Cochrane · systematic review · CD001088
Psychosocial interventions for people with both severe mental illness and substance misuse
Hunt, GE, Siegfried, N, Morley, K, et al. · Cochrane Database of Systematic Reviews · 2019 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
63
current version
GRADE rated
32
No studies
29
Included studies
NR
No studies 29 · 46%Ungraded 2 · 3.2%Very low 16 · 25.4%Low 14 · 22.2%Moderate 2 · 3.2%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Show all 2 versionsIntegrated models of care compared to standard care for both severe mental illness and substance misuse
Population: people with both severe mental illness and substance misuse
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Leaving the study early: Lost to treatment Integrated models of care vs standard care | RR 1.09 [0.82, 1.45] | 3 studies · 603 participants | Low Downgraded: risk of bias, imprecision |
Adverse event: Death Integrated models of care vs standard care | RR 1.18 [0.39, 3.57] | 2 studies · 421 participants | Low Downgraded: risk of bias, imprecision |
Substance use: any change ‐ Alcohol use (not in remission) Integrated models of care vs standard care | RR 1.15 [0.84, 1.56] | 1 study · 143 participants | Low Downgraded: risk of bias, imprecision |
Substance use: any change ‐ Drug use (not in remission) Integrated models of care vs standard care | RR 0.89 [0.63, 1.25] | 1 study · 85 participants | Low Downgraded: risk of bias, imprecision |
Mental state Integrated models of care vs standard care | no estimate extracted | 0 studies · 3 participants | Ungraded |
Global state: average score(GAF scale of 1 ‐ 100) Integrated models of care vs standard care | no estimate extracted | 1 study · 171 participants | Low Downgraded: risk of bias, imprecision |
Quality of life/life satisfaction: avearge score (General life satisfaction) Quality of Life Interview section, scale of 1 to 7 Integrated models of care vs standard care | no estimate extracted | 2 studies · 372 participants | Moderate Downgraded: risk of bias |
Non‐integrated models of care ‐ Assertive community treatment only/Intensive case management/Specialised case management services versus standard care for both severe mental illness and substance misuse
Population: people with both severe mental illness and substance misuse
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Leaving the study early: Lost to treatment Non‐integrated models of care ‐ Assertive community treatment only/Intensive case management/Specialised case management services vs standard care | RR 1.21 [0.73, 1.99] | 3 studies · 134 participants | Very low Downgraded: risk of bias, imprecision |
Adverse event: Death ‐ not measured Non‐integrated models of care ‐ Assertive community treatment only/Intensive case management/Specialised case management services vs standard care | no estimate extracted | NR | No studies |
Substance use: Alcohol ‐ average score (C‐DIS‐R computer program for Diagnostic Interview Schedule: average score) Non‐integrated models of care ‐ Assertive community treatment only/Intensive case management/Specialised case management services vs standard care | no estimate extracted | NR | No studies |
Substance use: Drug ‐ average score C‐DIS‐R computer program for Diagnostic Interview Schedule: average score Non‐integrated models of care ‐ Assertive community treatment only/Intensive case management/Specialised case management services vs standard care | no estimate extracted | NR | No studies |
Mental state: Average score Schizophrenia symptoms on C‐DIS‐R computer program for Diagnostic Interview Schedule: average score Non‐integrated models of care ‐ Assertive community treatment only/Intensive case management/Specialised case management services vs standard care | no estimate extracted | NR | No studies |
Global State: Average score (Role Functioning Scale, high = better functioning) Non‐integrated models of care ‐ Assertive community treatment only/Intensive case management/Specialised case management services vs standard care | no estimate extracted | 1 study · 50 participants | Very low Downgraded: risk of bias, imprecision |
Quality of life/life satisfaction: (Quality of Life Interview section, scale of 1 to 7) Non‐integrated models of care ‐ Assertive community treatment only/Intensive case management/Specialised case management services vs standard care | no estimate extracted | NR | No studies |
Cognitive behavioural therapy versus standard care for both severe mental illness and substance misuse
Population: people with both severe mental illness and substance misuse
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Leaving the study early: Lost to treatment Cognitive behavioural therapy vs standard care | RR 1.12 [0.44, 2.86] | 2 studies · 152 participants | Low Downgraded: risk of bias, imprecision |
