Psychosocial approaches to all psychostimulant use
Psychosocial approaches to regular psychostimulant use
CBT
Matrix model
Residential rehabilitation
Self help

Psychosocial approaches to all psychostimulant use

Key points:
  • Transition to injecting can be prevented with CBT intervention.
    Strength of evidence: 1 star

  • Brief interventions among current injectors can reduce initiation into injecting among non-injectors.
    Strength of evidence: 2 stars

  • Infrequent, heavy users of psychostimulants and instrumental users should be encouraged to be aware of symptoms of heavy use and the need for moderation or cessation.
    Strength of evidence: 1 star

  • Brief, opportunistic interventions are most appropriate for ecstasy users.
    Strength of evidence: 1 star

Psychosocial approaches to regular psychostimulant use

Behavioural reinforcement

Key points:
  • Positive reinforcers for abstinence, in combination with psychological treatment, can reduce cocaine use.
    Strength of evidence: 3 stars

  • The magnitude, immediacy and relevance of reinforcement to the target group may be critical to efficacy of positive reinforcement.
    Strength of evidence: 1 star

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CBT

Key points:
  • Cognitive behavioural therapy (CBT) has been effective in reducing amphetamine use.
    Strength of evidence: 3 stars

  • CBT is more effective at moderating cocaine use than equivalent time in non-therapeutic activities, but has not been shown to increase abstinence.
    Strength of evidence: 3 stars

  • Findings in relation to 12-step approaches have been equivocal.
    Strength of evidence: 3 stars

  • The effects of cognitive behavioural interventions may be more durable than other psychotherapies and hence be more protective against relapse.
    Strength of evidence: 3 stars

  • The use of high quality, manualised counselling with experienced counsellors may be an important factor contributing to outcomes.
    Strength of evidence: ?

  • A single concerted approach may be more effective than several different counselling approaches.
    Strength of evidence: ?

Matrix model

Key points:
  • Low rates of retention have been reported for programs of up to 6-months duration and it is currently not possible to identify effective strategies to encourage retention, or to relate treatment duration to outcome.
    Strength of evidence: 1 star

Residential rehabilitation

Key points:
  • Rates of dropout from residential rehabilitation programs are very high in the early stages of treatment (>40% dropout in the first month), but rates of attrition then decline. (Not specific to psychostimulants).
    Strength of evidence: 2 stars

  • For those who complete residential rehabilitation programs, drug use and criminal behaviour is reduced and legal employment increased, following treatment. (Not specific to psychostimulants).
    Strength of evidence: 2 stars

  • Treatment progress, not just time in treatment, is predictive of good outcomes. (Not specific to psychostimulants).
    Strength of evidence: 1 star

  • For psychostimulant users, enhancing residential treatment with behaviour therapy or CBT improves outcome.
    Strength of evidence: 1 star

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Self help

Key points:
  • The effectiveness of 12-step (self-help) approaches is equivocal.
    Strength of evidence: ?

  • Participation in self-help group meetings (not just attendance) is important in determining outcomes.
    Strength of evidence: 1 star

  • Attendance at self-help group meetings should not be mandated.
    Strength of evidence: ?