best practice

Occupation-based interventions are those programmes in which an occupation is performed, and occupations are defined as those activities a person engages in to structure time and create meaning in their life. In the addiction field, occupation-based interventions are typically in the areas of work, leisure, and social participation. Those interventions were found in a systematic review without meta-analysis (Wasmuth et al., 2016, 26 studies) to have no significant effect in:

• improving recovery short and long-term recovery outcomes (ASI scores)

A narrative review (Fischer et al., 2015), without meta-analysis, concluded that there is

• mixed evidence, thus not conclusive, on the effectiveness in relation to social outcomes, eg, housing and employment.

Drug court programmes are among the interventions/programmes aimed at improving employment outcomes evaluated in a narrative review (Magura et Marshall, 2020, 14 studies). The drug court interventions included in the review consisted of 26 individual and group counseling sessions provided by an employment specialist with experience in both employment and SUD counseling.

The review showed no significant effect on:

• increased number days of paid employment
• increased income

The other interventions reviewed are: Individual Placement and Support (IPS), Customized Employment Supports (CES), Therapeutic Workplace (TW), Job Seekers Workshop (JSW).

Drug court programmes were found to be effective in a systematic review (Mitchell et al., 2012, 154 studies) in

• reducing recidivism at three years follow-up for adult drug courts (3 studies; the mean effect size is analogous to a drop in recidivism from 50% for non-participants to approximately 38% for participants)
• reducing recidivism for drunk-driving drug courts (DWI) (4 studies – 3 found sizeable reductions in recidivism, however, 1 experimental evaluation found a negative effect)
• reducing recidivism for juvenile drug courts albeit with a smaller effect size (the mean effect size is analogous to a drop in recidivism from 50% for non-participants to roughly 43.5% for participants)

Motivational interviewing was found to have no different effect than treatment as usual in a systematic review  (Darker et al., 2015) in:

• reducing use at any time intervals;
• reducing drop-outs at any time intervals

A more recent systematic review with meta-analysis (Lynch at al., 2021,, studies = 8, n= 2071) investigated at the effectiveness of brief interventions in primary care compared to usual care. Results found promising yet very low quality (and thus not conclusive) evidence on:

• discontinuation of BZRA use at 6 months (eight studies, RR = 2.73, 95% CI = 1.84-4.06) and 12 months post-intervention (two studies, RR = 3.41, 95% CI = 2.22-5.25)

Cognitive behavioural therapy plus taper was found to have no different effect than only taper in a systematic review (Darker et al., 2015) in:

• reducing use at 6, 12 and 24 months follow-up;
• reducing drop-outs at any time intervals

Cognitive behavioural therapy plus taper was found to be effective in a systematic review (Darker et al., 2015), in:

• reducing use at post-treatment (RR 1.40, 95 % CI 1.05 to 1.86, 9 studies, N=423);
• reducing use at 3 months follow-up (RR 1.51, 95 % CI 1.15 to 1.98, 9 studies, N=460)

Psychosocial interventions for female drug-using offenders were found in a systematic review (Perry et al., 2015a) to have no significant effect (in different types of comparisons) in:

• reducing drug use

Interventions examined included collaborative case management, interpersonal psychotherapy, cognitive behavioural skills, single computerised intervention, dialectic behavioural therapy and case management and therapeutic community.

Pharmacological treatment (Buprenorphine) for female drug-using offenders was found in a systematic review (Perry et al., 2015) to have no different effect than placebo in:

• reducing drug use - self-reported at three months follow-up (RR 0.58, 95 % CI 0.25 to 1.35, 1 study, N=36)

Agonist pharmacological treatments for drug-using offenders were found in a systematic review (Perry et al., 2015) to have no different effect than non-pharmacological interventions in:

• reducing drug use
  • measured (RR 0.72, 95 % CI 0.51 to 1.00, 2 studies, N=237)
  • self-reported (RR 0.61, 95 % CI 0.31 to1.18, 3 studies, N=317)
• reducing criminal activity
  • arrests (RR 0.60, 95 % CI 0.32 to 1.14, 1 study, N=62)
  • re-incarceration (RR 0.77, 95 % CI 0.36 to 1.64, 3 studies, N=472)

Antagonist pharmacological treatments (Naltrexone) were found in the same review (Perry et al., 2015) to also have no different effect than non-pharmacological interventions in:

• reducing drug use (measured) (RR 0.69, 95 % CI 0.28 to 1.70, 1 study, N=63)

When comparing the drugs no significant differences between comparisons (methadone versus buprenorphine, diamorphine and naltrexone) on any of the outcome measures.