Bibliographic information
Recommendation
Psychosocial interventions – namely cognitive behavioural therapy (CBT) and contingency management – should be offered to adults with cocaine and stimulant dependence.
Recommended in favor
Strong
Certainty of evidence
Low
Notes and Remarks
Remarks y The term “cocaine and stimulants dependence” refers to diagnosis according to the ICD-10 or DSM-IV criteria or equivalent ICD-11 and DSM-5 diagnosis. y Psychosocial interventions considered in the current review included: cognitive behavioural approach (including: cognitive therapy, community reinforcement approach, coping skills training [CST], relapse prevention), contingency management approach, motivational interviewing approach (motivational interviewing, motivational enhancement), IPT approach, psychodynamic therapy and supportive expressive therapy and the 12-step approach. It included studies if they considered the above treatments alone or in combination with other types of treatment. Focus was on included structured and standardized interventions targeting individual, case management and counselling that are usually provided in standard care (TAU), so the review did not consider them among the experimental interventions. Similarly, family or couples-therapy was not included in the review, as they do not target only individuals but involve people in their close environment. The review excluded studies that compared the same type of intervention as a different modality or at a different intensity (e.g. intensive versus standard, group versus individual, long versus short). y Any treatment or support for people using drugs or with drug use disorders should ensure ethical standards – including respect for human rights and the individual’s dignity, and never using humiliating or degrading interventions – in line with the WHO and UNODC International standards for the treatment of drug use disorders (147) (see Box 3.1).
Implementation considerations y Face-to-face psychosocial interventions delivered by service providers are human resource-intensive as they require substantial provider time, training and supervision. y Psychosocial interventions can be delivered effectively in non-specialized health-care settings if proper training to health professionals is provided, as well as in other settings, including specialized services for mental and substance use disorders. y Integrating the provision of psychosocial interventions into primary care provides many advantages, including more holistic health care, increased accessibility of mental health services for people in need of care, opportunities for reducing the stigma of mental health problems and reduced costs. y Country adaptation and translation of training materials and tools for the provision of psychosocial interventions is essential.