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[null,"NICE Guidance"]
[null,"Source:","Population:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Behaviour change: digital and mobile health interventions. NG183. London: NICE; 2020.\nAvailable here.\n\n\n","Everyone, including Young People under 16 (and their families or 16 carers)\n• Pre-existing health conditions:\nOverweight/ obesity\nHypertension and cardiovascular disease\nRespiratory diseases\nCancers for which managing smoking may improve health outcomes\nMental health conditions\nSpecific consideration will also be given to people with learning disabilities and people with neurodevelopmental disorders such as autism.","This guideline covers interventions that use a digital or mobile platform to help people eat more healthily, become more active, stop smoking, reduce their alcohol intake or practise safer sex. The interventions include those delivered by text message, apps, wearable devices or the internet. The guideline only includes those that are delivered by the technology itself and not by healthcare professionals using technology to deliver interventions.\n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n1.1 Developing digital and mobile health interventions\n1.2 Commissioning digital and mobile health interventions\n1.3 Using digital and mobile health interventions\n1.4 Interventions for diet and physical activity\n1.5 Interventions for smoking\n1.6 Interventions for alcohol use (Based on Evidence Review B: alcohol)\n1.7 Interventions for unsafe sexual behaviour\n\nThe following recommendations for further research were also identified in evidence review B on alcohol:\n1. How can providers and healthcare professionals identify groups that do not initially engage, or do not stay engaged, with digital and mobile health behaviour change interventions?\n2. What components and characteristics of digital and mobile health behaviour change interventions are most effective, separately and in combination, to achieve behaviour change?\n3. What is the effectiveness and cost effectiveness of digital and mobile health behaviour change interventions in low socioeconomic and other underserved groups?\n4. Are digital and mobile health behaviour change interventions as effective as face-to-face, standard care, or combination approaches for some populations?\n5. What are the harms and adverse effects associated with different digital and mobile health behaviour change interventions?"]
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[null,"National Institute for Health and Care Excellence. Alcohol interventions in secondary and further education. NG135. London: NICE; 2019. \nAvailable here.\n","• CYP (11 to 18years) in full time education.\n• YP (18 to 25 years) with an Education, health and care (EHC) plan.\n• CYP (11 to 18years) in full time education considered ‘at risk’.\n• YP (18 to 25 years) EHC plan considered ‘at risk’.","This guideline covers interventions in secondary and further education to prevent and reduce alcohol use among children and young people aged 11 up to and including 18. It also covers people aged 11 to 25 with special educational needs or disabilities in full-time education. It will also be relevant to children aged 11 in year 6 of primary school.\n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n1.1 Planning alcohol education\n1.2 Delivering universal alcohol education (Evidence Review A: Universal interventions)\n1.3 Targeted interventions (Evidence review B: Targeted interventions)\n\nThe following recommendations for further research were also identified in Evidence review A and B:\n1. What components of alcohol education delivery contribute to its effectiveness for children and young people aged 11 to 18 in full-time education, and those with special educational needs and disabilities (SEND) up to the age of 25? (Evidence review A: universal interventions)\n2. How effective and cost effective are individual, compared with group, education-based interventions for children and young people aged 11 to 18 in full-time education who are thought to be vulnerable to alcohol misuse? (Evidence review B: targeted interventions)\n3. How effective and cost effective are universal, education-based alcohol interventions for children and young people aged 11 to 25 with SEND? (Evidence review A: universal interventions)\n4. How effective and cost effective are education-based alcohol interventions targeted at children and young people aged 11 to 25 with SEND who are thought to be vulnerable to alcohol misuse? (Evidence review B: targeted interventions)\n5. How effective are education-based alcohol prevention interventions (universal or targeted) for children and young people aged 11 to 25 with SEND in full-time education? (Evidence review A: universal interventions and Evidence review B: targeted interventions)\n6. What methods and techniques help secondary schools and providers to effectively engage with parents and carers as part of a whole-school approach to promote and support alcohol education? (Evidence review A: universal interventions)\n"]
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[null,"National Institute for Health and Care Excellence. Behaviour change: individual approaches. PH49. London: NICE; 2014. \nAvailable here.\n","Everyone aged 16 years and older","This guideline covers changing health-damaging behaviours among people aged 16 and over using interventions such as goals and planning, feedback and monitoring, and social support. It aims to help tackle a range of behaviours including alcohol misuse, poor eating patterns, lack of physical activity, unsafe sexual behaviour and smoking.\n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n1. Develop a local behaviour change policy and strategy\n2. Ensure organisation policies, strategies, resources and training all support behaviour change\n3. Commission interventions from services willing to share intervention details and data\n4. Commission high quality, effective behaviour change interventions\n5. Plan behaviour change interventions and programmes taking local needs into account\n6. Develop acceptable, practical and sustainable behaviour change interventions and programmes\n7. Use proven behaviour change techniques when designing interventions (Evidence review1 and Evidence review2)\n8. Ensure interventions meet individual needs\n9. Deliver very brief, brief, extended brief and high intensity behaviour change interventions and programmes\n10. Ensure behaviour change is maintained for at least a year (Evidence review1 and Evidence review2)\n11. Commission training for all staff involved in helping to change people's behaviour\n12. Provide training for behaviour change practitioners\n13. Provide training for health and social care practitioners\n14. Assess behaviour change practitioners and provide feedback\n15. Monitor behaviour change interventions\n16. Evaluate behaviour change interventions\n17. National support for behaviour change interventions and programmes\n\nEvidence review1 did not identify any recommendations for further research. Evidence review 2 made the following recommendation for further research:\n5.7 How do behaviour change techniques lead to change? What are the best methods of testing the relationship between the theories that describe change processes and the effectiveness of interventions in practice?"]
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[null,"National Institute for Health and Care Excellence. Nalmefene for reducing alcohol consumption in people with alcohol dependence. TA325. London: NICE; 2014.\nAvailable here.  \n\n","Adults with mild alcohol dependence (as defined in CG115) who have a high drinking risk level (≥ 60 g/day of pure alcohol for men and ≥ 40 g/day for women) without physical withdrawal symptoms and who do not require immediate detoxification","NICE currently make the following recommendation regarding use of Nalmefene for reducing alcohol consumption in people with alcohol dependence (the highlighted recommendation is relevant to the scope of this topic evidence map):\n\n1.1 Nalmefene is recommended within its marketing authorisation, as an option for reducing alcohol consumption, for people with alcohol dependence (Evidence review): \n• Who have a high drinking risk level (defined as alcohol consumption of more than 60 g per day for men and more than 40g per day for women, according to the World Health Organization's drinking risk levels) without physical withdrawal symptoms and;\n• Who do not require immediate detoxification.\n\nThe marketing authorisation states that nalmefene should:\n• Only be prescribed in conjunction with continuous psychosocial support focused on treatment adherence and reducing alcohol consumption and; \n• Be initiated only in patients who continue to have a high drinking risk level 2 weeks after initial assessment.\n\nMarch 2018: NICE reviewed the evidence for TA325. They found found nothing new that affects the recommendations in this guidance. This guidance will be reviewed if there is new evidence that is likely to affect the recommendations."]
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[null,"National Institute for Health and Care Excellence. Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence. CG115. London: NICE; 2011\nAvailable here.\n\n","Adults (>18 years) or young people (10 to 17 years of age) with a diagnosis of alcohol dependence or meeting criteria for harmful alcohol use (30 to 50 units of alcohol per week)","This guideline covers identifying, assessing and managing alcohol-use disorders (harmful drinking and alcohol dependence) in adults and young people aged 10-17 years. It aims to reduce harms (such as liver disease, heart problems, depression and anxiety) from alcohol by improving assessment and setting goals for reducing alcohol consumption. \n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n• Principles of care\n• Identification and assessment \n• Interventions for alcohol misuse (Evidence review 2011)\n\nThe following recommendations for further research were also identified in Evidence reviews underpinning this guidance:\n1 Is contingency management effective in reducing alcohol consumption in people who misuse alcohol compared with standard care?\n2 What methods are most effective for assessing and diagnosing the presence and severity of alcohol misuse in children and young people?\n3 Is acupuncture effective in reducing alcohol consumption compared with standard care?\n4. For which service users who are moderately and severely dependent on alcohol is an assertive community treatment model a clinically and cost-effective intervention compared with standard care?\n5. For people with moderate and severe alcohol dependence who have significant comorbid problems, is an intensive residential rehabilitation programme clinically and cost effective when compared with intensive community-based care?\n6 For people with alcohol dependence, which medication is most likely to improve adherence and thereby promote abstinence and prevent relapse?\n\nOctober 2022: NICE updated the recommendation about behavioural couples therapy to clarify that this is not suitable in cases of domestic abuse and to add a cross reference to the NICE technology appraisal guidance on nalmefene. They also updated information about off-label prescribing, and added cross references to legislation on controlled drugs and driving, to MHRA advice on addiction to benzodiazepines and codeine, and to NICE's guidelines on smoking, on antisocial personality disorder and on coexisting mental illness and substance misuse community health and social care services.\nJuly 2019: NICE have found no new evidence that affects the recommendations."]
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[null,"National Institute for Health and Care Excellence. Coexisting severe mental illness (psychosis) and substance misuse: assessment and management in healthcare settings. CG120. London: NICE; 2011. \nAvailable here.\n","People aged 14 years and over with coexisting severe mental illness (psychosis) and substance misuse","This guideline covers assessing and managing people aged 14 years and over with coexisting severe mental illness (psychosis) and substance misuse. It aims to help healthcare professionals guide people with psychosis with coexisting substance misuse to stabilise, reduce or stop their substance misuse, to improve treatment adherence and outcomes, and to enhance their lives. \n\nThe guideline includes the following recommendations. All the recommendations are relevant to the scope of this topic evidence map. The recommendations are supported by evidence from the underpinning Evidence Review 2011. \n• Principles of care\n• Recognising psychosis with coexisting substance misuse\n• Primary care\n• Secondary care mental health services\n• Substance misuse services\n• Inpatient mental health services and staffed accommodation\n• Specific issues for young people with psychosis and coexisting substance misuse\n\nThe following recommendations for further research were also identified in Evidence reviews underpinning this guidance:\n1. What are the prevalence, risk and protective factors, and course of illness for different combinations of psychosis and coexisting substance misuse (for example, schizophrenia and cannabis misuse or bipolar disorder and alcohol misuse)?\n2. What risk factors predict the onset of substance misuse in young people with psychosis?\n3. Are psychosocial interventions clinically and cost effective when compared with standard care for people with psychosis and coexisting substance misuse?\n4. Are environmental interventions clinically and cost effective when compared with standard care for people with psychosis and coexisting substance misuse?\n5. Is clozapine clinically and cost effective when compared with other pharmacological interventions for people with psychosis and coexisting substance misuse?\n\nNovember 2016: NICE reviewed the evidence and found no new evidence that affects the current recommendations in this guideline."]
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[null,"National Institute for Health and Care Excellence. Alcohol-use disorders: diagnosis and management of physical complications. CG100. London: NICE; 2010. \nAvailable here. \n","People aged 10 years and over with alcohol-use disorders","This guideline covers care for adults and young people (aged 10 years and older) with physical health problems that are completely or partly caused by an alcohol-use disorder. It aims to improve the health of people with alcohol-use disorders by providing recommendations on managing acute alcohol withdrawal and treating alcohol-related conditions. \n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n• Acute alcohol withdrawal (Evidence review 2014)\n• Wernicke’s encephalopathy\n• Alcohol-related liver disease\n• Alcohol-related pancreatitis\n\nThe following recommendations for further research were also identified in Evidence reviews underpinning this guidance:\n2. What is the efficacy and cost effectiveness of clomethiazole compared with chlordiazepoxide or carbamazepine or benzodiazepines for the treatment of acute alcohol withdrawal with regard to the outcomes of withdrawal severity, risk of seizures, risk of delirium tremens, length of treatment and patient satisfaction?\n\nJanuary 2019: NICE checked this guideline and are updating it. For more information, see the surveillance decision."]
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[null,"National Institute for Health and Care Excellence. Alcohol-use disorders: prevention. PH24. London: NICE; 2010\nAvailable here.\n\n\n\n","Children, young people and adults aged 10 years and above","This guideline covers alcohol problems among people over 10. It aims to prevent and identify such problems as early as possible using a mix of policy and practice.\n\nThe guideline includes the following recommendations. All the recommendations are relevant to the scope of this topic evidence map. The recommendations are supported by the underpinning Evidence reviews 1-3 and Evidence reviews 4-6:\n• Price, availability and marketing\n• Licencing\n• Supporting children and young people aged 10 to 15 years\n• Screening young people aged 16 and 17 years and offering them extended brief interventions\n• Screening adults and offering them brief advice and interventions\n• Referral\n\nThe underpinning evidence reviews in this report identifed several gaps in the evidence and made recommendations for further research with the following overarching question:\nHow does advertising by industry and health agencies affect the drinking behaviour of the population as whole? (This includes the use of new media.)\n\nJuly 2019: NICE checked this guideline and are updating it. For further information, see the surveillance decision."]
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[null,"National Institute for Health and Care Excellence. Behaviour change: general approaches. PH6. London: NICE; 2007\nAvailable here.\n\n\n\n","General population","This guideline covers a set of principles that can be used to help people change their behaviour. The aim is for practitioners to use these principles to encourage people to adopt a healthier lifestyle by, for example, stopping smoking, adopting a healthy diet and being more physically active.\n\nThe guideline includes the following recommendations. All the recommendations are relevant to the scope of this topic evidence map. The recommendations are supported by the underpinning Evidence review 1.\n• Providing education and training for those delivering them\n• Delivery of these activities, including one-to-one and community-based programmes and those aimed at specific populations\n• Evaluation of their effectiveness and cost effectiveness\n\nThe Programme Development Group identified a number of gaps in the evidence related to behaviour change interventions and programmes, based on an assessment of the evidence and made recommendations for research to address the most important gaps in the evidence. Please refer to 4. Recommendations for research' section of the guidance.\n\nNovember 2017: NICE checked this guideline and found no new evidence that affects the recommendations in this guideline."]
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[null,"Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' Conclusions:"]
[null,"Agabio R et al. Baclofen for alcohol use disorder. Cochrane Database Syst Rev 2023, Issue 1. Art.No. CD012557. DOI:0.1002/14651858.CD012557.pub3.\nAvailable here. ","Adults with a diagnosis of alcohol dependence. ","This is an update of a Cochrane Review first published in 2018. The aim of this update was to evaluate the benefits and harms of baclofen on achieving and maintaining abstinence or reducing alcohol consumption in people with AUD compared to placebo, no treatment or any other pharmacological relapse prevention treatment. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nThis update included 17 RCTs (1818 participants). Ten studies compared baclofen to placebo or another medication; seven compared two baclofen doses to placebo or another medication. Globally, 15 studies compared baclofen to placebo, two baclofen to acamprosate and two baclofen to naltrexone. In 16 studies, participants received psychosocial treatments. The authors judged most studies at low risk of selection, performance, detection (subjective outcome), attrition and reporting bias. Ten studies detoxified participants before treatment; in seven studies, participants were still drinking at the beginning of treatment. Treatment duration was 12 weeks for 15 RCTs and longer in two studies. Baclofen daily dose was 30 mg to 300 mg: 10 RCTs used low doses (30 mg or less); eight RCTs medium doses (above 30 and 100 mg or less) and four RCTs high doses (above 100 mg).\n\nCompared to placebo, moderate‐certainty evidence found that baclofen probably decreases the risk to relapse (risk ratio (RR) 0.87, 95% confidence interval (CI) 0.77 to 0.99; 12 studies, 1057 participants). This result was confirmed among detoxified participants but not among other subgroups of participants.\n\nHigh‐certainty evidence found that baclofen increases the percentage of days abstinent (mean difference (MD) 9.07, 95% CI 3.30 to 14.85; 16 studies, 1273 participants). This result was confirmed among all subgroups of participants except non‐detoxified or those who received medium doses.\n\nThere was no difference between baclofen and placebo in the other primary outcomes: heavy drinking days (standardised mean difference (SMD) −0.18, 95% CI −0.48 to 0.11; 13 studies, 840 participants; moderate‐certainty evidence); and number of drinks per drinking days (MD −0.45, 95% CI −1.20 to 0.30; 9 studies, 392 participants; moderate‐certainty evidence).\n\nCompared to acamprosate, one study (60 participants) found no differences in any outcomes but the evidence was very uncertain: relapse (RR 1.25, 95% CI 0.71 to 2.20; very low‐certainty evidence).\n\nCompared to naltrexone, baclofen may increase the risk of relapse (RR 2.50, 95% CI 1.12 to 5.56; 1 study, 60 participants; very low‐certainty evidence) but the evidence is very uncertain.","The authors concluded that baclofen likely reduces the risk of relapse to any drinking and increases the percentage of abstinent days, mainly among detoxified participants. It does not increase the number of participants with at least one adverse event, those who dropout for any reason or due to adverse events. It probably does not reduce number of heavy drinking days and the number of drinks per drinking days. Current evidence suggests that baclofen may help people with AUD in maintaining abstinence. The results of comparisons of baclofen with acamprosate and naltrexone were mainly based on only one study."]
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[null,"Wolfenden L et al. Strategies for enhancing the implementation of school‐based policies or practices targeting diet, physical activity, obesity, tobacco or alcohol use. Cochrane Database of Systematic Reviews 2022, Issue 8.\nAvailable here.","School age children (between 5 to 18 years of age)","This Cochrane review aimed to to find out how effective strategies were in supporting the implementation of school‐based interventions to address student diet, physical activity, unhealthy weight gain, and tobacco or alcohol use. Examples of strategies include methods of improving quality, education and training, feedback on how the school was doing, prompts and reminders, and educational resources (e.g. manuals).\n\nThe reviewers included an additional 11 trials in this update bringing the total number of included studies in the review to 38. Of these, 22 were conducted in the USA. Twenty‐six studies used RCT designs. Seventeen trials tested strategies to implement healthy eating, 12 physical activity and six a combination of risk factors. Just one trial sought to increase the implementation of interventions to delay initiation or reduce the consumption of alcohol. All trials used multiple implementation strategies, the most common being educational materials, educational outreach and educational meetings. The overall certainty of evidence was low and ranged from very low to moderate for secondary review outcomes. Only findings relevant to this evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nPooled analyses of RCTs found, relative to a control, the use of implementation strategies may result in a large increase in the implementation of interventions in schools (SMD 1.04, 95% CI 0.74 to 1.34; 22 RCTs, 1917 participants; low‐certainty evidence). One RCT assessed measures of student alcohol use and found strategies to support implementation may result in a slight increase in use (odds ratio 1.10, 95% CI 0.77 to 1.56; P = 0.60; 2105 participants).","The use of implementation strategies may result in large increases in implementation of interventions, and slight improvements in measures of student diet, and physical activity. Further research is required to assess the impact of implementation strategies on such behavioural‐ and obesity‐related outcomes, including on measures of alcohol use, where the findings of one trial suggest it may slightly increase student risk. Given the low certainty of the available evidence for most measures further research is required to guide efforts to facilitate the translation of evidence into practice in this setting."]
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[null,"Meiksin R et al. E-health interventions targeting STIs, sexual risk, substance use and mental health among men who have sex with men: four systematic reviews. Public Health Research. 2022;10(4):1-322. \nAvailable here.","Gay, bisexual and other men (including trans men) who have sex with men, including those who have been diagnosed as HIV positive, as well as those whose last HIV test was negative or who have never tested for HIV","This review aimed to  synthesise evidence addressing the following: (1) What approaches and theories of change do existing e-health interventions employ to prevent human immunodeficiency virus/sexually transmitted infections, sexual risk, alcohol/drug use or mental ill health among men who have sex with men? (2) What factors influence implementation? (3) What are the effects of such interventions on the aforementioned epidemics? (4) Are such interventions cost-effective? Only information relevant to this topic evidence map has been extracted below.\n\nEffects on alcohol and drug use: Two studies presented estimates for drug use (table 8 in the full report), both focused on open-ended interventions. Neither quantified outcomes on alcohol use specifically. Although both studies presented short-term results, only one study presented mid-term results. However, the primary method of analysis in that study was a longitudinal regression model; the authors present these estimates as well. Across studies, there was no consistent evidence of effectiveness of interventions in reducing drug use.\n\nMeta-analysis: Effect sizes for alcohol and drug use are presented in the full report in Figure 14 for outcomes of < 3 months post intervention and in Figure 15 for outcomes between 3 months and 1 year post intervention. In both plots, negative effect sizes represent benefits. The review authors do not present a pooled effect size for these estimates as meta-analyses included both substantial heterogeneity (I2 = 95% both overall and only including effect sizes of up to 3 months’ follow-up) and too few studies to explore this heterogeneity.","The authors concluded that the findings for drug use could not be meta-analysed because of study heterogeneity. Studies addressing this outcome did not present consistent evidence of effectiveness. Trials did not report effects on alcohol use or mental health."]
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[null,"Filges T, Dalgaard NT and Viinholt BC. 2022. Outreach programs to improve life circumstances and prevent further adverse developmental trajectories of at‐risk youth in OECD countries: A systematic review. Campbell Systematic Reviews, 18(4), p.e1282.\nAvailable here\n","Young people between 8 and 25 years of age living in OECD countries, who either have experienced or is at-risk of experiencing an adverse outcome such as school failure or drop-out, runaway and homelessness, substance and/or alcohol abuse, unemployment, long-term poverty, delinquency/criminal behaviour were eligible.","This Campbell systematic review examines the effects of outreach programmes on problem/high-risk behaviour of young people between eight and 25 year old, living in OECD countries. The review summarises evidence from five studies undertaken in the USA and Canada that involved 578 participants in total.\n\nFour of the five studies used for meta analysis were from the USA and one was from Canada. The timespan in which included studies were carried out was 32 years, from 1985 to 2017; on average the intervention year was 2005. The average number of participants in the analysed interventions was 116, ranging from 30 to 346 and the average number of controls was 81, ranging from 32 to 321. At most, the results from two studies could be pooled in a single meta-analysis. It was only possible to pool the outcomes drug (other than marijuana) use, marijuana use and alcohol use each at two different time points (one and 3 months follow up). At 1 month follow up the weighted averages varied between zero and 0.05 and at 3 months follow up between −0.17 and 0.07. None of them were statistically significant. In addition, a number of other outcomes were reported in a single study only.","Overall, there were too few studies included in any of the meta-analyses in order for us to draw any conclusion concerning the effectiveness of outreach. The vast majority of studies were undertaken in the USA.\nFurther, because too few studies reported results on the same type of outcome at most two studies could be combined in a particular meta-analysis. Given the limited number of rigorous studies available from countries other than the USA, it would be natural to consider conducting a series of randomised controlled trials evaluating the effectiveness of outreach for at-risk youth in countries outside the USA. The trial(s) should be designed, conducted and reported according to methodological criteria for rigour in respect of internal and external validity to achieve robust results and preferably reporting a larger number of outcomes."]
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[null,"Moledina A et al (2021). A comprehensive review of prioritised interventions to improve the health and wellbeing of persons with lived experience of homelessness. Campbell Systematic Reviews, 17, e1154.\nAvailable here. ","Populations experiencing homelessness, defined as those who lack stable, permanent, appropriate housing, or who may be without immediate prospects, means, and ability to acquire it","The objective of this systematic review is to identify, appraise, and synthesise the best available evidence on the benefits and cost-effectiveness of interventions to improve the health and social outcomes of people experiencing homelessness.\n\nEligible interventions included permanent supportive housing (PSH), income assistance, standard case management (SCM), peer support, mental health interventions such as assertive community treatment (ACT), intensive case management (ICM), critical time intervention (CTI) and injectable antipsychotics, and substance-use interventions, including supervised consumption facilities (SCFs), managed alcohol programmes and opioid agonist therapy. Outcomes of interest were housing stability, mental health, quality of life, substance use, hospitalisations, employment and income. Only results relevant to this topic evidence map have been extracted below.\n\nManaged alcohol programmes: The review did not identify any eligible studies.\n\nPermanent supportive housing: The effect of permanent housing on substance use was reported in nine trials. Out of these three studies reported improvements in alcohol and drug use in both groups, over time, but no differential benefit of the HF initiative. One study on homeless clients with problematic substance reported no group differences in problems associated with alcohol use, though both groups decreased their alcohol consumption over time. Hybrid approaches to housing (“integrative” versus “parallel” housing) were investigated in a single study. It found no statistically significant difference in the reported days of alcohol use or reported days of drug use both between groups as well as over time. Of note, analysis for this outcome had a lower statistical power as it was restricted to individuals who reported use at the baseline.\n\nIncome-assistance intervention: Four studies examined the effects of income-assistance intervention on substance use. For homeless veterans with substance dependence, CWT immediately reduced the consumption of alcohol and drugs within the first 3 months (β = −44.7%; 95% CI, −69.7% to −19.7%; t = 3.51; p = .001). The addition of priority access to housing vouchers for veterans with a diagnosis of a major psychiatric disorder or an alcohol/drug disorder, compared to existing case management, led to decreased days of drinking to intoxication (1.46 vs. 1.95, t = 0.73, p = .0053) and fewer days of alcohol use over the 3-year study period. However, no significant association was identified between priority access to housing subsidies and differences in the scores of the Addiction Severity Index (ASI). For homeless families with children aged 15 or younger, rental subsidies without case management did not lead to decreased use of substance compared to the usual community housing services.\n\nSCM and peer support interventions: Six studies reported on substance-use outcomes with different SCM treatments. Homeless male veterans with addictions problems with three to 6 months of hospital stays plus case management showed better improvements in the alcohol- and drug-use composite scores, but these were short-lived compared to TAU after 24 months. A three-arm trial reported reductions in average days of alcohol and drug consumption in a case-management-only group, a CM-with-supported-housing group in graduates of short-term in-patient substance-use programme who lacked housing. Homeless alcohol abusers who were offered different intensities of SCM (n = 469) showed no significant between-group differences in days of alcohol use. Similarly, a three-arm trial with homeless women and their intimate partners found no significant differences in substance-use outcomes between groups: a peer-mentored group, a group in a nurse case-managed programme, and one in an SCM programme. Another 12-months trial on homeless men recently released from jails/prisons who were exposed to weekly peer coaching, intermediate peer coaching compared with the usual treatment did not find any significant effects on substance-use outcomes. An RCT with homeless women with alcohol-use problems who received brief guideline-based interventions from primary care providers and referrals to the CM for ongoing follow-up visits for 6 months did not find any significant between-group differences on alcohol-consumption rates, percentages of completely abstained participants, or negative consequences of alcohol use, respectively.\n","PSH interventions improved housing stability for people living with homelessness. High-intensity case management and income-assistance interventions may also benefit housing stability. The majority of included interventions inconsistently detected benefits for mental health, quality of life, substance use, employment and income. These results have important implications for public health, social policy, and community programme implementation. The COVID-19 pandemic has highlighted the urgent need to tackle systemic inequality and address social determinants of health. Our review provides timely evidence on PSH, income assistance, and mental health interventions as a means of improving housing stability. PSH has major cost and policy implications and this approach could play a key role in ending homelessness. Evidence-based reviews like this one can guide practice and outcome research and contribute to advancing international networks committed to solving homelessness."]
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[null,"McGovern R et al. Effectiveness of psychosocial interventions for reducing parental substance misuse. Cochrane Database of Systematic Reviews 2021, Issue 3. Art. No.: CD012823.\nAvailable here\n","Participants were parents who use substances; this included mothers and fathers of children (sons and daughters) under the age of 21 years, regardless of custodial or residency status of the children. Same-sex parents and foster parents were eligible for inclusion.","The authors included 22 unique studies with a total of 2274 participants (mean age of parents ranged from 26.3 to 40.9 years), examining 24 experimental interventions. The majority of studies intervened with mothers only (n = 16; 73%). Heroin, cocaine, and alcohol were the most commonly reported substances used by participants. The interventions targeted either parenting only (n = 13; 59%); drug and alcohol use only (n = 5; 23%); or integrated interventions which addressed both (n = 6; 27%).\n\nThe authors found moderate-quality evidence that psychosocial interventions are probably more effective at reducing the frequency of parental alcohol misuse than comparison conditions at 6-month (mean difference (MD) −0.32, 95% confidence interval (CI) −0.51 to −0.13; 6 studies, 475 participants) and 12-month follow-up (standardised mean difference (SMD) −0.25, 95% CI −0.47 to −0.03; 4 studies, 366 participants). The authors found a significant reduction in frequency of use at 12 months only (SMD −0.21, 95% CI −0.41 to −0.01; 6 studies, 514 participants, moderate-quality evidence).\n\nThe authors examined the effect of the intervention type. They found low-quality evidence that psychosocial interventions targeting substance use only may not reduce the frequency of alcohol (6 months: SMD −0.35, 95% CI −0.86 to 0.16; 2 studies, 89 participants and 12 months: SMD −0.09, 95% CI −0.86 to 0.61; 1 study, 34 participants).\n\nA parenting intervention only, without an adjunctive substance use component, may not reduce frequency of alcohol misuse (6 months: SMD −0.21, 95% CI −0.46 to 0.04, 3 studies; 273 participants, low-quality evidence and 12 months: SMD −0.11, 95% CI −0.64 to 0.41; 2 studies; 219 participants, very low-quality evidence).\n\nParents receiving integrated interventions which combined both parenting- and substance use-targeted components may reduce alcohol misuse with a small effect size (6 months: SMD −0.56, 95% CI −0.96 to −0.16 and 12 months: SMD −0.42, 95% CI −0.82 to −0.03; 2 studies, 113 participants). However, this evidence was of low quality.\n\nInterventions appeared to be more often beneficial for fathers than for mothers. The authors found low- to very low-quality evidence of a reduction in frequency of alcohol misuse for mothers at six months only (SMD −0.27, 95% CI −0.50 to −0.04; 4 studies, 328 participants), whilst in fathers there was a reduction in frequency of alcohol misuse (6 months: SMD −0.43, 95% CI −0.78 to −0.09; 2 studies, 147 participants and 12 months: SMD −0.34, 95% CI −0.69 to 0.00; 2 studies, 147 participants).","The authors found moderate-quality evidence that psychosocial interventions probably reduce the frequency at which parents use alcohol. Integrated psychosocial interventions which combine parenting skills interventions with a substance use component may show the most promise. \nWhilst it appears that mothers may benefit less than fathers from intervention, caution is advised in the interpretation of this evidence, as the interventions provided to mothers alone typically did not address their substance use and other related needs. \nThe authors found low-quality evidence from few studies that interventions involving children are not beneficial."]
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[null,"Goldberg SB et al. Mindfulness‐based interventions for substance use disorders. Cochrane Database of Systematic Reviews 2021, Issue 10.\nAvailable here.","Patients suffering from substance use disorders including individuals with alcohol, prescription‐, illicit‐ and poly‐substance use disorders","This Cochrane review aimed to determine the effects of MBIs for SUDs in terms of substance use outcomes, craving and adverse events compared to standard care, further psychotherapeutic, psychosocial or pharmacological interventions, or instructions, waiting list and no treatment.\n\nForty RCTs met the inclusion criteria, with 35 RCTs involving 2825 participants eligible for meta‐analysis. All studies were at high risk of performance bias and most were at high risk of detection bias. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nMindfulness‐based interventions (MBIs) versus no treatment (24 RCTs): The evidence was uncertain about the effects of MBIs relative to no treatment on all primary outcomes: continuous abstinence rate (post: risk ratio (RR) = 0.96, 95% CI 0.44 to 2.14, 1 RCT, 112 participants; follow‐up: RR = 1.04, 95% CI 0.54 to 2.01, 1 RCT, 112 participants); percentage of days with substance use (post‐treatment: standardized mean difference (SMD) = 0.05, 95% CI ‐0.37 to 0.47, 4 RCTs, 248 participants; follow‐up: SMD = 0.21, 95% CI ‐0.12 to 0.54, 3 RCTs, 167 participants); and consumed amount (post‐treatment: SMD = 0.10, 95% CI ‐0.31 to 0.52, 3 RCTs, 221 participants; follow‐up: SMD = 0.33, 95% CI 0.00 to 0.66, 2 RCTs, 142 participants).\n\nMBIs versus other treatments (standard of care, cognitive behavioral therapy, psychoeducation, support group, physical exercise, medication; 19 RCTs): The evidence was very uncertain about the effects of MBIs relative to other treatments on continuous abstinence rate at post‐treatment (RR = 0.80, 95% CI 0.45 to 1.44, 1 RCT, 286 participants) and follow‐up (RR = 0.57, 95% CI 0.28 to 1.16, 1 RCT, 286 participants), and on consumed amount at post‐treatment (SMD = ‐0.42, 95% CI ‐1.23 to 0.39, 1 RCT, 25 participants) due to imprecision and risk of bias. The evidence suggests that MBIs reduce percentage of days with substance use slightly relative to other treatments at post‐treatment (SMD = ‐0.21, 95% CI ‐0.45 to 0.03, 5 RCTs, 523 participants) and follow‐up (SMD = ‐0.39, 95% CI ‐0.96 to 0.17, 3 RCTs, 409 participants).","Authors conclude that in comparison with no treatment, the evidence is uncertain regarding the impact of MBIs on SUD‐related outcomes. MBIs result in little to no higher attrition than no treatment. In comparison with other treatments, MBIs may slightly reduce days with substance use at post‐treatment and follow‐up (4 to 10 months). The evidence is uncertain regarding the impact of MBIs relative to other treatments on abstinence, consumed substance amount, or craving. MBIs result in little to no higher attrition than other treatments. Few studies reported adverse events."]
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[null,"Steele DW, et al. Interventions for Substance Use Disorders in Adolescents: A Systematic Review. Comparative Effectiveness Review No. 225.  AHRQ Publication No. 20-EHC014. Rockville, MD: Agency for Healthcare Research and Quality. May 2020.\nAvailable here.","Adolescents ages 12 to 20 years with problematic substance use or substance use disorder.","The authors included interventions designed to achieve abstinence, reduce use quantity and frequency, improve functional outcomes, and reduce substance-related harms. Interventions were categorised into seven primary intervention components: motivational interviewing (MI), family focused therapy (Fam), cognitive behavioral therapy (CBT), psychoeducation, contingency management (CM), peer group therapy, and intensive case management. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nMotivational interviewing reduced heavy alcohol use days by 0.7 days/month, alcohol use days by 1.2 days/month compared with treatment as usual. Across multiple intensive interventions, family focussed therapy was most effective, reducing alcohol use days by 3.5 days/month compared with treatment as usual.\n\n","Reviewers conclude that :\nBrief interventions: motivational interviewing reduces heavy alcohol use, low Strength of Evidence (SoE) and alcohol use days (moderate SoE). \nFamily focussed therapy: may be most effective in reducing alcohol use (low SoE). More research is needed to identify other effective intensive behavioral interventions for alcohol use disorder. Both motivational interviewing and CBT reduce combined alcohol and other drug use (low SoE).\nPharmacological interventions: systematic reviews in the college settings support use of brief interventions for students with any use, heavy or problematic use. More research is needed to identify the most effective combinations of behavioral and pharmacologic treatments for alcohol use disorders."]
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[null,"Kelly  JF, Humphreys  K, Ferri  M. Alcoholics Anonymous and other 12‐step programs for alcohol use disorder. Cochrane Database of Systematic Reviews 2020, Issue 3. Art. No.: CD012880. DOI: 10.1002/14651858.CD012880.pub2.\nAvailable here.","Non-coerced adults with Alcohol Use Disorder.","Alcoholics annonymous Twelve-Step Facilitation (AA/TSF) (manualized) compared to treatments with a different theoretical orientation (e.g. CBT) (randomized/quasi‐randomized evidence), RCTs comparing manualized AA/TSF to other clinical interventions (e.g. CBT), showed AA/TSF improves rates of continuous abstinence at 12 months (risk ratio (RR)) 1.21, 95% confidence interval (CI) 1.03 to 1.42; 2 studies, 1936 participants; high‐certainty evidence). This effect remained consistent at both 24 and 36 months.\n\nFor percentage days abstinent (PDA), AA/TSF appears to perform as well as other clinical interventions at 12 months (mean difference (MD) 3.03, 95% CI ‐4.36 to 10.43; 4 studies, 1999 participants; very low‐certainty evidence), and better at 24 months (MD 12.91, 95% CI 7.55 to 18.29; 2 studies, 302 participants; very low‐certainty evidence) and 36 months (MD 6.64, 95% CI 1.54 to 11.75; 1 study, 806 participants; very low‐certainty evidence). \nFor longest period of abstinence (LPA), AA/TSF may perform as well as comparison interventions at six months (MD 0.60, 95% CI ‐0.30 to 1.50; 2 studies, 136 participants; low‐certainty evidence).\n\nFor drinking intensity, AA/TSF may perform as well as other clinical interventions at 12 months, as measured by drinks per drinking day (DDD) (MD ‐0.17, 95% CI ‐1.11 to 0.77; 1 study, 1516 participants; moderate‐certainty evidence) and percentage days heavy drinking (PDHD) (MD ‐5.51, 95% CI ‐14.15 to 3.13; 1 study, 91 participants; low‐certainty evidence). \nFor alcohol‐related consequences, AA/TSF probably performs as well as other clinical interventions at 12 months (MD ‐2.88, 95% CI ‐6.81 to 1.04; 3 studies, 1762 participants; moderate‐certainty evidence).\n\nFor alcohol addiction severity, one study found evidence of a difference in favor of AA/TSF at 12 months (P < 0.05; low‐certainty evidence). \nThis study examines results for the same outcomes for non-manualized AA/TSF.\n","There is high quality evidence that manualized AA/TSF interventions are more effective than other established treatments, such as CBT, for increasing abstinence. Non‐manualized AA/TSF may perform as well as these other established treatments. AA/TSF interventions, both manualized and non‐manualized, may be at least as effective as other treatments for other alcohol‐related outcomes. AA/TSF probably produces substantial healthcare cost savings among people with alcohol use disorder."]
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[null,"Hunt G et al.  Psychosocial interventions for people with both severe mental illness and substance misuse. Cochrane Database Syst Rev 2019, Issue 12. Art. No.: CD001088. DOI: 10.1002/14651858.CD001088.pub4\nAvailable here.\n","People diagnosed with a severe mental illness and concurrent problem of substance misuse","This Cochrane review aimed to assess the effects of psychosocial interventions for reduction in substance use in people with a serious mental illness compared with standard care. It updates and replaces the 2013 version of the review.\n\nThe review now includes 41 trials with a total of 4024 participants. The reviewers identified nine comparisons within the included trials. Only two of these reported outcomes meeting the scope of this topic evidence map and have been reported below. For full detail and information on the other outcomes, please refer to the full-text. \n\n1. Integrated models of care versus standard care (36 months): No clear differences were found between treatment groups for alcohol use (RR 1.15, 95% CI 0.84 to 1.56; participants = 143; studies = 1; low‐quality evidence).\n\n5. Motivational interviewing (MI) versus standard care: A clear difference, favouring MI, was observed for abstaining from alcohol (RR 0.36, 95% CI 0.17 to 0.75; participants = 28; studies = 1; very low‐quality evidence).","Authors concluded that they included 41 RCTs but were unable to use much data for analyses. There is currently no high‐quality evidence to support any one psychosocial treatment over standard care for important outcomes such as remaining in treatment, reduction in substance use or improving mental or global state in people with serious mental illnesses and substance misuse. Furthermore, methodological difficulties exist which hinder pooling and interpreting results. Further high‐quality trials are required which address these concerns and improve the evidence in this important area."]
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[null,"Gilligan C, et al. Family‐based prevention programmes for alcohol use in young people. Cochrane Database of Systematic Reviews 2019, Issue 3. Art. No.: CD012287. DOI: 10.1002/14651858.CD012287.pub2.\nAvailable here.","School age children (up to 18 years of age)","This Cochrane review aimed to assess the effectiveness of universal, selective, and indicated family-based prevention programmes in preventing alcohol use or problem drinking in school-aged children (up to 18 years of age). \n\nForty six studies (39,822 participants) were included in the review, with 27 classified as universal, 12 as selective, and seven as indicated. Meta‐analyses were performed according to outcome, including studies reporting on the prevalence, frequency, or volume of alcohol use. The overall quality of evidence was low or very low, and there was high, unexplained heterogeneity. \n\nUpon comparing any family intervention to no intervention/standard care, the authors found no intervention effect on the prevalence (SMD) 0.00, 95% CI ‐0.08 to 0.08; studies = 12; participants = 7490; I² = 57%; low‐quality evidence) or frequency (SMD ‐0.31, 95% CI ‐0.83 to 0.21; studies = 8; participants = 1835; I² = 96%; very low‐quality evidence) of alcohol use in comparison with no intervention/standard care. The effect of any parent/family interventions on alcohol consumption volume compared with no intervention/standard care was very small (SMD ‐0.14, 95% CI ‐0.27 to 0.00; studies = 5; participants = 1825; I² = 42%; low‐quality evidence). \n\nWhen comparing parent/family and adolescent interventions versus interventions with young people alone, authors found no difference in alcohol use prevalence (SMD ‐0.39, 95% CI ‐0.91 to 0.14; studies = 4; participants = 5640; I² = 99%; very low‐quality evidence) or frequency (SMD ‐0.16, 95% CI ‐0.42 to 0.09; studies = 4; participants = 915; I² = 73%; very low‐quality evidence). For this comparison, no trials reporting on the volume of alcohol use could be pooled in meta‐analysis. \n\nIn general, the results remained consistent in separate subgroup analyses of universal, selective, and indicated interventions. No adverse effects were reported. \n","The results of this review indicate that there are no clear benefits of family‐based programmes for alcohol use among young people. Patterns differ slightly across outcomes, but overall, the variation, heterogeneity, and number of analyses performed preclude any conclusions about intervention effects. Additional independent studies are required to strengthen the evidence and clarify the marginal effects observed. "]
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[null,"Hollands  GJ et al. Altering the availability or proximity of food, alcohol, and tobacco products to change their selection and consumption. Cochrane Database of Systematic Reviews 2019, Issue 9. Art. No.: CD012573. DOI: 10.1002/14651858.CD012573.pub3.\nAvailable here.","Adults","This Cochrane review aimed to:\n1. To assess the impact on selection and consumption of altering the availability or proximity of (a) food (including non‐alcoholic beverages), (b) alcohol, and (c) tobacco products.\n2. To assess the extent to which the impact of these interventions is modified by characteristics of: i. studies, ii. interventions, and iii. participants.\n\nThe reviewers included 24 studies, with the majority (20/24) giving concerns about risk of bias. All of the included studies investigated food products; none investigated alcohol or tobacco. ","The authors concluded that:\n- Further research is warranted in real‐world settings, intervening across a wider range of foods as well as alcohol and tobacco products and over sustained time periods"]
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[null,"Stead M, Angus K, Langley T, Katikireddi SV, Hinds K, Hilton S,  et al. Mass media to communicate public health messages in six health topic areas: a systematic review and other reviews of the evidence. Public Health Res 2019;7(8)\nAvailable here.","General population","This systematic review by NIHR aimed to (1) review evidence on the effective use of mass media in six health topic areas (alcohol, diet, illicit drugs, physical activity, sexual and reproductive health and tobacco), (2) examine whether or not effectiveness varies with different target populations, (3) identify characteristics of mass media campaigns associated with effectiveness and (4) identify key research gaps.There was limited evidence of impact on alcohol use. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nChapter 3. What is the impact of mass media campaigns on alcohol-related behaviour and other outcomes? Findings from the review of primary studies of alcohol campaigns (review B).\nThe objective was to conduct a systematic review of evidence of the effectiveness of mass media public health campaigns to reduce alcohol consumption and related harms. Twenty-nine papers were included in the review. They reported 24 different studies that had a range of designs (11 controlled longitudinal and 13 uncontrolled or cross-sectional) and countries (eight in the USA, five in Australia, two in Finland, two in New Zealand, two in the UK, one in Canada, one in Denmark, one in Italy, one in the Netherlands and one in Sri Lanka). Television and/or radio were used in 18 studies. Other media channels that were used were posters, newspapers, pamphlets, e-mails and online video. On EPHPP study quality ratings, two were strong, four were moderate and 18 were weak.\n\nAlcohol consumption: There was little evidence of reductions in alcohol consumption associated with exposure to campaigns (13 studies). Six of these studies compared exposed and non-exposed groups, or exposed groups over time; five reported no statistically significant differences in consumption. One study found that participants in a group exposed to a television and mailed letter campaign decreased their consumption on a typical day by 47%, contrasting with increases in the groups receiving either the television or letter components or neither. Other studies examined associations between campaign viewing or awareness and consumption: one reported that increases in awareness in older adolescence, but not younger adolescence, was associated with decreases in binge drinking, one reported that campaign viewing significantly predicted drinks consumed and two found no significant difference in consumption.","Reviewers conclude that mass media public health campaigns about alcohol can often be recalled by individuals, and are associated with changes in knowledge, attitudes and beliefs about alcohol. There is little evidence that campaigns reduced alcohol consumption but most studies did not report consumption as an outcome. Mass media can, however, have an impact on outcomes that could lead to support for other public health actions to reduce alcohol consumption and harm."]
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[null,"Wolfenden, L. Strategies to improve the implementation of workplace-based policies or practices targeting tobacco, alcohol, diet, physical activity and obesity. Cochrane database Syst Rev 2018, Issue 11. Art. No.: CD012439. DOI: 10.1002/14651858.CD012439.pub2\nAvailable here. ","Adults in the workplace.","This review aimed to assess the effects of strategies for improving the implementation of workplace-based policies or practices targeting diet, physical activity, obesity, tobacco use and alcohol use. Six trials were included, four of which took place in the USA. Four trials employed randomised controlled trial (RCT) designs. Trials were conducted in workplaces from the manufacturing, industrial and services‐based sectors. The sample sizes of workplaces ranged from 12 to 114. Workplace policies and practices targeted included: healthy catering policies; point‐of‐purchase nutrition labelling; environmental supports for healthy eating and physical activity; tobacco control policies; weight management programmes; and adherence to guidelines for staff health promotion. All implementation interventions utilised multiple implementation strategies, the most common of which were educational meetings, tailored interventions and local consensus processes. \n\nOne included trial reported the effects of a workplace health promotion intervention on employee alcohol use (Parker 2010). However, as the implementation strategy and policies and practices targeted by the intervention did not include those addressing alcohol use, the effects on employee alcohol use reported in this trial were not included in the review. None of the other included trials reported effects of implementation strategies on this outcome. \n","Available evidence regarding the effectiveness of implementation strategies for improving implementation of health‐promoting policies and practices in the workplace setting is sparse and inconsistent. Low certainty evidence suggests that such strategies may make little or no difference on measures of implementation fidelity or different employee health behaviour outcomes. It is also unclear if such strategies are cost‐effective or have potential unintended adverse consequences. The limited number of trials identified suggests implementation research in the workplace setting is in its infancy, warranting further research to guide evidence translation in this setting."]
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[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This Cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text. Fifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect. One targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects. Among school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]
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[null,"Hennessy EA et al. Recovery schools for improving behavioral and academic outcomes among students in recovery from substance use disorders: a systematic review. Campbell Systematic Reviews 2018; 9. \nAvailable here. ","Students in recovery from substance use who were enrolled part-time or full-time in secondary (high school) or postsecondary (college or university) educational institutions. ","The review focused on two types of recover schools: recovery high schools (RHSs), which are schools that award secondary school dipolmas and offer a range of therapeutic services in addition to standard educational curricula; and collegiate recovery communities (CRCs), which offer therapeutic and sober support services on college campuses. \n\nOnly one study met the criteria for inclusion in the review. The study used a quasi-experimental design to examine the effects of RHSs on high school students' academic and substance use outcomes. No eligible studies examining CRCs were identified. \n\nThe results from the one eligible RHS study indicated that after adjusting for pretest values, students in the RHS condition reported levels of grade point averages (g = 0.26, 95% CI [-0.04, 0.56]), truancy (g = 0.01, 95% CI [-0.29, 0.31]), and alcohol use (g = 0.23, 95% CI [-0.07, 0.53]) similar to participants in the comparison condition. However, students in the RHS condition reported improvements in absenteeism (g = 0.56, 95% CI [0.25, 0.87]), abstinence from alcohol/drugs (OR = 4.36, 95% CI [1.19, 15.98]), marijuana use (g = 0.51, 95% CI [0.20, 0.82]), and other drug use (g = 0.45, 95% CI [0.14, 0.76]).\n\nOverall, there was a serious risk of bias in the one included study. The study had a serious risk of bias due to confounding, low risk of bias due to selection of participants into the study, moderate risk of bias due to classification of interventions, inconclusive risk of bias due to deviations from intended interventions, inconclusive risk of bias due to missing data, moderate risk of bias in measurement of outcomes, and low risk of bias in selection of reported results.","There is insufficient evidence regarding the effectiveness of RHSs and CRCs for improving academic and substance use outcomes among students in recovery from SUDs. Only one identified study examined the effectiveness of RHSs. Although the study reported some beneficial effects, the results must be interpreted with caution given the study's potential risk of bias due to confounding and limited external validity. The paucity of evidence on the effectiveness of recovery schools, as documented in this review, thus suggest the need for caution in the widespread adoption of recovery schools for students in recovery from SUDs. Given the lack of empirical support for these recovery schools, additional rigorous evaluation studies are needed to replicate the findings from the one study included in this review. Furthermore, additional research examining the costs of recovery schools may be needed, to help school administrators determine the potential cost-benefits associated with recovery schools. "]
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[null,"O'Connor EA et al. Screening and behavioral counseling interventions to reduce unhealthy alcohol use in adolescents and adults: An updated systematic review for the U.S. Preventive Services Task Force. Rockville MD: Agency for Healthcare Research and Quality; 2018. \nAvailable here. ","Adolescents or adults age 12 years or older. ","One hundred and thirteen studies (n=314,466) were included across all Key Questions. The authors did not find any studies that examined the benefits or harms of screening programs to reduce unhealthy alcohol use. For adolescents, data supported the use of the National Institute on Alcohol Abuse and Alcoholism Youth Screen and other similar one- or two-item screeners to detect alcohol use disorder. For adults, brief (1- to 3-item) screeners commonly reported sensitivity and specificity between 0.70 and 0.85, typically having better sensitivity than the full Alcohol Use Disorders Identification Test (AUDIT) for identifying the full spectrum of unhealthy use. However, the AUDIT tended to have higher specificity, particularly at the standard cutoff of 8 or higher.  \n\nIdentified interventions to reduce unhealth alcohol use were generally counselling interventions, with most involving one or two sessions (90% involved ≤ 4 sessions) with a median of 30 minutes contact time (88% involved ≤ 2 hours contact). The most commonly reported intervention element was the use of personalized normative feedback sessions, in which participants were shown how their alcohol use compares to others; this technique was used in more than half of the included trials and almost all trials in younger adults. Motivational techniques were also common, particularly in combination with personalized normative feedback.\n\nEvidence on the effects of interventions to reduce unhealthy alcohol use in adolescents was limited to two trials; both found mixed results for reduced alcohol use and did not report health or related outcomes. \n\nIn adults, interventions reduced the number of drinks per week (weighted mean difference, −1.82 [95% confidence interval {CI}, −2.42 to −1.22]), the proportion exceeding recommended drinking limits (odds ratio [OR], 0.60 [95% CI, 0.53 to 0.67]), and the proportion reporting a heavy use episode (OR, 0.62 [95% CI, 0.55 to 0.71]), and increased the proportion of pregnant women reporting abstinence (OR, 1.92 [95% CI, 1.19 to 3.09]) after 6 to 12 months. \n\nHeterogeneity was high and effect size was associated with a number of study characteristics such as setting, target age of the population, publication year, study size, and average baseline-use levels, but not clearly associated with any intervention characteristics. Data on effectiveness in important subgroups were very limited, but analyses by sex, the most commonly reported subgroup analysis, did not indicate differences in effectiveness of the interventions. Health outcomes were sparsely reported and, with some exceptions, generally did not demonstrate group differences in effect. No evidence of harm was found.","Among adults, screening instruments are available that can effectively identify persons with unhealthy alcohol use and that are feasible for use in primary care settings, and interventions in those who screen positive are associated with reductions in unhealthy alcohol use. There was no evidence that these interventions have unintended harmful effects. More evidence is needed to determine whether screening for unhealthy alcohol use is beneficial for adolescents."]
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[null,"Canadian Agency for Drugs and Technologies in Health. E-therapy interventions for treatments of substance use disorders and other addictions: a review of clinical effectiveness. Ottawa: CADTH; 2018. \nAvailable here.\n","Adults with diagnosed substance use disorders or with a diagnosed addiction disorder, with or without co-morbid mental health conditions. ","The purpose of this CADTH Rapid Response was to review the comparative effectiveness of therapist-guided e-therapy interventions versus other options for the treatment of adults with substance use disorders and other addictions. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nWhat is the clinical effectiveness of e-therapy for the treatment of patients with substance use disorders and other addictions? \nOne SR examined the efficacy of internet-delivered interventions for alcohol addiction. The difference in alcohol consumption between the e-therapy with therapist guidance and no treatment groups at the post-treatment follow-up was statistically significant (with the e-therapy group having less consumption) and the effect of guided e-therapy was found to be small. The authors concluded that internet-delivered interventions were effective in reducing alcohol consumption and that the effect was small.\n","Evidence on e-therapy for the treatment of substance use disorders and other addictions was from a small number of SRs and RCTs. Findings consistently showed that therapist-guided e-therapy was superior to no treatment and wait list in reducing alcohol consumption or cannabis use, and the effect was small. With respect to substances, evidence was limited to the treatment of problematic alcohol and cannabis use and it is therefore unclear if the results generalize to the misuse of other substances."]
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[null,"Egholm JWM et al. Perioperative alcohol cessation intervention for postoperative complications Cochrane Database of Syst Rev 2018, Issue 11. Art. No.: CD008343. DOI: 10.1002/14651858.CD008343.pub3\n\nAvailable here.\n","Included participants with risky consumption of alcohol who were undergoing all types of elective or acute surgical procedures under general or regional anaesthesia or sedation, who were offered perioperative alcohol cessation intervention or no intervention. ","This Cochrane systematic review aimed to assess the effects of perioperative alcohol cessation interventions on rates of postoperative complications and alcohol consumption. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nOne new study was included in this updated review, resulting in a total of three RCTs (140 participants who drank 3 to 40 AU/d). All three studies were of moderate to good quality. All studies evaluated the effects of intensive alcohol cessation interventions, including pharmacological strategies for alcohol withdrawal symptoms, patient education, and relapse prophylaxis. The authors identified one ongoing study.\n\nInvestigators describe more successful quitters at the end of the intervention programme than among controls. Forty-one out of 70 participants in the intervention groups successfully quit drinking compared with only five out of 70 participants in the control groups (RR 8.22, 95% CI 1.67 to 40.44). The quality of evidence for this outcome is moderate.\n\nAll three studies reported postoperative alcohol consumption (grams of alcohol/week) at the end of the programme as median and range values; therefore it was not possible to estimate the mean and the SD. We performed no meta-analysis. All three studies reported length of stay, and none of these studies described a significant difference in length of stay. Data were insufficient for review authors to perform a meta-analysis. No studies reported on the prevalence of participants without risky drinking in the longer term.\n\nIncluded studies were few and reported small sample sizes; therefore one should be careful about drawing firm conclusions based on these study results. All three studies were conducted in Denmark, and most participants were men. The included participants may represent a selective group, as they could have been more motivated and/or more interested in participating in clinical research or otherwise different, and effects may have been overestimated for both intervention and control groups in these studies. Trial results indicate that these studies are difficult to perform, that strong research competencies are necessary for future studies, and that further evaluation of perioperative alcohol cessation interventions in high-quality randomised controlled trials is needed. Once published and assessed, the one ’ongoing’ study identified may alter the conclusions of this review.","The authors conclude that all three studies showed a significant reduction in the number of participants who quit drinking alcohol during the intervention period. Intensive alcohol cessation interventions offered for four to eight weeks to participants undergoing all types of surgical procedures to achieve complete alcohol cessation before surgery probably reduced the number of postoperative complications. Data were insufficient for review authors to assess their effects on postoperative mortality. No studies reported an effect on length of stay, and no studies addressed the prevalence of risky drinking in the longer term.\n\n\n"]
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[null,"Klimas J et al. Psychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users. Cochrane Database Syst Rev 2018, Issue 12. Art. No.: CD009269. DOI: 10.1002/14651858.CD009269.pub4.\nAvailable here. \n","Problem alcohol and illicit drug users (principally problem drug users of opiates and stimulants). ","This Cochrane review aimed to assess the effects of psychosocial interventions for problem alcohol use in illicit drug users. \n\nThe psychosocial interventions considered in the studies were: cognitive‐behavioural coping skills training (one study), twelve‐step programme (one study), brief intervention (three studies), motivational interviewing (two studies), and brief motivational interviewing (one study). Two studies were considered in two comparisons. There were no data for the secondary outcome, alcohol‐related harm. The results were as follows. \n\nComparison 1: cognitive‐behavioural coping skills training versus twelve‐step programme (one study, 41 participants): There was no significant difference between groups for either of the primary outcomes (alcohol abstinence assessed with Substance Abuse Calendar and breathalyser at one year: risk ratio (RR) 2.38 (95% confidence interval [CI] 0.10 to 55.06); and retention in treatment, measured at end of treatment: RR 0.89 (95% CI 0.62 to 1.29), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was very low. \n\nComparison 2: brief intervention versus treatment as usual (three studies, 197 participants): There was no significant difference between groups for either of the primary outcomes (alcohol use, measured as scores on the Alcohol Use Disorders Identification Test (AUDIT) or Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) at three months: standardised mean difference (SMD) 0.07 (95% CI ‐0.24 to 0.37); and retention in treatment, measured at three months: RR 0.94 (95% CI 0.78 to 1.13), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was low. \n\nComparison 3: motivational interviewing versus treatment as usual or educational intervention only (three studies, 462 participants): There was no significant difference between groups for either of the primary outcomes (alcohol use, measured as scores on the AUDIT or ASSIST at three months: SMD 0.04 (95% CI ‐0.29 to 0.37); and retention in treatment, measured at three months: RR 0.93 (95% CI 0.60 to 1.43), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was low. \n\nComparison 4: brief motivational intervention (BMI) versus assessment only (one study, 187 participants): More people reduced alcohol use (by seven or more days in the past month, measured at six months) in the BMI group than in the control group (RR 1.67; 95% CI 1.08 to 2.60). There was no difference between groups for the other primary outcome, retention in treatment, measured at end of treatment: RR 0.98 (95% CI 0.94 to 1.02), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was moderate. \n\nComparison 5: motivational interviewing (intensive) versus motivational interviewing (one study, 163 participants): There was no significant difference between groups for either of the primary outcomes (alcohol use, measured using the Addiction Severity Index‐alcohol score (ASI) at two months: MD 0.03 (95% CI 0.02 to 0.08); and retention in treatment, measured at end of treatment: RR 17.63 (95% CI 1.03 to 300.48), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was low. \n\n","The review authors found low to very low‐quality evidence to suggest that there is no difference in effectiveness between different types of psychosocial interventions to reduce alcohol consumption among people who use illicit drugs, and that brief interventions are not superior to assessment‐only or to treatment as usual. No firm conclusions can be made because of the paucity of the data and the low quality of the retrieved studies."]
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[null,"Agabio R, Trogu E, Pani PP. Antidepressants for the treatment of people with co‐occurring depression and alcohol dependence. Cochrane Database Syst Rev 2018, Issue 4. Art. No.: CD008581. DOI: 10.1002/14651858.CD008581.pub2.\nAvailable here. \n","Adults with co-occurring depression and alcohol dependence. ","This Cochrane review aimed to assess the benefits and risks of antidepressants for the treatment of people with co‐occurring depression and alcohol dependence. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text\n\nReview authors report that 33 studies were included in the review (2242 participants). Antidepressants were compared to placebo (22 studies), psychotherapy (two studies), other medications (four studies), or other antidepressants (five studies). The mean duration of the trials was 9.9 weeks (range 3 to 26 weeks). Eighteen studies took place in the USA, 12 in Europe, two in Turkey, and one in Australia. The antidepressant included in most of the trials was sertraline; other medications were amitriptyline, citalopram, desipramine, doxepin, escitalopram, fluoxetine, fluvoxamine, imipramine, mianserin, mirtazepine, nefazodone, paroxetine, tianeptine, venlafaxine, and viloxazine. Eighteen studies were conducted in an outpatient setting, nine in an inpatient setting, and six in both settings. Psychosocial treatment was provided in 18 studies. There was high heterogeneity in the selection of outcomes and the rating systems used for diagnosis and outcome assessment.\n\nModerate‐quality evidence found that antidepressants increased the number of participants abstinent from alcohol during the trial (7 studies, 424 participants, RR 1.71, 95 per cent Cl 1.22 to 2.39) and reduced the number of drinks per drinking days (7 studies, 451 participants, mean difference (MD) ‐1.13 drinks per drinking days, 95 per cent Cl ‐1.79 to ‐0.46). After the exclusion of studies with high risk of bias, the number of abstinent remained higher (RR 1.69, 95 per cent CI 1.18 to 2.43) and the number of drinks per drinking days lower (MD ‐1.21 number of drinks per drinking days, 95 per cent CI ‐1.91 to ‐0.51) among participants who received antidepressants compared to those who received placebo. However, other outcomes such as the rate of abstinent days did not differ between antidepressants and placebo (9 studies, 821 participants, MD 1.34, 95 per cent Cl ‐1.66 to 4.34; low‐quality evidence).\n\nThere were few studies comparing one antidepressant versus another antidepressant or antidepressants versus other interventions, and these had a small sample size and were heterogeneous in terms of the types of interventions that were compared, yielding results that were not informative.\n","Authors found low‐quality evidence supporting the clinical use of antidepressants in the treatment of people with co‐occurring depression and alcohol dependence. Antidepressants had positive effects on certain relevant outcomes related to depression and alcohol use but not on other relevant outcomes. Moreover, most of these positive effects were no longer significant when studies with high risk of bias were excluded. Results were limited by the large number of studies showing high or unclear risk of bias and the low number of studies comparing one antidepressant to another or antidepressants to other medication. In people with co‐occurring depression and alcohol dependence, the risk of developing adverse effects appeared to be minimal, especially for the newer classes of antidepressants (such as selective serotonin reuptake inhibitors). According to these results, in people with co‐occurring depression and alcohol dependence, antidepressants may be useful for the treatment of depression, alcohol dependence, or both, although the clinical relevance may be modest."]
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[null,"Kaner E et al. Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev 2018, Issue 2.\nAvailable here. ","People who routinely presented to general practice, emergency care or other primary care settings for a range of health problems, whose alcohol consumption was identified by a screening tool as being excessive, or who had experienced harm as a result of their drinking behaviour","This Cochrane systematic review aimed to assess the effectiveness of screening and brief alcohol intervention to reduce excessive alcohol consumption in hazardous or harmful drinkers in general practice or emergency care settings.\n\nThe reviewers found moderate‐quality evidence that brief alcohol interventions have little impact on frequency of binges per week (MD ‐0.08, 95% CI ‐0.14 to ‐0.02; 15 studies, 6946 participants); drinking days per week (MD ‐0.13, 95% CI ‐0.23 to ‐0.04; 11 studies, 5469 participants); or drinking intensity (‐0.2 g/drinking day, 95% CI ‐3.1 to 2.7; 10 studies, 3128 participants).\n\nThey found moderate‐quality evidence of little difference in quantity of alcohol consumed when extended and no or minimal interventions were compared (‐20 g/week, 95% CI ‐40 to 1; 6 studies, 1296 participants). There was little difference in binges per week (‐0.08, 95% CI ‐0.28 to 0.12; 2 studies, 456 participants; moderate‐quality evidence) or difference in days drinking per week (‐0.45, 95% CI ‐0.81 to ‐0.09; 2 studies, 319 participants; moderate‐quality evidence). Extended versus no or minimal intervention provided little impact on drinking intensity (9 g/drinking day, 95% CI ‐26 to 9; 1 study, 158 participants; low‐quality evidence).\n\nExtended intervention had no greater impact than brief intervention on alcohol consumption, although findings were imprecise (MD 2 g/week, 95% CI ‐42 to 45; 3 studies, 552 participants; low‐quality evidence). Numbers of binges were not reported for this comparison, but one trial suggested a possible drop in days drinking per week (‐0.5, 95% CI ‐1.2 to 0.2; 147 participants; low‐quality evidence). Results from this trial also suggested very little impact on drinking intensity (‐1.7 g/drinking day, 95% CI ‐18.9 to 15.5; 147 participants; very low‐quality evidence).","The authors concluded that they found moderate‐quality evidence that brief interventions can reduce alcohol consumption in hazardous and harmful drinkers compared to minimal or no intervention. Longer counselling duration probably has little additional effect. Future studies should focus on identifying the components of interventions which are most closely associated with effectiveness."]
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[null,"Kaner E et al. Personalised digital interventions for reducing hazardous and harmful alcohol consumption in community-dwelling populations. Cochrane Database Syst Rev 2017, Issue 9, Art. No.: CD011479. DOI: 10.1002/14651858.CD011479.pub2. \nAvailable here. \n","People living in the community whose alcohol consumption had been screened as hazardous or harmful. ","This Cochrane review aimed to assess the effectiveness and cost‐effectiveness of digital interventions for reducing hazardous and harmful alcohol consumption, alcohol‐related problems, or both, in people living in the community.\n\nFifty-seven studies which randomised a total of 34,390 participants were included in the review. The main sources of bias were from attrition and participant blinding (36 per cent and 21 per cent of studies respectively, high risk of bias). Forty one studies (42 comparisons, 19,241 participants) provided data for the primary meta‐analysis, which demonstrated that participants using a digital intervention drank approximately 23g alcohol weekly (95 per cent CI 15 to 30) (about 3 UK units) less than participants who received no or minimal interventions at end of follow up (moderate‐quality evidence). \n\nFifteen studies (16 comparisons, 10,862 participants) demonstrated that participants who engaged with digital interventions had less than one drinking day per month fewer than no intervention controls (moderate‐quality evidence), 15 studies (3587 participants) showed about one binge drinking session less per month in the intervention group compared to no intervention controls (moderate‐quality evidence), and in 15 studies (9791 participants) intervention participants drank one unit per occasion less than no intervention control participants (moderate‐quality evidence). \n\nOnly five small studies (390 participants) compared digital and face‐to‐face interventions. There was no difference in alcohol consumption at end of follow up (MD 0.52 g/week, 95 per cent CI ‐24.59 to 25.63; low‐quality evidence). \n\nThe most frequently mentioned theories or models in the included studies were Motivational Interviewing Theory (7/20), Transtheoretical Model (6/20) and Social Norms Theory (6/20). Over half of the interventions (n = 21, 51per cent) made no mention of theory. Only two studies used theory to select participants or tailor the intervention. There was no evidence of an association between reporting theory use and intervention effectiveness.\n","There is moderate‐quality evidence that digital interventions may lower alcohol consumption, with an average reduction of up to three (UK) standard drinks per week compared to control participants. Substantial heterogeneity and risk of performance and publication bias may mean the reduction was lower. Low‐quality evidence from fewer studies suggested there may be little or no difference in impact on alcohol consumption between digital and face‐to‐face interventions. \n\nThe BCTs of behaviour substitution, problem solving and credible source were associated with the effectiveness of digital interventions to reduce alcohol consumption and warrant further investigation in an experimental context. \n\nReporting of theory use was very limited and often unclear when present. Over half of the interventions made no reference to any theories. Limited reporting of theory use was unrelated to heterogeneity in intervention effectiveness. \n"]
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[null,"Smedslund G et al. Effect of early, brief computerized interventions on risky alcohol and cannabis use among young people. Campbell systematic reviews 2017; 6:(13). Available here. ","Young people (aged 15-25) who abuse alcohol or cannabis. ","The review focused on the effects of brief interventions, provided by electronic devices. Sixty studies were included in the review that had randomised a total of 33,316 participants. \n\nModerate quality evidence was found that multi-dose assessment and feedback was more effective than single-dose assessment for alcohol. A meta-analysis of four studies by the same first author found a 16 per cent significant short-term reduction in drinking after a repeated assessment and feedback compared to a single assessment and feedback (Rate ratio: 0.84, 95 per cent CI: 0.78 to 0.91). However, a study by Anderson (2015) found an SMD of 0.10 (in favour of single dose, 95 per cent CI: -0.07 to 0.27). A study by Kypri (2008) found a long-term significant reduction in drinking after multi-dose feedback compared to single-dose feedback (Rate ratio: 0.77, 95 per cent CI: 0.63 to 0.94). \n\nLow quality evidence was found that assessment and feedback might be more effective than no intervention (Short term effect, 15 studies; SMD: -0.17, 95 per cent CI: -0.27 TO -0.08, I2 = 52 per cent. Long term effect, 3 studies; SMD: -0.17, 95 per cent CI: -0.30 to -0.04).\n\nAssessment and feedback might also be more effective than assessment alone (low quality evidence. Short-term effect, 24 studies; SMD: -0.15, 95 per cent CI: -0.25 to -0.06, I2 = 64 per cent. Long-term effect, 3 studies; SMD: -0.03, 95 per cent CI: -0.19 to 0.12). \n\nShort term effects (<6 months) were mostly larger than long-term (≥ 6 months) effects. \n","Computerized brief interventions are easy to administer, and the evidence from this review indicates that such brief interventions might reduce drinking for several months after the intervention. Additionally, there is no evidence for adverse effects. This means that brief, computerized interventions could be feasible ways of dealing with risky alcohol use among young people. The evidence on cannabis consumption is scarcer, suggesting the need for more research. "]
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[null,"Canadian Agency for Drugs and Technology in Health. Concurrent treatment for substance use disorder and trauma-related comorbidities: a review of clinical effectiveness and guidelines. Ottawa: CADTH; 2017. \nAvailable here. ","Adults with substance use disorder and trauma-related comorbidities (PTSD, anxiety or depression). \n\nSubgroup of interest: military veterans","The purpose of this report by CADTH was to review treatment options for patients with comorbid substance use disorder (SUD) and post-traumatic stress disorder, anxiety, or depression by comparing concurrent treatments for SUD and the mental disorders with no treatment, usual care or active treatment for one condition only and treatment for a single condition (SUD or the mental disorders) with no treatment, usual care or active treatment for the second disorder. Additionally, this review aimed to review evidence-based guidelines regarding the treatments for patients with these comorbidities. \n\nThe review addressed three main research questions. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\n1. What is clinical effectiveness of concurrent treatment for patients with substance use disorders and comorbid post-traumatic stress disorder, anxiety, or depression?\nPatients with comorbid SUD and PTSD: In summary, findings with respect to SUD outcomes for integrated treatments addressing both PTSD and SUD, were inconsistent.\nPatients with comorbid SUD and depression: In summary, there is a suggestion that integrated treatments are more effective than control treatments or treatments addressing a single condition, but findings were not always consistent.\nPatients with SUD and anxiety disorder: One RCT showed that fewer patients relapsed to any drinking in the CBT group compared to the PMRT group. Another RCT showed that the nine hour anxiety-sensitivity focused intervention plus TAU over TAU alone, showed improvement in percent days abstinent in both groups, but showed no significant between group difference.\nPatients with SUD and depression or anxiety disorder: An RCT showed that ICBT appeared to be more effective than usual care with respect to most measures of alcohol consumption.\n\n2. What is the clinical effectiveness of the treatment of one condition for the improvement of all symptoms in patients with substance use disorder and comorbid post-traumatic stress disorder, anxiety, or depression?\nA systematic review included six studies that evaluated addiction based interventions. Two studies comparing the experimental contingency management (CM) treatment with control treatment found slightly better early treatment gains with respect to substance use with CM, however the differences did not remain significant in the long term as shown in one study. Results from three studies (other than CM) showed within-group improvement in SUD outcomes over time even for minimal or no treatment. One study showed that the care management program was associated with better alcohol outcomes compared to the AUD treatment that patients identified on their own.\nAnother systematic review included one study comparing technology-based treatment (TAU plus web based intervention targeting alcohol use) with TAU alone, reported no findings with respect to substance use.\n\n3. What are the evidence-based guidelines regarding the treatment of patients with substance use disorders and comorbid post-traumatic stress disorder, anxiety, or depression?\nOne relevant evidence-based guideline was identified. For comorbid anxiety and alcohol use disorder or for comorbid PTSD and alcohol use disorder, an integrated approach was recommended (Recommendation grade: CCP i.e. “Clinical consent point”). For comorbid depression and alcohol use disorder, CBT was recommended to improve both depressive symptoms and drinking problems.","Report authors found there was a suggestion that integrated treatments offered greater improvement with respect to PTSD symptoms, depression or anxiety compared to no treatment or minimal treatment for patients with comorbid substance use disorder (SUD) and posttraumatic stress syndrome (PTSD), depression or anxiety disorder. However results were not always consistent. In patients with comorbid SUD and PTSD, there was a suggestion that addiction based interventions were more effective with respect to controlling substance use than control treatments. One evidence-based guideline recommended an integrated treatment approach for patients with comorbid alcohol use disorder and PTSD, or comorbid alcohol use disorder and anxiety disorder, and cognitive behavioural therapy for comorbid alcohol use disorder and depression."]
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[null,"Canadian Agency for Drugs and Technology in Health. Inpatient and outpatient treatment programs for substance use disorder: a review of clinical effectiveness and guidelines. Ottawa: CADTH; 2017a. \nAvailable here. \n","Adults 18 to 65 years with substance use disorder/addiction disorder (e.g., abuse of prescription medications or cocaine, heroin, cannabis, alcohol)\n","This Rapid Response report by CADTH aimed to review the clinical effectiveness of inpatient and outpatient treatment programs for adults with substance use disorders involving prescription medications such as analgesics or non-prescription substances such as cocaine, opioids such as heroine, marijuana (cannabis), or alcohol. Evidence-based guidelines associated with inpatient and outpatient treatment programs in adults with substance use disorders were also examined.\n\nThe review addressed two main research questions. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\n1. What is the clinical effectiveness of inpatient and outpatient treatment programs in adults with substance use disorders?\nOne narrative review concluded that evidence supports the case for community detoxification in patients with alcohol dependence. One RCT with long-term follow-up (18 months) concluded that the evidence found initial but decreasing benefit of inpatient over outpatient care across time. One prospective study found inpatients consumed significantly less alcohol in the year after entering treatment than outpatients as measured by the Graduated Frequency Scale questionnaire, and had significantly greater engagement with Alcohol Anonymous program than outpatients in the year after treatment. One retrospective study reported that inpatients with substance use disorders are three times more likely to complete treatment than outpatients.\n\n2. What are the evidence-based guidelines associated with inpatient and outpatients treatment programs in adults with substance use disorders?\nThe evidence-based guidelines from British Columbia Ministry of Health on opioids use disorder recommend that withdrawal management, if needed, can be provided more safely in an outpatient setting rather than in an inpatient setting in most patients. For patients who wish to avoid long-term opioid agonist treatment, supervised slow (longer than one month) outpatient or residential opioid agonist taper can be provided rather than rapid (less than one week) inpatient opioid agonist taper. The slow approach may permit a more flexible and individualised approach to tapered agonist reduction, which allows dose adjustment and stabilisation in case withdrawal symptoms occur.\n\n","For patients with alcohol use disorders, better detoxification completion and abstinence rates, and similar adverse event rates, were found in outpatient care compared to inpatient care in a couple of studies with short follow-up periods (one to two months). One study with a longer follow-up period found inpatients consumed less alcohol than outpatients in the year after entering treatment. This may be explained by the controlled environment of inpatient care that avoids the distractions that could be present in an outpatient care situation. In patients with severe alcohol dependence, data from one study found initial but decreasing benefit of inpatient over outpatient care across time in alcohol abstinence. For patients with substance use disorders, data from one study showed inpatients are more likely to complete treatment than outpatients. The small number of studies found and their heterogeneity in design and reported outcomes cautioned the interpretation of the findings. \n\n\n"]
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[null,"Foxcroft DR et al. Motivational interviewing for the prevention of alcohol misuse in young adults. Cochrane Database Syst Rev 2016, Issue 7. Art. No.: CD007025. DOI: 10.1002/14651858.CD007025.pub4.\nAvailable here.\n","Young adults up to 25 years of age (higher risk individuals or settings). ","This Cochrane review aimed to assess the effects of motivational interviewing (MI) interventions for preventing alcohol misuse and alcohol‐related problems in young adults. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nEighty four trials (22,872 participants) were included, with 70/84 studies reporting interventions in higher risk individuals or settings. Studies with follow‐up periods of at least four months were of more interest in assessing the sustainability of intervention effects and were also less susceptible to short‐term reporting or publication bias. Overall, the risk of bias assessment showed that these studies provided moderate or low quality evidence.\n\nAt four or more months follow‐up, effects in favour of MI were found for the quantity of alcohol consumed (standardised mean difference (SMD) −0.11, 95 per cent confidence interval (CI) −0.15 to −0.06 or a reduction from 13.7 drinks/week to 12.5 drinks/week; moderate quality evidence); frequency of alcohol consumption (SMD −0.14, 95 per cent CI −0.21 to −0.07 or a reduction in the number of days/week alcohol was consumed from 2.74 days to 2.52 days; moderate quality evidence); and peak blood alcohol concentration, or BAC (SMD −0.12, 95 per cent CI −0.20 to 0.05, or a reduction from 0.144 per cent to 0.131 per cent; moderate quality evidence).\n\nFurther analyses showed that there was no clear relationship between the duration of the MI intervention (in minutes) and effect size. Subgroup analyses revealed no clear subgroup effects for longer‐term outcomes (four or more months) for assessment only versus alternative intervention controls; for university/college vs other settings; or for higher risk vs all/low risk participants.\n","The results of this review indicate that there are no substantive, meaningful benefits of MI interventions for preventing alcohol use, misuse or alcohol‐related problems. Although the reviewers found some statistically significant effects, the effect sizes were too small, given the measurement scales used in the included studies, to be of relevance to policy or practice. Moreover, the statistically significant effects are not consistent for all misuse measures, and the quality of evidence is not strong, implying that any effects could be inflated by risk of bias."]
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[null,"Brown TJ, Todd A, O'Malley CL, Moore HJ, Husband AK, Bambra C, et al. Community pharmacy interventions for public health priorities: a systematic review of community pharmacy-delivered smoking, alcohol and weight management interventions. Public Health Res 2016;4(2)\nAvailable here.","People of all ages and in any country","This review aimed to systematically review the effectiveness of community pharmacy interventions to manage alcohol misuse, smoking cessation and weight loss; to explore if and how age, sex, ethnicity and socioeconomic status moderate effectiveness; and to describe how the interventions have been organised, implemented and delivered.\n\nTwenty-four studies were included: two alcohol, 12 smoking cessation, five weight loss and five multicomponent interventions that included pharmacotherapy and lifestyle changes in participants with diabetes mellitus, dyslipidaemia or hypertension. Nine of the studies were UK based; seven of the studies were rated ‘strong’ for quality. All studies were of adults. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nAlcohol outcomes: There were two RCTs of brief alcohol interventions in adults compared with usual care or leaflet-only control; global ratings were strong for one study and weak for the other. Table 8 in full-text summarises the results. Both studies had change in alcohol consumption as the primary outcome; however, different tools were used in each. Eligibility criteria for both studies were scores that indicated ‘possible harmful or hazardous alcohol consumption, but not alcohol dependence’. There were insufficient data to conduct meta-analyses.\n\nAt 12 weeks there was no evidence in effectiveness of community pharmacist delivery of brief alcohol intervention. The AUDIT total change score did not differ significantly between the two groups and did not change significantly between baseline and follow-up in either the intervention or control group. The 12-week AUDIT between-group difference adjusted for pharmacist, sex, age, ethnicity and education was –0.57 [95% confidence interval (CI) –1.59 to 0.45]. There was no significant difference between FAST score for the intervention group compared with control at 3 or 6 months and adjusted for baseline FAST. The 6-month FAST between-group difference was –1.84 (95% CI –4.49 to 0.82). At 6 months there was substantially lower follow-up of intervention clients (22.2%) than of control clients (33.3%).\n\nNeither study evaluated differential effects by demographic or socioeconomic factors. One study reported change in FAST scores by sex; however, the numbers of participants were very small and the study was not powered to detect differences between the two groups.","There was insufficient evidence for the effectiveness of community pharmacy-based brief alcohol interventions.\n\nEvaluations of interventions to manage alcohol misuse and obesity, set within the community pharmacy, are needed.\n\nThe effect of community pharmacy interventions on health inequalities is unclear. Future research in this area is warranted, and trials should include the assessment of age, sex, ethnicity, socioeconomic status and contextual factors, and present analysis of how these factors moderate effectiveness.\n"]
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[null,"Carney T, Myers BJ, Louw J, Okwundu CI. Brief school‐based interventions and behavioural outcomes for substance‐using adolescents. Cochrane Database Syst Rev 2016; Issue 1. Art. No.: CD008969. DOI: 10.1002/14651858.CD008969.pub3\nAvailable here.\n","Substance using adolescents.","The authors included six RCTs which evaluated the effects of brief school-based interventions for substance-using adolescents. Three studies with 732 adolescents compared brief interventions (Bls) with information provision only, and three studies with 444 adolescents compared Bls with assessment only. Reasons for downgrading the quality of evidence included risk of bias of the included studies, imprecision, and inconsistency. For outcomes that concern substance abuse, the retrieved studies only assessed alcohol and cannabis. \n\nGenerally, moderate quality evidence was found that, compared to information provision only, BIs did not have a significant effect on any of the substance use outcomes at short‐, medium‐, or long‐term follow‐up. \n\nWhen compared to assessment-only controls, BIs were found to significantly reduce the frequency of alcohol use (SMD ‐0.91; 95 per cent CI ‐1.21 to ‐0.61, n = 242), alcohol abuse (SMD ‐0.38; 95 per cent CI ‐0.7 to ‐0.07, n = 190) and dependence (SMD ‐0.58; 95 per cent CI ‐0.9 to ‐0.26, n = 190) at medium-term follow-up in one study. And, at long-term follow-up BI’s also reduced alcohol abuse (SMD ‐0.72; 95 per cent CI ‐1.05 to ‐0.40, n = 181) in one study. However, the evidence from studies that compared brief interventions to assessment‐only conditions was generally of low quality.\n","We found low or very low‐quality evidence that brief school‐based interventions may be more effective in reducing alcohol and cannabis use than the assessment‐only condition and that these reductions were sustained at long‐term follow‐up. We found moderate‐quality evidence that, when compared to information provision, brief interventions probably did not have a significant effect on substance use outcomes. It is premature to make definitive statements about the effectiveness of brief school‐based interventions for reducing adolescent substance use. Further high‐quality studies examining the relative effectiveness of BIs for substance use and other problem behaviours need to be conducted, particularly in low‐ and middle‐income countries."]
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[null,"Roberts NP et al. Psychological therapies for post‐traumatic stress disorder and comorbid substance use disorder. Cochrane Database Syst Rev 2016, Issue 4. Art. No.: CD010204. DOI: 10.1002/14651858.CD010204.pub2.\nAvailable here. \n","Individuals with comorbid PTSD and SUD","This Cochrane review aimed to determine the efficacy of psychological therapies aimed at treating traumatic stress symptoms, substance misuse symptoms, or both in people with comorbid PTSD and SUD in comparison with control conditions (usual care, waiting‐list conditions, and no treatment) and other psychological therapies. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nFourteen studies with 1506 participants were included, of which 13 studies were included in the quantitative synthesis. Most studies involved adult populations. Studies were conducted in a variety of settings. Four comparisons were undertaken investigating the effects of psychological therapies with a trauma‐focused component and non‐trauma‐focused interventions against treatment as usual/minimal intervention and other active psychological therapies. Comparisons were stratified for individual‐ or group‐based therapies. All active interventions were based on CBT.\n\nIndividual‐based psychological therapies with a trauma‐focused component plus adjunctive SUD intervention: There was no evidence of an effect for level of drug/alcohol use post‐treatment (SMD ‐0.13; 95% CI ‐0.41 to 0.15; 3 studies; n = 388; very low‐quality evidence), but there was a small effect in favour of individual psychological therapy at 5 to 7 months (SMD ‐0.28; 95% CI ‐0.48 to ‐0.07; 3 studies; n = 388) when compared against TAU.\n\nIndividual‐based psychological therapy with a trauma‐focused component: did not perform better than psychological therapy for SUD only for drug/alcohol use (MD ‐1.27; 95% CI ‐5.76 to 3.22; 1 study; n = 46; low‐quality evidence). Findings were based on one small study.\n\nNon‐trauma‐focused psychological therapies: did not perform better than TAU/minimal intervention. There were no data on the effects on drug/alcohol use for individual therapy. There was no evidence of an effect on the level of drug/alcohol use for group‐based therapy (SMD ‐0.03; 95% CI ‐0.37 to 0.31; 4 studies; n = 414; very low‐quality evidence). A post‐hoc analysis for full dose of a widely established group therapy called Seeking Safety showed reduced drug/alcohol use post‐treatment (SMD ‐0.67; 95% CI ‐1.14 to ‐0.19; 2 studies; n = 111), but not at subsequent follow‐ups.\nThese also did not perform better than psychological therapy for SUD only for drug/alcohol use (SMD 0.22; 95% CI ‐0.13 to 0.57; 2 studies; n = 128; low‐quality evidence).\n","The reviewers assessed the evidence in this review as mostly low to very low quality. Evidence showed that individual trauma‐focused psychological therapy delivered alongside SUD therapy did better than TAU/minimal intervention in reducing PTSD severity post‐treatment and at long‐term follow‐up, but only reduced SUD at long‐term follow‐up. All effects were small, and follow‐up periods were generally quite short. There was evidence that fewer participants receiving trauma‐focused therapy completed treatment. There was very little evidence to support use of non‐trauma‐focused individual‐ or group‐based integrated therapies. Individuals with more severe and complex presentations (e.g. serious mental illness, individuals with cognitive impairment, and suicidal individuals) were excluded from most studies in this review, and so the findings from this review are not generalisable to such individuals. Some studies suffered from significant methodological problems and some were underpowered, limiting the conclusions that can be drawn. Further research is needed in this area."]
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[null,"Tansil KA et al. Alcohol Electronic Screening and Brief Intervention A Community Guide Systematic Review. Am J Prev Med 2016;51(5):801–811). \nAvailable here. \n","Unspecified","This Community Guide review focused on e-screening and brief interventions (e-SBIs) that are similar in structure and intent to Alcohol screening and brief intervention (ASBI) and examined how e-SBI effectiveness varied by key intervention characteristics, in contrast to previous systematic reviews of e-SBI. This review is unique in that it excluded highly interactive interventions (i.e., those with more than three human-to-human sessions); those that were part of a treatment program for alcohol use disorders; those that were primarily educational programs (e.g., Alcohol Edu, College Alc); and those that only used an electronic device for monitoring drinking following traditional ASBI.\n\nTwenty-four studies (28 study arms) provided results for excessive drinkers only and seven studies (eight study arms) reported results for all drinkers. Nearly all studies found that e-SBI reduced excessive alcohol consumption and related harms: nine study arms reported a median 23.9% reduction in binge-drinking intensity (maximum drinks/binge episode) and nine study arms reported a median 16.5% reduction in binge-drinking frequency. Reductions in drinking measures were sustained for up to 12 months.","The authors conclude that, according to Community Guide rules of evidence, e-SBI is an effective method for reducing excessive alcohol consumption and related harms among intervention participants. Implementation of e-SBI could complement population-level strategies previously recommended by the Community Preventive Services Task Force for reducing excessive drinking (e.g., increasing alcohol taxes and regulating alcohol outlet density)."]
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[null,"Foxcroft DR et al. Social norms information for alcohol misuse in university and college students. Cochrane Database Syst Rev 2015, Issue 12. Art. No.: CD006748. DOI: 10.1002/14651858.CD006748.pub4.\nAvailable here. \n","University or college students. ","This Cochrane review aimed to determine whether social norms interventions reduce alcohol‐related negative consequences, alcohol misuse or alcohol consumption when compared with a control (ranging from assessment only/no intervention to other educational or psychosocial interventions) among university and college students.\n\nSeventy studies (44,958 participants) were included in the review, and 63 studies (42,784 participants) in the meta‐analyses. Overall, the risk of bias assessment showed that these studies provided moderate or low quality evidence. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nBinge drinking at four or more months (results pooled across delivery modes): SMD ‐0.06, 95 per cent CI ‐0.11 to ‐0.02 (participants = 11,292; studies = 16; moderate quality evidence), equivalent to 2.7 per cent fewer binge drinkers if 30‐day prevalence is 43.9 per cent.\n\nDrinking quantity at four or more months (results pooled across delivery modes): SMD ‐0.08, 95 per cent CI ‐0.12 to ‐0.04 (participants = 21,169; studies = 32; moderate quality evidence), equivalent to a reduction of 0.9 drinks consumed each week, from a baseline of 13.7 drinks per week.\n\nDrinking frequency at four or more months: WF SMD ‐0.11, 95 per cent CI ‐0.17 to ‐0.04 (participants = 9929; studies = 10; moderate quality evidence), equivalent to a decrease of 0.17 drinking days/wk, from a baseline of 2.74 days/wk; individual face‐to‐face normative feedback SMD ‐0.21, 95 per cent CI ‐0.31 to ‐0.10 (participants = 1464; studies = 8; moderate quality evidence), equivalent to a decrease of 0.32 drinking days/wk, from a baseline of 2.74 days/wk. No effects were found for group face‐to‐face normative feedback or normative marketing campaign.\n\nEstimated blood alcohol concentration (BAC) at four or more months: (Peak BAC results pooled across delivery modes) SMD ‐0.08, 95 per cent CI ‐0.17 to 0.00 (participants = 7198; studies = 11; low quality evidence), equivalent to a reduction in peak BAC from an average of 0.144 per cent to 0.135 per cent. No effects were found for typical BAC with individual face‐to‐face normative feedback.\n","The results of this review indicate that no substantive meaningful benefits are associated with social norms interventions for prevention of alcohol misuse among college/university students. Although some significant effects were found, we interpret the effect sizes as too small, given the measurement scales used in the studies included in this review, to be of relevance for policy or practice. Moreover, the significant effects are not consistent for all misuse measures, heterogeneity was a problem in some analyses and bias cannot be discounted as a potential cause of these findings. "]
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[null,"Canadian agency for Drugs and Technology in Health. Mindfulness interventions for the treatment of post-traumatic stress disorder, generalized anxiety disorder, depression and substance use disorders: a review of the clinical effectiveness and guidelines. Ottawa: CADTH; 2015. Available here. ","Adults with post-traumatic stress disorder (PTSD), generalised anxiety disorder (GAD), depression, or substance use disorders.","The objective of this review was to summarise the clinical effectiveness and guidelines for the use of mindfulness interventions for the treatment of PTSD, GAD, depression, and substance use disorders in adults. The review addressed two main research questions. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\n1. What is the clinical effectiveness of mindfulness interventions for the treatment of adults with PTSD, GAD, Depression, or substance use disorders?\nA study reported, that compared with treatment as usual, participants assigned to mindfulness-based relapse prevention reported significantly lower risk of heavy drinking, significantly fewer days of heavy drinking at the 6-month follow-up. At the 12-month follow-up, mindfulness-based relapse prevention participants reported significantly decreased heavy drinking compared with relapse prevention and treatment as usual.\n\n2. What are the evidence-based guidelines regarding the use of mindfulness interventions for the treatment of adults with PTSD, GAD, Depression, or substance use disorders?\nThe guideline by the New South Wales Department of Health suggested that mindfulness could be used to treat problematic drug and alcohol users.\n\n","The evidence for the efficacy of mindfulness as a treatment for individuals with substance use disorders was limited. One RCT of low methodological quality suggested that mindfulness intervention is more effective than treatment as usual in lowering risk of relapse to substance use and heavy drinking. One guideline suggested that mindfulness can be used to treat problematic drug and alcohol use problems by suitably trained and experienced drug and alcohol professionals.\n"]
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[null,"Canadian agency for Drugs and Technology in Health. Yoga for the Treatment of Post-Traumatic Stress Disorder, Generalized Anxiety Disorder, Depression, and Substance Abuse: A Review of the Clinical Effectiveness and Guidelines. Ottawa: CADTH; 2015a. Available here. ","Adults with PTSD, GAD, depression, or substance use disorders.","The objective of this Rapid Response report is to review the clinical effectiveness of yoga for treating PTSD, GAD, depression and substance abuse, and to summarize the guidelines that are associated with the use of yoga for these conditions.The review addressed two main research questions. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\n1. What is the clinical effectiveness of yoga as an intervention for the treatment of PTSD, GAD, depression, or substance use disorders?\nOne study found that yoga was a feasible adjunct treatment for treating alcohol dependence. Patients in the yoga intervention group had a higher baseline level of drinking compared to the control group and there were positive, non-significant changes in alcohol consumption at six month follow-up, numerically greater than that experienced by the control. \ngroup\n\n2. What are the evidence-based guidelines regarding the use of mindfulness interventions for the treatment of adults with PTSD, GAD, Depression, or substance use disorders?\nFive evidence-based guidelines were included in this report, two of which did not find enough evidence for yoga to provide a recommendation. None of the recommendations focused specifically on alcohol consumption.\n\n","Three RCTs of low methodological quality suggested that patients with substance abuse improved with respect to some symptoms with yoga. Five evidence based guideline documents considered the use of yoga in clinical practice. Three suggested that yoga may be useful as an adjunctive treatment for treating major depressive disorder (MDD), PTSD and GAD, if available. "]
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[null,"Ipser JC et al. Pharmacotherapy for anxiety and comorbid alcohol use disorders. Cochrane Database Syst Rev 2015, Issue 1. Art. No.: CD007505. DOI: 10.1002/14651858.CD007505.pub2\nAvailable here. \n","People diagnosed with alcohol dependence or abuse and an anxiety disorder according to DSM‐III, DSM‐IV, or DSM‐IV‐TR criteria.","This Cochrane review aimed to assess the effects of pharmacotherapy for treating anxiety in people with comorbid alcohol use disorders. Five placebo‐controlled pharmacotherapy RCTs (with 290 participants) were included in the review. Most of the trials provided little information on how randomisation was performed or on whether both participants and study personnel were blinded to the intervention. \n\nStudy participants had DSM) III‐ and DSM IV‐diagnosed alcohol use disorders and post‐traumatic stress disorder (two studies), social anxiety disorder (SAD; two studies) or generalized anxiety disorder (GAD; one study). Four trials assessed the efficacy of the selective serotonin re‐uptake inhibitors (SSRIs: sertraline, paroxetine); one RCT investigated the efficacy of buspirone, a 5‐hydroxytryptamine (5‐HT) partial agonist. Treatment duration lasted between eight and 24 weeks. Overall, 70% of participants included in the review were male. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nThere was no evidence of an effect for any of the medications tested on abstinence from alcohol use or depression symptoms.","The evidence‐base for the effectiveness of medication in treating anxiety disorders and comorbid alcohol use disorders is currently inconclusive. There was no evidence that alcohol use was responsive to medication. Large, rigorously conducted RCTs would help supplement the small evidence‐base for the efficacy and tolerability of pharmacotherapy for anxiety and comorbid alcohol use disorders. Further research on patient subgroups who may benefit from pharmacological treatment, as well as novel pharmacological interventions, is warranted. \n"]
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[null,"Langford R et al. The WHO Health Promoting School framework for improving the health and well‐being of students and their academic achievement. Cochrane Database Syst Rev 2014, Issue 4. Art. No.: CD008958. DOI: 10.1002/14651858.CD008958.pub2 \nAvailable here. ","School aged children (aged 4-18).","This Cochrane review aimed to assess the effectiveness of the Health Promoting Schools (HPS) framework in improving the health and well‐being of students and their academic achievement.\n\nSixty seven eligible cluster trials, randomising 1,443 schools or districts were included. This is made up of 1,345 schools and 98 districts. The studies tackled a range of health issues: physical activity (4), nutrition (12), physical activity and nutrition combined (18), bullying (7), tobacco (5), alcohol (2), sexual health (2), violence (2), mental health (2), hand‐washing (2), multiple risk behaviours (7), cycle‐helmet use (1), eating disorders (1), sun protection (1), and oral health (1). Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nReview authors report that the quality of evidence overall was low to moderate as determined by the GRADE approach. Risk of bias assessments identified methodological limitations, including heavy reliance on self‐reported data and high attrition rates for some studies. In addition, there was a lack of long‐term follow‐up data for most studies.\n\nEight studies provided data on alcohol use and all but one were included in the meta‐analysis. Overall, there was no evidence that any of the different intervention approaches were effective in reducing alcohol intake.","The results of this review provide evidence for the effectiveness of some interventions based on the HPS framework for improving certain health outcomes but not others. More well‐designed research is required to establish the effectiveness of this approach for other health topics and academic achievement."]
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[null,"Siegfried N et al. Restricting or banning alcohol advertising to reduce alcohol consumption in adults and adolescents. Cochrane Database Syst Rev 2014, Issue 11. Art. No.: CD010704. DOI: 10.1002/14651858.CD010704.pub2.\nAvailable here. \n","Adults of any age and adolescents (defined by WHO as aged 10 to 19 years)","The aim of this Cochrane review was to evaluate the benefits, harms and costs of restricting or banning the advertising of alcohol, via any format, compared with no restrictions or counter‐advertising, on alcohol consumption in adults and adolescents.\n\nOne small RCT (80 male student participants conducted in the Netherlands and published in 2009) and three ITS studies (general population studies in Canadian provinces conducted in the 1970s and 80s) were examined. The RCT found that young men exposed to movies with a low‐alcohol content drank less than men exposed to movies with a high‐alcohol content (MD ‐0.65 drinks; 95 per cent CI ‐1.2, ‐0.07; p value = 0.03, very‐low‐quality evidence). Young men exposed to commercials with a neutral content compared with those exposed to commercials for alcohol drank less (MD ‐0.73 drinks; 95 per cent CI ‐1.30, ‐0.16; p value = 0.01, very‐low‐quality evidence). Outcomes were assessed immediately after the end of the intervention (lasting 1.5 hours), so no follow‐up data were available.\n\nTwo of the ITS studies evaluated the implementation of an advertising ban and one study evaluated the lifting of such a ban (GRADE: very‐low‐quality evidence). Each of the three ITS studies evaluated a different type of ban (partial or full) compared with different degrees of restrictions or no restrictions during the control period. The results from the three ITS studies were inconsistent. A meta‐analysis of the two studies that evaluated the implementation of a ban showed an overall mean non‐significant increase in beer consumption in the general population of 1.10 per cent following the ban (95 per cent CI ‐5.26, 7.47; p value = 0.43; I2 = 83 per cent, very‐low‐quality evidence). This finding is consistent with an increase, no difference, or a decrease in alcohol consumption. In the study evaluating the lifting of a total ban on all forms of alcohol advertising to a partial ban on spirits advertising only, which utilised an Abrupt Auto‐regressive Integrated Moving Average model, the volume of all forms of alcohol sales decreased by 11.11 kilolitres (95 per cent CI ‐27.56, 5.34; p value = 0.19) per month after the ban was lifted. In this model, beer and wine sales increased per month by 14.89 kilolitres (95 per cent CI 0.39, 29.39; p value = 0.04) and 1.15 kilolitres (95 per cent CI ‐0.91, 3.21; p value = 0.27), respectively, and spirits sales decreased statistically significantly by 22.49 kilolitres (95 per cent CI ‐36.83, ‐8.15; p value = 0.002).\n\nNone of the studies were funded by the alcohol or advertising industries.\n","Authors conclude that there is a lack of robust evidence for or against recommending the implementation of alcohol advertising restrictions. Advertising restrictions should be implemented within a high‐quality, well‐monitored research programme to ensure the evaluation over time of all relevant outcomes in order to build the evidence base. "]
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[null,"Pani PP et al. Anticonvulsants for alcohol dependence. Cochrane Database Syst Rev 2014, Issue 2. Art. No.: CD008544. DOI: 10.1002/14651858.CD008544.pub2.\nAvailable here. \n","Alcohol dependent adults. ","The primary aim of this Cochrane review is to assess the benefits/risks of anticonvulsants for the treatment of alcohol dependence. \n\nA total of 25 studies were included in the review (2641 participants). Most participants were male, with an average age of 44 years. Anticonvulsants were compared with placebo (17 studies), other medications (seven studies) and no medication (two studies). The mean duration of the trials was 17 weeks (range four to 52 weeks). The studies took place in the USA, Europe, South America, India and Thailand. Variation was reported in the characteristics of the studies, including their design and the rating instruments used. For many key outcomes, the risk of bias associated with unclear or unconcealed allocation and lack of blinding affected the quality of the evidence. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nAnticonvulsants versus placebo: For continuous abstinence (eight studies, 634 participants, RR 1.21, 95% Cl 95 per cent 0.97 to 1.52, moderate‐quality evidence), results showed no evidence of differences. Moderate‐quality evidence suggested that anticonvulsants reduced drinks/drinking days (11 studies, 1126 participants, mean difference (MD) ‐1.49, 95% Cl ‐2.32 to ‐0.65) and heavy drinking (12 studies, 1129 participants, standardised mean difference (SMD) ‐0.35, 95% Cl ‐0.51 to ‐0.19). The direction of results was confirmed by subgroup analyses for topiramate and partially for gabapentin and valproate. \n\nAnticonvulsants versus naltrexone: No evidence of difference was shown in severe relapse rates (four studies, 427 participants, RR 0.69, 95% Cl 0.44 to 1.07) and continuous abstinence rates (five studies, 528 participants, RR 1.21, 95% Cl 0.99 to 1.49); anticonvulsants were associated with fewer heavy drinking days (three studies, 308 participants, MD ‐5.21, 95% Cl ‐8.58 to ‐1.83) and more days to severe relapse (three studies, 244 participants, MD 11.88, 95% Cl 3.29 to 20.46).\n","The authors concluded that at the current stage of research, randomised evidence supporting the clinical use of anticonvulsants to treat alcohol dependence is insufficient. Results are conditioned by heterogeneity and by the low number and quality of studies comparing anticonvulsants with other medications. The uncertainty associated with these results leaves to clinicians the need to balance possible benefits/risks of treatment with anticonvulsants versus other medications as supported by evidence of efficacy."]
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[null,"Dedert E et al. e-interventions for alcohol misuse. Durham NC: Evidence-based Synthesis Program Center; 2014.\nAvailable here.\n","Adults with alcohol use disorders (AUD). ","This review evaluates computer-based interventions for alcohol misuse. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nEffects of E-Interventions Compared with Inactive Controls in Adults who Misuse Alcohol: Twenty-two studies with 13,929 participants and judged to be low (n=7) or moderate (n=12) risk of bias. Overall, the available data suggest that long-term effects of e-interventions on alcohol outcomes are modest or absent.\n\nEffects of E-Interventions Compared with Inactive Controls in Adults at High Risk of AUD (eg, AUDIT-C ≥8) or with a Diagnosis of AUD: 3 studies (2 moderate, 1 high risk of bias) in 533 patients with a diagnosis of AUD. Neither computerized feedback plus telephone counseling nor an interactive voice response system decreased alcohol consumption or risk of relapse. A multicomponent smartphone program used to support recovery following residential treatment increased abstinence (OR 1.94; 95% CI, 1.14 to 3.31) and decreased risky drinking days at 12-month follow-up.\n\n Effects of E-Interventions Alone or Used in Combination with Face-to-Face Therapy Compared with Face-to-Face Therapy Alone in Adults who Misuse Alcohol: Six trials with 1090 participants. Overall, this diverse group of studies did not find a benefit of e-interventions alone or as an adjunct to face-to-face  brief MI compared with face-to-face brief MI alone for college students or midlife primary care patients who misuse alcohol.","The authors reported that they found limited evidence for small or no effects of e-interventions compared with controls on long-term (≥6 months) alcohol outcomes in participants who screened positive for alcohol misuse. Findings were even more limited for participants with AUD or comparisons of e-interventions to face-to-face treatment. Further research is needed to determine with higher confidence whether e-interventions can produce long-term benefits for alcohol-related outcomes. In particular, given the limited number and duration of intervention episodes in the studies reviewed, it is possible that these e-interventions were not designed to be robust enough to produce significant, enduring effects on alcohol misuse. As reported in previous reviews, brief in-person interventions produce sustained reductions in alcohol consumption in participants with alcohol misuse. Current evidence does not support substitution of e-interventions for brief, in-person treatment. Future research on e-interventions should include evaluations of more intensive or longer duration e-interventions for alcohol misuse. "]
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[null,"Jonas DE et al. Pharmacotherapy for adults with alcohol-use disorders in outpatient settings. Rockville MD: Agency for Healthcare Research and Quality; 2014. \nAvailable here. \n\nThis report has been archived by AHRQ and is being updated. The update protocol can be accessed here.","Adults with alcohol-use disorders. ","The aim of this report was to conduct a systematic review and meta-analysis of the efficacy, comparative effectiveness, and harms of medications (both FDA approved and others) for adults with alcohol-use disorders, and to evaluate the evidence from primary care settings.\n\nOne hundred and thirty five studies were included. Most patients met criteria for alcohol dependence; mean ages were in the 40s. Studies typically included psychosocial cointerventions; effect sizes reflect the added benefits of medications. For acamprosate and oral naltrexone (50 mg per day), numbers needed to treat (NNTs) to prevent 1 person from returning to any drinking were 12 and 20, respectively (moderate SOE); NNT to prevent 1 person from returning to heavy drinking was 12 for oral naltrexone (50 mg per day) (moderate SOE). Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nMeta-analyses of four head-to-head trials found no statistically significant difference between the two medications for consumption outcomes (moderate SOE). For injectable naltrexone, meta-analyses found no significant benefit for return to any or heavy drinking, but found a reduction in heavy drinking days (low SOE). Evidence from well-controlled trials does not support efficacy of disulfiram, except possibly for patients with excellent adherence. Among medications used off label, moderate evidence supports the efficacy of nalmefene and topiramate for improving some consumption outcomes, and limited evidence supports the efficacy of valproic acid. Evidence from primary care settings was scant. There was insufficient direct evidence to conclude whether medications for alcohol-use disorders are effective for improving health outcomes.","Authors concluded that acamprosate and oral naltrexone have the best evidence for improving alcohol consumption outcomes for patients with alcohol-use disorders. Head-to-head trials have not consistently established the superiority of one medication. Thus, other factors may guide medication choices, such as frequency of administration, potential adverse events, coexisting symptoms, and availability of treatments.\n\n"]

