Treatment of alcohol and drug abuse

Assessment 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. It also reviews mini-interventions in primary care and other types of care aimed to reduce intake among high consumers of alcohol. Recent meta-analyses on the subject are evaluated, and particular weight is given to interventions that now exist or can be easily introduced into the Swedish healthcare system. Treatment programs for patients with other concurrent mental disorders are assessed.
Topics not addressed include: low-dose dependence on benzodiazepines, other sedatives, and sleeping medications; effects of treatment aimed primarily at the physical complications of abuse; or ways to limit accessibility.

Assessment strategy

Structured literature review, cost analysis.

Primary data collection

Systematic search of relevant databases, literature lists from the studies identified and from relevant monographs. Search of literature through February 1999 (no historical cutoff point.)

Data criteria; types of studies included

Data were obtained mainly from double blind, randomized controlled trials and meta-analyses based on such studies and also cohort studies and other naturalistic studies that focus on long-term course and economic analysis.

Review of the literature

All studies were assessed using a quality assessment formula developed collaboratively and applied by other projects in psychiatry. All key studies were reviewed by at least two members of the group. The SBU Board of Directors, the SBU Scientific Advisory Committee, and external reviewers evaluated the final manuscript.