Department of Psychiatry, Addictive Behaviours Unit, Hospital de La Santa Creu I Sant Pau, Sant Antoni Maria Claret 167, Pavelló 20, Planta 2, 08025, Barcelona, Spain.
Mental Health Research Group, Institut de Recerca Sant Pau (IR Sant Pau), Sant Quintí 77-79, 08041, Barcelona, Spain.
Syst Rev. 2024 May 8;13(1):124. doi: 10.1186/s13643-024-02550-z.
Psychosocial approaches are the first-line treatments for cocaine dependence, although they still present high dropout and relapse rates. Thus, there is a pressing need to understand which variables influence treatment outcomes to improve current treatments and prevent dropout and relapse rates. The aim of this study is to explore predictors of treatment retention and abstinence in CUD.
This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We searched three databases-PubMed, PsychINFO and Web of Science-for randomized clinical trials (RCTs) published in English and Spanish from database inception through April 1, 2023. We selected all studies that met the inclusion criteria (adults aged ≥ 18, outpatient treatment, CUD as main addiction, and no severe mental illness) to obtain data for the narrative synthesis addressing cocaine abstinence and treatment retention as main outcome variables. After data extraction was completed, risk of bias was assessed using the Cochrane risk-of-bias tool for randomized trials (RoB-2).
A total of 566 studies were screened, and, of those, 32 RCTs were included in the synthesis. Younger age, more years of cocaine use, and craving levels were significant predictors of relapse and treatment dropout. Fewer withdrawal symptoms, greater baseline abstinence, greater treatment engagement, and more self-efficacy were all predictors of longer duration of abstinence. The role of impulsivity as a predictor of CUD is unclear due to conflicting data, although the evidence generally suggests that higher impulsivity scores can predict more severe addiction and withdrawal symptoms, and earlier discontinuation of treatment.
Current evidence indicates which variables have a direct influence on treatment outcomes, including well-studied cocaine use-related variables. However, additional variables, such as genetic markers, appear to have a high impact on treatment outcomes and need further study.
This systematic review is registered at PROSPERO (ID: CRD42021271847). This study was funded by the Spanish Ministry of Science, Innovation and Universities, Instituto Carlos III (ISCIII) (FIS PI20/00929) and FEDER funds and Fundació Privada Hospital de la Santa Creu i Sant Pau (Pla d'acció social 2020).
心理社会方法是可卡因依赖的一线治疗方法，尽管它们仍然存在较高的脱落率和复发率。因此，迫切需要了解哪些变量会影响治疗结果，以改进当前的治疗方法并防止脱落和复发。本研究旨在探讨可卡因使用障碍（CUD）患者治疗保留和戒断的预测因素。
本系统评价按照系统评价和荟萃分析的首选报告项目（PRISMA）进行。我们在 PubMed、PsychINFO 和 Web of Science 这三个数据库中检索了自数据库成立至 2023 年 4 月 1 日发表的英文和西班牙文的随机临床试验（RCT），以纳入符合纳入标准的所有研究（年龄≥18 岁、门诊治疗、CUD 为主要成瘾、无严重精神疾病），以获取关于可卡因戒断和治疗保留作为主要结局变量的叙述性综合数据。在完成数据提取后，使用 Cochrane 随机试验偏倚风险工具（RoB-2）评估偏倚风险。
共筛选出 566 项研究，其中 32 项 RCT 纳入综合分析。年龄较小、可卡因使用年限较长和渴求水平是复发和治疗脱落的显著预测因素。较少的戒断症状、较高的基线戒断、更高的治疗参与度和更高的自我效能感均是更长时间戒断的预测因素。冲动性作为 CUD 的预测因素的作用尚不清楚，因为存在相互矛盾的数据，但证据普遍表明，较高的冲动性评分可以预测更严重的成瘾和戒断症状，以及更早地停止治疗。
目前的证据表明，哪些变量对治疗结果有直接影响，包括经过充分研究的可卡因使用相关变量。然而，其他变量，如遗传标志物，似乎对治疗结果有很大影响，需要进一步研究。
本系统评价在 PROSPERO（ID：CRD42021271847）上注册。本研究由西班牙科学、创新和大学部、卡洛斯三世研究所（ISCIII）（FIS PI20/00929）和 FEDER 基金以及 Sant Pau 私人医院基金会（2020 年社会行动计划）资助。
