best practice

OST has been found to be effective in a a systematic review with meta-analysis (Platt et al., 2017, 28 studies, N= 11 070 PWID) in:

• reducing the risk of HCV acquisition by 50% (RR 0.50, 95 % CI 0.40 to 0.63).

Police interventions in licensed premises, with uniformed police officers visiting pubs two to three times a week was found in a narrative review (Calafat, Juan and Duch, 2009) to lead to:

• a 20 % reduction in recorded public disorders offences in the intervention area, compared with no reduction in the control area.

Police intervention in high-risk premises was found in a systematic review (Jones et al 2010) and in a narrative review (EMCDDA, 2012) to be a more effective strategy than ‘low level’ policing in:

• reducing alcohol-related incidents (narrative results only).

A narrative review (Calafat, Juan and Duch, 2009) found some evidence suggesting that pub-watching schemes have a significant desirable effect on:

• crime reduction (only narrative results).

Police interventions encompassing regular enforcement and visits by plain clothes officers aimed at promoting responsible alcohol service and at preventing driving while under the influence, and targeting servers in nightlife settings and licensed premises were found in a systematic review (Bolier et al 2011) to lead to:

• Bar tenders serving alcohol less often to pseudo-clients acting as though they were intoxicated (variation of results across three studies ranging from significant to not statistically significant results).

Police interventions aimed at reducing the movement of clients between bars, the overall alcohol consumption of clients and contain that consumption within safer settings was found to be effective in a systematic review (Ker and Chinnock, 2008) in:

• reducing assault rates: pre-intervention serious assault rate in the experimental area was 52 % higher than the rate in the control area. After intervention, the serious assault rate in the experimental area was 37 % lower than in the control area.

Mentoring (intended as a supportive relationship in which one person offers support, guidance and concrete assistance to a partner) is based on the sharing of experience and expertise without expectation of personal gain by the mentor - Center for Substance Abuse Prevention 2000) was found in a systematic review (Thomas et al., 2011) more effective than no interventions in:

• preventing alcohol use (3 RCTs) (RR 0.71, 95% CI  0.57 to 0.90, p = 0.005).

Continuing care, i.e. interventions following the initial period of more intensive care aimed at manage and sustain recovery (including cognitive behavioural therapies (CBT), recovery management check-ups, 12-step or self-help and technology based interventions) was found in a systematic review with meta-analysis (Blodgett  et al., 2014, 19 studies, N=3542) to be more effective than control conditions on:

• at least one substance use outcome (Hedges’ g = 0.187,  p< 0.001)

The same meta-analysis also found that

• longer planned treatments did not have larger effects sizes than studies with shorter prescribed periods of treatment
• there was no significant difference between treatments with protocol-specified intervention sessions and those without planned sessions per week

These results were confirmed by another systematic review without meta-analysis (Dennis et al., 2014) that looked specifically at the effects of different types of continuing care:  

• behavioural therapies showed promising results on use and retention in treatment outcomes, especially for moderate severity clients recovery managements check-ups are primarily effective in linking people back to treatment more robust evidence is still needed for self-help groups and technology-based interventions

Contingency management (CM) involves participants receiving something of value such as a gift card, voucher or chance to win a prize as a reward for the achievement of a specific and measurable desired behaviour, most commonly a negative urine drug test for stimulants when implemented for the treatment of stimulant use disorder.

CM alone was found in a systematic review of reviews (Ronsley et al., 2020, 29 systematic reviews examining eleven intervention modalities) to be effective in improving:

• abstinence at 12 weeks (Odds Ratio [OR] 2.29, 95% Confidence Interval [CI] 1.62, 3.24),
• abstinence at the end of treatment (OR 2.22, 95% CI 1.59, 3.10),
• dropout at 12 weeks (OR 1.39, 95% CI 1.09, 1.78),
• and dropout at the end of treatment (OR 1.41, 95% CI 1.10, 1.82). 

However the effect was not sustained at longest follow up (OR 1.10, 95% CI 0.83, 1.46).

Another more recent systematic review with meta-analysis (Bentzley et al., 2021) statistically compared all the different treatment options (157 studies comprising 402 treatment groups and 15 842 participants) looking for the interventions associated with an objective reductions in cocaine use among adults. Excluding other therapies, the largest treatment groups across all studies were psychotherapy (mean [SD] number of participants, 40.04 [36.88]) and contingency management programs (mean [SD] number of participants, 37.51 [25.51]). The analysis found that:

• only contingency management programs were significantly associated with an increased likelihood of having a negative test result for the presence of cocaine (OR, 2.13; 95% CI, 1.62-2.80), and this association remained significant in all sensitivity analyses.

METHAMPHETAMINE

A systematic review without meta-analysis (Hayley et al., 2020) described the broad benefits of contingency management, including greater drug abstinence, higher utilization of other treatments and medical services, and reductions in risky sexual behaviour specifically for methamphetamine users.

Another systematic review without meta-analysis (AshaRani et al., 2020) confirmed that CM interventions among all the behavioural interventions consistently showed benefits (reduced drug use, better treatment retention, reduction in psychiatric symptoms and better quality of life) during the treatment period of METH use; however, the sustainability of the effect, post-intervention, is not well-studied. Moreover they found that although CM and CBT, both demonstrated positive outcomes individually, no clear synergism was observed when CM interventions were combined together with CBT.

DCRs were found to be effective in a systematic review without meta-analysis (Kennedy et al., 2017, 47 studies) in:

• facilitating access and uptake of health care services, both addiction services (4 studies) and other health or social services (9 studies).

A systematic review (Potier et al., 2014), without meta-analysis, concluded that:

• DCRs are effective in reaching the most marginalized and problematic injecting users.

Another systematic review and meta-synthesis of qualitative studies (McNeil et al., 2014, 21 studies, n>800) that looked specifically at the effects of three types of safer environment interventions (SEI - syringe exchange, peer-based approaches and drug consumption rooms) found that SEI: 

• provide refuge from street-based drug scene
• enable safer injecting by reshaping social and environmental contexts
• mediate access to resources and health care services

DCRs were found to be effective in a systematic review without meta-analysis (Kennedy et al., 2017, 47 studies), in:

• reducing injecting risk behaviour (syringe sharing, syringe exchange and safer practices) (9 studies).

Also confirmed by a review of reviews (MacArthur et al., 2014, N=25 reviews) and another  systematic review (Potier et al., 2014).