Authors' objectives:

Alcohol and drug abuse comprise one of the greatest public health problems. Drug abuse is less common, but has major medical consequences for the user. The social and legal implications are substantial. This report presents a critical review of the scientific literature concerning the treatment of withdrawal, prolonged withdrawal, treatment aimed at preventing relapse, psychological and social therapy to reduce the rate of relapse, treatment programs, the role of institutional care, and the treatment of substance abuse during pregnancy.

Authors' results and conclusions: Alcohol - Hazardous Consumption, Abuse, and Addiction: - Short-term preventive interventions by healthcare providers that target hazardous levels of alcohol consumption are shown to be effective in reducing alcohol consumption for up to 2 years. - Many psychosocial treatment methods with a clear structure and well-defined interventions have favorable effects on alcohol dependence. These methods include cognitive behavioral therapy, 12-step treatment, structured interactional therapy, structured modern therapy with dynamic reference frameworks, motivation-enhancing treatment, partner therapy, and strategies that involve the family in treatment. - The effects of many psychosocial treatment methods (eg, general counseling) have not been scientifically documented. - Benzodiazepines are the most thoroughly documented medication for alcohol withdrawal. - The routine practice of supplementing this treatment with antiepileptic therapy does not have satisfactory scientific support. - In long-term treatment of alcohol addiction, acamprosate (Campral) and naltrexone (Revia) have confirmed effects, as does disulfiram (Antabuse) if delivered under supervision. - The scientific evidence shows that treatment with antidepressants and buspirone (BuSpar) relieves depression and anxiety in alcoholics, but it does not show any positive effects on alcohol dependence. Narcotics - Dependence and Abuse: - Relearning therapies targeted at the behaviors of substance abusers are the most effective among the psychosocial methods for treating heroin and cocaine dependence. - These methods are generally based on behavioral therapy. Dynamic psychotherapy appears to have a positive effect on heroin abuse. Nonspecific, supportive therapy is often used in Sweden to treat drug abuse, but its effectiveness has not been confirmed. - The psychosocial therapies that have been used to address other drugs have no proven effects (eg, cannabis) or are insufficiently studied (eg, amphetamines, etc). - Clonidine can be used successfully to treat heroin withdrawal, and it does not cause addiction. Morphine-like substances, ie, methadone and buprenorphin (Subutex), have effects that are similar to clonidine. - Methadone and buprenorphine (Subutex) used in maintenance therapy for heroin addiction reduces heroin use and improves participation in treatment programs. - Naltrexone also reduces abuse (Revia, not approved for this indication in Sweden). - No well-executed, controlled studies have shown that medication is effective in treating cocaine, amphetamine, or cannabis dependence.

Authors' recommendations: Alcohol-related injury can be prevented: Most physicians and nurses meet patients who consume hazardous levels of alcohol. Well-documented scientific studies show that 'mini-intervention' -based on identifying hazardous consumption and providing information, motivation, and support - leads to a reduction in alcohol consumption and alcohol-related problems. This simple but effective method to prevent the physical and psychological damage caused by alcohol is, however, not used to the extent possible. Effective methods are available to treat abuse and dependence on alcohol and drugs: Many specific psychosocial treatment methods and pharmaceuticals have been scientifically documented as effective means to treat abuse and dependence on alcohol and drugs. Several other methods currently used to treat alcohol and drug abuse and dependence have no documented effects, or are shown to be ineffective in scientific studies. Consequently, care for substance abuse can be improved by: (a) shifting resources away from ineffective treatment methods and into treatment methods that have been documented as effective and (b) committing more resources to treatment programs that apply evidence-based methods. Information, education, and research are needed: Programs to treat substance abuse should rest on a foundation of evidence-based knowledge. This requires a commitment to information, education, and research. Informational and educational efforts should encompass the findings presented in this report and should be pursued by all appropriate healthcare and social service providers in the public and private sectors.

Authors' methods: Systematic review, Cost study

Project Status: Completed

URL for project: http://www.sbu.se/Published

Year Published: 2001

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Sweden

Organisation Name: Swedish Agency for Health Technology Assessment and Assessment of Social Services

Contact Address: P.O. Box 3657, SE-103 59 Stockholm, Sweden. Tel: +46 8 4123200, Fax: +46 8 4113260

Contact Name: registrator@sbu.se

Contact Email: registrator@sbu.se

Copyright: Swedish Council on Technology Assessment in Health Care (SBU)