Adverse event: Death Cognitive behavioural therapy vs standard care | no estimate extracted | NR | No studies |
Substance use: Alcohol Cognitive behavioural therapy vs standard care | no estimate extracted | NR | No studies |
Substance use: Drug (Cannabis) Percentage of participants who used cannabis in last 4 weeks Cognitive behavioural therapy vs standard care | RR 1.3 [0.79, 2.15] | 1 study · 47 participants | Very low Downgraded: risk of bias, imprecision |
Mental state: average score (Insight scale) Cognitive behavioural therapy vs standard care | no estimate extracted | 1 study · 105 participants | Low Downgraded: risk of bias, imprecision |
Social functioning: Average score* The Social and Occupational Functioning Scale (SOFAS): scale of 1 to 100 Cognitive behavioural therapy vs standard care | no estimate extracted | 1 study · 47 participants | Very low Downgraded: risk of bias, imprecision |
Quality of life/ life satisfaction Cognitive behavioural therapy vs standard care | no estimate extracted | NR | No studies |
Contingency management versus standard care for both severe mental illness and substance misuse
Population: people with both severe mental illness and substance misuse
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Leaving the study early: Lost to treatment Contingency management vs standard care | RR 1.55 [1.13, 2.11] | 2 studies · 255 participants | Moderate Downgraded: risk of bias, imprecision |
Adverse event: Death ‐ not measured Contingency management vs standard care | no estimate extracted | NR | No studies |
Substance use: Alcohol Contingency management vs standard care | no estimate extracted | NR | No studies |
Substance use: Drug (non‐alcohol) Number with stimulant‐positive urine test Contingency management vs standard care | RR 0.83 [0.65, 1.06] | 1 study · 176 participants | Low Downgraded: risk of bias |
Service use*: Number hospitalised Contingency management vs standard care | RR 0.21 [0.05, 0.93] | 1 study · 176 participants | Low Downgraded: risk of bias |
Global state Contingency management vs standard care | no estimate extracted | NR | No studies |
Quality of life/life satisfaction Contingency management vs standard care | no estimate extracted | NR | No studies |
Motivational interviewing versus standard care for both severe mental illness and substance misuse
Population: people with both severe mental illness and substance misuse
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Lost to treatment Motivational interviewing vs standard care | RR 1.71 [0.63, 4.64] | 1 study · 62 participants | Very low Downgraded: risk of bias, imprecision |
Death Motivational interviewing vs standard care | RR 1.04 [0.07, 15.73] | 1 study · 49 participants | Very low Downgraded: risk of bias, imprecision |
Alcohol use Not abstaining from alcohol Motivational interviewing vs standard care | RR 0.36 [0.17, 0.75] | 1 study · 28 participants | Very low Downgraded: risk of bias, imprecision |
Drug (non‐alcohol) use Polydrug consumption levels measured by Opiate Treatment Index (OT) Motivational interviewing vs standard care | no estimate extracted | 1 study · 89 participants | Very low Downgraded: risk of bias, imprecision |
Mental state Symptom Checklist 90‐revised ‐ General Severity Index: Scale 0 to 4: Average score Motivational interviewing vs standard care | no estimate extracted | 1 study · 30 participants | Very low Downgraded: risk of bias, imprecision |
Global Assessment of Functioning GAF scale of 1‐ 100 Motivational interviewing vs standard care | no estimate extracted | 1 study · 54 participants | Very low Downgraded: risk of bias, imprecision |
Quality of life/life satisfaction ‐ not measured Motivational interviewing vs standard care | no estimate extracted | NR | No studies |
Skills training versus standard care for both severe mental illness and substance misuse
Population: people with both severe mental illness and substance misuse
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Leaving the study early: Lost to treatment Skills training vs standard care | RR 1.42 [0.2, 10.1] | 3 studies · 122 participants | Very low Downgraded: risk of bias, imprecision |
Adverse event: Death Skills training vs standard care | RR 0.15 | 1 study · 121 participants | Low Downgraded: risk of bias |
Substance use: Alcohol (C‐DIS‐R average score) Skills training vs standard care | no estimate extracted | NR | No studies |
Substance use: Drug (non‐alcohol) (C‐DIS‐R average score) Skills training vs standard care | no estimate extracted | NR | No studies |
Mental state Skills training vs standard care | no estimate extracted | NR | No studies |
Social functioning*: Role Functioning Scale: scale 1 to 7 Skills training vs standard care | no estimate extracted | 1 study · 47 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Quality of life/life satisfaction ‐ not measured Skills training vs standard care | no estimate extracted | NR | No studies |
