best practice

The Sacramento Neighbourhood Alcohol Prevention Project was found effective in a narrative review (EMCDDA, 2012) and in two systematic reviews (Jones et al., 2010; Bolier et al 2011) in:

• significantly reducing assaults and motor vehicle accidents (based on police and emergency medical service reports);

The 'A Matter of Degree' programme was found effective in a narrative review (EMCDDA, 2012) and in two systematic reviews (Jones et al., 2010; Bolier et al 2011) in:

• significantly reducing alcohol consumption, alcohol-related harms and drink-driving at follow-up, based on self-reported outcomes (but only at five sites with the highest implementation of environmental programming).

Opioid withdrawal with antagonists under heavy sedation or anaesthesia was compared to withdrawal managed with reducing doses of methadone in a systematic review of (Gowing 2010, 8 RCTs, N=1109) and:

• heavy sedation or anaesthesia increased adverse effects (RR 3.21, 95%CI 1.13 to 9.12);
• heavy sedation groups showed higher risk of life threatening than the non-heavy sedation groups (RR 14, 95%CI 0.74 to 264).

Psychosocial interventions were found in a systematic review (Terplan et al., 2015) to have no statistically significant different effect than other standard care interventions in:

• improving retention in treatment (RR 0.99, 95 % CI 0.93 to 1.06, 9 studies, N=743)
• improving abstincence (RR 1.14, 95 % CI 0.75 to 1.73, 3 studies, N=367)
• reducing pre-term birth (RR 0.71, 95 % CI 0.34 to 1.51, 3 studies, N=264)
• reducing low birth weight (RR 0.72, 95 % CI 0.36 to 1.43, 1 study, N=160)

Maintenance treatment with different medications was assessed in a systematic review (Minozzi et al., 2014, 2 studies, N=189 aged 14-21) finding no conclusive results on:

• completion of treatment;
• reducing the use of substances; and
• improving health and social status.

Among the studies, one (N=152) compared Buprenorphine-Naloxone maintenance with buprenorphine detoxification and found:

• the maintenance treatment group had fewer drop out (RR 0.37, 95 % CI 0.26 to 0.54);
• but no differences were found for opioid use (RR 0.97, 95 % CI 0.78 to 1.22)

Detoxification treatment alone or in combination with psychosocial intervention compared to no intervention, other pharmacological intervention or psychosocial interventions was assessed in a systematic review (Minozzi et al., 2014, 2 RCTs, N= 190 between 13–18 years of age) finding no conclusive results on:

• completion of treatment;
• reducing the use of substances; and
• improving health and social status.

Among the studies enclosed in the review, one (N=152) compared buprenorphine detoxification with Buprenorphine-Naloxone substitution and found that:

• the detox group group had more patients dropping out (RR 2.67, 95 % CI 1.85 to 3.86);
• but no differences were found for opioid use (RR 1.03, 95 % CI 0.82 to 1.28).