Psychosocial approaches to all psychostimulant use
Psychosocial approaches to regular psychostimulant use
CBT
Matrix model
Residential rehabilitation
Self help
Psychosocial approaches to all psychostimulant use
Key points:- Transition to injecting can be prevented with CBT intervention.
Strength of evidence: 1 star
- Brief interventions among current injectors can reduce initiation into injecting among non-injectors.
Strength of evidence: 2 stars
- Infrequent, heavy users of psychostimulants and instrumental users should be encouraged to be aware of symptoms of heavy use and the need for moderation or cessation.
Strength of evidence: 1 star
- Brief, opportunistic interventions are most appropriate for ecstasy users.
Strength of evidence: 1 star
Psychosocial approaches to regular psychostimulant use
Behavioural reinforcement
Key points:- Positive reinforcers for abstinence, in combination with psychological treatment, can reduce cocaine use.
Strength of evidence: 3 stars
- The magnitude, immediacy and relevance of reinforcement to the target group may be critical to efficacy of positive reinforcement.
Strength of evidence: 1 star
CBT
Key points:- Cognitive behavioural therapy (CBT) has been effective in reducing amphetamine use.
Strength of evidence: 3 stars
- CBT is more effective at moderating cocaine use than equivalent time in non-therapeutic activities, but has not been shown to increase abstinence.
Strength of evidence: 3 stars
- Findings in relation to 12-step approaches have been equivocal.
Strength of evidence: 3 stars
- The effects of cognitive behavioural interventions may be more durable than other psychotherapies and hence be more protective against relapse.
Strength of evidence: 3 stars
- The use of high quality, manualised counselling with experienced counsellors may be an important factor contributing to outcomes.
Strength of evidence: ?
- A single concerted approach may be more effective than several different counselling approaches.
Strength of evidence: ?
Matrix model
Key points:- Low rates of retention have been reported for programs of up to 6-months duration and it is currently not possible to identify effective strategies to encourage retention, or to relate treatment duration to outcome.
Strength of evidence: 1 star
Residential rehabilitation
Key points:- Rates of dropout from residential rehabilitation programs are very high in the early stages of treatment (>40% dropout in the first month), but rates of attrition then decline. (Not specific to psychostimulants).
Strength of evidence: 2 stars
- For those who complete residential rehabilitation programs, drug use and criminal behaviour is reduced and legal employment increased, following treatment. (Not specific to psychostimulants).
Strength of evidence: 2 stars
- Treatment progress, not just time in treatment, is predictive of good outcomes. (Not specific to psychostimulants).
Strength of evidence: 1 star
- For psychostimulant users, enhancing residential treatment with behaviour therapy or CBT improves outcome.
Strength of evidence: 1 star
Self help
Key points:- The effectiveness of 12-step (self-help) approaches is equivocal.
Strength of evidence: ?
- Participation in self-help group meetings (not just attendance) is important in determining outcomes.
Strength of evidence: 1 star
- Attendance at self-help group meetings should not be mandated.
Strength of evidence: ?