A collaborative team based at the University of Limerick’s Graduate-Entry Medical School has recently completed a HRB-funded Cochrane Review of psychosocial interventions for problem alcohol use among problem drug users.1 The review involved collaboration with the UCD School of Medicine and Medical Science and NUI Galway and was conducted over two years. It describes a gap in the research evidence relating to the important question of whether clinical interventions that are based on behavioural, motivational or social theories of change, and can be effective in treating alcohol problems, are also effective for patients with coexisting addiction issues.
What is problem alcohol use and what are psychosocial interventions?
Problematic use of alcohol means drinking above the recommended safe drinking limits. It can lead to serious health issues or dependence. Excessive drinking in people who have problems related to use of other drugs is common, and often both exacerbates the substance abuse and leads to serious health challenges. Psychosocial interventions are talking therapies that aim to identify an alcohol problem and motivate an individual to do something about it. They can be performed by staff with training in these approaches, a doctor, nurse, counsellor or psychologist, for example. Talking therapies may help people reduce their drinking, but their influence on people who have problems with other drugs is not known. In undertaking this review, we wanted to see whether talking therapies impact on alcohol problems in drug users. In particular, we wanted to evaluate data from published randomised trials with respect to talking therapies focused on alcohol drinking in adult users of illicit drugs (mainly opiates and stimulants).
Studies reviewed and conclusions made
We found four relevant studies that involved 594 adults (over the age of 18 years) with drug problems. One study looked at training in cognitive-behavioural coping skills versus 12-step facilitation. One study evaluated brief intervention versus treatment as usual. Another trial investigated motivational interviewing (group and individual format) versus hepatitis health promotion, while the final paper reported details of brief motivational intervention versus assessment only.
In summary, the studies were so different in their design and implementation that their results could not be combined; it therefore remains uncertain whether talking therapies affect alcohol consumption in people who have problems with other drugs. In essence, this is because of the low quality of the evidence. In addition, it remains uncertain whether talking therapies for drinking affect illicit drug use in people who have problems with other drugs. There was not enough information to compare different types of talking therapies. Many of the studies did not account for possible sources of bias; more high-quality studies, such as randomised controlled trials, are needed to answer this question.
The knowledge gained in this review will now form part of the baseline information for an initiative which develops this topic further – PINTA-lite – a feasibility study integrating addiction treatment and primary care which will develop an evaluation of a psychosocial intervention for polydrug use. This three-year project is led by a team at UL’s Graduate-Entry Medical School and involves academic, clinical, and policy experts responsible for planning and delivery of addiction care and primary care, and international experts on problem alcohol use in primary care and on the role of primary care in addressing the needs of vulnerable populations.
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1. Klimas J, Field C-A, Cullen W, O'Gorman CSM, Glynn LG, Keenan E et al. (2012) Psychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users. Cochrane Database of Systematic Reviews, 11. Published online 14 November. www.ncbi.nlm.nih.gov/pubmed/23152270