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[null,"NICE Guidance"]
[null,"Source:","Population:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Behaviour change: digital and mobile health interventions. NG183. London: NICE; 2020.\nAvailable here.\n\n\n","• Children and Young People (CYP ≤ 12years)\n• Adults\n• Pregnant and postpartum women\n• Pre-existing health conditions:\nHypertension and cardiovascular disease\nRespiratory diseases\nCancers for which managing smoking may improve health outcomes\nMental health conditions\nSpecific consideration will also be given to people with learning disabilities and people with neurodevelopmental disorders such as autism.","This guideline covers interventions that use a digital or mobile platform to help people eat more healthily, become more active, stop smoking, reduce their alcohol intake or practise safer sex. The interventions include those delivered by text message, apps, wearable devices or the internet. The guideline only includes those that are delivered by the technology itself and not by healthcare professionals using technology to deliver interventions.\n\nIt includes recommendations on:\n- Developing digital and mobile health interventions\n- Commissioning digital and mobile health interventions\n- Using digital and mobile health interventions\n- Interventions for diet and physical activity\n- Interventions for smoking\n- Interventions for alcohol use\n- Interventions for unsafe sexual behaviour"]
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[null,"National Institute for Health and Care Excellence. Alcohol interventions in secondary and further education. NG135. London: NICE; 2019. \nAvailable here.\n","• CYP (11 to 18years) in full time education.\n• YP (18 to 25 years) with an Education, health and care (EHC) plan.\n• CYP (11 to 18years) in full time education considered ‘at risk’.\n• YP (18 to 25 years) EHC plan considered ‘at risk’.","This guideline covers interventions in secondary and further education to prevent and reduce alcohol use among children and young people aged 11 up to and including 18. It also covers people aged 11 to 25 with special educational needs or disabilities in full-time education. It will also be relevant to children aged 11 in year 6 of primary school.\n\nThe guideline includes recommendations on:\n• Planning alcohol education \n• Delivering universal alcohol education \n• Targeted interventions.\n\nRationale and impact of this guidance includes: \n• Organising alcohol education\n• Planning alcohol education content\n• Confidentiality and safeguarding\n• Referral for further support\n• Structuring alcohol education\n• Using additional support for alcohol education\n• Selecting pupils for targeted interventions\n• Tailoring targeted interventions\n• Avoiding unintended consequences of group interventions"]
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[null,"National Institute for Health and Care Excellence. Behaviour change: individual approaches. PH49. London: NICE; 2014. \nAvailable here.\n","Everyone aged 16 years and older","This guideline covers changing health-damaging behaviours among people aged 16 and over using interventions such as goals and planning, feedback and monitoring, and social support. It aims to help tackle a range of behaviours including alcohol misuse, poor eating patterns, lack of physical activity, unsafe sexual behaviour and smoking.\n\nThe guideline includes recommendations on:\n● Developing local behaviour change policy and strategy\n● Commissioning interventions\n● Planning interventions that take account of local needs\n● Ensuring interventions meet individual needs\n● Delivering interventions\n● Commissioning and providing training\n● Monitoring and evaluating interventions\n\n"]
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[null,"National Institute for Health and Care Excellence. Nalmefene for reducing alcohol consumption in people with alcohol dependence. TA325. London: NICE; 2014.\nAvailable here.  ","Adults with mild alcohol dependence (as defined in CG115) who have a high drinking risk level (≥ 60 g/day of pure alcohol for men and ≥ 40 g/day for women) without physical withdrawal symptoms and who do not require immediate detoxification","Nalmefene is recommended within its marketing authorisation, as an option for reducing alcohol consumption, for people with alcohol dependence: \n\n• Who have a high drinking risk level (defined as alcohol consumption of more than 60 g per day for men and more than 40g per day for women, according to the World Health Organization's drinking risk levels) without physical withdrawal symptoms and;\n• Who do not require immediate detoxification.\n\nThe marketing authorisation states that nalmefene should:\n\n• Only be prescribed in conjunction with continuous psychosocial support focused on treatment adherence and reducing alcohol consumption and; \n• Be initiated only in patients who continue to have a high drinking risk level 2 weeks after initial assessment.\n"]
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[null,"National Institute for Health and Care Excellence. Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence. CG115. London: NICE; 2011\nAvailable here.\n\n","Adults (>18 years) or young people (10 to 17 years of age) with a diagnosis of alcohol dependence or meeting criteria for harmful alcohol use (30 to 50 units of alcohol per week)","This guideline covers identifying, assessing and managing alcohol-use disorders (harmful drinking and alcohol dependence) in adults and young people aged 10-17 years. It aims to reduce harms (such as liver disease, heart problems, depression and anxiety) from alcohol by improving assessment and setting goals for reducing alcohol consumption. \n\nThis guideline includes recommendations on:\n\n• Principles of care\n• Identification and assessment\n• Interventions for alcohol misuse"]
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[null,"National Institute for Health and Care Excellence. Coexisting severe mental illness (psychosis) and substance misuse: assessment and management in healthcare settings. CG120. London: NICE; 2011. \nAvailable here.\n","People aged 14 years and over with coexisting severe mental illness (psychosis) and substance misuse","This guideline covers assessing and managing people aged 14 years and over with coexisting severe mental illness (psychosis) and substance misuse. It aims to help healthcare professionals guide people with psychosis with coexisting substance misuse to stabilise, reduce or stop their substance misuse, to improve treatment adherence and outcomes, and to enhance their lives. \n\nThis guideline includes recommendations on:\n\n• Principles of care\n• Recognising psychosis with coexisting substance misuse\n• Primary care\n• Secondary care mental health services\n• Substance misuse services\n• Inpatient mental health services and staffed accommodation\n• Specific issues for young people with psychosis and coexisting substance misuse\n"]
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[null,"National Institute for Health and Care Excellence. Alcohol-use disorders: diagnosis and management of physical complications. CG100. London: NICE; 2010. \nAvailable here. \n","People aged 10 years and over with alcohol-use disorders","This guideline covers care for adults and young people (aged 10 years and older) with physical health problems that are completely or partly caused by an alcohol-use disorder. It aims to improve the health of people with alcohol-use disorders by providing recommendations on managing acute alcohol withdrawal and treating alcohol-related conditions. \n\nThis guideline includes recommendations on:\n\n• Acute alcohol withdrawal\n• Wernicke’s encephalopathy\n• Alcohol-related liver disease\n• Alcohol-related pancreatitis\n\nIn January 2019: NICE checked this guideline and are updating it. For more information, see the surveillance decision."]
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[null,"National Institute for Health and Care Excellence. Alcohol-use disorders: prevention. PH24. London: NICE; 2010\nAvailable here.\n\n\n\n","Children, young people and adults aged 10 years and above","The recommendations in this guideline cover:\n\n• Price, availability and marketing\n• Licencing\n• Supporting children and young people aged 10 to 15 years\n• Screening young people aged 16 and 17 years and offering them extended brief interventions\n• Screening adults and offering them brief advice and interventions\n• Referral\n\nThis guideline was checked in July 2019 and NICE are updating it. For further information, see the surveillance decision."]
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[null,"National Institute for Health and Care Excellence. Behaviour change: general approaches. PH6. London: NICE; 2007\nAvailable here.\n\n\n\n","General population\nProblem drinkers\nThose with raised risk (e.g. pregnant women, )\n","This guideline covers a set of principles that can be used to help people change their behaviour. The aim is for practitioners to use these principles to encourage people to adopt a healthier lifestyle by, for example, stopping smoking, adopting a healthy diet and being more physically active.\n\nThe recommendations in this guideline cover:\n• Providing education and training for those delivering them\n• Delivery of these activities, including one-to-one and community-based programmes and those aimed at specific populations\n• Evaluation of their effectiveness and cost effectiveness\n\nThis guideline was checked in November 2017. NICE found no new evidence that affects the recommendations in this guideline."]
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[null,"Evidence reviews underpinning NICE guidance"]
[null,"NICE underpinning evidence review:","Population:","Evidence statements","Recommendations:"]
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[null,"National  Institute for Health and Care Excellence (2020). Behaviour change: digital and mobile health interventions Evidence Review B: alcohol. London: NICE [NICE guideline NG183].\nAvailable here.","Everyone, including Young People under 16 (and their families or 16 carers)\n• Pre-existing health conditions:\nOverweight/ obesity\nHypertension and cardiovascular disease\nRespiratory diseases\nCancers for which managing smoking may improve health outcomes\nMental health conditions\nSpecific consideration will also be given to people with learning disabilities and people with neurodevelopmental disorders such as autism.","This evidence review underpinning NG183 aimed to describe individual-level digital and mobile health interventions for changing harmful drinking habits as well as identifying the critical components and intervention characteristics shown to be effective. For detailed summary of evidence, please refer to the full-text.\n\nNumber of drinks per week: Internet-based interventions reduced the number of drinks per week significantly more than no intervention control at 6 months (9 studies) but not at 12 months (2 studies). They were only effective at 6 months for drinkers who drank >14 drinks a week at baseline (4 studies). These were only significantly more effective than control at 6 months for non-student drinkers (3 studies) but not student drinkers (6 studies).\nThey did not reduce number of drinks per week significantly more than active controls at 6 months (4 studies) or 12 months (2 studies). A text-message based intervention and the active control were effective at reducing number of drinks per week but the difference between intervention and active control was not significant at 12 months (1 study). \nCompared to other interventions, internet-based interventions did not reduce number of drinks per week as much as the comparator intervention at 6 months (7 studies) and at 12 months (2 studies), the difference between interventions is not significant. \n\nNumber of days drinking per week: Internet-based interventions compared to no intervention control, were effective at reducing the number of days drinking per week at 6 months, but the change was not meaningful (2 studies). At 12 months, interventions were not significantly more effective than no intervention controls (2 studies). They did not significantly reduce number of days drinking per week more than active controls at 6 months (1 studies) and at 12 months (1 study). They reduced the number of days drinking per week at 6 months significantly more than other interventions (2 studies), but no difference was found at 12 months (2 studies).\n\nNumber of days binge drinking previous 7 days: Internet-based interventions did not reduce the number of days binge drinking per week at 6 months significantly compared with no intervention controls (2 studies). A text message-based intervention significantly reduced the number of days binge drinking at 6 months when compared with a no intervention control (1 study).\nNeither internet-based interventions or active controls did not reduce the number of days binge drinking per week at 6 months and the difference between interventions and active controls was not significant (3 studies). A text message intervention and an active control did not reduce the number of days binge drinking at 6 months and the difference between intervention and control was not significant.\nInternet-based interventions and other interventions did not reduce the number of days binge drinking at 6 months and the difference between the interventions was not significant (3 studies).\n\n\n\n","The recommendations 1.1 Developing digital and mobile health interventions, 1.2 Commissioning digital and mobile health interventions, 1.3 Using digital and mobile health interventions; and 1.6 Alcohol use, are based on the evidence and the committee's discussion from evidence review B: alcohol.\n\nResearch recommendations:\n1. How can providers and healthcare professionals identify groups that do not initially engage, or do not stay engaged, with digital and mobile health behaviour change interventions?\n2. What components and characteristics of digital and mobile health behaviour change interventions are most effective, separately and in combination, to achieve behaviour change?\n3. What is the effectiveness and cost effectiveness of digital and mobile health behaviour change interventions in low socioeconomic and other underserved groups?\n4. Are digital and mobile health behaviour change interventions as effective as face-to-face, standard care, or combination approaches for some populations?\n5. What are the harms and adverse effects associated with different digital and mobile health behaviour change interventions?"]
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[null,"National  Institute for Health and Care Excellence (2019). Alcohol interventions in secondary and further education. [A] Evidence review for universal interventions. London: NICE [NICE guideline NG135].\nAvailable here.","CYP (11 to 18years) in full time education.\nYP (18 to 25 years) with an Education, health and care (EHC) plan.\n","This evidence review underpinning NG135 looked at classroom-based alcohol prevention interventions, school-based alcohol interventions outside the classroom as well as school-based multicomponent interventions for alcohol. For summary of results and evidence statements, please refer to the full-text.\n\nUniversal classroom interventions: The evidence generally shows that universal classroom-based interventions are no better than usual education at reducing alcohol initiation or the amount and frequency of alcohol use. However, some studies showed a reduction in truancy and some alcohol harms (ranging from drinking until feeling sick to regretted sex and being in trouble with the police) and psychological distress among children and young people predominantly aged between 11 and 15 years.\nNo evidence was found for age at first experience of drunkenness. No evidence was reported for adverse effects.\n\nUniversal intervention based outside the classroom: The evidence suggests that universal interventions based outside of the classroom may reduce the outcome of lifetime alcohol use among children and young people predominantly aged between 11 and 13 years. By delaying the onset of alcohol use, age at first intoxication is potentially delayed and consequently the associated risks are prevented or reduced.\nFor other alcohol outcomes, the evidence generally shows no difference for preventing or reducing alcohol use, frequency of use, heavy use, and quantity consumed. This was the same for school attendance, risky behaviours and alcohol problems.\nNo evidence was found for age at first drink, age at first experience of drunkenness. No evidence was reported for adverse effects.\n\nUniversal multi-component interventions: The evidence generally shows that universal multi-component interventions are no better than usual education at reducing alcohol initiation or the amount and frequency of alcohol use. For other alcohol outcomes, the evidence generally shows no difference for reducing alcohol use, risky behaviour or mental health and wellbeing.\nNo evidence was found for age at first drink, age at first experience of drunkenness or school attendance. No evidence was reported for adverse effects but limited evidence suggests a universal multi-component intervention may increase the tendency to use alcohol.\n\nNo evidence was identified for young people aged 18 to 25 with SEND, therefore the committee sought expert testimony.","The recommendations 1.1 Planning alcohol education and 1.2 Delivering universal alcohol education, are based on the evidence and the committee's discussion from evidence review A: universal interventions.\n\nResearch recommendations:\n1. What components of alcohol education delivery contribute to its effectiveness for children and young people aged 11 to 18 in full-time education, and those with special educational needs and disabilities (SEND) up to the age of 25?\n3. How effective and cost effective are universal, education-based alcohol interventions for children and young people aged 11 to 25 with SEND?\n5. How effective are education-based alcohol prevention interventions (universal or targeted) for children and young people aged 11 to 25 with SEND in full-time education?\n6. What methods and techniques help secondary schools and providers to effectively engage with parents and carers as part of a whole-school approach to promote and support alcohol education?"]
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[null,"National  Institute for Health and Care Excellence (2019). Alcohol interventions in secondary and further education. [B] Evidence review for targeted interventions. London: NICE [NICE guideline NG135].\nAvailable here.","CYP (11 to 18years) in full time education considered ‘at risk’.\nYP (18 to 25 years) EHC plan considered ‘at risk’.","This evidence review underpinning NG135 aimed to answer the following questions:\nRQ 2.1: What school-based targeted alcohol interventions and pastoral support are effective and cost effective in children and young people aged 11 up to and including 18 years?\nRQ 4.1: What school-based targeted alcohol interventions and pastoral support are effective and cost effective among young people aged 18 up to and including 25 years with special educational needs and disabilities (SEND)?\n\nEvidence statements for 11 to 18 year olds:\nAge at first use and Age at first experience of drunkenness: No data reported.\n\nAmount and frequency of alcohol use: Very low quality evidence showed no significant difference in alcohol users at 4-12 months or reduced mean alcohol frequency for ‘at risk’ students receiving a school-based targeted intervention (usually brief interventions such as motivational interviewing) compared to the control group who received no intervention or usual education or minimal intervention. Whereas one RCT showed a significant difference in reduced drinking rates at 6 months for ‘at risk’ students receiving a personality-targeted group intervention compared to statutory drug education (aOR 0.6 95% CI 0.4, 0.8) and another RCT showed a significant difference in mean alcohol frequency at 6 months for ‘at risk’ students receiving brief intervention compared to assessment only (MD -1.56 95% CI -2.07, -1.02).\n\nBinge drinking: Low quality evidence showed no significant difference in binge drinking rates for ‘at risk’ students receiving a school-based targeted intervention (usually brief interventions such as motivational interviewing) compared to the control group who received no intervention or usual education or minimal intervention at 6-12 months (results were not pooled, 3 RCTs) whereas one RCT showed a significant difference in reduced binge drinking rates at 4 months for ‘at risk’ students receiving personality-targeted group intervention compared to no treatment control (RR 0.7 95% CI 0.6, 0.9).\n\nMean alcohol consumption: Moderate quality evidence from 3 RCTs showed no significant difference in reduction of mean alcohol consumption at 2-12 months for ‘at risk’ students receiving a school-based targeted intervention (usually brief interventions such as motivational interviewing) compared to the control group who received no intervention or usual education or minimal intervention (results were not pooled).\n\nMean alcohol quantity/frequency: Low quality evidence from 2 RCTs showed no significant difference in mean alcohol quantity/frequency at 6-12 months for ‘at risk’ students receiving a school-based targeted intervention (personality-targeted interventions) compared to the control group who received usual education or minimal intervention (results were not pooled).\n\nAlcohol related harms: Low quality evidence from 1 RCT suggests a significant difference for increased alcohol use problems in ‘at risk’ students receiving a school-based targeted intervention compared to control group (aRR 1.4 1.1 95% CI 1.1 to 1.7.).\n\nEvidence statements for SEND population (18 to 25 years): No evidence was identified for this question.","The recommendations 1.1 Planning alcohol education and 1.3 Targeted interventions, are based on the evidence and the committee's discussion from evidence review B: targeted interventions.\n\nResearch recommendations:\n2. How effective and cost effective are individual, compared with group, education-based interventions for children and young people aged 11 to 18 in full-time education who are thought to be vulnerable to alcohol misuse?\n4. How effective and cost effective are education-based alcohol interventions targeted at children and young people aged 11 to 25 with SEND who are thought to be vulnerable to alcohol misuse?\n5. How effective are education-based alcohol prevention interventions (universal or targeted) for children and young people aged 11 to 25 with SEND in full-time education?"]
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[null,"School of Health and Related Research (2014). Nalmefene for reducing alcohol consumption in people with alcohol dependence: A Single Technology Appraisal. London: NICE [NICE guideline TA325].\nAvailable here.\n\nNICE reviewed the evidence for TA325 in March 2018. They found found nothing new that affects the recommendations in this guidance. This guidance will be reviewed if there is new evidence that is likely to affect the recommendations.","Adults with mild alcohol dependence (as defined in NICE CG115) who have a high drinking risk level (≥ 60 g/day of pure alcohol for men and ≥ 40 g/day for women) without physical withdrawal symptoms and who do not require immediate detoxification","Clinical effectiveness: 4.6 The Committee considered the clinical‑effectiveness results of the 3 nalmefene studies. It agreed that it should only consider the post hoc subgroup analyses carried out on trial patients in the 3 nalmefene studies with a high or very high drinking risk level at baseline who maintained such a level at randomisation because these analyses formed the basis of the licensed population in the marketing authorisation for nalmefene. The Committee was aware that the subgroup analyses had not been pre‑specified but had been performed because 18% (ESENSE1), 33% (ESENSE2) and 25% (SENSE) of patients reduced drinking between screening study visits and randomisation, therefore leaving little scope for additional improvement. The Committee noted the ERG's concerns that the subgroup efficacy data may be less robust because none of the studies were powered for this analysis and initial randomisation may have been lost with the high dropout rate possibly affecting the results. It was also aware that the Scientific Advisory Group to the European Medicines Agency recognised the validity of the subgroup analyses and that these analyses formed the basis of the licensed population in the marketing authorisation for nalmefene. The Committee accepted that the post hoc subgroup analyses were sufficiently robust to use in its decision‑making. It noted that the results from the post hoc subgroup analyses suggested that people in the nalmefene plus BRENDA group had fewer heavy drinking days per month and total alcohol consumption per day compared with those who received placebo plus BRENDA. However, the Committee was concerned that the differences between the treatment groups were relatively small (13% in heavy drinking days and 11% in total alcohol consumption), suggesting that most of the treatment gain from nalmefene could be attributed to the psychosocial support (BRENDA). The Committee heard from the clinical experts that both the number of heavy drinking days and total alcohol consumption are clinically relevant outcome measures and that although the reduction in these outcomes appear modest, they are clinically significant. The Committee concluded that nalmefene plus BRENDA reduces the number of heavy drinking days and total alcohol consumption compared with BRENDA alone, although the exact magnitude of effect was uncertain because of the post hoc subgroup analyses and the trials were not powered for these analyses.\n\n4.7 The Committee noted that there were no trials directly comparing nalmefene plus psychosocial support with naltrexone plus psychosocial intervention, and the company had not presented an indirect comparison of the 2 treatments. The Committee accepted the rationale provided by the company and that the ERG had agreed it would be inappropriate to carry out an indirect comparison given the limitations of the naltrexone studies identified by the company. The Committee concluded that it would not consider further the comparison of nalmefene plus psychosocial support compared with naltrexone plus psychosocial intervention in its decision‑making.","Recommendation 1.1 states Nalmefene is recommended within its marketing authorisation, as an option for reducing alcohol consumption, for people with alcohol dependence:\n● who have a high drinking risk level (defined as alcohol consumption of more than 60 g per day for men and more than 40 g per day for women, according to the World Health Organization's drinking risk levels) without physical withdrawal symptoms and\n● who do not require immediate detoxification.\nThe marketing authorisation states that nalmefene should:\n● only be prescribed in conjunction with continuous psychosocial support focused on treatment adherence and reducing alcohol consumption and\n● be initiated only in patients who continue to have a high drinking risk level 2 weeks after initial assessment."]
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[null,"The National Clinical Guideline Centre for acute and chronic conditions (2014). Alcohol use disorders: diagnosis and clinical management of alcohol-related physical complications. London: NICE [NICE guideline CG100].\nAvailable here.\n\nJanuary 2019: NICE checked this guideline and are updating it. For more information, see the surveillance decision.","Adults and young people (aged 10 years and older) who have an alcohol-use disorder and whose condition is wholly alcohol attributable or where alcohol is a contributory cause","This guidance covers diagnosis and clinical management of a range of alcohol-related physical complications. However, as this map focuses on interventions for prevention and/or treatment of alcohol misuse, only Clinical evidence statements relavent to the scope of this map have been extracted below.\n\n2.2.3 Clinical evidence statements (Refer to table 2.2 in the full report for a summary of results)\nBenzodiazepines versus placebo: A meta-analysis of three studies (Chlordiazepoxide N=2, Lorazepam N=1) found that benzodiazepines were significantly more effective than placebo (RR: 0.16 [95% CI: 0.04 to 0.69] p=0.01) for alcohol withdrawal seizures. But there were no significant differences for therapeutic success, mortality, side effects or discontinuation due to side effects.\n\nBenzodiazepines versus benzodiazepines: There were non-significant differences when one benzodiazepine was compared with another benzodiazepine for alcohol withdrawal seizures, therapeutic success, mortality, side effects, life threatening side effects, discontinuation due to side effects, alcohol withdrawal delirium, Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) score (change from baseline) at 48 hours or CIWA-Ar score (change from baseline) at end of treatment.\n\nBenzodiazepines versus carbamazepine: There were no significant differences when benzodiazepines were compared with anticonvulsants for alcohol withdrawal seizures, mortality, side effects, discontinuation due to side effects, alcohol withdrawal delirium, CIWA-Ar score (change from baseline) at 48 hours or CIWA-Ar score (change from baseline) at end of treatment.\n\nBenzodiazepines versus clomethiazole: There were non-significant differences when benzodiazepines was compared with clomethiazole for alcohol withdrawal seizures, therapeutic success, mortality, side effects, life threatening side effects or discontinuation due to side effects.\n\nClomethiazole versus placebo: There were no results reported in the Cochrane systematic review for the outcomes specified.\n\nCarbamazepine versus placebo: No relevant papers were identified.","Based on the evidence statements in this 2014 update, CG100 makes the following recommendations:\n\nR5. Offer pharmacotherapy to treat the symptoms of acute alcohol withdrawal as follows:\n• Consider offering a benzodiazepine or carbamazepine.\n• Clomethiazole may be offered as an alternative to a benzodiazepine or carbamazepine. However, it should be used with caution, in inpatient\nsettings only and according to the summary of product characteristics.\n\nR6. People with decompensated liver disease who are being treated for acute alcohol withdrawal should be offered advice from a healthcare professional experienced in the management of patients with liver disease.\n\nR7. Offer information about how to contact local alcohol support services to people who are being treated for acute alcohol withdrawal.\n\nResearch recommendations: RR2. What is the efficacy and cost effectiveness of clomethiazole compared with chlordiazepoxide or carbamazepine or benzodiazepines for the treatment of acute alcohol withdrawal with regard to the outcomes of withdrawal severity, risk of seizures, risk of delirium tremens, length of treatment and patient satisfaction?\n\n"]
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[null,"Bazian (2012). Review 1: Individual-Level Behaviour Change: review of current NICE guidance and recommendations. London: NICE [NICE guideline PH49].\nAvailable here.\n\nMarch 2019: NICE checked this guideline. They found no new evidence that affects the recommendations in this guideline.","Everyone aged 16 years and older","Review 1: ‘Individual-level behaviour change: review of current NICE guidance and recommendations’ aimed to describe individual-level interventions, recommended by existing NICE Public Health Guidance, for changing behaviour in the target areas of smoking cessation, reducing alcohol consumption, promoting a healthy diet, physical activity and sexual health. However, as this map focuses on interventions for prevention and/or treatment of alcohol misuse, only evidence statements relavent to the scope of this map have been extracted below.\n\n1.15 There was evidence from 2 systematic reviews quoted in NICE public health guidance 6 that showed evidence of a small positive effect of brief behavioural counselling interventions in reducing alcohol intake (mean reduction of approximately 4 drinks per week) in problem drinkers. There was evidence from a systematic review of RCTs showing a small, positive effect of behavioural counselling interventions in reducing alcohol consumption.\n\n1.16 There is evidence from 27 systematic reviews that show brief counselling interventions are effective in reducing consumption in hazardous drinkers. Six of the systematic reviews demonstrated that interventions delivered in primary care are effective in reducing alcohol-related negative outcomes. Evidence of effectiveness in other settings (emergency care, inpatient and outpatient settings and the workplace) was limited or inconclusive.\n\n1.17 There is evidence from 1 systematic review that 1 or more motivational interviews including reflection on the issues related to substance misuse (alcohol, tobacco or illicit drug use), in conjunction with goal setting to reduce or stop misusing substances, are effective at initiating behaviour change for (3 to 4 months) but are not effective in the medium or long term (at 12 months).\n\n1.18 The most effective interventions for reducing alcohol consumption in adults and vulnerable young people appear to be brief counselling interventions and extended brief interventions. For people classed as problem drinkers there is evidence from multiple systematic reviews supporting the effectiveness of brief interventions delivered in primary care with a range of underlying behavioural change components.\n","Based on the evidence statements 1.15 to 1.18 in this review, PH49 makes the following recommendations:\n\nR7. Use proven behaviour change techniques when designing interventions\nR10. Ensure behaviour change is maintained for at least a year\n\nNo recommendations for further research were based on Review 1."]
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[null,"Bazian (2012). Review 2: Individual-Level Behaviour Change: review of evidence of effectiveness of interventions and behaviour change techniques in individual level interventions. London: NICE [NICE guideline PH49].\nAvailable here.\n\nMarch 2019: NICE checked this guideline. They found no new evidence that affects the recommendations in this guideline.","Adults aged 16 and over with an existing health status or behaviour that implies the need for behaviour change relating to one of the five areas described above.\nSpecifically target those aged 16 and over in schools/colleges","Review 2: ‘Individual-level behaviour change: review of evidence of effectiveness of interventions and behaviour change techniques in individual level interventions’ is a review of the evidence of effectiveness of interventions and BCTs in individual-level interventions for eliciting and maintaining behaviour change in the fields of sexual health, alcohol, smoking, diet and physical activity. This map focuses on interventions for prevention and/or treatment of alcohol misuse and only evidence statements relavent to the scope of this map have been extracted below. Additionally, only the strongest evidence statements for interventions targeting alcohol among specific populations are provided. For a complete list of topic specific evidence statements including statements supported by limited or inconsistent evidence, and for further information on the behaviour change techniques reported in the interventions, refer to the full-text.\n\n2.1 Overall Effectiveness of alcohol behaviour change interventions, BCT clusters and intervention functions: There is strong evidence from 32 trials describing 50 interventions that individual level behaviour change interventions can have a small effect on alcohol consumption behaviour, with an effect size of 0.11 (95% CI 0.06 to 0.16).\n\n2.5 Alcohol behaviour change interventions among hospital and Emergency Department patients: Strong evidence from ten interventions described in six trials suggests that alcohol interventions delivered to Emergency Department or hospital patients are no more effective than usual care at altering alcohol consumption.\n\n2.6 Brief alcohol interventions among university students: Moderate evidence from six trials assessing eleven interventions suggests that brief alcohol interventions delivered either face to face, one on one or remotely are no more effective than comparators at changing the drinking behaviours of university students.\n\n2.7 Extended alcohol interventions among university students: Strong evidence was identified from ten interventions described in six studies that extended face to face interventions delivered one on one or to groups are no more effective than comparators at altering the drinking behaviour of university students (SMD range -0.23 to 0.51; all non-significant).\n\n2.8 Multi-session alcohol interventions delivered face to face and one on one among university students: Moderate evidence from three trials describing four alcohol behaviour change interventions suggests that that multi-session alcohol interventions are no more effective than comparators at altering drinking behaviour among university students.\n\n2.9 Multi-session alcohol interventions among patients with or at risk for a cardiovascular condition: Moderate evidence from three trials suggests that multi-session, face to face interventions that target multiple risk behaviours no more effective than usual care at reducing alcohol consumption among individuals with or at risk for cardiovascular conditions.\n\n2.11 Alcohol interventions among individuals recruited in non-primary care settings: Moderate evidence from five trials suggests that brief interventions and multi-session interventions are no more effective than comparators at changing alcohol consumption among risky drinkers in non-primary care settings.","Based on the evidence statements 2.1 to 2.13 in this review, PH49 makes the following recommendations:\n\nR7. Use proven behaviour change techniques when designing interventions\nR10. Ensure behaviour change is maintained for at least a year\n\nResearch recommendations: 5.7 How do behaviour change techniques lead to change? What are the best methods of testing the relationship between the theories that describe change processes and the effectiveness of interventions in practice?"]
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[null,"The National Clinical Guideline Centre for mental health. Alcohol use disorders: The NICE guideline on diagnosis, assessment and management of harmful drinking and alcohol dependence. 2011. London: NICE [NICE guideline CG115].\nAvailable here.","Adults and young people (aged 10 years and older) who have an alcohol-use disorder and whose condition is wholly alcohol attributable or where alcohol is a contributory cause","This guidance addresses the management of alcohol dependence and harmful alcohol use in people aged 10 years and older, including assessment, pharmacological interventions, psychological and psychosocial interventions, and settings of assisted withdrawal and rehabilitation.\n\nChapter 6 is concerned with structured psychological interventions used to help people who experience alcohol dependence or harmful alcohol use.\n6.5 Review of Psychological therapies: This section aims to review the evidence for psychological interventions without pharmacological interventions for the treatment of alcohol dependence and harmful alcohol use. Refer to full-text for evidence summary of the psychological interventions considered for inclusion in this review.\n6.22 Special populations- Children and young people: This section aims to review the evidence for psychological interventions for the treatment of alcohol dependence and harmful alcohol use in children and young people. Refer to full-text for evidence summary of the psychological interventions considered for inclusion in this review.\n\nChapter 7 aims to detail the utility and efficacy of pharmacological interventions in the treatment of alcohol misuse. It focuses on the use of pharmacological interventions in the promotion of abstinence and the reduction in alcohol consumption, and the treatment of comorbid disorders.\n7.2 Review of pharmacological interventions: The review aimed to evaluate all available pharmacological interventions for relapse prevention. This was conducted for adults and, where evidence was available, separately for special populations such as children and young people or older people. Refer to full-text for evidence summary of the pharmacological treatments considered for inclusion in this review.\n\nOctober 2022: NICE updated the recommendation about behavioural couples therapy to clarify that this is not suitable in cases of domestic abuse and to add a cross reference to the NICE technology appraisal guidance on nalmefene. They also updated information about off-label prescribing, and added cross references to legislation on controlled drugs and driving, to MHRA advice on addiction to benzodiazepines and codeine, and to NICE's guidelines on smoking, on antisocial personality disorder and on coexisting mental illness and substance misuse community health and social care services.\n\nJuly 2019: NICE found no new evidence that affects the recommendations.","The evidence from the 2011 evidence reviews supports recommendations 1.1 Principles of care, 1.2 Identification and assessment and 1.3 Interventions for alcohol misuse.\n\nResearch recommendations:\n1 Is contingency management effective in reducing alcohol consumption in people who misuse alcohol compared with standard care?\n2 What methods are most effective for assessing and diagnosing the presence and severity of alcohol misuse in children and young people?\n3 Is acupuncture effective in reducing alcohol consumption compared with standard care?\n4. For which service users who are moderately and severely dependent on alcohol is an assertive community treatment model a clinically and cost-effective intervention compared with standard care?\n5. For people with moderate and severe alcohol dependence who have significant comorbid problems, is an intensive residential rehabilitation programme clinically and cost effective when compared with intensive community-based care?\n6 For people with alcohol dependence, which medication is most likely to improve adherence and thereby promote abstinence and prevent relapse?"]
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[null,"The National Clinical Guideline Centre for mental health. Psychosis with coexisting substance misuse: Assessment and management in adults and young people. 2011. London: NICE [NICE guideline CG120].\nAvailable here.","People with psychosis and coexisting substance misuse","CG120 has been developed to advise on the assessment and management of adults and young people (aged 14 years and older) with psychosis and coexisting substance misuse.\n\nChapter 7 Psychological and psychosocial interventions:  Please refer to full-text for evidence summary of the psychological interventions considered for inclusion in this review. Additionally, only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n7.2.7 Clinical evidence summary: For the majority of interventions included in related NICE guidelines, the current systematic review found no direct evidence for people with psychosis and coexisting substance misuse (see Table 29 in full text). With regard to the evidence that was available, it should be interpreted with some caution because the research was not conducted in the UK and methodological issues limit the quality of the evidence.\n\nChapter 8 Pharmacological and physical interventions: Please refer to full-text for evidence summary of the pharmacological and physical interventions considered for inclusion in this review.\n8.2.9 Clinical evidence summary: There is limited evidence from well conducted RCTs for the relative effectiveness of pharmacological treatments for people with psychosis and coexisting substance misuse, either for psychosis or aimed at improving substance misuse. There is also little data on interactions between drugs given as medication and drugs of misuse. See Table 33 in full-text for a summary for each medication.\n\nChapter 9 Young people with psychosis and coexisting substance misuse: The review questions relating to young people with psychosis and coexisting substance misuse were sub-questions of those for adults. \n9.8.6 Clinical evidence summary: In one small trial (N  25) assessing pharmacological interventions for young people, lithium was compared with placebo. Based on this evidence (GRADED low quality), it was not possible to reach a decision about the effectiveness of pharmacological interventions for young people with psychosis and coexisting substance misuse. There was no evidence for psychological or psychosocial interventions for young\npeople with psychosis and coexisting substance misuse.\n\nNovember 2016: NICE reviewed the evidence and found no new evidence that affects the current recommendations in this guideline.","The evidence from the 2011 evidence reviews supports recommendations 1.1 to 1.8.\n\nResearch recommendations:\n1. What are the prevalence, risk and protective factors, and course of illness for different combinations of psychosis and coexisting substance misuse (for example, schizophrenia and cannabis misuse or bipolar disorder and alcohol misuse)?\n2. What risk factors predict the onset of substance misuse in young people with psychosis?\n3. Are psychosocial interventions clinically and cost effective when compared with standard care for people with psychosis and coexisting substance misuse?\n4. Are environmental interventions clinically and cost effective when compared with standard care for people with psychosis and coexisting substance misuse?\n5. Is clozapine clinically and cost effective when compared with other pharmacological interventions for people with psychosis and coexisting substance misuse?"]
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[null,"Jackson R et al. Interventions on control of alcohol price, promotion and availability for prevention of alcohol use disorders in adults and young people. Sheffield: ScHARR Public Health Collaborating Center, University of Sheffield; 2010.\nAvailable here.","CYP and adults","This report underpinning PH24 includes the findings of the systematic reviews of the effectiveness of price controls, interventions in the management of the availability of alcohol, and the control of alcohol promotion. Only evidence statements that form the bases for the current recommendations and are relevant to this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nReview 1: The effectiveness of price controls in reducing alcohol consumption, alcohol misuse, alcohol-related harm or alcohol-related social problems among adults and young people\nEvidence statements 1.1 to 1.4 from this review form bases of the current recommendations. Please read full-text for further information.\n\nReview 2: The effectiveness of interventions in managing alcohol availability to reduce levels of consumption, alcohol misuse, alcohol-related harm or alcohol-related social problems among adults and young people\nEvidence statements 2.4, 2.5, 2.8, 2.9, 2.19 to 2.23 from this review form bases of the current recommendations. Please read full-text for further information.\n\nReview 3: The effectiveness of the control of alcohol promotion (e.g. advertising) in reducing levels of consumption, alcohol misuse, alcohol-related harm or alcohol-related social problems among adults and young people\nEvidence statements 3.1 to 3.4, 3.6 and 3.8 from this review form bases of the current recommendations. Please read full-text for further information.\n\nJuly 2019: NICE checked this guideline and are updating it. For more information, see the surveillance decision.","The evidence from the 2011 evidence reviews supports recommendations 1: Price, 2: Availability, 3: Marketing and 4: Licensing.\n\nThe underpinning evidence reviews in this report identifed several gaps in the evidence and made recommendations for further research with the following overarching question:\nHow does advertising by industry and health agencies affect the drinking behaviour of the population as whole? (This includes the use of new media.)\n\n"]
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[null,"Jackson R et al. Screening and brief interventions for prevention and early identification of alcohol use disorders in adults and young people. Sheffield: ScHARR Public Health Collaborating Center, University of Sheffield; 2010a.\nAvailable here.","CYP and adults","This report underpinning PH24 includes the findings of the systematic reviews relating to patterns of alcohol consumption, screening, brief interventions, and barriers and facilitators to implementation of screening and brief interventions. \n\nReview 4: Patterns of alcohol consumption \nNone of the evidence statements from this evidence review currently form the basis of the current recommendations.\n\nReview 5: The effectiveness of alcohol screening questionnaires, biochemical indicators and clinical indicators of alcohol misuse in identifying adults and young people who currently misuse or are at risk of misusing alcohol\nEvidence statements 5.1, 5.2, 5.5 to 5.7 and 5.9 to 5.11 from this review form bases of the current recommendations. Please read full-text for further information.\n\nReview 6: The effectiveness of brief interventions in preventing hazardous and harmful drinking among adults and young people\nEvidence statements 6.1 to 6.4, 6.10 and 6.11 from this review form bases of the current recommendations. Please read full-text for further information.\n\nJuly 2019: NICE checked this guideline and are updating it. For more information, see the surveillance decision.","The evidence from the 2011 evidence reviews supports recommendations 5: Resources for screening and brief interventions, 7: Screening young people aged 16 and 17 years, 8: Extended brief interventions with young people aged 16 and 17 years, 9: Screening adults and 10: Brief advice for adults\n\nThe underpinning evidence reviews in this report identifed several gaps in the evidence and made recommendations for further research with the following overarching question:\nHow does advertising by industry and health agencies affect the drinking behaviour of the population as whole? (This includes the use of new media.)\n\n"]
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[null,"Jepson R et al. A review of the effevtiveness of interventions, approaches and models at individual, community and population level that are aimed at changing health outcomes through changing knowledge, attitudes and behaviour. 2006. London: NICE [NICE guideline CG120]\nAvailable here.","General population","This document is the summary of a ‘review of reviews’, which aims to bring together a large body of evidence and provide a critical and structured overview of the effectiveness of interventions and models to change attitudes, knowledge and behaviours in six different areas: cigarette smoking, alcohol drinking (excluding alcohol dependence), physical activity, healthy eating (excluding diet for weight loss), illicit drug use (excluding drug dependence) and sexual risk taking in young people. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\n3.1.3 Alcohol Misuse\nEvidence summary for interventions aimed at individuals: There was evidence of a small positive effect of brief behavioural counselling interventions in reducing alcohol intake (mean reduction of approximately 4 drinks per week) in problem drinkers. There was variable quality evidence showing a small, positive effect of behavioural counselling interventions in reducing alcohol consumption. There was insufficient evidence of effect for home visits for women who were alcohol misusers. For drink drivers, there was evidence of an effect of alcohol interlock programmes (car ignition locked until the driver provided an appropriate breath specimen), but the effect of other interventions was inconclusive due to the variable quality of the review.\nEvidence summary for interventions aimed at communities: There was evidence of a positive effect of school-based instructional programmes for reducing riding with drinking drivers. However, there was insufficient evidence to determine the effectiveness of these programmes for reducing drinking and driving. There was also insufficient evidence to determine the effectiveness of peer organizations and social norming campaigns, due to the small number of available studies. There was evidence of mixed effect for psychological interventions aimed at preventing the onset of alcohol use or alcohol misuse by young people.\nSummary of evidence for interventions aimed at populations: Two reviews evaluated mass media interventions, and two evaluated legislative interventions. None of the four reviews included evidence from RCTs (mainly because of the difficulty of doing such trials in these areas). In addition, three out of the four reviews were of variable quality. No reviews evaluated evidence relating to mass media interventions to promote ‘safe’ drinking levels or reduce ‘risk drinking’ (e.g. binge drinking). The variable quality reviews found that effective interventions included mass media campaigns, minimum drinking laws, and low blood alcohol concentration law on alcohol and driving related outcomes.\n\nNovember 2017: NICE checked this guideline and found no new evidence that affects the recommendations in this guideline.","The evidence from the 2006 evidence review supports recommendations under Planning, Delivery and Evaluation.\n\nThe Programme Development Group identified a number of gaps in the evidence related to behaviour change interventions and programmes, based on an assessment of the evidence and made recommendations for research to address the most important gaps in the evidence. Please refer to 4. Recommendations for research' section of the guidance.\n\n"]

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[null,"Safe and Supportive Environment - NICE guidance"]
[null,"Source:","Population:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Alcohol interventions in secondary and further education. NG135. London: NICE; 2019. \nAvailable here.\n","• CYP (11 to 18years) in full time education.\n• YP (18 to 25 years) with an Education, health and care (EHC) plan.\n• CYP (11 to 18years) in full time education considered ‘at risk’.\n• YP (18 to 25 years) EHC plan considered ‘at risk’.","This guideline covers interventions in secondary and further education to prevent and reduce alcohol use among children and young people aged 11 up to and including 18. It also covers people aged 11 to 25 with special educational needs or disabilities in full-time education. It will also be relevant to children aged 11 in year 6 of primary school.\n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n1.1 Planning alcohol education\n1.2 Delivering universal alcohol education (Evidence Review A: Universal interventions)\n1.3 Targeted interventions (Evidence review B: Targeted interventions)\n\nThe following recommendations for further research were also identified in Evidence review A and B:\n1. What components of alcohol education delivery contribute to its effectiveness for children and young people aged 11 to 18 in full-time education, and those with special educational needs and disabilities (SEND) up to the age of 25? (Evidence review A: universal interventions)\n2. How effective and cost effective are individual, compared with group, education-based interventions for children and young people aged 11 to 18 in full-time education who are thought to be vulnerable to alcohol misuse? (Evidence review B: targeted interventions)\n3. How effective and cost effective are universal, education-based alcohol interventions for children and young people aged 11 to 25 with SEND? (Evidence review A: universal interventions)\n4. How effective and cost effective are education-based alcohol interventions targeted at children and young people aged 11 to 25 with SEND who are thought to be vulnerable to alcohol misuse? (Evidence review B: targeted interventions)\n5. How effective are education-based alcohol prevention interventions (universal or targeted) for children and young people aged 11 to 25 with SEND in full-time education? (Evidence review A: universal interventions and Evidence review B: targeted interventions)\n6. What methods and techniques help secondary schools and providers to effectively engage with parents and carers as part of a whole-school approach to promote and support alcohol education? (Evidence review A: universal interventions)\n"]
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[null,"National Institute for Health and Care Excellence. Alcohol-use disorders: prevention. PH24. London: NICE; 2010\nAvailable here.\n\n\n\n","Children, young people and adults aged 10 years and above","This guideline covers alcohol problems among people over 10. It aims to prevent and identify such problems as early as possible using a mix of policy and practice.\n\nThe guideline includes the following recommendations. All the recommendations are relevant to the scope of this topic evidence map. The recommendations are supported by the underpinning Evidence reviews 1-3 and Evidence reviews 4-6:\n• Price, availability and marketing\n• Licencing\n• Supporting children and young people aged 10 to 15 years\n• Screening young people aged 16 and 17 years and offering them extended brief interventions\n• Screening adults and offering them brief advice and interventions\n• Referral\n\nThe underpinning evidence reviews in this report identifed several gaps in the evidence and made recommendations for further research with the following overarching question:\nHow does advertising by industry and health agencies affect the drinking behaviour of the population as whole? (This includes the use of new media.)\n\nJuly 2019: NICE checked this guideline and are updating it. For further information, see the surveillance decision."]
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[null,"Safe and Supportive Environment - Universal Interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' Conclusions:"]
[null,"Wolfenden, L. Strategies to improve the implementation of workplace-based policies or practices targeting tobacco, alcohol, diet, physical activity and obesity. Cochrane database Syst Rev 2018, Issue 11. Art. No.: CD012439. DOI: 10.1002/14651858.CD012439.pub2\nAvailable here. ","Adults in the workplace.","This review aimed to assess the effects of strategies for improving the implementation of workplace-based policies or practices targeting diet, physical activity, obesity, tobacco use and alcohol use. Six trials were included, four of which took place in the USA. Four trials employed randomised controlled trial (RCT) designs. Trials were conducted in workplaces from the manufacturing, industrial and services‐based sectors. The sample sizes of workplaces ranged from 12 to 114. Workplace policies and practices targeted included: healthy catering policies; point‐of‐purchase nutrition labelling; environmental supports for healthy eating and physical activity; tobacco control policies; weight management programmes; and adherence to guidelines for staff health promotion. All implementation interventions utilised multiple implementation strategies, the most common of which were educational meetings, tailored interventions and local consensus processes. \n\nOne included trial reported the effects of a workplace health promotion intervention on employee alcohol use (Parker 2010). However, as the implementation strategy and policies and practices targeted by the intervention did not include those addressing alcohol use, the effects on employee alcohol use reported in this trial were not included in the review. None of the other included trials reported effects of implementation strategies on this outcome. \n","Available evidence regarding the effectiveness of implementation strategies for improving implementation of health‐promoting policies and practices in the workplace setting is sparse and inconsistent. Low certainty evidence suggests that such strategies may make little or no difference on measures of implementation fidelity or different employee health behaviour outcomes. It is also unclear if such strategies are cost‐effective or have potential unintended adverse consequences. The limited number of trials identified suggests implementation research in the workplace setting is in its infancy, warranting further research to guide evidence translation in this setting."]
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[null,"Safe and Supportive Environment - Selective Interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' Conclusions:"]
[null,"Moledina A et al (2021). A comprehensive review of prioritised interventions to improve the health and wellbeing of persons with lived experience of homelessness. Campbell Systematic Reviews, 17, e1154.\nAvailable here. ","Populations experiencing homelessness, defined as those who lack stable, permanent, appropriate housing, or who may be without immediate prospects, means, and ability to acquire it","The objective of this systematic review is to identify, appraise, and synthesise the best available evidence on the benefits and cost-effectiveness of interventions to improve the health and social outcomes of people experiencing homelessness.\n\nEligible interventions included permanent supportive housing (PSH), income assistance, standard case management (SCM), peer support, mental health interventions such as assertive community treatment (ACT), intensive case management (ICM), critical time intervention (CTI) and injectable antipsychotics, and substance-use interventions, including supervised consumption facilities (SCFs), managed alcohol programmes and opioid agonist therapy. Outcomes of interest were housing stability, mental health, quality of life, substance use, hospitalisations, employment and income. Only results relevant to this topic evidence map have been extracted below.\n\nManaged alcohol programmes: The review did not identify any eligible studies.\n\nPermanent supportive housing: The effect of permanent housing on substance use was reported in nine trials. Out of these three studies reported improvements in alcohol and drug use in both groups, over time, but no differential benefit of the HF initiative. One study on homeless clients with problematic substance reported no group differences in problems associated with alcohol use, though both groups decreased their alcohol consumption over time. Hybrid approaches to housing (“integrative” versus “parallel” housing) were investigated in a single study. It found no statistically significant difference in the reported days of alcohol use or reported days of drug use both between groups as well as over time. Of note, analysis for this outcome had a lower statistical power as it was restricted to individuals who reported use at the baseline.\n\nIncome-assistance intervention: Four studies examined the effects of income-assistance intervention on substance use. For homeless veterans with substance dependence, CWT immediately reduced the consumption of alcohol and drugs within the first 3 months (β = −44.7%; 95% CI, −69.7% to −19.7%; t = 3.51; p = .001). The addition of priority access to housing vouchers for veterans with a diagnosis of a major psychiatric disorder or an alcohol/drug disorder, compared to existing case management, led to decreased days of drinking to intoxication (1.46 vs. 1.95, t = 0.73, p = .0053) and fewer days of alcohol use over the 3-year study period. However, no significant association was identified between priority access to housing subsidies and differences in the scores of the Addiction Severity Index (ASI). For homeless families with children aged 15 or younger, rental subsidies without case management did not lead to decreased use of substance compared to the usual community housing services.\n\nSCM and peer support interventions: Six studies reported on substance-use outcomes with different SCM treatments. Homeless male veterans with addictions problems with three to 6 months of hospital stays plus case management showed better improvements in the alcohol- and drug-use composite scores, but these were short-lived compared to TAU after 24 months. A three-arm trial reported reductions in average days of alcohol and drug consumption in a case-management-only group, a CM-with-supported-housing group in graduates of short-term in-patient substance-use programme who lacked housing. Homeless alcohol abusers who were offered different intensities of SCM (n = 469) showed no significant between-group differences in days of alcohol use. Similarly, a three-arm trial with homeless women and their intimate partners found no significant differences in substance-use outcomes between groups: a peer-mentored group, a group in a nurse case-managed programme, and one in an SCM programme. Another 12-months trial on homeless men recently released from jails/prisons who were exposed to weekly peer coaching, intermediate peer coaching compared with the usual treatment did not find any significant effects on substance-use outcomes. An RCT with homeless women with alcohol-use problems who received brief guideline-based interventions from primary care providers and referrals to the CM for ongoing follow-up visits for 6 months did not find any significant between-group differences on alcohol-consumption rates, percentages of completely abstained participants, or negative consequences of alcohol use, respectively.\n","PSH interventions improved housing stability for people living with homelessness. High-intensity case management and income-assistance interventions may also benefit housing stability. The majority of included interventions inconsistently detected benefits for mental health, quality of life, substance use, employment and income. These results have important implications for public health, social policy, and community programme implementation. The COVID-19 pandemic has highlighted the urgent need to tackle systemic inequality and address social determinants of health. Our review provides timely evidence on PSH, income assistance, and mental health interventions as a means of improving housing stability. PSH has major cost and policy implications and this approach could play a key role in ending homelessness. Evidence-based reviews like this one can guide practice and outcome research and contribute to advancing international networks committed to solving homelessness."]
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[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This Cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text. Fifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect. One targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects. Among school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]
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[null,"Safe and Supported Environment - Indicated Interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"Hennessy EA et al. Recovery schools for improving behavioral and academic outcomes among students in recovery from substance use disorders: a systematic review. Campbell Systematic Reviews 2018; 9. \nAvailable here. ","Students in recovery from substance use who were enrolled part-time or full-time in secondary (high school) or postsecondary (college or university) educational institutions. ","The review focused on two types of recover schools: recovery high schools (RHSs), which are schools that award secondary school dipolmas and offer a range of therapeutic services in addition to standard educational curricula; and collegiate recovery communities (CRCs), which offer therapeutic and sober support services on college campuses. \n\nOnly one study met the criteria for inclusion in the review. The study used a quasi-experimental design to examine the effects of RHSs on high school students' academic and substance use outcomes. No eligible studies examining CRCs were identified. \n\nThe results from the one eligible RHS study indicated that after adjusting for pretest values, students in the RHS condition reported levels of grade point averages (g = 0.26, 95% CI [-0.04, 0.56]), truancy (g = 0.01, 95% CI [-0.29, 0.31]), and alcohol use (g = 0.23, 95% CI [-0.07, 0.53]) similar to participants in the comparison condition. However, students in the RHS condition reported improvements in absenteeism (g = 0.56, 95% CI [0.25, 0.87]), abstinence from alcohol/drugs (OR = 4.36, 95% CI [1.19, 15.98]), marijuana use (g = 0.51, 95% CI [0.20, 0.82]), and other drug use (g = 0.45, 95% CI [0.14, 0.76]).\n\nOverall, there was a serious risk of bias in the one included study. The study had a serious risk of bias due to confounding, low risk of bias due to selection of participants into the study, moderate risk of bias due to classification of interventions, inconclusive risk of bias due to deviations from intended interventions, inconclusive risk of bias due to missing data, moderate risk of bias in measurement of outcomes, and low risk of bias in selection of reported results.","There is insufficient evidence regarding the effectiveness of RHSs and CRCs for improving academic and substance use outcomes among students in recovery from SUDs. Only one identified study examined the effectiveness of RHSs. Although the study reported some beneficial effects, the results must be interpreted with caution given the study's potential risk of bias due to confounding and limited external validity. The paucity of evidence on the effectiveness of recovery schools, as documented in this review, thus suggest the need for caution in the widespread adoption of recovery schools for students in recovery from SUDs. Given the lack of empirical support for these recovery schools, additional rigorous evaluation studies are needed to replicate the findings from the one study included in this review. Furthermore, additional research examining the costs of recovery schools may be needed, to help school administrators determine the potential cost-benefits associated with recovery schools. "]

{"sheet":"Changed attitudes","index":6,"n_rows":237,"n_cols":5,"rows_kept":237,"cut":false,"hidden":false,"merged":[[182,1,182,4],[234,1,234,4],[82,1,82,4],[66,1,72,1],[66,2,80,2],[66,3,80,4],[77,1,80,1],[184,2,209,2],[184,3,209,3],[184,4,209,4],[105,1,117,1],[105,2,106,2],[105,3,132,3],[105,4,126,4],[184,1,209,1],[133,2,134,2],[24,1,24,4],[25,3,25,4],[26,1,49,1],[26,2,49,2],[26,3,49,4],[50,1,56,1],[50,2,65,2],[50,3,65,4],[84,1,99,1],[84,2,87,2],[84,3,104,3],[84,4,104,4],[133,1,146,1],[133,3,151,3],[133,4,151,4],[152,1,168,1],[152,2,180,2],[152,3,180,3],[152,4,171,4],[236,1,249,1],[236,2,241,2],[236,3,261,3],[236,4,261,4],[210,1,221,1],[210,2,212,2],[210,3,231,3],[210,4,231,4]]}
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[null,"Changed attitudes and social norms - NICE Guidance"]
[null,"Source:","Population:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Alcohol interventions in secondary and further education. NG135. London: NICE; 2019. \nAvailable here.\n","• CYP (11 to 18years) in full time education.\n• YP (18 to 25 years) with an Education, health and care (EHC) plan.\n• CYP (11 to 18years) in full time education considered ‘at risk’.\n• YP (18 to 25 years) EHC plan considered ‘at risk’.","This guideline covers interventions in secondary and further education to prevent and reduce alcohol use among children and young people aged 11 up to and including 18. It also covers people aged 11 to 25 with special educational needs or disabilities in full-time education. It will also be relevant to children aged 11 in year 6 of primary school.\n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n1.1 Planning alcohol education\n1.2 Delivering universal alcohol education (Evidence Review A: Universal interventions)\n1.3 Targeted interventions (Evidence review B: Targeted interventions)\n\nThe following recommendations for further research were also identified in Evidence review A and B:\n1. What components of alcohol education delivery contribute to its effectiveness for children and young people aged 11 to 18 in full-time education, and those with special educational needs and disabilities (SEND) up to the age of 25? (Evidence review A: universal interventions)\n2. How effective and cost effective are individual, compared with group, education-based interventions for children and young people aged 11 to 18 in full-time education who are thought to be vulnerable to alcohol misuse? (Evidence review B: targeted interventions)\n3. How effective and cost effective are universal, education-based alcohol interventions for children and young people aged 11 to 25 with SEND? (Evidence review A: universal interventions)\n4. How effective and cost effective are education-based alcohol interventions targeted at children and young people aged 11 to 25 with SEND who are thought to be vulnerable to alcohol misuse? (Evidence review B: targeted interventions)\n5. How effective are education-based alcohol prevention interventions (universal or targeted) for children and young people aged 11 to 25 with SEND in full-time education? (Evidence review A: universal interventions and Evidence review B: targeted interventions)\n6. What methods and techniques help secondary schools and providers to effectively engage with parents and carers as part of a whole-school approach to promote and support alcohol education? (Evidence review A: universal interventions)\n"]
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[null,"National Institute for Health and Care Excellence. Alcohol-use disorders: prevention. PH24. London: NICE; 2010\nAvailable here.\n\n\n\n","Children, young people and adults aged 10 years and above","This guideline covers alcohol problems among people over 10. It aims to prevent and identify such problems as early as possible using a mix of policy and practice.\n\nThe guideline includes the following recommendations. All the recommendations are relevant to the scope of this topic evidence map. The recommendations are supported by the underpinning Evidence reviews 1-3 and Evidence reviews 4-6:\n• Price, availability and marketing\n• Licencing\n• Supporting children and young people aged 10 to 15 years\n• Screening young people aged 16 and 17 years and offering them extended brief interventions\n• Screening adults and offering them brief advice and interventions\n• Referral\n\nThe underpinning evidence reviews in this report identifed several gaps in the evidence and made recommendations for further research with the following overarching question:\nHow does advertising by industry and health agencies affect the drinking behaviour of the population as whole? (This includes the use of new media.)\n\nJuly 2019: NICE checked this guideline and are updating it. For further information, see the surveillance decision."]
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[null,"National Institute for Health and Care Excellence. Behaviour change: general approaches. PH6. London: NICE; 2007\nAvailable here.\n\n\n\n","General population","This guideline covers a set of principles that can be used to help people change their behaviour. The aim is for practitioners to use these principles to encourage people to adopt a healthier lifestyle by, for example, stopping smoking, adopting a healthy diet and being more physically active.\n\nThe guideline includes the following recommendations. All the recommendations are relevant to the scope of this topic evidence map. The recommendations are supported by the underpinning Evidence review 1.\n• Providing education and training for those delivering them\n• Delivery of these activities, including one-to-one and community-based programmes and those aimed at specific populations\n• Evaluation of their effectiveness and cost effectiveness\n\nThe Programme Development Group identified a number of gaps in the evidence related to behaviour change interventions and programmes, based on an assessment of the evidence and made recommendations for research to address the most important gaps in the evidence. Please refer to 4. Recommendations for research' section of the guidance.\n\nNovember 2017: NICE checked this guideline and found no new evidence that affects the recommendations in this guideline."]
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[null,"Changed attitudes and social norms - Universal Interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"Wolfenden L et al. Strategies for enhancing the implementation of school‐based policies or practices targeting diet, physical activity, obesity, tobacco or alcohol use. Cochrane Database of Systematic Reviews 2022, Issue 8.\nAvailable here.","School age children (between 5 to 18 years of age)","This Cochrane review aimed to to find out how effective strategies were in supporting the implementation of school‐based interventions to address student diet, physical activity, unhealthy weight gain, and tobacco or alcohol use. Examples of strategies include methods of improving quality, education and training, feedback on how the school was doing, prompts and reminders, and educational resources (e.g. manuals).\n\nThe reviewers included an additional 11 trials in this update bringing the total number of included studies in the review to 38. Of these, 22 were conducted in the USA. Twenty‐six studies used RCT designs. Seventeen trials tested strategies to implement healthy eating, 12 physical activity and six a combination of risk factors. Just one trial sought to increase the implementation of interventions to delay initiation or reduce the consumption of alcohol. All trials used multiple implementation strategies, the most common being educational materials, educational outreach and educational meetings. The overall certainty of evidence was low and ranged from very low to moderate for secondary review outcomes. Only findings relevant to this evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nPooled analyses of RCTs found, relative to a control, the use of implementation strategies may result in a large increase in the implementation of interventions in schools (SMD 1.04, 95% CI 0.74 to 1.34; 22 RCTs, 1917 participants; low‐certainty evidence). One RCT assessed measures of student alcohol use and found strategies to support implementation may result in a slight increase in use (odds ratio 1.10, 95% CI 0.77 to 1.56; P = 0.60; 2105 participants).","The use of implementation strategies may result in large increases in implementation of interventions, and slight improvements in measures of student diet, and physical activity. Further research is required to assess the impact of implementation strategies on such behavioural‐ and obesity‐related outcomes, including on measures of alcohol use, where the findings of one trial suggest it may slightly increase student risk. Given the low certainty of the available evidence for most measures further research is required to guide efforts to facilitate the translation of evidence into practice in this setting."]
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[null,"Foxcroft DR et al. Social norms information for alcohol misuse in university and college students. Cochrane Database Syst Rev 2015, Issue 12. Art. No.: CD006748. DOI: 10.1002/14651858.CD006748.pub4.\nAvailable here. \n","University or college students. ","This Cochrane review aimed to determine whether social norms interventions reduce alcohol‐related negative consequences, alcohol misuse or alcohol consumption when compared with a control (ranging from assessment only/no intervention to other educational or psychosocial interventions) among university and college students.\n\nSeventy studies (44,958 participants) were included in the review, and 63 studies (42,784 participants) in the meta‐analyses. Overall, the risk of bias assessment showed that these studies provided moderate or low quality evidence. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nBinge drinking at four or more months (results pooled across delivery modes): SMD ‐0.06, 95 per cent CI ‐0.11 to ‐0.02 (participants = 11,292; studies = 16; moderate quality evidence), equivalent to 2.7 per cent fewer binge drinkers if 30‐day prevalence is 43.9 per cent.\n\nDrinking quantity at four or more months (results pooled across delivery modes): SMD ‐0.08, 95 per cent CI ‐0.12 to ‐0.04 (participants = 21,169; studies = 32; moderate quality evidence), equivalent to a reduction of 0.9 drinks consumed each week, from a baseline of 13.7 drinks per week.\n\nDrinking frequency at four or more months: WF SMD ‐0.11, 95 per cent CI ‐0.17 to ‐0.04 (participants = 9929; studies = 10; moderate quality evidence), equivalent to a decrease of 0.17 drinking days/wk, from a baseline of 2.74 days/wk; individual face‐to‐face normative feedback SMD ‐0.21, 95 per cent CI ‐0.31 to ‐0.10 (participants = 1464; studies = 8; moderate quality evidence), equivalent to a decrease of 0.32 drinking days/wk, from a baseline of 2.74 days/wk. No effects were found for group face‐to‐face normative feedback or normative marketing campaign.\n\nEstimated blood alcohol concentration (BAC) at four or more months: (Peak BAC results pooled across delivery modes) SMD ‐0.08, 95 per cent CI ‐0.17 to 0.00 (participants = 7198; studies = 11; low quality evidence), equivalent to a reduction in peak BAC from an average of 0.144 per cent to 0.135 per cent. No effects were found for typical BAC with individual face‐to‐face normative feedback.\n","The results of this review indicate that no substantive meaningful benefits are associated with social norms interventions for prevention of alcohol misuse among college/university students. Although some significant effects were found, we interpret the effect sizes as too small, given the measurement scales used in the studies included in this review, to be of relevance for policy or practice. Moreover, the significant effects are not consistent for all misuse measures, heterogeneity was a problem in some analyses and bias cannot be discounted as a potential cause of these findings. "]
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[null,"Langford R et al. The WHO Health Promoting School framework for improving the health and well‐being of students and their academic achievement. Cochrane Database Syst Rev 2014, Issue 4. Art. No.: CD008958. DOI: 10.1002/14651858.CD008958.pub2 \nAvailable here. ","School aged children (aged 4-18).","This Cochrane review aimed to assess the effectiveness of the Health Promoting Schools (HPS) framework in improving the health and well‐being of students and their academic achievement.\n\nSixty seven eligible cluster trials, randomising 1,443 schools or districts were included. This is made up of 1,345 schools and 98 districts. The studies tackled a range of health issues: physical activity (4), nutrition (12), physical activity and nutrition combined (18), bullying (7), tobacco (5), alcohol (2), sexual health (2), violence (2), mental health (2), hand‐washing (2), multiple risk behaviours (7), cycle‐helmet use (1), eating disorders (1), sun protection (1), and oral health (1). Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nReview authors report that the quality of evidence overall was low to moderate as determined by the GRADE approach. Risk of bias assessments identified methodological limitations, including heavy reliance on self‐reported data and high attrition rates for some studies. In addition, there was a lack of long‐term follow‐up data for most studies.\n\nEight studies provided data on alcohol use and all but one were included in the meta‐analysis. Overall, there was no evidence that any of the different intervention approaches were effective in reducing alcohol intake.","The results of this review provide evidence for the effectiveness of some interventions based on the HPS framework for improving certain health outcomes but not others. More well‐designed research is required to establish the effectiveness of this approach for other health topics and academic achievement."]
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[null,"Siegfried N et al. Restricting or banning alcohol advertising to reduce alcohol consumption in adults and adolescents. Cochrane Database Syst Rev 2014, Issue 11. Art. No.: CD010704. DOI: 10.1002/14651858.CD010704.pub2.\nAvailable here. \n","Adults of any age and adolescents (defined by WHO as aged 10 to 19 years)","The aim of this Cochrane review was to evaluate the benefits, harms and costs of restricting or banning the advertising of alcohol, via any format, compared with no restrictions or counter‐advertising, on alcohol consumption in adults and adolescents.\n\nOne small RCT (80 male student participants conducted in the Netherlands and published in 2009) and three ITS studies (general population studies in Canadian provinces conducted in the 1970s and 80s) were examined. The RCT found that young men exposed to movies with a low‐alcohol content drank less than men exposed to movies with a high‐alcohol content (MD ‐0.65 drinks; 95 per cent CI ‐1.2, ‐0.07; p value = 0.03, very‐low‐quality evidence). Young men exposed to commercials with a neutral content compared with those exposed to commercials for alcohol drank less (MD ‐0.73 drinks; 95 per cent CI ‐1.30, ‐0.16; p value = 0.01, very‐low‐quality evidence). Outcomes were assessed immediately after the end of the intervention (lasting 1.5 hours), so no follow‐up data were available.\n\nTwo of the ITS studies evaluated the implementation of an advertising ban and one study evaluated the lifting of such a ban (GRADE: very‐low‐quality evidence). Each of the three ITS studies evaluated a different type of ban (partial or full) compared with different degrees of restrictions or no restrictions during the control period. The results from the three ITS studies were inconsistent. A meta‐analysis of the two studies that evaluated the implementation of a ban showed an overall mean non‐significant increase in beer consumption in the general population of 1.10 per cent following the ban (95 per cent CI ‐5.26, 7.47; p value = 0.43; I2 = 83 per cent, very‐low‐quality evidence). This finding is consistent with an increase, no difference, or a decrease in alcohol consumption. In the study evaluating the lifting of a total ban on all forms of alcohol advertising to a partial ban on spirits advertising only, which utilised an Abrupt Auto‐regressive Integrated Moving Average model, the volume of all forms of alcohol sales decreased by 11.11 kilolitres (95 per cent CI ‐27.56, 5.34; p value = 0.19) per month after the ban was lifted. In this model, beer and wine sales increased per month by 14.89 kilolitres (95 per cent CI 0.39, 29.39; p value = 0.04) and 1.15 kilolitres (95 per cent CI ‐0.91, 3.21; p value = 0.27), respectively, and spirits sales decreased statistically significantly by 22.49 kilolitres (95 per cent CI ‐36.83, ‐8.15; p value = 0.002).\n\nNone of the studies were funded by the alcohol or advertising industries.\n","Authors conclude that there is a lack of robust evidence for or against recommending the implementation of alcohol advertising restrictions. Advertising restrictions should be implemented within a high‐quality, well‐monitored research programme to ensure the evaluation over time of all relevant outcomes in order to build the evidence base. "]
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[null,"Changed attitudes and social norms - Selective Interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This Cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text. Fifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect. One targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects. Among school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]
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[null,"Foxcroft DR et al. Motivational interviewing for the prevention of alcohol misuse in young adults. Cochrane Database Syst Rev 2016, Issue 7. Art. No.: CD007025. DOI: 10.1002/14651858.CD007025.pub4.\nAvailable here.\n","Young adults up to 25 years of age (higher risk individuals or settings). ","This Cochrane review aimed to assess the effects of motivational interviewing (MI) interventions for preventing alcohol misuse and alcohol‐related problems in young adults. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nEighty four trials (22,872 participants) were included, with 70/84 studies reporting interventions in higher risk individuals or settings. Studies with follow‐up periods of at least four months were of more interest in assessing the sustainability of intervention effects and were also less susceptible to short‐term reporting or publication bias. Overall, the risk of bias assessment showed that these studies provided moderate or low quality evidence.\n\nAt four or more months follow‐up, effects in favour of MI were found for the quantity of alcohol consumed (standardised mean difference (SMD) −0.11, 95 per cent confidence interval (CI) −0.15 to −0.06 or a reduction from 13.7 drinks/week to 12.5 drinks/week; moderate quality evidence); frequency of alcohol consumption (SMD −0.14, 95 per cent CI −0.21 to −0.07 or a reduction in the number of days/week alcohol was consumed from 2.74 days to 2.52 days; moderate quality evidence); and peak blood alcohol concentration, or BAC (SMD −0.12, 95 per cent CI −0.20 to 0.05, or a reduction from 0.144 per cent to 0.131 per cent; moderate quality evidence).\n\nFurther analyses showed that there was no clear relationship between the duration of the MI intervention (in minutes) and effect size. Subgroup analyses revealed no clear subgroup effects for longer‐term outcomes (four or more months) for assessment only versus alternative intervention controls; for university/college vs other settings; or for higher risk vs all/low risk participants.\n","The results of this review indicate that there are no substantive, meaningful benefits of MI interventions for preventing alcohol use, misuse or alcohol‐related problems. Although the reviewers found some statistically significant effects, the effect sizes were too small, given the measurement scales used in the included studies, to be of relevance to policy or practice. Moreover, the statistically significant effects are not consistent for all misuse measures, and the quality of evidence is not strong, implying that any effects could be inflated by risk of bias."]
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[null,"Changed attitudes and social norms - Indicated Interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"Kaner E et al. Personalised digital interventions for reducing hazardous and harmful alcohol consumption in community-dwelling populations. Cochrane Database Syst Rev 2017, Issue 9, Art. No.: CD011479. DOI: 10.1002/14651858.CD011479.pub2. \nAvailable here. \n","People living in the community whose alcohol consumption had been screened as hazardous or harmful. ","This Cochrane review aimed to assess the effectiveness and cost‐effectiveness of digital interventions for reducing hazardous and harmful alcohol consumption, alcohol‐related problems, or both, in people living in the community.\n\nFifty-seven studies which randomised a total of 34,390 participants were included in the review. The main sources of bias were from attrition and participant blinding (36 per cent and 21 per cent of studies respectively, high risk of bias). Forty one studies (42 comparisons, 19,241 participants) provided data for the primary meta‐analysis, which demonstrated that participants using a digital intervention drank approximately 23g alcohol weekly (95 per cent CI 15 to 30) (about 3 UK units) less than participants who received no or minimal interventions at end of follow up (moderate‐quality evidence). \n\nFifteen studies (16 comparisons, 10,862 participants) demonstrated that participants who engaged with digital interventions had less than one drinking day per month fewer than no intervention controls (moderate‐quality evidence), 15 studies (3587 participants) showed about one binge drinking session less per month in the intervention group compared to no intervention controls (moderate‐quality evidence), and in 15 studies (9791 participants) intervention participants drank one unit per occasion less than no intervention control participants (moderate‐quality evidence). \n\nOnly five small studies (390 participants) compared digital and face‐to‐face interventions. There was no difference in alcohol consumption at end of follow up (MD 0.52 g/week, 95 per cent CI ‐24.59 to 25.63; low‐quality evidence). \n\nThe most frequently mentioned theories or models in the included studies were Motivational Interviewing Theory (7/20), Transtheoretical Model (6/20) and Social Norms Theory (6/20). Over half of the interventions (n = 21, 51per cent) made no mention of theory. Only two studies used theory to select participants or tailor the intervention. There was no evidence of an association between reporting theory use and intervention effectiveness.\n","There is moderate‐quality evidence that digital interventions may lower alcohol consumption, with an average reduction of up to three (UK) standard drinks per week compared to control participants. Substantial heterogeneity and risk of performance and publication bias may mean the reduction was lower. Low‐quality evidence from fewer studies suggested there may be little or no difference in impact on alcohol consumption between digital and face‐to‐face interventions. \n\nThe BCTs of behaviour substitution, problem solving and credible source were associated with the effectiveness of digital interventions to reduce alcohol consumption and warrant further investigation in an experimental context. \n\nReporting of theory use was very limited and often unclear when present. Over half of the interventions made no reference to any theories. Limited reporting of theory use was unrelated to heterogeneity in intervention effectiveness. \n"]

