De Giorgi Riccardo, Cassar Carolina, Loreto D'alò Gian, Ciabattini Marco, Minozzi Silvia, Economou Alexis, Tambelli Renata, Lucchese Franco, Saulle Rosella, Amato Laura, Janiri Luigi, De Crescenzo Franco
Department of Psychiatry, University of Oxford, Oxford, UK - Oxford Health NHS Foundation Trust, Oxford, UK.
Department of Dynamic and Clinical Psychology, Sapienza University, Rome, Italy.
Riv Psichiatr. 2018 Sep-Oct;53(5):233-255. doi: 10.1708/3000.30003.
Stimulant use disorders are highly prevalent with a large burden of disease. Most clinical guidelines recommend psychosocial interventions, but there are no clear hierarchies or indications. Moreover, these interventions have been reported unevenly in the literature. Identifying the most suitable treatment for each patient therefore represents a major challenge. In this review, we describe all psychosocial interventions for stimulant use disorders investigated in randomized controlled trials - including contingency management, cognitive behavioral interventions, community reinforcement approach, 12-step program, meditation-based interventions and physical exercise, supportive expressive psychodynamic therapy, interpersonal psychotherapy, family therapy, motivational interviewing, drug counseling -, and we synthesize the main findings of these studies. Similarities and differences between treatments are highlighted, suggesting that distinct psychosocial interventions can be relevant for certain patients' groups but not for others. Conversely, several interventions can be equally effective in similar clinical contexts, suggesting that a shared element such as therapeutic alliance is key. Finally, combined approaches emerge as a viable option for people with complex needs. Future studies will need to benchmark psychosocial interventions in stimulant use disorders and ascertain markers of response with a view to individualized treatment.
兴奋剂使用障碍非常普遍，疾病负担沉重。大多数临床指南推荐心理社会干预措施，但没有明确的等级划分或适用指征。此外，这些干预措施在文献中的报道并不均衡。因此，为每位患者确定最合适的治疗方法是一项重大挑战。在本综述中，我们描述了在随机对照试验中研究的所有针对兴奋剂使用障碍的心理社会干预措施——包括应急管理、认知行为干预、社区强化法、12步计划、基于冥想的干预措施和体育锻炼、支持性表达心理动力疗法、人际心理治疗、家庭治疗、动机性访谈、药物咨询——并综合了这些研究的主要发现。强调了不同治疗方法之间的异同，表明不同的心理社会干预措施可能对某些患者群体适用，而对其他群体不适用。相反，几种干预措施在相似的临床环境中可能同样有效，这表明诸如治疗联盟等共同要素是关键。最后，综合方法成为有复杂需求者的可行选择。未来的研究需要对兴奋剂使用障碍的心理社会干预措施进行基准测试，并确定反应标志物，以实现个性化治疗。
