Predictors of cocaine use disorder treatment outcomes: a systematic review
Por:
Palazón-Llecha, A, Caparrós, B, Trujols, J, Duran-Sindreu, S, Batlle, F, Madre, M, Mallorquí-Bagué, N
Publicada:
8 may 2024
Resumen:
Background 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.Methods 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).Results 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.Conclusion 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.Systematic review registration 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 Fundaci & oacute; Privada Hospital de la Santa Creu i Sant Pau (Pla d'acci & oacute; social 2020).
Filiaciones:
Palazón-Llecha, A:
Hosp Santa Creu & Sant Pau, Dept Psychiat, Addict Behav Unit, St Antoni Maria Claret 167,Pavello 20,Planta 2, Barcelona 08025, Spain
Inst Recerca St Pau IR St Pau, Mental Hlth Res Grp, St Quinti 77-79, Barcelona 08041, Spain
Univ Girona, Dept Psychol, Edifici Seminari,Campus Barri Vell,St Domenech 9, Girona 17004, Spain
Caparrós, B:
Univ Girona, Dept Psychol, Edifici Seminari,Campus Barri Vell,St Domenech 9, Girona 17004, Spain
Trujols, J:
Hosp Santa Creu & Sant Pau, Dept Psychiat, Addict Behav Unit, St Antoni Maria Claret 167,Pavello 20,Planta 2, Barcelona 08025, Spain
Inst Recerca St Pau IR St Pau, Mental Hlth Res Grp, St Quinti 77-79, Barcelona 08041, Spain
Inst Salud Carlos III ISCIII, Ctr Invest Biomed Red Salud Mental CIBERSAM, Monforte de Lemos 3-5,Pavellon 11,Planta 0, Madrid 28029, Spain
Duran-Sindreu, S:
Hosp Santa Creu & Sant Pau, Dept Psychiat, Addict Behav Unit, St Antoni Maria Claret 167,Pavello 20,Planta 2, Barcelona 08025, Spain
Inst Recerca St Pau IR St Pau, Mental Hlth Res Grp, St Quinti 77-79, Barcelona 08041, Spain
Inst Salud Carlos III ISCIII, Ctr Invest Biomed Red Salud Mental CIBERSAM, Monforte de Lemos 3-5,Pavellon 11,Planta 0, Madrid 28029, Spain
Batlle, F:
Hosp Santa Creu & Sant Pau, Dept Psychiat, Addict Behav Unit, St Antoni Maria Claret 167,Pavello 20,Planta 2, Barcelona 08025, Spain
Inst Recerca St Pau IR St Pau, Mental Hlth Res Grp, St Quinti 77-79, Barcelona 08041, Spain
Madre, M:
Hosp Santa Creu & Sant Pau, Dept Psychiat, Addict Behav Unit, St Antoni Maria Claret 167,Pavello 20,Planta 2, Barcelona 08025, Spain
Inst Recerca St Pau IR St Pau, Mental Hlth Res Grp, St Quinti 77-79, Barcelona 08041, Spain
Mallorquí-Bagué, N:
Hosp Santa Creu & Sant Pau, Dept Psychiat, Addict Behav Unit, St Antoni Maria Claret 167,Pavello 20,Planta 2, Barcelona 08025, Spain
Inst Recerca St Pau IR St Pau, Mental Hlth Res Grp, St Quinti 77-79, Barcelona 08041, Spain
Univ Girona, Dept Psychol, Edifici Seminari,Campus Barri Vell,St Domenech 9, Girona 17004, Spain
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