{"sheet":"Reduced avail","index":7,"n_rows":69,"n_cols":5,"rows_kept":69,"cut":false,"hidden":false,"merged":[[25,1,25,4],[44,1,44,4],[62,1,64,1],[66,1,66,4],[68,1,70,1],[60,1,60,4],[27,1,33,1],[27,2,42,2],[27,3,42,4],[46,1,58,1],[46,2,58,2],[46,3,58,3],[46,4,58,4]]}
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[null,"Reduced availability - NICE Guidance"]
[null,"Source:","Population:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Alcohol-use disorders: prevention. PH24. London: NICE; 2010\nAvailable here.\n\n\n\n","Children, young people and adults aged 10 years and above","This guideline covers alcohol problems among people over 10. It aims to prevent and identify such problems as early as possible using a mix of policy and practice.\n\nThe guideline includes the following recommendations. All the recommendations are relevant to the scope of this topic evidence map. The recommendations are supported by the underpinning Evidence reviews 1-3 and Evidence reviews 4-6:\n• Price, availability and marketing\n• Licencing\n• Supporting children and young people aged 10 to 15 years\n• Screening young people aged 16 and 17 years and offering them extended brief interventions\n• Screening adults and offering them brief advice and interventions\n• Referral\n\nThe underpinning evidence reviews in this report identifed several gaps in the evidence and made recommendations for further research with the following overarching question:\nHow does advertising by industry and health agencies affect the drinking behaviour of the population as whole? (This includes the use of new media.)\n\nJuly 2019: NICE checked this guideline and are updating it. For further information, see the surveillance decision."]
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[null,"Reduced availability - Universal Interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"Hollands  GJ et al. Altering the availability or proximity of food, alcohol, and tobacco products to change their selection and consumption. Cochrane Database of Systematic Reviews 2019, Issue 9. Art. No.: CD012573. DOI: 10.1002/14651858.CD012573.pub3.\nAvailable here.","Adults","This Cochrane review aimed to:\n1. To assess the impact on selection and consumption of altering the availability or proximity of (a) food (including non‐alcoholic beverages), (b) alcohol, and (c) tobacco products.\n2. To assess the extent to which the impact of these interventions is modified by characteristics of: i. studies, ii. interventions, and iii. participants.\n\nThe reviewers included 24 studies, with the majority (20/24) giving concerns about risk of bias. All of the included studies investigated food products; none investigated alcohol or tobacco. ","The authors concluded that:\n- Further research is warranted in real‐world settings, intervening across a wider range of foods as well as alcohol and tobacco products and over sustained time periods"]
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[null,"Reduced availability - Selective Interventions - Systematic reviews"]
[null,"Source:","Populations:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]
[]
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[]
[null,"Reduced availability - Indicated Interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]

{"sheet":"Reduced afford","index":8,"n_rows":59,"n_cols":5,"rows_kept":59,"cut":false,"hidden":false,"merged":[[50,1,50,4],[56,1,56,4],[44,1,44,4],[25,1,25,4],[26,3,26,4],[27,1,33,1],[27,2,42,2],[27,3,42,4]]}
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[null,"Reduced affordability - NICE Guidance"]
[null,"Source:","Population:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Alcohol-use disorders: prevention. PH24. London: NICE; 2010\nAvailable here.\n\n\n\n","Children, young people and adults aged 10 years and above","This guideline covers alcohol problems among people over 10. It aims to prevent and identify such problems as early as possible using a mix of policy and practice.\n\nThe guideline includes the following recommendations. All the recommendations are relevant to the scope of this topic evidence map. The recommendations are supported by the underpinning Evidence reviews 1-3 and Evidence reviews 4-6:\n• Price, availability and marketing\n• Licencing\n• Supporting children and young people aged 10 to 15 years\n• Screening young people aged 16 and 17 years and offering them extended brief interventions\n• Screening adults and offering them brief advice and interventions\n• Referral\n\nThe underpinning evidence reviews in this report identifed several gaps in the evidence and made recommendations for further research with the following overarching question:\nHow does advertising by industry and health agencies affect the drinking behaviour of the population as whole? (This includes the use of new media.)\n\nJuly 2019: NICE checked this guideline and are updating it. For further information, see the surveillance decision."]
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[null,"Reduced affordability - Universal Interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]
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[]
[null,"Reduced affordability - Selective Interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]
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[]
[null,"Reduced affordability - Indicated Interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]

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[null,"Behaviour change - NICE Guidance"]
[null,"Source:","Population:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Behaviour change: digital and mobile health interventions. NG183. London: NICE; 2020.\nAvailable here.\n\n\n","Everyone, including Young People under 16 (and their families or 16 carers)\n• Pre-existing health conditions:\nOverweight/ obesity\nHypertension and cardiovascular disease\nRespiratory diseases\nCancers for which managing smoking may improve health outcomes\nMental health conditions\nSpecific consideration will also be given to people with learning disabilities and people with neurodevelopmental disorders such as autism.","This guideline covers interventions that use a digital or mobile platform to help people eat more healthily, become more active, stop smoking, reduce their alcohol intake or practise safer sex. The interventions include those delivered by text message, apps, wearable devices or the internet. The guideline only includes those that are delivered by the technology itself and not by healthcare professionals using technology to deliver interventions.\n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n1.1 Developing digital and mobile health interventions\n1.2 Commissioning digital and mobile health interventions\n1.3 Using digital and mobile health interventions\n1.4 Interventions for diet and physical activity\n1.5 Interventions for smoking\n1.6 Interventions for alcohol use (Based on Evidence Review B: alcohol)\n1.7 Interventions for unsafe sexual behaviour\n\nThe following recommendations for further research were also identified in evidence review B on alcohol:\n1. How can providers and healthcare professionals identify groups that do not initially engage, or do not stay engaged, with digital and mobile health behaviour change interventions?\n2. What components and characteristics of digital and mobile health behaviour change interventions are most effective, separately and in combination, to achieve behaviour change?\n3. What is the effectiveness and cost effectiveness of digital and mobile health behaviour change interventions in low socioeconomic and other underserved groups?\n4. Are digital and mobile health behaviour change interventions as effective as face-to-face, standard care, or combination approaches for some populations?\n5. What are the harms and adverse effects associated with different digital and mobile health behaviour change interventions?"]
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[null,"National Institute for Health and Care Excellence. Behaviour change: individual approaches. PH49. London: NICE; 2014. \nAvailable here.\n","Everyone aged 16 years and older","This guideline covers changing health-damaging behaviours among people aged 16 and over using interventions such as goals and planning, feedback and monitoring, and social support. It aims to help tackle a range of behaviours including alcohol misuse, poor eating patterns, lack of physical activity, unsafe sexual behaviour and smoking.\n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n1. Develop a local behaviour change policy and strategy\n2. Ensure organisation policies, strategies, resources and training all support behaviour change\n3. Commission interventions from services willing to share intervention details and data\n4. Commission high quality, effective behaviour change interventions\n5. Plan behaviour change interventions and programmes taking local needs into account\n6. Develop acceptable, practical and sustainable behaviour change interventions and programmes\n7. Use proven behaviour change techniques when designing interventions (Evidence review1 and Evidence review2)\n8. Ensure interventions meet individual needs\n9. Deliver very brief, brief, extended brief and high intensity behaviour change interventions and programmes\n10. Ensure behaviour change is maintained for at least a year (Evidence review1 and Evidence review2)\n11. Commission training for all staff involved in helping to change people's behaviour\n12. Provide training for behaviour change practitioners\n13. Provide training for health and social care practitioners\n14. Assess behaviour change practitioners and provide feedback\n15. Monitor behaviour change interventions\n16. Evaluate behaviour change interventions\n17. National support for behaviour change interventions and programmes\n\nEvidence review1 did not identify any recommendations for further research. Evidence review 2 made the following recommendation for further research:\n5.7 How do behaviour change techniques lead to change? What are the best methods of testing the relationship between the theories that describe change processes and the effectiveness of interventions in practice?"]
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[null,"National Institute for Health and Care Excellence. Nalmefene for reducing alcohol consumption in people with alcohol dependence. TA325. London: NICE; 2014.\nAvailable here.  \n\n","Adults with mild alcohol dependence (as defined in CG115) who have a high drinking risk level (≥ 60 g/day of pure alcohol for men and ≥ 40 g/day for women) without physical withdrawal symptoms and who do not require immediate detoxification","NICE currently make the following recommendation regarding use of Nalmefene for reducing alcohol consumption in people with alcohol dependence (the highlighted recommendation is relevant to the scope of this topic evidence map):\n\n1.1 Nalmefene is recommended within its marketing authorisation, as an option for reducing alcohol consumption, for people with alcohol dependence (Evidence review): \n• Who have a high drinking risk level (defined as alcohol consumption of more than 60 g per day for men and more than 40g per day for women, according to the World Health Organization's drinking risk levels) without physical withdrawal symptoms and;\n• Who do not require immediate detoxification.\n\nThe marketing authorisation states that nalmefene should:\n• Only be prescribed in conjunction with continuous psychosocial support focused on treatment adherence and reducing alcohol consumption and; \n• Be initiated only in patients who continue to have a high drinking risk level 2 weeks after initial assessment.\n\nMarch 2018: NICE reviewed the evidence for TA325. They found found nothing new that affects the recommendations in this guidance. This guidance will be reviewed if there is new evidence that is likely to affect the recommendations."]
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[null,"National Institute for Health and Care Excellence. Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence. CG115. London: NICE; 2011\nAvailable here.\n\n","Adults (>18 years) or young people (10 to 17 years of age) with a diagnosis of alcohol dependence or meeting criteria for harmful alcohol use (30 to 50 units of alcohol per week)","This guideline covers identifying, assessing and managing alcohol-use disorders (harmful drinking and alcohol dependence) in adults and young people aged 10-17 years. It aims to reduce harms (such as liver disease, heart problems, depression and anxiety) from alcohol by improving assessment and setting goals for reducing alcohol consumption. \n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n• Principles of care\n• Identification and assessment \n• Interventions for alcohol misuse (Evidence review 2011)\n\nThe following recommendations for further research were also identified in Evidence reviews underpinning this guidance:\n1 Is contingency management effective in reducing alcohol consumption in people who misuse alcohol compared with standard care?\n2 What methods are most effective for assessing and diagnosing the presence and severity of alcohol misuse in children and young people?\n3 Is acupuncture effective in reducing alcohol consumption compared with standard care?\n4. For which service users who are moderately and severely dependent on alcohol is an assertive community treatment model a clinically and cost-effective intervention compared with standard care?\n5. For people with moderate and severe alcohol dependence who have significant comorbid problems, is an intensive residential rehabilitation programme clinically and cost effective when compared with intensive community-based care?\n6 For people with alcohol dependence, which medication is most likely to improve adherence and thereby promote abstinence and prevent relapse?\n\nOctober 2022: NICE updated the recommendation about behavioural couples therapy to clarify that this is not suitable in cases of domestic abuse and to add a cross reference to the NICE technology appraisal guidance on nalmefene. They also updated information about off-label prescribing, and added cross references to legislation on controlled drugs and driving, to MHRA advice on addiction to benzodiazepines and codeine, and to NICE's guidelines on smoking, on antisocial personality disorder and on coexisting mental illness and substance misuse community health and social care services.\nJuly 2019: NICE have found no new evidence that affects the recommendations."]
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[null,"National Institute for Health and Care Excellence. Coexisting severe mental illness (psychosis) and substance misuse: assessment and management in healthcare settings. CG120. London: NICE; 2011. \nAvailable here.\n","People aged 14 years and over with coexisting severe mental illness (psychosis) and substance misuse","This guideline covers assessing and managing people aged 14 years and over with coexisting severe mental illness (psychosis) and substance misuse. It aims to help healthcare professionals guide people with psychosis with coexisting substance misuse to stabilise, reduce or stop their substance misuse, to improve treatment adherence and outcomes, and to enhance their lives. \n\nThe guideline includes the following recommendations. All the recommendations are relevant to the scope of this topic evidence map. The recommendations are supported by evidence from the underpinning Evidence Review 2011. \n• Principles of care\n• Recognising psychosis with coexisting substance misuse\n• Primary care\n• Secondary care mental health services\n• Substance misuse services\n• Inpatient mental health services and staffed accommodation\n• Specific issues for young people with psychosis and coexisting substance misuse\n\nThe following recommendations for further research were also identified in Evidence reviews underpinning this guidance:\n1. What are the prevalence, risk and protective factors, and course of illness for different combinations of psychosis and coexisting substance misuse (for example, schizophrenia and cannabis misuse or bipolar disorder and alcohol misuse)?\n2. What risk factors predict the onset of substance misuse in young people with psychosis?\n3. Are psychosocial interventions clinically and cost effective when compared with standard care for people with psychosis and coexisting substance misuse?\n4. Are environmental interventions clinically and cost effective when compared with standard care for people with psychosis and coexisting substance misuse?\n5. Is clozapine clinically and cost effective when compared with other pharmacological interventions for people with psychosis and coexisting substance misuse?\n\nNovember 2016: NICE reviewed the evidence and found no new evidence that affects the current recommendations in this guideline."]
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[null,"National Institute for Health and Care Excellence. Alcohol-use disorders: diagnosis and management of physical complications. CG100. London: NICE; 2010. \nAvailable here. \n","People aged 10 years and over with alcohol-use disorders","This guideline covers care for adults and young people (aged 10 years and older) with physical health problems that are completely or partly caused by an alcohol-use disorder. It aims to improve the health of people with alcohol-use disorders by providing recommendations on managing acute alcohol withdrawal and treating alcohol-related conditions. \n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n• Acute alcohol withdrawal (Evidence review 2014)\n• Wernicke’s encephalopathy\n• Alcohol-related liver disease\n• Alcohol-related pancreatitis\n\nThe following recommendations for further research were also identified in Evidence reviews underpinning this guidance:\n2. What is the efficacy and cost effectiveness of clomethiazole compared with chlordiazepoxide or carbamazepine or benzodiazepines for the treatment of acute alcohol withdrawal with regard to the outcomes of withdrawal severity, risk of seizures, risk of delirium tremens, length of treatment and patient satisfaction?\n\nJanuary 2019: NICE checked this guideline and are updating it. For more information, see the surveillance decision."]
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[null,"National Institute for Health and Care Excellence. Alcohol-use disorders: prevention. PH24. London: NICE; 2010\nAvailable here.\n\n\n\n","Children, young people and adults aged 10 years and above","This guideline covers alcohol problems among people over 10. It aims to prevent and identify such problems as early as possible using a mix of policy and practice.\n\nThe guideline includes the following recommendations. All the recommendations are relevant to the scope of this topic evidence map. The recommendations are supported by the underpinning Evidence reviews 1-3 and Evidence reviews 4-6:\n• Price, availability and marketing\n• Licencing\n• Supporting children and young people aged 10 to 15 years\n• Screening young people aged 16 and 17 years and offering them extended brief interventions\n• Screening adults and offering them brief advice and interventions\n• Referral\n\nThe underpinning evidence reviews in this report identifed several gaps in the evidence and made recommendations for further research with the following overarching question:\nHow does advertising by industry and health agencies affect the drinking behaviour of the population as whole? (This includes the use of new media.)\n\nJuly 2019: NICE checked this guideline and are updating it. For further information, see the surveillance decision."]
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[null,"National Institute for Health and Care Excellence. Behaviour change: general approaches. PH6. London: NICE; 2007\nAvailable here.\n\n\n\n","General population","This guideline covers a set of principles that can be used to help people change their behaviour. The aim is for practitioners to use these principles to encourage people to adopt a healthier lifestyle by, for example, stopping smoking, adopting a healthy diet and being more physically active.\n\nThe guideline includes the following recommendations. All the recommendations are relevant to the scope of this topic evidence map. The recommendations are supported by the underpinning Evidence review 1.\n• Providing education and training for those delivering them\n• Delivery of these activities, including one-to-one and community-based programmes and those aimed at specific populations\n• Evaluation of their effectiveness and cost effectiveness\n\nThe Programme Development Group identified a number of gaps in the evidence related to behaviour change interventions and programmes, based on an assessment of the evidence and made recommendations for research to address the most important gaps in the evidence. Please refer to 4. Recommendations for research' section of the guidance.\n\nNovember 2017: NICE checked this guideline and found no new evidence that affects the recommendations in this guideline."]
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[null,"Behaviour change - Universal Interventions - Systematic reviews"]
[null,"Source:","Population: ","Findings:","Authors' conclusions:"]
[null,"Stead M, Angus K, Langley T, Katikireddi SV, Hinds K, Hilton S,  et al. Mass media to communicate public health messages in six health topic areas: a systematic review and other reviews of the evidence. Public Health Res 2019;7(8)\nAvailable here.","General population.","There was limited evidence of impact on alcohol use\nMass media campaigns were found to increase knowledge and awareness across several topics.\nAlthough there was limited evidence on characteristics associated with effectiveness, longer or greater intensity campaigns were found to be more effective. \nThe evidence suggested that targeting messages to target audiences can be effective. \nThere was little evidence regarding the role that theory or media channels may play in campaign effectiveness, and also limited evidence on new media.","Overall, the evidence is mixed but suggests that longer and more intensive campaigns are likely to be more effective and message design and targeting campaigns to particular population groups can be effective."]
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[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. \n\nFifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect.\n\nOne targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects.\n\nAmong school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]
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[null,"Brown TJ, Todd A, O'Malley CL, Moore HJ, Husband AK, Bambra C,  et al. Community pharmacy interventions for public health priorities: a systematic review of community pharmacy-delivered smoking, alcohol and weight management interventions. Public Health Res 2016;4(2)\nAvailable here. ","Adults","The searches identified over 14,000 records, of which 24 studies were included. There were two alcohol, 12 smoking cessation, five weight loss and five multicomponent interventions that included pharmacotherapy and lifestyle changes in participants with diabetes mellitus, dyslipidaemia or hypertension. Nine of the studies were UK based; seven of the studies were rated ‘strong’ for quality. All studies were of adults. \nThere was insufficient evidence for the effectiveness of community pharmacy-based brief alcohol interventions.\nNone of the five multicomponent studies demonstrated an improvement compared with control for anthropometric outcomes in participants with comorbidities, but they did show improvement in measures associated with the comorbidities. Very few studies explored if and how sociodemographic or socioeconomic variables moderated the effect of interventions. In two studies based in areas of high deprivation, where participants chose the intervention, the sociodemographic characteristics of participants differed between intervention settings. There were also differences in recruitment, attendance and retention of participants by type of setting. The evidence suggests that a distinct group of people might access pharmacies compared with other settings for alcohol management, smoking cessation and weight loss. There is insufficient evidence to examine the relationship between behaviour change strategies and effectiveness; or evidence of consistent implementation factors or training components that underpin effective interventions.","Evaluations of interventions to manage alcohol misuse and obesity, set within the community pharmacy, are needed. \nThe effect of community pharmacy interventions on health inequalities is unclear. Future research in this area is warranted, and trials should include the assessment of age, sex, ethnicity, socioeconomic status and contextual factors, and present analysis of how these factors moderate effectiveness."]
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[null,"Behaviour change - Selective Interventions - Systematic reviews"]
[null,"Source:","Audience:","Findings:","Authors' conclusions:"]
[null,"Meiksin R et al. E-health interventions targeting STIs, sexual risk, substance use and mental health among men who have sex with men: four systematic reviews. Public Health Research. 2022;10(4):1-322. \nAvailable here.","Gay, bisexual and other men (including trans men) who have sex with men, including those who have been diagnosed as HIV positive, as well as those whose last HIV test was negative or who have never tested for HIV","This review aimed to  synthesise evidence addressing the following: (1) What approaches and theories of change do existing e-health interventions employ to prevent human immunodeficiency virus/sexually transmitted infections, sexual risk, alcohol/drug use or mental ill health among men who have sex with men? (2) What factors influence implementation? (3) What are the effects of such interventions on the aforementioned epidemics? (4) Are such interventions cost-effective? Only information relevant to this topic evidence map has been extracted below.\n\nEffects on alcohol and drug use: Two studies presented estimates for drug use (table 8 in the full report), both focused on open-ended interventions. Neither quantified outcomes on alcohol use specifically. Although both studies presented short-term results, only one study presented mid-term results. However, the primary method of analysis in that study was a longitudinal regression model; the authors present these estimates as well. Across studies, there was no consistent evidence of effectiveness of interventions in reducing drug use.\n\nMeta-analysis: Effect sizes for alcohol and drug use are presented in the full report in Figure 14 for outcomes of < 3 months post intervention and in Figure 15 for outcomes between 3 months and 1 year post intervention. In both plots, negative effect sizes represent benefits. The review authors do not present a pooled effect size for these estimates as meta-analyses included both substantial heterogeneity (I2 = 95% both overall and only including effect sizes of up to 3 months’ follow-up) and too few studies to explore this heterogeneity.","The authors concluded that the findings for drug use could not be meta-analysed because of study heterogeneity. Studies addressing this outcome did not present consistent evidence of effectiveness. Trials did not report effects on alcohol use or mental health."]
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[null,"Filges T, Dalgaard NT and Viinholt BC. 2022. Outreach programs to improve life circumstances and prevent further adverse developmental trajectories of at‐risk youth in OECD countries: A systematic review. Campbell Systematic Reviews, 18(4), p.e1282.\nAvailable here\n","Young people between 8 and 25 years of age living in OECD countries, who either have experienced or is at-risk of experiencing an adverse outcome such as school failure or drop-out, runaway and homelessness, substance and/or alcohol abuse, unemployment, long-term poverty, delinquency/criminal behaviour were eligible.","This Campbell systematic review examines the effects of outreach programmes on problem/high-risk behaviour of young people between eight and 25 year old, living in OECD countries. The review summarises evidence from five studies undertaken in the USA and Canada that involved 578 participants in total.\n\nFour of the five studies used for meta analysis were from the USA and one was from Canada. The timespan in which included studies were carried out was 32 years, from 1985 to 2017; on average the intervention year was 2005. The average number of participants in the analysed interventions was 116, ranging from 30 to 346 and the average number of controls was 81, ranging from 32 to 321. At most, the results from two studies could be pooled in a single meta-analysis. It was only possible to pool the outcomes drug (other than marijuana) use, marijuana use and alcohol use each at two different time points (one and 3 months follow up). At 1 month follow up the weighted averages varied between zero and 0.05 and at 3 months follow up between −0.17 and 0.07. None of them were statistically significant. In addition, a number of other outcomes were reported in a single study only.","Overall, there were too few studies included in any of the meta-analyses in order for us to draw any conclusion concerning the effectiveness of outreach. The vast majority of studies were undertaken in the USA.\nFurther, because too few studies reported results on the same type of outcome at most two studies could be combined in a particular meta-analysis. Given the limited number of rigorous studies available from countries other than the USA, it would be natural to consider conducting a series of randomised controlled trials evaluating the effectiveness of outreach for at-risk youth in countries outside the USA. The trial(s) should be designed, conducted and reported according to methodological criteria for rigour in respect of internal and external validity to achieve robust results and preferably reporting a larger number of outcomes."]
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[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. \n\nFifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect.\n\nOne targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects.\n\nAmong school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]
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[null,"O'Connor EA et al. Screening and behavioral counseling interventions to reduce unhealthy alcohol use in adolescents and adults: An updated systematic review for the U.S. Preventive Services Task Force. Rockville MD: Agency for Healthcare Research and Quality; 2018. \nAvailable here. ","Adolescents or adults age 12 years or older. ","One hundred and thirteen studies (n=314,466) were included across all Key Questions. The authors did not find any studies that examined the benefits or harms of screening programs to reduce unhealthy alcohol use. For adolescents, data supported the use of the National Institute on Alcohol Abuse and Alcoholism Youth Screen and other similar one- or two-item screeners to detect alcohol use disorder. For adults, brief (1- to 3-item) screeners commonly reported sensitivity and specificity between 0.70 and 0.85, typically having better sensitivity than the full Alcohol Use Disorders Identification Test (AUDIT) for identifying the full spectrum of unhealthy use. However, the AUDIT tended to have higher specificity, particularly at the standard cutoff of 8 or higher.  \n\nIdentified interventions to reduce unhealth alcohol use were generally counselling interventions, with most involving one or two sessions (90% involved ≤ 4 sessions) with a median of 30 minutes contact time (88% involved ≤ 2 hours contact). The most commonly reported intervention element was the use of personalized normative feedback sessions, in which participants were shown how their alcohol use compares to others; this technique was used in more than half of the included trials and almost all trials in younger adults. Motivational techniques were also common, particularly in combination with personalized normative feedback.\n\nEvidence on the effects of interventions to reduce unhealthy alcohol use in adolescents was limited to two trials; both found mixed results for reduced alcohol use and did not report health or related outcomes. \n\nIn adults, interventions reduced the number of drinks per week (weighted mean difference, −1.82 [95% confidence interval {CI}, −2.42 to −1.22]), the proportion exceeding recommended drinking limits (odds ratio [OR], 0.60 [95% CI, 0.53 to 0.67]), and the proportion reporting a heavy use episode (OR, 0.62 [95% CI, 0.55 to 0.71]), and increased the proportion of pregnant women reporting abstinence (OR, 1.92 [95% CI, 1.19 to 3.09]) after 6 to 12 months. \n\nHeterogeneity was high and effect size was associated with a number of study characteristics such as setting, target age of the population, publication year, study size, and average baseline-use levels, but not clearly associated with any intervention characteristics. Data on effectiveness in important subgroups were very limited, but analyses by sex, the most commonly reported subgroup analysis, did not indicate differences in effectiveness of the interventions. Health outcomes were sparsely reported and, with some exceptions, generally did not demonstrate group differences in effect. No evidence of harm was found.","Among adults, screening instruments are available that can effectively identify persons with unhealthy alcohol use and that are feasible for use in primary care settings, and interventions in those who screen positive are associated with reductions in unhealthy alcohol use. There was no evidence that these interventions have unintended harmful effects. More evidence is needed to determine whether screening for unhealthy alcohol use is beneficial for adolescents."]
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[null,"Tansil KA et al. Alcohol Electronic Screening and Brief Intervention A Community Guide Systematic Review. Am J Prev Med 2016;51(5):801–811). \nAvailable here. \n","Unspecified","This Community Guide review focused on e-screening and brief interventions (e-SBIs) that are similar in structure and intent to Alcohol screening and brief intervention (ASBI) and examined how e-SBI effectiveness varied by key intervention characteristics, in contrast to previous systematic reviews of e-SBI. This review is unique in that it excluded highly interactive interventions (i.e., those with more than three human-to-human sessions); those that were part of a treatment program for alcohol use disorders; those that were primarily educational programs (e.g., Alcohol Edu, College Alc); and those that only used an electronic device for monitoring drinking following traditional ASBI.\n\nTwenty-four studies (28 study arms) provided results for excessive drinkers only and seven studies (eight study arms) reported results for all drinkers. Nearly all studies found that e-SBI reduced excessive alcohol consumption and related harms: nine study arms reported a median 23.9% reduction in binge-drinking intensity (maximum drinks/binge episode) and nine study arms reported a median 16.5% reduction in binge-drinking frequency. Reductions in drinking measures were sustained for up to 12 months.","The authors conclude that, according to Community Guide rules of evidence, e-SBI is an effective method for reducing excessive alcohol consumption and related harms among intervention participants. Implementation of e-SBI could complement population-level strategies previously recommended by the Community Preventive Services Task Force for reducing excessive drinking (e.g., increasing alcohol taxes and regulating alcohol outlet density)."]
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[null,"Foxcroft DR et al. Motivational interviewing for the prevention of alcohol misuse in young adults. Cochrane Database Syst Rev 2016, Issue 7. Art. No.: CD007025. DOI: 10.1002/14651858.CD007025.pub4.\nAvailable here.\n","Young adults up to 25 years of age. ","This Cochrane review aimed to assess the effects of motivational interviewing (MI) interventions for preventing alcohol misuse and alcohol‐related problems in young adults.\n\nEighty four trials (22,872 participants) were included, with 70/84 studies reporting interventions in higher risk individuals or settings. Studies with follow‐up periods of at least four months were of more interest in assessing the sustainability of intervention effects and were also less susceptible to short‐term reporting or publication bias. Overall, the risk of bias assessment showed that these studies provided moderate or low quality evidence.\n\nAt four or more months follow‐up, effects in favour of MI were found for the quantity of alcohol consumed (standardised mean difference (SMD) −0.11, 95 per cent confidence interval (CI) −0.15 to −0.06 or a reduction from 13.7 drinks/week to 12.5 drinks/week; moderate quality evidence); frequency of alcohol consumption (SMD −0.14, 95 per cent CI −0.21 to −0.07 or a reduction in the number of days/week alcohol was consumed from 2.74 days to 2.52 days; moderate quality evidence); and peak blood alcohol concentration, or BAC (SMD −0.12, 95 per cent CI −0.20 to 0.05, or a reduction from 0.144 per cent to 0.131 per cent; moderate quality evidence).\nA marginal effect in favour of MI was found for alcohol problems (SMD −0.08, 95 per cent CI −0.17 to 0.00 or a reduction in an alcohol problems scale score from 8.91 to 8.18; low quality evidence) and no effects for binge drinking (SMD −0.04, 95 per cent CI −0.09 to 0.02, moderate quality evidence) or for average BAC (SMD −0.05, 95 per cent CI −0.18 to 0.08; moderate quality evidence). Other alcohol‐related behavioural outcomes were considered, and at four or more month’s follow‐up, we found no effects on drink‐driving (SMD −0.13, 95 per cent CI −0.36 to 0.10; moderate quality of evidence) or other alcohol‐related risky behaviour (SMD −0.15, 95 per cent CI −0.31 to 0.01; moderate quality evidence).\n\nFurther analyses showed that there was no clear relationship between the duration of the MI intervention (in minutes) and effect size. Subgroup analyses revealed no clear subgroup effects for longer‐term outcomes (four or more months) for assessment only versus alternative intervention controls; for university/college vs other settings; or for higher risk vs all/low risk participants.\n","The results of this review indicate that there are no substantive, meaningful benefits of MI interventions for preventing alcohol use, misuse or alcohol‐related problems. Although we found some statistically significant effects, the effect sizes were too small, given the measurement scales used in the included studies, to be of relevance to policy or practice. Moreover, the statistically significant effects are not consistent for all misuse measures, and the quality of evidence is not strong, implying that any effects could be inflated by risk of bias."]
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[null,"Behaviour change - Indicated interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"Agabio R et al. Baclofen for alcohol use disorder. Cochrane Database Syst Rev 2023, Issue 1. Art.No. CD012557. DOI:0.1002/14651858.CD012557.pub3.\nAvailable here. ","Adults with a diagnosis of alcohol dependence. ","This is an update of a Cochrane Review first published in 2018. The aim of this update was to evaluate the benefits and harms of baclofen on achieving and maintaining abstinence or reducing alcohol consumption in people with AUD compared to placebo, no treatment or any other pharmacological relapse prevention treatment. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nThis update included 17 RCTs (1818 participants). Ten studies compared baclofen to placebo or another medication; seven compared two baclofen doses to placebo or another medication. Globally, 15 studies compared baclofen to placebo, two baclofen to acamprosate and two baclofen to naltrexone. In 16 studies, participants received psychosocial treatments. The authors judged most studies at low risk of selection, performance, detection (subjective outcome), attrition and reporting bias. Ten studies detoxified participants before treatment; in seven studies, participants were still drinking at the beginning of treatment. Treatment duration was 12 weeks for 15 RCTs and longer in two studies. Baclofen daily dose was 30 mg to 300 mg: 10 RCTs used low doses (30 mg or less); eight RCTs medium doses (above 30 and 100 mg or less) and four RCTs high doses (above 100 mg).\n\nCompared to placebo, moderate‐certainty evidence found that baclofen probably decreases the risk to relapse (risk ratio (RR) 0.87, 95% confidence interval (CI) 0.77 to 0.99; 12 studies, 1057 participants). This result was confirmed among detoxified participants but not among other subgroups of participants.\n\nHigh‐certainty evidence found that baclofen increases the percentage of days abstinent (mean difference (MD) 9.07, 95% CI 3.30 to 14.85; 16 studies, 1273 participants). This result was confirmed among all subgroups of participants except non‐detoxified or those who received medium doses.\n\nThere was no difference between baclofen and placebo in the other primary outcomes: heavy drinking days (standardised mean difference (SMD) −0.18, 95% CI −0.48 to 0.11; 13 studies, 840 participants; moderate‐certainty evidence); and number of drinks per drinking days (MD −0.45, 95% CI −1.20 to 0.30; 9 studies, 392 participants; moderate‐certainty evidence).\n\nCompared to acamprosate, one study (60 participants) found no differences in any outcomes but the evidence was very uncertain: relapse (RR 1.25, 95% CI 0.71 to 2.20; very low‐certainty evidence).\n\nCompared to naltrexone, baclofen may increase the risk of relapse (RR 2.50, 95% CI 1.12 to 5.56; 1 study, 60 participants; very low‐certainty evidence) but the evidence is very uncertain.","The authors concluded that baclofen likely reduces the risk of relapse to any drinking and increases the percentage of abstinent days, mainly among detoxified participants. It does not increase the number of participants with at least one adverse event, those who dropout for any reason or due to adverse events. It probably does not reduce number of heavy drinking days and the number of drinks per drinking days. Current evidence suggests that baclofen may help people with AUD in maintaining abstinence. The results of comparisons of baclofen with acamprosate and naltrexone were mainly based on only one study."]
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[null,"Goldberg SB et al. Mindfulness‐based interventions for substance use disorders. Cochrane Database of Systematic Reviews 2021, Issue 10.\nAvailable here.","Patients suffering from Substance use disorders including individuals with alcohol, prescription‐, illicit‐ and poly‐substance use disorders","This Cochrane review aimed to determine the effects of MBIs for SUDs in terms of substance use outcomes, craving and adverse events compared to standard care, further psychotherapeutic, psychosocial or pharmacological interventions, or instructions, waiting list and no treatment.\n\nForty RCTs met the inclusion criteria, with 35 RCTs involving 2825 participants eligible for meta‐analysis. All studies were at high risk of performance bias and most were at high risk of detection bias.\n\nMindfulness‐based interventions (MBIs) versus no treatment: Twenty‐four RCTs included a comparison between MBI and no treatment. The evidence was uncertain about the effects of MBIs relative to no treatment on all primary outcomes: continuous abstinence rate (post: risk ratio (RR) = 0.96, 95% CI 0.44 to 2.14, 1 RCT, 112 participants; follow‐up: RR = 1.04, 95% CI 0.54 to 2.01, 1 RCT, 112 participants); percentage of days with substance use (post‐treatment: standardized mean difference (SMD) = 0.05, 95% CI ‐0.37 to 0.47, 4 RCTs, 248 participants; follow‐up: SMD = 0.21, 95% CI ‐0.12 to 0.54, 3 RCTs, 167 participants); and consumed amount (post‐treatment: SMD = 0.10, 95% CI ‐0.31 to 0.52, 3 RCTs, 221 participants; follow‐up: SMD = 0.33, 95% CI 0.00 to 0.66, 2 RCTs, 142 participants). Evidence was uncertain for craving intensity and serious adverse events. Analysis of treatment acceptability indicated MBIs result in little to no increase in study attrition relative to no treatment (RR = 1.04, 95% CI 0.77 to 1.40, 21 RCTs, 1087 participants). Certainty of evidence for all other outcomes was very low due to imprecision, risk of bias, and/or inconsistency. Data were unavailable to evaluate adverse events.\n\nMindfulness‐based interventions (MBIs) versus other treatments (standard of care, cognitive behavioral therapy, psychoeducation, support group, physical exercise, medication): Nineteen RCTs included a comparison between MBI and another treatment. The evidence was very uncertain about the effects of MBIs relative to other treatments on continuous abstinence rate at post‐treatment (RR = 0.80, 95% CI 0.45 to 1.44, 1 RCT, 286 participants) and follow‐up (RR = 0.57, 95% CI 0.28 to 1.16, 1 RCT, 286 participants), and on consumed amount at post‐treatment (SMD = ‐0.42, 95% CI ‐1.23 to 0.39, 1 RCT, 25 participants) due to imprecision and risk of bias. The evidence suggests that MBIs reduce percentage of days with substance use slightly relative to other treatments at post‐treatment (SMD = ‐0.21, 95% CI ‐0.45 to 0.03, 5 RCTs, 523 participants) and follow‐up (SMD = ‐0.39, 95% CI ‐0.96 to 0.17, 3 RCTs, 409 participants). The evidence was very uncertain about the effects of MBIs relative to other treatments on craving intensity due to imprecision and inconsistency. Analysis of treatment acceptability indicated MBIs result in little to no increase in attrition relative to other treatments (RR = 1.06, 95% CI 0.89 to 1.26, 14 RCTs, 1531 participants). Data were unavailable to evaluate adverse events.","In comparison with no treatment, the evidence is uncertain regarding the impact of MBIs on SUD‐related outcomes. MBIs result in little to no higher attrition than no treatment. In comparison with other treatments, MBIs may slightly reduce days with substance use at post‐treatment and follow‐up (4 to 10 months). The evidence is uncertain regarding the impact of MBIs relative to other treatments on abstinence, consumed substance amount, or craving. MBIs result in little to no higher attrition than other treatments. Few studies reported adverse events."]
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[null,"McGovern R et al. Effectiveness of psychosocial interventions for reducing parental substance misuse. Cochrane Database of Systematic Reviews 2021, Issue 3. Art. No.: CD012823.\nAvailable here","Participants were parents who use substances; this included mothers and fathers of children (sons and daughters) under the age of 21 years, regardless of custodial or residency status of the children. Same-sex parents and foster parents were eligible for inclusion.","The authors included 22 unique studies with a total of 2274 participants (mean age of parents ranged from 26.3 to 40.9 years), examining 24 experimental interventions. The majority of studies intervened with mothers only (n = 16; 73%). Heroin, cocaine, and alcohol were the most commonly reported substances used by participants. The interventions targeted either parenting only (n = 13; 59%); drug and alcohol use only (n = 5; 23%); or integrated interventions which addressed both (n = 6; 27%).\nThe authors found moderate-quality evidence that psychosocial interventions are probably more effective at reducing the frequency of parental alcohol misuse than comparison conditions at 6-month (mean difference (MD) −0.32, 95% confidence interval (CI) −0.51 to −0.13; 6 studies, 475 participants) and 12-month follow-up (standardised mean difference (SMD) −0.25, 95% CI −0.47 to −0.03; 4 studies, 366 participants). The authors found a significant reduction in frequency of use at 12 months only (SMD −0.21, 95% CI −0.41 to −0.01; 6 studies, 514 participants, moderate-quality evidence).\nThe authors examined the effect of the intervention type. They found low-quality evidence that psychosocial interventions targeting substance use only may not reduce the frequency of alcohol (6 months: SMD −0.35, 95% CI −0.86 to 0.16; 2 studies, 89 participants and 12 months: SMD −0.09, 95% CI −0.86 to 0.61; 1 study, 34 participants)\nA parenting intervention only, without an adjunctive substance use component, may not reduce frequency of alcohol misuse (6 months: SMD −0.21, 95% CI −0.46 to 0.04, 3 studies; 273 participants, low-quality evidence and 12 months: SMD −0.11, 95% CI −0.64 to 0.41; 2 studies; 219 participants, very low-quality evidence).\nParents receiving integrated interventions which combined both parenting- and substance use-targeted components may reduce alcohol misuse with a small effect size (6 months: SMD −0.56, 95% CI −0.96 to −0.16 and 12 months: SMD −0.42, 95% CI −0.82 to −0.03; 2 studies, 113 participants). However, this evidence was of low quality.\nInterventions appeared to be more often beneficial for fathers than for mothers. The authors found low- to very low-quality evidence of a reduction in frequency of alcohol misuse for mothers at six months only (SMD −0.27, 95% CI −0.50 to −0.04; 4 studies, 328 participants), whilst in fathers there was a reduction in frequency of alcohol misuse (6 months: SMD −0.43, 95% CI −0.78 to −0.09; 2 studies, 147 participants and 12 months: SMD −0.34, 95% CI −0.69 to 0.00; 2 studies, 147 participants).","The authors found moderate-quality evidence that psychosocial interventions probably reduce the frequency at which parents use alcohol. Integrated psychosocial interventions which combine parenting skills interventions with a substance use component may show the most promise. \nWhilst it appears that mothers may benefit less than fathers from intervention, caution is advised in the interpretation of this evidence, as the interventions provided to mothers alone typically did not address their substance use and other related needs. \nThe authors found low-quality evidence from few studies that interventions involving children are not beneficial."]
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[null,"Kelly  JF, Humphreys  K, Ferri  M. Alcoholics Anonymous and other 12‐step programs for alcohol use disorder. Cochrane Database of Systematic Reviews 2020, Issue 3. Art. No.: CD012880. DOI: 10.1002/14651858.CD012880.pub2.\nAvailable here.","Non‐coerced adults with Alcohol Use Disorder.","AA/TSF (manualized) compared to treatments with a different theoretical orientation (e.g. CBT) (randomized/quasi‐randomized evidence) \nRCTs comparing manualized AA/TSF to other clinical interventions (e.g. CBT), showed AA/TSF improves rates of continuous abstinence at 12 months (risk ratio (RR)) 1.21, 95% confidence interval (CI) 1.03 to 1.42; 2 studies, 1936 participants; high‐certainty evidence). This effect remained consistent at both 24 and 36 months. \nFor percentage days abstinent (PDA), AA/TSF appears to perform as well as other clinical interventions at 12 months (mean difference (MD) 3.03, 95% CI ‐4.36 to 10.43; 4 studies, 1999 participants; very low‐certainty evidence), and better at 24 months (MD 12.91, 95% CI 7.55 to 18.29; 2 studies, 302 participants; very low‐certainty evidence) and 36 months (MD 6.64, 95% CI 1.54 to 11.75; 1 study, 806 participants; very low‐certainty evidence). \nFor longest period of abstinence (LPA), AA/TSF may perform as well as comparison interventions at six months (MD 0.60, 95% CI ‐0.30 to 1.50; 2 studies, 136 participants; low‐certainty evidence). \nFor drinking intensity, AA/TSF may perform as well as other clinical interventions at 12 months, as measured by drinks per drinking day (DDD) (MD ‐0.17, 95% CI ‐1.11 to 0.77; 1 study, 1516 participants; moderate‐certainty evidence) and percentage days heavy drinking (PDHD) (MD ‐5.51, 95% CI ‐14.15 to 3.13; 1 study, 91 participants; low‐certainty evidence). \nFor alcohol‐related consequences, AA/TSF probably performs as well as other clinical interventions at 12 months (MD ‐2.88, 95% CI ‐6.81 to 1.04; 3 studies, 1762 participants; moderate‐certainty evidence). \nFor alcohol addiction severity, one study found evidence of a difference in favor of AA/TSF at 12 months (P < 0.05; low‐certainty evidence). \nThis study examines results for the same outcomes for non-manualized AA/TSF.\n","There is high quality evidence that manualized AA/TSF interventions are more effective than other established treatments, such as CBT, for increasing abstinence. Non‐manualized AA/TSF may perform as well as these other established treatments. AA/TSF interventions, both manualized and non‐manualized, may be at least as effective as other treatments for other alcohol‐related outcomes. AA/TSF probably produces substantial healthcare cost savings among people with alcohol use disorder. "]
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[null,"Steele DW, et al. Interventions for Substance Use Disorders in Adolescents: A Systematic Review. Comparative Effectiveness Review No. 225.  AHRQ Publication No. 20-EHC014. Rockville, MD: Agency for Healthcare Research and Quality. May 2020.\nAvailable here.","Adolescents ages 12 to 20 years with problematic substance use or substance use disorder.","The authors included interventions designed to achieve abstinence, reduce use quantity and frequency, improve functional outcomes, and reduce substance-related harms. Interventions were categorised into seven primary intervention components: motivational interviewing (MI), family focused therapy (Fam), cognitive behavioral therapy (CBT), psychoeducation, contingency management (CM), peer group therapy, and intensive case management. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nMotivational interviewing reduced heavy alcohol use days by 0.7 days/month, alcohol use days by 1.2 days/month compared with treatment as usual. Across multiple intensive interventions, family focussed therapy was most effective, reducing alcohol use days by 3.5 days/month compared with treatment as usual.\n\n","Reviewers conclude that :\nBrief interventions: motivational interviewing reduces heavy alcohol use, low Strength of Evidence (SoE) and alcohol use days (moderate SoE). \nFamily focussed therapy: may be most effective in reducing alcohol use (low SoE). More research is needed to identify other effective intensive behavioral interventions for alcohol use disorder. Both motivational interviewing and CBT reduce combined alcohol and other drug use (low SoE).\nPharmacological interventions: systematic reviews in the college settings support use of brief interventions for students with any use, heavy or problematic use. More research is needed to identify the most effective combinations of behavioral and pharmacologic treatments for alcohol use disorders."]
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[null,"Hunt G et al.  Psychosocial interventions for people with both severe mental illness and substance misuse. Cochrane Database Syst Rev 2019, Issue 12. Art. No.: CD001088. DOI: 10.1002/14651858.CD001088.pub4\nAvailable here.\n","People diagnosed with a severe mental illness and concurrent problem of substance misuse","This Cochrane review aimed to assess the effects of psychosocial interventions for reduction in substance use in people with a serious mental illness compared with standard care. It updates and replaces the 2013 version of the review.\n\nThe review now includes 41 trials with a total of 4024 participants. The reviewers identified nine comparisons within the included trials. Only two of these reported outcomes meeting the scope of this topic evidence map and have been reported below. For full detail and information on the other outcomes, please refer to the full-text. \n\n1. Integrated models of care versus standard care (36 months): No clear differences were found between treatment groups for alcohol use (RR 1.15, 95% CI 0.84 to 1.56; participants = 143; studies = 1; low‐quality evidence).\n\n5. Motivational interviewing (MI) versus standard care: A clear difference, favouring MI, was observed for abstaining from alcohol (RR 0.36, 95% CI 0.17 to 0.75; participants = 28; studies = 1; very low‐quality evidence).","Authors concluded that they included 41 RCTs but were unable to use much data for analyses. There is currently no high‐quality evidence to support any one psychosocial treatment over standard care for important outcomes such as remaining in treatment, reduction in substance use or improving mental or global state in people with serious mental illnesses and substance misuse. Furthermore, methodological difficulties exist which hinder pooling and interpreting results. Further high‐quality trials are required which address these concerns and improve the evidence in this important area."]
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[null,"Canadian Agency for Drugs and Technologies in Health. E-therapy interventions for treatments of substance use disorders and other addictions: a review of clinical effectiveness. Ottawa: CADTH; 2018. \nAvailable here.\n","Adults with diagnosed substance use disorders or with a diagnosed addiction disorder, with or without co-morbid mental health conditions. ","The purpose of this CADTH Rapid Response was to review the comparative effectiveness of therapist-guided e-therapy interventions versus other options for the treatment of adults with substance use disorders and other addictions. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nWhat is the clinical effectiveness of e-therapy for the treatment of patients with substance use disorders and other addictions? \nOne SR examined the efficacy of internet-delivered interventions for alcohol addiction. The difference in alcohol consumption between the e-therapy with therapist guidance and no treatment groups at the post-treatment follow-up was statistically significant (with the e-therapy group having less consumption) and the effect of guided e-therapy was found to be small. The authors concluded that internet-delivered interventions were effective in reducing alcohol consumption and that the effect was small.\n","Evidence on e-therapy for the treatment of substance use disorders and other addictions was from a small number of SRs and RCTs. Findings consistently showed that therapist-guided e-therapy was superior to no treatment and wait list in reducing alcohol consumption or cannabis use, and the effect was small. With respect to substances, evidence was limited to the treatment of problematic alcohol and cannabis use and it is therefore unclear if the results generalize to the misuse of other substances."]
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[null,"Egholm JWM et al. Perioperative alcohol cessation intervention for postoperative complications Cochrane Database of Syst Rev 2018, Issue 11. Art. No.: CD008343. DOI: 10.1002/14651858.CD008343.pub3\n\nAvailable here.\n","Included participants with risky consumption of alcohol who were undergoing all types of elective or acute surgical procedures under general or regional anaesthesia or sedation, who were offered perioperative alcohol cessation intervention or no intervention. ","This Cochrane systematic review aimed to assess the effects of perioperative alcohol cessation interventions on rates of postoperative complications and alcohol consumption. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nOne new study was included in this updated review, resulting in a total of three RCTs (140 participants who drank 3 to 40 AU/d). All three studies were of moderate to good quality. All studies evaluated the effects of intensive alcohol cessation interventions, including pharmacological strategies for alcohol withdrawal symptoms, patient education, and relapse prophylaxis. The authors identified one ongoing study.\n\nInvestigators describe more successful quitters at the end of the intervention programme than among controls. Forty-one out of 70 participants in the intervention groups successfully quit drinking compared with only five out of 70 participants in the control groups (RR 8.22, 95% CI 1.67 to 40.44). The quality of evidence for this outcome is moderate.\n\nAll three studies reported postoperative alcohol consumption (grams of alcohol/week) at the end of the programme as median and range values; therefore it was not possible to estimate the mean and the SD. We performed no meta-analysis. All three studies reported length of stay, and none of these studies described a significant difference in length of stay. Data were insufficient for review authors to perform a meta-analysis. No studies reported on the prevalence of participants without risky drinking in the longer term.\n\nIncluded studies were few and reported small sample sizes; therefore one should be careful about drawing firm conclusions based on these study results. All three studies were conducted in Denmark, and most participants were men. The included participants may represent a selective group, as they could have been more motivated and/or more interested in participating in clinical research or otherwise different, and effects may have been overestimated for both intervention and control groups in these studies. Trial results indicate that these studies are difficult to perform, that strong research competencies are necessary for future studies, and that further evaluation of perioperative alcohol cessation interventions in high-quality randomised controlled trials is needed. Once published and assessed, the one ’ongoing’ study identified may alter the conclusions of this review.","The authors conclude that all three studies showed a significant reduction in the number of participants who quit drinking alcohol during the intervention period. Intensive alcohol cessation interventions offered for four to eight weeks to participants undergoing all types of surgical procedures to achieve complete alcohol cessation before surgery probably reduced the number of postoperative complications. Data were insufficient for review authors to assess their effects on postoperative mortality. No studies reported an effect on length of stay, and no studies addressed the prevalence of risky drinking in the longer term.\n\n\n"]
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[null,"Klimas J et al. Psychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users. Cochrane Database Syst Rev 2018, Issue 12. Art. No.: CD009269. DOI: 10.1002/14651858.CD009269.pub4.\nAvailable here. \n","Problem alcohol and illicit drug users (principally problem drug users of opiates and stimulants). ","This Cochrane review aimed to assess the effects of psychosocial interventions for problem alcohol use in illicit drug users. \n\nThe psychosocial interventions considered in the studies were: cognitive‐behavioural coping skills training (one study), twelve‐step programme (one study), brief intervention (three studies), motivational interviewing (two studies), and brief motivational interviewing (one study). Two studies were considered in two comparisons. There were no data for the secondary outcome, alcohol‐related harm. The results were as follows. \n\nComparison 1: cognitive‐behavioural coping skills training versus twelve‐step programme (one study, 41 participants): There was no significant difference between groups for either of the primary outcomes (alcohol abstinence assessed with Substance Abuse Calendar and breathalyser at one year: risk ratio (RR) 2.38 (95% confidence interval [CI] 0.10 to 55.06); and retention in treatment, measured at end of treatment: RR 0.89 (95% CI 0.62 to 1.29), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was very low. \n\nComparison 2: brief intervention versus treatment as usual (three studies, 197 participants): There was no significant difference between groups for either of the primary outcomes (alcohol use, measured as scores on the Alcohol Use Disorders Identification Test (AUDIT) or Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) at three months: standardised mean difference (SMD) 0.07 (95% CI ‐0.24 to 0.37); and retention in treatment, measured at three months: RR 0.94 (95% CI 0.78 to 1.13), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was low. \n\nComparison 3: motivational interviewing versus treatment as usual or educational intervention only (three studies, 462 participants): There was no significant difference between groups for either of the primary outcomes (alcohol use, measured as scores on the AUDIT or ASSIST at three months: SMD 0.04 (95% CI ‐0.29 to 0.37); and retention in treatment, measured at three months: RR 0.93 (95% CI 0.60 to 1.43), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was low. \n\nComparison 4: brief motivational intervention (BMI) versus assessment only (one study, 187 participants): More people reduced alcohol use (by seven or more days in the past month, measured at six months) in the BMI group than in the control group (RR 1.67; 95% CI 1.08 to 2.60). There was no difference between groups for the other primary outcome, retention in treatment, measured at end of treatment: RR 0.98 (95% CI 0.94 to 1.02), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was moderate. \n\nComparison 5: motivational interviewing (intensive) versus motivational interviewing (one study, 163 participants): There was no significant difference between groups for either of the primary outcomes (alcohol use, measured using the Addiction Severity Index‐alcohol score (ASI) at two months: MD 0.03 (95% CI 0.02 to 0.08); and retention in treatment, measured at end of treatment: RR 17.63 (95% CI 1.03 to 300.48), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was low. \n\n","The review authors found low to very low‐quality evidence to suggest that there is no difference in effectiveness between different types of psychosocial interventions to reduce alcohol consumption among people who use illicit drugs, and that brief interventions are not superior to assessment‐only or to treatment as usual. No firm conclusions can be made because of the paucity of the data and the low quality of the retrieved studies."]
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[null,"Agabio R, Trogu E, Pani PP. Antidepressants for the treatment of people with co‐occurring depression and alcohol dependence. Cochrane Database Syst Rev 2018, Issue 4. Art. No.: CD008581. DOI: 10.1002/14651858.CD008581.pub2.\nAvailable here. \n","Adults with co-occurring depression and alcohol dependence. ","This Cochrane review aimed to assess the benefits and risks of antidepressants for the treatment of people with co‐occurring depression and alcohol dependence. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text\n\nReview authors report that 33 studies were included in the review (2242 participants). Antidepressants were compared to placebo (22 studies), psychotherapy (two studies), other medications (four studies), or other antidepressants (five studies). The mean duration of the trials was 9.9 weeks (range 3 to 26 weeks). Eighteen studies took place in the USA, 12 in Europe, two in Turkey, and one in Australia. The antidepressant included in most of the trials was sertraline; other medications were amitriptyline, citalopram, desipramine, doxepin, escitalopram, fluoxetine, fluvoxamine, imipramine, mianserin, mirtazepine, nefazodone, paroxetine, tianeptine, venlafaxine, and viloxazine. Eighteen studies were conducted in an outpatient setting, nine in an inpatient setting, and six in both settings. Psychosocial treatment was provided in 18 studies. There was high heterogeneity in the selection of outcomes and the rating systems used for diagnosis and outcome assessment.\n\nModerate‐quality evidence found that antidepressants increased the number of participants abstinent from alcohol during the trial (7 studies, 424 participants, RR 1.71, 95 per cent Cl 1.22 to 2.39) and reduced the number of drinks per drinking days (7 studies, 451 participants, mean difference (MD) ‐1.13 drinks per drinking days, 95 per cent Cl ‐1.79 to ‐0.46). After the exclusion of studies with high risk of bias, the number of abstinent remained higher (RR 1.69, 95 per cent CI 1.18 to 2.43) and the number of drinks per drinking days lower (MD ‐1.21 number of drinks per drinking days, 95 per cent CI ‐1.91 to ‐0.51) among participants who received antidepressants compared to those who received placebo. However, other outcomes such as the rate of abstinent days did not differ between antidepressants and placebo (9 studies, 821 participants, MD 1.34, 95 per cent Cl ‐1.66 to 4.34; low‐quality evidence).\n\nThere were few studies comparing one antidepressant versus another antidepressant or antidepressants versus other interventions, and these had a small sample size and were heterogeneous in terms of the types of interventions that were compared, yielding results that were not informative.\n","Authors found low‐quality evidence supporting the clinical use of antidepressants in the treatment of people with co‐occurring depression and alcohol dependence. Antidepressants had positive effects on certain relevant outcomes related to depression and alcohol use but not on other relevant outcomes. Moreover, most of these positive effects were no longer significant when studies with high risk of bias were excluded. Results were limited by the large number of studies showing high or unclear risk of bias and the low number of studies comparing one antidepressant to another or antidepressants to other medication. In people with co‐occurring depression and alcohol dependence, the risk of developing adverse effects appeared to be minimal, especially for the newer classes of antidepressants (such as selective serotonin reuptake inhibitors). According to these results, in people with co‐occurring depression and alcohol dependence, antidepressants may be useful for the treatment of depression, alcohol dependence, or both, although the clinical relevance may be modest."]
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[null,"Kaner E et al. Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev 2018, Issue 2.\nAvailable here. ","People who routinely presented to general practice, emergency care or other primary care settings for a range of health problems, whose alcohol consumption was identified by a screening tool as being excessive, or who had experienced harm as a result of their drinking behaviour","This Cochrane systematic review aimed to assess the effectiveness of screening and brief alcohol intervention to reduce excessive alcohol consumption in hazardous or harmful drinkers in general practice or emergency care settings.\n\nThe reviewers found moderate‐quality evidence that brief alcohol interventions have little impact on frequency of binges per week (MD ‐0.08, 95% CI ‐0.14 to ‐0.02; 15 studies, 6946 participants); drinking days per week (MD ‐0.13, 95% CI ‐0.23 to ‐0.04; 11 studies, 5469 participants); or drinking intensity (‐0.2 g/drinking day, 95% CI ‐3.1 to 2.7; 10 studies, 3128 participants).\n\nThey found moderate‐quality evidence of little difference in quantity of alcohol consumed when extended and no or minimal interventions were compared (‐20 g/week, 95% CI ‐40 to 1; 6 studies, 1296 participants). There was little difference in binges per week (‐0.08, 95% CI ‐0.28 to 0.12; 2 studies, 456 participants; moderate‐quality evidence) or difference in days drinking per week (‐0.45, 95% CI ‐0.81 to ‐0.09; 2 studies, 319 participants; moderate‐quality evidence). Extended versus no or minimal intervention provided little impact on drinking intensity (9 g/drinking day, 95% CI ‐26 to 9; 1 study, 158 participants; low‐quality evidence).\n\nExtended intervention had no greater impact than brief intervention on alcohol consumption, although findings were imprecise (MD 2 g/week, 95% CI ‐42 to 45; 3 studies, 552 participants; low‐quality evidence). Numbers of binges were not reported for this comparison, but one trial suggested a possible drop in days drinking per week (‐0.5, 95% CI ‐1.2 to 0.2; 147 participants; low‐quality evidence). Results from this trial also suggested very little impact on drinking intensity (‐1.7 g/drinking day, 95% CI ‐18.9 to 15.5; 147 participants; very low‐quality evidence).","The authors concluded that they found moderate‐quality evidence that brief interventions can reduce alcohol consumption in hazardous and harmful drinkers compared to minimal or no intervention. Longer counselling duration probably has little additional effect. Future studies should focus on identifying the components of interventions which are most closely associated with effectiveness."]
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[null,"Smedslund G et al. Effect of early, brief computerized interventions on risky alcohol and cannabis use among young people. Campbell systematic reviews 2017; 6:(13). Available here. ","Young people (aged 15-25) who abuse alcohol or cannabis. ","The review focused on the effects of brief interventions, provided by electronic devices. Sixty studies were included in the review that had randomised a total of 33,316 participants. \n\nModerate quality evidence was found that multi-dose assessment and feedback was more effective than single-dose assessment for alcohol. A meta-analysis of four studies by the same first author found a 16 per cent significant short-term reduction in drinking after a repeated assessment and feedback compared to a single assessment and feedback (Rate ratio: 0.84, 95 per cent CI: 0.78 to 0.91). However, a study by Anderson (2015) found an SMD of 0.10 (in favour of single dose, 95 per cent CI: -0.07 to 0.27). A study by Kypri (2008) found a long-term significant reduction in drinking after multi-dose feedback compared to single-dose feedback (Rate ratio: 0.77, 95 per cent CI: 0.63 to 0.94). \n\nLow quality evidence was found that assessment and feedback might be more effective than no intervention (Short term effect, 15 studies; SMD: -0.17, 95 per cent CI: -0.27 TO -0.08, I2 = 52 per cent. Long term effect, 3 studies; SMD: -0.17, 95 per cent CI: -0.30 to -0.04).\n\nAssessment and feedback might also be more effective than assessment alone (low quality evidence. Short-term effect, 24 studies; SMD: -0.15, 95 per cent CI: -0.25 to -0.06, I2 = 64 per cent. Long-term effect, 3 studies; SMD: -0.03, 95 per cent CI: -0.19 to 0.12). \n\nShort term effects (<6 months) were mostly larger than long-term (≥ 6 months) effects. \n","Computerized brief interventions are easy to administer, and the evidence from this review indicates that such brief interventions might reduce drinking for several months after the intervention. Additionally, there is no evidence for adverse effects. This means that brief, computerized interventions could be feasible ways of dealing with risky alcohol use among young people. The evidence on cannabis consumption is scarcer, suggesting the need for more research. "]
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[null,"Canadian Agency for Drugs and Technology in Health. Concurrent treatment for substance use disorder and trauma-related comorbidities: a review of clinical effectiveness and guidelines. Ottawa: CADTH; 2017. \nAvailable here. ","Adults with substance use disorder and trauma-related comorbidities (PTSD, anxiety or depression). \n\nSubgroup of interest: military veterans","The purpose of this report by CADTH was to review treatment options for patients with comorbid substance use disorder (SUD) and post-traumatic stress disorder, anxiety, or depression by comparing concurrent treatments for SUD and the mental disorders with no treatment, usual care or active treatment for one condition only and treatment for a single condition (SUD or the mental disorders) with no treatment, usual care or active treatment for the second disorder. Additionally, this review aimed to review evidence-based guidelines regarding the treatments for patients with these comorbidities. \n\nThe review addressed three main research questions. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\n1. What is clinical effectiveness of concurrent treatment for patients with substance use disorders and comorbid post-traumatic stress disorder, anxiety, or depression?\nPatients with comorbid SUD and PTSD: In summary, findings with respect to SUD outcomes for integrated treatments addressing both PTSD and SUD, were inconsistent.\nPatients with comorbid SUD and depression: In summary, there is a suggestion that integrated treatments are more effective than control treatments or treatments addressing a single condition, but findings were not always consistent.\nPatients with SUD and anxiety disorder: One RCT showed that fewer patients relapsed to any drinking in the CBT group compared to the PMRT group. Another RCT showed that the nine hour anxiety-sensitivity focused intervention plus TAU over TAU alone, showed improvement in percent days abstinent in both groups, but showed no significant between group difference.\nPatients with SUD and depression or anxiety disorder: An RCT showed that ICBT appeared to be more effective than usual care with respect to most measures of alcohol consumption.\n\n2. What is the clinical effectiveness of the treatment of one condition for the improvement of all symptoms in patients with substance use disorder and comorbid post-traumatic stress disorder, anxiety, or depression?\nA systematic review included six studies that evaluated addiction based interventions. Two studies comparing the experimental contingency management (CM) treatment with control treatment found slightly better early treatment gains with respect to substance use with CM, however the differences did not remain significant in the long term as shown in one study. Results from three studies (other than CM) showed within-group improvement in SUD outcomes over time even for minimal or no treatment. One study showed that the care management program was associated with better alcohol outcomes compared to the AUD treatment that patients identified on their own.\nAnother systematic review included one study comparing technology-based treatment (TAU plus web based intervention targeting alcohol use) with TAU alone, reported no findings with respect to substance use.\n\n3. What are the evidence-based guidelines regarding the treatment of patients with substance use disorders and comorbid post-traumatic stress disorder, anxiety, or depression?\nOne relevant evidence-based guideline was identified. For comorbid anxiety and alcohol use disorder or for comorbid PTSD and alcohol use disorder, an integrated approach was recommended (Recommendation grade: CCP i.e. “Clinical consent point”). For comorbid depression and alcohol use disorder, CBT was recommended to improve both depressive symptoms and drinking problems.","Report authors found there was a suggestion that integrated treatments offered greater improvement with respect to PTSD symptoms, depression or anxiety compared to no treatment or minimal treatment for patients with comorbid substance use disorder (SUD) and posttraumatic stress syndrome (PTSD), depression or anxiety disorder. However results were not always consistent. In patients with comorbid SUD and PTSD, there was a suggestion that addiction based interventions were more effective with respect to controlling substance use than control treatments. One evidence-based guideline recommended an integrated treatment approach for patients with comorbid alcohol use disorder and PTSD, or comorbid alcohol use disorder and anxiety disorder, and cognitive behavioural therapy for comorbid alcohol use disorder and depression."]
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[null,"Canadian Agency for Drugs and Technology in Health. Inpatient and outpatient treatment programs for substance use disorder: a review of clinical effectiveness and guidelines. Ottawa: CADTH; 2017a. \nAvailable here. \n","Adults 18 to 65 years with substance use disorder/addiction disorder (e.g., abuse of prescription medications or cocaine, heroin, cannabis, alcohol)\n","This Rapid Response report by CADTH aimed to review the clinical effectiveness of inpatient and outpatient treatment programs for adults with substance use disorders involving prescription medications such as analgesics or non-prescription substances such as cocaine, opioids such as heroine, marijuana (cannabis), or alcohol. Evidence-based guidelines associated with inpatient and outpatient treatment programs in adults with substance use disorders were also examined.\n\nThe review addressed two main research questions. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\n1. What is the clinical effectiveness of inpatient and outpatient treatment programs in adults with substance use disorders?\nOne narrative review concluded that evidence supports the case for community detoxification in patients with alcohol dependence. One RCT with long-term follow-up (18 months) concluded that the evidence found initial but decreasing benefit of inpatient over outpatient care across time. One prospective study found inpatients consumed significantly less alcohol in the year after entering treatment than outpatients as measured by the Graduated Frequency Scale questionnaire, and had significantly greater engagement with Alcohol Anonymous program than outpatients in the year after treatment. One retrospective study reported that inpatients with substance use disorders are three times more likely to complete treatment than outpatients.\n\n2. What are the evidence-based guidelines associated with inpatient and outpatients treatment programs in adults with substance use disorders?\nThe evidence-based guidelines from British Columbia Ministry of Health on opioids use disorder recommend that withdrawal management, if needed, can be provided more safely in an outpatient setting rather than in an inpatient setting in most patients. For patients who wish to avoid long-term opioid agonist treatment, supervised slow (longer than one month) outpatient or residential opioid agonist taper can be provided rather than rapid (less than one week) inpatient opioid agonist taper. The slow approach may permit a more flexible and individualised approach to tapered agonist reduction, which allows dose adjustment and stabilisation in case withdrawal symptoms occur.\n\n","For patients with alcohol use disorders, better detoxification completion and abstinence rates, and similar adverse event rates, were found in outpatient care compared to inpatient care in a couple of studies with short follow-up periods (one to two months). One study with a longer follow-up period found inpatients consumed less alcohol than outpatients in the year after entering treatment. This may be explained by the controlled environment of inpatient care that avoids the distractions that could be present in an outpatient care situation. In patients with severe alcohol dependence, data from one study found initial but decreasing benefit of inpatient over outpatient care across time in alcohol abstinence. For patients with substance use disorders, data from one study showed inpatients are more likely to complete treatment than outpatients. The small number of studies found and their heterogeneity in design and reported outcomes cautioned the interpretation of the findings. \n\n\n"]
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[null,"Carney T, Myers BJ, Louw J, Okwundu CI. Brief school‐based interventions and behavioural outcomes for substance‐using adolescents. Cochrane Database Syst Rev 2016; Issue 1. Art. No.: CD008969. DOI: 10.1002/14651858.CD008969.pub3\nAvailable here.\n","Substance using adolescents.","The authors included six RCTs which evaluated the effects of brief school-based interventions for substance-using adolescents. Three studies with 732 adolescents compared brief interventions (Bls) with information provision only, and three studies with 444 adolescents compared Bls with assessment only. Reasons for downgrading the quality of evidence included risk of bias of the included studies, imprecision, and inconsistency. For outcomes that concern substance abuse, the retrieved studies only assessed alcohol and cannabis. \n\nGenerally, moderate quality evidence was found that, compared to information provision only, BIs did not have a significant effect on any of the substance use outcomes at short‐, medium‐, or long‐term follow‐up. \n\nWhen compared to assessment-only controls, BIs were found to significantly reduce the frequency of alcohol use (SMD ‐0.91; 95 per cent CI ‐1.21 to ‐0.61, n = 242), alcohol abuse (SMD ‐0.38; 95 per cent CI ‐0.7 to ‐0.07, n = 190) and dependence (SMD ‐0.58; 95 per cent CI ‐0.9 to ‐0.26, n = 190) at medium-term follow-up in one study. And, at long-term follow-up BI’s also reduced alcohol abuse (SMD ‐0.72; 95 per cent CI ‐1.05 to ‐0.40, n = 181) in one study. However, the evidence from studies that compared brief interventions to assessment‐only conditions was generally of low quality.\n","We found low or very low‐quality evidence that brief school‐based interventions may be more effective in reducing alcohol and cannabis use than the assessment‐only condition and that these reductions were sustained at long‐term follow‐up. We found moderate‐quality evidence that, when compared to information provision, brief interventions probably did not have a significant effect on substance use outcomes. It is premature to make definitive statements about the effectiveness of brief school‐based interventions for reducing adolescent substance use. Further high‐quality studies examining the relative effectiveness of BIs for substance use and other problem behaviours need to be conducted, particularly in low‐ and middle‐income countries."]
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[null,"Roberts NP et al. Psychological therapies for post‐traumatic stress disorder and comorbid substance use disorder. Cochrane Database Syst Rev 2016, Issue 4. Art. No.: CD010204. DOI: 10.1002/14651858.CD010204.pub2.\nAvailable here. \n","Individuals with comorbid PTSD and SUD","This Cochrane review aimed to determine the efficacy of psychological therapies aimed at treating traumatic stress symptoms, substance misuse symptoms, or both in people with comorbid PTSD and SUD in comparison with control conditions (usual care, waiting‐list conditions, and no treatment) and other psychological therapies. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nFourteen studies with 1506 participants were included, of which 13 studies were included in the quantitative synthesis. Most studies involved adult populations. Studies were conducted in a variety of settings. Four comparisons were undertaken investigating the effects of psychological therapies with a trauma‐focused component and non‐trauma‐focused interventions against treatment as usual/minimal intervention and other active psychological therapies. Comparisons were stratified for individual‐ or group‐based therapies. All active interventions were based on CBT.\n\nIndividual‐based psychological therapies with a trauma‐focused component plus adjunctive SUD intervention: There was no evidence of an effect for level of drug/alcohol use post‐treatment (SMD ‐0.13; 95% CI ‐0.41 to 0.15; 3 studies; n = 388; very low‐quality evidence), but there was a small effect in favour of individual psychological therapy at 5 to 7 months (SMD ‐0.28; 95% CI ‐0.48 to ‐0.07; 3 studies; n = 388) when compared against TAU.\n\nIndividual‐based psychological therapy with a trauma‐focused component: did not perform better than psychological therapy for SUD only for drug/alcohol use (MD ‐1.27; 95% CI ‐5.76 to 3.22; 1 study; n = 46; low‐quality evidence). Findings were based on one small study.\n\nNon‐trauma‐focused psychological therapies: did not perform better than TAU/minimal intervention. There were no data on the effects on drug/alcohol use for individual therapy. There was no evidence of an effect on the level of drug/alcohol use for group‐based therapy (SMD ‐0.03; 95% CI ‐0.37 to 0.31; 4 studies; n = 414; very low‐quality evidence). A post‐hoc analysis for full dose of a widely established group therapy called Seeking Safety showed reduced drug/alcohol use post‐treatment (SMD ‐0.67; 95% CI ‐1.14 to ‐0.19; 2 studies; n = 111), but not at subsequent follow‐ups.\nThese also did not perform better than psychological therapy for SUD only for drug/alcohol use (SMD 0.22; 95% CI ‐0.13 to 0.57; 2 studies; n = 128; low‐quality evidence).\n","The reviewers assessed the evidence in this review as mostly low to very low quality. Evidence showed that individual trauma‐focused psychological therapy delivered alongside SUD therapy did better than TAU/minimal intervention in reducing PTSD severity post‐treatment and at long‐term follow‐up, but only reduced SUD at long‐term follow‐up. All effects were small, and follow‐up periods were generally quite short. There was evidence that fewer participants receiving trauma‐focused therapy completed treatment. There was very little evidence to support use of non‐trauma‐focused individual‐ or group‐based integrated therapies. Individuals with more severe and complex presentations (e.g. serious mental illness, individuals with cognitive impairment, and suicidal individuals) were excluded from most studies in this review, and so the findings from this review are not generalisable to such individuals. Some studies suffered from significant methodological problems and some were underpowered, limiting the conclusions that can be drawn. Further research is needed in this area."]
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[null,"Canadian agency for Drugs and Technology in Health. Mindfulness interventions for the treatment of post-traumatic stress disorder, generalized anxiety disorder, depression and substance use disorders: a review of the clinical effectiveness and guidelines. Ottawa: CADTH; 2015. Available here. ","Adults with post-traumatic stress disorder (PTSD), generalised anxiety disorder (GAD), depression, or substance use disorders.","The objective of this review was to summarise the clinical effectiveness and guidelines for the use of mindfulness interventions for the treatment of PTSD, GAD, depression, and substance use disorders in adults. The review addressed two main research questions. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\n1. What is the clinical effectiveness of mindfulness interventions for the treatment of adults with PTSD, GAD, Depression, or substance use disorders?\nA study reported, that compared with treatment as usual, participants assigned to mindfulness-based relapse prevention reported significantly lower risk of heavy drinking, significantly fewer days of heavy drinking at the 6-month follow-up. At the 12-month follow-up, mindfulness-based relapse prevention participants reported significantly decreased heavy drinking compared with relapse prevention and treatment as usual.\n\n2. What are the evidence-based guidelines regarding the use of mindfulness interventions for the treatment of adults with PTSD, GAD, Depression, or substance use disorders?\nThe guideline by the New South Wales Department of Health suggested that mindfulness could be used to treat problematic drug and alcohol users.\n\n","The evidence for the efficacy of mindfulness as a treatment for individuals with substance use disorders was limited. One RCT of low methodological quality suggested that mindfulness intervention is more effective than treatment as usual in lowering risk of relapse to substance use and heavy drinking. One guideline suggested that mindfulness can be used to treat problematic drug and alcohol use problems by suitably trained and experienced drug and alcohol professionals.\n"]
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[null,"Canadian agency for Drugs and Technology in Health. Yoga for the Treatment of Post-Traumatic Stress Disorder, Generalized Anxiety Disorder, Depression, and Substance Abuse: A Review of the Clinical Effectiveness and Guidelines. Ottawa: CADTH; 2015a. Available here. ","Adults with PTSD, GAD, depression, or substance use disorders.","The objective of this Rapid Response report is to review the clinical effectiveness of yoga for treating PTSD, GAD, depression and substance abuse, and to summarize the guidelines that are associated with the use of yoga for these conditions.The review addressed two main research questions. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\n1. What is the clinical effectiveness of yoga as an intervention for the treatment of PTSD, GAD, depression, or substance use disorders?\nOne study found that yoga was a feasible adjunct treatment for treating alcohol dependence. Patients in the yoga intervention group had a higher baseline level of drinking compared to the control group and there were positive, non-significant changes in alcohol consumption at six month follow-up, numerically greater than that experienced by the control. \ngroup\n\n2. What are the evidence-based guidelines regarding the use of mindfulness interventions for the treatment of adults with PTSD, GAD, Depression, or substance use disorders?\nFive evidence-based guidelines were included in this report, two of which did not find enough evidence for yoga to provide a recommendation. None of the recommendations focused specifically on alcohol consumption.\n\n","Three RCTs of low methodological quality suggested that patients with substance abuse improved with respect to some symptoms with yoga. Five evidence based guideline documents considered the use of yoga in clinical practice. Three suggested that yoga may be useful as an adjunctive treatment for treating major depressive disorder (MDD), PTSD and GAD, if available. "]
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[null,"Ipser JC et al. Pharmacotherapy for anxiety and comorbid alcohol use disorders. Cochrane Database Syst Rev 2015, Issue 1. Art. No.: CD007505. DOI: 10.1002/14651858.CD007505.pub2\nAvailable here. \n","People diagnosed with alcohol dependence or abuse and an anxiety disorder according to DSM‐III, DSM‐IV, or DSM‐IV‐TR criteria.","This Cochrane review aimed to assess the effects of pharmacotherapy for treating anxiety in people with comorbid alcohol use disorders. Five placebo‐controlled pharmacotherapy RCTs (with 290 participants) were included in the review. Most of the trials provided little information on how randomisation was performed or on whether both participants and study personnel were blinded to the intervention. \n\nStudy participants had DSM) III‐ and DSM IV‐diagnosed alcohol use disorders and post‐traumatic stress disorder (two studies), social anxiety disorder (SAD; two studies) or generalized anxiety disorder (GAD; one study). Four trials assessed the efficacy of the selective serotonin re‐uptake inhibitors (SSRIs: sertraline, paroxetine); one RCT investigated the efficacy of buspirone, a 5‐hydroxytryptamine (5‐HT) partial agonist. Treatment duration lasted between eight and 24 weeks. Overall, 70% of participants included in the review were male. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nThere was no evidence of an effect for any of the medications tested on abstinence from alcohol use or depression symptoms.","The evidence‐base for the effectiveness of medication in treating anxiety disorders and comorbid alcohol use disorders is currently inconclusive. There was no evidence that alcohol use was responsive to medication. Large, rigorously conducted RCTs would help supplement the small evidence‐base for the efficacy and tolerability of pharmacotherapy for anxiety and comorbid alcohol use disorders. Further research on patient subgroups who may benefit from pharmacological treatment, as well as novel pharmacological interventions, is warranted. \n"]
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[null,"Pani PP et al. Anticonvulsants for alcohol dependence. Cochrane Database Syst Rev 2014, Issue 2. Art. No.: CD008544. DOI: 10.1002/14651858.CD008544.pub2.\nAvailable here. \n","Alcohol dependent adults. ","The primary aim of this Cochrane review is to assess the benefits/risks of anticonvulsants for the treatment of alcohol dependence. \n\nA total of 25 studies were included in the review (2641 participants). Most participants were male, with an average age of 44 years. Anticonvulsants were compared with placebo (17 studies), other medications (seven studies) and no medication (two studies). The mean duration of the trials was 17 weeks (range four to 52 weeks). The studies took place in the USA, Europe, South America, India and Thailand. Variation was reported in the characteristics of the studies, including their design and the rating instruments used. For many key outcomes, the risk of bias associated with unclear or unconcealed allocation and lack of blinding affected the quality of the evidence. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nAnticonvulsants versus placebo: For continuous abstinence (eight studies, 634 participants, RR 1.21, 95% Cl 95 per cent 0.97 to 1.52, moderate‐quality evidence), results showed no evidence of differences. Moderate‐quality evidence suggested that anticonvulsants reduced drinks/drinking days (11 studies, 1126 participants, mean difference (MD) ‐1.49, 95% Cl ‐2.32 to ‐0.65) and heavy drinking (12 studies, 1129 participants, standardised mean difference (SMD) ‐0.35, 95% Cl ‐0.51 to ‐0.19). The direction of results was confirmed by subgroup analyses for topiramate and partially for gabapentin and valproate. \n\nAnticonvulsants versus naltrexone: No evidence of difference was shown in severe relapse rates (four studies, 427 participants, RR 0.69, 95% Cl 0.44 to 1.07) and continuous abstinence rates (five studies, 528 participants, RR 1.21, 95% Cl 0.99 to 1.49); anticonvulsants were associated with fewer heavy drinking days (three studies, 308 participants, MD ‐5.21, 95% Cl ‐8.58 to ‐1.83) and more days to severe relapse (three studies, 244 participants, MD 11.88, 95% Cl 3.29 to 20.46).\n","The authors concluded that at the current stage of research, randomised evidence supporting the clinical use of anticonvulsants to treat alcohol dependence is insufficient. Results are conditioned by heterogeneity and by the low number and quality of studies comparing anticonvulsants with other medications. The uncertainty associated with these results leaves to clinicians the need to balance possible benefits/risks of treatment with anticonvulsants versus other medications as supported by evidence of efficacy."]
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[null,"Dedert E et al. e-interventions for alcohol misuse. Durham NC: Evidence-based Synthesis Program Center; 2014.\nAvailable here.\n","Adults with alcohol use disorders (AUD). ","This review evaluates computer-based interventions for alcohol misuse. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nEffects of E-Interventions Compared with Inactive Controls in Adults who Misuse Alcohol: Twenty-two studies with 13,929 participants and judged to be low (n=7) or moderate (n=12) risk of bias. Overall, the available data suggest that long-term effects of e-interventions on alcohol outcomes are modest or absent.\n\nEffects of E-Interventions Compared with Inactive Controls in Adults at High Risk of AUD (eg, AUDIT-C ≥8) or with a Diagnosis of AUD: 3 studies (2 moderate, 1 high risk of bias) in 533 patients with a diagnosis of AUD. Neither computerized feedback plus telephone counseling nor an interactive voice response system decreased alcohol consumption or risk of relapse. A multicomponent smartphone program used to support recovery following residential treatment increased abstinence (OR 1.94; 95% CI, 1.14 to 3.31) and decreased risky drinking days at 12-month follow-up.\n\n Effects of E-Interventions Alone or Used in Combination with Face-to-Face Therapy Compared with Face-to-Face Therapy Alone in Adults who Misuse Alcohol: Six trials with 1090 participants. Overall, this diverse group of studies did not find a benefit of e-interventions alone or as an adjunct to face-to-face  brief MI compared with face-to-face brief MI alone for college students or midlife primary care patients who misuse alcohol.","The authors reported that they found limited evidence for small or no effects of e-interventions compared with controls on long-term (≥6 months) alcohol outcomes in participants who screened positive for alcohol misuse. Findings were even more limited for participants with AUD or comparisons of e-interventions to face-to-face treatment. Further research is needed to determine with higher confidence whether e-interventions can produce long-term benefits for alcohol-related outcomes. In particular, given the limited number and duration of intervention episodes in the studies reviewed, it is possible that these e-interventions were not designed to be robust enough to produce significant, enduring effects on alcohol misuse. As reported in previous reviews, brief in-person interventions produce sustained reductions in alcohol consumption in participants with alcohol misuse. Current evidence does not support substitution of e-interventions for brief, in-person treatment. Future research on e-interventions should include evaluations of more intensive or longer duration e-interventions for alcohol misuse. "]
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[null,"Jonas DE et al. Pharmacotherapy for adults with alcohol-use disorders in outpatient settings. Rockville MD: Agency for Healthcare Research and Quality; 2014. \nAvailable here. \n\nThis report has been archived by AHRQ and is being updated. The update protocol can be accessed here.","Adults with alcohol-use disorders. ","The aim of this report was to conduct a systematic review and meta-analysis of the efficacy, comparative effectiveness, and harms of medications (both FDA approved and others) for adults with alcohol-use disorders, and to evaluate the evidence from primary care settings.\n\nOne hundred and thirty five studies were included. Most patients met criteria for alcohol dependence; mean ages were in the 40s. Studies typically included psychosocial cointerventions; effect sizes reflect the added benefits of medications. For acamprosate and oral naltrexone (50 mg per day), numbers needed to treat (NNTs) to prevent 1 person from returning to any drinking were 12 and 20, respectively (moderate SOE); NNT to prevent 1 person from returning to heavy drinking was 12 for oral naltrexone (50 mg per day) (moderate SOE). Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nMeta-analyses of four head-to-head trials found no statistically significant difference between the two medications for consumption outcomes (moderate SOE). For injectable naltrexone, meta-analyses found no significant benefit for return to any or heavy drinking, but found a reduction in heavy drinking days (low SOE). Evidence from well-controlled trials does not support efficacy of disulfiram, except possibly for patients with excellent adherence. Among medications used off label, moderate evidence supports the efficacy of nalmefene and topiramate for improving some consumption outcomes, and limited evidence supports the efficacy of valproic acid. Evidence from primary care settings was scant. There was insufficient direct evidence to conclude whether medications for alcohol-use disorders are effective for improving health outcomes.","Authors concluded that acamprosate and oral naltrexone have the best evidence for improving alcohol consumption outcomes for patients with alcohol-use disorders. Head-to-head trials have not consistently established the superiority of one medication. Thus, other factors may guide medication choices, such as frequency of administration, potential adverse events, coexisting symptoms, and availability of treatments.\n\n"]

