Effectiveness of Psychosocial Interventions for Adults With Substance Use Disorder That Have a Co-Occurring Common Mental Health Disorder: An Umbrella Review.

ISSUES: People with substance use disorders can have co-occurring mental disorders.

APPROACH: An umbrella review was conducted to identify evidence of the effectiveness of psychosocial interventions for adults (aged 18+) with substance use disorders and co-occurring common mental health disorders. Systematic reviews were sought of randomised controlled trials of psychosocial interventions compared to each other, treatment as usual or wait-list. Five databases were systematically searched in February 2024. Data, including critical appraisal (Joanna Briggs Institute Checklist), were extracted by one reviewer and checked by another. Data were discussed in a narrative review.

KEY FINDINGS: Of 5420 unique records, 28 systematic reviews were included. The methodological quality of the reviews was good. Most reviews focused on depression, anxiety or post-traumatic stress disorder. There was much heterogeneity between reviews, and randomised controlled trials within reviews. Most of the interventions and many of the treatment-as-usual comparators resulted in significant improvement in substance use and mental health disorders. Results suggested integrated (co-ordinated) treatment for co-occurring diagnosis patients was better than treating one condition alone, and usually better than parallel uncoordinated services. There was limited evidence assessing sequential treatment, but this suggested similar effectiveness to integrated treatment.

IMPLICATIONS: Implications for current practise could not be recommended due to heterogeneity. Improvement shown by all types of psychosocial intervention including active comparators precluded recommending one type of intervention over another.

CONCLUSION

Further research is needed comparing integrated with parallel or sequential treatment, with follow-up of 6 months or longer, and sample size large enough to encompass dropout.