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Snowdon N, Allan J, Shakeshaft A, Rickwood D, Stockings E, Boland VC, Courtney RJ. Outpatient psychosocial substance use treatments for young people: An overview of reviews. Drug Alcohol Depend 2019; 205:107582. [PMID: 31778903 DOI: 10.1016/j.drugalcdep.2019.107582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/12/2019] [Accepted: 08/16/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Systematic reviews and meta-analyses (reviews) conflict regarding the efficacy and feasibility of substance disorder treatments for young people (YP). This overview of reviews, synthesizes, and methodologically assesses reviews examining substance disorder interventions for YP in outpatient settings. METHODS Reviews published between 1990 and March 2018 were searched using EBM Reviews, PsycINFO, Embase, Ovid Medline, and Campbell Collaboration. Reviews investigating efficacy and/or feasibility of YP substance disorder treatments in outpatient settings were included. FORTY-THREE REVIEWS MET ALL INCLUSION CRITERIA To appraise methodological biases, 40 reviews were assessed using A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR2) and 3 were narratively assessed. One reviewer (NS) extracted study data and evaluated all 43 reviews. For inter-rater reliability, 13 (30%) reviews were extracted and appraised in duplicate by a second reviewer (JA, RC or ES). Agreement on AMSTAR2 ratings reached 100%. Agreement was moderate; κ = .52 (p < .05), 95% CI (.20, .84). RESULTS All high quality methodological reviews (n = 6) focused on intervention efficacy and none on treatment feasibility. One (n = 1) high quality review reported evidence for an intervention. Multidimensional Family Therapy (MDFT) has possible efficacy in reducing YP substance use when compared to treatment as usual, Cognitive Behavior Therapy, Adolescent Community Reinforcement Approach and Multifamily Educational Therapy. CONCLUSIONS Methodological and reporting quality of reviews require improvement. High quality reviews focused on intervention efficacy but treatments commonly lacked evidence. One high quality review found MDFT demonstrated promising outcomes. Reviews examining feasibility of interventions were of low methodological quality.
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Affiliation(s)
- Nicole Snowdon
- Lives Lived Well Research Team, Lives Lived Well, P.O. Box 9374, Orange, NSW, 2800, Australia; National Drug and Alcohol Research Centre, 22 - 32 King Street, The University of New South Wales, Randwick, Sydney, NSW, 2031, Australia.
| | - Julaine Allan
- Lives Lived Well Research Team, Lives Lived Well, P.O. Box 9374, Orange, NSW, 2800, Australia
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre, 22 - 32 King Street, The University of New South Wales, Randwick, Sydney, NSW, 2031, Australia; Faculty of Health, Allawoona St, University of Canberra, Bruce, Canberra, ACT, 2617, Australia
| | - Debra Rickwood
- Research and Evaluation, headspace, The National Youth Mental Health Foundation, South Tower, Level 2, 485 La Trobe St, Melbourne VIC 3000, Australia; Faculty of Health, Allawoona St, University of Canberra, Bruce, Canberra, ACT, 2617, Australia
| | - Emily Stockings
- National Drug and Alcohol Research Centre, 22 - 32 King Street, The University of New South Wales, Randwick, Sydney, NSW, 2031, Australia
| | - Veronica C Boland
- National Drug and Alcohol Research Centre, 22 - 32 King Street, The University of New South Wales, Randwick, Sydney, NSW, 2031, Australia
| | - Ryan J Courtney
- National Drug and Alcohol Research Centre, 22 - 32 King Street, The University of New South Wales, Randwick, Sydney, NSW, 2031, Australia
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Zhand N, Milin R. What do we know about the pharmacotheraputic management of insomnia in cannabis withdrawal: A systematic review. Am J Addict 2018; 27:453-464. [PMID: 30113101 DOI: 10.1111/ajad.12783] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 06/04/2018] [Accepted: 07/22/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Sleep disturbance is one of the hallmarks of cannabis withdrawal. Studies have indicated that treatment of this key symptom may facilitate abstinence. In the present paper we aim to provide a systematic review of the extant literature on pharmacological management of sleep disturbance associated with cannabis withdrawal. METHOD We conducted a systematic literature search across five electronic databases including PubMed, Psycinfo, MEDLINE, Cochrane review and Embase. Human studies using a pharmacological treatment for sleep disturbances associated with cannabis withdrawal were included. Review articles, case-series, open trials, posters, and editorials were excluded. RESULTS Seventeen publications, involving 562 participants, were included in this review. Major limitations