol (also higher in the control group). When the proportion of adolescents that will “probably yes” use tobacco was analysed, 11% of the intervention group was willing to use, compared with 42% of the control group (chi-squared: 7.59, 1 df, p < .001). As to adolescents that will “probably yes” use alcohol, 11% of the intervention group chose this response,compared with 35% of the control group (chi-squared: 6.23, 1 df, p < .01). No differences were found in age at onset. There were significant differences in the frequency of actual tobacco usel, but no significant differences in relation to aggressive conduct, despite the fact that facing rage is one of the most emphasised contents of the component for children. Also no significant differences were found in emotional control skills or in empathy, which seems to suggest that the specific effects on interpersonal emotions are attenuated over time and, therefore, that these components require reinforcements during the intervention. No significant effects were found in cannabis use; probably due to its later onset than tobacco and alcohol use.

The Romero et al. 2019 study assessed the efficacy of Empecemos in 128 children with behavioural problems in 18 public schools in urban and semi-urban areas: 67 in the intervention condition and 59 controls. There was random allocation to IG or CG at school level: 9 schools each. The tutors of the children enrolled them in the third to fifth years of primary education completing a brief screening instrument (10 items). Inclusion criteria were higher score at a T of 70 in the “Externalizing” dimension of this instrument. The data suggest that Empecemos improves emotional, cognitive and social skills, and reduces conduct problems, especially teacher-reported conduct problems. The study did not assess substance use related outcomes but showed significant effects when comparing the evolution of the intervention group versus the control group in other relevant behavioural outcomes. 

The limited sample size (common  in  these  types  of  studies  with  high-risk  children) weakens the statistical strength of both analyses carried out. Key issues for the rating: The studies all focus on different components and target groups. Only one study is a RCT with less than 12 month follow-up (post-test after 1 month) that only examined child outcomes, plus the IG had significantly higher age compared to CG (Romero et al., 2019). 

References of studies

Romero, E., Rodríguez, C., Villar, P. & GómezFraguela, X.A. (2017). Intervention on early-onset conduct problems as indicated prevention for substance use: A seven-year follow up. Adicciones, 29(3), 150-162. doi: 10.20882/adicciones.722.

Romero, E., Gómez-Fraguela, X.A., Villar, P., Rodríguez, C. (2019). Prevención indicada de los problemas de conducta: Entrenamiento de habilidades socioemocionales en el contexto escolar. Revista de Psicología Clínica con Niños y Adolescentes. Vol. 6 nº. 3- Agosto 2019 - pp 1-9

 

Countries where evaluated

Spain

Protective factor(s) addressed

Family: attachment to and support from parents
Family: opportunities/rewards for prosocial involvement with parents
Family: positive family management
Individual and peers: skills for social interaction
Individual and peers: prosocial behaviour
Individual and peers: coping skills
School and work: opportunities for prosocial involvement in education
School and work: rewards and disincentives in school

Risk factor(s) addressed

Family: family conflict
Family: family management problems
Individual and peers: anti-social behaviour
Individual and peers: favourable attitudes towards anti-social behaviour
Individual and peers: sensation-seeking
School and work: low commitment/attachment to school/workplace

Outcomes targeted

Emotional well-being
Emotion regulation, coping, resilience
Other mental health outcomes
Positive relationships
Relations with parents
Relations with peers
Other relationships (community, school)
Substance-related behaviours
Bullying
Social behaviour (including conduct problems)

Description of programme

This multi-component programme is based on the principles of social learning and is inspired by empirically validated programmes, such as Coping Power and Incredible Years. The use of audiovisual material facilitates modelling and the transmission of content as a more direct and flexible means than didactic instruction, written schemes or mere discussion. The objectives of Empecemos are to change parents’ educational practices, encouraging effective behaviour monitoring, positive educational practices and proper context structuring. It also aims to improve the quantity and quality of positive interactions between parents and children by reversing the cycle of coercion, through the promotion of shared activities and time together. Parents are trained to enhance positive behaviours, through the use of praise and incentives for positive behaviour. This provides parents with resources to deal with problem behaviours, through the establishment of limits that are appropriate to age and development of the child, in addition to the imposition of mild and non-violent sanctions for misconduct. Beyond this, the programme strives to strengthen family-school ties, by promoting participation in school activities and encouraging constructive interviews with the teachers. Empecemos consists of 19 sessions applied in the school context, which train children in recognition and emotional regulation skills. Empecemos incorporates, as one of its three components, a direct intervention module on children (emotional, cognitive and social skills necessary to display a socially competent behaviour style). Although Empecemos was conceived of as a joint and coordinated intervention programme for families, teachers and children, its implementation showed that the intensive and simultaneous involvement of these three agents is not always possible. Work overload, difficulties in combining schedules due to family responsibilities, situations of personal stress, or scepticism regarding the effectiveness of interventions often make it difficult to participate in interventions aimed at families and teachers.

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