Evidence-Based Practices for Treatment Substance Use Disorders

Welcome to EBP Substance Abuse Update!

EBP Update is a literature alert feature to complement the EBP Substance Abuse website, produced by the Alcohol & Drug Abuse Institute at the University of Washington.  Each week, we'll post abstracts of journal articles and other new resources about evidence based practices for treating substance use disorders.  You can subscribe to EBP Update by e-mail or RSS, or read us on the Web.

Four Models for Evaluating the Evidence

McGovern MP; Carroll KM.  Evidence-based practices for substance use disorders.  Psychiatric Clinics of North America 2003; 26(4):991-1010.

There are inherent complexities in evaluating EBPs for substance use disorders: the heterogeneity of the disorder itself, the variability in people who suffer from them, the range of settings in which services are provided, and multiple lines of research development. This article outlined four models for evaluating the evidence for interventions for substance use disorders, and presented brief descriptions of pharmacological, behavioral/psychosocial, and treatment services that have a clearly defined intervention (chemical agent or manual-guided therapy) and a documented record of objective evaluation. [Pubmed abstract]

Are Self-Help Groups Evidence-Based?

Humphreys K; Wing S; McCarty D; Chappel J; Gallant L; Haberle B; Horvath AT; et al.  Self-help organizations for alcohol and drug problems: toward evidence-based practice and policy.  Journal of Substance Abuse Treatment 2004 Apr;26(3):151-8; discussion 159-65.

This expert consensus statement reviews evidence on the effectiveness of drug and alcohol self-help groups and presents potential implications for clinicians, treatment program managers and policymakers. Policies described here that could be implemented by clinicians and program managers include making greater use of empirically-validated self-help group referral methods in both specialty and non-specialty treatment settings and developing a menu of locally available self-help group options that are responsive to client's needs, preferences, and cultural background. [Available from Journal of Substance Abuse Treatment]

Effectiveness of Brief Interventions with Adolescents

Tait RJ; Hulse GK.  A systematic review of the effectiveness of brief interventions with substance using adolescents by type of drug. Drug and Alcohol Review 2003;22: 337-346.

The aim of this paper is to evaluate the effectiveness of brief interventions (BI) with adolescents (mean age <20) in reducing alcohol, tobacco or other drug (ATOD) use by means of a systematic review of BI for adolescent substance use in the English language literature up to 2002. We identified 11 studies involving 3734 adolescents. Follow-up ranged from 6 weeks to 24 months. Motivational interviewing was the predominant approach, underpinning eight studies: the remaining three provided personalized health information. [Available from Drug and Alcohol Review]

Smoking Interventions

Naidoo B; Warm D; Quigley R; Taylor.  Smoking and public health: A review of reviews of interventions to increase smoking cessation, reduce smoking initiation and prevent further uptake of smoking.  Evidence Briefing Summary.  London: Health Development Agency, 2004.

This evidence briefing is a review of reviews about the effectiveness of public health interventions to reduce smoking initiation and increase smoking cessation.  This briefing aims to: (1) Identify all relevant systematic reviews and metaanalyses; (2) Review these papers and highlight ‘what works’ to reduce smoking initiation and/or the further uptake of smoking, and to increase smoking cessation for all population groups, but with particular reference to disadvantaged and vulnerable groups; (3) Highlight conflicting evidence, gaps in the evidence and provide a steer for future policy and research commissioning.  [Free full text]

An Update on Mesa Grande

Miller WR: Wilbourne PL.  Mesa Grande: A methodological analysis of clinical trials of treatments for alcohol use disorders.  Addiction 2002;97:265-277.

AIM: A 3-year update with 59 new controlled trials is provided for the ongoing Mesa Grande project reviewing clinical trials of treatments for alcohol use disorders. The project summarizes the current evidence for various treatment approaches, weighting findings differentially according to the methodological strength of each study. DESIGN: The review includes 361 controlled studies that (1) evaluated at least one treatment for alcohol use disorders, (2) compared it with an alternative condition (such as a control group, a placebo, a brief intervention or an alternative treatment), (3) used a procedure designed to create equivalent groups before treatment and (4) reported at least one outcome measure of drinking or alcohol-related consequences. Studies were rated by two reviewers on 12 methodological criteria, and outcome logic was analyzed for the specific treatment modalities tested.  [Available from Addiction]

EBP Benefits and Costs for Washington State

Aos, S.  Evidence-based treatment of alcohol, drug, and mental health disorders: Potential benefits, costs, and fiscal impacts for Washington State.  Washington State Institute for Public Policy, June 2006.

This June 2006 report from the Washington State Institute for Public Policy asks whether "evidence-based" treatment for alcohol, drug, and mental health disorders offers economic advantages.  Do benefits outweigh costs?  And, if so, what is the magnitude of the potential fiscal savings to government, as well as the total net benefits to all of Washington?  WSIPP analysts systematically reviewed the "what works" literature regarding treatments for people with alcohol, drug, and mental health disorders, then estimated the monetary value of the benefits, including factors such as improved performance in the job market, reduced health care and other costs, and reduced crime-related costs. (WSIPP Report # 06-06-3901).  [Free full text]

Multisystemic Therapy (MST)

Scott W. Henggeler.  Director, Family Services Research Center; Professor, Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences.

Multisystemic Therapy (MST) is an evidence-based practice that addresses the factors associated with serious antisocial behavior in children and adolescents who abuse drugs. These factors include characteristics of the adolescent (for example, favorable attitudes toward drug use), the family (poor discipline, family conflict, parental drug abuse), peers (positive attitudes toward drug use), school (dropout, poor performance), and neighborhood (criminal subculture). By participating in intense treatment in natural environments (homes, schools, and neighborhood settings) most youths and families complete a full course of treatment. MST is a pragmatic and goal-oriented treatment, and uses cognitive behavioral, behavioral, and the pragmatic family therapies.

Visit the EBP Substance Abuse database record about MST.

Screening in Brief Intervention Trials

Beich A ; Thorsen T ; Rollnick S.  Screening in brief intervention trials targeting excessive drinkers in general practice: Systematic review and meta-analysis.  British Medical Journal 2003;327:536-542.

The objective of this study was to determine the effectiveness of programs of screening in general practice for excessive alcohol use and providing brief intervention.  This analysis was done using systematic review and meta-analysis of randomised controlled trials that used screening as a precursor to brief intervention.  Although even brief advice can reduce excessive drinking, screening in general practice does not seem to be an effective precursor to brief interventions targeting excessive alcohol use.  This meta-analysis raises questions about the feasibility of screening in general practice for excessive use of alcohol.   [Free full text]