Cognitive‐behavioural treatment for amphetamine‐type stimulants (ATS)‐use disorders

Abstract

Background: Amphetamine-type stimulants (ATS) refer to a group of synthetic stimulants including amphetamine, methamphetamine, 3,4-methylenedioxy-methamphetamine (MDMA) and related substances. ATS are highly addictive and prolonged use may result in a series of mental and physical symptoms including anxiety, confusion, insomnia, mood disturbances, cognitive impairments, paranoia, hallucinations and delusion.Currently there is no widely accepted treatment for ATS-use disorder. However, cognitive-behavioural treatment (CBT) is the first-choice treatment. The effectiveness of CBT for other substance-use disorders (e.g. alcohol-, opioid-and cocaine-use disorders) has been well documented and as such this basic treatment approach has been applied to the ATS-use disorder.Objectives: To investigate the efficacy of cognitive-behavioural treatment for people with ATS-use disorder for reducing ATS use compared to other types of psychotherapy, pharmacotherapy, 12-step facilitation, no intervention or treatment as usual. Search methods: We identified randomised controlled trials (RCT) and quasi-RCTs comparing CBT for ATS-use disorders with other types of psychotherapy, pharmacotherapy, 12 step facilitation or no intervention. We searched the Cochrane Drugs and Alcohol Group Specialised Register, Cochrane Central Register of Controlled Trials, MEDLINE via PubMed, Embase and five other databases up to July 2018. In addition, we examined reference lists of eligible studies and other systematic reviews. We contacted experts in the field. Selection criteria: Eligibility criteria consisted of RCTs and quasi-RCTs comparing CBT versus other types of interventions with adult ATS users (aged 18 years or older) diagnosed by any explicit diagnostic system. Primary outcomes included abstinence rate and other indicators of drug-using behaviours. Data collection and analysis: We used standard methodological procedures expected by Cochrane.Main results: Only two studies met the eligibility criteria. Both studies were at low risk of selection bias and reporting bias. In one study, almost half of participants in the intervention group dropped out and this study was at high risk of attrition bias.The studies compared a single session of brief CBT or a web-based CBT to a waiting-list control (total sample size across studies of 129). Results were mixed S Y S T E M A T I C R E V I E W

Psychosocial Interventions for Amphetamine Type Stimulant Use Disorder: An Overview of Systematic Reviews

“…First, the increasing number of individual studies and systematic reviews has revealed inconsistency in evidence about effectiveness. For example, a recent review has shown that the quality of evidence in many primary studies was low and insufficient to show the efficacy of CBT in treating ATS misuse (35). This conflicts with conclusions of other reviews supporting the effectiveness of CBT and other psychosocial interventions (36,37).…”

“…Ten of 11 systematic reviews demonstrated that psychosocial intervention could reduce the frequency, dose and risky routes such as injection of drug use. However, Harada et al (35) concluded that the overall quality of evidence was low and insufficient to determine the effectiveness or ineffectiveness of CBT. Additionally, systematic reviews showed the benefit of combining different therapies to lengthen the duration of drug abstinence, compared with single therapy (13,15).…”

Technological Interventions for the Treatment of Substance Use Disorders

“…However, less is known about the effectiveness of CBT in amphetamine-type stimulant reduction. A meta-analysis by Harada et al. (2018) identified only two RCTs of which one suffered high attrition bias and the other had a small sample size, indicating that there is not enough evidence to establish the efficacy of CBT for amphetamine-type stimulant reduction.…”

Stimulant safe supply: a potential opportunity to respond to the overdose epidemic

“…However, TSF has been fraught with controversy about its spiritual framing, and evidence indicates that it has limited effectiveness [1,20]. In brief, CBT aims to modify patterns of thinking that are believed to lead to drug use, and to support patients in developing healthier coping mechanisms [21]. CM also seeks to change substance use-related behavioral patterns by providing a reward (e.g., cash, gift cards) contingent upon the patient providing a urine sample to prove they have been abstinent from stimulants [20].…”