{"sheet":"Families","index":10,"n_rows":161,"n_cols":5,"rows_kept":161,"cut":false,"hidden":false,"merged":[[55,1,70,1],[55,2,58,2],[55,3,79,3],[55,4,79,4],[80,1,105,1],[80,2,105,2],[80,3,105,3],[80,4,105,4],[107,1,107,4],[160,1,175,1],[160,2,163,2],[160,3,184,3],[160,4,184,4],[140,1,159,1],[140,2,159,2],[140,3,159,3],[140,4,159,4],[109,1,137,1],[109,2,139,2],[109,3,139,3],[109,4,139,4],[25,1,25,4],[53,1,53,4],[27,1,42,1],[27,2,30,2],[27,3,51,3],[27,4,51,4]]}
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[null,"Families are supported and protected - Universal Interventions- Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"Gilligan C, et al. Family‐based prevention programmes for alcohol use in young people. Cochrane Database of Systematic Reviews 2019, Issue 3. Art. No.: CD012287. DOI: 10.1002/14651858.CD012287.pub2.\nAvailable here.","School age children (up to 18 years of age)","This Cochrane review aimed to assess the effectiveness of universal, selective, and indicated family-based prevention programmes in preventing alcohol use or problem drinking in school-aged children (up to 18 years of age). \n\nForty six studies (39,822 participants) were included in the review, with 27 classified as universal, 12 as selective, and seven as indicated. Meta‐analyses were performed according to outcome, including studies reporting on the prevalence, frequency, or volume of alcohol use. The overall quality of evidence was low or very low, and there was high, unexplained heterogeneity. \n\nUpon comparing any family intervention to no intervention/standard care, the authors found no intervention effect on the prevalence (SMD) 0.00, 95% CI ‐0.08 to 0.08; studies = 12; participants = 7490; I² = 57%; low‐quality evidence) or frequency (SMD ‐0.31, 95% CI ‐0.83 to 0.21; studies = 8; participants = 1835; I² = 96%; very low‐quality evidence) of alcohol use in comparison with no intervention/standard care. The effect of any parent/family interventions on alcohol consumption volume compared with no intervention/standard care was very small (SMD ‐0.14, 95% CI ‐0.27 to 0.00; studies = 5; participants = 1825; I² = 42%; low‐quality evidence). \n\nWhen comparing parent/family and adolescent interventions versus interventions with young people alone, authors found no difference in alcohol use prevalence (SMD ‐0.39, 95% CI ‐0.91 to 0.14; studies = 4; participants = 5640; I² = 99%; very low‐quality evidence) or frequency (SMD ‐0.16, 95% CI ‐0.42 to 0.09; studies = 4; participants = 915; I² = 73%; very low‐quality evidence). For this comparison, no trials reporting on the volume of alcohol use could be pooled in meta‐analysis. \n\nIn general, the results remained consistent in separate subgroup analyses of universal, selective, and indicated interventions. No adverse effects were reported. \n","The results of this review indicate that there are no clear benefits of family‐based programmes for alcohol use among young people. Patterns differ slightly across outcomes, but overall, the variation, heterogeneity, and number of analyses performed preclude any conclusions about intervention effects. Additional independent studies are required to strengthen the evidence and clarify the marginal effects observed. "]
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[null,"Families are supported and protected - Selective Interventions- Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"Gilligan C, et al. Family‐based prevention programmes for alcohol use in young people. Cochrane Database of Systematic Reviews 2019, Issue 3. Art. No.: CD012287. DOI: 10.1002/14651858.CD012287.pub2.\nAvailable here.","School age children (up to 18 years of age)","This Cochrane review aimed to assess the effectiveness of universal, selective, and indicated family-based prevention programmes in preventing alcohol use or problem drinking in school-aged children (up to 18 years of age). \n\nForty six studies (39,822 participants) were included in the review, with 27 classified as universal, 12 as selective, and seven as indicated. Meta‐analyses were performed according to outcome, including studies reporting on the prevalence, frequency, or volume of alcohol use. The overall quality of evidence was low or very low, and there was high, unexplained heterogeneity. \n\nUpon comparing any family intervention to no intervention/standard care, the authors found no intervention effect on the prevalence (SMD) 0.00, 95% CI ‐0.08 to 0.08; studies = 12; participants = 7490; I² = 57%; low‐quality evidence) or frequency (SMD ‐0.31, 95% CI ‐0.83 to 0.21; studies = 8; participants = 1835; I² = 96%; very low‐quality evidence) of alcohol use in comparison with no intervention/standard care. The effect of any parent/family interventions on alcohol consumption volume compared with no intervention/standard care was very small (SMD ‐0.14, 95% CI ‐0.27 to 0.00; studies = 5; participants = 1825; I² = 42%; low‐quality evidence). \n\nWhen comparing parent/family and adolescent interventions versus interventions with young people alone, authors found no difference in alcohol use prevalence (SMD ‐0.39, 95% CI ‐0.91 to 0.14; studies = 4; participants = 5640; I² = 99%; very low‐quality evidence) or frequency (SMD ‐0.16, 95% CI ‐0.42 to 0.09; studies = 4; participants = 915; I² = 73%; very low‐quality evidence). For this comparison, no trials reporting on the volume of alcohol use could be pooled in meta‐analysis. \n\nIn general, the results remained consistent in separate subgroup analyses of universal, selective, and indicated interventions. No adverse effects were reported. \n","The results of this review indicate that there are no clear benefits of family‐based programmes for alcohol use among young people. Patterns differ slightly across outcomes, but overall, the variation, heterogeneity, and number of analyses performed preclude any conclusions about intervention effects. Additional independent studies are required to strengthen the evidence and clarify the marginal effects observed. "]
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[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This Cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text. Fifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect. One targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects. Among school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]
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[null,"Families are supported and protected - Indicated Interventions- Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"McGovern R et al. Effectiveness of psychosocial interventions for reducing parental substance misuse. Cochrane Database of Systematic Reviews 2021, Issue 3. Art. No.: CD012823.\nAvailable here","Participants were parents who use substances; this included mothers and fathers of children (sons and daughters) under the age of 21 years, regardless of custodial or residency status of the children. Same-sex parents and foster parents were eligible for inclusion.","The authors included 22 unique studies with a total of 2274 participants (mean age of parents ranged from 26.3 to 40.9 years), examining 24 experimental interventions. The majority of studies intervened with mothers only (n = 16; 73%). Heroin, cocaine, and alcohol were the most commonly reported substances used by participants. The interventions targeted either parenting only (n = 13; 59%); drug and alcohol use only (n = 5; 23%); or integrated interventions which addressed both (n = 6; 27%).\nThe authors found moderate-quality evidence that psychosocial interventions are probably more effective at reducing the frequency of parental alcohol misuse than comparison conditions at 6-month (mean difference (MD) −0.32, 95% confidence interval (CI) −0.51 to −0.13; 6 studies, 475 participants) and 12-month follow-up (standardised mean difference (SMD) −0.25, 95% CI −0.47 to −0.03; 4 studies, 366 participants). The authors found a significant reduction in frequency of use at 12 months only (SMD −0.21, 95% CI −0.41 to −0.01; 6 studies, 514 participants, moderate-quality evidence).\nThe authors examined the effect of the intervention type. They found low-quality evidence that psychosocial interventions targeting substance use only may not reduce the frequency of alcohol (6 months: SMD −0.35, 95% CI −0.86 to 0.16; 2 studies, 89 participants and 12 months: SMD −0.09, 95% CI −0.86 to 0.61; 1 study, 34 participants)\nA parenting intervention only, without an adjunctive substance use component, may not reduce frequency of alcohol misuse (6 months: SMD −0.21, 95% CI −0.46 to 0.04, 3 studies; 273 participants, low-quality evidence and 12 months: SMD −0.11, 95% CI −0.64 to 0.41; 2 studies; 219 participants, very low-quality evidence).\nParents receiving integrated interventions which combined both parenting- and substance use-targeted components may reduce alcohol misuse with a small effect size (6 months: SMD −0.56, 95% CI −0.96 to −0.16 and 12 months: SMD −0.42, 95% CI −0.82 to −0.03; 2 studies, 113 participants). However, this evidence was of low quality.\nInterventions appeared to be more often beneficial for fathers than for mothers. The authors found low- to very low-quality evidence of a reduction in frequency of alcohol misuse for mothers at six months only (SMD −0.27, 95% CI −0.50 to −0.04; 4 studies, 328 participants), whilst in fathers there was a reduction in frequency of alcohol misuse (6 months: SMD −0.43, 95% CI −0.78 to −0.09; 2 studies, 147 participants and 12 months: SMD −0.34, 95% CI −0.69 to 0.00; 2 studies, 147 participants).","The authors found moderate-quality evidence that psychosocial interventions probably reduce the frequency at which parents use alcohol. Integrated psychosocial interventions which combine parenting skills interventions with a substance use component may show the most promise. \nWhilst it appears that mothers may benefit less than fathers from intervention, caution is advised in the interpretation of this evidence, as the interventions provided to mothers alone typically did not address their substance use and other related needs. \nThe authors found low-quality evidence from few studies that interventions involving children are not beneficial."]
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[null,"Steele DW, et al. Interventions for Substance Use Disorders in Adolescents: A Systematic Review. Comparative Effectiveness Review No. 225.  AHRQ Publication No. 20-EHC014. Rockville, MD: Agency for Healthcare Research and Quality. May 2020.\nAvailable here.","Adolescents ages 12 to 20 years with problematic substance use or substance use disorder.","The authors included interventions designed to achieve abstinence, reduce use quantity and frequency, improve functional outcomes, and reduce substance-related harms. Interventions were categorised into seven primary intervention components: motivational interviewing (MI), family focused therapy (Fam), cognitive behavioral therapy (CBT), psychoeducation, contingency management (CM), peer group therapy, and intensive case management. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nMotivational interviewing reduced heavy alcohol use days by 0.7 days/month, alcohol use days by 1.2 days/month compared with treatment as usual. Across multiple intensive interventions, family focussed therapy was most effective, reducing alcohol use days by 3.5 days/month compared with treatment as usual.\n\n","Reviewers conclude that :\nBrief interventions: motivational interviewing reduces heavy alcohol use, low Strength of Evidence (SoE) and alcohol use days (moderate SoE). \nFamily focussed therapy: may be most effective in reducing alcohol use (low SoE). More research is needed to identify other effective intensive behavioral interventions for alcohol use disorder. Both motivational interviewing and CBT reduce combined alcohol and other drug use (low SoE).\nPharmacological interventions: systematic reviews in the college settings support use of brief interventions for students with any use, heavy or problematic use. More research is needed to identify the most effective combinations of behavioral and pharmacologic treatments for alcohol use disorders."]
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[null,"Gilligan C, et al. Family‐based prevention programmes for alcohol use in young people. Cochrane Database of Systematic Reviews 2019, Issue 3. Art. No.: CD012287. DOI: 10.1002/14651858.CD012287.pub2.\nAvailable here.","School age children (up to 18 years of age)","This Cochrane review aimed to assess the effectiveness of universal, selective, and indicated family-based prevention programmes in preventing alcohol use or problem drinking in school-aged children (up to 18 years of age). \n\nForty six studies (39,822 participants) were included in the review, with 27 classified as universal, 12 as selective, and seven as indicated. Meta‐analyses were performed according to outcome, including studies reporting on the prevalence, frequency, or volume of alcohol use. The overall quality of evidence was low or very low, and there was high, unexplained heterogeneity. \n\nUpon comparing any family intervention to no intervention/standard care, the authors found no intervention effect on the prevalence (SMD) 0.00, 95% CI ‐0.08 to 0.08; studies = 12; participants = 7490; I² = 57%; low‐quality evidence) or frequency (SMD ‐0.31, 95% CI ‐0.83 to 0.21; studies = 8; participants = 1835; I² = 96%; very low‐quality evidence) of alcohol use in comparison with no intervention/standard care. The effect of any parent/family interventions on alcohol consumption volume compared with no intervention/standard care was very small (SMD ‐0.14, 95% CI ‐0.27 to 0.00; studies = 5; participants = 1825; I² = 42%; low‐quality evidence). \n\nWhen comparing parent/family and adolescent interventions versus interventions with young people alone, authors found no difference in alcohol use prevalence (SMD ‐0.39, 95% CI ‐0.91 to 0.14; studies = 4; participants = 5640; I² = 99%; very low‐quality evidence) or frequency (SMD ‐0.16, 95% CI ‐0.42 to 0.09; studies = 4; participants = 915; I² = 73%; very low‐quality evidence). For this comparison, no trials reporting on the volume of alcohol use could be pooled in meta‐analysis. \n\nIn general, the results remained consistent in separate subgroup analyses of universal, selective, and indicated interventions. No adverse effects were reported. \n","The results of this review indicate that there are no clear benefits of family‐based programmes for alcohol use among young people. Patterns differ slightly across outcomes, but overall, the variation, heterogeneity, and number of analyses performed preclude any conclusions about intervention effects. Additional independent studies are required to strengthen the evidence and clarify the marginal effects observed. "]

{"sheet":"all universal","index":11,"n_rows":288,"n_cols":5,"rows_kept":288,"cut":false,"hidden":false,"merged":[[112,1,127,1],[112,2,115,2],[112,3,132,3],[112,4,132,4],[133,1,145,1],[133,2,134,2],[133,3,160,3],[133,4,154,4],[234,1,243,1],[234,2,243,2],[234,3,243,3],[234,4,243,4],[244,1,267,1],[244,2,267,2],[244,3,267,3],[244,4,267,4],[285,1,285,4],[268,2,283,2],[268,3,283,3],[268,4,283,4],[287,1,302,1],[287,2,290,2],[287,3,311,3],[287,4,311,4],[268,1,283,1],[33,1,33,4],[35,1,56,1],[35,2,56,2],[35,3,56,4],[91,4,108,4],[89,1,89,4],[91,1,108,1],[91,2,108,2],[91,3,108,3],[57,1,63,1],[57,2,72,2],[57,3,72,4],[73,1,79,1],[73,2,87,2],[73,3,87,4],[84,1,87,1],[110,1,110,4],[212,4,224,4],[226,1,226,4],[232,1,232,4],[161,1,174,1],[161,2,162,2],[161,3,179,3],[161,4,179,4],[180,1,196,1],[180,2,208,2],[180,3,208,3],[180,4,199,4],[210,1,210,4],[212,1,224,1],[212,2,224,2],[212,3,224,3]]}
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[null,"Universal interventions - NICE Guidance"]
[null,"Source:","Population:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Alcohol interventions in secondary and further education. NG135. London: NICE; 2019. \nAvailable here.\n","• CYP (11 to 18years) in full time education.\n• YP (18 to 25 years) with an Education, health and care (EHC) plan.\n• CYP (11 to 18years) in full time education considered ‘at risk’.\n• YP (18 to 25 years) EHC plan considered ‘at risk’.","This guideline covers interventions in secondary and further education to prevent and reduce alcohol use among children and young people aged 11 up to and including 18. It also covers people aged 11 to 25 with special educational needs or disabilities in full-time education. It will also be relevant to children aged 11 in year 6 of primary school.\n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n1.1 Planning alcohol education\n1.2 Delivering universal alcohol education (Evidence Review A: Universal interventions)\n1.3 Targeted interventions (Evidence review B: Targeted interventions)\n\nThe following recommendations for further research were also identified in Evidence review A and B:\n1. What components of alcohol education delivery contribute to its effectiveness for children and young people aged 11 to 18 in full-time education, and those with special educational needs and disabilities (SEND) up to the age of 25? (Evidence review A: universal interventions)\n2. How effective and cost effective are individual, compared with group, education-based interventions for children and young people aged 11 to 18 in full-time education who are thought to be vulnerable to alcohol misuse? (Evidence review B: targeted interventions)\n3. How effective and cost effective are universal, education-based alcohol interventions for children and young people aged 11 to 25 with SEND? (Evidence review A: universal interventions)\n4. How effective and cost effective are education-based alcohol interventions targeted at children and young people aged 11 to 25 with SEND who are thought to be vulnerable to alcohol misuse? (Evidence review B: targeted interventions)\n5. How effective are education-based alcohol prevention interventions (universal or targeted) for children and young people aged 11 to 25 with SEND in full-time education? (Evidence review A: universal interventions and Evidence review B: targeted interventions)\n6. What methods and techniques help secondary schools and providers to effectively engage with parents and carers as part of a whole-school approach to promote and support alcohol education? (Evidence review A: universal interventions)\n"]
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[null,"National Institute for Health and Care Excellence. Alcohol-use disorders: prevention. PH24. London: NICE; 2010\nAvailable here.\n\n\n\n","Children, young people and adults aged 10 years and above","This guideline covers alcohol problems among people over 10. It aims to prevent and identify such problems as early as possible using a mix of policy and practice.\n\nThe guideline includes the following recommendations. All the recommendations are relevant to the scope of this topic evidence map. The recommendations are supported by the underpinning Evidence reviews 1-3 and Evidence reviews 4-6:\n• Price, availability and marketing\n• Licencing\n• Supporting children and young people aged 10 to 15 years\n• Screening young people aged 16 and 17 years and offering them extended brief interventions\n• Screening adults and offering them brief advice and interventions\n• Referral\n\nThe underpinning evidence reviews in this report identifed several gaps in the evidence and made recommendations for further research with the following overarching question:\nHow does advertising by industry and health agencies affect the drinking behaviour of the population as whole? (This includes the use of new media.)\n\nJuly 2019: NICE checked this guideline and are updating it. For further information, see the surveillance decision."]
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[null,"National Institute for Health and Care Excellence. Behaviour change: general approaches. PH6. London: NICE; 2007\nAvailable here.\n\n\n\n","General population","This guideline covers a set of principles that can be used to help people change their behaviour. The aim is for practitioners to use these principles to encourage people to adopt a healthier lifestyle by, for example, stopping smoking, adopting a healthy diet and being more physically active.\n\nThe guideline includes the following recommendations. All the recommendations are relevant to the scope of this topic evidence map. The recommendations are supported by the underpinning Evidence review 1.\n• Providing education and training for those delivering them\n• Delivery of these activities, including one-to-one and community-based programmes and those aimed at specific populations\n• Evaluation of their effectiveness and cost effectiveness\n\nThe Programme Development Group identified a number of gaps in the evidence related to behaviour change interventions and programmes, based on an assessment of the evidence and made recommendations for research to address the most important gaps in the evidence. Please refer to 4. Recommendations for research' section of the guidance.\n\nNovember 2017: NICE checked this guideline and found no new evidence that affects the recommendations in this guideline."]
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[null,"Safe and Supportive Environment - Universal Interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' Conclusions:"]
[null,"Wolfenden, L. Strategies to improve the implementation of workplace-based policies or practices targeting tobacco, alcohol, diet, physical activity and obesity. Cochrane database Syst Rev 2018, Issue 11. Art. No.: CD012439. DOI: 10.1002/14651858.CD012439.pub2\nAvailable here. ","Adults in the workplace.","This review aimed to assess the effects of strategies for improving the implementation of workplace-based policies or practices targeting diet, physical activity, obesity, tobacco use and alcohol use. Six trials were included, four of which took place in the USA. Four trials employed randomised controlled trial (RCT) designs. Trials were conducted in workplaces from the manufacturing, industrial and services‐based sectors. The sample sizes of workplaces ranged from 12 to 114. Workplace policies and practices targeted included: healthy catering policies; point‐of‐purchase nutrition labelling; environmental supports for healthy eating and physical activity; tobacco control policies; weight management programmes; and adherence to guidelines for staff health promotion. All implementation interventions utilised multiple implementation strategies, the most common of which were educational meetings, tailored interventions and local consensus processes. \n\nOne included trial reported the effects of a workplace health promotion intervention on employee alcohol use (Parker 2010). However, as the implementation strategy and policies and practices targeted by the intervention did not include those addressing alcohol use, the effects on employee alcohol use reported in this trial were not included in the review. None of the other included trials reported effects of implementation strategies on this outcome. \n","Available evidence regarding the effectiveness of implementation strategies for improving implementation of health‐promoting policies and practices in the workplace setting is sparse and inconsistent. Low certainty evidence suggests that such strategies may make little or no difference on measures of implementation fidelity or different employee health behaviour outcomes. It is also unclear if such strategies are cost‐effective or have potential unintended adverse consequences. The limited number of trials identified suggests implementation research in the workplace setting is in its infancy, warranting further research to guide evidence translation in this setting."]
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[null,"Changed attitudes and social norms - Universal Interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"Wolfenden L et al. Strategies for enhancing the implementation of school‐based policies or practices targeting diet, physical activity, obesity, tobacco or alcohol use. Cochrane Database of Systematic Reviews 2022, Issue 8.\nAvailable here.","School age children (between 5 to 18 years of age)","This Cochrane review aimed to to find out how effective strategies were in supporting the implementation of school‐based interventions to address student diet, physical activity, unhealthy weight gain, and tobacco or alcohol use. Examples of strategies include methods of improving quality, education and training, feedback on how the school was doing, prompts and reminders, and educational resources (e.g. manuals).\n\nThe reviewers included an additional 11 trials in this update bringing the total number of included studies in the review to 38. Of these, 22 were conducted in the USA. Twenty‐six studies used RCT designs. Seventeen trials tested strategies to implement healthy eating, 12 physical activity and six a combination of risk factors. Just one trial sought to increase the implementation of interventions to delay initiation or reduce the consumption of alcohol. All trials used multiple implementation strategies, the most common being educational materials, educational outreach and educational meetings. The overall certainty of evidence was low and ranged from very low to moderate for secondary review outcomes. Only findings relevant to this evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nPooled analyses of RCTs found, relative to a control, the use of implementation strategies may result in a large increase in the implementation of interventions in schools (SMD 1.04, 95% CI 0.74 to 1.34; 22 RCTs, 1917 participants; low‐certainty evidence). One RCT assessed measures of student alcohol use and found strategies to support implementation may result in a slight increase in use (odds ratio 1.10, 95% CI 0.77 to 1.56; P = 0.60; 2105 participants).","The use of implementation strategies may result in large increases in implementation of interventions, and slight improvements in measures of student diet, and physical activity. Further research is required to assess the impact of implementation strategies on such behavioural‐ and obesity‐related outcomes, including on measures of alcohol use, where the findings of one trial suggest it may slightly increase student risk. Given the low certainty of the available evidence for most measures further research is required to guide efforts to facilitate the translation of evidence into practice in this setting."]
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[null,"Foxcroft DR et al. Social norms information for alcohol misuse in university and college students. Cochrane Database Syst Rev 2015, Issue 12. Art. No.: CD006748. DOI: 10.1002/14651858.CD006748.pub4.\nAvailable here. \n","University or college students. ","This Cochrane review aimed to determine whether social norms interventions reduce alcohol‐related negative consequences, alcohol misuse or alcohol consumption when compared with a control (ranging from assessment only/no intervention to other educational or psychosocial interventions) among university and college students.\n\nSeventy studies (44,958 participants) were included in the review, and 63 studies (42,784 participants) in the meta‐analyses. Overall, the risk of bias assessment showed that these studies provided moderate or low quality evidence. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nBinge drinking at four or more months (results pooled across delivery modes): SMD ‐0.06, 95 per cent CI ‐0.11 to ‐0.02 (participants = 11,292; studies = 16; moderate quality evidence), equivalent to 2.7 per cent fewer binge drinkers if 30‐day prevalence is 43.9 per cent.\n\nDrinking quantity at four or more months (results pooled across delivery modes): SMD ‐0.08, 95 per cent CI ‐0.12 to ‐0.04 (participants = 21,169; studies = 32; moderate quality evidence), equivalent to a reduction of 0.9 drinks consumed each week, from a baseline of 13.7 drinks per week.\n\nDrinking frequency at four or more months: WF SMD ‐0.11, 95 per cent CI ‐0.17 to ‐0.04 (participants = 9929; studies = 10; moderate quality evidence), equivalent to a decrease of 0.17 drinking days/wk, from a baseline of 2.74 days/wk; individual face‐to‐face normative feedback SMD ‐0.21, 95 per cent CI ‐0.31 to ‐0.10 (participants = 1464; studies = 8; moderate quality evidence), equivalent to a decrease of 0.32 drinking days/wk, from a baseline of 2.74 days/wk. No effects were found for group face‐to‐face normative feedback or normative marketing campaign.\n\nEstimated blood alcohol concentration (BAC) at four or more months: (Peak BAC results pooled across delivery modes) SMD ‐0.08, 95 per cent CI ‐0.17 to 0.00 (participants = 7198; studies = 11; low quality evidence), equivalent to a reduction in peak BAC from an average of 0.144 per cent to 0.135 per cent. No effects were found for typical BAC with individual face‐to‐face normative feedback.\n","The results of this review indicate that no substantive meaningful benefits are associated with social norms interventions for prevention of alcohol misuse among college/university students. Although some significant effects were found, we interpret the effect sizes as too small, given the measurement scales used in the studies included in this review, to be of relevance for policy or practice. Moreover, the significant effects are not consistent for all misuse measures, heterogeneity was a problem in some analyses and bias cannot be discounted as a potential cause of these findings. "]
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[null,"Langford R et al. The WHO Health Promoting School framework for improving the health and well‐being of students and their academic achievement. Cochrane Database Syst Rev 2014, Issue 4. Art. No.: CD008958. DOI: 10.1002/14651858.CD008958.pub2 \nAvailable here. ","School aged children (aged 4-18).","This Cochrane review aimed to assess the effectiveness of the Health Promoting Schools (HPS) framework in improving the health and well‐being of students and their academic achievement.\n\nSixty seven eligible cluster trials, randomising 1,443 schools or districts were included. This is made up of 1,345 schools and 98 districts. The studies tackled a range of health issues: physical activity (4), nutrition (12), physical activity and nutrition combined (18), bullying (7), tobacco (5), alcohol (2), sexual health (2), violence (2), mental health (2), hand‐washing (2), multiple risk behaviours (7), cycle‐helmet use (1), eating disorders (1), sun protection (1), and oral health (1). Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nReview authors report that the quality of evidence overall was low to moderate as determined by the GRADE approach. Risk of bias assessments identified methodological limitations, including heavy reliance on self‐reported data and high attrition rates for some studies. In addition, there was a lack of long‐term follow‐up data for most studies.\n\nEight studies provided data on alcohol use and all but one were included in the meta‐analysis. Overall, there was no evidence that any of the different intervention approaches were effective in reducing alcohol intake.","The results of this review provide evidence for the effectiveness of some interventions based on the HPS framework for improving certain health outcomes but not others. More well‐designed research is required to establish the effectiveness of this approach for other health topics and academic achievement."]
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[null,"Siegfried N et al. Restricting or banning alcohol advertising to reduce alcohol consumption in adults and adolescents. Cochrane Database Syst Rev 2014, Issue 11. Art. No.: CD010704. DOI: 10.1002/14651858.CD010704.pub2.\nAvailable here. \n","Adults of any age and adolescents (defined by WHO as aged 10 to 19 years)","The aim of this Cochrane review was to evaluate the benefits, harms and costs of restricting or banning the advertising of alcohol, via any format, compared with no restrictions or counter‐advertising, on alcohol consumption in adults and adolescents.\n\nOne small RCT (80 male student participants conducted in the Netherlands and published in 2009) and three ITS studies (general population studies in Canadian provinces conducted in the 1970s and 80s) were examined. The RCT found that young men exposed to movies with a low‐alcohol content drank less than men exposed to movies with a high‐alcohol content (MD ‐0.65 drinks; 95 per cent CI ‐1.2, ‐0.07; p value = 0.03, very‐low‐quality evidence). Young men exposed to commercials with a neutral content compared with those exposed to commercials for alcohol drank less (MD ‐0.73 drinks; 95 per cent CI ‐1.30, ‐0.16; p value = 0.01, very‐low‐quality evidence). Outcomes were assessed immediately after the end of the intervention (lasting 1.5 hours), so no follow‐up data were available.\n\nTwo of the ITS studies evaluated the implementation of an advertising ban and one study evaluated the lifting of such a ban (GRADE: very‐low‐quality evidence). Each of the three ITS studies evaluated a different type of ban (partial or full) compared with different degrees of restrictions or no restrictions during the control period. The results from the three ITS studies were inconsistent. A meta‐analysis of the two studies that evaluated the implementation of a ban showed an overall mean non‐significant increase in beer consumption in the general population of 1.10 per cent following the ban (95 per cent CI ‐5.26, 7.47; p value = 0.43; I2 = 83 per cent, very‐low‐quality evidence). This finding is consistent with an increase, no difference, or a decrease in alcohol consumption. In the study evaluating the lifting of a total ban on all forms of alcohol advertising to a partial ban on spirits advertising only, which utilised an Abrupt Auto‐regressive Integrated Moving Average model, the volume of all forms of alcohol sales decreased by 11.11 kilolitres (95 per cent CI ‐27.56, 5.34; p value = 0.19) per month after the ban was lifted. In this model, beer and wine sales increased per month by 14.89 kilolitres (95 per cent CI 0.39, 29.39; p value = 0.04) and 1.15 kilolitres (95 per cent CI ‐0.91, 3.21; p value = 0.27), respectively, and spirits sales decreased statistically significantly by 22.49 kilolitres (95 per cent CI ‐36.83, ‐8.15; p value = 0.002).\n\nNone of the studies were funded by the alcohol or advertising industries.\n","Authors conclude that there is a lack of robust evidence for or against recommending the implementation of alcohol advertising restrictions. Advertising restrictions should be implemented within a high‐quality, well‐monitored research programme to ensure the evaluation over time of all relevant outcomes in order to build the evidence base. "]
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[null,"Reduced availability - Universal Interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"Hollands  GJ et al. Altering the availability or proximity of food, alcohol, and tobacco products to change their selection and consumption. Cochrane Database of Systematic Reviews 2019, Issue 9. Art. No.: CD012573. DOI: 10.1002/14651858.CD012573.pub3.\nAvailable here.","Adults","This Cochrane review aimed to:\n1. To assess the impact on selection and consumption of altering the availability or proximity of (a) food (including non‐alcoholic beverages), (b) alcohol, and (c) tobacco products.\n2. To assess the extent to which the impact of these interventions is modified by characteristics of: i. studies, ii. interventions, and iii. participants.\n\nThe reviewers included 24 studies, with the majority (20/24) giving concerns about risk of bias. All of the included studies investigated food products; none investigated alcohol or tobacco. ","The authors concluded that:\n- Further research is warranted in real‐world settings, intervening across a wider range of foods as well as alcohol and tobacco products and over sustained time periods"]
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[null,"Reduced affordability - Universal Interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]
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[null,"Behaviour change - Universal Interventions - Systematic reviews"]
[null,"Source:","Population: ","Findings:","Authors' conclusions:"]
[null,"Stead M, Angus K, Langley T, Katikireddi SV, Hinds K, Hilton S,  et al. Mass media to communicate public health messages in six health topic areas: a systematic review and other reviews of the evidence. Public Health Res 2019;7(8)\nAvailable here.","General population.","There was limited evidence of impact on alcohol use\nMass media campaigns were found to increase knowledge and awareness across several topics.\nAlthough there was limited evidence on characteristics associated with effectiveness, longer or greater intensity campaigns were found to be more effective. \nThe evidence suggested that targeting messages to target audiences can be effective. \nThere was little evidence regarding the role that theory or media channels may play in campaign effectiveness, and also limited evidence on new media.","Overall, the evidence is mixed but suggests that longer and more intensive campaigns are likely to be more effective and message design and targeting campaigns to particular population groups can be effective."]
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[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. \n\nFifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect.\n\nOne targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects.\n\nAmong school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]
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[null,"Brown TJ, Todd A, O'Malley CL, Moore HJ, Husband AK, Bambra C,  et al. Community pharmacy interventions for public health priorities: a systematic review of community pharmacy-delivered smoking, alcohol and weight management interventions. Public Health Res 2016;4(2)\nAvailable here. ","Adults","The searches identified over 14,000 records, of which 24 studies were included. There were two alcohol, 12 smoking cessation, five weight loss and five multicomponent interventions that included pharmacotherapy and lifestyle changes in participants with diabetes mellitus, dyslipidaemia or hypertension. Nine of the studies were UK based; seven of the studies were rated ‘strong’ for quality. All studies were of adults. \nThere was insufficient evidence for the effectiveness of community pharmacy-based brief alcohol interventions.\nNone of the five multicomponent studies demonstrated an improvement compared with control for anthropometric outcomes in participants with comorbidities, but they did show improvement in measures associated with the comorbidities. Very few studies explored if and how sociodemographic or socioeconomic variables moderated the effect of interventions. In two studies based in areas of high deprivation, where participants chose the intervention, the sociodemographic characteristics of participants differed between intervention settings. There were also differences in recruitment, attendance and retention of participants by type of setting. The evidence suggests that a distinct group of people might access pharmacies compared with other settings for alcohol management, smoking cessation and weight loss. There is insufficient evidence to examine the relationship between behaviour change strategies and effectiveness; or evidence of consistent implementation factors or training components that underpin effective interventions.","Evaluations of interventions to manage alcohol misuse and obesity, set within the community pharmacy, are needed. \nThe effect of community pharmacy interventions on health inequalities is unclear. Future research in this area is warranted, and trials should include the assessment of age, sex, ethnicity, socioeconomic status and contextual factors, and present analysis of how these factors moderate effectiveness."]
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[null,"Families are supported and protected - Universal Interventions- Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"Gilligan C, et al. Family‐based prevention programmes for alcohol use in young people. Cochrane Database of Systematic Reviews 2019, Issue 3. Art. No.: CD012287. DOI: 10.1002/14651858.CD012287.pub2.\nAvailable here.","School age children (up to 18 years of age)","This Cochrane review aimed to assess the effectiveness of universal, selective, and indicated family-based prevention programmes in preventing alcohol use or problem drinking in school-aged children (up to 18 years of age). \n\nForty six studies (39,822 participants) were included in the review, with 27 classified as universal, 12 as selective, and seven as indicated. Meta‐analyses were performed according to outcome, including studies reporting on the prevalence, frequency, or volume of alcohol use. The overall quality of evidence was low or very low, and there was high, unexplained heterogeneity. \n\nUpon comparing any family intervention to no intervention/standard care, the authors found no intervention effect on the prevalence (SMD) 0.00, 95% CI ‐0.08 to 0.08; studies = 12; participants = 7490; I² = 57%; low‐quality evidence) or frequency (SMD ‐0.31, 95% CI ‐0.83 to 0.21; studies = 8; participants = 1835; I² = 96%; very low‐quality evidence) of alcohol use in comparison with no intervention/standard care. The effect of any parent/family interventions on alcohol consumption volume compared with no intervention/standard care was very small (SMD ‐0.14, 95% CI ‐0.27 to 0.00; studies = 5; participants = 1825; I² = 42%; low‐quality evidence). \n\nWhen comparing parent/family and adolescent interventions versus interventions with young people alone, authors found no difference in alcohol use prevalence (SMD ‐0.39, 95% CI ‐0.91 to 0.14; studies = 4; participants = 5640; I² = 99%; very low‐quality evidence) or frequency (SMD ‐0.16, 95% CI ‐0.42 to 0.09; studies = 4; participants = 915; I² = 73%; very low‐quality evidence). For this comparison, no trials reporting on the volume of alcohol use could be pooled in meta‐analysis. \n\nIn general, the results remained consistent in separate subgroup analyses of universal, selective, and indicated interventions. No adverse effects were reported. \n","The results of this review indicate that there are no clear benefits of family‐based programmes for alcohol use among young people. Patterns differ slightly across outcomes, but overall, the variation, heterogeneity, and number of analyses performed preclude any conclusions about intervention effects. Additional independent studies are required to strengthen the evidence and clarify the marginal effects observed. "]

{"sheet":"all selective","index":12,"n_rows":397,"n_cols":5,"rows_kept":397,"cut":false,"hidden":false,"merged":[[34,1,55,1],[34,2,55,2],[34,3,55,4],[337,1,348,1],[337,2,339,2],[337,3,367,3],[337,4,353,4],[162,1,187,1],[162,2,187,2],[162,3,187,3],[162,4,187,4],[188,1,199,1],[188,2,190,2],[188,3,209,3],[188,4,209,4],[287,1,321,1],[287,3,321,3],[287,4,321,4],[322,1,336,1],[322,3,336,3],[322,4,336,4],[396,1,421,1],[396,2,421,2],[396,3,421,3],[396,4,421,4],[371,1,386,1],[371,2,374,2],[371,3,395,3],[371,4,395,4],[160,1,160,4],[133,4,158,4],[226,1,244,1],[369,1,369,4],[226,2,244,2],[226,3,244,3],[226,4,244,4],[245,1,262,1],[245,2,262,2],[245,3,262,3],[245,4,262,4],[263,1,286,1],[263,2,286,2],[263,3,286,3],[263,4,286,4],[287,2,321,2],[214,1,216,1],[218,1,218,4],[224,1,224,4],[32,1,32,4],[56,1,77,1],[56,2,77,2],[56,3,77,4],[212,1,212,4],[81,1,132,1],[81,2,105,2],[81,3,132,3],[81,4,132,4],[133,1,158,1],[133,2,158,2],[133,3,158,3],[79,1,79,4]]}
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[null,"Selective interventions - NICE Guidance"]
[null,"Source:","Population:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Behaviour change: digital and mobile health interventions. NG183. London: NICE; 2020.\nAvailable here.\n\n\n","Everyone, including Young People under 16 (and their families or 16 carers)\n• Pre-existing health conditions:\nOverweight/ obesity\nHypertension and cardiovascular disease\nRespiratory diseases\nCancers for which managing smoking may improve health outcomes\nMental health conditions\nSpecific consideration will also be given to people with learning disabilities and people with neurodevelopmental disorders such as autism.","This guideline covers interventions that use a digital or mobile platform to help people eat more healthily, become more active, stop smoking, reduce their alcohol intake or practise safer sex. The interventions include those delivered by text message, apps, wearable devices or the internet. The guideline only includes those that are delivered by the technology itself and not by healthcare professionals using technology to deliver interventions.\n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n1.1 Developing digital and mobile health interventions\n1.2 Commissioning digital and mobile health interventions\n1.3 Using digital and mobile health interventions\n1.4 Interventions for diet and physical activity\n1.5 Interventions for smoking\n1.6 Interventions for alcohol use (Based on Evidence Review B: alcohol)\n1.7 Interventions for unsafe sexual behaviour\n\nThe following recommendations for further research were also identified in evidence review B on alcohol:\n1. How can providers and healthcare professionals identify groups that do not initially engage, or do not stay engaged, with digital and mobile health behaviour change interventions?\n2. What components and characteristics of digital and mobile health behaviour change interventions are most effective, separately and in combination, to achieve behaviour change?\n3. What is the effectiveness and cost effectiveness of digital and mobile health behaviour change interventions in low socioeconomic and other underserved groups?\n4. Are digital and mobile health behaviour change interventions as effective as face-to-face, standard care, or combination approaches for some populations?\n5. What are the harms and adverse effects associated with different digital and mobile health behaviour change interventions?"]
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[null,"National Institute for Health and Care Excellence. Alcohol interventions in secondary and further education. NG135. London: NICE; 2019. \nAvailable here.\n","• CYP (11 to 18years) in full time education.\n• YP (18 to 25 years) with an Education, health and care (EHC) plan.\n• CYP (11 to 18years) in full time education considered ‘at risk’.\n• YP (18 to 25 years) EHC plan considered ‘at risk’.","This guideline covers interventions in secondary and further education to prevent and reduce alcohol use among children and young people aged 11 up to and including 18. It also covers people aged 11 to 25 with special educational needs or disabilities in full-time education. It will also be relevant to children aged 11 in year 6 of primary school.\n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n1.1 Planning alcohol education\n1.2 Delivering universal alcohol education (Evidence Review A: Universal interventions)\n1.3 Targeted interventions (Evidence review B: Targeted interventions)\n\nThe following recommendations for further research were also identified in Evidence review A and B:\n1. What components of alcohol education delivery contribute to its effectiveness for children and young people aged 11 to 18 in full-time education, and those with special educational needs and disabilities (SEND) up to the age of 25? (Evidence review A: universal interventions)\n2. How effective and cost effective are individual, compared with group, education-based interventions for children and young people aged 11 to 18 in full-time education who are thought to be vulnerable to alcohol misuse? (Evidence review B: targeted interventions)\n3. How effective and cost effective are universal, education-based alcohol interventions for children and young people aged 11 to 25 with SEND? (Evidence review A: universal interventions)\n4. How effective and cost effective are education-based alcohol interventions targeted at children and young people aged 11 to 25 with SEND who are thought to be vulnerable to alcohol misuse? (Evidence review B: targeted interventions)\n5. How effective are education-based alcohol prevention interventions (universal or targeted) for children and young people aged 11 to 25 with SEND in full-time education? (Evidence review A: universal interventions and Evidence review B: targeted interventions)\n6. What methods and techniques help secondary schools and providers to effectively engage with parents and carers as part of a whole-school approach to promote and support alcohol education? (Evidence review A: universal interventions)\n"]
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[null,"Safe and Supportive Environment - Selective Interventions- Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' Conclusions:"]
[null,"Moledina A et al (2021). A comprehensive review of prioritised interventions to improve the health and wellbeing of persons with lived experience of homelessness. Campbell Systematic Reviews, 17, e1154.\nAvailable here. ","Populations experiencing homelessness, defined as those who lack stable, permanent, appropriate housing, or who may be without immediate prospects, means, and ability to acquire it","The objective of this systematic review is to identify, appraise, and synthesise the best available evidence on the benefits and cost-effectiveness of interventions to improve the health and social outcomes of people experiencing homelessness.\n\nEligible interventions included permanent supportive housing (PSH), income assistance, standard case management (SCM), peer support, mental health interventions such as assertive community treatment (ACT), intensive case management (ICM), critical time intervention (CTI) and injectable antipsychotics, and substance-use interventions, including supervised consumption facilities (SCFs), managed alcohol programmes and opioid agonist therapy. Outcomes of interest were housing stability, mental health, quality of life, substance use, hospitalisations, employment and income. Only results relevant to this topic evidence map have been extracted below.\n\nManaged alcohol programmes: The review did not identify any eligible studies.\n\nPermanent supportive housing: The effect of permanent housing on substance use was reported in nine trials. Out of these three studies reported improvements in alcohol and drug use in both groups, over time, but no differential benefit of the HF initiative. One study on homeless clients with problematic substance reported no group differences in problems associated with alcohol use, though both groups decreased their alcohol consumption over time. Hybrid approaches to housing (“integrative” versus “parallel” housing) were investigated in a single study. It found no statistically significant difference in the reported days of alcohol use or reported days of drug use both between groups as well as over time. Of note, analysis for this outcome had a lower statistical power as it was restricted to individuals who reported use at the baseline.\n\nIncome-assistance intervention: Four studies examined the effects of income-assistance intervention on substance use. For homeless veterans with substance dependence, CWT immediately reduced the consumption of alcohol and drugs within the first 3 months (β = −44.7%; 95% CI, −69.7% to −19.7%; t = 3.51; p = .001). The addition of priority access to housing vouchers for veterans with a diagnosis of a major psychiatric disorder or an alcohol/drug disorder, compared to existing case management, led to decreased days of drinking to intoxication (1.46 vs. 1.95, t = 0.73, p = .0053) and fewer days of alcohol use over the 3-year study period. However, no significant association was identified between priority access to housing subsidies and differences in the scores of the Addiction Severity Index (ASI). For homeless families with children aged 15 or younger, rental subsidies without case management did not lead to decreased use of substance compared to the usual community housing services.\n\nSCM and peer support interventions: Six studies reported on substance-use outcomes with different SCM treatments. Homeless male veterans with addictions problems with three to 6 months of hospital stays plus case management showed better improvements in the alcohol- and drug-use composite scores, but these were short-lived compared to TAU after 24 months. A three-arm trial reported reductions in average days of alcohol and drug consumption in a case-management-only group, a CM-with-supported-housing group in graduates of short-term in-patient substance-use programme who lacked housing. Homeless alcohol abusers who were offered different intensities of SCM (n = 469) showed no significant between-group differences in days of alcohol use. Similarly, a three-arm trial with homeless women and their intimate partners found no significant differences in substance-use outcomes between groups: a peer-mentored group, a group in a nurse case-managed programme, and one in an SCM programme. Another 12-months trial on homeless men recently released from jails/prisons who were exposed to weekly peer coaching, intermediate peer coaching compared with the usual treatment did not find any significant effects on substance-use outcomes. An RCT with homeless women with alcohol-use problems who received brief guideline-based interventions from primary care providers and referrals to the CM for ongoing follow-up visits for 6 months did not find any significant between-group differences on alcohol-consumption rates, percentages of completely abstained participants, or negative consequences of alcohol use, respectively.\n","PSH interventions improved housing stability for people living with homelessness. High-intensity case management and income-assistance interventions may also benefit housing stability. The majority of included interventions inconsistently detected benefits for mental health, quality of life, substance use, employment and income. These results have important implications for public health, social policy, and community programme implementation. The COVID-19 pandemic has highlighted the urgent need to tackle systemic inequality and address social determinants of health. Our review provides timely evidence on PSH, income assistance, and mental health interventions as a means of improving housing stability. PSH has major cost and policy implications and this approach could play a key role in ending homelessness. Evidence-based reviews like this one can guide practice and outcome research and contribute to advancing international networks committed to solving homelessness."]
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[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This Cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text. Fifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect. One targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects. Among school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]
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[null,"Changed attitudes and social norms - Selective Interventions - Systematic reviews- Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This Cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text. Fifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect. One targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects. Among school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]
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[null,"Foxcroft DR et al. Motivational interviewing for the prevention of alcohol misuse in young adults. Cochrane Database Syst Rev 2016, Issue 7. Art. No.: CD007025. DOI: 10.1002/14651858.CD007025.pub4.\nAvailable here.\n","Young adults up to 25 years of age (higher risk individuals or settings). ","This Cochrane review aimed to assess the effects of motivational interviewing (MI) interventions for preventing alcohol misuse and alcohol‐related problems in young adults. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nEighty four trials (22,872 participants) were included, with 70/84 studies reporting interventions in higher risk individuals or settings. Studies with follow‐up periods of at least four months were of more interest in assessing the sustainability of intervention effects and were also less susceptible to short‐term reporting or publication bias. Overall, the risk of bias assessment showed that these studies provided moderate or low quality evidence.\n\nAt four or more months follow‐up, effects in favour of MI were found for the quantity of alcohol consumed (standardised mean difference (SMD) −0.11, 95 per cent confidence interval (CI) −0.15 to −0.06 or a reduction from 13.7 drinks/week to 12.5 drinks/week; moderate quality evidence); frequency of alcohol consumption (SMD −0.14, 95 per cent CI −0.21 to −0.07 or a reduction in the number of days/week alcohol was consumed from 2.74 days to 2.52 days; moderate quality evidence); and peak blood alcohol concentration, or BAC (SMD −0.12, 95 per cent CI −0.20 to 0.05, or a reduction from 0.144 per cent to 0.131 per cent; moderate quality evidence).\n\nFurther analyses showed that there was no clear relationship between the duration of the MI intervention (in minutes) and effect size. Subgroup analyses revealed no clear subgroup effects for longer‐term outcomes (four or more months) for assessment only versus alternative intervention controls; for university/college vs other settings; or for higher risk vs all/low risk participants.\n","The results of this review indicate that there are no substantive, meaningful benefits of MI interventions for preventing alcohol use, misuse or alcohol‐related problems. Although the reviewers found some statistically significant effects, the effect sizes were too small, given the measurement scales used in the included studies, to be of relevance to policy or practice. Moreover, the statistically significant effects are not consistent for all misuse measures, and the quality of evidence is not strong, implying that any effects could be inflated by risk of bias."]
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[null,"Reduced availability - Selective Interventions - Systematic reviews"]
[null,"Source:","Populations:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]
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[null,"Reduced affordability - Universal Interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]
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[null,"Behaviour change - Selective Interventions - Systematic reviews"]
[null,"Source:","Audience:","Findings:","Authors' conclusions:"]
[null,"Meiksin R et al. E-health interventions targeting STIs, sexual risk, substance use and mental health among men who have sex with men: four systematic reviews. Public Health Research. 2022;10(4):1-322. \nAvailable here.","Gay, bisexual and other men (including trans men) who have sex with men, including those who have been diagnosed as HIV positive, as well as those whose last HIV test was negative or who have never tested for HIV","This review aimed to  synthesise evidence addressing the following: (1) What approaches and theories of change do existing e-health interventions employ to prevent human immunodeficiency virus/sexually transmitted infections, sexual risk, alcohol/drug use or mental ill health among men who have sex with men? (2) What factors influence implementation? (3) What are the effects of such interventions on the aforementioned epidemics? (4) Are such interventions cost-effective? Only information relevant to this topic evidence map has been extracted below.\n\nEffects on alcohol and drug use: Two studies presented estimates for drug use (table 8 in the full report), both focused on open-ended interventions. Neither quantified outcomes on alcohol use specifically. Although both studies presented short-term results, only one study presented mid-term results. However, the primary method of analysis in that study was a longitudinal regression model; the authors present these estimates as well. Across studies, there was no consistent evidence of effectiveness of interventions in reducing drug use.\n\nMeta-analysis: Effect sizes for alcohol and drug use are presented in the full report in Figure 14 for outcomes of < 3 months post intervention and in Figure 15 for outcomes between 3 months and 1 year post intervention. In both plots, negative effect sizes represent benefits. The review authors do not present a pooled effect size for these estimates as meta-analyses included both substantial heterogeneity (I2 = 95% both overall and only including effect sizes of up to 3 months’ follow-up) and too few studies to explore this heterogeneity.","The authors concluded that the findings for drug use could not be meta-analysed because of study heterogeneity. Studies addressing this outcome did not present consistent evidence of effectiveness. Trials did not report effects on alcohol use or mental health."]
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[null,"Filges T, Dalgaard NT and Viinholt BC. 2022. Outreach programs to improve life circumstances and prevent further adverse developmental trajectories of at‐risk youth in OECD countries: A systematic review. Campbell Systematic Reviews, 18(4), p.e1282.\nAvailable here\n","Young people between 8 and 25 years of age living in OECD countries, who either have experienced or is at-risk of experiencing an adverse outcome such as school failure or drop-out, runaway and homelessness, substance and/or alcohol abuse, unemployment, long-term poverty, delinquency/criminal behaviour were eligible.","This Campbell systematic review examines the effects of outreach programmes on problem/high-risk behaviour of young people between eight and 25 year old, living in OECD countries. The review summarises evidence from five studies undertaken in the USA and Canada that involved 578 participants in total.\n\nFour of the five studies used for meta analysis were from the USA and one was from Canada. The timespan in which included studies were carried out was 32 years, from 1985 to 2017; on average the intervention year was 2005. The average number of participants in the analysed interventions was 116, ranging from 30 to 346 and the average number of controls was 81, ranging from 32 to 321. At most, the results from two studies could be pooled in a single meta-analysis. It was only possible to pool the outcomes drug (other than marijuana) use, marijuana use and alcohol use each at two different time points (one and 3 months follow up). At 1 month follow up the weighted averages varied between zero and 0.05 and at 3 months follow up between −0.17 and 0.07. None of them were statistically significant. In addition, a number of other outcomes were reported in a single study only.","Overall, there were too few studies included in any of the meta-analyses in order for us to draw any conclusion concerning the effectiveness of outreach. The vast majority of studies were undertaken in the USA.\nFurther, because too few studies reported results on the same type of outcome at most two studies could be combined in a particular meta-analysis. Given the limited number of rigorous studies available from countries other than the USA, it would be natural to consider conducting a series of randomised controlled trials evaluating the effectiveness of outreach for at-risk youth in countries outside the USA. The trial(s) should be designed, conducted and reported according to methodological criteria for rigour in respect of internal and external validity to achieve robust results and preferably reporting a larger number of outcomes."]
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[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. \n\nFifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect.\n\nOne targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects.\n\nAmong school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]
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[null,"O'Connor EA et al. Screening and behavioral counseling interventions to reduce unhealthy alcohol use in adolescents and adults: An updated systematic review for the U.S. Preventive Services Task Force. Rockville MD: Agency for Healthcare Research and Quality; 2018. \nAvailable here. ","Adolescents or adults age 12 years or older. ","One hundred and thirteen studies (n=314,466) were included across all Key Questions. The authors did not find any studies that examined the benefits or harms of screening programs to reduce unhealthy alcohol use. For adolescents, data supported the use of the National Institute on Alcohol Abuse and Alcoholism Youth Screen and other similar one- or two-item screeners to detect alcohol use disorder. For adults, brief (1- to 3-item) screeners commonly reported sensitivity and specificity between 0.70 and 0.85, typically having better sensitivity than the full Alcohol Use Disorders Identification Test (AUDIT) for identifying the full spectrum of unhealthy use. However, the AUDIT tended to have higher specificity, particularly at the standard cutoff of 8 or higher.  \n\nIdentified interventions to reduce unhealth alcohol use were generally counselling interventions, with most involving one or two sessions (90% involved ≤ 4 sessions) with a median of 30 minutes contact time (88% involved ≤ 2 hours contact). The most commonly reported intervention element was the use of personalized normative feedback sessions, in which participants were shown how their alcohol use compares to others; this technique was used in more than half of the included trials and almost all trials in younger adults. Motivational techniques were also common, particularly in combination with personalized normative feedback.\n\nEvidence on the effects of interventions to reduce unhealthy alcohol use in adolescents was limited to two trials; both found mixed results for reduced alcohol use and did not report health or related outcomes. \n\nIn adults, interventions reduced the number of drinks per week (weighted mean difference, −1.82 [95% confidence interval {CI}, −2.42 to −1.22]), the proportion exceeding recommended drinking limits (odds ratio [OR], 0.60 [95% CI, 0.53 to 0.67]), and the proportion reporting a heavy use episode (OR, 0.62 [95% CI, 0.55 to 0.71]), and increased the proportion of pregnant women reporting abstinence (OR, 1.92 [95% CI, 1.19 to 3.09]) after 6 to 12 months. \n\nHeterogeneity was high and effect size was associated with a number of study characteristics such as setting, target age of the population, publication year, study size, and average baseline-use levels, but not clearly associated with any intervention characteristics. Data on effectiveness in important subgroups were very limited, but analyses by sex, the most commonly reported subgroup analysis, did not indicate differences in effectiveness of the interventions. Health outcomes were sparsely reported and, with some exceptions, generally did not demonstrate group differences in effect. No evidence of harm was found.","Among adults, screening instruments are available that can effectively identify persons with unhealthy alcohol use and that are feasible for use in primary care settings, and interventions in those who screen positive are associated with reductions in unhealthy alcohol use. There was no evidence that these interventions have unintended harmful effects. More evidence is needed to determine whether screening for unhealthy alcohol use is beneficial for adolescents."]
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[null,"Tansil KA et al. Alcohol Electronic Screening and Brief Intervention A Community Guide Systematic Review. Am J Prev Med 2016;51(5):801–811). \nAvailable here. \n","Unspecified","This Community Guide review focused on e-screening and brief interventions (e-SBIs) that are similar in structure and intent to Alcohol screening and brief intervention (ASBI) and examined how e-SBI effectiveness varied by key intervention characteristics, in contrast to previous systematic reviews of e-SBI. This review is unique in that it excluded highly interactive interventions (i.e., those with more than three human-to-human sessions); those that were part of a treatment program for alcohol use disorders; those that were primarily educational programs (e.g., Alcohol Edu, College Alc); and those that only used an electronic device for monitoring drinking following traditional ASBI.\n\nTwenty-four studies (28 study arms) provided results for excessive drinkers only and seven studies (eight study arms) reported results for all drinkers. Nearly all studies found that e-SBI reduced excessive alcohol consumption and related harms: nine study arms reported a median 23.9% reduction in binge-drinking intensity (maximum drinks/binge episode) and nine study arms reported a median 16.5% reduction in binge-drinking frequency. Reductions in drinking measures were sustained for up to 12 months.","The authors conclude that, according to Community Guide rules of evidence, e-SBI is an effective method for reducing excessive alcohol consumption and related harms among intervention participants. Implementation of e-SBI could complement population-level strategies previously recommended by the Community Preventive Services Task Force for reducing excessive drinking (e.g., increasing alcohol taxes and regulating alcohol outlet density)."]
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[null,"Foxcroft DR et al. Motivational interviewing for the prevention of alcohol misuse in young adults. Cochrane Database Syst Rev 2016, Issue 7. Art. No.: CD007025. DOI: 10.1002/14651858.CD007025.pub4.\nAvailable here.\n","Young adults up to 25 years of age. ","This Cochrane review aimed to assess the effects of motivational interviewing (MI) interventions for preventing alcohol misuse and alcohol‐related problems in young adults.\n\nEighty four trials (22,872 participants) were included, with 70/84 studies reporting interventions in higher risk individuals or settings. Studies with follow‐up periods of at least four months were of more interest in assessing the sustainability of intervention effects and were also less susceptible to short‐term reporting or publication bias. Overall, the risk of bias assessment showed that these studies provided moderate or low quality evidence.\n\nAt four or more months follow‐up, effects in favour of MI were found for the quantity of alcohol consumed (standardised mean difference (SMD) −0.11, 95 per cent confidence interval (CI) −0.15 to −0.06 or a reduction from 13.7 drinks/week to 12.5 drinks/week; moderate quality evidence); frequency of alcohol consumption (SMD −0.14, 95 per cent CI −0.21 to −0.07 or a reduction in the number of days/week alcohol was consumed from 2.74 days to 2.52 days; moderate quality evidence); and peak blood alcohol concentration, or BAC (SMD −0.12, 95 per cent CI −0.20 to 0.05, or a reduction from 0.144 per cent to 0.131 per cent; moderate quality evidence).\nA marginal effect in favour of MI was found for alcohol problems (SMD −0.08, 95 per cent CI −0.17 to 0.00 or a reduction in an alcohol problems scale score from 8.91 to 8.18; low quality evidence) and no effects for binge drinking (SMD −0.04, 95 per cent CI −0.09 to 0.02, moderate quality evidence) or for average BAC (SMD −0.05, 95 per cent CI −0.18 to 0.08; moderate quality evidence). Other alcohol‐related behavioural outcomes were considered, and at four or more month’s follow‐up, we found no effects on drink‐driving (SMD −0.13, 95 per cent CI −0.36 to 0.10; moderate quality of evidence) or other alcohol‐related risky behaviour (SMD −0.15, 95 per cent CI −0.31 to 0.01; moderate quality evidence).\n\nFurther analyses showed that there was no clear relationship between the duration of the MI intervention (in minutes) and effect size. Subgroup analyses revealed no clear subgroup effects for longer‐term outcomes (four or more months) for assessment only versus alternative intervention controls; for university/college vs other settings; or for higher risk vs all/low risk participants.\n","The results of this review indicate that there are no substantive, meaningful benefits of MI interventions for preventing alcohol use, misuse or alcohol‐related problems. Although we found some statistically significant effects, the effect sizes were too small, given the measurement scales used in the included studies, to be of relevance to policy or practice. Moreover, the statistically significant effects are not consistent for all misuse measures, and the quality of evidence is not strong, implying that any effects could be inflated by risk of bias."]
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[null,"Families are supported and protected - Selective Interventions"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"Gilligan C, et al. Family‐based prevention programmes for alcohol use in young people. Cochrane Database of Systematic Reviews 2019, Issue 3. Art. No.: CD012287. DOI: 10.1002/14651858.CD012287.pub2.\nAvailable here.","School age children (up to 18 years of age)","This Cochrane review aimed to assess the effectiveness of universal, selective, and indicated family-based prevention programmes in preventing alcohol use or problem drinking in school-aged children (up to 18 years of age). \n\nForty six studies (39,822 participants) were included in the review, with 27 classified as universal, 12 as selective, and seven as indicated. Meta‐analyses were performed according to outcome, including studies reporting on the prevalence, frequency, or volume of alcohol use. The overall quality of evidence was low or very low, and there was high, unexplained heterogeneity. \n\nUpon comparing any family intervention to no intervention/standard care, the authors found no intervention effect on the prevalence (SMD) 0.00, 95% CI ‐0.08 to 0.08; studies = 12; participants = 7490; I² = 57%; low‐quality evidence) or frequency (SMD ‐0.31, 95% CI ‐0.83 to 0.21; studies = 8; participants = 1835; I² = 96%; very low‐quality evidence) of alcohol use in comparison with no intervention/standard care. The effect of any parent/family interventions on alcohol consumption volume compared with no intervention/standard care was very small (SMD ‐0.14, 95% CI ‐0.27 to 0.00; studies = 5; participants = 1825; I² = 42%; low‐quality evidence). \n\nWhen comparing parent/family and adolescent interventions versus interventions with young people alone, authors found no difference in alcohol use prevalence (SMD ‐0.39, 95% CI ‐0.91 to 0.14; studies = 4; participants = 5640; I² = 99%; very low‐quality evidence) or frequency (SMD ‐0.16, 95% CI ‐0.42 to 0.09; studies = 4; participants = 915; I² = 73%; very low‐quality evidence). For this comparison, no trials reporting on the volume of alcohol use could be pooled in meta‐analysis. \n\nIn general, the results remained consistent in separate subgroup analyses of universal, selective, and indicated interventions. No adverse effects were reported. \n","The results of this review indicate that there are no clear benefits of family‐based programmes for alcohol use among young people. Patterns differ slightly across outcomes, but overall, the variation, heterogeneity, and number of analyses performed preclude any conclusions about intervention effects. Additional independent studies are required to strengthen the evidence and clarify the marginal effects observed. "]
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[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This Cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text. Fifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect. One targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects. Among school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]

