Mehta Kahini, Hoadley Ariel, Ray Lara A, Kiluk Brian D, Carroll Kathleen M, Magill Molly
Center for Alcohol and Addiction Studies, Brown University, Providence, RI 02912, USA.
College of Public Health, Temple University, Philadelphia, PA 19122, USA.
Alcohol Alcohol. 2021 Aug 30;56(5):535-544. doi: 10.1093/alcalc/agab016.
This meta-analysis reviewed 15 clinical trials (18 study sites/arms), examining the efficacy of an integrated cognitive-behavioral intervention (CBI) delivered to individuals with an alcohol or other drug use disorder and a co-occurring mental health disorder (AOD/MHD). Outcomes were alcohol or other drug use and mental health symptoms at post-treatment through follow-up.
The inverse-variance weighted effect size was calculated for each study and pooled under random effects assumptions.
Integrated CBI showed a small effect size for AOD (g = 0.188, P = 0.061; I2 = 86%, τ2 = 0.126, k = 18) and MHD (g = 0.169, P = 0.024; I2 = 58%, τ2 = 0.052, k = 18) outcomes, although only MHD outcomes were statistically significant. Analysis by subgroup suggested that effect magnitude varied by type of contrast condition (integrated CBI + usual care vs. usual care only; integrated CBI vs. a single-disorder intervention), follow-up time point (post-treatment vs. 3-6 months) and primary AOD/MHD diagnosis, although these sub-groups often contained significant residual heterogeneity. In a series of mixed effects, meta-regression models, demographic factors were non-significant predictors of between-study heterogeneity. For AOD outcomes, greater effects were observed in higher quality studies, but study quality was not related to effect size variability for MHD outcomes.
The current meta-analysis shows a small and variable effect for integrated CBI with the most promising effect sizes observed for integrated CBI compared with a single disorder intervention (typically an AOD-only intervention) for follow-up outcomes, and for interventions targeting alcohol use and/or post-traumatic stress disorder. Given the clinical and methodological variability within the sample, results should be considered a preliminary, but important step forward in our understanding of treatment for co-occurring AOD/MHD.
本荟萃分析回顾了15项临床试验（18个研究地点/研究组），考察了综合认知行为干预（CBI）对患有酒精或其他药物使用障碍及共病精神健康障碍（AOD/MHD）的个体的疗效。结局指标为治疗后至随访期间的酒精或其他药物使用情况及精神健康症状。
计算每项研究的逆方差加权效应量，并在随机效应假设下进行合并。
综合CBI在AOD结局（g = 0.188，P = 0.061；I² = 86%，τ² = 0.126，k = 18）和MHD结局（g = 0.169，P = 0.024；I² = 58%，τ² = 0.052，k = 18）方面显示出较小的效应量，不过只有MHD结局具有统计学意义。亚组分析表明，效应大小因对照条件类型（综合CBI + 常规护理与仅常规护理；综合CBI与单一障碍干预）、随访时间点（治疗后与3 - 6个月）以及主要的AOD/MHD诊断而异，尽管这些亚组通常存在显著的残余异质性。在一系列混合效应的荟萃回归模型中，人口统计学因素并非研究间异质性的显著预测因素。对于AOD结局，在质量较高的研究中观察到更大的效应，但研究质量与MHD结局的效应大小变异性无关。
当前的荟萃分析表明，综合CBI的效应较小且存在变异性，与单一障碍干预（通常是仅针对AOD的干预）相比，综合CBI在随访结局以及针对酒精使用和/或创伤后应激障碍的干预方面观察到最有前景的效应大小。鉴于样本中的临床和方法学变异性，结果应被视为我们在理解AOD/MHD共病治疗方面迈出的初步但重要的一步。
