“As they say in the West of Ireland, you can’t fit a square peg in a round hole*. If some trials in your systematic review are like that round hole and other are that square peg, you aren’t going to be able to do a meta-analysis unless you re-shape ‘the edges’ of your systematic literature review.”
Which talking therapies (counselling) work for drug users with alcohol problems?
The following text is based on a lay summary of a my recent Cochrane systematic review: Klimas J, Field C-A, Cullen W, O’Gorman CSM, Glynn LG, Keenan E, Saunders J, Bury G, Dunne C. Psychosocial interventions for problem alcohol use in illicit drug users. Cochrane Database of Systematic Reviews 2011, Issue 8. Art. No.: CD009269. DOI: 10.1002/14651858.CD009269.pub2
Check my presentation from the Annual Symposium of the Society for the study of Addiction on November 8th, 2012 in York, UK here:
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 alcohol problems or dependence. Excessive drinking in people who have problems with other drugs is common and often makes their problems worse as well as having serious health consequences for the person involved.
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, for example doctor, nurse, counsellor, psychologist etc. Talking therapies may help people cut down their drinking but the impact is not known in people who have problems with other drugs.
We wanted to do a review to see whether talking therapies have an impact on alcohol problems in drug users. In this review, we wanted to evaluate information from randomised trials in relation to impact of talking therapies on alcohol drinking in adult (over the age of 18 years) users of illicit drugs (mainly opiates and stimulants).
This review found the following studies, and came to the following conclusions:
We found four studies which examined 594 people with drug problems. One study looked at Cognitive-behavioural coping skills training vs. Twelve-step facilitation. One study looked at Brief intervention vs. Treatment as usual. One study looked at Motivational interviewing (group and individual format) vs. Hepatitis health promotion. The last study looked at Brief motivational intervention vs. Assessment only.
– The studies were so different that we could not combine their results to answer our question.
– It remains uncertain whether talking therapies affect drinking in people who have problems with other drugs because of the low quality of the evidence.
– 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 our question.
The review was funded by a Cochrane Training Fellowship awarded to me by the Health Research Board of Ireland. Praise from the Cochrane quality advisor:
… compliments and congratulations for the high methodological quality of your systenatic review. It is really well done and I think I’ll use it in the future as an example for other review authors on how to do a good and clear work. (Minozzi, September 7, 2012)
*Note: A square peg in a round hole is an idiomatic expression which describes the unusual individualist who could not fit into a niche of his society. (http://en.wikipedia.org/wiki/Square_peg_in_a_round_hole)