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[null,"All indicated - NICE Guidance"]
[null,"Source:","Population:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Behaviour change: individual approaches. PH49. London: NICE; 2014. \nAvailable here.\n","Everyone aged 16 years and older","This guideline covers changing health-damaging behaviours among people aged 16 and over using interventions such as goals and planning, feedback and monitoring, and social support. It aims to help tackle a range of behaviours including alcohol misuse, poor eating patterns, lack of physical activity, unsafe sexual behaviour and smoking.\n\nThe guideline includes recommendations on:\n● Developing local behaviour change policy and strategy\n● Commissioning interventions\n● Planning interventions that take account of local needs\n● Ensuring interventions meet individual needs\n● Delivering interventions\n● Commissioning and providing training\n● Monitoring and evaluating interventions\n\n"]
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[null,"National Institute for Health and Care Excellence. Nalmefene for reducing alcohol consumption in people with alcohol dependence. TA325. London: NICE; 2014.\nAvailable here.  ","Adults with mild alcohol dependence (as defined in CG115) who have a high drinking risk level (≥ 60 g/day of pure alcohol for men and ≥ 40 g/day for women) without physical withdrawal symptoms and who do not require immediate detoxification","Nalmefene is recommended within its marketing authorisation, as an option for reducing alcohol consumption, for people with alcohol dependence: \n\n• Who have a high drinking risk level (defined as alcohol consumption of more than 60 g per day for men and more than 40g per day for women, according to the World Health Organization's drinking risk levels) without physical withdrawal symptoms and;\n• Who do not require immediate detoxification.\n\nThe marketing authorisation states that nalmefene should:\n\n• Only be prescribed in conjunction with continuous psychosocial support focused on treatment adherence and reducing alcohol consumption and; \n• Be initiated only in patients who continue to have a high drinking risk level 2 weeks after initial assessment.\n"]
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[null,"National Institute for Health and Care Excellence. Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence. CG115. London: NICE; 2011\nAvailable here.\n\n","Adults (>18 years) or young people (10 to 17 years of age) with a diagnosis of alcohol dependence or meeting criteria for harmful alcohol use (30 to 50 units of alcohol per week)","This guideline covers identifying, assessing and managing alcohol-use disorders (harmful drinking and alcohol dependence) in adults and young people aged 10-17 years. It aims to reduce harms (such as liver disease, heart problems, depression and anxiety) from alcohol by improving assessment and setting goals for reducing alcohol consumption. \n\nThis guideline includes recommendations on:\n\n• Principles of care\n• Identification and assessment\n• Interventions for alcohol misuse"]
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[null,"National Institute for Health and Care Excellence. Coexisting severe mental illness (psychosis) and substance misuse: assessment and management in healthcare settings. CG120. London: NICE; 2011. \nAvailable here.\n","People aged 14 years and over with coexisting severe mental illness (psychosis) and substance misuse","This guideline covers assessing and managing people aged 14 years and over with coexisting severe mental illness (psychosis) and substance misuse. It aims to help healthcare professionals guide people with psychosis with coexisting substance misuse to stabilise, reduce or stop their substance misuse, to improve treatment adherence and outcomes, and to enhance their lives. \n\nThis guideline includes recommendations on:\n\n• Principles of care\n• Recognising psychosis with coexisting substance misuse\n• Primary care\n• Secondary care mental health services\n• Substance misuse services\n• Inpatient mental health services and staffed accommodation\n• Specific issues for young people with psychosis and coexisting substance misuse\n"]
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[null,"National Institute for Health and Care Excellence. Alcohol-use disorders: diagnosis and management of physical complications. CG100. London: NICE; 2010. \nAvailable here. \n","People aged 10 years and over with alcohol-use disorders","This guideline covers care for adults and young people (aged 10 years and older) with physical health problems that are completely or partly caused by an alcohol-use disorder. It aims to improve the health of people with alcohol-use disorders by providing recommendations on managing acute alcohol withdrawal and treating alcohol-related conditions. \n\nThis guideline includes recommendations on:\n\n• Acute alcohol withdrawal\n• Wernicke’s encephalopathy\n• Alcohol-related liver disease\n• Alcohol-related pancreatitis\n\nIn January 2019: NICE checked this guideline and are updating it. For more information, see the surveillance decision."]
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[null,"National Institute for Health and Care Excellence. Alcohol-use disorders: prevention. PH24. London: NICE; 2010\nAvailable here.\n\n\n\n","Children, young people and adults aged 10 years and above","The recommendations in this guideline cover:\n\n• Price, availability and marketing\n• Licencing\n• Supporting children and young people aged 10 to 15 years\n• Screening young people aged 16 and 17 years and offering them extended brief interventions\n• Screening adults and offering them brief advice and interventions\n• Referral\n\nThis guideline was checked in July 2019 and NICE are updating it. For further information, see the surveillance decision."]
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[null,"National Institute for Health and Care Excellence. Behaviour change: general approaches. PH6. London: NICE; 2007\nAvailable here.\n\n\n\n","General population\nProblem drinkers\nThose with raised risk (e.g. pregnant women, )\n","This guideline covers a set of principles that can be used to help people change their behaviour. The aim is for practitioners to use these principles to encourage people to adopt a healthier lifestyle by, for example, stopping smoking, adopting a healthy diet and being more physically active.\n\nThe recommendations in this guideline cover:\n• Providing education and training for those delivering them\n• Delivery of these activities, including one-to-one and community-based programmes and those aimed at specific populations\n• Evaluation of their effectiveness and cost effectiveness\n\nThis guideline was checked in November 2017. NICE found no new evidence that affects the recommendations in this guideline."]
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[null,"Safe and Supported Environment - Indicated Interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"Hennessy EA et al. Recovery schools for improving behavioral and academic outcomes among students in recovery from substance use disorders: a systematic review. Campbell Systematic Reviews 2018; 9. \nAvailable here. ","Students in recovery from substance use who were enrolled part-time or full-time in secondary (high school) or postsecondary (college or university) educational institutions. ","The review focused on two types of recover schools: recovery high schools (RHSs), which are schools that award secondary school dipolmas and offer a range of therapeutic services in addition to standard educational curricula; and collegiate recovery communities (CRCs), which offer therapeutic and sober support services on college campuses. \n\nOnly one study met the criteria for inclusion in the review. The study used a quasi-experimental design to examine the effects of RHSs on high school students' academic and substance use outcomes. No eligible studies examining CRCs were identified. \n\nThe results from the one eligible RHS study indicated that after adjusting for pretest values, students in the RHS condition reported levels of grade point averages (g = 0.26, 95% CI [-0.04, 0.56]), truancy (g = 0.01, 95% CI [-0.29, 0.31]), and alcohol use (g = 0.23, 95% CI [-0.07, 0.53]) similar to participants in the comparison condition. However, students in the RHS condition reported improvements in absenteeism (g = 0.56, 95% CI [0.25, 0.87]), abstinence from alcohol/drugs (OR = 4.36, 95% CI [1.19, 15.98]), marijuana use (g = 0.51, 95% CI [0.20, 0.82]), and other drug use (g = 0.45, 95% CI [0.14, 0.76]).\n\nOverall, there was a serious risk of bias in the one included study. The study had a serious risk of bias due to confounding, low risk of bias due to selection of participants into the study, moderate risk of bias due to classification of interventions, inconclusive risk of bias due to deviations from intended interventions, inconclusive risk of bias due to missing data, moderate risk of bias in measurement of outcomes, and low risk of bias in selection of reported results.","There is insufficient evidence regarding the effectiveness of RHSs and CRCs for improving academic and substance use outcomes among students in recovery from SUDs. Only one identified study examined the effectiveness of RHSs. Although the study reported some beneficial effects, the results must be interpreted with caution given the study's potential risk of bias due to confounding and limited external validity. The paucity of evidence on the effectiveness of recovery schools, as documented in this review, thus suggest the need for caution in the widespread adoption of recovery schools for students in recovery from SUDs. Given the lack of empirical support for these recovery schools, additional rigorous evaluation studies are needed to replicate the findings from the one study included in this review. Furthermore, additional research examining the costs of recovery schools may be needed, to help school administrators determine the potential cost-benefits associated with recovery schools. "]
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[null,"Changed attitudes and social norms - Indicated Interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"Kaner E et al. Personalised digital interventions for reducing hazardous and harmful alcohol consumption in community-dwelling populations. Cochrane Database Syst Rev 2017, Issue 9, Art. No.: CD011479. DOI: 10.1002/14651858.CD011479.pub2. \nAvailable here. \n","People living in the community whose alcohol consumption had been screened as hazardous or harmful. ","This Cochrane review aimed to assess the effectiveness and cost‐effectiveness of digital interventions for reducing hazardous and harmful alcohol consumption, alcohol‐related problems, or both, in people living in the community.\n\nFifty-seven studies which randomised a total of 34,390 participants were included in the review. The main sources of bias were from attrition and participant blinding (36 per cent and 21 per cent of studies respectively, high risk of bias). Forty one studies (42 comparisons, 19,241 participants) provided data for the primary meta‐analysis, which demonstrated that participants using a digital intervention drank approximately 23g alcohol weekly (95 per cent CI 15 to 30) (about 3 UK units) less than participants who received no or minimal interventions at end of follow up (moderate‐quality evidence). \n\nFifteen studies (16 comparisons, 10,862 participants) demonstrated that participants who engaged with digital interventions had less than one drinking day per month fewer than no intervention controls (moderate‐quality evidence), 15 studies (3587 participants) showed about one binge drinking session less per month in the intervention group compared to no intervention controls (moderate‐quality evidence), and in 15 studies (9791 participants) intervention participants drank one unit per occasion less than no intervention control participants (moderate‐quality evidence). \n\nOnly five small studies (390 participants) compared digital and face‐to‐face interventions. There was no difference in alcohol consumption at end of follow up (MD 0.52 g/week, 95 per cent CI ‐24.59 to 25.63; low‐quality evidence). \n\nThe most frequently mentioned theories or models in the included studies were Motivational Interviewing Theory (7/20), Transtheoretical Model (6/20) and Social Norms Theory (6/20). Over half of the interventions (n = 21, 51per cent) made no mention of theory. Only two studies used theory to select participants or tailor the intervention. There was no evidence of an association between reporting theory use and intervention effectiveness.\n","There is moderate‐quality evidence that digital interventions may lower alcohol consumption, with an average reduction of up to three (UK) standard drinks per week compared to control participants. Substantial heterogeneity and risk of performance and publication bias may mean the reduction was lower. Low‐quality evidence from fewer studies suggested there may be little or no difference in impact on alcohol consumption between digital and face‐to‐face interventions. \n\nThe BCTs of behaviour substitution, problem solving and credible source were associated with the effectiveness of digital interventions to reduce alcohol consumption and warrant further investigation in an experimental context. \n\nReporting of theory use was very limited and often unclear when present. Over half of the interventions made no reference to any theories. Limited reporting of theory use was unrelated to heterogeneity in intervention effectiveness. \n"]
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[null,"Reduced availability - Indicated Interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]
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[null,"Reduced affordability - Indicated Interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]
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[null,"Behaviour change - Indicated interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"Agabio R et al. Baclofen for alcohol use disorder. Cochrane Database Syst Rev 2023, Issue 1. Art.No. CD012557. DOI:0.1002/14651858.CD012557.pub3.\nAvailable here. ","Adults with a diagnosis of alcohol dependence. ","This is an update of a Cochrane Review first published in 2018. The aim of this update was to evaluate the benefits and harms of baclofen on achieving and maintaining abstinence or reducing alcohol consumption in people with AUD compared to placebo, no treatment or any other pharmacological relapse prevention treatment. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nThis update included 17 RCTs (1818 participants). Ten studies compared baclofen to placebo or another medication; seven compared two baclofen doses to placebo or another medication. Globally, 15 studies compared baclofen to placebo, two baclofen to acamprosate and two baclofen to naltrexone. In 16 studies, participants received psychosocial treatments. The authors judged most studies at low risk of selection, performance, detection (subjective outcome), attrition and reporting bias. Ten studies detoxified participants before treatment; in seven studies, participants were still drinking at the beginning of treatment. Treatment duration was 12 weeks for 15 RCTs and longer in two studies. Baclofen daily dose was 30 mg to 300 mg: 10 RCTs used low doses (30 mg or less); eight RCTs medium doses (above 30 and 100 mg or less) and four RCTs high doses (above 100 mg).\n\nCompared to placebo, moderate‐certainty evidence found that baclofen probably decreases the risk to relapse (risk ratio (RR) 0.87, 95% confidence interval (CI) 0.77 to 0.99; 12 studies, 1057 participants). This result was confirmed among detoxified participants but not among other subgroups of participants.\n\nHigh‐certainty evidence found that baclofen increases the percentage of days abstinent (mean difference (MD) 9.07, 95% CI 3.30 to 14.85; 16 studies, 1273 participants). This result was confirmed among all subgroups of participants except non‐detoxified or those who received medium doses.\n\nThere was no difference between baclofen and placebo in the other primary outcomes: heavy drinking days (standardised mean difference (SMD) −0.18, 95% CI −0.48 to 0.11; 13 studies, 840 participants; moderate‐certainty evidence); and number of drinks per drinking days (MD −0.45, 95% CI −1.20 to 0.30; 9 studies, 392 participants; moderate‐certainty evidence).\n\nCompared to acamprosate, one study (60 participants) found no differences in any outcomes but the evidence was very uncertain: relapse (RR 1.25, 95% CI 0.71 to 2.20; very low‐certainty evidence).\n\nCompared to naltrexone, baclofen may increase the risk of relapse (RR 2.50, 95% CI 1.12 to 5.56; 1 study, 60 participants; very low‐certainty evidence) but the evidence is very uncertain.","The authors concluded that baclofen likely reduces the risk of relapse to any drinking and increases the percentage of abstinent days, mainly among detoxified participants. It does not increase the number of participants with at least one adverse event, those who dropout for any reason or due to adverse events. It probably does not reduce number of heavy drinking days and the number of drinks per drinking days. Current evidence suggests that baclofen may help people with AUD in maintaining abstinence. The results of comparisons of baclofen with acamprosate and naltrexone were mainly based on only one study."]
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[null,"Goldberg SB et al. Mindfulness‐based interventions for substance use disorders. Cochrane Database of Systematic Reviews 2021, Issue 10.\nAvailable here.","Patients suffering from Substance use disorders including individuals with alcohol, prescription‐, illicit‐ and poly‐substance use disorders","This Cochrane review aimed to determine the effects of MBIs for SUDs in terms of substance use outcomes, craving and adverse events compared to standard care, further psychotherapeutic, psychosocial or pharmacological interventions, or instructions, waiting list and no treatment.\n\nForty RCTs met the inclusion criteria, with 35 RCTs involving 2825 participants eligible for meta‐analysis. All studies were at high risk of performance bias and most were at high risk of detection bias.\n\nMindfulness‐based interventions (MBIs) versus no treatment: Twenty‐four RCTs included a comparison between MBI and no treatment. The evidence was uncertain about the effects of MBIs relative to no treatment on all primary outcomes: continuous abstinence rate (post: risk ratio (RR) = 0.96, 95% CI 0.44 to 2.14, 1 RCT, 112 participants; follow‐up: RR = 1.04, 95% CI 0.54 to 2.01, 1 RCT, 112 participants); percentage of days with substance use (post‐treatment: standardized mean difference (SMD) = 0.05, 95% CI ‐0.37 to 0.47, 4 RCTs, 248 participants; follow‐up: SMD = 0.21, 95% CI ‐0.12 to 0.54, 3 RCTs, 167 participants); and consumed amount (post‐treatment: SMD = 0.10, 95% CI ‐0.31 to 0.52, 3 RCTs, 221 participants; follow‐up: SMD = 0.33, 95% CI 0.00 to 0.66, 2 RCTs, 142 participants). Evidence was uncertain for craving intensity and serious adverse events. Analysis of treatment acceptability indicated MBIs result in little to no increase in study attrition relative to no treatment (RR = 1.04, 95% CI 0.77 to 1.40, 21 RCTs, 1087 participants). Certainty of evidence for all other outcomes was very low due to imprecision, risk of bias, and/or inconsistency. Data were unavailable to evaluate adverse events.\n\nMindfulness‐based interventions (MBIs) versus other treatments (standard of care, cognitive behavioral therapy, psychoeducation, support group, physical exercise, medication): Nineteen RCTs included a comparison between MBI and another treatment. The evidence was very uncertain about the effects of MBIs relative to other treatments on continuous abstinence rate at post‐treatment (RR = 0.80, 95% CI 0.45 to 1.44, 1 RCT, 286 participants) and follow‐up (RR = 0.57, 95% CI 0.28 to 1.16, 1 RCT, 286 participants), and on consumed amount at post‐treatment (SMD = ‐0.42, 95% CI ‐1.23 to 0.39, 1 RCT, 25 participants) due to imprecision and risk of bias. The evidence suggests that MBIs reduce percentage of days with substance use slightly relative to other treatments at post‐treatment (SMD = ‐0.21, 95% CI ‐0.45 to 0.03, 5 RCTs, 523 participants) and follow‐up (SMD = ‐0.39, 95% CI ‐0.96 to 0.17, 3 RCTs, 409 participants). The evidence was very uncertain about the effects of MBIs relative to other treatments on craving intensity due to imprecision and inconsistency. Analysis of treatment acceptability indicated MBIs result in little to no increase in attrition relative to other treatments (RR = 1.06, 95% CI 0.89 to 1.26, 14 RCTs, 1531 participants). Data were unavailable to evaluate adverse events.","In comparison with no treatment, the evidence is uncertain regarding the impact of MBIs on SUD‐related outcomes. MBIs result in little to no higher attrition than no treatment. In comparison with other treatments, MBIs may slightly reduce days with substance use at post‐treatment and follow‐up (4 to 10 months). The evidence is uncertain regarding the impact of MBIs relative to other treatments on abstinence, consumed substance amount, or craving. MBIs result in little to no higher attrition than other treatments. Few studies reported adverse events."]
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[null,"McGovern R et al. Effectiveness of psychosocial interventions for reducing parental substance misuse. Cochrane Database of Systematic Reviews 2021, Issue 3. Art. No.: CD012823.\nAvailable here","Participants were parents who use substances; this included mothers and fathers of children (sons and daughters) under the age of 21 years, regardless of custodial or residency status of the children. Same-sex parents and foster parents were eligible for inclusion.","The authors included 22 unique studies with a total of 2274 participants (mean age of parents ranged from 26.3 to 40.9 years), examining 24 experimental interventions. The majority of studies intervened with mothers only (n = 16; 73%). Heroin, cocaine, and alcohol were the most commonly reported substances used by participants. The interventions targeted either parenting only (n = 13; 59%); drug and alcohol use only (n = 5; 23%); or integrated interventions which addressed both (n = 6; 27%).\nThe authors found moderate-quality evidence that psychosocial interventions are probably more effective at reducing the frequency of parental alcohol misuse than comparison conditions at 6-month (mean difference (MD) −0.32, 95% confidence interval (CI) −0.51 to −0.13; 6 studies, 475 participants) and 12-month follow-up (standardised mean difference (SMD) −0.25, 95% CI −0.47 to −0.03; 4 studies, 366 participants). The authors found a significant reduction in frequency of use at 12 months only (SMD −0.21, 95% CI −0.41 to −0.01; 6 studies, 514 participants, moderate-quality evidence).\nThe authors examined the effect of the intervention type. They found low-quality evidence that psychosocial interventions targeting substance use only may not reduce the frequency of alcohol (6 months: SMD −0.35, 95% CI −0.86 to 0.16; 2 studies, 89 participants and 12 months: SMD −0.09, 95% CI −0.86 to 0.61; 1 study, 34 participants)\nA parenting intervention only, without an adjunctive substance use component, may not reduce frequency of alcohol misuse (6 months: SMD −0.21, 95% CI −0.46 to 0.04, 3 studies; 273 participants, low-quality evidence and 12 months: SMD −0.11, 95% CI −0.64 to 0.41; 2 studies; 219 participants, very low-quality evidence).\nParents receiving integrated interventions which combined both parenting- and substance use-targeted components may reduce alcohol misuse with a small effect size (6 months: SMD −0.56, 95% CI −0.96 to −0.16 and 12 months: SMD −0.42, 95% CI −0.82 to −0.03; 2 studies, 113 participants). However, this evidence was of low quality.\nInterventions appeared to be more often beneficial for fathers than for mothers. The authors found low- to very low-quality evidence of a reduction in frequency of alcohol misuse for mothers at six months only (SMD −0.27, 95% CI −0.50 to −0.04; 4 studies, 328 participants), whilst in fathers there was a reduction in frequency of alcohol misuse (6 months: SMD −0.43, 95% CI −0.78 to −0.09; 2 studies, 147 participants and 12 months: SMD −0.34, 95% CI −0.69 to 0.00; 2 studies, 147 participants).","The authors found moderate-quality evidence that psychosocial interventions probably reduce the frequency at which parents use alcohol. Integrated psychosocial interventions which combine parenting skills interventions with a substance use component may show the most promise. \nWhilst it appears that mothers may benefit less than fathers from intervention, caution is advised in the interpretation of this evidence, as the interventions provided to mothers alone typically did not address their substance use and other related needs. \nThe authors found low-quality evidence from few studies that interventions involving children are not beneficial."]
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[null,"Kelly  JF, Humphreys  K, Ferri  M. Alcoholics Anonymous and other 12‐step programs for alcohol use disorder. Cochrane Database of Systematic Reviews 2020, Issue 3. Art. No.: CD012880. DOI: 10.1002/14651858.CD012880.pub2.\nAvailable here.","Non‐coerced adults with Alcohol Use Disorder.","AA/TSF (manualized) compared to treatments with a different theoretical orientation (e.g. CBT) (randomized/quasi‐randomized evidence) \nRCTs comparing manualized AA/TSF to other clinical interventions (e.g. CBT), showed AA/TSF improves rates of continuous abstinence at 12 months (risk ratio (RR)) 1.21, 95% confidence interval (CI) 1.03 to 1.42; 2 studies, 1936 participants; high‐certainty evidence). This effect remained consistent at both 24 and 36 months. \nFor percentage days abstinent (PDA), AA/TSF appears to perform as well as other clinical interventions at 12 months (mean difference (MD) 3.03, 95% CI ‐4.36 to 10.43; 4 studies, 1999 participants; very low‐certainty evidence), and better at 24 months (MD 12.91, 95% CI 7.55 to 18.29; 2 studies, 302 participants; very low‐certainty evidence) and 36 months (MD 6.64, 95% CI 1.54 to 11.75; 1 study, 806 participants; very low‐certainty evidence). \nFor longest period of abstinence (LPA), AA/TSF may perform as well as comparison interventions at six months (MD 0.60, 95% CI ‐0.30 to 1.50; 2 studies, 136 participants; low‐certainty evidence). \nFor drinking intensity, AA/TSF may perform as well as other clinical interventions at 12 months, as measured by drinks per drinking day (DDD) (MD ‐0.17, 95% CI ‐1.11 to 0.77; 1 study, 1516 participants; moderate‐certainty evidence) and percentage days heavy drinking (PDHD) (MD ‐5.51, 95% CI ‐14.15 to 3.13; 1 study, 91 participants; low‐certainty evidence). \nFor alcohol‐related consequences, AA/TSF probably performs as well as other clinical interventions at 12 months (MD ‐2.88, 95% CI ‐6.81 to 1.04; 3 studies, 1762 participants; moderate‐certainty evidence). \nFor alcohol addiction severity, one study found evidence of a difference in favor of AA/TSF at 12 months (P < 0.05; low‐certainty evidence). \nThis study examines results for the same outcomes for non-manualized AA/TSF.\n","There is high quality evidence that manualized AA/TSF interventions are more effective than other established treatments, such as CBT, for increasing abstinence. Non‐manualized AA/TSF may perform as well as these other established treatments. AA/TSF interventions, both manualized and non‐manualized, may be at least as effective as other treatments for other alcohol‐related outcomes. AA/TSF probably produces substantial healthcare cost savings among people with alcohol use disorder. "]
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[null,"Steele DW, et al. Interventions for Substance Use Disorders in Adolescents: A Systematic Review. Comparative Effectiveness Review No. 225.  AHRQ Publication No. 20-EHC014. Rockville, MD: Agency for Healthcare Research and Quality. May 2020.\nAvailable here.","Adolescents ages 12 to 20 years with problematic substance use or substance use disorder.","The authors included interventions designed to achieve abstinence, reduce use quantity and frequency, improve functional outcomes, and reduce substance-related harms. Interventions were categorised into seven primary intervention components: motivational interviewing (MI), family focused therapy (Fam), cognitive behavioral therapy (CBT), psychoeducation, contingency management (CM), peer group therapy, and intensive case management. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nMotivational interviewing reduced heavy alcohol use days by 0.7 days/month, alcohol use days by 1.2 days/month compared with treatment as usual. Across multiple intensive interventions, family focussed therapy was most effective, reducing alcohol use days by 3.5 days/month compared with treatment as usual.\n\n","Reviewers conclude that :\nBrief interventions: motivational interviewing reduces heavy alcohol use, low Strength of Evidence (SoE) and alcohol use days (moderate SoE). \nFamily focussed therapy: may be most effective in reducing alcohol use (low SoE). More research is needed to identify other effective intensive behavioral interventions for alcohol use disorder. Both motivational interviewing and CBT reduce combined alcohol and other drug use (low SoE).\nPharmacological interventions: systematic reviews in the college settings support use of brief interventions for students with any use, heavy or problematic use. More research is needed to identify the most effective combinations of behavioral and pharmacologic treatments for alcohol use disorders."]
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[null,"Hunt G et al.  Psychosocial interventions for people with both severe mental illness and substance misuse. Cochrane Database Syst Rev 2019, Issue 12. Art. No.: CD001088. DOI: 10.1002/14651858.CD001088.pub4\nAvailable here.\n","People diagnosed with a severe mental illness and concurrent problem of substance misuse","This Cochrane review aimed to assess the effects of psychosocial interventions for reduction in substance use in people with a serious mental illness compared with standard care. It updates and replaces the 2013 version of the review.\n\nThe review now includes 41 trials with a total of 4024 participants. The reviewers identified nine comparisons within the included trials. Only two of these reported outcomes meeting the scope of this topic evidence map and have been reported below. For full detail and information on the other outcomes, please refer to the full-text. \n\n1. Integrated models of care versus standard care (36 months): No clear differences were found between treatment groups for alcohol use (RR 1.15, 95% CI 0.84 to 1.56; participants = 143; studies = 1; low‐quality evidence).\n\n5. Motivational interviewing (MI) versus standard care: A clear difference, favouring MI, was observed for abstaining from alcohol (RR 0.36, 95% CI 0.17 to 0.75; participants = 28; studies = 1; very low‐quality evidence).","Authors concluded that they included 41 RCTs but were unable to use much data for analyses. There is currently no high‐quality evidence to support any one psychosocial treatment over standard care for important outcomes such as remaining in treatment, reduction in substance use or improving mental or global state in people with serious mental illnesses and substance misuse. Furthermore, methodological difficulties exist which hinder pooling and interpreting results. Further high‐quality trials are required which address these concerns and improve the evidence in this important area."]
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[null,"Canadian Agency for Drugs and Technologies in Health. E-therapy interventions for treatments of substance use disorders and other addictions: a review of clinical effectiveness. Ottawa: CADTH; 2018. \nAvailable here.\n","Adults with diagnosed substance use disorders or with a diagnosed addiction disorder, with or without co-morbid mental health conditions. ","The purpose of this CADTH Rapid Response was to review the comparative effectiveness of therapist-guided e-therapy interventions versus other options for the treatment of adults with substance use disorders and other addictions. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nWhat is the clinical effectiveness of e-therapy for the treatment of patients with substance use disorders and other addictions? \nOne SR examined the efficacy of internet-delivered interventions for alcohol addiction. The difference in alcohol consumption between the e-therapy with therapist guidance and no treatment groups at the post-treatment follow-up was statistically significant (with the e-therapy group having less consumption) and the effect of guided e-therapy was found to be small. The authors concluded that internet-delivered interventions were effective in reducing alcohol consumption and that the effect was small.\n","Evidence on e-therapy for the treatment of substance use disorders and other addictions was from a small number of SRs and RCTs. Findings consistently showed that therapist-guided e-therapy was superior to no treatment and wait list in reducing alcohol consumption or cannabis use, and the effect was small. With respect to substances, evidence was limited to the treatment of problematic alcohol and cannabis use and it is therefore unclear if the results generalize to the misuse of other substances."]
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[null,"Egholm JWM et al. Perioperative alcohol cessation intervention for postoperative complications Cochrane Database of Syst Rev 2018, Issue 11. Art. No.: CD008343. DOI: 10.1002/14651858.CD008343.pub3\n\nAvailable here.\n","Included participants with risky consumption of alcohol who were undergoing all types of elective or acute surgical procedures under general or regional anaesthesia or sedation, who were offered perioperative alcohol cessation intervention or no intervention. ","This Cochrane systematic review aimed to assess the effects of perioperative alcohol cessation interventions on rates of postoperative complications and alcohol consumption. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nOne new study was included in this updated review, resulting in a total of three RCTs (140 participants who drank 3 to 40 AU/d). All three studies were of moderate to good quality. All studies evaluated the effects of intensive alcohol cessation interventions, including pharmacological strategies for alcohol withdrawal symptoms, patient education, and relapse prophylaxis. The authors identified one ongoing study.\n\nInvestigators describe more successful quitters at the end of the intervention programme than among controls. Forty-one out of 70 participants in the intervention groups successfully quit drinking compared with only five out of 70 participants in the control groups (RR 8.22, 95% CI 1.67 to 40.44). The quality of evidence for this outcome is moderate.\n\nAll three studies reported postoperative alcohol consumption (grams of alcohol/week) at the end of the programme as median and range values; therefore it was not possible to estimate the mean and the SD. We performed no meta-analysis. All three studies reported length of stay, and none of these studies described a significant difference in length of stay. Data were insufficient for review authors to perform a meta-analysis. No studies reported on the prevalence of participants without risky drinking in the longer term.\n\nIncluded studies were few and reported small sample sizes; therefore one should be careful about drawing firm conclusions based on these study results. All three studies were conducted in Denmark, and most participants were men. The included participants may represent a selective group, as they could have been more motivated and/or more interested in participating in clinical research or otherwise different, and effects may have been overestimated for both intervention and control groups in these studies. Trial results indicate that these studies are difficult to perform, that strong research competencies are necessary for future studies, and that further evaluation of perioperative alcohol cessation interventions in high-quality randomised controlled trials is needed. Once published and assessed, the one ’ongoing’ study identified may alter the conclusions of this review.","The authors conclude that all three studies showed a significant reduction in the number of participants who quit drinking alcohol during the intervention period. Intensive alcohol cessation interventions offered for four to eight weeks to participants undergoing all types of surgical procedures to achieve complete alcohol cessation before surgery probably reduced the number of postoperative complications. Data were insufficient for review authors to assess their effects on postoperative mortality. No studies reported an effect on length of stay, and no studies addressed the prevalence of risky drinking in the longer term.\n\n\n"]
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[null,"Klimas J et al. Psychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users. Cochrane Database Syst Rev 2018, Issue 12. Art. No.: CD009269. DOI: 10.1002/14651858.CD009269.pub4.\nAvailable here. \n","Problem alcohol and illicit drug users (principally problem drug users of opiates and stimulants). ","This Cochrane review aimed to assess the effects of psychosocial interventions for problem alcohol use in illicit drug users. \n\nThe psychosocial interventions considered in the studies were: cognitive‐behavioural coping skills training (one study), twelve‐step programme (one study), brief intervention (three studies), motivational interviewing (two studies), and brief motivational interviewing (one study). Two studies were considered in two comparisons. There were no data for the secondary outcome, alcohol‐related harm. The results were as follows. \n\nComparison 1: cognitive‐behavioural coping skills training versus twelve‐step programme (one study, 41 participants): There was no significant difference between groups for either of the primary outcomes (alcohol abstinence assessed with Substance Abuse Calendar and breathalyser at one year: risk ratio (RR) 2.38 (95% confidence interval [CI] 0.10 to 55.06); and retention in treatment, measured at end of treatment: RR 0.89 (95% CI 0.62 to 1.29), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was very low. \n\nComparison 2: brief intervention versus treatment as usual (three studies, 197 participants): There was no significant difference between groups for either of the primary outcomes (alcohol use, measured as scores on the Alcohol Use Disorders Identification Test (AUDIT) or Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) at three months: standardised mean difference (SMD) 0.07 (95% CI ‐0.24 to 0.37); and retention in treatment, measured at three months: RR 0.94 (95% CI 0.78 to 1.13), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was low. \n\nComparison 3: motivational interviewing versus treatment as usual or educational intervention only (three studies, 462 participants): There was no significant difference between groups for either of the primary outcomes (alcohol use, measured as scores on the AUDIT or ASSIST at three months: SMD 0.04 (95% CI ‐0.29 to 0.37); and retention in treatment, measured at three months: RR 0.93 (95% CI 0.60 to 1.43), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was low. \n\nComparison 4: brief motivational intervention (BMI) versus assessment only (one study, 187 participants): More people reduced alcohol use (by seven or more days in the past month, measured at six months) in the BMI group than in the control group (RR 1.67; 95% CI 1.08 to 2.60). There was no difference between groups for the other primary outcome, retention in treatment, measured at end of treatment: RR 0.98 (95% CI 0.94 to 1.02), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was moderate. \n\nComparison 5: motivational interviewing (intensive) versus motivational interviewing (one study, 163 participants): There was no significant difference between groups for either of the primary outcomes (alcohol use, measured using the Addiction Severity Index‐alcohol score (ASI) at two months: MD 0.03 (95% CI 0.02 to 0.08); and retention in treatment, measured at end of treatment: RR 17.63 (95% CI 1.03 to 300.48), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was low. \n\n","The review authors found low to very low‐quality evidence to suggest that there is no difference in effectiveness between different types of psychosocial interventions to reduce alcohol consumption among people who use illicit drugs, and that brief interventions are not superior to assessment‐only or to treatment as usual. No firm conclusions can be made because of the paucity of the data and the low quality of the retrieved studies."]
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[null,"Agabio R, Trogu E, Pani PP. Antidepressants for the treatment of people with co‐occurring depression and alcohol dependence. Cochrane Database Syst Rev 2018, Issue 4. Art. No.: CD008581. DOI: 10.1002/14651858.CD008581.pub2.\nAvailable here. \n","Adults with co-occurring depression and alcohol dependence. ","This Cochrane review aimed to assess the benefits and risks of antidepressants for the treatment of people with co‐occurring depression and alcohol dependence. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text\n\nReview authors report that 33 studies were included in the review (2242 participants). Antidepressants were compared to placebo (22 studies), psychotherapy (two studies), other medications (four studies), or other antidepressants (five studies). The mean duration of the trials was 9.9 weeks (range 3 to 26 weeks). Eighteen studies took place in the USA, 12 in Europe, two in Turkey, and one in Australia. The antidepressant included in most of the trials was sertraline; other medications were amitriptyline, citalopram, desipramine, doxepin, escitalopram, fluoxetine, fluvoxamine, imipramine, mianserin, mirtazepine, nefazodone, paroxetine, tianeptine, venlafaxine, and viloxazine. Eighteen studies were conducted in an outpatient setting, nine in an inpatient setting, and six in both settings. Psychosocial treatment was provided in 18 studies. There was high heterogeneity in the selection of outcomes and the rating systems used for diagnosis and outcome assessment.\n\nModerate‐quality evidence found that antidepressants increased the number of participants abstinent from alcohol during the trial (7 studies, 424 participants, RR 1.71, 95 per cent Cl 1.22 to 2.39) and reduced the number of drinks per drinking days (7 studies, 451 participants, mean difference (MD) ‐1.13 drinks per drinking days, 95 per cent Cl ‐1.79 to ‐0.46). After the exclusion of studies with high risk of bias, the number of abstinent remained higher (RR 1.69, 95 per cent CI 1.18 to 2.43) and the number of drinks per drinking days lower (MD ‐1.21 number of drinks per drinking days, 95 per cent CI ‐1.91 to ‐0.51) among participants who received antidepressants compared to those who received placebo. However, other outcomes such as the rate of abstinent days did not differ between antidepressants and placebo (9 studies, 821 participants, MD 1.34, 95 per cent Cl ‐1.66 to 4.34; low‐quality evidence).\n\nThere were few studies comparing one antidepressant versus another antidepressant or antidepressants versus other interventions, and these had a small sample size and were heterogeneous in terms of the types of interventions that were compared, yielding results that were not informative.\n","Authors found low‐quality evidence supporting the clinical use of antidepressants in the treatment of people with co‐occurring depression and alcohol dependence. Antidepressants had positive effects on certain relevant outcomes related to depression and alcohol use but not on other relevant outcomes. Moreover, most of these positive effects were no longer significant when studies with high risk of bias were excluded. Results were limited by the large number of studies showing high or unclear risk of bias and the low number of studies comparing one antidepressant to another or antidepressants to other medication. In people with co‐occurring depression and alcohol dependence, the risk of developing adverse effects appeared to be minimal, especially for the newer classes of antidepressants (such as selective serotonin reuptake inhibitors). According to these results, in people with co‐occurring depression and alcohol dependence, antidepressants may be useful for the treatment of depression, alcohol dependence, or both, although the clinical relevance may be modest."]
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[null,"Kaner E et al. Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev 2018, Issue 2.\nAvailable here. ","People who routinely presented to general practice, emergency care or other primary care settings for a range of health problems, whose alcohol consumption was identified by a screening tool as being excessive, or who had experienced harm as a result of their drinking behaviour","This Cochrane systematic review aimed to assess the effectiveness of screening and brief alcohol intervention to reduce excessive alcohol consumption in hazardous or harmful drinkers in general practice or emergency care settings.\n\nThe reviewers found moderate‐quality evidence that brief alcohol interventions have little impact on frequency of binges per week (MD ‐0.08, 95% CI ‐0.14 to ‐0.02; 15 studies, 6946 participants); drinking days per week (MD ‐0.13, 95% CI ‐0.23 to ‐0.04; 11 studies, 5469 participants); or drinking intensity (‐0.2 g/drinking day, 95% CI ‐3.1 to 2.7; 10 studies, 3128 participants).\n\nThey found moderate‐quality evidence of little difference in quantity of alcohol consumed when extended and no or minimal interventions were compared (‐20 g/week, 95% CI ‐40 to 1; 6 studies, 1296 participants). There was little difference in binges per week (‐0.08, 95% CI ‐0.28 to 0.12; 2 studies, 456 participants; moderate‐quality evidence) or difference in days drinking per week (‐0.45, 95% CI ‐0.81 to ‐0.09; 2 studies, 319 participants; moderate‐quality evidence). Extended versus no or minimal intervention provided little impact on drinking intensity (9 g/drinking day, 95% CI ‐26 to 9; 1 study, 158 participants; low‐quality evidence).\n\nExtended intervention had no greater impact than brief intervention on alcohol consumption, although findings were imprecise (MD 2 g/week, 95% CI ‐42 to 45; 3 studies, 552 participants; low‐quality evidence). Numbers of binges were not reported for this comparison, but one trial suggested a possible drop in days drinking per week (‐0.5, 95% CI ‐1.2 to 0.2; 147 participants; low‐quality evidence). Results from this trial also suggested very little impact on drinking intensity (‐1.7 g/drinking day, 95% CI ‐18.9 to 15.5; 147 participants; very low‐quality evidence).","The authors concluded that they found moderate‐quality evidence that brief interventions can reduce alcohol consumption in hazardous and harmful drinkers compared to minimal or no intervention. Longer counselling duration probably has little additional effect. Future studies should focus on identifying the components of interventions which are most closely associated with effectiveness."]
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[null,"Smedslund G et al. Effect of early, brief computerized interventions on risky alcohol and cannabis use among young people. Campbell systematic reviews 2017; 6:(13). Available here. ","Young people (aged 15-25) who abuse alcohol or cannabis. ","The review focused on the effects of brief interventions, provided by electronic devices. Sixty studies were included in the review that had randomised a total of 33,316 participants. \n\nModerate quality evidence was found that multi-dose assessment and feedback was more effective than single-dose assessment for alcohol. A meta-analysis of four studies by the same first author found a 16 per cent significant short-term reduction in drinking after a repeated assessment and feedback compared to a single assessment and feedback (Rate ratio: 0.84, 95 per cent CI: 0.78 to 0.91). However, a study by Anderson (2015) found an SMD of 0.10 (in favour of single dose, 95 per cent CI: -0.07 to 0.27). A study by Kypri (2008) found a long-term significant reduction in drinking after multi-dose feedback compared to single-dose feedback (Rate ratio: 0.77, 95 per cent CI: 0.63 to 0.94). \n\nLow quality evidence was found that assessment and feedback might be more effective than no intervention (Short term effect, 15 studies; SMD: -0.17, 95 per cent CI: -0.27 TO -0.08, I2 = 52 per cent. Long term effect, 3 studies; SMD: -0.17, 95 per cent CI: -0.30 to -0.04).\n\nAssessment and feedback might also be more effective than assessment alone (low quality evidence. Short-term effect, 24 studies; SMD: -0.15, 95 per cent CI: -0.25 to -0.06, I2 = 64 per cent. Long-term effect, 3 studies; SMD: -0.03, 95 per cent CI: -0.19 to 0.12). \n\nShort term effects (<6 months) were mostly larger than long-term (≥ 6 months) effects. \n","Computerized brief interventions are easy to administer, and the evidence from this review indicates that such brief interventions might reduce drinking for several months after the intervention. Additionally, there is no evidence for adverse effects. This means that brief, computerized interventions could be feasible ways of dealing with risky alcohol use among young people. The evidence on cannabis consumption is scarcer, suggesting the need for more research. "]
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[null,"Canadian Agency for Drugs and Technology in Health. Concurrent treatment for substance use disorder and trauma-related comorbidities: a review of clinical effectiveness and guidelines. Ottawa: CADTH; 2017. \nAvailable here. ","Adults with substance use disorder and trauma-related comorbidities (PTSD, anxiety or depression). \n\nSubgroup of interest: military veterans","The purpose of this report by CADTH was to review treatment options for patients with comorbid substance use disorder (SUD) and post-traumatic stress disorder, anxiety, or depression by comparing concurrent treatments for SUD and the mental disorders with no treatment, usual care or active treatment for one condition only and treatment for a single condition (SUD or the mental disorders) with no treatment, usual care or active treatment for the second disorder. Additionally, this review aimed to review evidence-based guidelines regarding the treatments for patients with these comorbidities. \n\nThe review addressed three main research questions. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\n1. What is clinical effectiveness of concurrent treatment for patients with substance use disorders and comorbid post-traumatic stress disorder, anxiety, or depression?\nPatients with comorbid SUD and PTSD: In summary, findings with respect to SUD outcomes for integrated treatments addressing both PTSD and SUD, were inconsistent.\nPatients with comorbid SUD and depression: In summary, there is a suggestion that integrated treatments are more effective than control treatments or treatments addressing a single condition, but findings were not always consistent.\nPatients with SUD and anxiety disorder: One RCT showed that fewer patients relapsed to any drinking in the CBT group compared to the PMRT group. Another RCT showed that the nine hour anxiety-sensitivity focused intervention plus TAU over TAU alone, showed improvement in percent days abstinent in both groups, but showed no significant between group difference.\nPatients with SUD and depression or anxiety disorder: An RCT showed that ICBT appeared to be more effective than usual care with respect to most measures of alcohol consumption.\n\n2. What is the clinical effectiveness of the treatment of one condition for the improvement of all symptoms in patients with substance use disorder and comorbid post-traumatic stress disorder, anxiety, or depression?\nA systematic review included six studies that evaluated addiction based interventions. Two studies comparing the experimental contingency management (CM) treatment with control treatment found slightly better early treatment gains with respect to substance use with CM, however the differences did not remain significant in the long term as shown in one study. Results from three studies (other than CM) showed within-group improvement in SUD outcomes over time even for minimal or no treatment. One study showed that the care management program was associated with better alcohol outcomes compared to the AUD treatment that patients identified on their own.\nAnother systematic review included one study comparing technology-based treatment (TAU plus web based intervention targeting alcohol use) with TAU alone, reported no findings with respect to substance use.\n\n3. What are the evidence-based guidelines regarding the treatment of patients with substance use disorders and comorbid post-traumatic stress disorder, anxiety, or depression?\nOne relevant evidence-based guideline was identified. For comorbid anxiety and alcohol use disorder or for comorbid PTSD and alcohol use disorder, an integrated approach was recommended (Recommendation grade: CCP i.e. “Clinical consent point”). For comorbid depression and alcohol use disorder, CBT was recommended to improve both depressive symptoms and drinking problems.","Report authors found there was a suggestion that integrated treatments offered greater improvement with respect to PTSD symptoms, depression or anxiety compared to no treatment or minimal treatment for patients with comorbid substance use disorder (SUD) and posttraumatic stress syndrome (PTSD), depression or anxiety disorder. However results were not always consistent. In patients with comorbid SUD and PTSD, there was a suggestion that addiction based interventions were more effective with respect to controlling substance use than control treatments. One evidence-based guideline recommended an integrated treatment approach for patients with comorbid alcohol use disorder and PTSD, or comorbid alcohol use disorder and anxiety disorder, and cognitive behavioural therapy for comorbid alcohol use disorder and depression."]
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[null,"Canadian Agency for Drugs and Technology in Health. Inpatient and outpatient treatment programs for substance use disorder: a review of clinical effectiveness and guidelines. Ottawa: CADTH; 2017a. \nAvailable here. \n","Adults 18 to 65 years with substance use disorder/addiction disorder (e.g., abuse of prescription medications or cocaine, heroin, cannabis, alcohol)\n","This Rapid Response report by CADTH aimed to review the clinical effectiveness of inpatient and outpatient treatment programs for adults with substance use disorders involving prescription medications such as analgesics or non-prescription substances such as cocaine, opioids such as heroine, marijuana (cannabis), or alcohol. Evidence-based guidelines associated with inpatient and outpatient treatment programs in adults with substance use disorders were also examined.\n\nThe review addressed two main research questions. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\n1. What is the clinical effectiveness of inpatient and outpatient treatment programs in adults with substance use disorders?\nOne narrative review concluded that evidence supports the case for community detoxification in patients with alcohol dependence. One RCT with long-term follow-up (18 months) concluded that the evidence found initial but decreasing benefit of inpatient over outpatient care across time. One prospective study found inpatients consumed significantly less alcohol in the year after entering treatment than outpatients as measured by the Graduated Frequency Scale questionnaire, and had significantly greater engagement with Alcohol Anonymous program than outpatients in the year after treatment. One retrospective study reported that inpatients with substance use disorders are three times more likely to complete treatment than outpatients.\n\n2. What are the evidence-based guidelines associated with inpatient and outpatients treatment programs in adults with substance use disorders?\nThe evidence-based guidelines from British Columbia Ministry of Health on opioids use disorder recommend that withdrawal management, if needed, can be provided more safely in an outpatient setting rather than in an inpatient setting in most patients. For patients who wish to avoid long-term opioid agonist treatment, supervised slow (longer than one month) outpatient or residential opioid agonist taper can be provided rather than rapid (less than one week) inpatient opioid agonist taper. The slow approach may permit a more flexible and individualised approach to tapered agonist reduction, which allows dose adjustment and stabilisation in case withdrawal symptoms occur.\n\n","For patients with alcohol use disorders, better detoxification completion and abstinence rates, and similar adverse event rates, were found in outpatient care compared to inpatient care in a couple of studies with short follow-up periods (one to two months). One study with a longer follow-up period found inpatients consumed less alcohol than outpatients in the year after entering treatment. This may be explained by the controlled environment of inpatient care that avoids the distractions that could be present in an outpatient care situation. In patients with severe alcohol dependence, data from one study found initial but decreasing benefit of inpatient over outpatient care across time in alcohol abstinence. For patients with substance use disorders, data from one study showed inpatients are more likely to complete treatment than outpatients. The small number of studies found and their heterogeneity in design and reported outcomes cautioned the interpretation of the findings. \n\n\n"]
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[null,"Carney T, Myers BJ, Louw J, Okwundu CI. Brief school‐based interventions and behavioural outcomes for substance‐using adolescents. Cochrane Database Syst Rev 2016; Issue 1. Art. No.: CD008969. DOI: 10.1002/14651858.CD008969.pub3\nAvailable here.\n","Substance using adolescents.","The authors included six RCTs which evaluated the effects of brief school-based interventions for substance-using adolescents. Three studies with 732 adolescents compared brief interventions (Bls) with information provision only, and three studies with 444 adolescents compared Bls with assessment only. Reasons for downgrading the quality of evidence included risk of bias of the included studies, imprecision, and inconsistency. For outcomes that concern substance abuse, the retrieved studies only assessed alcohol and cannabis. \n\nGenerally, moderate quality evidence was found that, compared to information provision only, BIs did not have a significant effect on any of the substance use outcomes at short‐, medium‐, or long‐term follow‐up. \n\nWhen compared to assessment-only controls, BIs were found to significantly reduce the frequency of alcohol use (SMD ‐0.91; 95 per cent CI ‐1.21 to ‐0.61, n = 242), alcohol abuse (SMD ‐0.38; 95 per cent CI ‐0.7 to ‐0.07, n = 190) and dependence (SMD ‐0.58; 95 per cent CI ‐0.9 to ‐0.26, n = 190) at medium-term follow-up in one study. And, at long-term follow-up BI’s also reduced alcohol abuse (SMD ‐0.72; 95 per cent CI ‐1.05 to ‐0.40, n = 181) in one study. However, the evidence from studies that compared brief interventions to assessment‐only conditions was generally of low quality.\n","We found low or very low‐quality evidence that brief school‐based interventions may be more effective in reducing alcohol and cannabis use than the assessment‐only condition and that these reductions were sustained at long‐term follow‐up. We found moderate‐quality evidence that, when compared to information provision, brief interventions probably did not have a significant effect on substance use outcomes. It is premature to make definitive statements about the effectiveness of brief school‐based interventions for reducing adolescent substance use. Further high‐quality studies examining the relative effectiveness of BIs for substance use and other problem behaviours need to be conducted, particularly in low‐ and middle‐income countries."]
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[null,"Roberts NP et al. Psychological therapies for post‐traumatic stress disorder and comorbid substance use disorder. Cochrane Database Syst Rev 2016, Issue 4. Art. No.: CD010204. DOI: 10.1002/14651858.CD010204.pub2.\nAvailable here. \n","Individuals with comorbid PTSD and SUD","This Cochrane review aimed to determine the efficacy of psychological therapies aimed at treating traumatic stress symptoms, substance misuse symptoms, or both in people with comorbid PTSD and SUD in comparison with control conditions (usual care, waiting‐list conditions, and no treatment) and other psychological therapies. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nFourteen studies with 1506 participants were included, of which 13 studies were included in the quantitative synthesis. Most studies involved adult populations. Studies were conducted in a variety of settings. Four comparisons were undertaken investigating the effects of psychological therapies with a trauma‐focused component and non‐trauma‐focused interventions against treatment as usual/minimal intervention and other active psychological therapies. Comparisons were stratified for individual‐ or group‐based therapies. All active interventions were based on CBT.\n\nIndividual‐based psychological therapies with a trauma‐focused component plus adjunctive SUD intervention: There was no evidence of an effect for level of drug/alcohol use post‐treatment (SMD ‐0.13; 95% CI ‐0.41 to 0.15; 3 studies; n = 388; very low‐quality evidence), but there was a small effect in favour of individual psychological therapy at 5 to 7 months (SMD ‐0.28; 95% CI ‐0.48 to ‐0.07; 3 studies; n = 388) when compared against TAU.\n\nIndividual‐based psychological therapy with a trauma‐focused component: did not perform better than psychological therapy for SUD only for drug/alcohol use (MD ‐1.27; 95% CI ‐5.76 to 3.22; 1 study; n = 46; low‐quality evidence). Findings were based on one small study.\n\nNon‐trauma‐focused psychological therapies: did not perform better than TAU/minimal intervention. There were no data on the effects on drug/alcohol use for individual therapy. There was no evidence of an effect on the level of drug/alcohol use for group‐based therapy (SMD ‐0.03; 95% CI ‐0.37 to 0.31; 4 studies; n = 414; very low‐quality evidence). A post‐hoc analysis for full dose of a widely established group therapy called Seeking Safety showed reduced drug/alcohol use post‐treatment (SMD ‐0.67; 95% CI ‐1.14 to ‐0.19; 2 studies; n = 111), but not at subsequent follow‐ups.\nThese also did not perform better than psychological therapy for SUD only for drug/alcohol use (SMD 0.22; 95% CI ‐0.13 to 0.57; 2 studies; n = 128; low‐quality evidence).\n","The reviewers assessed the evidence in this review as mostly low to very low quality. Evidence showed that individual trauma‐focused psychological therapy delivered alongside SUD therapy did better than TAU/minimal intervention in reducing PTSD severity post‐treatment and at long‐term follow‐up, but only reduced SUD at long‐term follow‐up. All effects were small, and follow‐up periods were generally quite short. There was evidence that fewer participants receiving trauma‐focused therapy completed treatment. There was very little evidence to support use of non‐trauma‐focused individual‐ or group‐based integrated therapies. Individuals with more severe and complex presentations (e.g. serious mental illness, individuals with cognitive impairment, and suicidal individuals) were excluded from most studies in this review, and so the findings from this review are not generalisable to such individuals. Some studies suffered from significant methodological problems and some were underpowered, limiting the conclusions that can be drawn. Further research is needed in this area."]
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[null,"Canadian agency for Drugs and Technology in Health. Mindfulness interventions for the treatment of post-traumatic stress disorder, generalized anxiety disorder, depression and substance use disorders: a review of the clinical effectiveness and guidelines. Ottawa: CADTH; 2015. Available here. ","Adults with post-traumatic stress disorder (PTSD), generalised anxiety disorder (GAD), depression, or substance use disorders.","The objective of this review was to summarise the clinical effectiveness and guidelines for the use of mindfulness interventions for the treatment of PTSD, GAD, depression, and substance use disorders in adults. The review addressed two main research questions. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\n1. What is the clinical effectiveness of mindfulness interventions for the treatment of adults with PTSD, GAD, Depression, or substance use disorders?\nA study reported, that compared with treatment as usual, participants assigned to mindfulness-based relapse prevention reported significantly lower risk of heavy drinking, significantly fewer days of heavy drinking at the 6-month follow-up. At the 12-month follow-up, mindfulness-based relapse prevention participants reported significantly decreased heavy drinking compared with relapse prevention and treatment as usual.\n\n2. What are the evidence-based guidelines regarding the use of mindfulness interventions for the treatment of adults with PTSD, GAD, Depression, or substance use disorders?\nThe guideline by the New South Wales Department of Health suggested that mindfulness could be used to treat problematic drug and alcohol users.\n\n","The evidence for the efficacy of mindfulness as a treatment for individuals with substance use disorders was limited. One RCT of low methodological quality suggested that mindfulness intervention is more effective than treatment as usual in lowering risk of relapse to substance use and heavy drinking. One guideline suggested that mindfulness can be used to treat problematic drug and alcohol use problems by suitably trained and experienced drug and alcohol professionals.\n"]
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[null,"Canadian agency for Drugs and Technology in Health. Yoga for the Treatment of Post-Traumatic Stress Disorder, Generalized Anxiety Disorder, Depression, and Substance Abuse: A Review of the Clinical Effectiveness and Guidelines. Ottawa: CADTH; 2015a. Available here. ","Adults with PTSD, GAD, depression, or substance use disorders.","The objective of this Rapid Response report is to review the clinical effectiveness of yoga for treating PTSD, GAD, depression and substance abuse, and to summarize the guidelines that are associated with the use of yoga for these conditions.The review addressed two main research questions. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\n1. What is the clinical effectiveness of yoga as an intervention for the treatment of PTSD, GAD, depression, or substance use disorders?\nOne study found that yoga was a feasible adjunct treatment for treating alcohol dependence. Patients in the yoga intervention group had a higher baseline level of drinking compared to the control group and there were positive, non-significant changes in alcohol consumption at six month follow-up, numerically greater than that experienced by the control. \ngroup\n\n2. What are the evidence-based guidelines regarding the use of mindfulness interventions for the treatment of adults with PTSD, GAD, Depression, or substance use disorders?\nFive evidence-based guidelines were included in this report, two of which did not find enough evidence for yoga to provide a recommendation. None of the recommendations focused specifically on alcohol consumption.\n\n","Three RCTs of low methodological quality suggested that patients with substance abuse improved with respect to some symptoms with yoga. Five evidence based guideline documents considered the use of yoga in clinical practice. Three suggested that yoga may be useful as an adjunctive treatment for treating major depressive disorder (MDD), PTSD and GAD, if available. "]
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[null,"Ipser JC et al. Pharmacotherapy for anxiety and comorbid alcohol use disorders. Cochrane Database Syst Rev 2015, Issue 1. Art. No.: CD007505. DOI: 10.1002/14651858.CD007505.pub2\nAvailable here. \n","People diagnosed with alcohol dependence or abuse and an anxiety disorder according to DSM‐III, DSM‐IV, or DSM‐IV‐TR criteria.","This Cochrane review aimed to assess the effects of pharmacotherapy for treating anxiety in people with comorbid alcohol use disorders. Five placebo‐controlled pharmacotherapy RCTs (with 290 participants) were included in the review. Most of the trials provided little information on how randomisation was performed or on whether both participants and study personnel were blinded to the intervention. \n\nStudy participants had DSM) III‐ and DSM IV‐diagnosed alcohol use disorders and post‐traumatic stress disorder (two studies), social anxiety disorder (SAD; two studies) or generalized anxiety disorder (GAD; one study). Four trials assessed the efficacy of the selective serotonin re‐uptake inhibitors (SSRIs: sertraline, paroxetine); one RCT investigated the efficacy of buspirone, a 5‐hydroxytryptamine (5‐HT) partial agonist. Treatment duration lasted between eight and 24 weeks. Overall, 70% of participants included in the review were male. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nThere was no evidence of an effect for any of the medications tested on abstinence from alcohol use or depression symptoms.","The evidence‐base for the effectiveness of medication in treating anxiety disorders and comorbid alcohol use disorders is currently inconclusive. There was no evidence that alcohol use was responsive to medication. Large, rigorously conducted RCTs would help supplement the small evidence‐base for the efficacy and tolerability of pharmacotherapy for anxiety and comorbid alcohol use disorders. Further research on patient subgroups who may benefit from pharmacological treatment, as well as novel pharmacological interventions, is warranted. \n"]
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[null,"Pani PP et al. Anticonvulsants for alcohol dependence. Cochrane Database Syst Rev 2014, Issue 2. Art. No.: CD008544. DOI: 10.1002/14651858.CD008544.pub2.\nAvailable here. \n","Alcohol dependent adults. ","The primary aim of this Cochrane review is to assess the benefits/risks of anticonvulsants for the treatment of alcohol dependence. \n\nA total of 25 studies were included in the review (2641 participants). Most participants were male, with an average age of 44 years. Anticonvulsants were compared with placebo (17 studies), other medications (seven studies) and no medication (two studies). The mean duration of the trials was 17 weeks (range four to 52 weeks). The studies took place in the USA, Europe, South America, India and Thailand. Variation was reported in the characteristics of the studies, including their design and the rating instruments used. For many key outcomes, the risk of bias associated with unclear or unconcealed allocation and lack of blinding affected the quality of the evidence. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nAnticonvulsants versus placebo: For continuous abstinence (eight studies, 634 participants, RR 1.21, 95% Cl 95 per cent 0.97 to 1.52, moderate‐quality evidence), results showed no evidence of differences. Moderate‐quality evidence suggested that anticonvulsants reduced drinks/drinking days (11 studies, 1126 participants, mean difference (MD) ‐1.49, 95% Cl ‐2.32 to ‐0.65) and heavy drinking (12 studies, 1129 participants, standardised mean difference (SMD) ‐0.35, 95% Cl ‐0.51 to ‐0.19). The direction of results was confirmed by subgroup analyses for topiramate and partially for gabapentin and valproate. \n\nAnticonvulsants versus naltrexone: No evidence of difference was shown in severe relapse rates (four studies, 427 participants, RR 0.69, 95% Cl 0.44 to 1.07) and continuous abstinence rates (five studies, 528 participants, RR 1.21, 95% Cl 0.99 to 1.49); anticonvulsants were associated with fewer heavy drinking days (three studies, 308 participants, MD ‐5.21, 95% Cl ‐8.58 to ‐1.83) and more days to severe relapse (three studies, 244 participants, MD 11.88, 95% Cl 3.29 to 20.46).\n","The authors concluded that at the current stage of research, randomised evidence supporting the clinical use of anticonvulsants to treat alcohol dependence is insufficient. Results are conditioned by heterogeneity and by the low number and quality of studies comparing anticonvulsants with other medications. The uncertainty associated with these results leaves to clinicians the need to balance possible benefits/risks of treatment with anticonvulsants versus other medications as supported by evidence of efficacy."]
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[null,"Dedert E et al. e-interventions for alcohol misuse. Durham NC: Evidence-based Synthesis Program Center; 2014.\nAvailable here.\n","Adults with alcohol use disorders (AUD). ","This review evaluates computer-based interventions for alcohol misuse. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nEffects of E-Interventions Compared with Inactive Controls in Adults who Misuse Alcohol: Twenty-two studies with 13,929 participants and judged to be low (n=7) or moderate (n=12) risk of bias. Overall, the available data suggest that long-term effects of e-interventions on alcohol outcomes are modest or absent.\n\nEffects of E-Interventions Compared with Inactive Controls in Adults at High Risk of AUD (eg, AUDIT-C ≥8) or with a Diagnosis of AUD: 3 studies (2 moderate, 1 high risk of bias) in 533 patients with a diagnosis of AUD. Neither computerized feedback plus telephone counseling nor an interactive voice response system decreased alcohol consumption or risk of relapse. A multicomponent smartphone program used to support recovery following residential treatment increased abstinence (OR 1.94; 95% CI, 1.14 to 3.31) and decreased risky drinking days at 12-month follow-up.\n\n Effects of E-Interventions Alone or Used in Combination with Face-to-Face Therapy Compared with Face-to-Face Therapy Alone in Adults who Misuse Alcohol: Six trials with 1090 participants. Overall, this diverse group of studies did not find a benefit of e-interventions alone or as an adjunct to face-to-face  brief MI compared with face-to-face brief MI alone for college students or midlife primary care patients who misuse alcohol.","The authors reported that they found limited evidence for small or no effects of e-interventions compared with controls on long-term (≥6 months) alcohol outcomes in participants who screened positive for alcohol misuse. Findings were even more limited for participants with AUD or comparisons of e-interventions to face-to-face treatment. Further research is needed to determine with higher confidence whether e-interventions can produce long-term benefits for alcohol-related outcomes. In particular, given the limited number and duration of intervention episodes in the studies reviewed, it is possible that these e-interventions were not designed to be robust enough to produce significant, enduring effects on alcohol misuse. As reported in previous reviews, brief in-person interventions produce sustained reductions in alcohol consumption in participants with alcohol misuse. Current evidence does not support substitution of e-interventions for brief, in-person treatment. Future research on e-interventions should include evaluations of more intensive or longer duration e-interventions for alcohol misuse. "]
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[null,"Jonas DE et al. Pharmacotherapy for adults with alcohol-use disorders in outpatient settings. Rockville MD: Agency for Healthcare Research and Quality; 2014. \nAvailable here. \n\nThis report has been archived by AHRQ and is being updated. The update protocol can be accessed here.","Adults with alcohol-use disorders. ","The aim of this report was to conduct a systematic review and meta-analysis of the efficacy, comparative effectiveness, and harms of medications (both FDA approved and others) for adults with alcohol-use disorders, and to evaluate the evidence from primary care settings.\n\nOne hundred and thirty five studies were included. Most patients met criteria for alcohol dependence; mean ages were in the 40s. Studies typically included psychosocial cointerventions; effect sizes reflect the added benefits of medications. For acamprosate and oral naltrexone (50 mg per day), numbers needed to treat (NNTs) to prevent 1 person from returning to any drinking were 12 and 20, respectively (moderate SOE); NNT to prevent 1 person from returning to heavy drinking was 12 for oral naltrexone (50 mg per day) (moderate SOE). Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nMeta-analyses of four head-to-head trials found no statistically significant difference between the two medications for consumption outcomes (moderate SOE). For injectable naltrexone, meta-analyses found no significant benefit for return to any or heavy drinking, but found a reduction in heavy drinking days (low SOE). Evidence from well-controlled trials does not support efficacy of disulfiram, except possibly for patients with excellent adherence. Among medications used off label, moderate evidence supports the efficacy of nalmefene and topiramate for improving some consumption outcomes, and limited evidence supports the efficacy of valproic acid. Evidence from primary care settings was scant. There was insufficient direct evidence to conclude whether medications for alcohol-use disorders are effective for improving health outcomes.","Authors concluded that acamprosate and oral naltrexone have the best evidence for improving alcohol consumption outcomes for patients with alcohol-use disorders. Head-to-head trials have not consistently established the superiority of one medication. Thus, other factors may guide medication choices, such as frequency of administration, potential adverse events, coexisting symptoms, and availability of treatments.\n\n"]
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[null,"Families are supported and protected - Indicated Interventions- Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"McGovern R et al. Effectiveness of psychosocial interventions for reducing parental substance misuse. Cochrane Database of Systematic Reviews 2021, Issue 3. Art. No.: CD012823.\nAvailable here","Participants were parents who use substances; this included mothers and fathers of children (sons and daughters) under the age of 21 years, regardless of custodial or residency status of the children. Same-sex parents and foster parents were eligible for inclusion.","The authors included 22 unique studies with a total of 2274 participants (mean age of parents ranged from 26.3 to 40.9 years), examining 24 experimental interventions. The majority of studies intervened with mothers only (n = 16; 73%). Heroin, cocaine, and alcohol were the most commonly reported substances used by participants. The interventions targeted either parenting only (n = 13; 59%); drug and alcohol use only (n = 5; 23%); or integrated interventions which addressed both (n = 6; 27%).\nThe authors found moderate-quality evidence that psychosocial interventions are probably more effective at reducing the frequency of parental alcohol misuse than comparison conditions at 6-month (mean difference (MD) −0.32, 95% confidence interval (CI) −0.51 to −0.13; 6 studies, 475 participants) and 12-month follow-up (standardised mean difference (SMD) −0.25, 95% CI −0.47 to −0.03; 4 studies, 366 participants). The authors found a significant reduction in frequency of use at 12 months only (SMD −0.21, 95% CI −0.41 to −0.01; 6 studies, 514 participants, moderate-quality evidence).\nThe authors examined the effect of the intervention type. They found low-quality evidence that psychosocial interventions targeting substance use only may not reduce the frequency of alcohol (6 months: SMD −0.35, 95% CI −0.86 to 0.16; 2 studies, 89 participants and 12 months: SMD −0.09, 95% CI −0.86 to 0.61; 1 study, 34 participants)\nA parenting intervention only, without an adjunctive substance use component, may not reduce frequency of alcohol misuse (6 months: SMD −0.21, 95% CI −0.46 to 0.04, 3 studies; 273 participants, low-quality evidence and 12 months: SMD −0.11, 95% CI −0.64 to 0.41; 2 studies; 219 participants, very low-quality evidence).\nParents receiving integrated interventions which combined both parenting- and substance use-targeted components may reduce alcohol misuse with a small effect size (6 months: SMD −0.56, 95% CI −0.96 to −0.16 and 12 months: SMD −0.42, 95% CI −0.82 to −0.03; 2 studies, 113 participants). However, this evidence was of low quality.\nInterventions appeared to be more often beneficial for fathers than for mothers. The authors found low- to very low-quality evidence of a reduction in frequency of alcohol misuse for mothers at six months only (SMD −0.27, 95% CI −0.50 to −0.04; 4 studies, 328 participants), whilst in fathers there was a reduction in frequency of alcohol misuse (6 months: SMD −0.43, 95% CI −0.78 to −0.09; 2 studies, 147 participants and 12 months: SMD −0.34, 95% CI −0.69 to 0.00; 2 studies, 147 participants).","The authors found moderate-quality evidence that psychosocial interventions probably reduce the frequency at which parents use alcohol. Integrated psychosocial interventions which combine parenting skills interventions with a substance use component may show the most promise. \nWhilst it appears that mothers may benefit less than fathers from intervention, caution is advised in the interpretation of this evidence, as the interventions provided to mothers alone typically did not address their substance use and other related needs. \nThe authors found low-quality evidence from few studies that interventions involving children are not beneficial."]
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[null,"Steele DW, et al. Interventions for Substance Use Disorders in Adolescents: A Systematic Review. Comparative Effectiveness Review No. 225.  AHRQ Publication No. 20-EHC014. Rockville, MD: Agency for Healthcare Research and Quality. May 2020.\nAvailable here.","Adolescents ages 12 to 20 years with problematic substance use or substance use disorder.","The authors included interventions designed to achieve abstinence, reduce use quantity and frequency, improve functional outcomes, and reduce substance-related harms. Interventions were categorised into seven primary intervention components: motivational interviewing (MI), family focused therapy (Fam), cognitive behavioral therapy (CBT), psychoeducation, contingency management (CM), peer group therapy, and intensive case management. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nMotivational interviewing reduced heavy alcohol use days by 0.7 days/month, alcohol use days by 1.2 days/month compared with treatment as usual. Across multiple intensive interventions, family focussed therapy was most effective, reducing alcohol use days by 3.5 days/month compared with treatment as usual.\n\n","Reviewers conclude that :\nBrief interventions: motivational interviewing reduces heavy alcohol use, low Strength of Evidence (SoE) and alcohol use days (moderate SoE). \nFamily focussed therapy: may be most effective in reducing alcohol use (low SoE). More research is needed to identify other effective intensive behavioral interventions for alcohol use disorder. Both motivational interviewing and CBT reduce combined alcohol and other drug use (low SoE).\nPharmacological interventions: systematic reviews in the college settings support use of brief interventions for students with any use, heavy or problematic use. More research is needed to identify the most effective combinations of behavioral and pharmacologic treatments for alcohol use disorders."]
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[null,"Gilligan C, et al. Family‐based prevention programmes for alcohol use in young people. Cochrane Database of Systematic Reviews 2019, Issue 3. Art. No.: CD012287. DOI: 10.1002/14651858.CD012287.pub2.\nAvailable here.","School age children (up to 18 years of age)","This Cochrane review aimed to assess the effectiveness of universal, selective, and indicated family-based prevention programmes in preventing alcohol use or problem drinking in school-aged children (up to 18 years of age). \n\nForty six studies (39,822 participants) were included in the review, with 27 classified as universal, 12 as selective, and seven as indicated. Meta‐analyses were performed according to outcome, including studies reporting on the prevalence, frequency, or volume of alcohol use. The overall quality of evidence was low or very low, and there was high, unexplained heterogeneity. \n\nUpon comparing any family intervention to no intervention/standard care, the authors found no intervention effect on the prevalence (SMD) 0.00, 95% CI ‐0.08 to 0.08; studies = 12; participants = 7490; I² = 57%; low‐quality evidence) or frequency (SMD ‐0.31, 95% CI ‐0.83 to 0.21; studies = 8; participants = 1835; I² = 96%; very low‐quality evidence) of alcohol use in comparison with no intervention/standard care. The effect of any parent/family interventions on alcohol consumption volume compared with no intervention/standard care was very small (SMD ‐0.14, 95% CI ‐0.27 to 0.00; studies = 5; participants = 1825; I² = 42%; low‐quality evidence). \n\nWhen comparing parent/family and adolescent interventions versus interventions with young people alone, authors found no difference in alcohol use prevalence (SMD ‐0.39, 95% CI ‐0.91 to 0.14; studies = 4; participants = 5640; I² = 99%; very low‐quality evidence) or frequency (SMD ‐0.16, 95% CI ‐0.42 to 0.09; studies = 4; participants = 915; I² = 73%; very low‐quality evidence). For this comparison, no trials reporting on the volume of alcohol use could be pooled in meta‐analysis. \n\nIn general, the results remained consistent in separate subgroup analyses of universal, selective, and indicated interventions. No adverse effects were reported. \n","The results of this review indicate that there are no clear benefits of family‐based programmes for alcohol use among young people. Patterns differ slightly across outcomes, but overall, the variation, heterogeneity, and number of analyses performed preclude any conclusions about intervention effects. Additional independent studies are required to strengthen the evidence and clarify the marginal effects observed. "]

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[null,"Educational setting - NICE Guidance"]
[null,"Source:","Population:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Alcohol interventions in secondary and further education. NG135. London: NICE; 2019. \nAvailable here.\n","• CYP (11 to 18years) in full time education.\n• YP (18 to 25 years) with an Education, health and care (EHC) plan.\n• CYP (11 to 18years) in full time education considered ‘at risk’.\n• YP (18 to 25 years) EHC plan considered ‘at risk’.","This guideline covers interventions in secondary and further education to prevent and reduce alcohol use among children and young people aged 11 up to and including 18. It also covers people aged 11 to 25 with special educational needs or disabilities in full-time education. It will also be relevant to children aged 11 in year 6 of primary school.\n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n1.1 Planning alcohol education\n1.2 Delivering universal alcohol education (Evidence Review A: Universal interventions)\n1.3 Targeted interventions (Evidence review B: Targeted interventions)\n\nThe following recommendations for further research were also identified in Evidence review A and B:\n1. What components of alcohol education delivery contribute to its effectiveness for children and young people aged 11 to 18 in full-time education, and those with special educational needs and disabilities (SEND) up to the age of 25? (Evidence review A: universal interventions)\n2. How effective and cost effective are individual, compared with group, education-based interventions for children and young people aged 11 to 18 in full-time education who are thought to be vulnerable to alcohol misuse? (Evidence review B: targeted interventions)\n3. How effective and cost effective are universal, education-based alcohol interventions for children and young people aged 11 to 25 with SEND? (Evidence review A: universal interventions)\n4. How effective and cost effective are education-based alcohol interventions targeted at children and young people aged 11 to 25 with SEND who are thought to be vulnerable to alcohol misuse? (Evidence review B: targeted interventions)\n5. How effective are education-based alcohol prevention interventions (universal or targeted) for children and young people aged 11 to 25 with SEND in full-time education? (Evidence review A: universal interventions and Evidence review B: targeted interventions)\n6. What methods and techniques help secondary schools and providers to effectively engage with parents and carers as part of a whole-school approach to promote and support alcohol education? (Evidence review A: universal interventions)\n"]
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[null,"National Institute for Health and Care Excellence. Behaviour change: individual approaches. PH49. London: NICE; 2014. \nAvailable here.\n","Everyone aged 16 years and older","This guideline covers changing health-damaging behaviours among people aged 16 and over using interventions such as goals and planning, feedback and monitoring, and social support. It aims to help tackle a range of behaviours including alcohol misuse, poor eating patterns, lack of physical activity, unsafe sexual behaviour and smoking.\n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n1. Develop a local behaviour change policy and strategy\n2. Ensure organisation policies, strategies, resources and training all support behaviour change\n3. Commission interventions from services willing to share intervention details and data\n4. Commission high quality, effective behaviour change interventions\n5. Plan behaviour change interventions and programmes taking local needs into account\n6. Develop acceptable, practical and sustainable behaviour change interventions and programmes\n7. Use proven behaviour change techniques when designing interventions (Evidence review1 and Evidence review2)\n8. Ensure interventions meet individual needs\n9. Deliver very brief, brief, extended brief and high intensity behaviour change interventions and programmes\n10. Ensure behaviour change is maintained for at least a year (Evidence review1 and Evidence review2)\n11. Commission training for all staff involved in helping to change people's behaviour\n12. Provide training for behaviour change practitioners\n13. Provide training for health and social care practitioners\n14. Assess behaviour change practitioners and provide feedback\n15. Monitor behaviour change interventions\n16. Evaluate behaviour change interventions\n17. National support for behaviour change interventions and programmes\n\nEvidence review1 did not identify any recommendations for further research. Evidence review 2 made the following recommendation for further research:\n5.7 How do behaviour change techniques lead to change? What are the best methods of testing the relationship between the theories that describe change processes and the effectiveness of interventions in practice?"]
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[null,"National Institute for Health and Care Excellence. Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence. CG115. London: NICE; 2011\nAvailable here.\n\n","Adults (>18 years) or young people (10 to 17 years of age) with a diagnosis of alcohol dependence or meeting criteria for harmful alcohol use (30 to 50 units of alcohol per week)","This guideline covers identifying, assessing and managing alcohol-use disorders (harmful drinking and alcohol dependence) in adults and young people aged 10-17 years. It aims to reduce harms (such as liver disease, heart problems, depression and anxiety) from alcohol by improving assessment and setting goals for reducing alcohol consumption. \n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n• Principles of care\n• Identification and assessment \n• Interventions for alcohol misuse (Evidence review 2011)\n\nThe following recommendations for further research were also identified in Evidence reviews underpinning this guidance:\n1 Is contingency management effective in reducing alcohol consumption in people who misuse alcohol compared with standard care?\n2 What methods are most effective for assessing and diagnosing the presence and severity of alcohol misuse in children and young people?\n3 Is acupuncture effective in reducing alcohol consumption compared with standard care?\n4. For which service users who are moderately and severely dependent on alcohol is an assertive community treatment model a clinically and cost-effective intervention compared with standard care?\n5. For people with moderate and severe alcohol dependence who have significant comorbid problems, is an intensive residential rehabilitation programme clinically and cost effective when compared with intensive community-based care?\n6 For people with alcohol dependence, which medication is most likely to improve adherence and thereby promote abstinence and prevent relapse?\n\nOctober 2022: NICE updated the recommendation about behavioural couples therapy to clarify that this is not suitable in cases of domestic abuse and to add a cross reference to the NICE technology appraisal guidance on nalmefene. They also updated information about off-label prescribing, and added cross references to legislation on controlled drugs and driving, to MHRA advice on addiction to benzodiazepines and codeine, and to NICE's guidelines on smoking, on antisocial personality disorder and on coexisting mental illness and substance misuse community health and social care services.\nJuly 2019: NICE have found no new evidence that affects the recommendations."]
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[null,"National Institute for Health and Care Excellence. Behaviour change: general approaches. PH6. London: NICE; 2007\nAvailable here.\n\n\n\n","General population","This guideline covers a set of principles that can be used to help people change their behaviour. The aim is for practitioners to use these principles to encourage people to adopt a healthier lifestyle by, for example, stopping smoking, adopting a healthy diet and being more physically active.\n\nThe guideline includes the following recommendations. All the recommendations are relevant to the scope of this topic evidence map. The recommendations are supported by the underpinning Evidence review 1.\n• Providing education and training for those delivering them\n• Delivery of these activities, including one-to-one and community-based programmes and those aimed at specific populations\n• Evaluation of their effectiveness and cost effectiveness\n\nThe Programme Development Group identified a number of gaps in the evidence related to behaviour change interventions and programmes, based on an assessment of the evidence and made recommendations for research to address the most important gaps in the evidence. Please refer to 4. Recommendations for research' section of the guidance.\n\nNovember 2017: NICE checked this guideline and found no new evidence that affects the recommendations in this guideline."]
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[null,"Educational setting - Safe and Supportive Environment - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' Conclusions:"]
[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This Cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text. Fifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect. One targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects. Among school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]
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[null,"Hennessy EA et al. Recovery schools for improving behavioral and academic outcomes among students in recovery from substance use disorders: a systematic review. Campbell Systematic Reviews 2018; 9. \nAvailable here. ","Students in recovery from substance use who were enrolled part-time or full-time in secondary (high school) or postsecondary (college or university) educational institutions. ","The review focused on two types of recover schools: recovery high schools (RHSs), which are schools that award secondary school dipolmas and offer a range of therapeutic services in addition to standard educational curricula; and collegiate recovery communities (CRCs), which offer therapeutic and sober support services on college campuses. \n\nOnly one study met the criteria for inclusion in the review. The study used a quasi-experimental design to examine the effects of RHSs on high school students' academic and substance use outcomes. No eligible studies examining CRCs were identified. \n\nThe results from the one eligible RHS study indicated that after adjusting for pretest values, students in the RHS condition reported levels of grade point averages (g = 0.26, 95% CI [-0.04, 0.56]), truancy (g = 0.01, 95% CI [-0.29, 0.31]), and alcohol use (g = 0.23, 95% CI [-0.07, 0.53]) similar to participants in the comparison condition. However, students in the RHS condition reported improvements in absenteeism (g = 0.56, 95% CI [0.25, 0.87]), abstinence from alcohol/drugs (OR = 4.36, 95% CI [1.19, 15.98]), marijuana use (g = 0.51, 95% CI [0.20, 0.82]), and other drug use (g = 0.45, 95% CI [0.14, 0.76]).\n\nOverall, there was a serious risk of bias in the one included study. The study had a serious risk of bias due to confounding, low risk of bias due to selection of participants into the study, moderate risk of bias due to classification of interventions, inconclusive risk of bias due to deviations from intended interventions, inconclusive risk of bias due to missing data, moderate risk of bias in measurement of outcomes, and low risk of bias in selection of reported results.","There is insufficient evidence regarding the effectiveness of RHSs and CRCs for improving academic and substance use outcomes among students in recovery from SUDs. Only one identified study examined the effectiveness of RHSs. Although the study reported some beneficial effects, the results must be interpreted with caution given the study's potential risk of bias due to confounding and limited external validity. No identified studies examined the effectiveness of CRCs across the outcomes of interest in this review, so it is unclear what effects these programs may have on students' academic and behavioural outcomes. \n\nThe paucity of evidence on the effectiveness of recovery schools, as documented in this review, thus suggest the need for caution in the widespread adoption of recovery schools for students in recovery from SUDs. Given the lack of empirical support for these recovery schools, additional rigorous evaluation studies are needed to replicate the findings from the one study included in this review. Furthermore, additional research examining the costs of recovery schools may be needed, to help school administrators determine the potential cost-benefits associated with recovery schools. "]
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[null,"Educational setting - Changed attitudes and social norms - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"Wolfenden L et al. Strategies for enhancing the implementation of school‐based policies or practices targeting diet, physical activity, obesity, tobacco or alcohol use. Cochrane Database of Systematic Reviews 2022, Issue 8.\nAvailable here.","School age children (between 5 to 18 years of age)","This Cochrane review aimed to to find out how effective strategies were in supporting the implementation of school‐based interventions to address student diet, physical activity, unhealthy weight gain, and tobacco or alcohol use. Examples of strategies include methods of improving quality, education and training, feedback on how the school was doing, prompts and reminders, and educational resources (e.g. manuals).\n\nThe reviewers included an additional 11 trials in this update bringing the total number of included studies in the review to 38. Of these, 22 were conducted in the USA. Twenty‐six studies used RCT designs. Seventeen trials tested strategies to implement healthy eating, 12 physical activity and six a combination of risk factors. Just one trial sought to increase the implementation of interventions to delay initiation or reduce the consumption of alcohol. All trials used multiple implementation strategies, the most common being educational materials, educational outreach and educational meetings. Only findings relevant to this evidence map have been reported below.\n\nThe overall certainty of evidence was low and ranged from very low to moderate for secondary review outcomes.\n\nPooled analyses of RCTs found, relative to a control, the use of implementation strategies may result in a large increase in the implementation of interventions in schools (SMD 1.04, 95% CI 0.74 to 1.34; 22 RCTs, 1917 participants; low‐certainty evidence). One RCT assessed measures of student alcohol use and found strategies to support implementation may result in a slight increase in use (odds ratio 1.10, 95% CI 0.77 to 1.56; P = 0.60; 2105 participants).","The use of implementation strategies may result in large increases in implementation of interventions, and slight improvements in measures of student diet, and physical activity. Further research is required to assess the impact of implementation strategies on such behavioural‐ and obesity‐related outcomes, including on measures of alcohol use, where the findings of one trial suggest it may slightly increase student risk. Given the low certainty of the available evidence for most measures further research is required to guide efforts to facilitate the translation of evidence into practice in this setting."]
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[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This Cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text. Fifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect. One targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects. Among school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]
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[null,"Foxcroft DR et al. Motivational interviewing for the prevention of alcohol misuse in young adults. Cochrane Database Syst Rev 2016, Issue 7. Art. No.: CD007025. DOI: 10.1002/14651858.CD007025.pub4.\nAvailable here.\n","Young adults up to 25 years of age (higher risk individuals or settings). ","This Cochrane review aimed to assess the effects of motivational interviewing (MI) interventions for preventing alcohol misuse and alcohol‐related problems in young adults. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nEighty four trials (22,872 participants) were included, with 70/84 studies reporting interventions in higher risk individuals or settings. Studies with follow‐up periods of at least four months were of more interest in assessing the sustainability of intervention effects and were also less susceptible to short‐term reporting or publication bias. Overall, the risk of bias assessment showed that these studies provided moderate or low quality evidence.\n\nAt four or more months follow‐up, effects in favour of MI were found for the quantity of alcohol consumed (standardised mean difference (SMD) −0.11, 95 per cent confidence interval (CI) −0.15 to −0.06 or a reduction from 13.7 drinks/week to 12.5 drinks/week; moderate quality evidence); frequency of alcohol consumption (SMD −0.14, 95 per cent CI −0.21 to −0.07 or a reduction in the number of days/week alcohol was consumed from 2.74 days to 2.52 days; moderate quality evidence); and peak blood alcohol concentration, or BAC (SMD −0.12, 95 per cent CI −0.20 to 0.05, or a reduction from 0.144 per cent to 0.131 per cent; moderate quality evidence).\n\nFurther analyses showed that there was no clear relationship between the duration of the MI intervention (in minutes) and effect size. Subgroup analyses revealed no clear subgroup effects for longer‐term outcomes (four or more months) for assessment only versus alternative intervention controls; for university/college vs other settings; or for higher risk vs all/low risk participants.\n","The results of this review indicate that there are no substantive, meaningful benefits of MI interventions for preventing alcohol use, misuse or alcohol‐related problems. Although the reviewers found some statistically significant effects, the effect sizes were too small, given the measurement scales used in the included studies, to be of relevance to policy or practice. Moreover, the statistically significant effects are not consistent for all misuse measures, and the quality of evidence is not strong, implying that any effects could be inflated by risk of bias."]
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[null,"Foxcroft DR et al. Social norms information for alcohol misuse in university and college students. Cochrane Database Syst Rev 2015, Issue 12. Art. No.: CD006748. DOI: 10.1002/14651858.CD006748.pub4.\nAvailable here. \n","University or college students. ","This Cochrane review aimed to determine whether social norms interventions reduce alcohol‐related negative consequences, alcohol misuse or alcohol consumption when compared with a control (ranging from assessment only/no intervention to other educational or psychosocial interventions) among university and college students.\n\nSeventy studies (44,958 participants) were included in the review, and 63 studies (42,784 participants) in the meta‐analyses. Overall, the risk of bias assessment showed that these studies provided moderate or low quality evidence. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nBinge drinking at four or more months (results pooled across delivery modes): SMD ‐0.06, 95 per cent CI ‐0.11 to ‐0.02 (participants = 11,292; studies = 16; moderate quality evidence), equivalent to 2.7 per cent fewer binge drinkers if 30‐day prevalence is 43.9 per cent.\n\nDrinking quantity at four or more months (results pooled across delivery modes): SMD ‐0.08, 95 per cent CI ‐0.12 to ‐0.04 (participants = 21,169; studies = 32; moderate quality evidence), equivalent to a reduction of 0.9 drinks consumed each week, from a baseline of 13.7 drinks per week.\n\nDrinking frequency at four or more months: WF SMD ‐0.11, 95 per cent CI ‐0.17 to ‐0.04 (participants = 9929; studies = 10; moderate quality evidence), equivalent to a decrease of 0.17 drinking days/wk, from a baseline of 2.74 days/wk; individual face‐to‐face normative feedback SMD ‐0.21, 95 per cent CI ‐0.31 to ‐0.10 (participants = 1464; studies = 8; moderate quality evidence), equivalent to a decrease of 0.32 drinking days/wk, from a baseline of 2.74 days/wk. No effects were found for group face‐to‐face normative feedback or normative marketing campaign.\n\nEstimated blood alcohol concentration (BAC) at four or more months: (Peak BAC results pooled across delivery modes) SMD ‐0.08, 95 per cent CI ‐0.17 to 0.00 (participants = 7198; studies = 11; low quality evidence), equivalent to a reduction in peak BAC from an average of 0.144 per cent to 0.135 per cent. No effects were found for typical BAC with individual face‐to‐face normative feedback.\n","The results of this review indicate that no substantive meaningful benefits are associated with social norms interventions for prevention of alcohol misuse among college/university students. Although some significant effects were found, we interpret the effect sizes as too small, given the measurement scales used in the studies included in this review, to be of relevance for policy or practice. Moreover, the significant effects are not consistent for all misuse measures, heterogeneity was a problem in some analyses and bias cannot be discounted as a potential cause of these findings. "]
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[null,"Langford R et al. The WHO Health Promoting School framework for improving the health and well‐being of students and their academic achievement. Cochrane Database Syst Rev 2014, Issue 4. Art. No.: CD008958. DOI: 10.1002/14651858.CD008958.pub2 \nAvailable here. ","School aged children (aged 4-18).","This Cochrane review aimed to assess the effectiveness of the Health Promoting Schools (HPS) framework in improving the health and well‐being of students and their academic achievement.\n\nSixty seven eligible cluster trials, randomising 1,443 schools or districts were included. This is made up of 1,345 schools and 98 districts. The studies tackled a range of health issues: physical activity (4), nutrition (12), physical activity and nutrition combined (18), bullying (7), tobacco (5), alcohol (2), sexual health (2), violence (2), mental health (2), hand‐washing (2), multiple risk behaviours (7), cycle‐helmet use (1), eating disorders (1), sun protection (1), and oral health (1). Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nReview authors report that the quality of evidence overall was low to moderate as determined by the GRADE approach. Risk of bias assessments identified methodological limitations, including heavy reliance on self‐reported data and high attrition rates for some studies. In addition, there was a lack of long‐term follow‐up data for most studies.\n\nEight studies provided data on alcohol use and all but one were included in the meta‐analysis. Overall, there was no evidence that any of the different intervention approaches were effective in reducing alcohol intake.","The results of this review provide evidence for the effectiveness of some interventions based on the HPS framework for improving certain health outcomes but not others. More well‐designed research is required to establish the effectiveness of this approach for other health topics and academic achievement."]
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[null,"Siegfried N et al. Restricting or banning alcohol advertising to reduce alcohol consumption in adults and adolescents. Cochrane Database Syst Rev 2014, Issue 11. Art. No.: CD010704. DOI: 10.1002/14651858.CD010704.pub2.\nAvailable here. \n","Adults of any age and adolescents (defined by WHO as aged 10 to 19 years)","The aim of this Cochrane review was to evaluate the benefits, harms and costs of restricting or banning the advertising of alcohol, via any format, compared with no restrictions or counter‐advertising, on alcohol consumption in adults and adolescents.\n\nOne small RCT (80 male student participants conducted in the Netherlands and published in 2009) and three ITS studies (general population studies in Canadian provinces conducted in the 1970s and 80s) were examined. The RCT found that young men exposed to movies with a low‐alcohol content drank less than men exposed to movies with a high‐alcohol content (MD ‐0.65 drinks; 95 per cent CI ‐1.2, ‐0.07; p value = 0.03, very‐low‐quality evidence). Young men exposed to commercials with a neutral content compared with those exposed to commercials for alcohol drank less (MD ‐0.73 drinks; 95 per cent CI ‐1.30, ‐0.16; p value = 0.01, very‐low‐quality evidence). Outcomes were assessed immediately after the end of the intervention (lasting 1.5 hours), so no follow‐up data were available.\n\nTwo of the ITS studies evaluated the implementation of an advertising ban and one study evaluated the lifting of such a ban (GRADE: very‐low‐quality evidence). Each of the three ITS studies evaluated a different type of ban (partial or full) compared with different degrees of restrictions or no restrictions during the control period. The results from the three ITS studies were inconsistent. A meta‐analysis of the two studies that evaluated the implementation of a ban showed an overall mean non‐significant increase in beer consumption in the general population of 1.10 per cent following the ban (95 per cent CI ‐5.26, 7.47; p value = 0.43; I2 = 83 per cent, very‐low‐quality evidence). This finding is consistent with an increase, no difference, or a decrease in alcohol consumption. In the study evaluating the lifting of a total ban on all forms of alcohol advertising to a partial ban on spirits advertising only, which utilised an Abrupt Auto‐regressive Integrated Moving Average model, the volume of all forms of alcohol sales decreased by 11.11 kilolitres (95 per cent CI ‐27.56, 5.34; p value = 0.19) per month after the ban was lifted. In this model, beer and wine sales increased per month by 14.89 kilolitres (95 per cent CI 0.39, 29.39; p value = 0.04) and 1.15 kilolitres (95 per cent CI ‐0.91, 3.21; p value = 0.27), respectively, and spirits sales decreased statistically significantly by 22.49 kilolitres (95 per cent CI ‐36.83, ‐8.15; p value = 0.002).\n\nNone of the studies were funded by the alcohol or advertising industries.\n","Authors conclude that there is a lack of robust evidence for or against recommending the implementation of alcohol advertising restrictions. Advertising restrictions should be implemented within a high‐quality, well‐monitored research programme to ensure the evaluation over time of all relevant outcomes in order to build the evidence base. "]
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[null,"Educational setting - Reduced availability - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"Hollands  GJ et al. Altering the availability or proximity of food, alcohol, and tobacco products to change their selection and consumption. Cochrane Database of Systematic Reviews 2019, Issue 9. Art. No.: CD012573. DOI: 10.1002/14651858.CD012573.pub3.\nAvailable here.","Adults","This Cochrane review aimed to:\n1. To assess the impact on selection and consumption of altering the availability or proximity of (a) food (including non‐alcoholic beverages), (b) alcohol, and (c) tobacco products.\n2. To assess the extent to which the impact of these interventions is modified by characteristics of: i. studies, ii. interventions, and iii. participants.\n\nThe reviewers included 24 studies, with the majority (20/24) giving concerns about risk of bias. All of the included studies investigated food products; none investigated alcohol or tobacco. ","The authors concluded that:\n- Further research is warranted in real‐world settings, intervening across a wider range of foods as well as alcohol and tobacco products and over sustained time periods"]
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[null,"Educational setting - Reduced affordability - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]
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[null,"Educational setting - Behaviour change - Systematic reviews"]
[null,"Source:","Audience: ","Findings:","Authors' conclusions:"]
[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. \n\nFifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect.\n\nOne targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects.\n\nAmong school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]
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[null,"O'Connor EA et al. Screening and behavioral counseling interventions to reduce unhealthy alcohol use in adolescents and adults: An updated systematic review for the U.S. Preventive Services Task Force. Rockville MD: Agency for Healthcare Research and Quality; 2018. \nAvailable here. ","Adolescents or adults age 12 years or older. ","One hundred and thirteen studies (n=314,466) were included across all Key Questions. The authors did not find any studies that examined the benefits or harms of screening programs to reduce unhealthy alcohol use. For adolescents, data supported the use of the National Institute on Alcohol Abuse and Alcoholism Youth Screen and other similar one- or two-item screeners to detect alcohol use disorder. For adults, brief (1- to 3-item) screeners commonly reported sensitivity and specificity between 0.70 and 0.85, typically having better sensitivity than the full Alcohol Use Disorders Identification Test (AUDIT) for identifying the full spectrum of unhealthy use. However, the AUDIT tended to have higher specificity, particularly at the standard cutoff of 8 or higher.  \n\nIdentified interventions to reduce unhealth alcohol use were generally counselling interventions, with most involving one or two sessions (90% involved ≤ 4 sessions) with a median of 30 minutes contact time (88% involved ≤ 2 hours contact). The most commonly reported intervention element was the use of personalized normative feedback sessions, in which participants were shown how their alcohol use compares to others; this technique was used in more than half of the included trials and almost all trials in younger adults. Motivational techniques were also common, particularly in combination with personalized normative feedback.\n\nEvidence on the effects of interventions to reduce unhealthy alcohol use in adolescents was limited to two trials; both found mixed results for reduced alcohol use and did not report health or related outcomes. \n\nIn adults, interventions reduced the number of drinks per week (weighted mean difference, −1.82 [95% confidence interval {CI}, −2.42 to −1.22]), the proportion exceeding recommended drinking limits (odds ratio [OR], 0.60 [95% CI, 0.53 to 0.67]), and the proportion reporting a heavy use episode (OR, 0.62 [95% CI, 0.55 to 0.71]), and increased the proportion of pregnant women reporting abstinence (OR, 1.92 [95% CI, 1.19 to 3.09]) after 6 to 12 months. \n\nHeterogeneity was high and effect size was associated with a number of study characteristics such as setting, target age of the population, publication year, study size, and average baseline-use levels, but not clearly associated with any intervention characteristics. Data on effectiveness in important subgroups were very limited, but analyses by sex, the most commonly reported subgroup analysis, did not indicate differences in effectiveness of the interventions. Health outcomes were sparsely reported and, with some exceptions, generally did not demonstrate group differences in effect. No evidence of harm was found.","Among adults, screening instruments are available that can effectively identify persons with unhealthy alcohol use and that are feasible for use in primary care settings, and interventions in those who screen positive are associated with reductions in unhealthy alcohol use. There was no evidence that these interventions have unintended harmful effects. More evidence is needed to determine whether screening for unhealthy alcohol use is beneficial for adolescents."]
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[null,"Foxcroft DR et al. Motivational interviewing for the prevention of alcohol misuse in young adults. Cochrane Database Syst Rev 2016, Issue 7. Art. No.: CD007025. DOI: 10.1002/14651858.CD007025.pub4.\nAvailable here.\n","Young adults up to 25 years of age (higher risk individuals or settings). ","This Cochrane review aimed to assess the effects of motivational interviewing (MI) interventions for preventing alcohol misuse and alcohol‐related problems in young adults. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nEighty four trials (22,872 participants) were included, with 70/84 studies reporting interventions in higher risk individuals or settings. Studies with follow‐up periods of at least four months were of more interest in assessing the sustainability of intervention effects and were also less susceptible to short‐term reporting or publication bias. Overall, the risk of bias assessment showed that these studies provided moderate or low quality evidence.\n\nAt four or more months follow‐up, effects in favour of MI were found for the quantity of alcohol consumed (standardised mean difference (SMD) −0.11, 95 per cent confidence interval (CI) −0.15 to −0.06 or a reduction from 13.7 drinks/week to 12.5 drinks/week; moderate quality evidence); frequency of alcohol consumption (SMD −0.14, 95 per cent CI −0.21 to −0.07 or a reduction in the number of days/week alcohol was consumed from 2.74 days to 2.52 days; moderate quality evidence); and peak blood alcohol concentration, or BAC (SMD −0.12, 95 per cent CI −0.20 to 0.05, or a reduction from 0.144 per cent to 0.131 per cent; moderate quality evidence).\n\nFurther analyses showed that there was no clear relationship between the duration of the MI intervention (in minutes) and effect size. Subgroup analyses revealed no clear subgroup effects for longer‐term outcomes (four or more months) for assessment only versus alternative intervention controls; for university/college vs other settings; or for higher risk vs all/low risk participants.\n","The results of this review indicate that there are no substantive, meaningful benefits of MI interventions for preventing alcohol use, misuse or alcohol‐related problems. Although the reviewers found some statistically significant effects, the effect sizes were too small, given the measurement scales used in the included studies, to be of relevance to policy or practice. Moreover, the statistically significant effects are not consistent for all misuse measures, and the quality of evidence is not strong, implying that any effects could be inflated by risk of bias."]
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[null,"Carney T, Myers BJ, Louw J, Okwundu CI. Brief school‐based interventions and behavioural outcomes for substance‐using adolescents. Cochrane Database Syst Rev 2016; Issue 1. Art. No.: CD008969. DOI: 10.1002/14651858.CD008969.pub3\nAvailable here.\n","Substance using adolescents.","The authors included six RCTs which evaluated the effects of brief school-based interventions for substance-using adolescents. Three studies with 732 adolescents compared brief interventions (Bls) with information provision only, and three studies with 444 adolescents compared Bls with assessment only. Reasons for downgrading the quality of evidence included risk of bias of the included studies, imprecision, and inconsistency. For outcomes that concern substance abuse, the retrieved studies only assessed alcohol and cannabis. \n\nGenerally, moderate quality evidence was found that, compared to information provision only, BIs did not have a significant effect on any of the substance use outcomes at short‐, medium‐, or long‐term follow‐up. \n\nWhen compared to assessment-only controls, BIs were found to significantly reduce the frequency of alcohol use (SMD ‐0.91; 95 per cent CI ‐1.21 to ‐0.61, n = 242), alcohol abuse (SMD ‐0.38; 95 per cent CI ‐0.7 to ‐0.07, n = 190) and dependence (SMD ‐0.58; 95 per cent CI ‐0.9 to ‐0.26, n = 190) at medium-term follow-up in one study. And, at long-term follow-up BI’s also reduced alcohol abuse (SMD ‐0.72; 95 per cent CI ‐1.05 to ‐0.40, n = 181) in one study. However, the evidence from studies that compared brief interventions to assessment‐only conditions was generally of low quality.\n","We found low or very low‐quality evidence that brief school‐based interventions may be more effective in reducing alcohol and cannabis use than the assessment‐only condition and that these reductions were sustained at long‐term follow‐up. We found moderate‐quality evidence that, when compared to information provision, brief interventions probably did not have a significant effect on substance use outcomes. It is premature to make definitive statements about the effectiveness of brief school‐based interventions for reducing adolescent substance use. Further high‐quality studies examining the relative effectiveness of BIs for substance use and other problem behaviours need to be conducted, particularly in low‐ and middle‐income countries."]
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[null,"Educational setting - Families are supported and protected - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This Cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text. Fifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect. One targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects. Among school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]

