Which talking therapies work for drug users with alcohol problems? A Cochrane update

Have you ever had an unresolved question and you kept asking again, again and again, until you got the answer? We wanted to find out whether talking therapies have an impact on alcohol problems in adult people who use illicit drugs (mainly opiates and stimulants), and which therapy is the best. We queried the scientific literature in 2012 and this year again.

Drinking above the recommended safe drinking limits can lead to serious alcohol problems or dependence. Excessive drinking in people who also have problems with other drugs is common and often makes these problems worse; their health deteriorates. Talking therapies may help people drink less but their impact in people who also have problems with other drugs is unknown. Talking treatments were the focus for an updated Cochrane review (Figure 1) published today (Dec 3).
Figure 1. Cochrane
We found four studies that included 594 people with drug problems. One study focused on the way people think and act, versus an approach based on Alcoholics Anonymous, aiming to motivate the person to develop a desire to stop using drugs or alcohol. One study looked at a practice that aimed to identify an alcohol problem and motivate the person to do something about it, versus usual treatment. One study looked at a counselling style for helping people to explore and resolve doubts about changing their behaviour (group and individual form), versus hepatitis health promotion. The last study looked at the same style versus assessment only.
In sum, the studies were so different that we could not combine their results to answer our question. As of June 2014, we still don’t know whether talking therapies affect drinking in people who have problems with both alcohol and other drugs because of the low quality of the evidence. We still don’t know whether talking therapies for drinking affect illicit drug use in people who have problems with both alcohol and 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. New clinical trials would help us to answer our question.
Citation example: Klimas J, Tobin H, Field C-A, O’Gorman CSM, Glynn LG, Keenan E, Saunders J, Bury G, Dunne C, Cullen W. Psychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users. Cochrane Database of Systematic Reviews 2014 , Issue 11 . Art. No.: CD009269. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009269.pub3/abstract

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