Open Access Research

Psychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users: Cochrane Reviewa

Jan Klimas12*, Catherine-Anne Field2, Walter Cullen13, Clodagh SM O’Gorman134, Liam G Glynn5, Eamon Keenan6, Jean Saunders7, Gerard Bury2 and Colum Dunne13

Author Affiliations

1 Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland

2 School of Medicine and Medical Science, University College Dublin, Coombe Healthcare Centre, Dolphins Barn Street, Dublin 8, Ireland

3 Centre for Interventions in Infection, Inflammation & Immunity (4i), Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland

4 Department of Paediatrics, Mid-Western Regional Hospital, Limerick, Ireland

5 Department of General Practice, National University of Ireland, Galway, Ireland

6 Addiction Services, Health Service Executive, Dublin, Ireland

7 Statistical Consulting Unit/ Applied Biostatistics Consulting Centre /CSTAR, Graduate Entry Medical School, University of Limerick, Limerick, Ireland

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Systematic Reviews 2013, 2:3  doi:10.1186/2046-4053-2-3

Published: 12 January 2013

Abstract

Background

Problem alcohol use is common among illicit drug users and is associated with adverse health outcomes. It is also an important factor in poor prognosis among drug users with hepatitis C virus (HCV) as it impacts progression to hepatic cirrhosis or opiate overdose in opioid users. The aim of this systematic review was to assess the effects of psychosocial interventions for problem alcohol use in adult illicit drug users with concurrent problem alcohol use (principally, problem drug users of opiates and stimulants).

Methods

We searched the following databases (November 2011): Cochrane Library, PUBMED, EMBASE, CINAHL, PsycINFO and reference list of articles. We also searched conference proceedings and online registers of clinical trials. Two reviewers independently assessed risk of bias and extracted data from included randomized controlled trials.

Results

Four studies (594 participants) were included in this review. Half of the trials were rated as having a high or unclear risk of bias. The four studies considered six different psychosocial interventions grouped into four comparisons: 1) cognitive-behavioral coping skills training versus 12-step facilitation (N = 41), 2) brief intervention versus treatment as usual (N = 110), 3) hepatitis health promotion versus motivational interviewing (N = 256), and 4) brief motivational intervention versus assessment-only group (N = 187). Differences between studies precluded any pooling of data. Findings are described for each trial individually. Most findings were not statistically significant except for comparison 2: decreased alcohol use at three months (risk ratio (RR) 0.32; 95% confidence interval (CI) 0.19 to 0.54) and nine months (RR 0.16; 95% CI 0.08 to 0.33) in the treatment-as-usual group and comparison 4: reduced alcohol use in the brief motivational intervention (RR 1.67; 95% CI 1.08 to 2.60).

Conclusions

No conclusion can be made because of the paucity of the data and the low quality of the retrieved studies.

Keywords:
Alcohol; Brief intervention; Illicit drugs; Opioids; Systematic review; Screening; Methadone