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[null,"Community setting - NICE Guidance"]
[null,"Source:","Population:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Alcohol interventions in secondary and further education. NG135. London: NICE; 2019. \nAvailable here.\n","• CYP (11 to 18years) in full time education.\n• YP (18 to 25 years) with an Education, health and care (EHC) plan.\n• CYP (11 to 18years) in full time education considered ‘at risk’.\n• YP (18 to 25 years) EHC plan considered ‘at risk’.","This guideline covers interventions in secondary and further education to prevent and reduce alcohol use among children and young people aged 11 up to and including 18. It also covers people aged 11 to 25 with special educational needs or disabilities in full-time education. It will also be relevant to children aged 11 in year 6 of primary school.\n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n1.1 Planning alcohol education\n1.2 Delivering universal alcohol education (Evidence Review A: Universal interventions)\n1.3 Targeted interventions (Evidence review B: Targeted interventions)\n\nThe following recommendations for further research were also identified in Evidence review A and B:\n1. What components of alcohol education delivery contribute to its effectiveness for children and young people aged 11 to 18 in full-time education, and those with special educational needs and disabilities (SEND) up to the age of 25? (Evidence review A: universal interventions)\n2. How effective and cost effective are individual, compared with group, education-based interventions for children and young people aged 11 to 18 in full-time education who are thought to be vulnerable to alcohol misuse? (Evidence review B: targeted interventions)\n3. How effective and cost effective are universal, education-based alcohol interventions for children and young people aged 11 to 25 with SEND? (Evidence review A: universal interventions)\n4. How effective and cost effective are education-based alcohol interventions targeted at children and young people aged 11 to 25 with SEND who are thought to be vulnerable to alcohol misuse? (Evidence review B: targeted interventions)\n5. How effective are education-based alcohol prevention interventions (universal or targeted) for children and young people aged 11 to 25 with SEND in full-time education? (Evidence review A: universal interventions and Evidence review B: targeted interventions)\n6. What methods and techniques help secondary schools and providers to effectively engage with parents and carers as part of a whole-school approach to promote and support alcohol education? (Evidence review A: universal interventions)\n"]
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[null,"National Institute for Health and Care Excellence. Behaviour change: individual approaches. PH49. London: NICE; 2014. \nAvailable here.\n","Everyone aged 16 years and older","This guideline covers changing health-damaging behaviours among people aged 16 and over using interventions such as goals and planning, feedback and monitoring, and social support. It aims to help tackle a range of behaviours including alcohol misuse, poor eating patterns, lack of physical activity, unsafe sexual behaviour and smoking.\n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n1. Develop a local behaviour change policy and strategy\n2. Ensure organisation policies, strategies, resources and training all support behaviour change\n3. Commission interventions from services willing to share intervention details and data\n4. Commission high quality, effective behaviour change interventions\n5. Plan behaviour change interventions and programmes taking local needs into account\n6. Develop acceptable, practical and sustainable behaviour change interventions and programmes\n7. Use proven behaviour change techniques when designing interventions (Evidence review1 and Evidence review2)\n8. Ensure interventions meet individual needs\n9. Deliver very brief, brief, extended brief and high intensity behaviour change interventions and programmes\n10. Ensure behaviour change is maintained for at least a year (Evidence review1 and Evidence review2)\n11. Commission training for all staff involved in helping to change people's behaviour\n12. Provide training for behaviour change practitioners\n13. Provide training for health and social care practitioners\n14. Assess behaviour change practitioners and provide feedback\n15. Monitor behaviour change interventions\n16. Evaluate behaviour change interventions\n17. National support for behaviour change interventions and programmes\n\nEvidence review1 did not identify any recommendations for further research. Evidence review 2 made the following recommendation for further research:\n5.7 How do behaviour change techniques lead to change? What are the best methods of testing the relationship between the theories that describe change processes and the effectiveness of interventions in practice?"]
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[null,"National Institute for Health and Care Excellence. Nalmefene for reducing alcohol consumption in people with alcohol dependence. TA325. London: NICE; 2014.\nAvailable here.  \n\n","Adults with mild alcohol dependence (as defined in CG115) who have a high drinking risk level (≥ 60 g/day of pure alcohol for men and ≥ 40 g/day for women) without physical withdrawal symptoms and who do not require immediate detoxification","NICE currently make the following recommendation regarding use of Nalmefene for reducing alcohol consumption in people with alcohol dependence (the highlighted recommendation is relevant to the scope of this topic evidence map):\n\n1.1 Nalmefene is recommended within its marketing authorisation, as an option for reducing alcohol consumption, for people with alcohol dependence (Evidence review): \n• Who have a high drinking risk level (defined as alcohol consumption of more than 60 g per day for men and more than 40g per day for women, according to the World Health Organization's drinking risk levels) without physical withdrawal symptoms and;\n• Who do not require immediate detoxification.\n\nThe marketing authorisation states that nalmefene should:\n• Only be prescribed in conjunction with continuous psychosocial support focused on treatment adherence and reducing alcohol consumption and; \n• Be initiated only in patients who continue to have a high drinking risk level 2 weeks after initial assessment.\n\nMarch 2018: NICE reviewed the evidence for TA325. They found found nothing new that affects the recommendations in this guidance. This guidance will be reviewed if there is new evidence that is likely to affect the recommendations."]
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[null,"National Institute for Health and Care Excellence. Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence. CG115. London: NICE; 2011\nAvailable here.\n\n","Adults (>18 years) or young people (10 to 17 years of age) with a diagnosis of alcohol dependence or meeting criteria for harmful alcohol use (30 to 50 units of alcohol per week)","This guideline covers identifying, assessing and managing alcohol-use disorders (harmful drinking and alcohol dependence) in adults and young people aged 10-17 years. It aims to reduce harms (such as liver disease, heart problems, depression and anxiety) from alcohol by improving assessment and setting goals for reducing alcohol consumption. \n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n• Principles of care\n• Identification and assessment \n• Interventions for alcohol misuse (Evidence review 2011)\n\nThe following recommendations for further research were also identified in Evidence reviews underpinning this guidance:\n1 Is contingency management effective in reducing alcohol consumption in people who misuse alcohol compared with standard care?\n2 What methods are most effective for assessing and diagnosing the presence and severity of alcohol misuse in children and young people?\n3 Is acupuncture effective in reducing alcohol consumption compared with standard care?\n4. For which service users who are moderately and severely dependent on alcohol is an assertive community treatment model a clinically and cost-effective intervention compared with standard care?\n5. For people with moderate and severe alcohol dependence who have significant comorbid problems, is an intensive residential rehabilitation programme clinically and cost effective when compared with intensive community-based care?\n6 For people with alcohol dependence, which medication is most likely to improve adherence and thereby promote abstinence and prevent relapse?\n\nOctober 2022: NICE updated the recommendation about behavioural couples therapy to clarify that this is not suitable in cases of domestic abuse and to add a cross reference to the NICE technology appraisal guidance on nalmefene. They also updated information about off-label prescribing, and added cross references to legislation on controlled drugs and driving, to MHRA advice on addiction to benzodiazepines and codeine, and to NICE's guidelines on smoking, on antisocial personality disorder and on coexisting mental illness and substance misuse community health and social care services.\nJuly 2019: NICE have found no new evidence that affects the recommendations."]
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[null,"National Institute for Health and Care Excellence. Coexisting severe mental illness (psychosis) and substance misuse: assessment and management in healthcare settings. CG120. London: NICE; 2011. \nAvailable here.\n","People aged 14 years and over with coexisting severe mental illness (psychosis) and substance misuse","This guideline covers assessing and managing people aged 14 years and over with coexisting severe mental illness (psychosis) and substance misuse. It aims to help healthcare professionals guide people with psychosis with coexisting substance misuse to stabilise, reduce or stop their substance misuse, to improve treatment adherence and outcomes, and to enhance their lives. \n\nThe guideline includes the following recommendations. All the recommendations are relevant to the scope of this topic evidence map. The recommendations are supported by evidence from the underpinning Evidence Review 2011. \n• Principles of care\n• Recognising psychosis with coexisting substance misuse\n• Primary care\n• Secondary care mental health services\n• Substance misuse services\n• Inpatient mental health services and staffed accommodation\n• Specific issues for young people with psychosis and coexisting substance misuse\n\nThe following recommendations for further research were also identified in Evidence reviews underpinning this guidance:\n1. What are the prevalence, risk and protective factors, and course of illness for different combinations of psychosis and coexisting substance misuse (for example, schizophrenia and cannabis misuse or bipolar disorder and alcohol misuse)?\n2. What risk factors predict the onset of substance misuse in young people with psychosis?\n3. Are psychosocial interventions clinically and cost effective when compared with standard care for people with psychosis and coexisting substance misuse?\n4. Are environmental interventions clinically and cost effective when compared with standard care for people with psychosis and coexisting substance misuse?\n5. Is clozapine clinically and cost effective when compared with other pharmacological interventions for people with psychosis and coexisting substance misuse?\n\nNovember 2016: NICE reviewed the evidence and found no new evidence that affects the current recommendations in this guideline."]
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[null,"National Institute for Health and Care Excellence. Alcohol-use disorders: diagnosis and management of physical complications. CG100. London: NICE; 2010. \nAvailable here. \n","People aged 10 years and over with alcohol-use disorders","This guideline covers care for adults and young people (aged 10 years and older) with physical health problems that are completely or partly caused by an alcohol-use disorder. It aims to improve the health of people with alcohol-use disorders by providing recommendations on managing acute alcohol withdrawal and treating alcohol-related conditions. \n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n• Acute alcohol withdrawal (Evidence review 2014)\n• Wernicke’s encephalopathy\n• Alcohol-related liver disease\n• Alcohol-related pancreatitis\n\nThe following recommendations for further research were also identified in Evidence reviews underpinning this guidance:\n2. What is the efficacy and cost effectiveness of clomethiazole compared with chlordiazepoxide or carbamazepine or benzodiazepines for the treatment of acute alcohol withdrawal with regard to the outcomes of withdrawal severity, risk of seizures, risk of delirium tremens, length of treatment and patient satisfaction?\n\nJanuary 2019: NICE checked this guideline and are updating it. For more information, see the surveillance decision."]
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[null,"National Institute for Health and Care Excellence. Alcohol-use disorders: prevention. PH24. London: NICE; 2010\nAvailable here.\n\n\n\n","Children, young people and adults aged 10 years and above","This guideline covers alcohol problems among people over 10. It aims to prevent and identify such problems as early as possible using a mix of policy and practice.\n\nThe guideline includes the following recommendations. All the recommendations are relevant to the scope of this topic evidence map. The recommendations are supported by the underpinning Evidence reviews 1-3 and Evidence reviews 4-6:\n• Price, availability and marketing\n• Licencing\n• Supporting children and young people aged 10 to 15 years\n• Screening young people aged 16 and 17 years and offering them extended brief interventions\n• Screening adults and offering them brief advice and interventions\n• Referral\n\nThe underpinning evidence reviews in this report identifed several gaps in the evidence and made recommendations for further research with the following overarching question:\nHow does advertising by industry and health agencies affect the drinking behaviour of the population as whole? (This includes the use of new media.)\n\nJuly 2019: NICE checked this guideline and are updating it. For further information, see the surveillance decision."]
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[null,"National Institute for Health and Care Excellence. Behaviour change: general approaches. PH6. London: NICE; 2007\nAvailable here.\n\n\n\n","General population","This guideline covers a set of principles that can be used to help people change their behaviour. The aim is for practitioners to use these principles to encourage people to adopt a healthier lifestyle by, for example, stopping smoking, adopting a healthy diet and being more physically active.\n\nThe guideline includes the following recommendations. All the recommendations are relevant to the scope of this topic evidence map. The recommendations are supported by the underpinning Evidence review 1.\n• Providing education and training for those delivering them\n• Delivery of these activities, including one-to-one and community-based programmes and those aimed at specific populations\n• Evaluation of their effectiveness and cost effectiveness\n\nThe Programme Development Group identified a number of gaps in the evidence related to behaviour change interventions and programmes, based on an assessment of the evidence and made recommendations for research to address the most important gaps in the evidence. Please refer to 4. Recommendations for research' section of the guidance.\n\nNovember 2017: NICE checked this guideline and found no new evidence that affects the recommendations in this guideline."]
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[null,"Community setting - Safe and Supportive Environment - Systematic reviews"]
[null,"Source:","Audience:","Recommendations:"]
[null,"Moledina A et al (2021). A comprehensive review of prioritised interventions to improve the health and wellbeing of persons with lived experience of homelessness. Campbell Systematic Reviews, 17, e1154.\nAvailable here. ","Populations experiencing homelessness, defined as those who lack stable, permanent, appropriate housing, or who may be without immediate prospects, means, and ability to acquire it","The objective of this systematic review is to identify, appraise, and synthesise the best available evidence on the benefits and cost-effectiveness of interventions to improve the health and social outcomes of people experiencing homelessness.\n\nEligible interventions included permanent supportive housing (PSH), income assistance, standard case management (SCM), peer support, mental health interventions such as assertive community treatment (ACT), intensive case management (ICM), critical time intervention (CTI) and injectable antipsychotics, and substance-use interventions, including supervised consumption facilities (SCFs), managed alcohol programmes and opioid agonist therapy. Outcomes of interest were housing stability, mental health, quality of life, substance use, hospitalisations, employment and income. Only results relevant to this topic evidence map have been extracted below.\n\nManaged alcohol programmes: The review did not identify any eligible studies.\n\nPermanent supportive housing: The effect of permanent housing on substance use was reported in nine trials. Out of these three studies reported improvements in alcohol and drug use in both groups, over time, but no differential benefit of the HF initiative. One study on homeless clients with problematic substance reported no group differences in problems associated with alcohol use, though both groups decreased their alcohol consumption over time. Hybrid approaches to housing (“integrative” versus “parallel” housing) were investigated in a single study. It found no statistically significant difference in the reported days of alcohol use or reported days of drug use both between groups as well as over time. Of note, analysis for this outcome had a lower statistical power as it was restricted to individuals who reported use at the baseline.\n\nIncome-assistance intervention: Four studies examined the effects of income-assistance intervention on substance use. For homeless veterans with substance dependence, CWT immediately reduced the consumption of alcohol and drugs within the first 3 months (β = −44.7%; 95% CI, −69.7% to −19.7%; t = 3.51; p = .001). The addition of priority access to housing vouchers for veterans with a diagnosis of a major psychiatric disorder or an alcohol/drug disorder, compared to existing case management, led to decreased days of drinking to intoxication (1.46 vs. 1.95, t = 0.73, p = .0053) and fewer days of alcohol use over the 3-year study period. However, no significant association was identified between priority access to housing subsidies and differences in the scores of the Addiction Severity Index (ASI). For homeless families with children aged 15 or younger, rental subsidies without case management did not lead to decreased use of substance compared to the usual community housing services.\n\nSCM and peer support interventions: Six studies reported on substance-use outcomes with different SCM treatments. Homeless male veterans with addictions problems with three to 6 months of hospital stays plus case management showed better improvements in the alcohol- and drug-use composite scores, but these were short-lived compared to TAU after 24 months. A three-arm trial reported reductions in average days of alcohol and drug consumption in a case-management-only group, a CM-with-supported-housing group in graduates of short-term in-patient substance-use programme who lacked housing. Homeless alcohol abusers who were offered different intensities of SCM (n = 469) showed no significant between-group differences in days of alcohol use. Similarly, a three-arm trial with homeless women and their intimate partners found no significant differences in substance-use outcomes between groups: a peer-mentored group, a group in a nurse case-managed programme, and one in an SCM programme. Another 12-months trial on homeless men recently released from jails/prisons who were exposed to weekly peer coaching, intermediate peer coaching compared with the usual treatment did not find any significant effects on substance-use outcomes. An RCT with homeless women with alcohol-use problems who received brief guideline-based interventions from primary care providers and referrals to the CM for ongoing follow-up visits for 6 months did not find any significant between-group differences on alcohol-consumption rates, percentages of completely abstained participants, or negative consequences of alcohol use, respectively.\n","PSH interventions improved housing stability for people living with homelessness. High-intensity case management and income-assistance interventions may also benefit housing stability. The majority of included interventions inconsistently detected benefits for mental health, quality of life, substance use, employment and income. These results have important implications for public health, social policy, and community programme implementation. The COVID-19 pandemic has highlighted the urgent need to tackle systemic inequality and address social determinants of health. Our review provides timely evidence on PSH, income assistance, and mental health interventions as a means of improving housing stability. PSH has major cost and policy implications and this approach could play a key role in ending homelessness. Evidence-based reviews like this one can guide practice and outcome research and contribute to advancing international networks committed to solving homelessness."]
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[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This Cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text. Fifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect. One targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects. Among school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]
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[null,"Community setting - Changed attitudes and social norms - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This Cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text. Fifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect. One targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects. Among school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]
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[null,"Foxcroft DR et al. Motivational interviewing for the prevention of alcohol misuse in young adults. Cochrane Database Syst Rev 2016, Issue 7. Art. No.: CD007025. DOI: 10.1002/14651858.CD007025.pub4.\nAvailable here.\n","Young adults up to 25 years of age (higher risk individuals or settings). ","This Cochrane review aimed to assess the effects of motivational interviewing (MI) interventions for preventing alcohol misuse and alcohol‐related problems in young adults. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nEighty four trials (22,872 participants) were included, with 70/84 studies reporting interventions in higher risk individuals or settings. Studies with follow‐up periods of at least four months were of more interest in assessing the sustainability of intervention effects and were also less susceptible to short‐term reporting or publication bias. Overall, the risk of bias assessment showed that these studies provided moderate or low quality evidence.\n\nAt four or more months follow‐up, effects in favour of MI were found for the quantity of alcohol consumed (standardised mean difference (SMD) −0.11, 95 per cent confidence interval (CI) −0.15 to −0.06 or a reduction from 13.7 drinks/week to 12.5 drinks/week; moderate quality evidence); frequency of alcohol consumption (SMD −0.14, 95 per cent CI −0.21 to −0.07 or a reduction in the number of days/week alcohol was consumed from 2.74 days to 2.52 days; moderate quality evidence); and peak blood alcohol concentration, or BAC (SMD −0.12, 95 per cent CI −0.20 to 0.05, or a reduction from 0.144 per cent to 0.131 per cent; moderate quality evidence).\n\nFurther analyses showed that there was no clear relationship between the duration of the MI intervention (in minutes) and effect size. Subgroup analyses revealed no clear subgroup effects for longer‐term outcomes (four or more months) for assessment only versus alternative intervention controls; for university/college vs other settings; or for higher risk vs all/low risk participants.\n","The results of this review indicate that there are no substantive, meaningful benefits of MI interventions for preventing alcohol use, misuse or alcohol‐related problems. Although the reviewers found some statistically significant effects, the effect sizes were too small, given the measurement scales used in the included studies, to be of relevance to policy or practice. Moreover, the statistically significant effects are not consistent for all misuse measures, and the quality of evidence is not strong, implying that any effects could be inflated by risk of bias."]
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[null,"Community setting - Reduced availability - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"Hollands  GJ et al. Altering the availability or proximity of food, alcohol, and tobacco products to change their selection and consumption. Cochrane Database of Systematic Reviews 2019, Issue 9. Art. No.: CD012573. DOI: 10.1002/14651858.CD012573.pub3.\nAvailable here.","Adults","This Cochrane review aimed to:\n1. To assess the impact on selection and consumption of altering the availability or proximity of (a) food (including non‐alcoholic beverages), (b) alcohol, and (c) tobacco products.\n2. To assess the extent to which the impact of these interventions is modified by characteristics of: i. studies, ii. interventions, and iii. participants.\n\nThe reviewers included 24 studies, with the majority (20/24) giving concerns about risk of bias. All of the included studies investigated food products; none investigated alcohol or tobacco. ","The authors concluded that:\n- Further research is warranted in real‐world settings, intervening across a wider range of foods as well as alcohol and tobacco products and over sustained time periods"]
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[null,"Community setting - Reduced affordability - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]
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[null,"Community setting -Behaviour change - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"Agabio R et al. Baclofen for alcohol use disorder. Cochrane Database Syst Rev 2023, Issue 1. Art.No. CD012557. DOI:0.1002/14651858.CD012557.pub3.\nAvailable here. ","Adults with a diagnosis of alcohol dependence. ","This is an update of a Cochrane Review first published in 2018. The aim of this update was to evaluate the benefits and harms of baclofen on achieving and maintaining abstinence or reducing alcohol consumption in people with AUD compared to placebo, no treatment or any other pharmacological relapse prevention treatment. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nThis update included 17 RCTs (1818 participants). Ten studies compared baclofen to placebo or another medication; seven compared two baclofen doses to placebo or another medication. Globally, 15 studies compared baclofen to placebo, two baclofen to acamprosate and two baclofen to naltrexone. In 16 studies, participants received psychosocial treatments. The authors judged most studies at low risk of selection, performance, detection (subjective outcome), attrition and reporting bias. Ten studies detoxified participants before treatment; in seven studies, participants were still drinking at the beginning of treatment. Treatment duration was 12 weeks for 15 RCTs and longer in two studies. Baclofen daily dose was 30 mg to 300 mg: 10 RCTs used low doses (30 mg or less); eight RCTs medium doses (above 30 and 100 mg or less) and four RCTs high doses (above 100 mg).\n\nCompared to placebo, moderate‐certainty evidence found that baclofen probably decreases the risk to relapse (risk ratio (RR) 0.87, 95% confidence interval (CI) 0.77 to 0.99; 12 studies, 1057 participants). This result was confirmed among detoxified participants but not among other subgroups of participants.\n\nHigh‐certainty evidence found that baclofen increases the percentage of days abstinent (mean difference (MD) 9.07, 95% CI 3.30 to 14.85; 16 studies, 1273 participants). This result was confirmed among all subgroups of participants except non‐detoxified or those who received medium doses.\n\nThere was no difference between baclofen and placebo in the other primary outcomes: heavy drinking days (standardised mean difference (SMD) −0.18, 95% CI −0.48 to 0.11; 13 studies, 840 participants; moderate‐certainty evidence); and number of drinks per drinking days (MD −0.45, 95% CI −1.20 to 0.30; 9 studies, 392 participants; moderate‐certainty evidence).\n\nCompared to acamprosate, one study (60 participants) found no differences in any outcomes but the evidence was very uncertain: relapse (RR 1.25, 95% CI 0.71 to 2.20; very low‐certainty evidence).\n\nCompared to naltrexone, baclofen may increase the risk of relapse (RR 2.50, 95% CI 1.12 to 5.56; 1 study, 60 participants; very low‐certainty evidence) but the evidence is very uncertain.","The authors concluded that baclofen likely reduces the risk of relapse to any drinking and increases the percentage of abstinent days, mainly among detoxified participants. It does not increase the number of participants with at least one adverse event, those who dropout for any reason or due to adverse events. It probably does not reduce number of heavy drinking days and the number of drinks per drinking days. Current evidence suggests that baclofen may help people with AUD in maintaining abstinence. The results of comparisons of baclofen with acamprosate and naltrexone were mainly based on only one study."]
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[null,"Filges T, Dalgaard NT and Viinholt BC. 2022. Outreach programs to improve life circumstances and prevent further adverse developmental trajectories of at‐risk youth in OECD countries: A systematic review. Campbell Systematic Reviews, 18(4), p.e1282.\nAvailable here\n","Young people between 8 and 25 years of age living in OECD countries, who either have experienced or is at-risk of experiencing an adverse outcome such as school failure or drop-out, runaway and homelessness, substance and/or alcohol abuse, unemployment, long-term poverty, delinquency/criminal behaviour were eligible.","This Campbell systematic review examines the effects of outreach programmes on problem/high-risk behaviour of young people between eight and 25 year old, living in OECD countries. The review summarises evidence from five studies undertaken in the USA and Canada that involved 578 participants in total.\n\nFour of the five studies used for meta analysis were from the USA and one was from Canada. The timespan in which included studies were carried out was 32 years, from 1985 to 2017; on average the intervention year was 2005. The average number of participants in the analysed interventions was 116, ranging from 30 to 346 and the average number of controls was 81, ranging from 32 to 321. At most, the results from two studies could be pooled in a single meta-analysis. It was only possible to pool the outcomes drug (other than marijuana) use, marijuana use and alcohol use each at two different time points (one and 3 months follow up). At 1 month follow up the weighted averages varied between zero and 0.05 and at 3 months follow up between −0.17 and 0.07. None of them were statistically significant. In addition, a number of other outcomes were reported in a single study only.","Overall, there were too few studies included in any of the meta-analyses in order for us to draw any conclusion concerning the effectiveness of outreach. The vast majority of studies were undertaken in the USA.\nFurther, because too few studies reported results on the same type of outcome at most two studies could be combined in a particular meta-analysis. Given the limited number of rigorous studies available from countries other than the USA, it would be natural to consider conducting a series of randomised controlled trials evaluating the effectiveness of outreach for at-risk youth in countries outside the USA. The trial(s) should be designed, conducted and reported according to methodological criteria for rigour in respect of internal and external validity to achieve robust results and preferably reporting a larger number of outcomes."]
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[null,"McGovern R et al. Effectiveness of psychosocial interventions for reducing parental substance misuse. Cochrane Database of Systematic Reviews 2021, Issue 3. Art. No.: CD012823.\nAvailable here","Participants were parents who use substances; this included mothers and fathers of children (sons and daughters) under the age of 21 years, regardless of custodial or residency status of the children. Same-sex parents and foster parents were eligible for inclusion.","The authors included 22 unique studies with a total of 2274 participants (mean age of parents ranged from 26.3 to 40.9 years), examining 24 experimental interventions. The majority of studies intervened with mothers only (n = 16; 73%). Heroin, cocaine, and alcohol were the most commonly reported substances used by participants. The interventions targeted either parenting only (n = 13; 59%); drug and alcohol use only (n = 5; 23%); or integrated interventions which addressed both (n = 6; 27%).\nThe authors found moderate-quality evidence that psychosocial interventions are probably more effective at reducing the frequency of parental alcohol misuse than comparison conditions at 6-month (mean difference (MD) −0.32, 95% confidence interval (CI) −0.51 to −0.13; 6 studies, 475 participants) and 12-month follow-up (standardised mean difference (SMD) −0.25, 95% CI −0.47 to −0.03; 4 studies, 366 participants). The authors found a significant reduction in frequency of use at 12 months only (SMD −0.21, 95% CI −0.41 to −0.01; 6 studies, 514 participants, moderate-quality evidence).\nThe authors examined the effect of the intervention type. They found low-quality evidence that psychosocial interventions targeting substance use only may not reduce the frequency of alcohol (6 months: SMD −0.35, 95% CI −0.86 to 0.16; 2 studies, 89 participants and 12 months: SMD −0.09, 95% CI −0.86 to 0.61; 1 study, 34 participants)\nA parenting intervention only, without an adjunctive substance use component, may not reduce frequency of alcohol misuse (6 months: SMD −0.21, 95% CI −0.46 to 0.04, 3 studies; 273 participants, low-quality evidence and 12 months: SMD −0.11, 95% CI −0.64 to 0.41; 2 studies; 219 participants, very low-quality evidence).\nParents receiving integrated interventions which combined both parenting- and substance use-targeted components may reduce alcohol misuse with a small effect size (6 months: SMD −0.56, 95% CI −0.96 to −0.16 and 12 months: SMD −0.42, 95% CI −0.82 to −0.03; 2 studies, 113 participants). However, this evidence was of low quality.\nInterventions appeared to be more often beneficial for fathers than for mothers. The authors found low- to very low-quality evidence of a reduction in frequency of alcohol misuse for mothers at six months only (SMD −0.27, 95% CI −0.50 to −0.04; 4 studies, 328 participants), whilst in fathers there was a reduction in frequency of alcohol misuse (6 months: SMD −0.43, 95% CI −0.78 to −0.09; 2 studies, 147 participants and 12 months: SMD −0.34, 95% CI −0.69 to 0.00; 2 studies, 147 participants).","The authors found moderate-quality evidence that psychosocial interventions probably reduce the frequency at which parents use alcohol. Integrated psychosocial interventions which combine parenting skills interventions with a substance use component may show the most promise. \nWhilst it appears that mothers may benefit less than fathers from intervention, caution is advised in the interpretation of this evidence, as the interventions provided to mothers alone typically did not address their substance use and other related needs. \nThe authors found low-quality evidence from few studies that interventions involving children are not beneficial."]
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[null,"Goldberg SB et al. Mindfulness‐based interventions for substance use disorders. Cochrane Database of Systematic Reviews 2021, Issue 10.\nAvailable here.","Patients suffering from Substance use disorders including individuals with alcohol, prescription‐, illicit‐ and poly‐substance use disorders","This Cochrane review aimed to determine the effects of MBIs for SUDs in terms of substance use outcomes, craving and adverse events compared to standard care, further psychotherapeutic, psychosocial or pharmacological interventions, or instructions, waiting list and no treatment.\n\nForty RCTs met the inclusion criteria, with 35 RCTs involving 2825 participants eligible for meta‐analysis. All studies were at high risk of performance bias and most were at high risk of detection bias.\n\nMindfulness‐based interventions (MBIs) versus no treatment: Twenty‐four RCTs included a comparison between MBI and no treatment. The evidence was uncertain about the effects of MBIs relative to no treatment on all primary outcomes: continuous abstinence rate (post: risk ratio (RR) = 0.96, 95% CI 0.44 to 2.14, 1 RCT, 112 participants; follow‐up: RR = 1.04, 95% CI 0.54 to 2.01, 1 RCT, 112 participants); percentage of days with substance use (post‐treatment: standardized mean difference (SMD) = 0.05, 95% CI ‐0.37 to 0.47, 4 RCTs, 248 participants; follow‐up: SMD = 0.21, 95% CI ‐0.12 to 0.54, 3 RCTs, 167 participants); and consumed amount (post‐treatment: SMD = 0.10, 95% CI ‐0.31 to 0.52, 3 RCTs, 221 participants; follow‐up: SMD = 0.33, 95% CI 0.00 to 0.66, 2 RCTs, 142 participants). Evidence was uncertain for craving intensity and serious adverse events. Analysis of treatment acceptability indicated MBIs result in little to no increase in study attrition relative to no treatment (RR = 1.04, 95% CI 0.77 to 1.40, 21 RCTs, 1087 participants). Certainty of evidence for all other outcomes was very low due to imprecision, risk of bias, and/or inconsistency. Data were unavailable to evaluate adverse events.\n\nMindfulness‐based interventions (MBIs) versus other treatments (standard of care, cognitive behavioral therapy, psychoeducation, support group, physical exercise, medication): Nineteen RCTs included a comparison between MBI and another treatment. The evidence was very uncertain about the effects of MBIs relative to other treatments on continuous abstinence rate at post‐treatment (RR = 0.80, 95% CI 0.45 to 1.44, 1 RCT, 286 participants) and follow‐up (RR = 0.57, 95% CI 0.28 to 1.16, 1 RCT, 286 participants), and on consumed amount at post‐treatment (SMD = ‐0.42, 95% CI ‐1.23 to 0.39, 1 RCT, 25 participants) due to imprecision and risk of bias. The evidence suggests that MBIs reduce percentage of days with substance use slightly relative to other treatments at post‐treatment (SMD = ‐0.21, 95% CI ‐0.45 to 0.03, 5 RCTs, 523 participants) and follow‐up (SMD = ‐0.39, 95% CI ‐0.96 to 0.17, 3 RCTs, 409 participants). The evidence was very uncertain about the effects of MBIs relative to other treatments on craving intensity due to imprecision and inconsistency. Analysis of treatment acceptability indicated MBIs result in little to no increase in attrition relative to other treatments (RR = 1.06, 95% CI 0.89 to 1.26, 14 RCTs, 1531 participants). Data were unavailable to evaluate adverse events.","In comparison with no treatment, the evidence is uncertain regarding the impact of MBIs on SUD‐related outcomes. MBIs result in little to no higher attrition than no treatment. In comparison with other treatments, MBIs may slightly reduce days with substance use at post‐treatment and follow‐up (4 to 10 months). The evidence is uncertain regarding the impact of MBIs relative to other treatments on abstinence, consumed substance amount, or craving. MBIs result in little to no higher attrition than other treatments. Few studies reported adverse events."]
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[null,"Kelly  JF, Humphreys  K, Ferri  M. Alcoholics Anonymous and other 12‐step programs for alcohol use disorder. Cochrane Database of Systematic Reviews 2020, Issue 3. Art. No.: CD012880. DOI: 10.1002/14651858.CD012880.pub2.\nAvailable here.","Non‐coerced adults with Alcohol Use Disorder.","AA/TSF (manualized) compared to treatments with a different theoretical orientation (e.g. CBT) (randomized/quasi‐randomized evidence) \nRCTs comparing manualized AA/TSF to other clinical interventions (e.g. CBT), showed AA/TSF improves rates of continuous abstinence at 12 months (risk ratio (RR)) 1.21, 95% confidence interval (CI) 1.03 to 1.42; 2 studies, 1936 participants; high‐certainty evidence). This effect remained consistent at both 24 and 36 months. \nFor percentage days abstinent (PDA), AA/TSF appears to perform as well as other clinical interventions at 12 months (mean difference (MD) 3.03, 95% CI ‐4.36 to 10.43; 4 studies, 1999 participants; very low‐certainty evidence), and better at 24 months (MD 12.91, 95% CI 7.55 to 18.29; 2 studies, 302 participants; very low‐certainty evidence) and 36 months (MD 6.64, 95% CI 1.54 to 11.75; 1 study, 806 participants; very low‐certainty evidence). \nFor longest period of abstinence (LPA), AA/TSF may perform as well as comparison interventions at six months (MD 0.60, 95% CI ‐0.30 to 1.50; 2 studies, 136 participants; low‐certainty evidence). \nFor drinking intensity, AA/TSF may perform as well as other clinical interventions at 12 months, as measured by drinks per drinking day (DDD) (MD ‐0.17, 95% CI ‐1.11 to 0.77; 1 study, 1516 participants; moderate‐certainty evidence) and percentage days heavy drinking (PDHD) (MD ‐5.51, 95% CI ‐14.15 to 3.13; 1 study, 91 participants; low‐certainty evidence). \nFor alcohol‐related consequences, AA/TSF probably performs as well as other clinical interventions at 12 months (MD ‐2.88, 95% CI ‐6.81 to 1.04; 3 studies, 1762 participants; moderate‐certainty evidence). \nFor alcohol addiction severity, one study found evidence of a difference in favor of AA/TSF at 12 months (P < 0.05; low‐certainty evidence). \nThis study examines results for the same outcomes for non-manualized AA/TSF.\n","There is high quality evidence that manualized AA/TSF interventions are more effective than other established treatments, such as CBT, for increasing abstinence. Non‐manualized AA/TSF may perform as well as these other established treatments. AA/TSF interventions, both manualized and non‐manualized, may be at least as effective as other treatments for other alcohol‐related outcomes. AA/TSF probably produces substantial healthcare cost savings among people with alcohol use disorder. "]
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[null,"Hunt G et al.  Psychosocial interventions for people with both severe mental illness and substance misuse. Cochrane Database Syst Rev 2019, Issue 12. Art. No.: CD001088. DOI: 10.1002/14651858.CD001088.pub4\nAvailable here.\n","People diagnosed with a severe mental illness and concurrent problem of substance misuse","This Cochrane review aimed to assess the effects of psychosocial interventions for reduction in substance use in people with a serious mental illness compared with standard care. It updates and replaces the 2013 version of the review.\n\nThe review now includes 41 trials with a total of 4024 participants. The reviewers identified nine comparisons within the included trials. Only two of these reported outcomes meeting the scope of this topic evidence map and have been reported below. For full detail and information on the other outcomes, please refer to the full-text. \n\n1. Integrated models of care versus standard care (36 months): No clear differences were found between treatment groups for alcohol use (RR 1.15, 95% CI 0.84 to 1.56; participants = 143; studies = 1; low‐quality evidence).\n\n5. Motivational interviewing (MI) versus standard care: A clear difference, favouring MI, was observed for abstaining from alcohol (RR 0.36, 95% CI 0.17 to 0.75; participants = 28; studies = 1; very low‐quality evidence).","Authors concluded that they included 41 RCTs but were unable to use much data for analyses. There is currently no high‐quality evidence to support any one psychosocial treatment over standard care for important outcomes such as remaining in treatment, reduction in substance use or improving mental or global state in people with serious mental illnesses and substance misuse. Furthermore, methodological difficulties exist which hinder pooling and interpreting results. Further high‐quality trials are required which address these concerns and improve the evidence in this important area."]
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[null,"Stead M, Angus K, Langley T, Katikireddi SV, Hinds K, Hilton S,  et al. Mass media to communicate public health messages in six health topic areas: a systematic review and other reviews of the evidence. Public Health Res 2019;7(8)\nAvailable here.","General population.","There was limited evidence of impact on alcohol use\nMass media campaigns were found to increase knowledge and awareness across several topics.\nAlthough there was limited evidence on characteristics associated with effectiveness, longer or greater intensity campaigns were found to be more effective. \nThe evidence suggested that targeting messages to target audiences can be effective. \nThere was little evidence regarding the role that theory or media channels may play in campaign effectiveness, and also limited evidence on new media.","Overall, the evidence is mixed but suggests that longer and more intensive campaigns are likely to be more effective and message design and targeting campaigns to particular population groups can be effective."]
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[null,"Agabio R, Trogu E, Pani PP. Antidepressants for the treatment of people with co‐occurring depression and alcohol dependence. Cochrane Database Syst Rev 2018, Issue 4. Art. No.: CD008581. DOI: 10.1002/14651858.CD008581.pub2.\nAvailable here. \n","Adults with co-occurring depression and alcohol dependence. ","This Cochrane review aimed to assess the benefits and risks of antidepressants for the treatment of people with co‐occurring depression and alcohol dependence. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text\n\nReview authors report that 33 studies were included in the review (2242 participants). Antidepressants were compared to placebo (22 studies), psychotherapy (two studies), other medications (four studies), or other antidepressants (five studies). The mean duration of the trials was 9.9 weeks (range 3 to 26 weeks). Eighteen studies took place in the USA, 12 in Europe, two in Turkey, and one in Australia. The antidepressant included in most of the trials was sertraline; other medications were amitriptyline, citalopram, desipramine, doxepin, escitalopram, fluoxetine, fluvoxamine, imipramine, mianserin, mirtazepine, nefazodone, paroxetine, tianeptine, venlafaxine, and viloxazine. Eighteen studies were conducted in an outpatient setting, nine in an inpatient setting, and six in both settings. Psychosocial treatment was provided in 18 studies. There was high heterogeneity in the selection of outcomes and the rating systems used for diagnosis and outcome assessment.\n\nModerate‐quality evidence found that antidepressants increased the number of participants abstinent from alcohol during the trial (7 studies, 424 participants, RR 1.71, 95 per cent Cl 1.22 to 2.39) and reduced the number of drinks per drinking days (7 studies, 451 participants, mean difference (MD) ‐1.13 drinks per drinking days, 95 per cent Cl ‐1.79 to ‐0.46). After the exclusion of studies with high risk of bias, the number of abstinent remained higher (RR 1.69, 95 per cent CI 1.18 to 2.43) and the number of drinks per drinking days lower (MD ‐1.21 number of drinks per drinking days, 95 per cent CI ‐1.91 to ‐0.51) among participants who received antidepressants compared to those who received placebo. However, other outcomes such as the rate of abstinent days did not differ between antidepressants and placebo (9 studies, 821 participants, MD 1.34, 95 per cent Cl ‐1.66 to 4.34; low‐quality evidence).\n\nThere were few studies comparing one antidepressant versus another antidepressant or antidepressants versus other interventions, and these had a small sample size and were heterogeneous in terms of the types of interventions that were compared, yielding results that were not informative.\n","Authors found low‐quality evidence supporting the clinical use of antidepressants in the treatment of people with co‐occurring depression and alcohol dependence. Antidepressants had positive effects on certain relevant outcomes related to depression and alcohol use but not on other relevant outcomes. Moreover, most of these positive effects were no longer significant when studies with high risk of bias were excluded. Results were limited by the large number of studies showing high or unclear risk of bias and the low number of studies comparing one antidepressant to another or antidepressants to other medication. In people with co‐occurring depression and alcohol dependence, the risk of developing adverse effects appeared to be minimal, especially for the newer classes of antidepressants (such as selective serotonin reuptake inhibitors). According to these results, in people with co‐occurring depression and alcohol dependence, antidepressants may be useful for the treatment of depression, alcohol dependence, or both, although the clinical relevance may be modest."]
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[null,"Kaner E et al. Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev 2018, Issue 2.\nAvailable here. ","People who routinely presented to general practice, emergency care or other primary care settings for a range of health problems, whose alcohol consumption was identified by a screening tool as being excessive, or who had experienced harm as a result of their drinking behaviour","This Cochrane systematic review aimed to assess the effectiveness of screening and brief alcohol intervention to reduce excessive alcohol consumption in hazardous or harmful drinkers in general practice or emergency care settings.\n\nThe reviewers found moderate‐quality evidence that brief alcohol interventions have little impact on frequency of binges per week (MD ‐0.08, 95% CI ‐0.14 to ‐0.02; 15 studies, 6946 participants); drinking days per week (MD ‐0.13, 95% CI ‐0.23 to ‐0.04; 11 studies, 5469 participants); or drinking intensity (‐0.2 g/drinking day, 95% CI ‐3.1 to 2.7; 10 studies, 3128 participants).\n\nThey found moderate‐quality evidence of little difference in quantity of alcohol consumed when extended and no or minimal interventions were compared (‐20 g/week, 95% CI ‐40 to 1; 6 studies, 1296 participants). There was little difference in binges per week (‐0.08, 95% CI ‐0.28 to 0.12; 2 studies, 456 participants; moderate‐quality evidence) or difference in days drinking per week (‐0.45, 95% CI ‐0.81 to ‐0.09; 2 studies, 319 participants; moderate‐quality evidence). Extended versus no or minimal intervention provided little impact on drinking intensity (9 g/drinking day, 95% CI ‐26 to 9; 1 study, 158 participants; low‐quality evidence).\n\nExtended intervention had no greater impact than brief intervention on alcohol consumption, although findings were imprecise (MD 2 g/week, 95% CI ‐42 to 45; 3 studies, 552 participants; low‐quality evidence). Numbers of binges were not reported for this comparison, but one trial suggested a possible drop in days drinking per week (‐0.5, 95% CI ‐1.2 to 0.2; 147 participants; low‐quality evidence). Results from this trial also suggested very little impact on drinking intensity (‐1.7 g/drinking day, 95% CI ‐18.9 to 15.5; 147 participants; very low‐quality evidence).","The authors concluded that they found moderate‐quality evidence that brief interventions can reduce alcohol consumption in hazardous and harmful drinkers compared to minimal or no intervention. Longer counselling duration probably has little additional effect. Future studies should focus on identifying the components of interventions which are most closely associated with effectiveness."]
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[null,"Egholm JWM et al. Perioperative alcohol cessation intervention for postoperative complications Cochrane Database of Syst Rev 2018, Issue 11. Art. No.: CD008343. DOI: 10.1002/14651858.CD008343.pub3\n\nAvailable here.\n","Included participants with risky consumption of alcohol who were undergoing all types of elective or acute surgical procedures under general or regional anaesthesia or sedation, who were offered perioperative alcohol cessation intervention or no intervention. ","This Cochrane systematic review aimed to assess the effects of perioperative alcohol cessation interventions on rates of postoperative complications and alcohol consumption. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nOne new study was included in this updated review, resulting in a total of three RCTs (140 participants who drank 3 to 40 AU/d). All three studies were of moderate to good quality. All studies evaluated the effects of intensive alcohol cessation interventions, including pharmacological strategies for alcohol withdrawal symptoms, patient education, and relapse prophylaxis. The authors identified one ongoing study.\n\nInvestigators describe more successful quitters at the end of the intervention programme than among controls. Forty-one out of 70 participants in the intervention groups successfully quit drinking compared with only five out of 70 participants in the control groups (RR 8.22, 95% CI 1.67 to 40.44). The quality of evidence for this outcome is moderate.\n\nAll three studies reported postoperative alcohol consumption (grams of alcohol/week) at the end of the programme as median and range values; therefore it was not possible to estimate the mean and the SD. We performed no meta-analysis. All three studies reported length of stay, and none of these studies described a significant difference in length of stay. Data were insufficient for review authors to perform a meta-analysis. No studies reported on the prevalence of participants without risky drinking in the longer term.\n\nIncluded studies were few and reported small sample sizes; therefore one should be careful about drawing firm conclusions based on these study results. All three studies were conducted in Denmark, and most participants were men. The included participants may represent a selective group, as they could have been more motivated and/or more interested in participating in clinical research or otherwise different, and effects may have been overestimated for both intervention and control groups in these studies. Trial results indicate that these studies are difficult to perform, that strong research competencies are necessary for future studies, and that further evaluation of perioperative alcohol cessation interventions in high-quality randomised controlled trials is needed. Once published and assessed, the one ’ongoing’ study identified may alter the conclusions of this review.","The authors conclude that all three studies showed a significant reduction in the number of participants who quit drinking alcohol during the intervention period. Intensive alcohol cessation interventions offered for four to eight weeks to participants undergoing all types of surgical procedures to achieve complete alcohol cessation before surgery probably reduced the number of postoperative complications. Data were insufficient for review authors to assess their effects on postoperative mortality. No studies reported an effect on length of stay, and no studies addressed the prevalence of risky drinking in the longer term.\n\n\n"]
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[null,"Klimas J et al. Psychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users. Cochrane Database Syst Rev 2018, Issue 12. Art. No.: CD009269. DOI: 10.1002/14651858.CD009269.pub4.\nAvailable here. \n","Problem alcohol and illicit drug users (principally problem drug users of opiates and stimulants). ","This Cochrane review aimed to assess the effects of psychosocial interventions for problem alcohol use in illicit drug users. \n\nThe psychosocial interventions considered in the studies were: cognitive‐behavioural coping skills training (one study), twelve‐step programme (one study), brief intervention (three studies), motivational interviewing (two studies), and brief motivational interviewing (one study). Two studies were considered in two comparisons. There were no data for the secondary outcome, alcohol‐related harm. The results were as follows. \n\nComparison 1: cognitive‐behavioural coping skills training versus twelve‐step programme (one study, 41 participants): There was no significant difference between groups for either of the primary outcomes (alcohol abstinence assessed with Substance Abuse Calendar and breathalyser at one year: risk ratio (RR) 2.38 (95% confidence interval [CI] 0.10 to 55.06); and retention in treatment, measured at end of treatment: RR 0.89 (95% CI 0.62 to 1.29), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was very low. \n\nComparison 2: brief intervention versus treatment as usual (three studies, 197 participants): There was no significant difference between groups for either of the primary outcomes (alcohol use, measured as scores on the Alcohol Use Disorders Identification Test (AUDIT) or Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) at three months: standardised mean difference (SMD) 0.07 (95% CI ‐0.24 to 0.37); and retention in treatment, measured at three months: RR 0.94 (95% CI 0.78 to 1.13), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was low. \n\nComparison 3: motivational interviewing versus treatment as usual or educational intervention only (three studies, 462 participants): There was no significant difference between groups for either of the primary outcomes (alcohol use, measured as scores on the AUDIT or ASSIST at three months: SMD 0.04 (95% CI ‐0.29 to 0.37); and retention in treatment, measured at three months: RR 0.93 (95% CI 0.60 to 1.43), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was low. \n\nComparison 4: brief motivational intervention (BMI) versus assessment only (one study, 187 participants): More people reduced alcohol use (by seven or more days in the past month, measured at six months) in the BMI group than in the control group (RR 1.67; 95% CI 1.08 to 2.60). There was no difference between groups for the other primary outcome, retention in treatment, measured at end of treatment: RR 0.98 (95% CI 0.94 to 1.02), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was moderate. \n\nComparison 5: motivational interviewing (intensive) versus motivational interviewing (one study, 163 participants): There was no significant difference between groups for either of the primary outcomes (alcohol use, measured using the Addiction Severity Index‐alcohol score (ASI) at two months: MD 0.03 (95% CI 0.02 to 0.08); and retention in treatment, measured at end of treatment: RR 17.63 (95% CI 1.03 to 300.48), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was low. \n\n","The review authors found low to very low‐quality evidence to suggest that there is no difference in effectiveness between different types of psychosocial interventions to reduce alcohol consumption among people who use illicit drugs, and that brief interventions are not superior to assessment‐only or to treatment as usual. No firm conclusions can be made because of the paucity of the data and the low quality of the retrieved studies."]
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[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. \n\nFifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect.\n\nOne targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects.\n\nAmong school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]
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[null,"O'Connor EA et al. Screening and behavioral counseling interventions to reduce unhealthy alcohol use in adolescents and adults: An updated systematic review for the U.S. Preventive Services Task Force. Rockville MD: Agency for Healthcare Research and Quality; 2018. \nAvailable here. ","Adolescents or adults age 12 years or older. ","One hundred and thirteen studies (n=314,466) were included across all Key Questions. The authors did not find any studies that examined the benefits or harms of screening programs to reduce unhealthy alcohol use. For adolescents, data supported the use of the National Institute on Alcohol Abuse and Alcoholism Youth Screen and other similar one- or two-item screeners to detect alcohol use disorder. For adults, brief (1- to 3-item) screeners commonly reported sensitivity and specificity between 0.70 and 0.85, typically having better sensitivity than the full Alcohol Use Disorders Identification Test (AUDIT) for identifying the full spectrum of unhealthy use. However, the AUDIT tended to have higher specificity, particularly at the standard cutoff of 8 or higher.  \n\nIdentified interventions to reduce unhealth alcohol use were generally counselling interventions, with most involving one or two sessions (90% involved ≤ 4 sessions) with a median of 30 minutes contact time (88% involved ≤ 2 hours contact). The most commonly reported intervention element was the use of personalized normative feedback sessions, in which participants were shown how their alcohol use compares to others; this technique was used in more than half of the included trials and almost all trials in younger adults. Motivational techniques were also common, particularly in combination with personalized normative feedback.\n\nEvidence on the effects of interventions to reduce unhealthy alcohol use in adolescents was limited to two trials; both found mixed results for reduced alcohol use and did not report health or related outcomes. \n\nIn adults, interventions reduced the number of drinks per week (weighted mean difference, −1.82 [95% confidence interval {CI}, −2.42 to −1.22]), the proportion exceeding recommended drinking limits (odds ratio [OR], 0.60 [95% CI, 0.53 to 0.67]), and the proportion reporting a heavy use episode (OR, 0.62 [95% CI, 0.55 to 0.71]), and increased the proportion of pregnant women reporting abstinence (OR, 1.92 [95% CI, 1.19 to 3.09]) after 6 to 12 months. \n\nHeterogeneity was high and effect size was associated with a number of study characteristics such as setting, target age of the population, publication year, study size, and average baseline-use levels, but not clearly associated with any intervention characteristics. Data on effectiveness in important subgroups were very limited, but analyses by sex, the most commonly reported subgroup analysis, did not indicate differences in effectiveness of the interventions. Health outcomes were sparsely reported and, with some exceptions, generally did not demonstrate group differences in effect. No evidence of harm was found.","Among adults, screening instruments are available that can effectively identify persons with unhealthy alcohol use and that are feasible for use in primary care settings, and interventions in those who screen positive are associated with reductions in unhealthy alcohol use. There was no evidence that these interventions have unintended harmful effects. More evidence is needed to determine whether screening for unhealthy alcohol use is beneficial for adolescents."]
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[null,"Canadian Agency for Drugs and Technology in Health. Concurrent treatment for substance use disorder and trauma-related comorbidities: a review of clinical effectiveness and guidelines. Ottawa: CADTH; 2017. \nAvailable here. ","Adults with substance use disorder and trauma-related comorbidities (PTSD, anxiety or depression). \n\nSubgroup of interest: military veterans","The purpose of this report by CADTH was to review treatment options for patients with comorbid substance use disorder (SUD) and post-traumatic stress disorder, anxiety, or depression by comparing concurrent treatments for SUD and the mental disorders with no treatment, usual care or active treatment for one condition only and treatment for a single condition (SUD or the mental disorders) with no treatment, usual care or active treatment for the second disorder. Additionally, this review aimed to review evidence-based guidelines regarding the treatments for patients with these comorbidities. \n\nThe review addressed three main research questions. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\n1. What is clinical effectiveness of concurrent treatment for patients with substance use disorders and comorbid post-traumatic stress disorder, anxiety, or depression?\nPatients with comorbid SUD and PTSD: In summary, findings with respect to SUD outcomes for integrated treatments addressing both PTSD and SUD, were inconsistent.\nPatients with comorbid SUD and depression: In summary, there is a suggestion that integrated treatments are more effective than control treatments or treatments addressing a single condition, but findings were not always consistent.\nPatients with SUD and anxiety disorder: One RCT showed that fewer patients relapsed to any drinking in the CBT group compared to the PMRT group. Another RCT showed that the nine hour anxiety-sensitivity focused intervention plus TAU over TAU alone, showed improvement in percent days abstinent in both groups, but showed no significant between group difference.\nPatients with SUD and depression or anxiety disorder: An RCT showed that ICBT appeared to be more effective than usual care with respect to most measures of alcohol consumption.\n\n2. What is the clinical effectiveness of the treatment of one condition for the improvement of all symptoms in patients with substance use disorder and comorbid post-traumatic stress disorder, anxiety, or depression?\nA systematic review included six studies that evaluated addiction based interventions. Two studies comparing the experimental contingency management (CM) treatment with control treatment found slightly better early treatment gains with respect to substance use with CM, however the differences did not remain significant in the long term as shown in one study. Results from three studies (other than CM) showed within-group improvement in SUD outcomes over time even for minimal or no treatment. One study showed that the care management program was associated with better alcohol outcomes compared to the AUD treatment that patients identified on their own.\nAnother systematic review included one study comparing technology-based treatment (TAU plus web based intervention targeting alcohol use) with TAU alone, reported no findings with respect to substance use.\n\n3. What are the evidence-based guidelines regarding the treatment of patients with substance use disorders and comorbid post-traumatic stress disorder, anxiety, or depression?\nOne relevant evidence-based guideline was identified. For comorbid anxiety and alcohol use disorder or for comorbid PTSD and alcohol use disorder, an integrated approach was recommended (Recommendation grade: CCP i.e. “Clinical consent point”). For comorbid depression and alcohol use disorder, CBT was recommended to improve both depressive symptoms and drinking problems.","Report authors found there was a suggestion that integrated treatments offered greater improvement with respect to PTSD symptoms, depression or anxiety compared to no treatment or minimal treatment for patients with comorbid substance use disorder (SUD) and posttraumatic stress syndrome (PTSD), depression or anxiety disorder. However results were not always consistent. In patients with comorbid SUD and PTSD, there was a suggestion that addiction based interventions were more effective with respect to controlling substance use than control treatments. One evidence-based guideline recommended an integrated treatment approach for patients with comorbid alcohol use disorder and PTSD, or comorbid alcohol use disorder and anxiety disorder, and cognitive behavioural therapy for comorbid alcohol use disorder and depression."]
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[null,"Canadian Agency for Drugs and Technology in Health. Inpatient and outpatient treatment programs for substance use disorder: a review of clinical effectiveness and guidelines. Ottawa: CADTH; 2017a. \nAvailable here. \n","Adults 18 to 65 years with substance use disorder/addiction disorder (e.g., abuse of prescription medications or cocaine, heroin, cannabis, alcohol)\n","This Rapid Response report by CADTH aimed to review the clinical effectiveness of inpatient and outpatient treatment programs for adults with substance use disorders involving prescription medications such as analgesics or non-prescription substances such as cocaine, opioids such as heroine, marijuana (cannabis), or alcohol. Evidence-based guidelines associated with inpatient and outpatient treatment programs in adults with substance use disorders were also examined.\n\nThe review addressed two main research questions. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\n1. What is the clinical effectiveness of inpatient and outpatient treatment programs in adults with substance use disorders?\nOne narrative review concluded that evidence supports the case for community detoxification in patients with alcohol dependence. One RCT with long-term follow-up (18 months) concluded that the evidence found initial but decreasing benefit of inpatient over outpatient care across time. One prospective study found inpatients consumed significantly less alcohol in the year after entering treatment than outpatients as measured by the Graduated Frequency Scale questionnaire, and had significantly greater engagement with Alcohol Anonymous program than outpatients in the year after treatment. One retrospective study reported that inpatients with substance use disorders are three times more likely to complete treatment than outpatients.\n\n2. What are the evidence-based guidelines associated with inpatient and outpatients treatment programs in adults with substance use disorders?\nThe evidence-based guidelines from British Columbia Ministry of Health on opioids use disorder recommend that withdrawal management, if needed, can be provided more safely in an outpatient setting rather than in an inpatient setting in most patients. For patients who wish to avoid long-term opioid agonist treatment, supervised slow (longer than one month) outpatient or residential opioid agonist taper can be provided rather than rapid (less than one week) inpatient opioid agonist taper. The slow approach may permit a more flexible and individualised approach to tapered agonist reduction, which allows dose adjustment and stabilisation in case withdrawal symptoms occur.\n\n","For patients with alcohol use disorders, better detoxification completion and abstinence rates, and similar adverse event rates, were found in outpatient care compared to inpatient care in a couple of studies with short follow-up periods (one to two months). One study with a longer follow-up period found inpatients consumed less alcohol than outpatients in the year after entering treatment. This may be explained by the controlled environment of inpatient care that avoids the distractions that could be present in an outpatient care situation. In patients with severe alcohol dependence, data from one study found initial but decreasing benefit of inpatient over outpatient care across time in alcohol abstinence. For patients with substance use disorders, data from one study showed inpatients are more likely to complete treatment than outpatients. The small number of studies found and their heterogeneity in design and reported outcomes cautioned the interpretation of the findings. \n\n\n"]
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[null,"Brown TJ, Todd A, O'Malley CL, Moore HJ, Husband AK, Bambra C,  et al. Community pharmacy interventions for public health priorities: a systematic review of community pharmacy-delivered smoking, alcohol and weight management interventions. Public Health Res 2016;4(2)\nAvailable here. ","Adults","The searches identified over 14,000 records, of which 24 studies were included. There were two alcohol, 12 smoking cessation, five weight loss and five multicomponent interventions that included pharmacotherapy and lifestyle changes in participants with diabetes mellitus, dyslipidaemia or hypertension. Nine of the studies were UK based; seven of the studies were rated ‘strong’ for quality. All studies were of adults. \nThere was insufficient evidence for the effectiveness of community pharmacy-based brief alcohol interventions.\nNone of the five multicomponent studies demonstrated an improvement compared with control for anthropometric outcomes in participants with comorbidities, but they did show improvement in measures associated with the comorbidities. Very few studies explored if and how sociodemographic or socioeconomic variables moderated the effect of interventions. In two studies based in areas of high deprivation, where participants chose the intervention, the sociodemographic characteristics of participants differed between intervention settings. There were also differences in recruitment, attendance and retention of participants by type of setting. The evidence suggests that a distinct group of people might access pharmacies compared with other settings for alcohol management, smoking cessation and weight loss. There is insufficient evidence to examine the relationship between behaviour change strategies and effectiveness; or evidence of consistent implementation factors or training components that underpin effective interventions.","Evaluations of interventions to manage alcohol misuse and obesity, set within the community pharmacy, are needed. \nThe effect of community pharmacy interventions on health inequalities is unclear. Future research in this area is warranted, and trials should include the assessment of age, sex, ethnicity, socioeconomic status and contextual factors, and present analysis of how these factors moderate effectiveness."]
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[null,"Foxcroft DR et al. Motivational interviewing for the prevention of alcohol misuse in young adults. Cochrane Database Syst Rev 2016, Issue 7. Art. No.: CD007025. DOI: 10.1002/14651858.CD007025.pub4.\nAvailable here.\n","Young adults up to 25 years of age. ","This Cochrane review aimed to assess the effects of motivational interviewing (MI) interventions for preventing alcohol misuse and alcohol‐related problems in young adults.\n\nEighty four trials (22,872 participants) were included, with 70/84 studies reporting interventions in higher risk individuals or settings. Studies with follow‐up periods of at least four months were of more interest in assessing the sustainability of intervention effects and were also less susceptible to short‐term reporting or publication bias. Overall, the risk of bias assessment showed that these studies provided moderate or low quality evidence.\n\nAt four or more months follow‐up, effects in favour of MI were found for the quantity of alcohol consumed (standardised mean difference (SMD) −0.11, 95 per cent confidence interval (CI) −0.15 to −0.06 or a reduction from 13.7 drinks/week to 12.5 drinks/week; moderate quality evidence); frequency of alcohol consumption (SMD −0.14, 95 per cent CI −0.21 to −0.07 or a reduction in the number of days/week alcohol was consumed from 2.74 days to 2.52 days; moderate quality evidence); and peak blood alcohol concentration, or BAC (SMD −0.12, 95 per cent CI −0.20 to 0.05, or a reduction from 0.144 per cent to 0.131 per cent; moderate quality evidence).\nA marginal effect in favour of MI was found for alcohol problems (SMD −0.08, 95 per cent CI −0.17 to 0.00 or a reduction in an alcohol problems scale score from 8.91 to 8.18; low quality evidence) and no effects for binge drinking (SMD −0.04, 95 per cent CI −0.09 to 0.02, moderate quality evidence) or for average BAC (SMD −0.05, 95 per cent CI −0.18 to 0.08; moderate quality evidence). Other alcohol‐related behavioural outcomes were considered, and at four or more month’s follow‐up, we found no effects on drink‐driving (SMD −0.13, 95 per cent CI −0.36 to 0.10; moderate quality of evidence) or other alcohol‐related risky behaviour (SMD −0.15, 95 per cent CI −0.31 to 0.01; moderate quality evidence).\n\nFurther analyses showed that there was no clear relationship between the duration of the MI intervention (in minutes) and effect size. Subgroup analyses revealed no clear subgroup effects for longer‐term outcomes (four or more months) for assessment only versus alternative intervention controls; for university/college vs other settings; or for higher risk vs all/low risk participants.\n","The results of this review indicate that there are no substantive, meaningful benefits of MI interventions for preventing alcohol use, misuse or alcohol‐related problems. Although we found some statistically significant effects, the effect sizes were too small, given the measurement scales used in the included studies, to be of relevance to policy or practice. Moreover, the statistically significant effects are not consistent for all misuse measures, and the quality of evidence is not strong, implying that any effects could be inflated by risk of bias."]
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[null,"Roberts NP et al. Psychological therapies for post‐traumatic stress disorder and comorbid substance use disorder. Cochrane Database Syst Rev 2016, Issue 4. Art. No.: CD010204. DOI: 10.1002/14651858.CD010204.pub2.\nAvailable here. \n","Individuals with comorbid PTSD and SUD","This Cochrane review aimed to determine the efficacy of psychological therapies aimed at treating traumatic stress symptoms, substance misuse symptoms, or both in people with comorbid PTSD and SUD in comparison with control conditions (usual care, waiting‐list conditions, and no treatment) and other psychological therapies. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nFourteen studies with 1506 participants were included, of which 13 studies were included in the quantitative synthesis. Most studies involved adult populations. Studies were conducted in a variety of settings. Four comparisons were undertaken investigating the effects of psychological therapies with a trauma‐focused component and non‐trauma‐focused interventions against treatment as usual/minimal intervention and other active psychological therapies. Comparisons were stratified for individual‐ or group‐based therapies. All active interventions were based on CBT.\n\nIndividual‐based psychological therapies with a trauma‐focused component plus adjunctive SUD intervention: There was no evidence of an effect for level of drug/alcohol use post‐treatment (SMD ‐0.13; 95% CI ‐0.41 to 0.15; 3 studies; n = 388; very low‐quality evidence), but there was a small effect in favour of individual psychological therapy at 5 to 7 months (SMD ‐0.28; 95% CI ‐0.48 to ‐0.07; 3 studies; n = 388) when compared against TAU.\n\nIndividual‐based psychological therapy with a trauma‐focused component: did not perform better than psychological therapy for SUD only for drug/alcohol use (MD ‐1.27; 95% CI ‐5.76 to 3.22; 1 study; n = 46; low‐quality evidence). Findings were based on one small study.\n\nNon‐trauma‐focused psychological therapies: did not perform better than TAU/minimal intervention. There were no data on the effects on drug/alcohol use for individual therapy. There was no evidence of an effect on the level of drug/alcohol use for group‐based therapy (SMD ‐0.03; 95% CI ‐0.37 to 0.31; 4 studies; n = 414; very low‐quality evidence). A post‐hoc analysis for full dose of a widely established group therapy called Seeking Safety showed reduced drug/alcohol use post‐treatment (SMD ‐0.67; 95% CI ‐1.14 to ‐0.19; 2 studies; n = 111), but not at subsequent follow‐ups.\nThese also did not perform better than psychological therapy for SUD only for drug/alcohol use (SMD 0.22; 95% CI ‐0.13 to 0.57; 2 studies; n = 128; low‐quality evidence).\n","The reviewers assessed the evidence in this review as mostly low to very low quality. Evidence showed that individual trauma‐focused psychological therapy delivered alongside SUD therapy did better than TAU/minimal intervention in reducing PTSD severity post‐treatment and at long‐term follow‐up, but only reduced SUD at long‐term follow‐up. All effects were small, and follow‐up periods were generally quite short. There was evidence that fewer participants receiving trauma‐focused therapy completed treatment. There was very little evidence to support use of non‐trauma‐focused individual‐ or group‐based integrated therapies. Individuals with more severe and complex presentations (e.g. serious mental illness, individuals with cognitive impairment, and suicidal individuals) were excluded from most studies in this review, and so the findings from this review are not generalisable to such individuals. Some studies suffered from significant methodological problems and some were underpowered, limiting the conclusions that can be drawn. Further research is needed in this area."]
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[null,"Canadian agency for Drugs and Technology in Health. Mindfulness interventions for the treatment of post-traumatic stress disorder, generalized anxiety disorder, depression and substance use disorders: a review of the clinical effectiveness and guidelines. Ottawa: CADTH; 2015. Available here. ","Adults with post-traumatic stress disorder (PTSD), generalised anxiety disorder (GAD), depression, or substance use disorders.","The objective of this review was to summarise the clinical effectiveness and guidelines for the use of mindfulness interventions for the treatment of PTSD, GAD, depression, and substance use disorders in adults. The review addressed two main research questions. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\n1. What is the clinical effectiveness of mindfulness interventions for the treatment of adults with PTSD, GAD, Depression, or substance use disorders?\nA study reported, that compared with treatment as usual, participants assigned to mindfulness-based relapse prevention reported significantly lower risk of heavy drinking, significantly fewer days of heavy drinking at the 6-month follow-up. At the 12-month follow-up, mindfulness-based relapse prevention participants reported significantly decreased heavy drinking compared with relapse prevention and treatment as usual.\n\n2. What are the evidence-based guidelines regarding the use of mindfulness interventions for the treatment of adults with PTSD, GAD, Depression, or substance use disorders?\nThe guideline by the New South Wales Department of Health suggested that mindfulness could be used to treat problematic drug and alcohol users.\n\n","The evidence for the efficacy of mindfulness as a treatment for individuals with substance use disorders was limited. One RCT of low methodological quality suggested that mindfulness intervention is more effective than treatment as usual in lowering risk of relapse to substance use and heavy drinking. One guideline suggested that mindfulness can be used to treat problematic drug and alcohol use problems by suitably trained and experienced drug and alcohol professionals.\n"]
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[null,"Canadian agency for Drugs and Technology in Health. Yoga for the Treatment of Post-Traumatic Stress Disorder, Generalized Anxiety Disorder, Depression, and Substance Abuse: A Review of the Clinical Effectiveness and Guidelines. Ottawa: CADTH; 2015a. Available here. ","Adults with PTSD, GAD, depression, or substance use disorders.","The objective of this Rapid Response report is to review the clinical effectiveness of yoga for treating PTSD, GAD, depression and substance abuse, and to summarize the guidelines that are associated with the use of yoga for these conditions.The review addressed two main research questions. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\n1. What is the clinical effectiveness of yoga as an intervention for the treatment of PTSD, GAD, depression, or substance use disorders?\nOne study found that yoga was a feasible adjunct treatment for treating alcohol dependence. Patients in the yoga intervention group had a higher baseline level of drinking compared to the control group and there were positive, non-significant changes in alcohol consumption at six month follow-up, numerically greater than that experienced by the control. \ngroup\n\n2. What are the evidence-based guidelines regarding the use of mindfulness interventions for the treatment of adults with PTSD, GAD, Depression, or substance use disorders?\nFive evidence-based guidelines were included in this report, two of which did not find enough evidence for yoga to provide a recommendation. None of the recommendations focused specifically on alcohol consumption.\n\n","Three RCTs of low methodological quality suggested that patients with substance abuse improved with respect to some symptoms with yoga. Five evidence based guideline documents considered the use of yoga in clinical practice. Three suggested that yoga may be useful as an adjunctive treatment for treating major depressive disorder (MDD), PTSD and GAD, if available. "]
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[null,"Ipser JC et al. Pharmacotherapy for anxiety and comorbid alcohol use disorders. Cochrane Database Syst Rev 2015, Issue 1. Art. No.: CD007505. DOI: 10.1002/14651858.CD007505.pub2\nAvailable here. \n","People diagnosed with alcohol dependence or abuse and an anxiety disorder according to DSM‐III, DSM‐IV, or DSM‐IV‐TR criteria.","This Cochrane review aimed to assess the effects of pharmacotherapy for treating anxiety in people with comorbid alcohol use disorders. Five placebo‐controlled pharmacotherapy RCTs (with 290 participants) were included in the review. Most of the trials provided little information on how randomisation was performed or on whether both participants and study personnel were blinded to the intervention. \n\nStudy participants had DSM) III‐ and DSM IV‐diagnosed alcohol use disorders and post‐traumatic stress disorder (two studies), social anxiety disorder (SAD; two studies) or generalized anxiety disorder (GAD; one study). Four trials assessed the efficacy of the selective serotonin re‐uptake inhibitors (SSRIs: sertraline, paroxetine); one RCT investigated the efficacy of buspirone, a 5‐hydroxytryptamine (5‐HT) partial agonist. Treatment duration lasted between eight and 24 weeks. Overall, 70% of participants included in the review were male. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nThere was no evidence of an effect for any of the medications tested on abstinence from alcohol use or depression symptoms.","The evidence‐base for the effectiveness of medication in treating anxiety disorders and comorbid alcohol use disorders is currently inconclusive. There was no evidence that alcohol use was responsive to medication. Large, rigorously conducted RCTs would help supplement the small evidence‐base for the efficacy and tolerability of pharmacotherapy for anxiety and comorbid alcohol use disorders. Further research on patient subgroups who may benefit from pharmacological treatment, as well as novel pharmacological interventions, is warranted. \n"]
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[null,"Pani PP et al. Anticonvulsants for alcohol dependence. Cochrane Database Syst Rev 2014, Issue 2. Art. No.: CD008544. DOI: 10.1002/14651858.CD008544.pub2.\nAvailable here. \n","Alcohol dependent adults. ","The primary aim of this Cochrane review is to assess the benefits/risks of anticonvulsants for the treatment of alcohol dependence. \n\nA total of 25 studies were included in the review (2641 participants). Most participants were male, with an average age of 44 years. Anticonvulsants were compared with placebo (17 studies), other medications (seven studies) and no medication (two studies). The mean duration of the trials was 17 weeks (range four to 52 weeks). The studies took place in the USA, Europe, South America, India and Thailand. Variation was reported in the characteristics of the studies, including their design and the rating instruments used. For many key outcomes, the risk of bias associated with unclear or unconcealed allocation and lack of blinding affected the quality of the evidence. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nAnticonvulsants versus placebo: For continuous abstinence (eight studies, 634 participants, RR 1.21, 95% Cl 95 per cent 0.97 to 1.52, moderate‐quality evidence), results showed no evidence of differences. Moderate‐quality evidence suggested that anticonvulsants reduced drinks/drinking days (11 studies, 1126 participants, mean difference (MD) ‐1.49, 95% Cl ‐2.32 to ‐0.65) and heavy drinking (12 studies, 1129 participants, standardised mean difference (SMD) ‐0.35, 95% Cl ‐0.51 to ‐0.19). The direction of results was confirmed by subgroup analyses for topiramate and partially for gabapentin and valproate. \n\nAnticonvulsants versus naltrexone: No evidence of difference was shown in severe relapse rates (four studies, 427 participants, RR 0.69, 95% Cl 0.44 to 1.07) and continuous abstinence rates (five studies, 528 participants, RR 1.21, 95% Cl 0.99 to 1.49); anticonvulsants were associated with fewer heavy drinking days (three studies, 308 participants, MD ‐5.21, 95% Cl ‐8.58 to ‐1.83) and more days to severe relapse (three studies, 244 participants, MD 11.88, 95% Cl 3.29 to 20.46).\n","The authors concluded that at the current stage of research, randomised evidence supporting the clinical use of anticonvulsants to treat alcohol dependence is insufficient. Results are conditioned by heterogeneity and by the low number and quality of studies comparing anticonvulsants with other medications. The uncertainty associated with these results leaves to clinicians the need to balance possible benefits/risks of treatment with anticonvulsants versus other medications as supported by evidence of efficacy."]
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[null,"Jonas DE et al. Pharmacotherapy for adults with alcohol-use disorders in outpatient settings. Rockville MD: Agency for Healthcare Research and Quality; 2014. \nAvailable here. \n\nThis report has been archived by AHRQ and is being updated. The update protocol can be accessed here.","Adults with alcohol-use disorders. ","The aim of this report was to conduct a systematic review and meta-analysis of the efficacy, comparative effectiveness, and harms of medications (both FDA approved and others) for adults with alcohol-use disorders, and to evaluate the evidence from primary care settings.\n\nOne hundred and thirty five studies were included. Most patients met criteria for alcohol dependence; mean ages were in the 40s. Studies typically included psychosocial cointerventions; effect sizes reflect the added benefits of medications. For acamprosate and oral naltrexone (50 mg per day), numbers needed to treat (NNTs) to prevent 1 person from returning to any drinking were 12 and 20, respectively (moderate SOE); NNT to prevent 1 person from returning to heavy drinking was 12 for oral naltrexone (50 mg per day) (moderate SOE). Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nMeta-analyses of four head-to-head trials found no statistically significant difference between the two medications for consumption outcomes (moderate SOE). For injectable naltrexone, meta-analyses found no significant benefit for return to any or heavy drinking, but found a reduction in heavy drinking days (low SOE). Evidence from well-controlled trials does not support efficacy of disulfiram, except possibly for patients with excellent adherence. Among medications used off label, moderate evidence supports the efficacy of nalmefene and topiramate for improving some consumption outcomes, and limited evidence supports the efficacy of valproic acid. Evidence from primary care settings was scant. There was insufficient direct evidence to conclude whether medications for alcohol-use disorders are effective for improving health outcomes.","Authors concluded that acamprosate and oral naltrexone have the best evidence for improving alcohol consumption outcomes for patients with alcohol-use disorders. Head-to-head trials have not consistently established the superiority of one medication. Thus, other factors may guide medication choices, such as frequency of administration, potential adverse events, coexisting symptoms, and availability of treatments.\n\n"]
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[null,"Community setting -Families are supported and protected - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"McGovern R et al. Effectiveness of psychosocial interventions for reducing parental substance misuse. Cochrane Database of Systematic Reviews 2021, Issue 3. Art. No.: CD012823.\nAvailable here","Participants were parents who use substances; this included mothers and fathers of children (sons and daughters) under the age of 21 years, regardless of custodial or residency status of the children. Same-sex parents and foster parents were eligible for inclusion.","The authors included 22 unique studies with a total of 2274 participants (mean age of parents ranged from 26.3 to 40.9 years), examining 24 experimental interventions. The majority of studies intervened with mothers only (n = 16; 73%). Heroin, cocaine, and alcohol were the most commonly reported substances used by participants. The interventions targeted either parenting only (n = 13; 59%); drug and alcohol use only (n = 5; 23%); or integrated interventions which addressed both (n = 6; 27%).\nThe authors found moderate-quality evidence that psychosocial interventions are probably more effective at reducing the frequency of parental alcohol misuse than comparison conditions at 6-month (mean difference (MD) −0.32, 95% confidence interval (CI) −0.51 to −0.13; 6 studies, 475 participants) and 12-month follow-up (standardised mean difference (SMD) −0.25, 95% CI −0.47 to −0.03; 4 studies, 366 participants). The authors found a significant reduction in frequency of use at 12 months only (SMD −0.21, 95% CI −0.41 to −0.01; 6 studies, 514 participants, moderate-quality evidence).\nThe authors examined the effect of the intervention type. They found low-quality evidence that psychosocial interventions targeting substance use only may not reduce the frequency of alcohol (6 months: SMD −0.35, 95% CI −0.86 to 0.16; 2 studies, 89 participants and 12 months: SMD −0.09, 95% CI −0.86 to 0.61; 1 study, 34 participants)\nA parenting intervention only, without an adjunctive substance use component, may not reduce frequency of alcohol misuse (6 months: SMD −0.21, 95% CI −0.46 to 0.04, 3 studies; 273 participants, low-quality evidence and 12 months: SMD −0.11, 95% CI −0.64 to 0.41; 2 studies; 219 participants, very low-quality evidence).\nParents receiving integrated interventions which combined both parenting- and substance use-targeted components may reduce alcohol misuse with a small effect size (6 months: SMD −0.56, 95% CI −0.96 to −0.16 and 12 months: SMD −0.42, 95% CI −0.82 to −0.03; 2 studies, 113 participants). However, this evidence was of low quality.\nInterventions appeared to be more often beneficial for fathers than for mothers. The authors found low- to very low-quality evidence of a reduction in frequency of alcohol misuse for mothers at six months only (SMD −0.27, 95% CI −0.50 to −0.04; 4 studies, 328 participants), whilst in fathers there was a reduction in frequency of alcohol misuse (6 months: SMD −0.43, 95% CI −0.78 to −0.09; 2 studies, 147 participants and 12 months: SMD −0.34, 95% CI −0.69 to 0.00; 2 studies, 147 participants).","The authors found moderate-quality evidence that psychosocial interventions probably reduce the frequency at which parents use alcohol. Integrated psychosocial interventions which combine parenting skills interventions with a substance use component may show the most promise. \nWhilst it appears that mothers may benefit less than fathers from intervention, caution is advised in the interpretation of this evidence, as the interventions provided to mothers alone typically did not address their substance use and other related needs. \nThe authors found low-quality evidence from few studies that interventions involving children are not beneficial."]
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[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This Cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text. Fifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect. One targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects. Among school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]

{"sheet":"all families","index":16,"n_rows":256,"n_cols":5,"rows_kept":256,"cut":false,"hidden":false,"merged":[[130,1,149,1],[130,2,149,2],[130,3,149,3],[130,4,149,4],[150,1,175,1],[150,2,175,2],[255,1,280,1],[255,2,280,2],[255,3,280,3],[255,4,280,4],[230,1,245,1],[230,2,233,2],[230,3,254,3],[230,4,254,4],[99,1,129,1],[99,2,129,2],[99,3,129,3],[99,4,129,4],[87,1,89,1],[91,1,91,4],[29,2,54,2],[29,3,54,3],[29,4,54,4],[58,1,83,1],[58,2,83,2],[58,3,83,3],[58,4,83,4],[210,1,229,1],[210,2,229,2],[210,3,229,3],[210,4,229,4],[27,1,27,4],[56,1,56,4],[97,1,97,4],[85,1,85,4],[177,1,177,4],[179,1,209,1],[179,2,209,2],[179,3,209,3],[179,4,209,4],[150,3,175,3],[150,4,175,4],[29,1,54,1]]}
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[null,"Family setting - Safe and Supportive Environment - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' Conclusions:"]
[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This Cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text. Fifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect. One targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects. Among school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]
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[null,"Family setting - Changed attitudes and social norms - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This Cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text. Fifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect. One targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects. Among school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]
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[null,"Family setting - Reduced availability - Systematic reviews"]
[null,"Source:","Populations:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]
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[null,"Family setting - Reduced affordability - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]
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[null,"Family setting - Behaviour change - Systematic reviews"]
[null,"Source:","Audience: ","Findings:","Authors' conclusions:"]
[null,"McGovern R et al. Effectiveness of psychosocial interventions for reducing parental substance misuse. Cochrane Database of Systematic Reviews 2021, Issue 3. Art. No.: CD012823.\nAvailable here","Participants were parents who use substances; this included mothers and fathers of children (sons and daughters) under the age of 21 years, regardless of custodial or residency status of the children. Same-sex parents and foster parents were eligible for inclusion.","The authors included 22 unique studies with a total of 2274 participants (mean age of parents ranged from 26.3 to 40.9 years), examining 24 experimental interventions. The majority of studies intervened with mothers only (n = 16; 73%). Heroin, cocaine, and alcohol were the most commonly reported substances used by participants. The interventions targeted either parenting only (n = 13; 59%); drug and alcohol use only (n = 5; 23%); or integrated interventions which addressed both (n = 6; 27%).\nThe authors found moderate-quality evidence that psychosocial interventions are probably more effective at reducing the frequency of parental alcohol misuse than comparison conditions at 6-month (mean difference (MD) −0.32, 95% confidence interval (CI) −0.51 to −0.13; 6 studies, 475 participants) and 12-month follow-up (standardised mean difference (SMD) −0.25, 95% CI −0.47 to −0.03; 4 studies, 366 participants). The authors found a significant reduction in frequency of use at 12 months only (SMD −0.21, 95% CI −0.41 to −0.01; 6 studies, 514 participants, moderate-quality evidence).\nThe authors examined the effect of the intervention type. They found low-quality evidence that psychosocial interventions targeting substance use only may not reduce the frequency of alcohol (6 months: SMD −0.35, 95% CI −0.86 to 0.16; 2 studies, 89 participants and 12 months: SMD −0.09, 95% CI −0.86 to 0.61; 1 study, 34 participants)\nA parenting intervention only, without an adjunctive substance use component, may not reduce frequency of alcohol misuse (6 months: SMD −0.21, 95% CI −0.46 to 0.04, 3 studies; 273 participants, low-quality evidence and 12 months: SMD −0.11, 95% CI −0.64 to 0.41; 2 studies; 219 participants, very low-quality evidence).\nParents receiving integrated interventions which combined both parenting- and substance use-targeted components may reduce alcohol misuse with a small effect size (6 months: SMD −0.56, 95% CI −0.96 to −0.16 and 12 months: SMD −0.42, 95% CI −0.82 to −0.03; 2 studies, 113 participants). However, this evidence was of low quality.\nInterventions appeared to be more often beneficial for fathers than for mothers. The authors found low- to very low-quality evidence of a reduction in frequency of alcohol misuse for mothers at six months only (SMD −0.27, 95% CI −0.50 to −0.04; 4 studies, 328 participants), whilst in fathers there was a reduction in frequency of alcohol misuse (6 months: SMD −0.43, 95% CI −0.78 to −0.09; 2 studies, 147 participants and 12 months: SMD −0.34, 95% CI −0.69 to 0.00; 2 studies, 147 participants).","The authors found moderate-quality evidence that psychosocial interventions probably reduce the frequency at which parents use alcohol. Integrated psychosocial interventions which combine parenting skills interventions with a substance use component may show the most promise. \nWhilst it appears that mothers may benefit less than fathers from intervention, caution is advised in the interpretation of this evidence, as the interventions provided to mothers alone typically did not address their substance use and other related needs. \nThe authors found low-quality evidence from few studies that interventions involving children are not beneficial."]
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[null,"Steele DW, et al. Interventions for Substance Use Disorders in Adolescents: A Systematic Review. Comparative Effectiveness Review No. 225.  AHRQ Publication No. 20-EHC014. Rockville, MD: Agency for Healthcare Research and Quality. May 2020.\nAvailable here.","Adolescents ages 12 to 20 years with problematic substance use or substance use disorder.","The authors included interventions designed to achieve abstinence, reduce use quantity and frequency, improve functional outcomes, and reduce substance-related harms. Interventions were categorised into seven primary intervention components: motivational interviewing (MI), family focused therapy (Fam), cognitive behavioral therapy (CBT), psychoeducation, contingency management (CM), peer group therapy, and intensive case management. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nMotivational interviewing reduced heavy alcohol use days by 0.7 days/month, alcohol use days by 1.2 days/month compared with treatment as usual. Across multiple intensive interventions, family focussed therapy was most effective, reducing alcohol use days by 3.5 days/month compared with treatment as usual.\n\n","Reviewers conclude that :\nBrief interventions: motivational interviewing reduces heavy alcohol use, low Strength of Evidence (SoE) and alcohol use days (moderate SoE). \nFamily focussed therapy: may be most effective in reducing alcohol use (low SoE). More research is needed to identify other effective intensive behavioral interventions for alcohol use disorder. Both motivational interviewing and CBT reduce combined alcohol and other drug use (low SoE).\nPharmacological interventions: systematic reviews in the college settings support use of brief interventions for students with any use, heavy or problematic use. More research is needed to identify the most effective combinations of behavioral and pharmacologic treatments for alcohol use disorders."]
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[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This Cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text. Fifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect. One targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects. Among school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]
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[null,"Family setting - Families are supported and protected - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"McGovern R et al. Effectiveness of psychosocial interventions for reducing parental substance misuse. Cochrane Database of Systematic Reviews 2021, Issue 3. Art. No.: CD012823.\nAvailable here","Participants were parents who use substances; this included mothers and fathers of children (sons and daughters) under the age of 21 years, regardless of custodial or residency status of the children. Same-sex parents and foster parents were eligible for inclusion.","The authors included 22 unique studies with a total of 2274 participants (mean age of parents ranged from 26.3 to 40.9 years), examining 24 experimental interventions. The majority of studies intervened with mothers only (n = 16; 73%). Heroin, cocaine, and alcohol were the most commonly reported substances used by participants. The interventions targeted either parenting only (n = 13; 59%); drug and alcohol use only (n = 5; 23%); or integrated interventions which addressed both (n = 6; 27%).\nThe authors found moderate-quality evidence that psychosocial interventions are probably more effective at reducing the frequency of parental alcohol misuse than comparison conditions at 6-month (mean difference (MD) −0.32, 95% confidence interval (CI) −0.51 to −0.13; 6 studies, 475 participants) and 12-month follow-up (standardised mean difference (SMD) −0.25, 95% CI −0.47 to −0.03; 4 studies, 366 participants). The authors found a significant reduction in frequency of use at 12 months only (SMD −0.21, 95% CI −0.41 to −0.01; 6 studies, 514 participants, moderate-quality evidence).\nThe authors examined the effect of the intervention type. They found low-quality evidence that psychosocial interventions targeting substance use only may not reduce the frequency of alcohol (6 months: SMD −0.35, 95% CI −0.86 to 0.16; 2 studies, 89 participants and 12 months: SMD −0.09, 95% CI −0.86 to 0.61; 1 study, 34 participants)\nA parenting intervention only, without an adjunctive substance use component, may not reduce frequency of alcohol misuse (6 months: SMD −0.21, 95% CI −0.46 to 0.04, 3 studies; 273 participants, low-quality evidence and 12 months: SMD −0.11, 95% CI −0.64 to 0.41; 2 studies; 219 participants, very low-quality evidence).\nParents receiving integrated interventions which combined both parenting- and substance use-targeted components may reduce alcohol misuse with a small effect size (6 months: SMD −0.56, 95% CI −0.96 to −0.16 and 12 months: SMD −0.42, 95% CI −0.82 to −0.03; 2 studies, 113 participants). However, this evidence was of low quality.\nInterventions appeared to be more often beneficial for fathers than for mothers. The authors found low- to very low-quality evidence of a reduction in frequency of alcohol misuse for mothers at six months only (SMD −0.27, 95% CI −0.50 to −0.04; 4 studies, 328 participants), whilst in fathers there was a reduction in frequency of alcohol misuse (6 months: SMD −0.43, 95% CI −0.78 to −0.09; 2 studies, 147 participants and 12 months: SMD −0.34, 95% CI −0.69 to 0.00; 2 studies, 147 participants).","The authors found moderate-quality evidence that psychosocial interventions probably reduce the frequency at which parents use alcohol. Integrated psychosocial interventions which combine parenting skills interventions with a substance use component may show the most promise. \nWhilst it appears that mothers may benefit less than fathers from intervention, caution is advised in the interpretation of this evidence, as the interventions provided to mothers alone typically did not address their substance use and other related needs. \nThe authors found low-quality evidence from few studies that interventions involving children are not beneficial."]
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[null,"Steele DW, et al. Interventions for Substance Use Disorders in Adolescents: A Systematic Review. Comparative Effectiveness Review No. 225.  AHRQ Publication No. 20-EHC014. Rockville, MD: Agency for Healthcare Research and Quality. May 2020.\nAvailable here.","Adolescents ages 12 to 20 years with problematic substance use or substance use disorder.","The authors included interventions designed to achieve abstinence, reduce use quantity and frequency, improve functional outcomes, and reduce substance-related harms. Interventions were categorised into seven primary intervention components: motivational interviewing (MI), family focused therapy (Fam), cognitive behavioral therapy (CBT), psychoeducation, contingency management (CM), peer group therapy, and intensive case management. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nMotivational interviewing reduced heavy alcohol use days by 0.7 days/month, alcohol use days by 1.2 days/month compared with treatment as usual. Across multiple intensive interventions, family focussed therapy was most effective, reducing alcohol use days by 3.5 days/month compared with treatment as usual.\n\n","Reviewers conclude that :\nBrief interventions: motivational interviewing reduces heavy alcohol use, low Strength of Evidence (SoE) and alcohol use days (moderate SoE). \nFamily focussed therapy: may be most effective in reducing alcohol use (low SoE). More research is needed to identify other effective intensive behavioral interventions for alcohol use disorder. Both motivational interviewing and CBT reduce combined alcohol and other drug use (low SoE).\nPharmacological interventions: systematic reviews in the college settings support use of brief interventions for students with any use, heavy or problematic use. More research is needed to identify the most effective combinations of behavioral and pharmacologic treatments for alcohol use disorders."]
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[null,"Gilligan C, et al. Family‐based prevention programmes for alcohol use in young people. Cochrane Database of Systematic Reviews 2019, Issue 3. Art. No.: CD012287. DOI: 10.1002/14651858.CD012287.pub2.\nAvailable here.","School age children (up to 18 years of age)","This Cochrane review aimed to assess the effectiveness of universal, selective, and indicated family-based prevention programmes in preventing alcohol use or problem drinking in school-aged children (up to 18 years of age). \n\nForty six studies (39,822 participants) were included in the review, with 27 classified as universal, 12 as selective, and seven as indicated. Meta‐analyses were performed according to outcome, including studies reporting on the prevalence, frequency, or volume of alcohol use. The overall quality of evidence was low or very low, and there was high, unexplained heterogeneity. \n\nUpon comparing any family intervention to no intervention/standard care, the authors found no intervention effect on the prevalence (SMD) 0.00, 95% CI ‐0.08 to 0.08; studies = 12; participants = 7490; I² = 57%; low‐quality evidence) or frequency (SMD ‐0.31, 95% CI ‐0.83 to 0.21; studies = 8; participants = 1835; I² = 96%; very low‐quality evidence) of alcohol use in comparison with no intervention/standard care. The effect of any parent/family interventions on alcohol consumption volume compared with no intervention/standard care was very small (SMD ‐0.14, 95% CI ‐0.27 to 0.00; studies = 5; participants = 1825; I² = 42%; low‐quality evidence). \n\nWhen comparing parent/family and adolescent interventions versus interventions with young people alone, authors found no difference in alcohol use prevalence (SMD ‐0.39, 95% CI ‐0.91 to 0.14; studies = 4; participants = 5640; I² = 99%; very low‐quality evidence) or frequency (SMD ‐0.16, 95% CI ‐0.42 to 0.09; studies = 4; participants = 915; I² = 73%; very low‐quality evidence). For this comparison, no trials reporting on the volume of alcohol use could be pooled in meta‐analysis. \n\nIn general, the results remained consistent in separate subgroup analyses of universal, selective, and indicated interventions. No adverse effects were reported. \n","The results of this review indicate that there are no clear benefits of family‐based programmes for alcohol use among young people. Patterns differ slightly across outcomes, but overall, the variation, heterogeneity, and number of analyses performed preclude any conclusions about intervention effects. Additional independent studies are required to strengthen the evidence and clarify the marginal effects observed. "]
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[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This Cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text. Fifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect. One targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects. Among school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]

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[null,"Safe and Supportive Environment - Universal Interventions"]
[null,"Source:","Population:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Alcohol interventions in secondary and further education. NG135. London: NICE; 2019. \nAvailable here.\n","• CYP (11 to 18years) in full time education.\n• YP (18 to 25 years) with an Education, health and care (EHC) plan.\n• CYP (11 to 18years) in full time education considered ‘at risk’.\n• YP (18 to 25 years) EHC plan considered ‘at risk’.","This guideline covers interventions in secondary and further education to prevent and reduce alcohol use among children and young people aged 11 up to and including 18. It also covers people aged 11 to 25 with special educational needs or disabilities in full-time education. It will also be relevant to children aged 11 in year 6 of primary school.\n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n1.1 Planning alcohol education\n1.2 Delivering universal alcohol education (Evidence Review A: Universal interventions)\n1.3 Targeted interventions (Evidence review B: Targeted interventions)\n\nThe following recommendations for further research were also identified in Evidence review A and B:\n1. What components of alcohol education delivery contribute to its effectiveness for children and young people aged 11 to 18 in full-time education, and those with special educational needs and disabilities (SEND) up to the age of 25? (Evidence review A: universal interventions)\n2. How effective and cost effective are individual, compared with group, education-based interventions for children and young people aged 11 to 18 in full-time education who are thought to be vulnerable to alcohol misuse? (Evidence review B: targeted interventions)\n3. How effective and cost effective are universal, education-based alcohol interventions for children and young people aged 11 to 25 with SEND? (Evidence review A: universal interventions)\n4. How effective and cost effective are education-based alcohol interventions targeted at children and young people aged 11 to 25 with SEND who are thought to be vulnerable to alcohol misuse? (Evidence review B: targeted interventions)\n5. How effective are education-based alcohol prevention interventions (universal or targeted) for children and young people aged 11 to 25 with SEND in full-time education? (Evidence review A: universal interventions and Evidence review B: targeted interventions)\n6. What methods and techniques help secondary schools and providers to effectively engage with parents and carers as part of a whole-school approach to promote and support alcohol education? (Evidence review A: universal interventions)\n"]
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[null,"National Institute for Health and Care Excellence. Alcohol-use disorders: prevention. PH24. London: NICE; 2010\nAvailable here.\n\n\n\n","Children, young people and adults aged 10 years and above","This guideline covers alcohol problems among people over 10. It aims to prevent and identify such problems as early as possible using a mix of policy and practice.\n\nThe guideline includes the following recommendations. All the recommendations are relevant to the scope of this topic evidence map. The recommendations are supported by the underpinning Evidence reviews 1-3 and Evidence reviews 4-6:\n• Price, availability and marketing\n• Licencing\n• Supporting children and young people aged 10 to 15 years\n• Screening young people aged 16 and 17 years and offering them extended brief interventions\n• Screening adults and offering them brief advice and interventions\n• Referral\n\nThe underpinning evidence reviews in this report identifed several gaps in the evidence and made recommendations for further research with the following overarching question:\nHow does advertising by industry and health agencies affect the drinking behaviour of the population as whole? (This includes the use of new media.)\n\nJuly 2019: NICE checked this guideline and are updating it. For further information, see the surveillance decision."]
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[null,"Safe and Supportive Environment - Universal Interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' Conclusions:"]
[null,"Wolfenden, L. Strategies to improve the implementation of workplace-based policies or practices targeting tobacco, alcohol, diet, physical activity and obesity. Cochrane database Syst Rev 2018, Issue 11. Art. No.: CD012439. DOI: 10.1002/14651858.CD012439.pub2\nAvailable here. ","Adults in the workplace.","This review aimed to assess the effects of strategies for improving the implementation of workplace-based policies or practices targeting diet, physical activity, obesity, tobacco use and alcohol use. Six trials were included, four of which took place in the USA. Four trials employed randomised controlled trial (RCT) designs. Trials were conducted in workplaces from the manufacturing, industrial and services‐based sectors. The sample sizes of workplaces ranged from 12 to 114. Workplace policies and practices targeted included: healthy catering policies; point‐of‐purchase nutrition labelling; environmental supports for healthy eating and physical activity; tobacco control policies; weight management programmes; and adherence to guidelines for staff health promotion. All implementation interventions utilised multiple implementation strategies, the most common of which were educational meetings, tailored interventions and local consensus processes. \n\nOne included trial reported the effects of a workplace health promotion intervention on employee alcohol use (Parker 2010). However, as the implementation strategy and policies and practices targeted by the intervention did not include those addressing alcohol use, the effects on employee alcohol use reported in this trial were not included in the review. None of the other included trials reported effects of implementation strategies on this outcome. \n","Available evidence regarding the effectiveness of implementation strategies for improving implementation of health‐promoting policies and practices in the workplace setting is sparse and inconsistent. Low certainty evidence suggests that such strategies may make little or no difference on measures of implementation fidelity or different employee health behaviour outcomes. It is also unclear if such strategies are cost‐effective or have potential unintended adverse consequences. The limited number of trials identified suggests implementation research in the workplace setting is in its infancy, warranting further research to guide evidence translation in this setting."]
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[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This Cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text. Fifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect. One targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects. Among school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]

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[null,"Safe and Supportive Environment - Selective interventions - NICE Guidance"]
[null,"Source:","Population:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Alcohol interventions in secondary and further education. NG135. London: NICE; 2019. \nAvailable here.\n","• CYP (11 to 18years) in full time education.\n• YP (18 to 25 years) with an Education, health and care (EHC) plan.\n• CYP (11 to 18years) in full time education considered ‘at risk’.\n• YP (18 to 25 years) EHC plan considered ‘at risk’.","This guideline covers interventions in secondary and further education to prevent and reduce alcohol use among children and young people aged 11 up to and including 18. It also covers people aged 11 to 25 with special educational needs or disabilities in full-time education. It will also be relevant to children aged 11 in year 6 of primary school.\n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n1.1 Planning alcohol education\n1.2 Delivering universal alcohol education (Evidence Review A: Universal interventions)\n1.3 Targeted interventions (Evidence review B: Targeted interventions)\n\nThe following recommendations for further research were also identified in Evidence review A and B:\n1. What components of alcohol education delivery contribute to its effectiveness for children and young people aged 11 to 18 in full-time education, and those with special educational needs and disabilities (SEND) up to the age of 25? (Evidence review A: universal interventions)\n2. How effective and cost effective are individual, compared with group, education-based interventions for children and young people aged 11 to 18 in full-time education who are thought to be vulnerable to alcohol misuse? (Evidence review B: targeted interventions)\n3. How effective and cost effective are universal, education-based alcohol interventions for children and young people aged 11 to 25 with SEND? (Evidence review A: universal interventions)\n4. How effective and cost effective are education-based alcohol interventions targeted at children and young people aged 11 to 25 with SEND who are thought to be vulnerable to alcohol misuse? (Evidence review B: targeted interventions)\n5. How effective are education-based alcohol prevention interventions (universal or targeted) for children and young people aged 11 to 25 with SEND in full-time education? (Evidence review A: universal interventions and Evidence review B: targeted interventions)\n6. What methods and techniques help secondary schools and providers to effectively engage with parents and carers as part of a whole-school approach to promote and support alcohol education? (Evidence review A: universal interventions)\n"]
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[null,"Safe and Supportive Environment - Selective Interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' Conclusions:"]
[null,"Moledina A et al (2021). A comprehensive review of prioritised interventions to improve the health and wellbeing of persons with lived experience of homelessness. Campbell Systematic Reviews, 17, e1154.\nAvailable here. ","Populations experiencing homelessness, defined as those who lack stable, permanent, appropriate housing, or who may be without immediate prospects, means, and ability to acquire it","The objective of this systematic review is to identify, appraise, and synthesise the best available evidence on the benefits and cost-effectiveness of interventions to improve the health and social outcomes of people experiencing homelessness.\n\nEligible interventions included permanent supportive housing (PSH), income assistance, standard case management (SCM), peer support, mental health interventions such as assertive community treatment (ACT), intensive case management (ICM), critical time intervention (CTI) and injectable antipsychotics, and substance-use interventions, including supervised consumption facilities (SCFs), managed alcohol programmes and opioid agonist therapy. Outcomes of interest were housing stability, mental health, quality of life, substance use, hospitalisations, employment and income. Only results relevant to this topic evidence map have been extracted below.\n\nManaged alcohol programmes: The review did not identify any eligible studies.\n\nPermanent supportive housing: The effect of permanent housing on substance use was reported in nine trials. Out of these three studies reported improvements in alcohol and drug use in both groups, over time, but no differential benefit of the HF initiative. One study on homeless clients with problematic substance reported no group differences in problems associated with alcohol use, though both groups decreased their alcohol consumption over time. Hybrid approaches to housing (“integrative” versus “parallel” housing) were investigated in a single study. It found no statistically significant difference in the reported days of alcohol use or reported days of drug use both between groups as well as over time. Of note, analysis for this outcome had a lower statistical power as it was restricted to individuals who reported use at the baseline.\n\nIncome-assistance intervention: Four studies examined the effects of income-assistance intervention on substance use. For homeless veterans with substance dependence, CWT immediately reduced the consumption of alcohol and drugs within the first 3 months (β = −44.7%; 95% CI, −69.7% to −19.7%; t = 3.51; p = .001). The addition of priority access to housing vouchers for veterans with a diagnosis of a major psychiatric disorder or an alcohol/drug disorder, compared to existing case management, led to decreased days of drinking to intoxication (1.46 vs. 1.95, t = 0.73, p = .0053) and fewer days of alcohol use over the 3-year study period. However, no significant association was identified between priority access to housing subsidies and differences in the scores of the Addiction Severity Index (ASI). For homeless families with children aged 15 or younger, rental subsidies without case management did not lead to decreased use of substance compared to the usual community housing services.\n\nSCM and peer support interventions: Six studies reported on substance-use outcomes with different SCM treatments. Homeless male veterans with addictions problems with three to 6 months of hospital stays plus case management showed better improvements in the alcohol- and drug-use composite scores, but these were short-lived compared to TAU after 24 months. A three-arm trial reported reductions in average days of alcohol and drug consumption in a case-management-only group, a CM-with-supported-housing group in graduates of short-term in-patient substance-use programme who lacked housing. Homeless alcohol abusers who were offered different intensities of SCM (n = 469) showed no significant between-group differences in days of alcohol use. Similarly, a three-arm trial with homeless women and their intimate partners found no significant differences in substance-use outcomes between groups: a peer-mentored group, a group in a nurse case-managed programme, and one in an SCM programme. Another 12-months trial on homeless men recently released from jails/prisons who were exposed to weekly peer coaching, intermediate peer coaching compared with the usual treatment did not find any significant effects on substance-use outcomes. An RCT with homeless women with alcohol-use problems who received brief guideline-based interventions from primary care providers and referrals to the CM for ongoing follow-up visits for 6 months did not find any significant between-group differences on alcohol-consumption rates, percentages of completely abstained participants, or negative consequences of alcohol use, respectively.\n","PSH interventions improved housing stability for people living with homelessness. High-intensity case management and income-assistance interventions may also benefit housing stability. The majority of included interventions inconsistently detected benefits for mental health, quality of life, substance use, employment and income. These results have important implications for public health, social policy, and community programme implementation. The COVID-19 pandemic has highlighted the urgent need to tackle systemic inequality and address social determinants of health. Our review provides timely evidence on PSH, income assistance, and mental health interventions as a means of improving housing stability. PSH has major cost and policy implications and this approach could play a key role in ending homelessness. Evidence-based reviews like this one can guide practice and outcome research and contribute to advancing international networks committed to solving homelessness."]
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[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This Cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text. Fifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect. One targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects. Among school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]

