PMID- 30586362 OWN - NLM STAT- MEDLINE DCOM- 20190501 LR - 20220408 IS - 1549-1676 (Electronic) IS - 1549-1277 (Print) IS - 1549-1277 (Linking) VI - 15 IP - 12 DP - 2018 Dec TI - Comparative efficacy and acceptability of psychosocial interventions for individuals with cocaine and amphetamine addiction: A systematic review and network meta-analysis. PG - e1002715 LID - 10.1371/journal.pmed.1002715 [doi] LID - e1002715 AB - BACKGROUND: Clinical guidelines recommend psychosocial interventions for cocaine and/or amphetamine addiction as first-line treatment, but it is still unclear which intervention, if any, should be offered first. We aimed to estimate the comparative effectiveness of all available psychosocial interventions (alone or in combination) for the short- and long-term treatment of people with cocaine and/or amphetamine addiction. METHODS AND FINDINGS: We searched published and unpublished randomised controlled trials (RCTs) comparing any structured psychosocial intervention against an active control or treatment as usual (TAU) for the treatment of cocaine and/or amphetamine addiction in adults. Primary outcome measures were efficacy (proportion of patients in abstinence, assessed by urinalysis) and acceptability (proportion of patients who dropped out due to any cause) at the end of treatment, but we also measured the acute (12 weeks) and long-term (longest duration of study follow-up) effects of the interventions and the longest duration of abstinence. Odds ratios (ORs) and standardised mean differences were estimated using pairwise and network meta-analysis with random effects. The risk of bias of the included studies was assessed with the Cochrane tool, and the strength of evidence with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. We followed the PRISMA for Network Meta-Analyses (PRISMA-NMA) guidelines, and the protocol was registered in PROSPERO (CRD 42017042900). We included 50 RCTs evaluating 12 psychosocial interventions or TAU in 6,942 participants. The strength of evidence ranged from high to very low. Compared to TAU, contingency management (CM) plus community reinforcement approach was the only intervention that increased the number of abstinent patients at the end of treatment (OR 2.84, 95% CI 1.24-6.51, P = 0.013), and also at 12 weeks (OR 7.60, 95% CI 2.03-28.37, P = 0.002) and at longest follow-up (OR 3.08, 95% CI 1.33-7.17, P = 0.008). At the end of treatment, CM plus community reinforcement approach had the highest number of statistically significant results in head-to-head comparisons, being more efficacious than cognitive behavioural therapy (CBT) (OR 2.44, 95% CI 1.02-5.88, P = 0.045), non-contingent rewards (OR 3.31, 95% CI 1.32-8.28, P = 0.010), and 12-step programme plus non-contingent rewards (OR 4.07, 95% CI 1.13-14.69, P = 0.031). CM plus community reinforcement approach was also associated with fewer dropouts than TAU, both at 12 weeks and the end of treatment (OR 3.92, P < 0.001, and 3.63, P < 0.001, respectively). At the longest follow-up, community reinforcement approach was more effective than non-contingent rewards, supportive-expressive psychodynamic therapy, TAU, and 12-step programme (OR ranging between 2.71, P = 0.026, and 4.58, P = 0.001), but the combination of community reinforcement approach with CM was superior also to CBT alone, CM alone, CM plus CBT, and 12-step programme plus non-contingent rewards (ORs between 2.50, P = 0.039, and 5.22, P < 0.001). The main limitations of our study were the quality of included studies and the lack of blinding, which may have increased the risk of performance bias. However, our analyses were based on objective outcomes, which are less likely to be biased. CONCLUSIONS: To our knowledge, this network meta-analysis is the most comprehensive synthesis of data for psychosocial interventions in individuals with cocaine and/or amphetamine addiction. Our findings provide the best evidence base currently available to guide decision-making about psychosocial interventions for individuals with cocaine and/or amphetamine addiction and should inform patients, clinicians, and policy-makers. FAU - De Crescenzo, Franco AU - De Crescenzo F AUID- ORCID: 0000-0002-2478-7763 AD - Department of Psychiatry, University of Oxford, Oxford, United Kingdom. AD - Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom. AD - Institute of Psychiatry and Clinical Psychology, Catholic University of the Sacred Heart, Rome, Italy. FAU - Ciabattini, Marco AU - Ciabattini M AUID- ORCID: 0000-0003-2022-2690 AD - School of Hygiene and Preventive Medicine, University of Rome Tor Vergata, Rome, Italy. FAU - D'Alo, Gian Loreto AU - D'Alo GL AUID- ORCID: 0000-0002-4125-2066 AD - School of Hygiene and Preventive Medicine, University of Rome Tor Vergata, Rome, Italy. FAU - De Giorgi, Riccardo AU - De Giorgi R AUID- ORCID: 0000-0001-5984-8696 AD - Department of Psychiatry, University of Oxford, Oxford, United Kingdom. AD - Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom. FAU - Del Giovane, Cinzia AU - Del Giovane C AD - Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland. FAU - Cassar, Carolina AU - Cassar C AD - Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy. FAU - Janiri, Luigi AU - Janiri L AD - Institute of Psychiatry and Clinical Psychology, Catholic University of the Sacred Heart, Rome, Italy. FAU - Clark, Nicolas AU - Clark N AUID- ORCID: 0000-0001-8697-6183 AD - Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland. FAU - Ostacher, Michael Joshua AU - Ostacher MJ AUID- ORCID: 0000-0003-0353-7535 AD - Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, United States of America. AD - Department of Psychiatry, VA Palo Alto Health Care System, Palo Alto, California, United States of America. FAU - Cipriani, Andrea AU - Cipriani A AUID- ORCID: 0000-0001-5179-8321 AD - Department of Psychiatry, University of Oxford, Oxford, United Kingdom. AD - Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom. LA - eng GR - 001/WHO_/World Health Organization/International PT - Comparative Study PT - Journal Article PT - Meta-Analysis PT - Research Support, Non-U.S. Gov't PT - Systematic Review DEP - 20181226 PL - United States TA - PLoS Med JT - PLoS medicine JID - 101231360 SB - IM MH - Amphetamine-Related Disorders/diagnosis/*psychology/*therapy MH - Cocaine-Related Disorders/diagnosis/*psychology/*therapy MH - Cognitive Behavioral Therapy/methods MH - Humans MH - Network Meta-Analysis MH - Patient Acceptance of Health Care/*psychology MH - *Psychosocial Support Systems MH - Randomized Controlled Trials as Topic/methods MH - Treatment Outcome PMC - PMC6306153 COIS- I have read the journal's policy and the authors of this manuscript have the following competing interests: MJO is a consultant to Acadia Pharmaceuticals, Genomind, Johnson & Johnson/Janssen, Otsuka/Lundbeck, Sage Therapeutics, Sunovion, and Supernus Pharmaceuticals, and has received research funding from Palo Alto Health Sciences. All other authors have declared that no competing interests exist. EDAT- 2018/12/27 06:00 MHDA- 2019/05/02 06:00 PMCR- 2018/12/26 CRDT- 2018/12/27 06:00 PHST- 2018/06/26 00:00 [received] PHST- 2018/11/15 00:00 [accepted] PHST- 2018/12/27 06:00 [entrez] PHST- 2018/12/27 06:00 [pubmed] PHST- 2019/05/02 06:00 [medline] PHST- 2018/12/26 00:00 [pmc-release] AID - PMEDICINE-D-18-02294 [pii] AID - 10.1371/journal.pmed.1002715 [doi] PST - epublish SO - PLoS Med. 2018 Dec 26;15(12):e1002715. doi: 10.1371/journal.pmed.1002715. eCollection 2018 Dec.