involved small sample size, high dropout rate, methodological limitations, and heterogeneity of participants. Most of the studies were at high risk of bias, further downgrading the level of evidence. A meta-analysis was not performed due to lack of quantitative data, marked heterogeneity and low quality of the included studies. CONCLUSION There is not sufficient evidence for any of the reviewed treatment options. Methodological limitations in a majority of the studies rendered their findings preliminary. Of the twelve investigated pharmacological agents, Gabapentin, Lofexidine, Mirtazapine, Quetiapine, and Zolpidem showed some primary benefits for treatment of sleep difficulties associated with cannabis withdrawal; however, future prospective studies are required to confirm such results. SCIENTIFIC SIGNIFICANCE This review examines the current evidence for potential pharmacological options for treatment of cannabis withdrawal and associated sleep disturbance. It furthers our knowledge and provides groundwork for future research. (Am J Addict 2018;27:453-464).
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Affiliation(s)
- Naista Zhand
- Department of Psychiatry, University of Ottawa, Ontario, Canada
| | - Robert Milin
- Department of Psychiatry, University of Ottawa, Ontario, Canada.,Head, Division of Addiction and Mental Health, Department of Psychiatry, University of Ottawa, Ontario, Canada
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Abstract
Substance use disorders in children and adolescents are a significant cause of concern as they can have long term implications in practically every sphere. The etiological factors that contribute to substance use disorders are complex and the formulation must amalgamate and synthesize all the different factors including the predisposing, perpetuating, precipitating and protective factors in order to plan management. Interventions must stem from this comprehensive formulation and must be child-focused, multidisciplinary, multisystemic, with strong family participation and community involvement. The treating team must actively collaborate with the young person and help him/her understand the rationale for treatment in order for them to engage in it. Assessment and treatment of comorbidities are an important part of intervention package. Skill training for problem solving, emotional regulation, social skills, and communication are an essential part of the treatment for substance use disorders in adolescents. Relapse prevention strategies, including how to seek help when there is a lapse must be part and parcel of the interventions delivered to the young person. Substance use disorder interventions must be part of a larger plan that addresses other areas of concern in the young person's life. While there are few studies, and so a relatively weak and preliminary evidence base for pharmacotherapeutic interventions, early evidence shows that their combination with psychosocial interventions may have a synergistic effect on substance use reduction. Substance use disorders affect the entire family and the community at large and thus must be treated holistically, but by individualising the treatment to suit the needs of that particular child and family.
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Affiliation(s)
- Deepak Jayarajan
- Department of Psychiatry, Psychiatric Rehabilitation Services, Bengaluru, Karnataka, India
| | - Preeti Jacob
- Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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Emerging Pharmacologic Treatments for Adolescent Substance Use: Challenges and New Directions. CURRENT ADDICTION REPORTS 2016; 3:145-156. [PMID: 27570728 DOI: 10.1007/s40429-016-0098-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Adolescence is a key period in the development of substance use and misuse. Substance use typically begins during adolescence and prevalence rates for many substance use disorders peak before age 21 years. Yet, despite clinical demand, treatments for youth rely almost entirely on psychosocial interventions that yield only modest benefit. One potential way to improve treatment effects is to augment the best available psychosocial interventions with pharmacotherapy. Although pharmacotherapy research has advanced care for adults with substance use disorders, no medication is indicated for adolescents and controlled trials with teenagers are scant. Optimizing treatments for youth will require closing this important gap in medication development research. In this paper we review the paucity of pharmacotherapy research for adolescent substance misuse, and we discuss how we can leverage human laboratory paradigms and technology to advance our understanding regarding if and how medications may improve treatment options for youths.
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