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[null,"Safe and Supported Environment - Indicated Interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"Hennessy EA et al. Recovery schools for improving behavioral and academic outcomes among students in recovery from substance use disorders: a systematic review. Campbell Systematic Reviews 2018; 9. \nAvailable here. ","Students in recovery from substance use who were enrolled part-time or full-time in secondary (high school) or postsecondary (college or university) educational institutions. ","The review focused on two types of recover schools: recovery high schools (RHSs), which are schools that award secondary school dipolmas and offer a range of therapeutic services in addition to standard educational curricula; and collegiate recovery communities (CRCs), which offer therapeutic and sober support services on college campuses. \n\nOnly one study met the criteria for inclusion in the review. The study used a quasi-experimental design to examine the effects of RHSs on high school students' academic and substance use outcomes. No eligible studies examining CRCs were identified. \n\nThe results from the one eligible RHS study indicated that after adjusting for pretest values, students in the RHS condition reported levels of grade point averages (g = 0.26, 95% CI [-0.04, 0.56]), truancy (g = 0.01, 95% CI [-0.29, 0.31]), and alcohol use (g = 0.23, 95% CI [-0.07, 0.53]) similar to participants in the comparison condition. However, students in the RHS condition reported improvements in absenteeism (g = 0.56, 95% CI [0.25, 0.87]), abstinence from alcohol/drugs (OR = 4.36, 95% CI [1.19, 15.98]), marijuana use (g = 0.51, 95% CI [0.20, 0.82]), and other drug use (g = 0.45, 95% CI [0.14, 0.76]).\n\nOverall, there was a serious risk of bias in the one included study. The study had a serious risk of bias due to confounding, low risk of bias due to selection of participants into the study, moderate risk of bias due to classification of interventions, inconclusive risk of bias due to deviations from intended interventions, inconclusive risk of bias due to missing data, moderate risk of bias in measurement of outcomes, and low risk of bias in selection of reported results.","There is insufficient evidence regarding the effectiveness of RHSs and CRCs for improving academic and substance use outcomes among students in recovery from SUDs. Only one identified study examined the effectiveness of RHSs. Although the study reported some beneficial effects, the results must be interpreted with caution given the study's potential risk of bias due to confounding and limited external validity. The paucity of evidence on the effectiveness of recovery schools, as documented in this review, thus suggest the need for caution in the widespread adoption of recovery schools for students in recovery from SUDs. Given the lack of empirical support for these recovery schools, additional rigorous evaluation studies are needed to replicate the findings from the one study included in this review. Furthermore, additional research examining the costs of recovery schools may be needed, to help school administrators determine the potential cost-benefits associated with recovery schools. "]

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[null,"Changed attitudes and social norms - Universal interventions - NICE Guidance"]
[null,"Source:","Population:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Alcohol interventions in secondary and further education. NG135. London: NICE; 2019. \nAvailable here.\n","• CYP (11 to 18years) in full time education.\n• YP (18 to 25 years) with an Education, health and care (EHC) plan.\n• CYP (11 to 18years) in full time education considered ‘at risk’.\n• YP (18 to 25 years) EHC plan considered ‘at risk’.","This guideline covers interventions in secondary and further education to prevent and reduce alcohol use among children and young people aged 11 up to and including 18. It also covers people aged 11 to 25 with special educational needs or disabilities in full-time education. It will also be relevant to children aged 11 in year 6 of primary school.\n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n1.1 Planning alcohol education\n1.2 Delivering universal alcohol education (Evidence Review A: Universal interventions)\n1.3 Targeted interventions (Evidence review B: Targeted interventions)\n\nThe following recommendations for further research were also identified in Evidence review A and B:\n1. What components of alcohol education delivery contribute to its effectiveness for children and young people aged 11 to 18 in full-time education, and those with special educational needs and disabilities (SEND) up to the age of 25? (Evidence review A: universal interventions)\n2. How effective and cost effective are individual, compared with group, education-based interventions for children and young people aged 11 to 18 in full-time education who are thought to be vulnerable to alcohol misuse? (Evidence review B: targeted interventions)\n3. How effective and cost effective are universal, education-based alcohol interventions for children and young people aged 11 to 25 with SEND? (Evidence review A: universal interventions)\n4. How effective and cost effective are education-based alcohol interventions targeted at children and young people aged 11 to 25 with SEND who are thought to be vulnerable to alcohol misuse? (Evidence review B: targeted interventions)\n5. How effective are education-based alcohol prevention interventions (universal or targeted) for children and young people aged 11 to 25 with SEND in full-time education? (Evidence review A: universal interventions and Evidence review B: targeted interventions)\n6. What methods and techniques help secondary schools and providers to effectively engage with parents and carers as part of a whole-school approach to promote and support alcohol education? (Evidence review A: universal interventions)\n"]
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[null,"National Institute for Health and Care Excellence. Alcohol-use disorders: prevention. PH24. London: NICE; 2010\nAvailable here.\n\n\n\n","Children, young people and adults aged 10 years and above","This guideline covers alcohol problems among people over 10. It aims to prevent and identify such problems as early as possible using a mix of policy and practice.\n\nThe guideline includes the following recommendations. All the recommendations are relevant to the scope of this topic evidence map. The recommendations are supported by the underpinning Evidence reviews 1-3 and Evidence reviews 4-6:\n• Price, availability and marketing\n• Licencing\n• Supporting children and young people aged 10 to 15 years\n• Screening young people aged 16 and 17 years and offering them extended brief interventions\n• Screening adults and offering them brief advice and interventions\n• Referral\n\nThe underpinning evidence reviews in this report identifed several gaps in the evidence and made recommendations for further research with the following overarching question:\nHow does advertising by industry and health agencies affect the drinking behaviour of the population as whole? (This includes the use of new media.)\n\nJuly 2019: NICE checked this guideline and are updating it. For further information, see the surveillance decision."]
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[null,"National Institute for Health and Care Excellence. Behaviour change: general approaches. PH6. London: NICE; 2007\nAvailable here.\n\n\n\n","General population","This guideline covers a set of principles that can be used to help people change their behaviour. The aim is for practitioners to use these principles to encourage people to adopt a healthier lifestyle by, for example, stopping smoking, adopting a healthy diet and being more physically active.\n\nThe guideline includes the following recommendations. All the recommendations are relevant to the scope of this topic evidence map. The recommendations are supported by the underpinning Evidence review 1.\n• Providing education and training for those delivering them\n• Delivery of these activities, including one-to-one and community-based programmes and those aimed at specific populations\n• Evaluation of their effectiveness and cost effectiveness\n\nThe Programme Development Group identified a number of gaps in the evidence related to behaviour change interventions and programmes, based on an assessment of the evidence and made recommendations for research to address the most important gaps in the evidence. Please refer to 4. Recommendations for research' section of the guidance.\n\nNovember 2017: NICE checked this guideline and found no new evidence that affects the recommendations in this guideline."]
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[null,"Changed attitudes and social norms - Universal Interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"Wolfenden L et al. Strategies for enhancing the implementation of school‐based policies or practices targeting diet, physical activity, obesity, tobacco or alcohol use. Cochrane Database of Systematic Reviews 2022, Issue 8.\nAvailable here.","School age children (between 5 to 18 years of age)","This Cochrane review aimed to to find out how effective strategies were in supporting the implementation of school‐based interventions to address student diet, physical activity, unhealthy weight gain, and tobacco or alcohol use. Examples of strategies include methods of improving quality, education and training, feedback on how the school was doing, prompts and reminders, and educational resources (e.g. manuals).\n\nThe reviewers included an additional 11 trials in this update bringing the total number of included studies in the review to 38. Of these, 22 were conducted in the USA. Twenty‐six studies used RCT designs. Seventeen trials tested strategies to implement healthy eating, 12 physical activity and six a combination of risk factors. Just one trial sought to increase the implementation of interventions to delay initiation or reduce the consumption of alcohol. All trials used multiple implementation strategies, the most common being educational materials, educational outreach and educational meetings. The overall certainty of evidence was low and ranged from very low to moderate for secondary review outcomes. Only findings relevant to this evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nPooled analyses of RCTs found, relative to a control, the use of implementation strategies may result in a large increase in the implementation of interventions in schools (SMD 1.04, 95% CI 0.74 to 1.34; 22 RCTs, 1917 participants; low‐certainty evidence). One RCT assessed measures of student alcohol use and found strategies to support implementation may result in a slight increase in use (odds ratio 1.10, 95% CI 0.77 to 1.56; P = 0.60; 2105 participants).","The use of implementation strategies may result in large increases in implementation of interventions, and slight improvements in measures of student diet, and physical activity. Further research is required to assess the impact of implementation strategies on such behavioural‐ and obesity‐related outcomes, including on measures of alcohol use, where the findings of one trial suggest it may slightly increase student risk. Given the low certainty of the available evidence for most measures further research is required to guide efforts to facilitate the translation of evidence into practice in this setting."]
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[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This Cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text. Fifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect. One targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects. Among school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]
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[null,"Foxcroft DR et al. Social norms information for alcohol misuse in university and college students. Cochrane Database Syst Rev 2015, Issue 12. Art. No.: CD006748. DOI: 10.1002/14651858.CD006748.pub4.\nAvailable here. \n","University or college students. ","This Cochrane review aimed to determine whether social norms interventions reduce alcohol‐related negative consequences, alcohol misuse or alcohol consumption when compared with a control (ranging from assessment only/no intervention to other educational or psychosocial interventions) among university and college students.\n\nSeventy studies (44,958 participants) were included in the review, and 63 studies (42,784 participants) in the meta‐analyses. Overall, the risk of bias assessment showed that these studies provided moderate or low quality evidence. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nBinge drinking at four or more months (results pooled across delivery modes): SMD ‐0.06, 95 per cent CI ‐0.11 to ‐0.02 (participants = 11,292; studies = 16; moderate quality evidence), equivalent to 2.7 per cent fewer binge drinkers if 30‐day prevalence is 43.9 per cent.\n\nDrinking quantity at four or more months (results pooled across delivery modes): SMD ‐0.08, 95 per cent CI ‐0.12 to ‐0.04 (participants = 21,169; studies = 32; moderate quality evidence), equivalent to a reduction of 0.9 drinks consumed each week, from a baseline of 13.7 drinks per week.\n\nDrinking frequency at four or more months: WF SMD ‐0.11, 95 per cent CI ‐0.17 to ‐0.04 (participants = 9929; studies = 10; moderate quality evidence), equivalent to a decrease of 0.17 drinking days/wk, from a baseline of 2.74 days/wk; individual face‐to‐face normative feedback SMD ‐0.21, 95 per cent CI ‐0.31 to ‐0.10 (participants = 1464; studies = 8; moderate quality evidence), equivalent to a decrease of 0.32 drinking days/wk, from a baseline of 2.74 days/wk. No effects were found for group face‐to‐face normative feedback or normative marketing campaign.\n\nEstimated blood alcohol concentration (BAC) at four or more months: (Peak BAC results pooled across delivery modes) SMD ‐0.08, 95 per cent CI ‐0.17 to 0.00 (participants = 7198; studies = 11; low quality evidence), equivalent to a reduction in peak BAC from an average of 0.144 per cent to 0.135 per cent. No effects were found for typical BAC with individual face‐to‐face normative feedback.\n","The results of this review indicate that no substantive meaningful benefits are associated with social norms interventions for prevention of alcohol misuse among college/university students. Although some significant effects were found, we interpret the effect sizes as too small, given the measurement scales used in the studies included in this review, to be of relevance for policy or practice. Moreover, the significant effects are not consistent for all misuse measures, heterogeneity was a problem in some analyses and bias cannot be discounted as a potential cause of these findings. "]
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[null,"Langford R et al. The WHO Health Promoting School framework for improving the health and well‐being of students and their academic achievement. Cochrane Database Syst Rev 2014, Issue 4. Art. No.: CD008958. DOI: 10.1002/14651858.CD008958.pub2 \nAvailable here. ","School aged children (aged 4-18).","This Cochrane review aimed to assess the effectiveness of the Health Promoting Schools (HPS) framework in improving the health and well‐being of students and their academic achievement.\n\nSixty seven eligible cluster trials, randomising 1,443 schools or districts were included. This is made up of 1,345 schools and 98 districts. The studies tackled a range of health issues: physical activity (4), nutrition (12), physical activity and nutrition combined (18), bullying (7), tobacco (5), alcohol (2), sexual health (2), violence (2), mental health (2), hand‐washing (2), multiple risk behaviours (7), cycle‐helmet use (1), eating disorders (1), sun protection (1), and oral health (1). Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nReview authors report that the quality of evidence overall was low to moderate as determined by the GRADE approach. Risk of bias assessments identified methodological limitations, including heavy reliance on self‐reported data and high attrition rates for some studies. In addition, there was a lack of long‐term follow‐up data for most studies.\n\nEight studies provided data on alcohol use and all but one were included in the meta‐analysis. Overall, there was no evidence that any of the different intervention approaches were effective in reducing alcohol intake.","The results of this review provide evidence for the effectiveness of some interventions based on the HPS framework for improving certain health outcomes but not others. More well‐designed research is required to establish the effectiveness of this approach for other health topics and academic achievement."]
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[null,"Siegfried N et al. Restricting or banning alcohol advertising to reduce alcohol consumption in adults and adolescents. Cochrane Database Syst Rev 2014, Issue 11. Art. No.: CD010704. DOI: 10.1002/14651858.CD010704.pub2.\nAvailable here. \n","Adults of any age and adolescents (defined by WHO as aged 10 to 19 years)","The aim of this Cochrane review was to evaluate the benefits, harms and costs of restricting or banning the advertising of alcohol, via any format, compared with no restrictions or counter‐advertising, on alcohol consumption in adults and adolescents.\n\nOne small RCT (80 male student participants conducted in the Netherlands and published in 2009) and three ITS studies (general population studies in Canadian provinces conducted in the 1970s and 80s) were examined. The RCT found that young men exposed to movies with a low‐alcohol content drank less than men exposed to movies with a high‐alcohol content (MD ‐0.65 drinks; 95 per cent CI ‐1.2, ‐0.07; p value = 0.03, very‐low‐quality evidence). Young men exposed to commercials with a neutral content compared with those exposed to commercials for alcohol drank less (MD ‐0.73 drinks; 95 per cent CI ‐1.30, ‐0.16; p value = 0.01, very‐low‐quality evidence). Outcomes were assessed immediately after the end of the intervention (lasting 1.5 hours), so no follow‐up data were available.\n\nTwo of the ITS studies evaluated the implementation of an advertising ban and one study evaluated the lifting of such a ban (GRADE: very‐low‐quality evidence). Each of the three ITS studies evaluated a different type of ban (partial or full) compared with different degrees of restrictions or no restrictions during the control period. The results from the three ITS studies were inconsistent. A meta‐analysis of the two studies that evaluated the implementation of a ban showed an overall mean non‐significant increase in beer consumption in the general population of 1.10 per cent following the ban (95 per cent CI ‐5.26, 7.47; p value = 0.43; I2 = 83 per cent, very‐low‐quality evidence). This finding is consistent with an increase, no difference, or a decrease in alcohol consumption. In the study evaluating the lifting of a total ban on all forms of alcohol advertising to a partial ban on spirits advertising only, which utilised an Abrupt Auto‐regressive Integrated Moving Average model, the volume of all forms of alcohol sales decreased by 11.11 kilolitres (95 per cent CI ‐27.56, 5.34; p value = 0.19) per month after the ban was lifted. In this model, beer and wine sales increased per month by 14.89 kilolitres (95 per cent CI 0.39, 29.39; p value = 0.04) and 1.15 kilolitres (95 per cent CI ‐0.91, 3.21; p value = 0.27), respectively, and spirits sales decreased statistically significantly by 22.49 kilolitres (95 per cent CI ‐36.83, ‐8.15; p value = 0.002).\n\nNone of the studies were funded by the alcohol or advertising industries.\n","Authors conclude that there is a lack of robust evidence for or against recommending the implementation of alcohol advertising restrictions. Advertising restrictions should be implemented within a high‐quality, well‐monitored research programme to ensure the evaluation over time of all relevant outcomes in order to build the evidence base. "]

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[null,"Changed attitudes and social norms - NICE Guidance"]
[null,"Source:","Population:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Alcohol interventions in secondary and further education. NG135. London: NICE; 2019. \nAvailable here.\n","• CYP (11 to 18years) in full time education.\n• YP (18 to 25 years) with an Education, health and care (EHC) plan.\n• CYP (11 to 18years) in full time education considered ‘at risk’.\n• YP (18 to 25 years) EHC plan considered ‘at risk’.","This guideline covers interventions in secondary and further education to prevent and reduce alcohol use among children and young people aged 11 up to and including 18. It also covers people aged 11 to 25 with special educational needs or disabilities in full-time education. It will also be relevant to children aged 11 in year 6 of primary school.\n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n1.1 Planning alcohol education\n1.2 Delivering universal alcohol education (Evidence Review A: Universal interventions)\n1.3 Targeted interventions (Evidence review B: Targeted interventions)\n\nThe following recommendations for further research were also identified in Evidence review A and B:\n1. What components of alcohol education delivery contribute to its effectiveness for children and young people aged 11 to 18 in full-time education, and those with special educational needs and disabilities (SEND) up to the age of 25? (Evidence review A: universal interventions)\n2. How effective and cost effective are individual, compared with group, education-based interventions for children and young people aged 11 to 18 in full-time education who are thought to be vulnerable to alcohol misuse? (Evidence review B: targeted interventions)\n3. How effective and cost effective are universal, education-based alcohol interventions for children and young people aged 11 to 25 with SEND? (Evidence review A: universal interventions)\n4. How effective and cost effective are education-based alcohol interventions targeted at children and young people aged 11 to 25 with SEND who are thought to be vulnerable to alcohol misuse? (Evidence review B: targeted interventions)\n5. How effective are education-based alcohol prevention interventions (universal or targeted) for children and young people aged 11 to 25 with SEND in full-time education? (Evidence review A: universal interventions and Evidence review B: targeted interventions)\n6. What methods and techniques help secondary schools and providers to effectively engage with parents and carers as part of a whole-school approach to promote and support alcohol education? (Evidence review A: universal interventions)\n"]
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[null,"Changed attitudes and social norms - Selective Interventions - Systematic reviews- Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This Cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text. Fifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect. One targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects. Among school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]
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[null,"Foxcroft DR et al. Motivational interviewing for the prevention of alcohol misuse in young adults. Cochrane Database Syst Rev 2016, Issue 7. Art. No.: CD007025. DOI: 10.1002/14651858.CD007025.pub4.\nAvailable here.\n","Young adults up to 25 years of age (higher risk individuals or settings). ","This Cochrane review aimed to assess the effects of motivational interviewing (MI) interventions for preventing alcohol misuse and alcohol‐related problems in young adults. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nEighty four trials (22,872 participants) were included, with 70/84 studies reporting interventions in higher risk individuals or settings. Studies with follow‐up periods of at least four months were of more interest in assessing the sustainability of intervention effects and were also less susceptible to short‐term reporting or publication bias. Overall, the risk of bias assessment showed that these studies provided moderate or low quality evidence.\n\nAt four or more months follow‐up, effects in favour of MI were found for the quantity of alcohol consumed (standardised mean difference (SMD) −0.11, 95 per cent confidence interval (CI) −0.15 to −0.06 or a reduction from 13.7 drinks/week to 12.5 drinks/week; moderate quality evidence); frequency of alcohol consumption (SMD −0.14, 95 per cent CI −0.21 to −0.07 or a reduction in the number of days/week alcohol was consumed from 2.74 days to 2.52 days; moderate quality evidence); and peak blood alcohol concentration, or BAC (SMD −0.12, 95 per cent CI −0.20 to 0.05, or a reduction from 0.144 per cent to 0.131 per cent; moderate quality evidence).\n\nFurther analyses showed that there was no clear relationship between the duration of the MI intervention (in minutes) and effect size. Subgroup analyses revealed no clear subgroup effects for longer‐term outcomes (four or more months) for assessment only versus alternative intervention controls; for university/college vs other settings; or for higher risk vs all/low risk participants.\n","The results of this review indicate that there are no substantive, meaningful benefits of MI interventions for preventing alcohol use, misuse or alcohol‐related problems. Although the reviewers found some statistically significant effects, the effect sizes were too small, given the measurement scales used in the included studies, to be of relevance to policy or practice. Moreover, the statistically significant effects are not consistent for all misuse measures, and the quality of evidence is not strong, implying that any effects could be inflated by risk of bias."]

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[null,"Changed attitudes and social norms - Indicated Interventions - NICE Guidance"]
[null,"Source:","Population:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Behaviour change: general approaches. PH6. London: NICE; 2007\nAvailable here.\n\n\n\n","General population\nProblem drinkers\nThose with raised risk (e.g. pregnant women, )\n","This guideline covers a set of principles that can be used to help people change their behaviour. The aim is for practitioners to use these principles to encourage people to adopt a healthier lifestyle by, for example, stopping smoking, adopting a healthy diet and being more physically active.\n\nThe recommendations in this guideline cover:\n• Providing education and training for those delivering them\n• Delivery of these activities, including one-to-one and community-based programmes and those aimed at specific populations\n• Evaluation of their effectiveness and cost effectiveness\n\nThis guideline was checked in November 2017. NICE found no new evidence that affects the recommendations in this guideline."]
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[null,"Changed attitudes and social norms - Indicated Interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"Kaner E et al. Personalised digital interventions for reducing hazardous and harmful alcohol consumption in community-dwelling populations. Cochrane Database Syst Rev 2017, Issue 9, Art. No.: CD011479. DOI: 10.1002/14651858.CD011479.pub2. \nAvailable here. \n","People living in the community whose alcohol consumption had been screened as hazardous or harmful. ","This Cochrane review aimed to assess the effectiveness and cost‐effectiveness of digital interventions for reducing hazardous and harmful alcohol consumption, alcohol‐related problems, or both, in people living in the community.\n\nFifty-seven studies which randomised a total of 34,390 participants were included in the review. The main sources of bias were from attrition and participant blinding (36 per cent and 21 per cent of studies respectively, high risk of bias). Forty one studies (42 comparisons, 19,241 participants) provided data for the primary meta‐analysis, which demonstrated that participants using a digital intervention drank approximately 23g alcohol weekly (95 per cent CI 15 to 30) (about 3 UK units) less than participants who received no or minimal interventions at end of follow up (moderate‐quality evidence). \n\nFifteen studies (16 comparisons, 10,862 participants) demonstrated that participants who engaged with digital interventions had less than one drinking day per month fewer than no intervention controls (moderate‐quality evidence), 15 studies (3587 participants) showed about one binge drinking session less per month in the intervention group compared to no intervention controls (moderate‐quality evidence), and in 15 studies (9791 participants) intervention participants drank one unit per occasion less than no intervention control participants (moderate‐quality evidence). \n\nOnly five small studies (390 participants) compared digital and face‐to‐face interventions. There was no difference in alcohol consumption at end of follow up (MD 0.52 g/week, 95 per cent CI ‐24.59 to 25.63; low‐quality evidence). \n\nThe most frequently mentioned theories or models in the included studies were Motivational Interviewing Theory (7/20), Transtheoretical Model (6/20) and Social Norms Theory (6/20). Over half of the interventions (n = 21, 51per cent) made no mention of theory. Only two studies used theory to select participants or tailor the intervention. There was no evidence of an association between reporting theory use and intervention effectiveness.\n","There is moderate‐quality evidence that digital interventions may lower alcohol consumption, with an average reduction of up to three (UK) standard drinks per week compared to control participants. Substantial heterogeneity and risk of performance and publication bias may mean the reduction was lower. Low‐quality evidence from fewer studies suggested there may be little or no difference in impact on alcohol consumption between digital and face‐to‐face interventions. \n\nThe BCTs of behaviour substitution, problem solving and credible source were associated with the effectiveness of digital interventions to reduce alcohol consumption and warrant further investigation in an experimental context. \n\nReporting of theory use was very limited and often unclear when present. Over half of the interventions made no reference to any theories. Limited reporting of theory use was unrelated to heterogeneity in intervention effectiveness. \n"]

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[null,"Reduced availability - - Universal interventions - NICE Guidance"]
[null,"Source:","Population:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Alcohol-use disorders: prevention. PH24. London: NICE; 2010\nAvailable here.\n\n\n\n","Children, young people and adults aged 10 years and above","This guideline covers alcohol problems among people over 10. It aims to prevent and identify such problems as early as possible using a mix of policy and practice.\n\nThe guideline includes the following recommendations. All the recommendations are relevant to the scope of this topic evidence map. The recommendations are supported by the underpinning Evidence reviews 1-3 and Evidence reviews 4-6:\n• Price, availability and marketing\n• Licencing\n• Supporting children and young people aged 10 to 15 years\n• Screening young people aged 16 and 17 years and offering them extended brief interventions\n• Screening adults and offering them brief advice and interventions\n• Referral\n\nThe underpinning evidence reviews in this report identifed several gaps in the evidence and made recommendations for further research with the following overarching question:\nHow does advertising by industry and health agencies affect the drinking behaviour of the population as whole? (This includes the use of new media.)\n\nJuly 2019: NICE checked this guideline and are updating it. For further information, see the surveillance decision."]
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[null,"Reduced availability - Universal Interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"Hollands  GJ et al. Altering the availability or proximity of food, alcohol, and tobacco products to change their selection and consumption. Cochrane Database of Systematic Reviews 2019, Issue 9. Art. No.: CD012573. DOI: 10.1002/14651858.CD012573.pub3.\nAvailable here.","Adults","This Cochrane review aimed to:\n1. To assess the impact on selection and consumption of altering the availability or proximity of (a) food (including non‐alcoholic beverages), (b) alcohol, and (c) tobacco products.\n2. To assess the extent to which the impact of these interventions is modified by characteristics of: i. studies, ii. interventions, and iii. participants.\n\nThe reviewers included 24 studies, with the majority (20/24) giving concerns about risk of bias. All of the included studies investigated food products; none investigated alcohol or tobacco. ","The authors concluded that:\n- Further research is warranted in real‐world settings, intervening across a wider range of foods as well as alcohol and tobacco products and over sustained time periods"]

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[null,"Reduced availability - Selective Interventions"]
[null,"Source:","Populations:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]

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[null,"Reduced availability - Indicated Interventions"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]

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[null,"Reduced affordability - Universal interventions - NICE Guidance"]
[null,"Source:","Population:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Alcohol-use disorders: prevention. PH24. London: NICE; 2010\nAvailable here.\n\n\n\n","Children, young people and adults aged 10 years and above","This guideline covers alcohol problems among people over 10. It aims to prevent and identify such problems as early as possible using a mix of policy and practice.\n\nThe guideline includes the following recommendations. All the recommendations are relevant to the scope of this topic evidence map. The recommendations are supported by the underpinning Evidence reviews 1-3 and Evidence reviews 4-6:\n• Price, availability and marketing\n• Licencing\n• Supporting children and young people aged 10 to 15 years\n• Screening young people aged 16 and 17 years and offering them extended brief interventions\n• Screening adults and offering them brief advice and interventions\n• Referral\n\nThe underpinning evidence reviews in this report identifed several gaps in the evidence and made recommendations for further research with the following overarching question:\nHow does advertising by industry and health agencies affect the drinking behaviour of the population as whole? (This includes the use of new media.)\n\nJuly 2019: NICE checked this guideline and are updating it. For further information, see the surveillance decision."]
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[]
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[]
[null,"Reduced affordability - Universal Interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]

{"sheet":"aff sel","index":27,"n_rows":25,"n_cols":5,"rows_kept":25,"cut":false,"hidden":false,"merged":[[22,1,22,4]]}
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[null,"Reduced affordability - Selective Interventions"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]

{"sheet":"aff ind","index":28,"n_rows":25,"n_cols":5,"rows_kept":25,"cut":false,"hidden":false,"merged":[[22,1,22,4]]}
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[null,"Reduced affordability - Indicated Interventions"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]

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[null,"Behaviour change - Universal interventions - NICE Guidance"]
[null,"Source:","Audience:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Alcohol-use disorders: prevention. PH24. London: NICE; 2010\nAvailable here.\n\n\n\n","Children, young people and adults aged 10 years and above","This guideline covers alcohol problems among people over 10. It aims to prevent and identify such problems as early as possible using a mix of policy and practice.\n\nThe guideline includes the following recommendations. All the recommendations are relevant to the scope of this topic evidence map. The recommendations are supported by the underpinning Evidence reviews 1-3 and Evidence reviews 4-6:\n• Price, availability and marketing\n• Licencing\n• Supporting children and young people aged 10 to 15 years\n• Screening young people aged 16 and 17 years and offering them extended brief interventions\n• Screening adults and offering them brief advice and interventions\n• Referral\n\nThe underpinning evidence reviews in this report identifed several gaps in the evidence and made recommendations for further research with the following overarching question:\nHow does advertising by industry and health agencies affect the drinking behaviour of the population as whole? (This includes the use of new media.)\n\nJuly 2019: NICE checked this guideline and are updating it. For further information, see the surveillance decision."]
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[null,"National Institute for Health and Care Excellence. Behaviour change: general approaches. PH6. London: NICE; 2007\nAvailable here.\n\n\n\n","General population","This guideline covers a set of principles that can be used to help people change their behaviour. The aim is for practitioners to use these principles to encourage people to adopt a healthier lifestyle by, for example, stopping smoking, adopting a healthy diet and being more physically active.\n\nThe guideline includes the following recommendations. All the recommendations are relevant to the scope of this topic evidence map. The recommendations are supported by the underpinning Evidence review 1.\n• Providing education and training for those delivering them\n• Delivery of these activities, including one-to-one and community-based programmes and those aimed at specific populations\n• Evaluation of their effectiveness and cost effectiveness\n\nThe Programme Development Group identified a number of gaps in the evidence related to behaviour change interventions and programmes, based on an assessment of the evidence and made recommendations for research to address the most important gaps in the evidence. Please refer to 4. Recommendations for research' section of the guidance.\n\nNovember 2017: NICE checked this guideline and found no new evidence that affects the recommendations in this guideline."]
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[null,"Behaviour change - Universal Interventions - Systematic reviews"]
[null,"Source:","Audience: ","Findings:","Authors' conclusions:"]
[null,"Stead M, Angus K, Langley T, Katikireddi SV, Hinds K, Hilton S,  et al. Mass media to communicate public health messages in six health topic areas: a systematic review and other reviews of the evidence. Public Health Res 2019;7(8)\nAvailable here.","General population.","There was limited evidence of impact on alcohol use\nMass media campaigns were found to increase knowledge and awareness across several topics.\nAlthough there was limited evidence on characteristics associated with effectiveness, longer or greater intensity campaigns were found to be more effective. \nThe evidence suggested that targeting messages to target audiences can be effective. \nThere was little evidence regarding the role that theory or media channels may play in campaign effectiveness, and also limited evidence on new media.","Overall, the evidence is mixed but suggests that longer and more intensive campaigns are likely to be more effective and message design and targeting campaigns to particular population groups can be effective."]
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[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. \n\nFifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect.\n\nOne targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects.\n\nAmong school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]
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[null,"Brown TJ, Todd A, O'Malley CL, Moore HJ, Husband AK, Bambra C,  et al. Community pharmacy interventions for public health priorities: a systematic review of community pharmacy-delivered smoking, alcohol and weight management interventions. Public Health Res 2016;4(2)\nAvailable here. ","Adults","The searches identified over 14,000 records, of which 24 studies were included. There were two alcohol, 12 smoking cessation, five weight loss and five multicomponent interventions that included pharmacotherapy and lifestyle changes in participants with diabetes mellitus, dyslipidaemia or hypertension. Nine of the studies were UK based; seven of the studies were rated ‘strong’ for quality. All studies were of adults. \nThere was insufficient evidence for the effectiveness of community pharmacy-based brief alcohol interventions.\nNone of the five multicomponent studies demonstrated an improvement compared with control for anthropometric outcomes in participants with comorbidities, but they did show improvement in measures associated with the comorbidities. Very few studies explored if and how sociodemographic or socioeconomic variables moderated the effect of interventions. In two studies based in areas of high deprivation, where participants chose the intervention, the sociodemographic characteristics of participants differed between intervention settings. There were also differences in recruitment, attendance and retention of participants by type of setting. The evidence suggests that a distinct group of people might access pharmacies compared with other settings for alcohol management, smoking cessation and weight loss. There is insufficient evidence to examine the relationship between behaviour change strategies and effectiveness; or evidence of consistent implementation factors or training components that underpin effective interventions.","Evaluations of interventions to manage alcohol misuse and obesity, set within the community pharmacy, are needed. \nThe effect of community pharmacy interventions on health inequalities is unclear. Future research in this area is warranted, and trials should include the assessment of age, sex, ethnicity, socioeconomic status and contextual factors, and present analysis of how these factors moderate effectiveness."]

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[null,"Behaviour change - Selective interventions - NICE Guidance"]
[null,"Source:","Population:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Behaviour change: digital and mobile health interventions. NG183. London: NICE; 2020.\nAvailable here.\n\n\n","Everyone, including Young People under 16 (and their families or 16 carers)\n• Pre-existing health conditions:\nOverweight/ obesity\nHypertension and cardiovascular disease\nRespiratory diseases\nCancers for which managing smoking may improve health outcomes\nMental health conditions\nSpecific consideration will also be given to people with learning disabilities and people with neurodevelopmental disorders such as autism.","This guideline covers interventions that use a digital or mobile platform to help people eat more healthily, become more active, stop smoking, reduce their alcohol intake or practise safer sex. The interventions include those delivered by text message, apps, wearable devices or the internet. The guideline only includes those that are delivered by the technology itself and not by healthcare professionals using technology to deliver interventions.\n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n1.1 Developing digital and mobile health interventions\n1.2 Commissioning digital and mobile health interventions\n1.3 Using digital and mobile health interventions\n1.4 Interventions for diet and physical activity\n1.5 Interventions for smoking\n1.6 Interventions for alcohol use (Based on Evidence Review B: alcohol)\n1.7 Interventions for unsafe sexual behaviour\n\nThe following recommendations for further research were also identified in evidence review B on alcohol:\n1. How can providers and healthcare professionals identify groups that do not initially engage, or do not stay engaged, with digital and mobile health behaviour change interventions?\n2. What components and characteristics of digital and mobile health behaviour change interventions are most effective, separately and in combination, to achieve behaviour change?\n3. What is the effectiveness and cost effectiveness of digital and mobile health behaviour change interventions in low socioeconomic and other underserved groups?\n4. Are digital and mobile health behaviour change interventions as effective as face-to-face, standard care, or combination approaches for some populations?\n5. What are the harms and adverse effects associated with different digital and mobile health behaviour change interventions?"]
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[null,"Behaviour change - Selective Interventions - Systematic reviews"]
[null,"Source:","Audience:","Findings:","Authors' conclusions:"]
[null,"Meiksin R et al. E-health interventions targeting STIs, sexual risk, substance use and mental health among men who have sex with men: four systematic reviews. Public Health Research. 2022;10(4):1-322. \nAvailable here.","Gay, bisexual and other men (including trans men) who have sex with men, including those who have been diagnosed as HIV positive, as well as those whose last HIV test was negative or who have never tested for HIV","This review aimed to  synthesise evidence addressing the following: (1) What approaches and theories of change do existing e-health interventions employ to prevent human immunodeficiency virus/sexually transmitted infections, sexual risk, alcohol/drug use or mental ill health among men who have sex with men? (2) What factors influence implementation? (3) What are the effects of such interventions on the aforementioned epidemics? (4) Are such interventions cost-effective? Only information relevant to this topic evidence map has been extracted below.\n\nEffects on alcohol and drug use: Two studies presented estimates for drug use (table 8 in the full report), both focused on open-ended interventions. Neither quantified outcomes on alcohol use specifically. Although both studies presented short-term results, only one study presented mid-term results. However, the primary method of analysis in that study was a longitudinal regression model; the authors present these estimates as well. Across studies, there was no consistent evidence of effectiveness of interventions in reducing drug use.\n\nMeta-analysis: Effect sizes for alcohol and drug use are presented in the full report in Figure 14 for outcomes of < 3 months post intervention and in Figure 15 for outcomes between 3 months and 1 year post intervention. In both plots, negative effect sizes represent benefits. The review authors do not present a pooled effect size for these estimates as meta-analyses included both substantial heterogeneity (I2 = 95% both overall and only including effect sizes of up to 3 months’ follow-up) and too few studies to explore this heterogeneity.","The authors concluded that the findings for drug use could not be meta-analysed because of study heterogeneity. Studies addressing this outcome did not present consistent evidence of effectiveness. Trials did not report effects on alcohol use or mental health."]
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[null,"Filges T, Dalgaard NT and Viinholt BC. 2022. Outreach programs to improve life circumstances and prevent further adverse developmental trajectories of at‐risk youth in OECD countries: A systematic review. Campbell Systematic Reviews, 18(4), p.e1282.\nAvailable here\n","Young people between 8 and 25 years of age living in OECD countries, who either have experienced or is at-risk of experiencing an adverse outcome such as school failure or drop-out, runaway and homelessness, substance and/or alcohol abuse, unemployment, long-term poverty, delinquency/criminal behaviour were eligible.","This Campbell systematic review examines the effects of outreach programmes on problem/high-risk behaviour of young people between eight and 25 year old, living in OECD countries. The review summarises evidence from five studies undertaken in the USA and Canada that involved 578 participants in total.\n\nFour of the five studies used for meta analysis were from the USA and one was from Canada. The timespan in which included studies were carried out was 32 years, from 1985 to 2017; on average the intervention year was 2005. The average number of participants in the analysed interventions was 116, ranging from 30 to 346 and the average number of controls was 81, ranging from 32 to 321. At most, the results from two studies could be pooled in a single meta-analysis. It was only possible to pool the outcomes drug (other than marijuana) use, marijuana use and alcohol use each at two different time points (one and 3 months follow up). At 1 month follow up the weighted averages varied between zero and 0.05 and at 3 months follow up between −0.17 and 0.07. None of them were statistically significant. In addition, a number of other outcomes were reported in a single study only.","Overall, there were too few studies included in any of the meta-analyses in order for us to draw any conclusion concerning the effectiveness of outreach. The vast majority of studies were undertaken in the USA.\nFurther, because too few studies reported results on the same type of outcome at most two studies could be combined in a particular meta-analysis. Given the limited number of rigorous studies available from countries other than the USA, it would be natural to consider conducting a series of randomised controlled trials evaluating the effectiveness of outreach for at-risk youth in countries outside the USA. The trial(s) should be designed, conducted and reported according to methodological criteria for rigour in respect of internal and external validity to achieve robust results and preferably reporting a larger number of outcomes."]
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[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. \n\nFifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect.\n\nOne targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects.\n\nAmong school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]
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[null,"O'Connor EA et al. Screening and behavioral counseling interventions to reduce unhealthy alcohol use in adolescents and adults: An updated systematic review for the U.S. Preventive Services Task Force. Rockville MD: Agency for Healthcare Research and Quality; 2018. \nAvailable here. ","Adolescents or adults age 12 years or older. ","One hundred and thirteen studies (n=314,466) were included across all Key Questions. The authors did not find any studies that examined the benefits or harms of screening programs to reduce unhealthy alcohol use. For adolescents, data supported the use of the National Institute on Alcohol Abuse and Alcoholism Youth Screen and other similar one- or two-item screeners to detect alcohol use disorder. For adults, brief (1- to 3-item) screeners commonly reported sensitivity and specificity between 0.70 and 0.85, typically having better sensitivity than the full Alcohol Use Disorders Identification Test (AUDIT) for identifying the full spectrum of unhealthy use. However, the AUDIT tended to have higher specificity, particularly at the standard cutoff of 8 or higher.  \n\nIdentified interventions to reduce unhealth alcohol use were generally counselling interventions, with most involving one or two sessions (90% involved ≤ 4 sessions) with a median of 30 minutes contact time (88% involved ≤ 2 hours contact). The most commonly reported intervention element was the use of personalized normative feedback sessions, in which participants were shown how their alcohol use compares to others; this technique was used in more than half of the included trials and almost all trials in younger adults. Motivational techniques were also common, particularly in combination with personalized normative feedback.\n\nEvidence on the effects of interventions to reduce unhealthy alcohol use in adolescents was limited to two trials; both found mixed results for reduced alcohol use and did not report health or related outcomes. \n\nIn adults, interventions reduced the number of drinks per week (weighted mean difference, −1.82 [95% confidence interval {CI}, −2.42 to −1.22]), the proportion exceeding recommended drinking limits (odds ratio [OR], 0.60 [95% CI, 0.53 to 0.67]), and the proportion reporting a heavy use episode (OR, 0.62 [95% CI, 0.55 to 0.71]), and increased the proportion of pregnant women reporting abstinence (OR, 1.92 [95% CI, 1.19 to 3.09]) after 6 to 12 months. \n\nHeterogeneity was high and effect size was associated with a number of study characteristics such as setting, target age of the population, publication year, study size, and average baseline-use levels, but not clearly associated with any intervention characteristics. Data on effectiveness in important subgroups were very limited, but analyses by sex, the most commonly reported subgroup analysis, did not indicate differences in effectiveness of the interventions. Health outcomes were sparsely reported and, with some exceptions, generally did not demonstrate group differences in effect. No evidence of harm was found.","Among adults, screening instruments are available that can effectively identify persons with unhealthy alcohol use and that are feasible for use in primary care settings, and interventions in those who screen positive are associated with reductions in unhealthy alcohol use. There was no evidence that these interventions have unintended harmful effects. More evidence is needed to determine whether screening for unhealthy alcohol use is beneficial for adolescents."]
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[null,"Tansil KA et al. Alcohol Electronic Screening and Brief Intervention A Community Guide Systematic Review. Am J Prev Med 2016;51(5):801–811). \nAvailable here. \n","Unspecified","This Community Guide review focused on e-screening and brief interventions (e-SBIs) that are similar in structure and intent to Alcohol screening and brief intervention (ASBI) and examined how e-SBI effectiveness varied by key intervention characteristics, in contrast to previous systematic reviews of e-SBI. This review is unique in that it excluded highly interactive interventions (i.e., those with more than three human-to-human sessions); those that were part of a treatment program for alcohol use disorders; those that were primarily educational programs (e.g., Alcohol Edu, College Alc); and those that only used an electronic device for monitoring drinking following traditional ASBI.\n\nTwenty-four studies (28 study arms) provided results for excessive drinkers only and seven studies (eight study arms) reported results for all drinkers. Nearly all studies found that e-SBI reduced excessive alcohol consumption and related harms: nine study arms reported a median 23.9% reduction in binge-drinking intensity (maximum drinks/binge episode) and nine study arms reported a median 16.5% reduction in binge-drinking frequency. Reductions in drinking measures were sustained for up to 12 months.","The authors conclude that, according to Community Guide rules of evidence, e-SBI is an effective method for reducing excessive alcohol consumption and related harms among intervention participants. Implementation of e-SBI could complement population-level strategies previously recommended by the Community Preventive Services Task Force for reducing excessive drinking (e.g., increasing alcohol taxes and regulating alcohol outlet density)."]
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[null,"Foxcroft DR et al. Motivational interviewing for the prevention of alcohol misuse in young adults. Cochrane Database Syst Rev 2016, Issue 7. Art. No.: CD007025. DOI: 10.1002/14651858.CD007025.pub4.\nAvailable here.\n","Young adults up to 25 years of age. ","This Cochrane review aimed to assess the effects of motivational interviewing (MI) interventions for preventing alcohol misuse and alcohol‐related problems in young adults.\n\nEighty four trials (22,872 participants) were included, with 70/84 studies reporting interventions in higher risk individuals or settings. Studies with follow‐up periods of at least four months were of more interest in assessing the sustainability of intervention effects and were also less susceptible to short‐term reporting or publication bias. Overall, the risk of bias assessment showed that these studies provided moderate or low quality evidence.\n\nAt four or more months follow‐up, effects in favour of MI were found for the quantity of alcohol consumed (standardised mean difference (SMD) −0.11, 95 per cent confidence interval (CI) −0.15 to −0.06 or a reduction from 13.7 drinks/week to 12.5 drinks/week; moderate quality evidence); frequency of alcohol consumption (SMD −0.14, 95 per cent CI −0.21 to −0.07 or a reduction in the number of days/week alcohol was consumed from 2.74 days to 2.52 days; moderate quality evidence); and peak blood alcohol concentration, or BAC (SMD −0.12, 95 per cent CI −0.20 to 0.05, or a reduction from 0.144 per cent to 0.131 per cent; moderate quality evidence).\nA marginal effect in favour of MI was found for alcohol problems (SMD −0.08, 95 per cent CI −0.17 to 0.00 or a reduction in an alcohol problems scale score from 8.91 to 8.18; low quality evidence) and no effects for binge drinking (SMD −0.04, 95 per cent CI −0.09 to 0.02, moderate quality evidence) or for average BAC (SMD −0.05, 95 per cent CI −0.18 to 0.08; moderate quality evidence). Other alcohol‐related behavioural outcomes were considered, and at four or more month’s follow‐up, we found no effects on drink‐driving (SMD −0.13, 95 per cent CI −0.36 to 0.10; moderate quality of evidence) or other alcohol‐related risky behaviour (SMD −0.15, 95 per cent CI −0.31 to 0.01; moderate quality evidence).\n\nFurther analyses showed that there was no clear relationship between the duration of the MI intervention (in minutes) and effect size. Subgroup analyses revealed no clear subgroup effects for longer‐term outcomes (four or more months) for assessment only versus alternative intervention controls; for university/college vs other settings; or for higher risk vs all/low risk participants.\n","The results of this review indicate that there are no substantive, meaningful benefits of MI interventions for preventing alcohol use, misuse or alcohol‐related problems. Although we found some statistically significant effects, the effect sizes were too small, given the measurement scales used in the included studies, to be of relevance to policy or practice. Moreover, the statistically significant effects are not consistent for all misuse measures, and the quality of evidence is not strong, implying that any effects could be inflated by risk of bias."]

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[null,"Behaviour change - Indicated interventions - NICE Guidance"]
[null,"Source:","Population:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Behaviour change: individual approaches. PH49. London: NICE; 2014. \nAvailable here.\n","Everyone aged 16 years and older","This guideline covers changing health-damaging behaviours among people aged 16 and over using interventions such as goals and planning, feedback and monitoring, and social support. It aims to help tackle a range of behaviours including alcohol misuse, poor eating patterns, lack of physical activity, unsafe sexual behaviour and smoking.\n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n1. Develop a local behaviour change policy and strategy\n2. Ensure organisation policies, strategies, resources and training all support behaviour change\n3. Commission interventions from services willing to share intervention details and data\n4. Commission high quality, effective behaviour change interventions\n5. Plan behaviour change interventions and programmes taking local needs into account\n6. Develop acceptable, practical and sustainable behaviour change interventions and programmes\n7. Use proven behaviour change techniques when designing interventions (Evidence review1 and Evidence review2)\n8. Ensure interventions meet individual needs\n9. Deliver very brief, brief, extended brief and high intensity behaviour change interventions and programmes\n10. Ensure behaviour change is maintained for at least a year (Evidence review1 and Evidence review2)\n11. Commission training for all staff involved in helping to change people's behaviour\n12. Provide training for behaviour change practitioners\n13. Provide training for health and social care practitioners\n14. Assess behaviour change practitioners and provide feedback\n15. Monitor behaviour change interventions\n16. Evaluate behaviour change interventions\n17. National support for behaviour change interventions and programmes\n\nEvidence review1 did not identify any recommendations for further research. Evidence review 2 made the following recommendation for further research:\n5.7 How do behaviour change techniques lead to change? What are the best methods of testing the relationship between the theories that describe change processes and the effectiveness of interventions in practice?"]
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[null,"National Institute for Health and Care Excellence. Nalmefene for reducing alcohol consumption in people with alcohol dependence. TA325. London: NICE; 2014.\nAvailable here.  \n\n","Adults with mild alcohol dependence (as defined in CG115) who have a high drinking risk level (≥ 60 g/day of pure alcohol for men and ≥ 40 g/day for women) without physical withdrawal symptoms and who do not require immediate detoxification","NICE currently make the following recommendation regarding use of Nalmefene for reducing alcohol consumption in people with alcohol dependence (the highlighted recommendation is relevant to the scope of this topic evidence map):\n\n1.1 Nalmefene is recommended within its marketing authorisation, as an option for reducing alcohol consumption, for people with alcohol dependence (Evidence review): \n• Who have a high drinking risk level (defined as alcohol consumption of more than 60 g per day for men and more than 40g per day for women, according to the World Health Organization's drinking risk levels) without physical withdrawal symptoms and;\n• Who do not require immediate detoxification.\n\nThe marketing authorisation states that nalmefene should:\n• Only be prescribed in conjunction with continuous psychosocial support focused on treatment adherence and reducing alcohol consumption and; \n• Be initiated only in patients who continue to have a high drinking risk level 2 weeks after initial assessment.\n\nMarch 2018: NICE reviewed the evidence for TA325. They found found nothing new that affects the recommendations in this guidance. This guidance will be reviewed if there is new evidence that is likely to affect the recommendations."]
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[null,"National Institute for Health and Care Excellence. Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence. CG115. London: NICE; 2011\nAvailable here.\n\n","Adults (>18 years) or young people (10 to 17 years of age) with a diagnosis of alcohol dependence or meeting criteria for harmful alcohol use (30 to 50 units of alcohol per week)","This guideline covers identifying, assessing and managing alcohol-use disorders (harmful drinking and alcohol dependence) in adults and young people aged 10-17 years. It aims to reduce harms (such as liver disease, heart problems, depression and anxiety) from alcohol by improving assessment and setting goals for reducing alcohol consumption. \n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n• Principles of care\n• Identification and assessment \n• Interventions for alcohol misuse (Evidence review 2011)\n\nThe following recommendations for further research were also identified in Evidence reviews underpinning this guidance:\n1 Is contingency management effective in reducing alcohol consumption in people who misuse alcohol compared with standard care?\n2 What methods are most effective for assessing and diagnosing the presence and severity of alcohol misuse in children and young people?\n3 Is acupuncture effective in reducing alcohol consumption compared with standard care?\n4. For which service users who are moderately and severely dependent on alcohol is an assertive community treatment model a clinically and cost-effective intervention compared with standard care?\n5. For people with moderate and severe alcohol dependence who have significant comorbid problems, is an intensive residential rehabilitation programme clinically and cost effective when compared with intensive community-based care?\n6 For people with alcohol dependence, which medication is most likely to improve adherence and thereby promote abstinence and prevent relapse?\n\nOctober 2022: NICE updated the recommendation about behavioural couples therapy to clarify that this is not suitable in cases of domestic abuse and to add a cross reference to the NICE technology appraisal guidance on nalmefene. They also updated information about off-label prescribing, and added cross references to legislation on controlled drugs and driving, to MHRA advice on addiction to benzodiazepines and codeine, and to NICE's guidelines on smoking, on antisocial personality disorder and on coexisting mental illness and substance misuse community health and social care services.\nJuly 2019: NICE have found no new evidence that affects the recommendations."]
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[null,"National Institute for Health and Care Excellence. Coexisting severe mental illness (psychosis) and substance misuse: assessment and management in healthcare settings. CG120. London: NICE; 2011. \nAvailable here.\n","People aged 14 years and over with coexisting severe mental illness (psychosis) and substance misuse","This guideline covers assessing and managing people aged 14 years and over with coexisting severe mental illness (psychosis) and substance misuse. It aims to help healthcare professionals guide people with psychosis with coexisting substance misuse to stabilise, reduce or stop their substance misuse, to improve treatment adherence and outcomes, and to enhance their lives. \n\nThe guideline includes the following recommendations. All the recommendations are relevant to the scope of this topic evidence map. The recommendations are supported by evidence from the underpinning Evidence Review 2011. \n• Principles of care\n• Recognising psychosis with coexisting substance misuse\n• Primary care\n• Secondary care mental health services\n• Substance misuse services\n• Inpatient mental health services and staffed accommodation\n• Specific issues for young people with psychosis and coexisting substance misuse\n\nThe following recommendations for further research were also identified in Evidence reviews underpinning this guidance:\n1. What are the prevalence, risk and protective factors, and course of illness for different combinations of psychosis and coexisting substance misuse (for example, schizophrenia and cannabis misuse or bipolar disorder and alcohol misuse)?\n2. What risk factors predict the onset of substance misuse in young people with psychosis?\n3. Are psychosocial interventions clinically and cost effective when compared with standard care for people with psychosis and coexisting substance misuse?\n4. Are environmental interventions clinically and cost effective when compared with standard care for people with psychosis and coexisting substance misuse?\n5. Is clozapine clinically and cost effective when compared with other pharmacological interventions for people with psychosis and coexisting substance misuse?\n\nNovember 2016: NICE reviewed the evidence and found no new evidence that affects the current recommendations in this guideline."]
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[null,"National Institute for Health and Care Excellence. Alcohol-use disorders: diagnosis and management of physical complications. CG100. London: NICE; 2010. \nAvailable here. \n","People aged 10 years and over with alcohol-use disorders","This guideline covers care for adults and young people (aged 10 years and older) with physical health problems that are completely or partly caused by an alcohol-use disorder. It aims to improve the health of people with alcohol-use disorders by providing recommendations on managing acute alcohol withdrawal and treating alcohol-related conditions. \n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n• Acute alcohol withdrawal (Evidence review 2014)\n• Wernicke’s encephalopathy\n• Alcohol-related liver disease\n• Alcohol-related pancreatitis\n\nThe following recommendations for further research were also identified in Evidence reviews underpinning this guidance:\n2. What is the efficacy and cost effectiveness of clomethiazole compared with chlordiazepoxide or carbamazepine or benzodiazepines for the treatment of acute alcohol withdrawal with regard to the outcomes of withdrawal severity, risk of seizures, risk of delirium tremens, length of treatment and patient satisfaction?\n\nJanuary 2019: NICE checked this guideline and are updating it. For more information, see the surveillance decision."]
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[null,"National Institute for Health and Care Excellence. Behaviour change: general approaches. PH6. London: NICE; 2007\nAvailable here.\n\n\n\n","General population","This guideline covers a set of principles that can be used to help people change their behaviour. The aim is for practitioners to use these principles to encourage people to adopt a healthier lifestyle by, for example, stopping smoking, adopting a healthy diet and being more physically active.\n\nThe guideline includes the following recommendations. All the recommendations are relevant to the scope of this topic evidence map. The recommendations are supported by the underpinning Evidence review 1.\n• Providing education and training for those delivering them\n• Delivery of these activities, including one-to-one and community-based programmes and those aimed at specific populations\n• Evaluation of their effectiveness and cost effectiveness\n\nThe Programme Development Group identified a number of gaps in the evidence related to behaviour change interventions and programmes, based on an assessment of the evidence and made recommendations for research to address the most important gaps in the evidence. Please refer to 4. Recommendations for research' section of the guidance.\n\nNovember 2017: NICE checked this guideline and found no new evidence that affects the recommendations in this guideline."]
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[null,"Behaviour change - Indicated interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"Agabio R et al. Baclofen for alcohol use disorder. Cochrane Database Syst Rev 2023, Issue 1. Art.No. CD012557. DOI:0.1002/14651858.CD012557.pub3.\nAvailable here. ","Adults with a diagnosis of alcohol dependence. ","This is an update of a Cochrane Review first published in 2018. The aim of this update was to evaluate the benefits and harms of baclofen on achieving and maintaining abstinence or reducing alcohol consumption in people with AUD compared to placebo, no treatment or any other pharmacological relapse prevention treatment. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nThis update included 17 RCTs (1818 participants). Ten studies compared baclofen to placebo or another medication; seven compared two baclofen doses to placebo or another medication. Globally, 15 studies compared baclofen to placebo, two baclofen to acamprosate and two baclofen to naltrexone. In 16 studies, participants received psychosocial treatments. The authors judged most studies at low risk of selection, performance, detection (subjective outcome), attrition and reporting bias. Ten studies detoxified participants before treatment; in seven studies, participants were still drinking at the beginning of treatment. Treatment duration was 12 weeks for 15 RCTs and longer in two studies. Baclofen daily dose was 30 mg to 300 mg: 10 RCTs used low doses (30 mg or less); eight RCTs medium doses (above 30 and 100 mg or less) and four RCTs high doses (above 100 mg).\n\nCompared to placebo, moderate‐certainty evidence found that baclofen probably decreases the risk to relapse (risk ratio (RR) 0.87, 95% confidence interval (CI) 0.77 to 0.99; 12 studies, 1057 participants). This result was confirmed among detoxified participants but not among other subgroups of participants.\n\nHigh‐certainty evidence found that baclofen increases the percentage of days abstinent (mean difference (MD) 9.07, 95% CI 3.30 to 14.85; 16 studies, 1273 participants). This result was confirmed among all subgroups of participants except non‐detoxified or those who received medium doses.\n\nThere was no difference between baclofen and placebo in the other primary outcomes: heavy drinking days (standardised mean difference (SMD) −0.18, 95% CI −0.48 to 0.11; 13 studies, 840 participants; moderate‐certainty evidence); and number of drinks per drinking days (MD −0.45, 95% CI −1.20 to 0.30; 9 studies, 392 participants; moderate‐certainty evidence).\n\nCompared to acamprosate, one study (60 participants) found no differences in any outcomes but the evidence was very uncertain: relapse (RR 1.25, 95% CI 0.71 to 2.20; very low‐certainty evidence).\n\nCompared to naltrexone, baclofen may increase the risk of relapse (RR 2.50, 95% CI 1.12 to 5.56; 1 study, 60 participants; very low‐certainty evidence) but the evidence is very uncertain.","The authors concluded that baclofen likely reduces the risk of relapse to any drinking and increases the percentage of abstinent days, mainly among detoxified participants. It does not increase the number of participants with at least one adverse event, those who dropout for any reason or due to adverse events. It probably does not reduce number of heavy drinking days and the number of drinks per drinking days. Current evidence suggests that baclofen may help people with AUD in maintaining abstinence. The results of comparisons of baclofen with acamprosate and naltrexone were mainly based on only one study."]
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[null,"Goldberg SB et al. Mindfulness‐based interventions for substance use disorders. Cochrane Database of Systematic Reviews 2021, Issue 10.\nAvailable here.","Patients suffering from Substance use disorders including individuals with alcohol, prescription‐, illicit‐ and poly‐substance use disorders","This Cochrane review aimed to determine the effects of MBIs for SUDs in terms of substance use outcomes, craving and adverse events compared to standard care, further psychotherapeutic, psychosocial or pharmacological interventions, or instructions, waiting list and no treatment.\n\nForty RCTs met the inclusion criteria, with 35 RCTs involving 2825 participants eligible for meta‐analysis. All studies were at high risk of performance bias and most were at high risk of detection bias.\n\nMindfulness‐based interventions (MBIs) versus no treatment: Twenty‐four RCTs included a comparison between MBI and no treatment. The evidence was uncertain about the effects of MBIs relative to no treatment on all primary outcomes: continuous abstinence rate (post: risk ratio (RR) = 0.96, 95% CI 0.44 to 2.14, 1 RCT, 112 participants; follow‐up: RR = 1.04, 95% CI 0.54 to 2.01, 1 RCT, 112 participants); percentage of days with substance use (post‐treatment: standardized mean difference (SMD) = 0.05, 95% CI ‐0.37 to 0.47, 4 RCTs, 248 participants; follow‐up: SMD = 0.21, 95% CI ‐0.12 to 0.54, 3 RCTs, 167 participants); and consumed amount (post‐treatment: SMD = 0.10, 95% CI ‐0.31 to 0.52, 3 RCTs, 221 participants; follow‐up: SMD = 0.33, 95% CI 0.00 to 0.66, 2 RCTs, 142 participants). Evidence was uncertain for craving intensity and serious adverse events. Analysis of treatment acceptability indicated MBIs result in little to no increase in study attrition relative to no treatment (RR = 1.04, 95% CI 0.77 to 1.40, 21 RCTs, 1087 participants). Certainty of evidence for all other outcomes was very low due to imprecision, risk of bias, and/or inconsistency. Data were unavailable to evaluate adverse events.\n\nMindfulness‐based interventions (MBIs) versus other treatments (standard of care, cognitive behavioral therapy, psychoeducation, support group, physical exercise, medication): Nineteen RCTs included a comparison between MBI and another treatment. The evidence was very uncertain about the effects of MBIs relative to other treatments on continuous abstinence rate at post‐treatment (RR = 0.80, 95% CI 0.45 to 1.44, 1 RCT, 286 participants) and follow‐up (RR = 0.57, 95% CI 0.28 to 1.16, 1 RCT, 286 participants), and on consumed amount at post‐treatment (SMD = ‐0.42, 95% CI ‐1.23 to 0.39, 1 RCT, 25 participants) due to imprecision and risk of bias. The evidence suggests that MBIs reduce percentage of days with substance use slightly relative to other treatments at post‐treatment (SMD = ‐0.21, 95% CI ‐0.45 to 0.03, 5 RCTs, 523 participants) and follow‐up (SMD = ‐0.39, 95% CI ‐0.96 to 0.17, 3 RCTs, 409 participants). The evidence was very uncertain about the effects of MBIs relative to other treatments on craving intensity due to imprecision and inconsistency. Analysis of treatment acceptability indicated MBIs result in little to no increase in attrition relative to other treatments (RR = 1.06, 95% CI 0.89 to 1.26, 14 RCTs, 1531 participants). Data were unavailable to evaluate adverse events.","In comparison with no treatment, the evidence is uncertain regarding the impact of MBIs on SUD‐related outcomes. MBIs result in little to no higher attrition than no treatment. In comparison with other treatments, MBIs may slightly reduce days with substance use at post‐treatment and follow‐up (4 to 10 months). The evidence is uncertain regarding the impact of MBIs relative to other treatments on abstinence, consumed substance amount, or craving. MBIs result in little to no higher attrition than other treatments. Few studies reported adverse events."]
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[null,"McGovern R et al. Effectiveness of psychosocial interventions for reducing parental substance misuse. Cochrane Database of Systematic Reviews 2021, Issue 3. Art. No.: CD012823.\nAvailable here","Participants were parents who use substances; this included mothers and fathers of children (sons and daughters) under the age of 21 years, regardless of custodial or residency status of the children. Same-sex parents and foster parents were eligible for inclusion.","The authors included 22 unique studies with a total of 2274 participants (mean age of parents ranged from 26.3 to 40.9 years), examining 24 experimental interventions. The majority of studies intervened with mothers only (n = 16; 73%). Heroin, cocaine, and alcohol were the most commonly reported substances used by participants. The interventions targeted either parenting only (n = 13; 59%); drug and alcohol use only (n = 5; 23%); or integrated interventions which addressed both (n = 6; 27%).\nThe authors found moderate-quality evidence that psychosocial interventions are probably more effective at reducing the frequency of parental alcohol misuse than comparison conditions at 6-month (mean difference (MD) −0.32, 95% confidence interval (CI) −0.51 to −0.13; 6 studies, 475 participants) and 12-month follow-up (standardised mean difference (SMD) −0.25, 95% CI −0.47 to −0.03; 4 studies, 366 participants). The authors found a significant reduction in frequency of use at 12 months only (SMD −0.21, 95% CI −0.41 to −0.01; 6 studies, 514 participants, moderate-quality evidence).\nThe authors examined the effect of the intervention type. They found low-quality evidence that psychosocial interventions targeting substance use only may not reduce the frequency of alcohol (6 months: SMD −0.35, 95% CI −0.86 to 0.16; 2 studies, 89 participants and 12 months: SMD −0.09, 95% CI −0.86 to 0.61; 1 study, 34 participants)\nA parenting intervention only, without an adjunctive substance use component, may not reduce frequency of alcohol misuse (6 months: SMD −0.21, 95% CI −0.46 to 0.04, 3 studies; 273 participants, low-quality evidence and 12 months: SMD −0.11, 95% CI −0.64 to 0.41; 2 studies; 219 participants, very low-quality evidence).\nParents receiving integrated interventions which combined both parenting- and substance use-targeted components may reduce alcohol misuse with a small effect size (6 months: SMD −0.56, 95% CI −0.96 to −0.16 and 12 months: SMD −0.42, 95% CI −0.82 to −0.03; 2 studies, 113 participants). However, this evidence was of low quality.\nInterventions appeared to be more often beneficial for fathers than for mothers. The authors found low- to very low-quality evidence of a reduction in frequency of alcohol misuse for mothers at six months only (SMD −0.27, 95% CI −0.50 to −0.04; 4 studies, 328 participants), whilst in fathers there was a reduction in frequency of alcohol misuse (6 months: SMD −0.43, 95% CI −0.78 to −0.09; 2 studies, 147 participants and 12 months: SMD −0.34, 95% CI −0.69 to 0.00; 2 studies, 147 participants).","The authors found moderate-quality evidence that psychosocial interventions probably reduce the frequency at which parents use alcohol. Integrated psychosocial interventions which combine parenting skills interventions with a substance use component may show the most promise. \nWhilst it appears that mothers may benefit less than fathers from intervention, caution is advised in the interpretation of this evidence, as the interventions provided to mothers alone typically did not address their substance use and other related needs. \nThe authors found low-quality evidence from few studies that interventions involving children are not beneficial."]
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[null,"Kelly  JF, Humphreys  K, Ferri  M. Alcoholics Anonymous and other 12‐step programs for alcohol use disorder. Cochrane Database of Systematic Reviews 2020, Issue 3. Art. No.: CD012880. DOI: 10.1002/14651858.CD012880.pub2.\nAvailable here.","Non‐coerced adults with Alcohol Use Disorder.","AA/TSF (manualized) compared to treatments with a different theoretical orientation (e.g. CBT) (randomized/quasi‐randomized evidence) \nRCTs comparing manualized AA/TSF to other clinical interventions (e.g. CBT), showed AA/TSF improves rates of continuous abstinence at 12 months (risk ratio (RR)) 1.21, 95% confidence interval (CI) 1.03 to 1.42; 2 studies, 1936 participants; high‐certainty evidence). This effect remained consistent at both 24 and 36 months. \nFor percentage days abstinent (PDA), AA/TSF appears to perform as well as other clinical interventions at 12 months (mean difference (MD) 3.03, 95% CI ‐4.36 to 10.43; 4 studies, 1999 participants; very low‐certainty evidence), and better at 24 months (MD 12.91, 95% CI 7.55 to 18.29; 2 studies, 302 participants; very low‐certainty evidence) and 36 months (MD 6.64, 95% CI 1.54 to 11.75; 1 study, 806 participants; very low‐certainty evidence). \nFor longest period of abstinence (LPA), AA/TSF may perform as well as comparison interventions at six months (MD 0.60, 95% CI ‐0.30 to 1.50; 2 studies, 136 participants; low‐certainty evidence). \nFor drinking intensity, AA/TSF may perform as well as other clinical interventions at 12 months, as measured by drinks per drinking day (DDD) (MD ‐0.17, 95% CI ‐1.11 to 0.77; 1 study, 1516 participants; moderate‐certainty evidence) and percentage days heavy drinking (PDHD) (MD ‐5.51, 95% CI ‐14.15 to 3.13; 1 study, 91 participants; low‐certainty evidence). \nFor alcohol‐related consequences, AA/TSF probably performs as well as other clinical interventions at 12 months (MD ‐2.88, 95% CI ‐6.81 to 1.04; 3 studies, 1762 participants; moderate‐certainty evidence). \nFor alcohol addiction severity, one study found evidence of a difference in favor of AA/TSF at 12 months (P < 0.05; low‐certainty evidence). \nThis study examines results for the same outcomes for non-manualized AA/TSF.\n","There is high quality evidence that manualized AA/TSF interventions are more effective than other established treatments, such as CBT, for increasing abstinence. Non‐manualized AA/TSF may perform as well as these other established treatments. AA/TSF interventions, both manualized and non‐manualized, may be at least as effective as other treatments for other alcohol‐related outcomes. AA/TSF probably produces substantial healthcare cost savings among people with alcohol use disorder. "]
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[null,"Steele DW, et al. Interventions for Substance Use Disorders in Adolescents: A Systematic Review. Comparative Effectiveness Review No. 225.  AHRQ Publication No. 20-EHC014. Rockville, MD: Agency for Healthcare Research and Quality. May 2020.\nAvailable here.","Adolescents ages 12 to 20 years with problematic substance use or substance use disorder.","The authors included interventions designed to achieve abstinence, reduce use quantity and frequency, improve functional outcomes, and reduce substance-related harms. Interventions were categorised into seven primary intervention components: motivational interviewing (MI), family focused therapy (Fam), cognitive behavioral therapy (CBT), psychoeducation, contingency management (CM), peer group therapy, and intensive case management. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nMotivational interviewing reduced heavy alcohol use days by 0.7 days/month, alcohol use days by 1.2 days/month compared with treatment as usual. Across multiple intensive interventions, family focussed therapy was most effective, reducing alcohol use days by 3.5 days/month compared with treatment as usual.\n\n","Reviewers conclude that :\nBrief interventions: motivational interviewing reduces heavy alcohol use, low Strength of Evidence (SoE) and alcohol use days (moderate SoE). \nFamily focussed therapy: may be most effective in reducing alcohol use (low SoE). More research is needed to identify other effective intensive behavioral interventions for alcohol use disorder. Both motivational interviewing and CBT reduce combined alcohol and other drug use (low SoE).\nPharmacological interventions: systematic reviews in the college settings support use of brief interventions for students with any use, heavy or problematic use. More research is needed to identify the most effective combinations of behavioral and pharmacologic treatments for alcohol use disorders."]
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[null,"Hunt G et al.  Psychosocial interventions for people with both severe mental illness and substance misuse. Cochrane Database Syst Rev 2019, Issue 12. Art. No.: CD001088. DOI: 10.1002/14651858.CD001088.pub4\nAvailable here.\n","People diagnosed with a severe mental illness and concurrent problem of substance misuse","This Cochrane review aimed to assess the effects of psychosocial interventions for reduction in substance use in people with a serious mental illness compared with standard care. It updates and replaces the 2013 version of the review.\n\nThe review now includes 41 trials with a total of 4024 participants. The reviewers identified nine comparisons within the included trials. Only two of these reported outcomes meeting the scope of this topic evidence map and have been reported below. For full detail and information on the other outcomes, please refer to the full-text. \n\n1. Integrated models of care versus standard care (36 months): No clear differences were found between treatment groups for alcohol use (RR 1.15, 95% CI 0.84 to 1.56; participants = 143; studies = 1; low‐quality evidence).\n\n5. Motivational interviewing (MI) versus standard care: A clear difference, favouring MI, was observed for abstaining from alcohol (RR 0.36, 95% CI 0.17 to 0.75; participants = 28; studies = 1; very low‐quality evidence).","Authors concluded that they included 41 RCTs but were unable to use much data for analyses. There is currently no high‐quality evidence to support any one psychosocial treatment over standard care for important outcomes such as remaining in treatment, reduction in substance use or improving mental or global state in people with serious mental illnesses and substance misuse. Furthermore, methodological difficulties exist which hinder pooling and interpreting results. Further high‐quality trials are required which address these concerns and improve the evidence in this important area."]
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[null,"Canadian Agency for Drugs and Technologies in Health. E-therapy interventions for treatments of substance use disorders and other addictions: a review of clinical effectiveness. Ottawa: CADTH; 2018. \nAvailable here.\n","Adults with diagnosed substance use disorders or with a diagnosed addiction disorder, with or without co-morbid mental health conditions. ","The purpose of this CADTH Rapid Response was to review the comparative effectiveness of therapist-guided e-therapy interventions versus other options for the treatment of adults with substance use disorders and other addictions. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nWhat is the clinical effectiveness of e-therapy for the treatment of patients with substance use disorders and other addictions? \nOne SR examined the efficacy of internet-delivered interventions for alcohol addiction. The difference in alcohol consumption between the e-therapy with therapist guidance and no treatment groups at the post-treatment follow-up was statistically significant (with the e-therapy group having less consumption) and the effect of guided e-therapy was found to be small. The authors concluded that internet-delivered interventions were effective in reducing alcohol consumption and that the effect was small.\n","Evidence on e-therapy for the treatment of substance use disorders and other addictions was from a small number of SRs and RCTs. Findings consistently showed that therapist-guided e-therapy was superior to no treatment and wait list in reducing alcohol consumption or cannabis use, and the effect was small. With respect to substances, evidence was limited to the treatment of problematic alcohol and cannabis use and it is therefore unclear if the results generalize to the misuse of other substances."]
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[null,"Egholm JWM et al. Perioperative alcohol cessation intervention for postoperative complications Cochrane Database of Syst Rev 2018, Issue 11. Art. No.: CD008343. DOI: 10.1002/14651858.CD008343.pub3\n\nAvailable here.\n","Included participants with risky consumption of alcohol who were undergoing all types of elective or acute surgical procedures under general or regional anaesthesia or sedation, who were offered perioperative alcohol cessation intervention or no intervention. ","This Cochrane systematic review aimed to assess the effects of perioperative alcohol cessation interventions on rates of postoperative complications and alcohol consumption. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nOne new study was included in this updated review, resulting in a total of three RCTs (140 participants who drank 3 to 40 AU/d). All three studies were of moderate to good quality. All studies evaluated the effects of intensive alcohol cessation interventions, including pharmacological strategies for alcohol withdrawal symptoms, patient education, and relapse prophylaxis. The authors identified one ongoing study.\n\nInvestigators describe more successful quitters at the end of the intervention programme than among controls. Forty-one out of 70 participants in the intervention groups successfully quit drinking compared with only five out of 70 participants in the control groups (RR 8.22, 95% CI 1.67 to 40.44). The quality of evidence for this outcome is moderate.\n\nAll three studies reported postoperative alcohol consumption (grams of alcohol/week) at the end of the programme as median and range values; therefore it was not possible to estimate the mean and the SD. We performed no meta-analysis. All three studies reported length of stay, and none of these studies described a significant difference in length of stay. Data were insufficient for review authors to perform a meta-analysis. No studies reported on the prevalence of participants without risky drinking in the longer term.\n\nIncluded studies were few and reported small sample sizes; therefore one should be careful about drawing firm conclusions based on these study results. All three studies were conducted in Denmark, and most participants were men. The included participants may represent a selective group, as they could have been more motivated and/or more interested in participating in clinical research or otherwise different, and effects may have been overestimated for both intervention and control groups in these studies. Trial results indicate that these studies are difficult to perform, that strong research competencies are necessary for future studies, and that further evaluation of perioperative alcohol cessation interventions in high-quality randomised controlled trials is needed. Once published and assessed, the one ’ongoing’ study identified may alter the conclusions of this review.","The authors conclude that all three studies showed a significant reduction in the number of participants who quit drinking alcohol during the intervention period. Intensive alcohol cessation interventions offered for four to eight weeks to participants undergoing all types of surgical procedures to achieve complete alcohol cessation before surgery probably reduced the number of postoperative complications. Data were insufficient for review authors to assess their effects on postoperative mortality. No studies reported an effect on length of stay, and no studies addressed the prevalence of risky drinking in the longer term.\n\n\n"]
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[null,"Klimas J et al. Psychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users. Cochrane Database Syst Rev 2018, Issue 12. Art. No.: CD009269. DOI: 10.1002/14651858.CD009269.pub4.\nAvailable here. \n","Problem alcohol and illicit drug users (principally problem drug users of opiates and stimulants). ","This Cochrane review aimed to assess the effects of psychosocial interventions for problem alcohol use in illicit drug users. \n\nThe psychosocial interventions considered in the studies were: cognitive‐behavioural coping skills training (one study), twelve‐step programme (one study), brief intervention (three studies), motivational interviewing (two studies), and brief motivational interviewing (one study). Two studies were considered in two comparisons. There were no data for the secondary outcome, alcohol‐related harm. The results were as follows. \n\nComparison 1: cognitive‐behavioural coping skills training versus twelve‐step programme (one study, 41 participants): There was no significant difference between groups for either of the primary outcomes (alcohol abstinence assessed with Substance Abuse Calendar and breathalyser at one year: risk ratio (RR) 2.38 (95% confidence interval [CI] 0.10 to 55.06); and retention in treatment, measured at end of treatment: RR 0.89 (95% CI 0.62 to 1.29), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was very low. \n\nComparison 2: brief intervention versus treatment as usual (three studies, 197 participants): There was no significant difference between groups for either of the primary outcomes (alcohol use, measured as scores on the Alcohol Use Disorders Identification Test (AUDIT) or Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) at three months: standardised mean difference (SMD) 0.07 (95% CI ‐0.24 to 0.37); and retention in treatment, measured at three months: RR 0.94 (95% CI 0.78 to 1.13), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was low. \n\nComparison 3: motivational interviewing versus treatment as usual or educational intervention only (three studies, 462 participants): There was no significant difference between groups for either of the primary outcomes (alcohol use, measured as scores on the AUDIT or ASSIST at three months: SMD 0.04 (95% CI ‐0.29 to 0.37); and retention in treatment, measured at three months: RR 0.93 (95% CI 0.60 to 1.43), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was low. \n\nComparison 4: brief motivational intervention (BMI) versus assessment only (one study, 187 participants): More people reduced alcohol use (by seven or more days in the past month, measured at six months) in the BMI group than in the control group (RR 1.67; 95% CI 1.08 to 2.60). There was no difference between groups for the other primary outcome, retention in treatment, measured at end of treatment: RR 0.98 (95% CI 0.94 to 1.02), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was moderate. \n\nComparison 5: motivational interviewing (intensive) versus motivational interviewing (one study, 163 participants): There was no significant difference between groups for either of the primary outcomes (alcohol use, measured using the Addiction Severity Index‐alcohol score (ASI) at two months: MD 0.03 (95% CI 0.02 to 0.08); and retention in treatment, measured at end of treatment: RR 17.63 (95% CI 1.03 to 300.48), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was low. \n\n","The review authors found low to very low‐quality evidence to suggest that there is no difference in effectiveness between different types of psychosocial interventions to reduce alcohol consumption among people who use illicit drugs, and that brief interventions are not superior to assessment‐only or to treatment as usual. No firm conclusions can be made because of the paucity of the data and the low quality of the retrieved studies."]
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[null,"Agabio R, Trogu E, Pani PP. Antidepressants for the treatment of people with co‐occurring depression and alcohol dependence. Cochrane Database Syst Rev 2018, Issue 4. Art. No.: CD008581. DOI: 10.1002/14651858.CD008581.pub2.\nAvailable here. \n","Adults with co-occurring depression and alcohol dependence. ","This Cochrane review aimed to assess the benefits and risks of antidepressants for the treatment of people with co‐occurring depression and alcohol dependence. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text\n\nReview authors report that 33 studies were included in the review (2242 participants). Antidepressants were compared to placebo (22 studies), psychotherapy (two studies), other medications (four studies), or other antidepressants (five studies). The mean duration of the trials was 9.9 weeks (range 3 to 26 weeks). Eighteen studies took place in the USA, 12 in Europe, two in Turkey, and one in Australia. The antidepressant included in most of the trials was sertraline; other medications were amitriptyline, citalopram, desipramine, doxepin, escitalopram, fluoxetine, fluvoxamine, imipramine, mianserin, mirtazepine, nefazodone, paroxetine, tianeptine, venlafaxine, and viloxazine. Eighteen studies were conducted in an outpatient setting, nine in an inpatient setting, and six in both settings. Psychosocial treatment was provided in 18 studies. There was high heterogeneity in the selection of outcomes and the rating systems used for diagnosis and outcome assessment.\n\nModerate‐quality evidence found that antidepressants increased the number of participants abstinent from alcohol during the trial (7 studies, 424 participants, RR 1.71, 95 per cent Cl 1.22 to 2.39) and reduced the number of drinks per drinking days (7 studies, 451 participants, mean difference (MD) ‐1.13 drinks per drinking days, 95 per cent Cl ‐1.79 to ‐0.46). After the exclusion of studies with high risk of bias, the number of abstinent remained higher (RR 1.69, 95 per cent CI 1.18 to 2.43) and the number of drinks per drinking days lower (MD ‐1.21 number of drinks per drinking days, 95 per cent CI ‐1.91 to ‐0.51) among participants who received antidepressants compared to those who received placebo. However, other outcomes such as the rate of abstinent days did not differ between antidepressants and placebo (9 studies, 821 participants, MD 1.34, 95 per cent Cl ‐1.66 to 4.34; low‐quality evidence).\n\nThere were few studies comparing one antidepressant versus another antidepressant or antidepressants versus other interventions, and these had a small sample size and were heterogeneous in terms of the types of interventions that were compared, yielding results that were not informative.\n","Authors found low‐quality evidence supporting the clinical use of antidepressants in the treatment of people with co‐occurring depression and alcohol dependence. Antidepressants had positive effects on certain relevant outcomes related to depression and alcohol use but not on other relevant outcomes. Moreover, most of these positive effects were no longer significant when studies with high risk of bias were excluded. Results were limited by the large number of studies showing high or unclear risk of bias and the low number of studies comparing one antidepressant to another or antidepressants to other medication. In people with co‐occurring depression and alcohol dependence, the risk of developing adverse effects appeared to be minimal, especially for the newer classes of antidepressants (such as selective serotonin reuptake inhibitors). According to these results, in people with co‐occurring depression and alcohol dependence, antidepressants may be useful for the treatment of depression, alcohol dependence, or both, although the clinical relevance may be modest."]
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[null,"Kaner E et al. Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev 2018, Issue 2.\nAvailable here. ","People who routinely presented to general practice, emergency care or other primary care settings for a range of health problems, whose alcohol consumption was identified by a screening tool as being excessive, or who had experienced harm as a result of their drinking behaviour","This Cochrane systematic review aimed to assess the effectiveness of screening and brief alcohol intervention to reduce excessive alcohol consumption in hazardous or harmful drinkers in general practice or emergency care settings.\n\nThe reviewers found moderate‐quality evidence that brief alcohol interventions have little impact on frequency of binges per week (MD ‐0.08, 95% CI ‐0.14 to ‐0.02; 15 studies, 6946 participants); drinking days per week (MD ‐0.13, 95% CI ‐0.23 to ‐0.04; 11 studies, 5469 participants); or drinking intensity (‐0.2 g/drinking day, 95% CI ‐3.1 to 2.7; 10 studies, 3128 participants).\n\nThey found moderate‐quality evidence of little difference in quantity of alcohol consumed when extended and no or minimal interventions were compared (‐20 g/week, 95% CI ‐40 to 1; 6 studies, 1296 participants). There was little difference in binges per week (‐0.08, 95% CI ‐0.28 to 0.12; 2 studies, 456 participants; moderate‐quality evidence) or difference in days drinking per week (‐0.45, 95% CI ‐0.81 to ‐0.09; 2 studies, 319 participants; moderate‐quality evidence). Extended versus no or minimal intervention provided little impact on drinking intensity (9 g/drinking day, 95% CI ‐26 to 9; 1 study, 158 participants; low‐quality evidence).\n\nExtended intervention had no greater impact than brief intervention on alcohol consumption, although findings were imprecise (MD 2 g/week, 95% CI ‐42 to 45; 3 studies, 552 participants; low‐quality evidence). Numbers of binges were not reported for this comparison, but one trial suggested a possible drop in days drinking per week (‐0.5, 95% CI ‐1.2 to 0.2; 147 participants; low‐quality evidence). Results from this trial also suggested very little impact on drinking intensity (‐1.7 g/drinking day, 95% CI ‐18.9 to 15.5; 147 participants; very low‐quality evidence).","The authors concluded that they found moderate‐quality evidence that brief interventions can reduce alcohol consumption in hazardous and harmful drinkers compared to minimal or no intervention. Longer counselling duration probably has little additional effect. Future studies should focus on identifying the components of interventions which are most closely associated with effectiveness."]
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[null,"Smedslund G et al. Effect of early, brief computerized interventions on risky alcohol and cannabis use among young people. Campbell systematic reviews 2017; 6:(13). Available here. ","Young people (aged 15-25) who abuse alcohol or cannabis. ","The review focused on the effects of brief interventions, provided by electronic devices. Sixty studies were included in the review that had randomised a total of 33,316 participants. \n\nModerate quality evidence was found that multi-dose assessment and feedback was more effective than single-dose assessment for alcohol. A meta-analysis of four studies by the same first author found a 16 per cent significant short-term reduction in drinking after a repeated assessment and feedback compared to a single assessment and feedback (Rate ratio: 0.84, 95 per cent CI: 0.78 to 0.91). However, a study by Anderson (2015) found an SMD of 0.10 (in favour of single dose, 95 per cent CI: -0.07 to 0.27). A study by Kypri (2008) found a long-term significant reduction in drinking after multi-dose feedback compared to single-dose feedback (Rate ratio: 0.77, 95 per cent CI: 0.63 to 0.94). \n\nLow quality evidence was found that assessment and feedback might be more effective than no intervention (Short term effect, 15 studies; SMD: -0.17, 95 per cent CI: -0.27 TO -0.08, I2 = 52 per cent. Long term effect, 3 studies; SMD: -0.17, 95 per cent CI: -0.30 to -0.04).\n\nAssessment and feedback might also be more effective than assessment alone (low quality evidence. Short-term effect, 24 studies; SMD: -0.15, 95 per cent CI: -0.25 to -0.06, I2 = 64 per cent. Long-term effect, 3 studies; SMD: -0.03, 95 per cent CI: -0.19 to 0.12). \n\nShort term effects (<6 months) were mostly larger than long-term (≥ 6 months) effects. \n","Computerized brief interventions are easy to administer, and the evidence from this review indicates that such brief interventions might reduce drinking for several months after the intervention. Additionally, there is no evidence for adverse effects. This means that brief, computerized interventions could be feasible ways of dealing with risky alcohol use among young people. The evidence on cannabis consumption is scarcer, suggesting the need for more research. "]
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[null,"Canadian Agency for Drugs and Technology in Health. Concurrent treatment for substance use disorder and trauma-related comorbidities: a review of clinical effectiveness and guidelines. Ottawa: CADTH; 2017. \nAvailable here. ","Adults with substance use disorder and trauma-related comorbidities (PTSD, anxiety or depression). \n\nSubgroup of interest: military veterans","The purpose of this report by CADTH was to review treatment options for patients with comorbid substance use disorder (SUD) and post-traumatic stress disorder, anxiety, or depression by comparing concurrent treatments for SUD and the mental disorders with no treatment, usual care or active treatment for one condition only and treatment for a single condition (SUD or the mental disorders) with no treatment, usual care or active treatment for the second disorder. Additionally, this review aimed to review evidence-based guidelines regarding the treatments for patients with these comorbidities. \n\nThe review addressed three main research questions. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\n1. What is clinical effectiveness of concurrent treatment for patients with substance use disorders and comorbid post-traumatic stress disorder, anxiety, or depression?\nPatients with comorbid SUD and PTSD: In summary, findings with respect to SUD outcomes for integrated treatments addressing both PTSD and SUD, were inconsistent.\nPatients with comorbid SUD and depression: In summary, there is a suggestion that integrated treatments are more effective than control treatments or treatments addressing a single condition, but findings were not always consistent.\nPatients with SUD and anxiety disorder: One RCT showed that fewer patients relapsed to any drinking in the CBT group compared to the PMRT group. Another RCT showed that the nine hour anxiety-sensitivity focused intervention plus TAU over TAU alone, showed improvement in percent days abstinent in both groups, but showed no significant between group difference.\nPatients with SUD and depression or anxiety disorder: An RCT showed that ICBT appeared to be more effective than usual care with respect to most measures of alcohol consumption.\n\n2. What is the clinical effectiveness of the treatment of one condition for the improvement of all symptoms in patients with substance use disorder and comorbid post-traumatic stress disorder, anxiety, or depression?\nA systematic review included six studies that evaluated addiction based interventions. Two studies comparing the experimental contingency management (CM) treatment with control treatment found slightly better early treatment gains with respect to substance use with CM, however the differences did not remain significant in the long term as shown in one study. Results from three studies (other than CM) showed within-group improvement in SUD outcomes over time even for minimal or no treatment. One study showed that the care management program was associated with better alcohol outcomes compared to the AUD treatment that patients identified on their own.\nAnother systematic review included one study comparing technology-based treatment (TAU plus web based intervention targeting alcohol use) with TAU alone, reported no findings with respect to substance use.\n\n3. What are the evidence-based guidelines regarding the treatment of patients with substance use disorders and comorbid post-traumatic stress disorder, anxiety, or depression?\nOne relevant evidence-based guideline was identified. For comorbid anxiety and alcohol use disorder or for comorbid PTSD and alcohol use disorder, an integrated approach was recommended (Recommendation grade: CCP i.e. “Clinical consent point”). For comorbid depression and alcohol use disorder, CBT was recommended to improve both depressive symptoms and drinking problems.","Report authors found there was a suggestion that integrated treatments offered greater improvement with respect to PTSD symptoms, depression or anxiety compared to no treatment or minimal treatment for patients with comorbid substance use disorder (SUD) and posttraumatic stress syndrome (PTSD), depression or anxiety disorder. However results were not always consistent. In patients with comorbid SUD and PTSD, there was a suggestion that addiction based interventions were more effective with respect to controlling substance use than control treatments. One evidence-based guideline recommended an integrated treatment approach for patients with comorbid alcohol use disorder and PTSD, or comorbid alcohol use disorder and anxiety disorder, and cognitive behavioural therapy for comorbid alcohol use disorder and depression."]
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[null,"Canadian Agency for Drugs and Technology in Health. Inpatient and outpatient treatment programs for substance use disorder: a review of clinical effectiveness and guidelines. Ottawa: CADTH; 2017a. \nAvailable here. \n","Adults 18 to 65 years with substance use disorder/addiction disorder (e.g., abuse of prescription medications or cocaine, heroin, cannabis, alcohol)\n","This Rapid Response report by CADTH aimed to review the clinical effectiveness of inpatient and outpatient treatment programs for adults with substance use disorders involving prescription medications such as analgesics or non-prescription substances such as cocaine, opioids such as heroine, marijuana (cannabis), or alcohol. Evidence-based guidelines associated with inpatient and outpatient treatment programs in adults with substance use disorders were also examined.\n\nThe review addressed two main research questions. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\n1. What is the clinical effectiveness of inpatient and outpatient treatment programs in adults with substance use disorders?\nOne narrative review concluded that evidence supports the case for community detoxification in patients with alcohol dependence. One RCT with long-term follow-up (18 months) concluded that the evidence found initial but decreasing benefit of inpatient over outpatient care across time. One prospective study found inpatients consumed significantly less alcohol in the year after entering treatment than outpatients as measured by the Graduated Frequency Scale questionnaire, and had significantly greater engagement with Alcohol Anonymous program than outpatients in the year after treatment. One retrospective study reported that inpatients with substance use disorders are three times more likely to complete treatment than outpatients.\n\n2. What are the evidence-based guidelines associated with inpatient and outpatients treatment programs in adults with substance use disorders?\nThe evidence-based guidelines from British Columbia Ministry of Health on opioids use disorder recommend that withdrawal management, if needed, can be provided more safely in an outpatient setting rather than in an inpatient setting in most patients. For patients who wish to avoid long-term opioid agonist treatment, supervised slow (longer than one month) outpatient or residential opioid agonist taper can be provided rather than rapid (less than one week) inpatient opioid agonist taper. The slow approach may permit a more flexible and individualised approach to tapered agonist reduction, which allows dose adjustment and stabilisation in case withdrawal symptoms occur.\n\n","For patients with alcohol use disorders, better detoxification completion and abstinence rates, and similar adverse event rates, were found in outpatient care compared to inpatient care in a couple of studies with short follow-up periods (one to two months). One study with a longer follow-up period found inpatients consumed less alcohol than outpatients in the year after entering treatment. This may be explained by the controlled environment of inpatient care that avoids the distractions that could be present in an outpatient care situation. In patients with severe alcohol dependence, data from one study found initial but decreasing benefit of inpatient over outpatient care across time in alcohol abstinence. For patients with substance use disorders, data from one study showed inpatients are more likely to complete treatment than outpatients. The small number of studies found and their heterogeneity in design and reported outcomes cautioned the interpretation of the findings. \n\n\n"]
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[null,"Carney T, Myers BJ, Louw J, Okwundu CI. Brief school‐based interventions and behavioural outcomes for substance‐using adolescents. Cochrane Database Syst Rev 2016; Issue 1. Art. No.: CD008969. DOI: 10.1002/14651858.CD008969.pub3\nAvailable here.\n","Substance using adolescents.","The authors included six RCTs which evaluated the effects of brief school-based interventions for substance-using adolescents. Three studies with 732 adolescents compared brief interventions (Bls) with information provision only, and three studies with 444 adolescents compared Bls with assessment only. Reasons for downgrading the quality of evidence included risk of bias of the included studies, imprecision, and inconsistency. For outcomes that concern substance abuse, the retrieved studies only assessed alcohol and cannabis. \n\nGenerally, moderate quality evidence was found that, compared to information provision only, BIs did not have a significant effect on any of the substance use outcomes at short‐, medium‐, or long‐term follow‐up. \n\nWhen compared to assessment-only controls, BIs were found to significantly reduce the frequency of alcohol use (SMD ‐0.91; 95 per cent CI ‐1.21 to ‐0.61, n = 242), alcohol abuse (SMD ‐0.38; 95 per cent CI ‐0.7 to ‐0.07, n = 190) and dependence (SMD ‐0.58; 95 per cent CI ‐0.9 to ‐0.26, n = 190) at medium-term follow-up in one study. And, at long-term follow-up BI’s also reduced alcohol abuse (SMD ‐0.72; 95 per cent CI ‐1.05 to ‐0.40, n = 181) in one study. However, the evidence from studies that compared brief interventions to assessment‐only conditions was generally of low quality.\n","We found low or very low‐quality evidence that brief school‐based interventions may be more effective in reducing alcohol and cannabis use than the assessment‐only condition and that these reductions were sustained at long‐term follow‐up. We found moderate‐quality evidence that, when compared to information provision, brief interventions probably did not have a significant effect on substance use outcomes. It is premature to make definitive statements about the effectiveness of brief school‐based interventions for reducing adolescent substance use. Further high‐quality studies examining the relative effectiveness of BIs for substance use and other problem behaviours need to be conducted, particularly in low‐ and middle‐income countries."]
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[null,"Roberts NP et al. Psychological therapies for post‐traumatic stress disorder and comorbid substance use disorder. Cochrane Database Syst Rev 2016, Issue 4. Art. No.: CD010204. DOI: 10.1002/14651858.CD010204.pub2.\nAvailable here. \n","Individuals with comorbid PTSD and SUD","This Cochrane review aimed to determine the efficacy of psychological therapies aimed at treating traumatic stress symptoms, substance misuse symptoms, or both in people with comorbid PTSD and SUD in comparison with control conditions (usual care, waiting‐list conditions, and no treatment) and other psychological therapies. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nFourteen studies with 1506 participants were included, of which 13 studies were included in the quantitative synthesis. Most studies involved adult populations. Studies were conducted in a variety of settings. Four comparisons were undertaken investigating the effects of psychological therapies with a trauma‐focused component and non‐trauma‐focused interventions against treatment as usual/minimal intervention and other active psychological therapies. Comparisons were stratified for individual‐ or group‐based therapies. All active interventions were based on CBT.\n\nIndividual‐based psychological therapies with a trauma‐focused component plus adjunctive SUD intervention: There was no evidence of an effect for level of drug/alcohol use post‐treatment (SMD ‐0.13; 95% CI ‐0.41 to 0.15; 3 studies; n = 388; very low‐quality evidence), but there was a small effect in favour of individual psychological therapy at 5 to 7 months (SMD ‐0.28; 95% CI ‐0.48 to ‐0.07; 3 studies; n = 388) when compared against TAU.\n\nIndividual‐based psychological therapy with a trauma‐focused component: did not perform better than psychological therapy for SUD only for drug/alcohol use (MD ‐1.27; 95% CI ‐5.76 to 3.22; 1 study; n = 46; low‐quality evidence). Findings were based on one small study.\n\nNon‐trauma‐focused psychological therapies: did not perform better than TAU/minimal intervention. There were no data on the effects on drug/alcohol use for individual therapy. There was no evidence of an effect on the level of drug/alcohol use for group‐based therapy (SMD ‐0.03; 95% CI ‐0.37 to 0.31; 4 studies; n = 414; very low‐quality evidence). A post‐hoc analysis for full dose of a widely established group therapy called Seeking Safety showed reduced drug/alcohol use post‐treatment (SMD ‐0.67; 95% CI ‐1.14 to ‐0.19; 2 studies; n = 111), but not at subsequent follow‐ups.\nThese also did not perform better than psychological therapy for SUD only for drug/alcohol use (SMD 0.22; 95% CI ‐0.13 to 0.57; 2 studies; n = 128; low‐quality evidence).\n","The reviewers assessed the evidence in this review as mostly low to very low quality. Evidence showed that individual trauma‐focused psychological therapy delivered alongside SUD therapy did better than TAU/minimal intervention in reducing PTSD severity post‐treatment and at long‐term follow‐up, but only reduced SUD at long‐term follow‐up. All effects were small, and follow‐up periods were generally quite short. There was evidence that fewer participants receiving trauma‐focused therapy completed treatment. There was very little evidence to support use of non‐trauma‐focused individual‐ or group‐based integrated therapies. Individuals with more severe and complex presentations (e.g. serious mental illness, individuals with cognitive impairment, and suicidal individuals) were excluded from most studies in this review, and so the findings from this review are not generalisable to such individuals. Some studies suffered from significant methodological problems and some were underpowered, limiting the conclusions that can be drawn. Further research is needed in this area."]
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[null,"Canadian agency for Drugs and Technology in Health. Mindfulness interventions for the treatment of post-traumatic stress disorder, generalized anxiety disorder, depression and substance use disorders: a review of the clinical effectiveness and guidelines. Ottawa: CADTH; 2015. Available here. ","Adults with post-traumatic stress disorder (PTSD), generalised anxiety disorder (GAD), depression, or substance use disorders.","The objective of this review was to summarise the clinical effectiveness and guidelines for the use of mindfulness interventions for the treatment of PTSD, GAD, depression, and substance use disorders in adults. The review addressed two main research questions. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\n1. What is the clinical effectiveness of mindfulness interventions for the treatment of adults with PTSD, GAD, Depression, or substance use disorders?\nA study reported, that compared with treatment as usual, participants assigned to mindfulness-based relapse prevention reported significantly lower risk of heavy drinking, significantly fewer days of heavy drinking at the 6-month follow-up. At the 12-month follow-up, mindfulness-based relapse prevention participants reported significantly decreased heavy drinking compared with relapse prevention and treatment as usual.\n\n2. What are the evidence-based guidelines regarding the use of mindfulness interventions for the treatment of adults with PTSD, GAD, Depression, or substance use disorders?\nThe guideline by the New South Wales Department of Health suggested that mindfulness could be used to treat problematic drug and alcohol users.\n\n","The evidence for the efficacy of mindfulness as a treatment for individuals with substance use disorders was limited. One RCT of low methodological quality suggested that mindfulness intervention is more effective than treatment as usual in lowering risk of relapse to substance use and heavy drinking. One guideline suggested that mindfulness can be used to treat problematic drug and alcohol use problems by suitably trained and experienced drug and alcohol professionals.\n"]
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[null,"Canadian agency for Drugs and Technology in Health. Yoga for the Treatment of Post-Traumatic Stress Disorder, Generalized Anxiety Disorder, Depression, and Substance Abuse: A Review of the Clinical Effectiveness and Guidelines. Ottawa: CADTH; 2015a. Available here. ","Adults with PTSD, GAD, depression, or substance use disorders.","The objective of this Rapid Response report is to review the clinical effectiveness of yoga for treating PTSD, GAD, depression and substance abuse, and to summarize the guidelines that are associated with the use of yoga for these conditions.The review addressed two main research questions. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\n1. What is the clinical effectiveness of yoga as an intervention for the treatment of PTSD, GAD, depression, or substance use disorders?\nOne study found that yoga was a feasible adjunct treatment for treating alcohol dependence. Patients in the yoga intervention group had a higher baseline level of drinking compared to the control group and there were positive, non-significant changes in alcohol consumption at six month follow-up, numerically greater than that experienced by the control. \ngroup\n\n2. What are the evidence-based guidelines regarding the use of mindfulness interventions for the treatment of adults with PTSD, GAD, Depression, or substance use disorders?\nFive evidence-based guidelines were included in this report, two of which did not find enough evidence for yoga to provide a recommendation. None of the recommendations focused specifically on alcohol consumption.\n\n","Three RCTs of low methodological quality suggested that patients with substance abuse improved with respect to some symptoms with yoga. Five evidence based guideline documents considered the use of yoga in clinical practice. Three suggested that yoga may be useful as an adjunctive treatment for treating major depressive disorder (MDD), PTSD and GAD, if available. "]
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[null,"Ipser JC et al. Pharmacotherapy for anxiety and comorbid alcohol use disorders. Cochrane Database Syst Rev 2015, Issue 1. Art. No.: CD007505. DOI: 10.1002/14651858.CD007505.pub2\nAvailable here. \n","People diagnosed with alcohol dependence or abuse and an anxiety disorder according to DSM‐III, DSM‐IV, or DSM‐IV‐TR criteria.","This Cochrane review aimed to assess the effects of pharmacotherapy for treating anxiety in people with comorbid alcohol use disorders. Five placebo‐controlled pharmacotherapy RCTs (with 290 participants) were included in the review. Most of the trials provided little information on how randomisation was performed or on whether both participants and study personnel were blinded to the intervention. \n\nStudy participants had DSM) III‐ and DSM IV‐diagnosed alcohol use disorders and post‐traumatic stress disorder (two studies), social anxiety disorder (SAD; two studies) or generalized anxiety disorder (GAD; one study). Four trials assessed the efficacy of the selective serotonin re‐uptake inhibitors (SSRIs: sertraline, paroxetine); one RCT investigated the efficacy of buspirone, a 5‐hydroxytryptamine (5‐HT) partial agonist. Treatment duration lasted between eight and 24 weeks. Overall, 70% of participants included in the review were male. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nThere was no evidence of an effect for any of the medications tested on abstinence from alcohol use or depression symptoms.","The evidence‐base for the effectiveness of medication in treating anxiety disorders and comorbid alcohol use disorders is currently inconclusive. There was no evidence that alcohol use was responsive to medication. Large, rigorously conducted RCTs would help supplement the small evidence‐base for the efficacy and tolerability of pharmacotherapy for anxiety and comorbid alcohol use disorders. Further research on patient subgroups who may benefit from pharmacological treatment, as well as novel pharmacological interventions, is warranted. \n"]
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[null,"Pani PP et al. Anticonvulsants for alcohol dependence. Cochrane Database Syst Rev 2014, Issue 2. Art. No.: CD008544. DOI: 10.1002/14651858.CD008544.pub2.\nAvailable here. \n","Alcohol dependent adults. ","The primary aim of this Cochrane review is to assess the benefits/risks of anticonvulsants for the treatment of alcohol dependence. \n\nA total of 25 studies were included in the review (2641 participants). Most participants were male, with an average age of 44 years. Anticonvulsants were compared with placebo (17 studies), other medications (seven studies) and no medication (two studies). The mean duration of the trials was 17 weeks (range four to 52 weeks). The studies took place in the USA, Europe, South America, India and Thailand. Variation was reported in the characteristics of the studies, including their design and the rating instruments used. For many key outcomes, the risk of bias associated with unclear or unconcealed allocation and lack of blinding affected the quality of the evidence. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nAnticonvulsants versus placebo: For continuous abstinence (eight studies, 634 participants, RR 1.21, 95% Cl 95 per cent 0.97 to 1.52, moderate‐quality evidence), results showed no evidence of differences. Moderate‐quality evidence suggested that anticonvulsants reduced drinks/drinking days (11 studies, 1126 participants, mean difference (MD) ‐1.49, 95% Cl ‐2.32 to ‐0.65) and heavy drinking (12 studies, 1129 participants, standardised mean difference (SMD) ‐0.35, 95% Cl ‐0.51 to ‐0.19). The direction of results was confirmed by subgroup analyses for topiramate and partially for gabapentin and valproate. \n\nAnticonvulsants versus naltrexone: No evidence of difference was shown in severe relapse rates (four studies, 427 participants, RR 0.69, 95% Cl 0.44 to 1.07) and continuous abstinence rates (five studies, 528 participants, RR 1.21, 95% Cl 0.99 to 1.49); anticonvulsants were associated with fewer heavy drinking days (three studies, 308 participants, MD ‐5.21, 95% Cl ‐8.58 to ‐1.83) and more days to severe relapse (three studies, 244 participants, MD 11.88, 95% Cl 3.29 to 20.46).\n","The authors concluded that at the current stage of research, randomised evidence supporting the clinical use of anticonvulsants to treat alcohol dependence is insufficient. Results are conditioned by heterogeneity and by the low number and quality of studies comparing anticonvulsants with other medications. The uncertainty associated with these results leaves to clinicians the need to balance possible benefits/risks of treatment with anticonvulsants versus other medications as supported by evidence of efficacy."]
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[null,"Dedert E et al. e-interventions for alcohol misuse. Durham NC: Evidence-based Synthesis Program Center; 2014.\nAvailable here.\n","Adults with alcohol use disorders (AUD). ","This review evaluates computer-based interventions for alcohol misuse. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nEffects of E-Interventions Compared with Inactive Controls in Adults who Misuse Alcohol: Twenty-two studies with 13,929 participants and judged to be low (n=7) or moderate (n=12) risk of bias. Overall, the available data suggest that long-term effects of e-interventions on alcohol outcomes are modest or absent.\n\nEffects of E-Interventions Compared with Inactive Controls in Adults at High Risk of AUD (eg, AUDIT-C ≥8) or with a Diagnosis of AUD: 3 studies (2 moderate, 1 high risk of bias) in 533 patients with a diagnosis of AUD. Neither computerized feedback plus telephone counseling nor an interactive voice response system decreased alcohol consumption or risk of relapse. A multicomponent smartphone program used to support recovery following residential treatment increased abstinence (OR 1.94; 95% CI, 1.14 to 3.31) and decreased risky drinking days at 12-month follow-up.\n\n Effects of E-Interventions Alone or Used in Combination with Face-to-Face Therapy Compared with Face-to-Face Therapy Alone in Adults who Misuse Alcohol: Six trials with 1090 participants. Overall, this diverse group of studies did not find a benefit of e-interventions alone or as an adjunct to face-to-face  brief MI compared with face-to-face brief MI alone for college students or midlife primary care patients who misuse alcohol.","The authors reported that they found limited evidence for small or no effects of e-interventions compared with controls on long-term (≥6 months) alcohol outcomes in participants who screened positive for alcohol misuse. Findings were even more limited for participants with AUD or comparisons of e-interventions to face-to-face treatment. Further research is needed to determine with higher confidence whether e-interventions can produce long-term benefits for alcohol-related outcomes. In particular, given the limited number and duration of intervention episodes in the studies reviewed, it is possible that these e-interventions were not designed to be robust enough to produce significant, enduring effects on alcohol misuse. As reported in previous reviews, brief in-person interventions produce sustained reductions in alcohol consumption in participants with alcohol misuse. Current evidence does not support substitution of e-interventions for brief, in-person treatment. Future research on e-interventions should include evaluations of more intensive or longer duration e-interventions for alcohol misuse. "]
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[null,"Jonas DE et al. Pharmacotherapy for adults with alcohol-use disorders in outpatient settings. Rockville MD: Agency for Healthcare Research and Quality; 2014. \nAvailable here. \n\nThis report has been archived by AHRQ and is being updated. The update protocol can be accessed here.","Adults with alcohol-use disorders. ","The aim of this report was to conduct a systematic review and meta-analysis of the efficacy, comparative effectiveness, and harms of medications (both FDA approved and others) for adults with alcohol-use disorders, and to evaluate the evidence from primary care settings.\n\nOne hundred and thirty five studies were included. Most patients met criteria for alcohol dependence; mean ages were in the 40s. Studies typically included psychosocial cointerventions; effect sizes reflect the added benefits of medications. For acamprosate and oral naltrexone (50 mg per day), numbers needed to treat (NNTs) to prevent 1 person from returning to any drinking were 12 and 20, respectively (moderate SOE); NNT to prevent 1 person from returning to heavy drinking was 12 for oral naltrexone (50 mg per day) (moderate SOE). Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nMeta-analyses of four head-to-head trials found no statistically significant difference between the two medications for consumption outcomes (moderate SOE). For injectable naltrexone, meta-analyses found no significant benefit for return to any or heavy drinking, but found a reduction in heavy drinking days (low SOE). Evidence from well-controlled trials does not support efficacy of disulfiram, except possibly for patients with excellent adherence. Among medications used off label, moderate evidence supports the efficacy of nalmefene and topiramate for improving some consumption outcomes, and limited evidence supports the efficacy of valproic acid. Evidence from primary care settings was scant. There was insufficient direct evidence to conclude whether medications for alcohol-use disorders are effective for improving health outcomes.","Authors concluded that acamprosate and oral naltrexone have the best evidence for improving alcohol consumption outcomes for patients with alcohol-use disorders. Head-to-head trials have not consistently established the superiority of one medication. Thus, other factors may guide medication choices, such as frequency of administration, potential adverse events, coexisting symptoms, and availability of treatments.\n\n"]

