RESUMEN
BACKGROUND: Stepped-care is a commonly recommended and implemented care model across health care domains, including substance use. Despite their presumed efficient allocation of treatment resources, a current and robust evidence synthesis is needed on the efficacy, effectiveness and cost-effectiveness of stepped-care for substance use. METHODS: This systematic review analyzed articles describing evaluations of stepped-care models that measured the use of acutely psychoactive substances (i.e., alcohol, cannabis, hallucinogens, inhalants, opioids, sedatives, hypnotics, anxiolytics, and stimulants) as a primary or secondary outcome, in participants over 18 years old. The analysis investigated model and participant characteristics associated with treatment outcomes. RESULTS: The study team conducted a search of five databases of literature (PsychINFO, MEDLINE, Embase, Cochrane Library and Scopus) published between January 1, 2010, and November 1, 2020. The search yielded 1051 unique articles, 19 of which were included in the analysis. The studies had considerable variability in sample sizes (n = 18-2310), time to follow-up (4.5 months to 3 years), and retention rates (35.1-100 %). Studies examined outcomes for either alcohol alone (n = 9), alcohol and other drug use (n = 9), or drug use alone (n = 1). Most studies (n = 13;) were rated as good quality. Three (15.8 %) were rated as fair and three (15.8 %) were rated as poor quality. The evidence regarding the efficacy, effectiveness and cost-effectiveness of stepped-care approaches is limited, but four of seven studies found that adaptive-care interventions delivered in the context of other systemic interventions produced greater benefit than control conditions in relation to at least one alcohol-related outcome. We have insufficient evidence to determine whether the modes or intensity of interventions included in the models, or decision rules used to step people up or down to differing levels of care, have an impact on outcome. CONCLUSION: Heterogeneity between studies with regard to model and evaluation design limited the degree to which the analysis could draw robust conclusions. Sample recruitment and statistical power are particular challenges, and the field needs more innovative evaluation designs to assess the efficacy, effectiveness, and cost-effectiveness of stepped-care models.
Asunto(s)
Trastornos Relacionados con Sustancias , Humanos , Adolescente , Análisis Costo-Beneficio , Trastornos Relacionados con Sustancias/terapia , Resultado del TratamientoRESUMEN
Employee alcohol and other drug use can negatively impact the workplace, resulting in absenteeism, reduced productivity, high turnover, and worksite safety issues. As the workplace can influence employee substance use through environmental and cultural factors, it also presents a key opportunity to deliver interventions, particularly to employees who may not otherwise seek help. This is a systematic review of workplace-based interventions for the prevention and treatment of problematic substance use. Five databases were searched for efficacy, effectiveness and/or cost-effectiveness studies and reviews published since 2010 that measured use of psychoactive substances (i.e., alcohol, cannabis, hallucinogens, inhalants, opioids, sedatives, hypnotics, anxiolytics, and stimulants) as a primary or secondary outcome, in employees aged over 18. Thirty-nine articles were identified, 28 describing primary research and 11 reviews, most of which focused solely on alcohol use. Heterogeneity between studies with respect to intervention and evaluation design limited the degree to which findings could be synthesized, however, there is some promising evidence for workplace-based universal health promotion interventions, targeted brief interventions, and universal substance use screening. The few studies that examined implementation in the workplace revealed specific barriers including lack of engagement with e-health interventions, heavy use and reluctance to seek help amongst male employees, and confidentiality concerns. Tailoring interventions to each workplace, and ease of implementation and employee engagement emerged as facilitators. Further high-quality research is needed to examine the effectiveness of workplace substance use testing, Employee Assistance Programs, and strategies targeting the use of substances other than alcohol in the workplace. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=227598, PROSPERO [CRD42021227598].
Asunto(s)
Cannabis , Trastornos Relacionados con Sustancias , Masculino , Humanos , Adolescente , Adulto , Lugar de Trabajo , Análisis Costo-Beneficio , Trastornos Relacionados con Sustancias/prevención & control , Compromiso Laboral , EtanolRESUMEN
OBJECTIVES: The primary aim is to evaluate the feasibility of a newly developed, neuroscience-based, alcohol and other drug (AOD) use prevention programme, 'The Illicit Project', in Australian older adolescents. The secondary aim is to investigate the impact of the programme on students' drug literacy levels (a combination of knowledge, attitudes and skills). DESIGN: A pilot study examining the feasibility of The Illicit Project in Australian schools was conducted. PARTICIPANTS: Students aged 15-19 years from two secondary schools and a youth centre and 11 teachers and health professionals from various organisations in Sydney were recruited. INTERVENTION: The intervention consisted of three 90 min workshops delivered by trained facilitators within a month. PRIMARY AND SECONDARY MEASURES: Students completed a drug literacy questionnaire before and after intervention. All participants (students, teachers and health professionals) completed an evaluation questionnaire postprogramme delivery. A paired-sample t-test and descriptive analytics were performed. RESULTS: Students (n=169) demonstrated a significant increase in drug literacy levels from preintervention to postintervention (t(169) = -13.22, p<0.0001). Of students evaluating the programme (n=252), over threequarters agreed that The Illicit Project was good or very good (76%), that the neuroscience content was interesting (76%) and relevant (81%), and that they plan to apply the concepts learnt to their own lives (80%). In addition, all teachers and health professionals (n=11) agreed that the programme was feasible and valid for schools and perceived the programme to be effective in reducing the harms and use of AOD. CONCLUSIONS: There is evidence to suggest that The Illicit Project is credible and feasible in the school environment and there are preliminary data to suggest it may help to improve drug literacy levels in young people. A large-scale evaluation trial of the intervention will be conducted to determine the programme's effectiveness in minimising the harms of AOD in older adolescents.
Asunto(s)
Reducción del Daño , Alfabetización en Salud/organización & administración , Promoción de la Salud/organización & administración , Servicios de Salud Escolar/organización & administración , Adolescente , Femenino , Educación en Salud , Humanos , Masculino , Proyectos Piloto , Evaluación de Programas y Proyectos de Salud , Trastornos Relacionados con Sustancias/prevención & control , Adulto JovenRESUMEN
Older adolescence represents a critical period of brain development whereby the prefrontal cortex, responsible for higher level thinking and emotional regulation, is under construction. During this period, the brain is wired to underestimate risk and overestimate pleasure, which primes young people towards risky, pleasure-oriented experiences. Substance use during this time can hinder brain maturation and lead to development related disorders. However, young people are the most likely to drink at risky quantities, use cannabis, MDMA and cocaine in the previous 12 months than any other age group. Despite this, there are no validated, age-appropriate prevention programs targeting school leavers, which leaves a group of young people to navigate a landscape where drug use is the most common, without formal support. Drug and alcohol prevention programs should be developed for this age group that combine features of universal prevention programs and targeted intervention programs to support the wider range of drug use behaviours relevant to this older audience. This article outlines potential evidence-based strategies that programs could focus on in the future.