Should psychosocial intervention be added to pharmacological treatment for opiate abuse/dependence? An overview of systematic reviews of the literature

Abstract

Background: Opioid abuse and dependence are major health and social issues in most societies. Different
interventions are available, but the majority of heroin patients relapse and these relapses are a substantial
problem to their rehabilitation. Psychosocial interventions for drug addicts have been suggested as possible
instruments to overcome the difficulty of maintaining a drug-free state. The aim of this paper is to provide a
summary of the available evidence of effectiveness.
Methods: We summarised the results from two systematic reviews on psychosocial interventions combined
with Methadone Maintenance Treatment and Methadone or Buprenorphine Detoxification Treatment. Results:
For detoxification treatments, the results show that benefits can be gained from adding any psychosocial
treatment to any substitution detoxification treatment in terms of completion of treatment: relative risk (RR)
1.68 (95% CI 1.11-2.55), and compliance (proportion of clinical absences): RR 0.48 (95% CI 0.38-0.59); for the
use of heroin during treatment, the differences were not statistically significant. For maintenance treatments,
there is an additional benefit to be gained in adding any psychosocial treatment to methadone maintenance
treatment in relation to the use of heroin during treatment: RR 0.69(95% CI 0.53-0.91); no statistically
significant additional benefit was shown in terms of treatment retention and results at follow-up.
Conclusions: Psychosocial treatments offered in addition to pharmacological detoxification treatments are
effective in terms of completion of treatment and compliance, while adding any psychosocial support to
methadone maintenance significantly improves the non-use of heroin during treatment but does not improve
the other outcomes considered