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

Evaluation of the Intensive Treatment and Rehabilitation Program for Residential Treatment and Rehabilitation Centers (INTREPRET) in the Philippines: a study protocol for a randomized controlled trial

“…Based on recently published findings from a systematic review that included studies with a similar design [ 7 ], this study considered a minimum detectable effect of 0.23 and a population standard deviation of 0.42. With a significance level of 0.05, and a power of 0.95, a sample size of 88 participants per group (or 176 patients in total) was determined as needed to test the causal effect of the intervention.…”

Evaluation of the Intensive Treatment and Rehabilitation Program for Residential Treatment and Rehabilitation Centers (INTREPRET) in the Philippines: a study protocol for a randomized controlled trial

“…Based on recently published findings from a systematic review that included studies with a similar design [ 7 ], this study considered a minimum detectable effect of 0.23 and a population standard deviation of 0.42. With a significance level of 0.05, and a power of 0.95, a sample size of 88 participants per group (or 176 patients in total) was determined as needed to test the causal effect of the intervention.…”

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).…”

“…Previous systematic reviews identified low-quality evidence of reducing drug use (37), increasing mental health (57), reducing injection and sexual risk behaviour. Other reviews had significant heterogeneity and inconclusive outcomes (35). This overview synthesised evidence from several systematic reviews and included primary studies, identifying significant differences in outcomes between the primary studies in these 11 reviews.…”

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.…”

Evaluation of the Intensive Treatment and Rehabilitation Program for Residential Treatment and Rehabilitation Centers (INTREPRET) in the Philippines: a study protocol for a randomized controlled trial

“…Based on recently published findings from a systematic review that included studies with a similar design [ 7 ], this study considered a minimum detectable effect of 0.23 and a population standard deviation of 0.42. With a significance level of 0.05, and a power of 0.95, a sample size of 88 participants per group (or 176 patients in total) was determined as needed to test the causal effect of the intervention.…”

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).…”

“…Previous systematic reviews identified low-quality evidence of reducing drug use (37), increasing mental health (57), reducing injection and sexual risk behaviour. Other reviews had significant heterogeneity and inconclusive outcomes (35). This overview synthesised evidence from several systematic reviews and included primary studies, identifying significant differences in outcomes between the primary studies in these 11 reviews.…”

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.…”

Evaluation of the Intensive Treatment and Rehabilitation Program for Residential Treatment and Rehabilitation Centers (INTREPRET) in the Philippines: a study protocol for a randomized controlled trial

“…Based on recently published findings from a systematic review that included studies with a similar design [ 7 ], this study considered a minimum detectable effect of 0.23 and a population standard deviation of 0.42. With a significance level of 0.05, and a power of 0.95, a sample size of 88 participants per group (or 176 patients in total) was determined as needed to test the causal effect of the intervention.…”

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).…”

“…Previous systematic reviews identified low-quality evidence of reducing drug use (37), increasing mental health (57), reducing injection and sexual risk behaviour. Other reviews had significant heterogeneity and inconclusive outcomes (35). This overview synthesised evidence from several systematic reviews and included primary studies, identifying significant differences in outcomes between the primary studies in these 11 reviews.…”

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.…”