Cognitive behavioural therapy + motivational interviewing versus standard care for both severe mental illness and substance misuse
Population: people with both severe mental illness and substance misuse
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Leaving the study early: Lost to treatment Cognitive behavioural therapy + motivational interviewing vs standard care | RR 0.99 [0.62, 1.59] | 1 study · 327 participants | Low Downgraded: risk of bias, imprecision |
Adverse event: Death Cognitive behavioural therapy + motivational interviewing vs standard care | RR 0.6 [0.2, 1.76] | 4 studies · 603 participants | Low Downgraded: risk of bias, imprecision |
Substance use: Alcohol ( Estimated daily consumption in previous month) Cognitive behavioural therapy + motivational interviewing vs standard care | no estimate extracted | 1 study · 46 participants | Ungraded |
Substance use: Drug (non‐alcohol) use (Average number of different drugs used during the past month measured by the Opiate Treatment Index) Cognitive behavioural therapy + motivational interviewing vs standard care | no estimate extracted | 1 study · 119 participants | Low Downgraded: risk of bias, imprecision |
Relapse:* Relapse at 3 months after 9 months of treatment Cognitive behavioural therapy + motivational interviewing vs standard care | RR 0.5 [0.24, 1.04] | 1 study · 36 participants | Very low Downgraded: risk of bias, imprecision |
Global State: GAF scale of 1‐ 100 Cognitive behavioural therapy + motivational interviewing vs standard care | no estimate extracted | 4 studies · 445 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Quality of life / life satisfaction: Brief Quality of Life Scale Cognitive behavioural therapy + motivational interviewing vs standard care | no estimate extracted | 1 study · 110 participants | Low Downgraded: risk of bias, imprecision |
Cognitive behavioural therapy + psychosocial rehabilitation versus standard care for both severe mental illness and substance misuse
Population: people with both severe mental illness and substance misuse
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Leavint the study early: Loss to Treatment Cognitive behavioural therapy + psychosocial rehabilitation vs standard care | no estimate extracted | 1 study · 61 participants | Very low Downgraded: risk of bias, imprecision |
Adverse event: Death ‐ not measured Cognitive behavioural therapy + psychosocial rehabilitation vs standard care | no estimate extracted | NR | No studies |
Substance use: Alcohol ‐ not measured Cognitive behavioural therapy + psychosocial rehabilitation vs standard care | no estimate extracted | NR | No studies |
Substance use: Drug (non‐alcohol) ‐ not measured Cognitive behavioural therapy + psychosocial rehabilitation vs standard care | no estimate extracted | NR | No studies |
Mental state ‐ not measured Cognitive behavioural therapy + psychosocial rehabilitation vs standard care | no estimate extracted | NR | No studies |
Global State‐ not measured Cognitive behavioural therapy + psychosocial rehabilitation vs standard care | no estimate extracted | NR | No studies |
Quality of life/life satisfaction ‐ not measured Cognitive behavioural therapy + psychosocial rehabilitation vs standard care | no estimate extracted | NR | No studies |
Cognitive behavioural therapy + intensive case management versus standard care for both severe mental illness and substance misuse
Population: people with both severe mental illness and substance misuse
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Leaving the study early: Loss to Treatment Cognitive behavioural therapy + intensive case management vs standard care | no estimate extracted | 1 study · 59 participants | Very low Downgraded: risk of bias |
Adverse event: Death Cognitive behavioural therapy + intensive case management vs standard care | no estimate extracted | NR | No studies |
Substance use: alcohol ‐ not measured Cognitive behavioural therapy + intensive case management vs standard care | no estimate extracted | NR | No studies |
Substance use: Drug (non‐alcohol) ‐ not measured Cognitive behavioural therapy + intensive case management vs standard care | no estimate extracted | NR | No studies |
Mental state ‐ not measured Cognitive behavioural therapy + intensive case management vs standard care | no estimate extracted | NR | No studies |
Global State ‐ not measured Cognitive behavioural therapy + intensive case management vs standard care | no estimate extracted | NR | No studies |
Quality of life/life satisfaction ‐ not measured Cognitive behavioural therapy + intensive case management vs standard care | no estimate extracted | NR | No studies |