Psychotherapeutic interventions for cannabis abuse and/or dependence in outpatient settings

 

Abstract

Background

Cannabis use disorder is the most common illicit substance use disorder in general population. Despite that, only a minority seek assistance from a health professional, but the demand for treatment is now increasing internationally. Trials of treatment have been published but to our knowledge, there is no published systematic review .

Objectives

To evaluate the efficacy of psychosocial interventions for cannabis abuse or dependence.

Search methods

We searched the Cochrane Central Register of Trials (CENTRAL) The Cochrane Library Issue 3, 2004; MEDLINE (January 1966 to August 2004), PsycInfo (1985 to October 2004), CINAHL (1982 to October 2004), Toxibase (until September 2004) and reference lists of articles. We also contacted researchers in the field.

Selection criteria

All randomised controlled studies examining a psychotherapeutic intervention for cannabis dependence or abuse in comparison with a delayed-treatment control group or combinations of psychotherapeutic interventions.

Data collection and analysis

Two authors independently assessed trial quality and extracted data

Main results

Six trials involving 1297 people were included. Five studies took place in the United States, one in Australia. Studies were not pooled in meta-analysis because of heterogeneity. The six included studies suggested that counselling approaches might have beneficial effects for the treatment of cannabis dependence. Group and individual sessions of cognitive behavioral therapy (CBT) had both efficacy for the treatment of cannabis dependence and associated problems, CBT produced better outcomes than a brief intervention when CBT was delivered in individual sessions. Two studies suggested that adding voucher-based incentives may enhance treatment when used in combination with other effective psychotherapeutic interventions. Abstinence rates were relatively small overall but favoured the individual CBT 9-session (or more) condition. All included trials reported a statistically significant reductions in frequency of cannabis use and dependence symptoms. But other measures of problems related to cannabis use were not consistently different.

Authors' conclusions

The included studies were too heterogenous and could not allow to draw up a clear conclusion. The studies comparing different therapeutic modalities raise important questions about the duration, intensity and type of treatment. The generalizability of findings is also unknown because the studies have been conducted in a limited number of localities with fairly homogenous samples of treatment seekers. However, the low abstinence rate indicated that cannabis dependence is not easily treated by psychotherapies in outpatient settings.

 

Plain language summary

Psychotherapeutic interventions for cannabis abuse and/or dependence in outpatient settings

Cannabis use disorder is the most commonly occurring illicit substance use disorder in the general population. Despite the large number of cannabis users who seek or may need treatment only a few randomised clinical trials exist that explore the most effective interventions. The six studies included in this review show that cannabis dependence is not easily treated by psychotherapies in outpatient settings. Cognitive-behavioral (CB) both in individual or group sessions, motivational enhancement in individual sessions have been demonstrated to be effective to reduce cannabis use. The most recent, best quality and largest controlled trial, found extended individual CBT to be more effective than brief individual motivational therapy. The two studies on contingency-management treatments concluded that this may enhance outcomes combined with CBT or motivational enhancement.

 

摘要

背景

門診機構中對於大麻濫用及/或依賴的心理治療介入措施

一般族群中使用大麻的疾病是最常見使用的違法藥物疾病。儘管如此，只有少數人尋求健康專家的協助，但現在全球對於治療的需求逐漸增加。已有發表治療的試驗，但就我們所知沒有已發表的系統性回顧。

目標

評估用於大麻濫用或依賴的心理社會介入措施的效用。

搜尋策略

我們檢索考科藍圖書館2004年第3期the Cochrane Central Register of Trials (CENTRAL)；MEDLINE (1966年1月至2004年8月)，PsycInfo (1985至2004年10月)，CINAHL (1982至2004年10月)，Toxibase (直到2004年9月)與文章的參考文獻。我們也連絡該領域的研究人員。

選擇標準

所有評估心理治療介入措施對於大麻依賴或濫用對照於延緩治療對照組或合併心理治療介入措施的隨機對照試驗。

資料收集與分析

兩名作者分別評估試驗品質並摘錄資料。

主要結論

納入六篇研究，共包含1297人。五篇研究在美國進行，一篇在澳洲進行。由於研究異質性因此並未將研究加總進行統合分析。納入的六篇研究認為諮詢方法對於大麻依賴的治療也許具有有利的效果。認知行為療法(cognitive behavioral therapy (CBT))的小組與個人課程兩者對於大麻依賴與相關問題皆具有效用，當個人課程中提供CBT時CBT也許比簡單的介入措施有較佳的結果。兩篇研究認為當使用合併其他有效的心理治療介入措施時，增加以證書為基礎的動機也許會加強治療效果。整體來說戒斷率相對不高，但偏好個人CBT9堂(或更多)課程的結果。所有納入的試驗報告，使用大麻與依賴症狀的頻率有統計顯著減少。但其他有關大麻使用的測量結果沒有一致性的差異。

作者結論

納入的研究其異質性太大且無法有一個明確的定論。比較不同治療模式的研究發現治療期間，強度與類型會出現重要的問題。結果的推論性也是未知的，因為研究建立在數量有限的地區，其尋求治療者為相當同質性的樣本。無論如何，低戒斷率意指在門診機構中大麻依賴不容易經由心理療法而被治療。

翻譯人

本摘要由高雄榮民總醫院金沁琳翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

門診機構中對於大麻濫用及/或依賴的心理治療介入措施。一般族群中使用大麻的疾病是最常見使用違法藥物的疾病。儘管有大量的大麻使用者尋求或也許需要治療，但只有少數隨機臨床試驗探究最有效的介入措施。這篇回顧納入的六篇研究顯示門診機構中大麻依賴不容易經由心理療法而被治療。在個人或小組課程中認知行為(CB)已被證實減少大麻使用是有效果的。最近，最佳品質且最大型的對照試驗發現長期的個人CBT比簡單的個人動機療法來的有效。兩篇在應變管理的治療研究推斷，合併CBT或動機強化也許可以加強結果。