Department of Addictions, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 4 Windsor Walk, London SE5 8AF, United Kingdom.
Alcohol Alcohol. 2023 Sep 9;58(5):478-484. doi: 10.1093/alcalc/agad051.
This systematic review (PROSPERO CRD42021234598) fills a gap in the literature by assessing the efficacy of psychosocial interventions in patients with alcohol use disorder and alcohol-related liver disease (ARLD), focusing on drinking reduction and abstinence as intervention goals. A systematic search for randomized controlled trials (RCTs) was conducted across various databases. Study screening and data extraction were conducted independently by two reviewers. The data were presented through narrative synthesis. Primary outcomes were alcohol reduction and abstinence at the longest follow-up. Ten RCTs were included, evaluating interventions such as cognitive behavioral therapy (CBT), motivational enhancement therapy (MET), motivational interviewing, or peer support. The total population included 1519 participants. Four studies included a combination of more than one intervention, and two trialed an integrated approach, including medical and psychosocial management. A significant reduction was observed with MET, while abstinence was observed with peer support, MET, and CBT/MET within integrated treatment. The overall certainty of the evidence was moderate. Six studies presented a low risk of bias, one had some concerns, and three were high risk. The findings highlight the potential of psychosocial interventions, with MET being repeatedly associated with improved outcomes. Integrated treatment also demonstrated a promising role in ARLD. Future research should head toward improving the robustness and quality of the evidence. It should also aim to further tailor and trial new psychosocial interventions on this specific clinical population. This will enhance the translation of the evidence into real-world settings.
这篇系统评价（PROSPERO CRD42021234598）填补了文献中的空白，评估了心理社会干预在酒精使用障碍和酒精相关肝病（ARLD）患者中的疗效，重点关注减少饮酒和戒酒作为干预目标。通过对多个数据库进行系统搜索，找到了随机对照试验（RCT）。两位评审员独立进行了研究筛选和数据提取。数据通过叙述性综合呈现。主要结局是在最长随访时的酒精减少和戒酒。纳入了 10 项 RCT，评估了认知行为疗法（CBT）、动机增强疗法（MET）、动机访谈或同伴支持等干预措施。总人群包括 1519 名参与者。四项研究包括了一种以上干预措施的组合，两项试验了一种综合方法，包括医疗和心理社会管理。MET 显著减少了饮酒，而同伴支持、MET 和 CBT/MET 联合治疗则观察到了戒酒。证据的总体确定性为中等。六项研究的偏倚风险较低，一项有一些担忧，三项为高风险。研究结果强调了心理社会干预的潜力，MET 多次与改善结果相关。综合治疗在 ARLD 中也表现出了有希望的作用。未来的研究应致力于提高证据的稳健性和质量。还应针对这一特定临床人群进一步调整和试验新的心理社会干预措施。这将促进证据在实际环境中的转化。
