PDF(Pubmed)
Abstract：
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.
CONCLUSIONS: 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.
BACKGROUND: 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 Fundació Privada Hospital de la Santa Creu i Sant Pau (Pla d\'acció social 2020).
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.
CONCLUSIONS: 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.
BACKGROUND: 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 Fundació Privada Hospital de la Santa Creu i Sant Pau (Pla d\'acció social 2020).
摘要：
背景：心理社会方法是可卡因依赖的一线治疗方法，尽管他们仍然有很高的辍学率和复发率。因此，迫切需要了解哪些变量会影响治疗结果，以改善当前的治疗方法并防止退出和复发率。这项研究的目的是探索CUD治疗保留和禁欲的预测因素。
方法：本系统评价是根据系统评价和荟萃分析（PRISMA）的首选报告项目进行的。我们搜索了三个数据库——PubMed,PsychINFO和WebofScience-从数据库开始到2023年4月1日以英语和西班牙语发表的随机临床试验（RCT）。我们选择了所有符合纳入标准的研究(≥18岁的成年人，门诊治疗，CUD作为主要成瘾，并且没有严重的精神疾病），以获取将可卡因禁欲和治疗保留作为主要结果变量的叙述性综合数据。数据提取完成后,使用Cochrane偏倚风险工具对随机试验的偏倚风险进行评估(RoB-2).
结果：共筛选了566项研究，and,其中，在合成中包括32个RCT。年龄更小,多年的可卡因使用，和渴望水平是复发和治疗退出的重要预测因素。戒断症状减少，更多的基线禁欲，更大的治疗参与度，更高的自我效能感是禁欲持续时间更长的预测因素。由于数据相互矛盾，冲动性作为CUD预测指标的作用尚不清楚，尽管证据通常表明，更高的冲动评分可以预测更严重的成瘾和戒断症状，并提前停止治疗。
结论：目前的证据表明哪些变量对治疗结果有直接影响，包括研究良好的可卡因使用相关变量。然而,其他变量，比如遗传标记，似乎对治疗结果有很大影响,需要进一步研究.
背景：本系统综述已在PROSPERO注册（ID：CRD42021271847）。这项研究由西班牙科学部资助，创新与大学,卡洛斯三世研究所（ISCIII）（FISPI20/00929）和FEDER基金和圣克鲁伊圣保大学私人医院（2020年社会计划）。
方法：本系统评价是根据系统评价和荟萃分析（PRISMA）的首选报告项目进行的。我们搜索了三个数据库——PubMed,PsychINFO和WebofScience-从数据库开始到2023年4月1日以英语和西班牙语发表的随机临床试验（RCT）。我们选择了所有符合纳入标准的研究(≥18岁的成年人，门诊治疗，CUD作为主要成瘾，并且没有严重的精神疾病），以获取将可卡因禁欲和治疗保留作为主要结果变量的叙述性综合数据。数据提取完成后,使用Cochrane偏倚风险工具对随机试验的偏倚风险进行评估(RoB-2).
结果：共筛选了566项研究，and,其中，在合成中包括32个RCT。年龄更小,多年的可卡因使用，和渴望水平是复发和治疗退出的重要预测因素。戒断症状减少，更多的基线禁欲，更大的治疗参与度，更高的自我效能感是禁欲持续时间更长的预测因素。由于数据相互矛盾，冲动性作为CUD预测指标的作用尚不清楚，尽管证据通常表明，更高的冲动评分可以预测更严重的成瘾和戒断症状，并提前停止治疗。
结论：目前的证据表明哪些变量对治疗结果有直接影响，包括研究良好的可卡因使用相关变量。然而,其他变量，比如遗传标记，似乎对治疗结果有很大影响,需要进一步研究.
背景：本系统综述已在PROSPERO注册（ID：CRD42021271847）。这项研究由西班牙科学部资助，创新与大学,卡洛斯三世研究所（ISCIII）（FISPI20/00929）和FEDER基金和圣克鲁伊圣保大学私人医院（2020年社会计划）。