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[null,"Families are supported and protected - Universal Interventions- Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"Gilligan C, et al. Family‐based prevention programmes for alcohol use in young people. Cochrane Database of Systematic Reviews 2019, Issue 3. Art. No.: CD012287. DOI: 10.1002/14651858.CD012287.pub2.\nAvailable here.","School age children (up to 18 years of age)","This Cochrane review aimed to assess the effectiveness of universal, selective, and indicated family-based prevention programmes in preventing alcohol use or problem drinking in school-aged children (up to 18 years of age). \n\nForty six studies (39,822 participants) were included in the review, with 27 classified as universal, 12 as selective, and seven as indicated. Meta‐analyses were performed according to outcome, including studies reporting on the prevalence, frequency, or volume of alcohol use. The overall quality of evidence was low or very low, and there was high, unexplained heterogeneity. \n\nUpon comparing any family intervention to no intervention/standard care, the authors found no intervention effect on the prevalence (SMD) 0.00, 95% CI ‐0.08 to 0.08; studies = 12; participants = 7490; I² = 57%; low‐quality evidence) or frequency (SMD ‐0.31, 95% CI ‐0.83 to 0.21; studies = 8; participants = 1835; I² = 96%; very low‐quality evidence) of alcohol use in comparison with no intervention/standard care. The effect of any parent/family interventions on alcohol consumption volume compared with no intervention/standard care was very small (SMD ‐0.14, 95% CI ‐0.27 to 0.00; studies = 5; participants = 1825; I² = 42%; low‐quality evidence). \n\nWhen comparing parent/family and adolescent interventions versus interventions with young people alone, authors found no difference in alcohol use prevalence (SMD ‐0.39, 95% CI ‐0.91 to 0.14; studies = 4; participants = 5640; I² = 99%; very low‐quality evidence) or frequency (SMD ‐0.16, 95% CI ‐0.42 to 0.09; studies = 4; participants = 915; I² = 73%; very low‐quality evidence). For this comparison, no trials reporting on the volume of alcohol use could be pooled in meta‐analysis. \n\nIn general, the results remained consistent in separate subgroup analyses of universal, selective, and indicated interventions. No adverse effects were reported. \n","The results of this review indicate that there are no clear benefits of family‐based programmes for alcohol use among young people. Patterns differ slightly across outcomes, but overall, the variation, heterogeneity, and number of analyses performed preclude any conclusions about intervention effects. Additional independent studies are required to strengthen the evidence and clarify the marginal effects observed. "]
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[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This Cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text. Fifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect. One targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects. Among school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]

{"sheet":"Fam sel","index":33,"n_rows":52,"n_cols":5,"rows_kept":52,"cut":false,"hidden":false,"merged":[[51,1,76,1],[51,2,76,2],[51,3,76,3],[51,4,76,4],[24,1,24,4],[26,1,41,1],[26,2,29,2],[26,3,50,3],[26,4,50,4]]}
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[null,"Families are supported and protected - Selective Interventions"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"Gilligan C, et al. Family‐based prevention programmes for alcohol use in young people. Cochrane Database of Systematic Reviews 2019, Issue 3. Art. No.: CD012287. DOI: 10.1002/14651858.CD012287.pub2.\nAvailable here.","School age children (up to 18 years of age)","This Cochrane review aimed to assess the effectiveness of universal, selective, and indicated family-based prevention programmes in preventing alcohol use or problem drinking in school-aged children (up to 18 years of age). \n\nForty six studies (39,822 participants) were included in the review, with 27 classified as universal, 12 as selective, and seven as indicated. Meta‐analyses were performed according to outcome, including studies reporting on the prevalence, frequency, or volume of alcohol use. The overall quality of evidence was low or very low, and there was high, unexplained heterogeneity. \n\nUpon comparing any family intervention to no intervention/standard care, the authors found no intervention effect on the prevalence (SMD) 0.00, 95% CI ‐0.08 to 0.08; studies = 12; participants = 7490; I² = 57%; low‐quality evidence) or frequency (SMD ‐0.31, 95% CI ‐0.83 to 0.21; studies = 8; participants = 1835; I² = 96%; very low‐quality evidence) of alcohol use in comparison with no intervention/standard care. The effect of any parent/family interventions on alcohol consumption volume compared with no intervention/standard care was very small (SMD ‐0.14, 95% CI ‐0.27 to 0.00; studies = 5; participants = 1825; I² = 42%; low‐quality evidence). \n\nWhen comparing parent/family and adolescent interventions versus interventions with young people alone, authors found no difference in alcohol use prevalence (SMD ‐0.39, 95% CI ‐0.91 to 0.14; studies = 4; participants = 5640; I² = 99%; very low‐quality evidence) or frequency (SMD ‐0.16, 95% CI ‐0.42 to 0.09; studies = 4; participants = 915; I² = 73%; very low‐quality evidence). For this comparison, no trials reporting on the volume of alcohol use could be pooled in meta‐analysis. \n\nIn general, the results remained consistent in separate subgroup analyses of universal, selective, and indicated interventions. No adverse effects were reported. \n","The results of this review indicate that there are no clear benefits of family‐based programmes for alcohol use among young people. Patterns differ slightly across outcomes, but overall, the variation, heterogeneity, and number of analyses performed preclude any conclusions about intervention effects. Additional independent studies are required to strengthen the evidence and clarify the marginal effects observed. "]
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[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This Cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text. Fifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect. One targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects. Among school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]

{"sheet":"Fam ind","index":34,"n_rows":79,"n_cols":5,"rows_kept":79,"cut":false,"hidden":false,"merged":[[78,3,102,3],[78,4,102,4],[24,1,24,4],[26,1,54,1],[26,2,56,2],[26,3,56,3],[26,4,56,4],[57,1,77,1],[57,2,77,2],[57,3,77,3],[57,4,77,4],[78,1,93,1],[78,2,81,2]]}
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[null,"Families are supported and protected - Indicated Interventions- Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"McGovern R et al. Effectiveness of psychosocial interventions for reducing parental substance misuse. Cochrane Database of Systematic Reviews 2021, Issue 3. Art. No.: CD012823.\nAvailable here","Participants were parents who use substances; this included mothers and fathers of children (sons and daughters) under the age of 21 years, regardless of custodial or residency status of the children. Same-sex parents and foster parents were eligible for inclusion.","The authors included 22 unique studies with a total of 2274 participants (mean age of parents ranged from 26.3 to 40.9 years), examining 24 experimental interventions. The majority of studies intervened with mothers only (n = 16; 73%). Heroin, cocaine, and alcohol were the most commonly reported substances used by participants. The interventions targeted either parenting only (n = 13; 59%); drug and alcohol use only (n = 5; 23%); or integrated interventions which addressed both (n = 6; 27%).\nThe authors found moderate-quality evidence that psychosocial interventions are probably more effective at reducing the frequency of parental alcohol misuse than comparison conditions at 6-month (mean difference (MD) −0.32, 95% confidence interval (CI) −0.51 to −0.13; 6 studies, 475 participants) and 12-month follow-up (standardised mean difference (SMD) −0.25, 95% CI −0.47 to −0.03; 4 studies, 366 participants). The authors found a significant reduction in frequency of use at 12 months only (SMD −0.21, 95% CI −0.41 to −0.01; 6 studies, 514 participants, moderate-quality evidence).\nThe authors examined the effect of the intervention type. They found low-quality evidence that psychosocial interventions targeting substance use only may not reduce the frequency of alcohol (6 months: SMD −0.35, 95% CI −0.86 to 0.16; 2 studies, 89 participants and 12 months: SMD −0.09, 95% CI −0.86 to 0.61; 1 study, 34 participants)\nA parenting intervention only, without an adjunctive substance use component, may not reduce frequency of alcohol misuse (6 months: SMD −0.21, 95% CI −0.46 to 0.04, 3 studies; 273 participants, low-quality evidence and 12 months: SMD −0.11, 95% CI −0.64 to 0.41; 2 studies; 219 participants, very low-quality evidence).\nParents receiving integrated interventions which combined both parenting- and substance use-targeted components may reduce alcohol misuse with a small effect size (6 months: SMD −0.56, 95% CI −0.96 to −0.16 and 12 months: SMD −0.42, 95% CI −0.82 to −0.03; 2 studies, 113 participants). However, this evidence was of low quality.\nInterventions appeared to be more often beneficial for fathers than for mothers. The authors found low- to very low-quality evidence of a reduction in frequency of alcohol misuse for mothers at six months only (SMD −0.27, 95% CI −0.50 to −0.04; 4 studies, 328 participants), whilst in fathers there was a reduction in frequency of alcohol misuse (6 months: SMD −0.43, 95% CI −0.78 to −0.09; 2 studies, 147 participants and 12 months: SMD −0.34, 95% CI −0.69 to 0.00; 2 studies, 147 participants).","The authors found moderate-quality evidence that psychosocial interventions probably reduce the frequency at which parents use alcohol. Integrated psychosocial interventions which combine parenting skills interventions with a substance use component may show the most promise. \nWhilst it appears that mothers may benefit less than fathers from intervention, caution is advised in the interpretation of this evidence, as the interventions provided to mothers alone typically did not address their substance use and other related needs. \nThe authors found low-quality evidence from few studies that interventions involving children are not beneficial."]
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[null,"Steele DW, et al. Interventions for Substance Use Disorders in Adolescents: A Systematic Review. Comparative Effectiveness Review No. 225.  AHRQ Publication No. 20-EHC014. Rockville, MD: Agency for Healthcare Research and Quality. May 2020.\nAvailable here.","Adolescents ages 12 to 20 years with problematic substance use or substance use disorder.","The authors included interventions designed to achieve abstinence, reduce use quantity and frequency, improve functional outcomes, and reduce substance-related harms. Interventions were categorised into seven primary intervention components: motivational interviewing (MI), family focused therapy (Fam), cognitive behavioral therapy (CBT), psychoeducation, contingency management (CM), peer group therapy, and intensive case management. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nMotivational interviewing reduced heavy alcohol use days by 0.7 days/month, alcohol use days by 1.2 days/month compared with treatment as usual. Across multiple intensive interventions, family focussed therapy was most effective, reducing alcohol use days by 3.5 days/month compared with treatment as usual.\n\n","Reviewers conclude that :\nBrief interventions: motivational interviewing reduces heavy alcohol use, low Strength of Evidence (SoE) and alcohol use days (moderate SoE). \nFamily focussed therapy: may be most effective in reducing alcohol use (low SoE). More research is needed to identify other effective intensive behavioral interventions for alcohol use disorder. Both motivational interviewing and CBT reduce combined alcohol and other drug use (low SoE).\nPharmacological interventions: systematic reviews in the college settings support use of brief interventions for students with any use, heavy or problematic use. More research is needed to identify the most effective combinations of behavioral and pharmacologic treatments for alcohol use disorders."]
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[null,"Gilligan C, et al. Family‐based prevention programmes for alcohol use in young people. Cochrane Database of Systematic Reviews 2019, Issue 3. Art. No.: CD012287. DOI: 10.1002/14651858.CD012287.pub2.\nAvailable here.","School age children (up to 18 years of age)","This Cochrane review aimed to assess the effectiveness of universal, selective, and indicated family-based prevention programmes in preventing alcohol use or problem drinking in school-aged children (up to 18 years of age). \n\nForty six studies (39,822 participants) were included in the review, with 27 classified as universal, 12 as selective, and seven as indicated. Meta‐analyses were performed according to outcome, including studies reporting on the prevalence, frequency, or volume of alcohol use. The overall quality of evidence was low or very low, and there was high, unexplained heterogeneity. \n\nUpon comparing any family intervention to no intervention/standard care, the authors found no intervention effect on the prevalence (SMD) 0.00, 95% CI ‐0.08 to 0.08; studies = 12; participants = 7490; I² = 57%; low‐quality evidence) or frequency (SMD ‐0.31, 95% CI ‐0.83 to 0.21; studies = 8; participants = 1835; I² = 96%; very low‐quality evidence) of alcohol use in comparison with no intervention/standard care. The effect of any parent/family interventions on alcohol consumption volume compared with no intervention/standard care was very small (SMD ‐0.14, 95% CI ‐0.27 to 0.00; studies = 5; participants = 1825; I² = 42%; low‐quality evidence). \n\nWhen comparing parent/family and adolescent interventions versus interventions with young people alone, authors found no difference in alcohol use prevalence (SMD ‐0.39, 95% CI ‐0.91 to 0.14; studies = 4; participants = 5640; I² = 99%; very low‐quality evidence) or frequency (SMD ‐0.16, 95% CI ‐0.42 to 0.09; studies = 4; participants = 915; I² = 73%; very low‐quality evidence). For this comparison, no trials reporting on the volume of alcohol use could be pooled in meta‐analysis. \n\nIn general, the results remained consistent in separate subgroup analyses of universal, selective, and indicated interventions. No adverse effects were reported. \n","The results of this review indicate that there are no clear benefits of family‐based programmes for alcohol use among young people. Patterns differ slightly across outcomes, but overall, the variation, heterogeneity, and number of analyses performed preclude any conclusions about intervention effects. Additional independent studies are required to strengthen the evidence and clarify the marginal effects observed. "]

{"sheet":"school uni","index":35,"n_rows":276,"n_cols":5,"rows_kept":276,"cut":false,"hidden":false,"merged":[[273,1,273,4],[275,1,301,1],[275,2,301,2],[275,3,301,3],[246,1,246,4],[248,1,271,1],[248,2,271,2],[248,3,271,3],[248,4,271,4],[275,4,301,4],[226,1,238,1],[226,2,238,2],[226,3,238,3],[226,4,238,4],[240,1,240,4],[194,1,210,1],[194,2,222,2],[194,3,222,3],[194,4,213,4],[224,1,224,4],[66,1,66,4],[24,1,24,4],[26,1,48,1],[26,2,48,2],[26,3,48,4],[49,1,55,1],[49,2,63,2],[49,3,63,4],[60,1,63,1],[174,4,193,4],[95,1,95,4],[97,1,112,1],[97,2,100,2],[97,3,117,3],[97,4,117,4],[144,1,156,1],[144,2,145,2],[144,3,173,3],[144,4,165,4],[174,1,187,1],[174,2,175,2],[174,3,193,3],[68,1,93,1],[68,2,93,2],[68,3,93,3],[68,4,93,4],[118,1,143,1],[118,2,143,2],[118,3,143,3],[118,4,143,4]]}
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[null,"Educational setting - Universal interventions - NICE Guidance"]
[null,"Source:","Population:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Alcohol interventions in secondary and further education. NG135. London: NICE; 2019. \nAvailable here.\n","• CYP (11 to 18years) in full time education.\n• YP (18 to 25 years) with an Education, health and care (EHC) plan.\n• CYP (11 to 18years) in full time education considered ‘at risk’.\n• YP (18 to 25 years) EHC plan considered ‘at risk’.","This guideline covers interventions in secondary and further education to prevent and reduce alcohol use among children and young people aged 11 up to and including 18. It also covers people aged 11 to 25 with special educational needs or disabilities in full-time education. It will also be relevant to children aged 11 in year 6 of primary school.\n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n1.1 Planning alcohol education\n1.2 Delivering universal alcohol education (Evidence Review A: Universal interventions)\n1.3 Targeted interventions (Evidence review B: Targeted interventions)\n\nThe following recommendations for further research were also identified in Evidence review A and B:\n1. What components of alcohol education delivery contribute to its effectiveness for children and young people aged 11 to 18 in full-time education, and those with special educational needs and disabilities (SEND) up to the age of 25? (Evidence review A: universal interventions)\n2. How effective and cost effective are individual, compared with group, education-based interventions for children and young people aged 11 to 18 in full-time education who are thought to be vulnerable to alcohol misuse? (Evidence review B: targeted interventions)\n3. How effective and cost effective are universal, education-based alcohol interventions for children and young people aged 11 to 25 with SEND? (Evidence review A: universal interventions)\n4. How effective and cost effective are education-based alcohol interventions targeted at children and young people aged 11 to 25 with SEND who are thought to be vulnerable to alcohol misuse? (Evidence review B: targeted interventions)\n5. How effective are education-based alcohol prevention interventions (universal or targeted) for children and young people aged 11 to 25 with SEND in full-time education? (Evidence review A: universal interventions and Evidence review B: targeted interventions)\n6. What methods and techniques help secondary schools and providers to effectively engage with parents and carers as part of a whole-school approach to promote and support alcohol education? (Evidence review A: universal interventions)\n"]
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[null,"National Institute for Health and Care Excellence. Behaviour change: general approaches. PH6. London: NICE; 2007\nAvailable here.\n\n\n\n","General population","This guideline covers a set of principles that can be used to help people change their behaviour. The aim is for practitioners to use these principles to encourage people to adopt a healthier lifestyle by, for example, stopping smoking, adopting a healthy diet and being more physically active.\n\nThe guideline includes the following recommendations. All the recommendations are relevant to the scope of this topic evidence map. The recommendations are supported by the underpinning Evidence review 1.\n• Providing education and training for those delivering them\n• Delivery of these activities, including one-to-one and community-based programmes and those aimed at specific populations\n• Evaluation of their effectiveness and cost effectiveness\n\nThe Programme Development Group identified a number of gaps in the evidence related to behaviour change interventions and programmes, based on an assessment of the evidence and made recommendations for research to address the most important gaps in the evidence. Please refer to 4. Recommendations for research' section of the guidance.\n\nNovember 2017: NICE checked this guideline and found no new evidence that affects the recommendations in this guideline."]
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[null,"Educational setting - Safe and Supportive Environment- Universal interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' Conclusions:"]
[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This Cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text. Fifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect. One targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects. Among school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]
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[null,"Educational setting - Changed attitudes and social norms- Universal interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"Wolfenden L et al. Strategies for enhancing the implementation of school‐based policies or practices targeting diet, physical activity, obesity, tobacco or alcohol use. Cochrane Database of Systematic Reviews 2022, Issue 8.\nAvailable here.","School age children (between 5 to 18 years of age)","This Cochrane review aimed to to find out how effective strategies were in supporting the implementation of school‐based interventions to address student diet, physical activity, unhealthy weight gain, and tobacco or alcohol use. Examples of strategies include methods of improving quality, education and training, feedback on how the school was doing, prompts and reminders, and educational resources (e.g. manuals).\n\nThe reviewers included an additional 11 trials in this update bringing the total number of included studies in the review to 38. Of these, 22 were conducted in the USA. Twenty‐six studies used RCT designs. Seventeen trials tested strategies to implement healthy eating, 12 physical activity and six a combination of risk factors. Just one trial sought to increase the implementation of interventions to delay initiation or reduce the consumption of alcohol. All trials used multiple implementation strategies, the most common being educational materials, educational outreach and educational meetings. Only findings relevant to this evidence map have been reported below.\n\nThe overall certainty of evidence was low and ranged from very low to moderate for secondary review outcomes.\n\nPooled analyses of RCTs found, relative to a control, the use of implementation strategies may result in a large increase in the implementation of interventions in schools (SMD 1.04, 95% CI 0.74 to 1.34; 22 RCTs, 1917 participants; low‐certainty evidence). One RCT assessed measures of student alcohol use and found strategies to support implementation may result in a slight increase in use (odds ratio 1.10, 95% CI 0.77 to 1.56; P = 0.60; 2105 participants).","The use of implementation strategies may result in large increases in implementation of interventions, and slight improvements in measures of student diet, and physical activity. Further research is required to assess the impact of implementation strategies on such behavioural‐ and obesity‐related outcomes, including on measures of alcohol use, where the findings of one trial suggest it may slightly increase student risk. Given the low certainty of the available evidence for most measures further research is required to guide efforts to facilitate the translation of evidence into practice in this setting."]
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[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This Cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text. Fifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect. One targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects. Among school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]
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[null,"Foxcroft DR et al. Social norms information for alcohol misuse in university and college students. Cochrane Database Syst Rev 2015, Issue 12. Art. No.: CD006748. DOI: 10.1002/14651858.CD006748.pub4.\nAvailable here. \n","University or college students. ","This Cochrane review aimed to determine whether social norms interventions reduce alcohol‐related negative consequences, alcohol misuse or alcohol consumption when compared with a control (ranging from assessment only/no intervention to other educational or psychosocial interventions) among university and college students.\n\nSeventy studies (44,958 participants) were included in the review, and 63 studies (42,784 participants) in the meta‐analyses. Overall, the risk of bias assessment showed that these studies provided moderate or low quality evidence. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nBinge drinking at four or more months (results pooled across delivery modes): SMD ‐0.06, 95 per cent CI ‐0.11 to ‐0.02 (participants = 11,292; studies = 16; moderate quality evidence), equivalent to 2.7 per cent fewer binge drinkers if 30‐day prevalence is 43.9 per cent.\n\nDrinking quantity at four or more months (results pooled across delivery modes): SMD ‐0.08, 95 per cent CI ‐0.12 to ‐0.04 (participants = 21,169; studies = 32; moderate quality evidence), equivalent to a reduction of 0.9 drinks consumed each week, from a baseline of 13.7 drinks per week.\n\nDrinking frequency at four or more months: WF SMD ‐0.11, 95 per cent CI ‐0.17 to ‐0.04 (participants = 9929; studies = 10; moderate quality evidence), equivalent to a decrease of 0.17 drinking days/wk, from a baseline of 2.74 days/wk; individual face‐to‐face normative feedback SMD ‐0.21, 95 per cent CI ‐0.31 to ‐0.10 (participants = 1464; studies = 8; moderate quality evidence), equivalent to a decrease of 0.32 drinking days/wk, from a baseline of 2.74 days/wk. No effects were found for group face‐to‐face normative feedback or normative marketing campaign.\n\nEstimated blood alcohol concentration (BAC) at four or more months: (Peak BAC results pooled across delivery modes) SMD ‐0.08, 95 per cent CI ‐0.17 to 0.00 (participants = 7198; studies = 11; low quality evidence), equivalent to a reduction in peak BAC from an average of 0.144 per cent to 0.135 per cent. No effects were found for typical BAC with individual face‐to‐face normative feedback.\n","The results of this review indicate that no substantive meaningful benefits are associated with social norms interventions for prevention of alcohol misuse among college/university students. Although some significant effects were found, we interpret the effect sizes as too small, given the measurement scales used in the studies included in this review, to be of relevance for policy or practice. Moreover, the significant effects are not consistent for all misuse measures, heterogeneity was a problem in some analyses and bias cannot be discounted as a potential cause of these findings. "]
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[null,"Langford R et al. The WHO Health Promoting School framework for improving the health and well‐being of students and their academic achievement. Cochrane Database Syst Rev 2014, Issue 4. Art. No.: CD008958. DOI: 10.1002/14651858.CD008958.pub2 \nAvailable here. ","School aged children (aged 4-18).","This Cochrane review aimed to assess the effectiveness of the Health Promoting Schools (HPS) framework in improving the health and well‐being of students and their academic achievement.\n\nSixty seven eligible cluster trials, randomising 1,443 schools or districts were included. This is made up of 1,345 schools and 98 districts. The studies tackled a range of health issues: physical activity (4), nutrition (12), physical activity and nutrition combined (18), bullying (7), tobacco (5), alcohol (2), sexual health (2), violence (2), mental health (2), hand‐washing (2), multiple risk behaviours (7), cycle‐helmet use (1), eating disorders (1), sun protection (1), and oral health (1). Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nReview authors report that the quality of evidence overall was low to moderate as determined by the GRADE approach. Risk of bias assessments identified methodological limitations, including heavy reliance on self‐reported data and high attrition rates for some studies. In addition, there was a lack of long‐term follow‐up data for most studies.\n\nEight studies provided data on alcohol use and all but one were included in the meta‐analysis. Overall, there was no evidence that any of the different intervention approaches were effective in reducing alcohol intake.","The results of this review provide evidence for the effectiveness of some interventions based on the HPS framework for improving certain health outcomes but not others. More well‐designed research is required to establish the effectiveness of this approach for other health topics and academic achievement."]
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[null,"Siegfried N et al. Restricting or banning alcohol advertising to reduce alcohol consumption in adults and adolescents. Cochrane Database Syst Rev 2014, Issue 11. Art. No.: CD010704. DOI: 10.1002/14651858.CD010704.pub2.\nAvailable here. \n","Adults of any age and adolescents (defined by WHO as aged 10 to 19 years)","The aim of this Cochrane review was to evaluate the benefits, harms and costs of restricting or banning the advertising of alcohol, via any format, compared with no restrictions or counter‐advertising, on alcohol consumption in adults and adolescents.\n\nOne small RCT (80 male student participants conducted in the Netherlands and published in 2009) and three ITS studies (general population studies in Canadian provinces conducted in the 1970s and 80s) were examined. The RCT found that young men exposed to movies with a low‐alcohol content drank less than men exposed to movies with a high‐alcohol content (MD ‐0.65 drinks; 95 per cent CI ‐1.2, ‐0.07; p value = 0.03, very‐low‐quality evidence). Young men exposed to commercials with a neutral content compared with those exposed to commercials for alcohol drank less (MD ‐0.73 drinks; 95 per cent CI ‐1.30, ‐0.16; p value = 0.01, very‐low‐quality evidence). Outcomes were assessed immediately after the end of the intervention (lasting 1.5 hours), so no follow‐up data were available.\n\nTwo of the ITS studies evaluated the implementation of an advertising ban and one study evaluated the lifting of such a ban (GRADE: very‐low‐quality evidence). Each of the three ITS studies evaluated a different type of ban (partial or full) compared with different degrees of restrictions or no restrictions during the control period. The results from the three ITS studies were inconsistent. A meta‐analysis of the two studies that evaluated the implementation of a ban showed an overall mean non‐significant increase in beer consumption in the general population of 1.10 per cent following the ban (95 per cent CI ‐5.26, 7.47; p value = 0.43; I2 = 83 per cent, very‐low‐quality evidence). This finding is consistent with an increase, no difference, or a decrease in alcohol consumption. In the study evaluating the lifting of a total ban on all forms of alcohol advertising to a partial ban on spirits advertising only, which utilised an Abrupt Auto‐regressive Integrated Moving Average model, the volume of all forms of alcohol sales decreased by 11.11 kilolitres (95 per cent CI ‐27.56, 5.34; p value = 0.19) per month after the ban was lifted. In this model, beer and wine sales increased per month by 14.89 kilolitres (95 per cent CI 0.39, 29.39; p value = 0.04) and 1.15 kilolitres (95 per cent CI ‐0.91, 3.21; p value = 0.27), respectively, and spirits sales decreased statistically significantly by 22.49 kilolitres (95 per cent CI ‐36.83, ‐8.15; p value = 0.002).\n\nNone of the studies were funded by the alcohol or advertising industries.\n","Authors conclude that there is a lack of robust evidence for or against recommending the implementation of alcohol advertising restrictions. Advertising restrictions should be implemented within a high‐quality, well‐monitored research programme to ensure the evaluation over time of all relevant outcomes in order to build the evidence base. "]
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[null,"Educational setting - Reduced availability- Universal interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"Hollands  GJ et al. Altering the availability or proximity of food, alcohol, and tobacco products to change their selection and consumption. Cochrane Database of Systematic Reviews 2019, Issue 9. Art. No.: CD012573. DOI: 10.1002/14651858.CD012573.pub3.\nAvailable here.","Adults","This Cochrane review aimed to:\n1. To assess the impact on selection and consumption of altering the availability or proximity of (a) food (including non‐alcoholic beverages), (b) alcohol, and (c) tobacco products.\n2. To assess the extent to which the impact of these interventions is modified by characteristics of: i. studies, ii. interventions, and iii. participants.\n\nThe reviewers included 24 studies, with the majority (20/24) giving concerns about risk of bias. All of the included studies investigated food products; none investigated alcohol or tobacco. ","The authors concluded that:\n- Further research is warranted in real‐world settings, intervening across a wider range of foods as well as alcohol and tobacco products and over sustained time periods"]
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[null,"Educational setting - Reduced affordability- Universal interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]
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[null,"Educational setting - Behaviour change- Universal interventions - Systematic reviews"]
[null,"Source:","Audience: ","Findings:","Authors' conclusions:"]
[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. \n\nFifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect.\n\nOne targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects.\n\nAmong school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]
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[null,"Educational setting - Families are supported and protected - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This Cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text. Fifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect. One targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects. Among school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]

{"sheet":"school sel","index":36,"n_rows":236,"n_cols":5,"rows_kept":236,"cut":false,"hidden":false,"merged":[[25,1,25,4],[27,1,50,1],[27,2,50,2],[27,3,50,4],[52,1,52,4],[54,4,81,4],[83,1,83,4],[85,1,111,1],[85,2,111,2],[85,3,111,3],[85,4,111,4],[54,1,81,1],[54,2,81,2],[54,3,81,3],[112,1,123,1],[112,2,114,2],[112,3,134,3],[112,4,134,4],[136,1,136,4],[138,1,140,1],[142,1,142,4],[148,1,148,4],[150,1,173,1],[150,2,173,2],[150,3,173,3],[150,4,173,4],[174,1,207,1],[174,2,207,2],[174,3,207,3],[174,4,207,4],[208,1,219,1],[208,2,210,2],[208,3,231,3],[208,4,231,4],[233,1,233,4],[235,1,261,1],[235,2,261,2],[235,3,261,3],[235,4,261,4]]}
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[null,"Educational setting - Selective interventions - NICE Guidance"]
[null,"Source:","Population:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Alcohol interventions in secondary and further education. NG135. London: NICE; 2019. \nAvailable here.\n","• CYP (11 to 18years) in full time education.\n• YP (18 to 25 years) with an Education, health and care (EHC) plan.\n• CYP (11 to 18years) in full time education considered ‘at risk’.\n• YP (18 to 25 years) EHC plan considered ‘at risk’.","This guideline covers interventions in secondary and further education to prevent and reduce alcohol use among children and young people aged 11 up to and including 18. It also covers people aged 11 to 25 with special educational needs or disabilities in full-time education. It will also be relevant to children aged 11 in year 6 of primary school.\n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n1.1 Planning alcohol education\n1.2 Delivering universal alcohol education (Evidence Review A: Universal interventions)\n1.3 Targeted interventions (Evidence review B: Targeted interventions)\n\nThe following recommendations for further research were also identified in Evidence review A and B:\n1. What components of alcohol education delivery contribute to its effectiveness for children and young people aged 11 to 18 in full-time education, and those with special educational needs and disabilities (SEND) up to the age of 25? (Evidence review A: universal interventions)\n2. How effective and cost effective are individual, compared with group, education-based interventions for children and young people aged 11 to 18 in full-time education who are thought to be vulnerable to alcohol misuse? (Evidence review B: targeted interventions)\n3. How effective and cost effective are universal, education-based alcohol interventions for children and young people aged 11 to 25 with SEND? (Evidence review A: universal interventions)\n4. How effective and cost effective are education-based alcohol interventions targeted at children and young people aged 11 to 25 with SEND who are thought to be vulnerable to alcohol misuse? (Evidence review B: targeted interventions)\n5. How effective are education-based alcohol prevention interventions (universal or targeted) for children and young people aged 11 to 25 with SEND in full-time education? (Evidence review A: universal interventions and Evidence review B: targeted interventions)\n6. What methods and techniques help secondary schools and providers to effectively engage with parents and carers as part of a whole-school approach to promote and support alcohol education? (Evidence review A: universal interventions)\n"]
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[null,"Educational setting - Safe and Supportive Environment - Selective interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' Conclusions:"]
[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This Cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text. Fifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect. One targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects. Among school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]
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[null,"Educational setting - Changed attitudes and social norms - Selective interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This Cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text. Fifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect. One targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects. Among school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]
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[null,"Foxcroft DR et al. Motivational interviewing for the prevention of alcohol misuse in young adults. Cochrane Database Syst Rev 2016, Issue 7. Art. No.: CD007025. DOI: 10.1002/14651858.CD007025.pub4.\nAvailable here.\n","Young adults up to 25 years of age (higher risk individuals or settings). ","This Cochrane review aimed to assess the effects of motivational interviewing (MI) interventions for preventing alcohol misuse and alcohol‐related problems in young adults. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nEighty four trials (22,872 participants) were included, with 70/84 studies reporting interventions in higher risk individuals or settings. Studies with follow‐up periods of at least four months were of more interest in assessing the sustainability of intervention effects and were also less susceptible to short‐term reporting or publication bias. Overall, the risk of bias assessment showed that these studies provided moderate or low quality evidence.\n\nAt four or more months follow‐up, effects in favour of MI were found for the quantity of alcohol consumed (standardised mean difference (SMD) −0.11, 95 per cent confidence interval (CI) −0.15 to −0.06 or a reduction from 13.7 drinks/week to 12.5 drinks/week; moderate quality evidence); frequency of alcohol consumption (SMD −0.14, 95 per cent CI −0.21 to −0.07 or a reduction in the number of days/week alcohol was consumed from 2.74 days to 2.52 days; moderate quality evidence); and peak blood alcohol concentration, or BAC (SMD −0.12, 95 per cent CI −0.20 to 0.05, or a reduction from 0.144 per cent to 0.131 per cent; moderate quality evidence).\n\nFurther analyses showed that there was no clear relationship between the duration of the MI intervention (in minutes) and effect size. Subgroup analyses revealed no clear subgroup effects for longer‐term outcomes (four or more months) for assessment only versus alternative intervention controls; for university/college vs other settings; or for higher risk vs all/low risk participants.\n","The results of this review indicate that there are no substantive, meaningful benefits of MI interventions for preventing alcohol use, misuse or alcohol‐related problems. Although the reviewers found some statistically significant effects, the effect sizes were too small, given the measurement scales used in the included studies, to be of relevance to policy or practice. Moreover, the statistically significant effects are not consistent for all misuse measures, and the quality of evidence is not strong, implying that any effects could be inflated by risk of bias."]
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[null,"Educational setting - Reduced availability - Selective Interventions - Systematic reviews"]
[null,"Source:","Populations:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]
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[null,"Educational setting - Reduced affordability - Selective Interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]
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[null,"Educational setting - Behaviour change - Selective interventions - Systematic reviews"]
[null,"Source:","Audience: ","Findings:","Authors' conclusions:"]
[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. \n\nFifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect.\n\nOne targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects.\n\nAmong school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]
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[null,"O'Connor EA et al. Screening and behavioral counseling interventions to reduce unhealthy alcohol use in adolescents and adults: An updated systematic review for the U.S. Preventive Services Task Force. Rockville MD: Agency for Healthcare Research and Quality; 2018. \nAvailable here. ","Adolescents or adults age 12 years or older. ","One hundred and thirteen studies (n=314,466) were included across all Key Questions. The authors did not find any studies that examined the benefits or harms of screening programs to reduce unhealthy alcohol use. For adolescents, data supported the use of the National Institute on Alcohol Abuse and Alcoholism Youth Screen and other similar one- or two-item screeners to detect alcohol use disorder. For adults, brief (1- to 3-item) screeners commonly reported sensitivity and specificity between 0.70 and 0.85, typically having better sensitivity than the full Alcohol Use Disorders Identification Test (AUDIT) for identifying the full spectrum of unhealthy use. However, the AUDIT tended to have higher specificity, particularly at the standard cutoff of 8 or higher.  \n\nIdentified interventions to reduce unhealth alcohol use were generally counselling interventions, with most involving one or two sessions (90% involved ≤ 4 sessions) with a median of 30 minutes contact time (88% involved ≤ 2 hours contact). The most commonly reported intervention element was the use of personalized normative feedback sessions, in which participants were shown how their alcohol use compares to others; this technique was used in more than half of the included trials and almost all trials in younger adults. Motivational techniques were also common, particularly in combination with personalized normative feedback.\n\nEvidence on the effects of interventions to reduce unhealthy alcohol use in adolescents was limited to two trials; both found mixed results for reduced alcohol use and did not report health or related outcomes. \n\nIn adults, interventions reduced the number of drinks per week (weighted mean difference, −1.82 [95% confidence interval {CI}, −2.42 to −1.22]), the proportion exceeding recommended drinking limits (odds ratio [OR], 0.60 [95% CI, 0.53 to 0.67]), and the proportion reporting a heavy use episode (OR, 0.62 [95% CI, 0.55 to 0.71]), and increased the proportion of pregnant women reporting abstinence (OR, 1.92 [95% CI, 1.19 to 3.09]) after 6 to 12 months. \n\nHeterogeneity was high and effect size was associated with a number of study characteristics such as setting, target age of the population, publication year, study size, and average baseline-use levels, but not clearly associated with any intervention characteristics. Data on effectiveness in important subgroups were very limited, but analyses by sex, the most commonly reported subgroup analysis, did not indicate differences in effectiveness of the interventions. Health outcomes were sparsely reported and, with some exceptions, generally did not demonstrate group differences in effect. No evidence of harm was found.","Among adults, screening instruments are available that can effectively identify persons with unhealthy alcohol use and that are feasible for use in primary care settings, and interventions in those who screen positive are associated with reductions in unhealthy alcohol use. There was no evidence that these interventions have unintended harmful effects. More evidence is needed to determine whether screening for unhealthy alcohol use is beneficial for adolescents."]
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[null,"Foxcroft DR et al. Motivational interviewing for the prevention of alcohol misuse in young adults. Cochrane Database Syst Rev 2016, Issue 7. Art. No.: CD007025. DOI: 10.1002/14651858.CD007025.pub4.\nAvailable here.\n","Young adults up to 25 years of age (higher risk individuals or settings). ","This Cochrane review aimed to assess the effects of motivational interviewing (MI) interventions for preventing alcohol misuse and alcohol‐related problems in young adults. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nEighty four trials (22,872 participants) were included, with 70/84 studies reporting interventions in higher risk individuals or settings. Studies with follow‐up periods of at least four months were of more interest in assessing the sustainability of intervention effects and were also less susceptible to short‐term reporting or publication bias. Overall, the risk of bias assessment showed that these studies provided moderate or low quality evidence.\n\nAt four or more months follow‐up, effects in favour of MI were found for the quantity of alcohol consumed (standardised mean difference (SMD) −0.11, 95 per cent confidence interval (CI) −0.15 to −0.06 or a reduction from 13.7 drinks/week to 12.5 drinks/week; moderate quality evidence); frequency of alcohol consumption (SMD −0.14, 95 per cent CI −0.21 to −0.07 or a reduction in the number of days/week alcohol was consumed from 2.74 days to 2.52 days; moderate quality evidence); and peak blood alcohol concentration, or BAC (SMD −0.12, 95 per cent CI −0.20 to 0.05, or a reduction from 0.144 per cent to 0.131 per cent; moderate quality evidence).\n\nFurther analyses showed that there was no clear relationship between the duration of the MI intervention (in minutes) and effect size. Subgroup analyses revealed no clear subgroup effects for longer‐term outcomes (four or more months) for assessment only versus alternative intervention controls; for university/college vs other settings; or for higher risk vs all/low risk participants.\n","The results of this review indicate that there are no substantive, meaningful benefits of MI interventions for preventing alcohol use, misuse or alcohol‐related problems. Although the reviewers found some statistically significant effects, the effect sizes were too small, given the measurement scales used in the included studies, to be of relevance to policy or practice. Moreover, the statistically significant effects are not consistent for all misuse measures, and the quality of evidence is not strong, implying that any effects could be inflated by risk of bias."]
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[null,"Educational setting - Families are supported and protected - Selective interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This Cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text. Fifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect. One targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects. Among school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]

{"sheet":"school ind","index":37,"n_rows":167,"n_cols":5,"rows_kept":167,"cut":false,"hidden":false,"merged":[[75,1,81,1],[75,2,89,2],[75,3,89,4],[86,1,89,1],[24,1,24,4],[26,1,49,1],[26,2,49,2],[26,3,49,4],[50,1,74,1],[50,2,74,2],[50,3,74,4],[91,1,91,4],[93,1,119,1],[93,2,119,2],[93,3,119,3],[93,4,119,4],[121,1,121,4],[123,1,127,1],[123,2,127,2],[123,3,127,3],[123,4,127,4],[164,1,164,4],[129,1,129,4],[131,1,133,1],[135,1,135,4],[142,1,142,4],[144,1,161,1],[144,2,145,2],[144,3,161,3],[144,4,162,4]]}
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[null,"Educational setting - NICE Guidance"]
[null,"Source:","Population:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Behaviour change: individual approaches. PH49. London: NICE; 2014. \nAvailable here.\n","Everyone aged 16 years and older","This guideline covers changing health-damaging behaviours among people aged 16 and over using interventions such as goals and planning, feedback and monitoring, and social support. It aims to help tackle a range of behaviours including alcohol misuse, poor eating patterns, lack of physical activity, unsafe sexual behaviour and smoking.\n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n1. Develop a local behaviour change policy and strategy\n2. Ensure organisation policies, strategies, resources and training all support behaviour change\n3. Commission interventions from services willing to share intervention details and data\n4. Commission high quality, effective behaviour change interventions\n5. Plan behaviour change interventions and programmes taking local needs into account\n6. Develop acceptable, practical and sustainable behaviour change interventions and programmes\n7. Use proven behaviour change techniques when designing interventions (Evidence review1 and Evidence review2)\n8. Ensure interventions meet individual needs\n9. Deliver very brief, brief, extended brief and high intensity behaviour change interventions and programmes\n10. Ensure behaviour change is maintained for at least a year (Evidence review1 and Evidence review2)\n11. Commission training for all staff involved in helping to change people's behaviour\n12. Provide training for behaviour change practitioners\n13. Provide training for health and social care practitioners\n14. Assess behaviour change practitioners and provide feedback\n15. Monitor behaviour change interventions\n16. Evaluate behaviour change interventions\n17. National support for behaviour change interventions and programmes\n\nEvidence review1 did not identify any recommendations for further research. Evidence review 2 made the following recommendation for further research:\n5.7 How do behaviour change techniques lead to change? What are the best methods of testing the relationship between the theories that describe change processes and the effectiveness of interventions in practice?"]
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[null,"National Institute for Health and Care Excellence. Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence. CG115. London: NICE; 2011\nAvailable here.\n\n","Adults (>18 years) or young people (10 to 17 years of age) with a diagnosis of alcohol dependence or meeting criteria for harmful alcohol use (30 to 50 units of alcohol per week)","This guideline covers identifying, assessing and managing alcohol-use disorders (harmful drinking and alcohol dependence) in adults and young people aged 10-17 years. It aims to reduce harms (such as liver disease, heart problems, depression and anxiety) from alcohol by improving assessment and setting goals for reducing alcohol consumption. \n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n• Principles of care\n• Identification and assessment \n• Interventions for alcohol misuse (Evidence review 2011)\n\nThe following recommendations for further research were also identified in Evidence reviews underpinning this guidance:\n1 Is contingency management effective in reducing alcohol consumption in people who misuse alcohol compared with standard care?\n2 What methods are most effective for assessing and diagnosing the presence and severity of alcohol misuse in children and young people?\n3 Is acupuncture effective in reducing alcohol consumption compared with standard care?\n4. For which service users who are moderately and severely dependent on alcohol is an assertive community treatment model a clinically and cost-effective intervention compared with standard care?\n5. For people with moderate and severe alcohol dependence who have significant comorbid problems, is an intensive residential rehabilitation programme clinically and cost effective when compared with intensive community-based care?\n6 For people with alcohol dependence, which medication is most likely to improve adherence and thereby promote abstinence and prevent relapse?\n\nOctober 2022: NICE updated the recommendation about behavioural couples therapy to clarify that this is not suitable in cases of domestic abuse and to add a cross reference to the NICE technology appraisal guidance on nalmefene. They also updated information about off-label prescribing, and added cross references to legislation on controlled drugs and driving, to MHRA advice on addiction to benzodiazepines and codeine, and to NICE's guidelines on smoking, on antisocial personality disorder and on coexisting mental illness and substance misuse community health and social care services.\nJuly 2019: NICE have found no new evidence that affects the recommendations."]
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[null,"National Institute for Health and Care Excellence. Behaviour change: general approaches. PH6. London: NICE; 2007\nAvailable here.\n\n\n\n","General population","This guideline covers a set of principles that can be used to help people change their behaviour. The aim is for practitioners to use these principles to encourage people to adopt a healthier lifestyle by, for example, stopping smoking, adopting a healthy diet and being more physically active.\n\nThe guideline includes the following recommendations. All the recommendations are relevant to the scope of this topic evidence map. The recommendations are supported by the underpinning Evidence review 1.\n• Providing education and training for those delivering them\n• Delivery of these activities, including one-to-one and community-based programmes and those aimed at specific populations\n• Evaluation of their effectiveness and cost effectiveness\n\nThe Programme Development Group identified a number of gaps in the evidence related to behaviour change interventions and programmes, based on an assessment of the evidence and made recommendations for research to address the most important gaps in the evidence. Please refer to 4. Recommendations for research' section of the guidance.\n\nNovember 2017: NICE checked this guideline and found no new evidence that affects the recommendations in this guideline."]
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[null,"Educational setting - Safe and Supportive Environment - Indicated interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' Conclusions:"]
[null,"Hennessy EA et al. Recovery schools for improving behavioral and academic outcomes among students in recovery from substance use disorders: a systematic review. Campbell Systematic Reviews 2018; 9. \nAvailable here. ","Students in recovery from substance use who were enrolled part-time or full-time in secondary (high school) or postsecondary (college or university) educational institutions. ","The review focused on two types of recover schools: recovery high schools (RHSs), which are schools that award secondary school dipolmas and offer a range of therapeutic services in addition to standard educational curricula; and collegiate recovery communities (CRCs), which offer therapeutic and sober support services on college campuses. \n\nOnly one study met the criteria for inclusion in the review. The study used a quasi-experimental design to examine the effects of RHSs on high school students' academic and substance use outcomes. No eligible studies examining CRCs were identified. \n\nThe results from the one eligible RHS study indicated that after adjusting for pretest values, students in the RHS condition reported levels of grade point averages (g = 0.26, 95% CI [-0.04, 0.56]), truancy (g = 0.01, 95% CI [-0.29, 0.31]), and alcohol use (g = 0.23, 95% CI [-0.07, 0.53]) similar to participants in the comparison condition. However, students in the RHS condition reported improvements in absenteeism (g = 0.56, 95% CI [0.25, 0.87]), abstinence from alcohol/drugs (OR = 4.36, 95% CI [1.19, 15.98]), marijuana use (g = 0.51, 95% CI [0.20, 0.82]), and other drug use (g = 0.45, 95% CI [0.14, 0.76]).\n\nOverall, there was a serious risk of bias in the one included study. The study had a serious risk of bias due to confounding, low risk of bias due to selection of participants into the study, moderate risk of bias due to classification of interventions, inconclusive risk of bias due to deviations from intended interventions, inconclusive risk of bias due to missing data, moderate risk of bias in measurement of outcomes, and low risk of bias in selection of reported results.","There is insufficient evidence regarding the effectiveness of RHSs and CRCs for improving academic and substance use outcomes among students in recovery from SUDs. Only one identified study examined the effectiveness of RHSs. Although the study reported some beneficial effects, the results must be interpreted with caution given the study's potential risk of bias due to confounding and limited external validity. No identified studies examined the effectiveness of CRCs across the outcomes of interest in this review, so it is unclear what effects these programs may have on students' academic and behavioural outcomes. \n\nThe paucity of evidence on the effectiveness of recovery schools, as documented in this review, thus suggest the need for caution in the widespread adoption of recovery schools for students in recovery from SUDs. Given the lack of empirical support for these recovery schools, additional rigorous evaluation studies are needed to replicate the findings from the one study included in this review. Furthermore, additional research examining the costs of recovery schools may be needed, to help school administrators determine the potential cost-benefits associated with recovery schools. "]
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[null,"Educational setting - Changed attitudes and social norms - Indicated interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]
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[null,"Educational setting - Reduced availability - Indicated interventions - Systematic reviews"]
[null,"Source:","Populations:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]
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[null,"Educational setting - Reduced affordability - Indicated interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]
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[null,"Educational setting - Behaviour change - Indicated interventions - Systematic reviews"]
[null,"Source:","Audience: ","Findings:","Authors' conclusions:"]
[null,"Carney T, Myers BJ, Louw J, Okwundu CI. Brief school‐based interventions and behavioural outcomes for substance‐using adolescents. Cochrane Database Syst Rev 2016; Issue 1. Art. No.: CD008969. DOI: 10.1002/14651858.CD008969.pub3\nAvailable here.\n","Substance using adolescents.","The authors included six RCTs which evaluated the effects of brief school-based interventions for substance-using adolescents. Three studies with 732 adolescents compared brief interventions (Bls) with information provision only, and three studies with 444 adolescents compared Bls with assessment only. Reasons for downgrading the quality of evidence included risk of bias of the included studies, imprecision, and inconsistency. For outcomes that concern substance abuse, the retrieved studies only assessed alcohol and cannabis. \n\nGenerally, moderate quality evidence was found that, compared to information provision only, BIs did not have a significant effect on any of the substance use outcomes at short‐, medium‐, or long‐term follow‐up. \n\nWhen compared to assessment-only controls, BIs were found to significantly reduce the frequency of alcohol use (SMD ‐0.91; 95 per cent CI ‐1.21 to ‐0.61, n = 242), alcohol abuse (SMD ‐0.38; 95 per cent CI ‐0.7 to ‐0.07, n = 190) and dependence (SMD ‐0.58; 95 per cent CI ‐0.9 to ‐0.26, n = 190) at medium-term follow-up in one study. And, at long-term follow-up BI’s also reduced alcohol abuse (SMD ‐0.72; 95 per cent CI ‐1.05 to ‐0.40, n = 181) in one study. However, the evidence from studies that compared brief interventions to assessment‐only conditions was generally of low quality.\n","We found low or very low‐quality evidence that brief school‐based interventions may be more effective in reducing alcohol and cannabis use than the assessment‐only condition and that these reductions were sustained at long‐term follow‐up. We found moderate‐quality evidence that, when compared to information provision, brief interventions probably did not have a significant effect on substance use outcomes. It is premature to make definitive statements about the effectiveness of brief school‐based interventions for reducing adolescent substance use. Further high‐quality studies examining the relative effectiveness of BIs for substance use and other problem behaviours need to be conducted, particularly in low‐ and middle‐income countries."]
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[null,"Educational setting - Families are supported and protected - Indicated interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]

{"sheet":"comm uni","index":38,"n_rows":196,"n_cols":5,"rows_kept":196,"cut":false,"hidden":false,"merged":[[176,1,191,1],[176,2,191,2],[176,3,191,3],[176,4,191,4],[193,1,193,4],[24,1,24,4],[26,1,48,1],[26,2,48,2],[26,3,48,4],[49,1,55,1],[49,2,64,2],[49,3,64,4],[81,1,81,4],[65,1,71,1],[65,2,79,2],[65,3,79,4],[76,1,79,1],[110,1,110,4],[112,1,116,1],[152,4,175,4],[83,1,108,1],[83,2,108,2],[83,3,108,3],[83,4,108,4],[134,1,134,4],[140,1,140,4],[142,1,151,1],[142,2,151,2],[142,3,151,3],[142,4,151,4],[118,1,118,4],[120,1,132,1],[152,1,175,1],[112,2,116,2],[112,3,116,3],[112,4,116,4],[152,2,175,2],[152,3,175,3],[120,2,132,2],[120,3,132,3],[120,4,132,4]]}
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[null,"Community setting - Universal interventions- NICE Guidance"]
[null,"Source:","Population:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Alcohol interventions in secondary and further education. NG135. London: NICE; 2019. \nAvailable here.\n","• CYP (11 to 18years) in full time education.\n• YP (18 to 25 years) with an Education, health and care (EHC) plan.\n• CYP (11 to 18years) in full time education considered ‘at risk’.\n• YP (18 to 25 years) EHC plan considered ‘at risk’.","This guideline covers interventions in secondary and further education to prevent and reduce alcohol use among children and young people aged 11 up to and including 18. It also covers people aged 11 to 25 with special educational needs or disabilities in full-time education. It will also be relevant to children aged 11 in year 6 of primary school.\n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n1.1 Planning alcohol education\n1.2 Delivering universal alcohol education (Evidence Review A: Universal interventions)\n1.3 Targeted interventions (Evidence review B: Targeted interventions)\n\nThe following recommendations for further research were also identified in Evidence review A and B:\n1. What components of alcohol education delivery contribute to its effectiveness for children and young people aged 11 to 18 in full-time education, and those with special educational needs and disabilities (SEND) up to the age of 25? (Evidence review A: universal interventions)\n2. How effective and cost effective are individual, compared with group, education-based interventions for children and young people aged 11 to 18 in full-time education who are thought to be vulnerable to alcohol misuse? (Evidence review B: targeted interventions)\n3. How effective and cost effective are universal, education-based alcohol interventions for children and young people aged 11 to 25 with SEND? (Evidence review A: universal interventions)\n4. How effective and cost effective are education-based alcohol interventions targeted at children and young people aged 11 to 25 with SEND who are thought to be vulnerable to alcohol misuse? (Evidence review B: targeted interventions)\n5. How effective are education-based alcohol prevention interventions (universal or targeted) for children and young people aged 11 to 25 with SEND in full-time education? (Evidence review A: universal interventions and Evidence review B: targeted interventions)\n6. What methods and techniques help secondary schools and providers to effectively engage with parents and carers as part of a whole-school approach to promote and support alcohol education? (Evidence review A: universal interventions)\n"]
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[null,"National Institute for Health and Care Excellence. Alcohol-use disorders: prevention. PH24. London: NICE; 2010\nAvailable here.\n\n\n\n","Children, young people and adults aged 10 years and above","This guideline covers alcohol problems among people over 10. It aims to prevent and identify such problems as early as possible using a mix of policy and practice.\n\nThe guideline includes the following recommendations. All the recommendations are relevant to the scope of this topic evidence map. The recommendations are supported by the underpinning Evidence reviews 1-3 and Evidence reviews 4-6:\n• Price, availability and marketing\n• Licencing\n• Supporting children and young people aged 10 to 15 years\n• Screening young people aged 16 and 17 years and offering them extended brief interventions\n• Screening adults and offering them brief advice and interventions\n• Referral\n\nThe underpinning evidence reviews in this report identifed several gaps in the evidence and made recommendations for further research with the following overarching question:\nHow does advertising by industry and health agencies affect the drinking behaviour of the population as whole? (This includes the use of new media.)\n\nJuly 2019: NICE checked this guideline and are updating it. For further information, see the surveillance decision."]
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[null,"National Institute for Health and Care Excellence. Behaviour change: general approaches. PH6. London: NICE; 2007\nAvailable here.\n\n\n\n","General population","This guideline covers a set of principles that can be used to help people change their behaviour. The aim is for practitioners to use these principles to encourage people to adopt a healthier lifestyle by, for example, stopping smoking, adopting a healthy diet and being more physically active.\n\nThe guideline includes the following recommendations. All the recommendations are relevant to the scope of this topic evidence map. The recommendations are supported by the underpinning Evidence review 1.\n• Providing education and training for those delivering them\n• Delivery of these activities, including one-to-one and community-based programmes and those aimed at specific populations\n• Evaluation of their effectiveness and cost effectiveness\n\nThe Programme Development Group identified a number of gaps in the evidence related to behaviour change interventions and programmes, based on an assessment of the evidence and made recommendations for research to address the most important gaps in the evidence. Please refer to 4. Recommendations for research' section of the guidance.\n\nNovember 2017: NICE checked this guideline and found no new evidence that affects the recommendations in this guideline."]
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[null,"Community setting - Safe and Supportive Environment- Universal interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' Conclusions:"]
[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This Cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text. Fifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect. One targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects. Among school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]
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[null,"Community setting - Changed attitudes and social norms - Universal interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]
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[null,"Community setting - Reduced availability - Universal interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"Hollands  GJ et al. Altering the availability or proximity of food, alcohol, and tobacco products to change their selection and consumption. Cochrane Database of Systematic Reviews 2019, Issue 9. Art. No.: CD012573. DOI: 10.1002/14651858.CD012573.pub3.\nAvailable here.","Adults","This Cochrane review aimed to:\n1. To assess the impact on selection and consumption of altering the availability or proximity of (a) food (including non‐alcoholic beverages), (b) alcohol, and (c) tobacco products.\n2. To assess the extent to which the impact of these interventions is modified by characteristics of: i. studies, ii. interventions, and iii. participants.\n\nThe reviewers included 24 studies, with the majority (20/24) giving concerns about risk of bias. All of the included studies investigated food products; none investigated alcohol or tobacco. ","The authors concluded that:\n- Further research is warranted in real‐world settings, intervening across a wider range of foods as well as alcohol and tobacco products and over sustained time periods"]
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[null,"Community setting - Reduced affordability - Universal interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]
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[]
[null,"Community setting -Behaviour change - Universal interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"Stead M, Angus K, Langley T, Katikireddi SV, Hinds K, Hilton S,  et al. Mass media to communicate public health messages in six health topic areas: a systematic review and other reviews of the evidence. Public Health Res 2019;7(8)\nAvailable here.","General population.","There was limited evidence of impact on alcohol use\nMass media campaigns were found to increase knowledge and awareness across several topics.\nAlthough there was limited evidence on characteristics associated with effectiveness, longer or greater intensity campaigns were found to be more effective. \nThe evidence suggested that targeting messages to target audiences can be effective. \nThere was little evidence regarding the role that theory or media channels may play in campaign effectiveness, and also limited evidence on new media.","Overall, the evidence is mixed but suggests that longer and more intensive campaigns are likely to be more effective and message design and targeting campaigns to particular population groups can be effective."]
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[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. \n\nFifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect.\n\nOne targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects.\n\nAmong school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]
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[null,"Brown TJ, Todd A, O'Malley CL, Moore HJ, Husband AK, Bambra C,  et al. Community pharmacy interventions for public health priorities: a systematic review of community pharmacy-delivered smoking, alcohol and weight management interventions. Public Health Res 2016;4(2)\nAvailable here. ","Adults","The searches identified over 14,000 records, of which 24 studies were included. There were two alcohol, 12 smoking cessation, five weight loss and five multicomponent interventions that included pharmacotherapy and lifestyle changes in participants with diabetes mellitus, dyslipidaemia or hypertension. Nine of the studies were UK based; seven of the studies were rated ‘strong’ for quality. All studies were of adults. \nThere was insufficient evidence for the effectiveness of community pharmacy-based brief alcohol interventions.\nNone of the five multicomponent studies demonstrated an improvement compared with control for anthropometric outcomes in participants with comorbidities, but they did show improvement in measures associated with the comorbidities. Very few studies explored if and how sociodemographic or socioeconomic variables moderated the effect of interventions. In two studies based in areas of high deprivation, where participants chose the intervention, the sociodemographic characteristics of participants differed between intervention settings. There were also differences in recruitment, attendance and retention of participants by type of setting. The evidence suggests that a distinct group of people might access pharmacies compared with other settings for alcohol management, smoking cessation and weight loss. There is insufficient evidence to examine the relationship between behaviour change strategies and effectiveness; or evidence of consistent implementation factors or training components that underpin effective interventions.","Evaluations of interventions to manage alcohol misuse and obesity, set within the community pharmacy, are needed. \nThe effect of community pharmacy interventions on health inequalities is unclear. Future research in this area is warranted, and trials should include the assessment of age, sex, ethnicity, socioeconomic status and contextual factors, and present analysis of how these factors moderate effectiveness."]
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[null,"Community setting -Families are supported and protected - Universal interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]

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[null,"Community setting - Selective interventions - NICE Guidance"]
[null,"Source:","Population:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Alcohol interventions in secondary and further education. NG135. London: NICE; 2019. \nAvailable here.\n","• CYP (11 to 18years) in full time education.\n• YP (18 to 25 years) with an Education, health and care (EHC) plan.\n• CYP (11 to 18years) in full time education considered ‘at risk’.\n• YP (18 to 25 years) EHC plan considered ‘at risk’.","This guideline covers interventions in secondary and further education to prevent and reduce alcohol use among children and young people aged 11 up to and including 18. It also covers people aged 11 to 25 with special educational needs or disabilities in full-time education. It will also be relevant to children aged 11 in year 6 of primary school.\n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n1.1 Planning alcohol education\n1.2 Delivering universal alcohol education (Evidence Review A: Universal interventions)\n1.3 Targeted interventions (Evidence review B: Targeted interventions)\n\nThe following recommendations for further research were also identified in Evidence review A and B:\n1. What components of alcohol education delivery contribute to its effectiveness for children and young people aged 11 to 18 in full-time education, and those with special educational needs and disabilities (SEND) up to the age of 25? (Evidence review A: universal interventions)\n2. How effective and cost effective are individual, compared with group, education-based interventions for children and young people aged 11 to 18 in full-time education who are thought to be vulnerable to alcohol misuse? (Evidence review B: targeted interventions)\n3. How effective and cost effective are universal, education-based alcohol interventions for children and young people aged 11 to 25 with SEND? (Evidence review A: universal interventions)\n4. How effective and cost effective are education-based alcohol interventions targeted at children and young people aged 11 to 25 with SEND who are thought to be vulnerable to alcohol misuse? (Evidence review B: targeted interventions)\n5. How effective are education-based alcohol prevention interventions (universal or targeted) for children and young people aged 11 to 25 with SEND in full-time education? (Evidence review A: universal interventions and Evidence review B: targeted interventions)\n6. What methods and techniques help secondary schools and providers to effectively engage with parents and carers as part of a whole-school approach to promote and support alcohol education? (Evidence review A: universal interventions)\n"]
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[null,"Community setting - Safe and Supportive Environment - Selective interventions - Systematic reviews"]
[null,"Source:","Audience:","Recommendations:"]
[null,"Moledina A et al (2021). A comprehensive review of prioritised interventions to improve the health and wellbeing of persons with lived experience of homelessness. Campbell Systematic Reviews, 17, e1154.\nAvailable here. ","Populations experiencing homelessness, defined as those who lack stable, permanent, appropriate housing, or who may be without immediate prospects, means, and ability to acquire it","The objective of this systematic review is to identify, appraise, and synthesise the best available evidence on the benefits and cost-effectiveness of interventions to improve the health and social outcomes of people experiencing homelessness.\n\nEligible interventions included permanent supportive housing (PSH), income assistance, standard case management (SCM), peer support, mental health interventions such as assertive community treatment (ACT), intensive case management (ICM), critical time intervention (CTI) and injectable antipsychotics, and substance-use interventions, including supervised consumption facilities (SCFs), managed alcohol programmes and opioid agonist therapy. Outcomes of interest were housing stability, mental health, quality of life, substance use, hospitalisations, employment and income. Only results relevant to this topic evidence map have been extracted below.\n\nManaged alcohol programmes: The review did not identify any eligible studies.\n\nPermanent supportive housing: The effect of permanent housing on substance use was reported in nine trials. Out of these three studies reported improvements in alcohol and drug use in both groups, over time, but no differential benefit of the HF initiative. One study on homeless clients with problematic substance reported no group differences in problems associated with alcohol use, though both groups decreased their alcohol consumption over time. Hybrid approaches to housing (“integrative” versus “parallel” housing) were investigated in a single study. It found no statistically significant difference in the reported days of alcohol use or reported days of drug use both between groups as well as over time. Of note, analysis for this outcome had a lower statistical power as it was restricted to individuals who reported use at the baseline.\n\nIncome-assistance intervention: Four studies examined the effects of income-assistance intervention on substance use. For homeless veterans with substance dependence, CWT immediately reduced the consumption of alcohol and drugs within the first 3 months (β = −44.7%; 95% CI, −69.7% to −19.7%; t = 3.51; p = .001). The addition of priority access to housing vouchers for veterans with a diagnosis of a major psychiatric disorder or an alcohol/drug disorder, compared to existing case management, led to decreased days of drinking to intoxication (1.46 vs. 1.95, t = 0.73, p = .0053) and fewer days of alcohol use over the 3-year study period. However, no significant association was identified between priority access to housing subsidies and differences in the scores of the Addiction Severity Index (ASI). For homeless families with children aged 15 or younger, rental subsidies without case management did not lead to decreased use of substance compared to the usual community housing services.\n\nSCM and peer support interventions: Six studies reported on substance-use outcomes with different SCM treatments. Homeless male veterans with addictions problems with three to 6 months of hospital stays plus case management showed better improvements in the alcohol- and drug-use composite scores, but these were short-lived compared to TAU after 24 months. A three-arm trial reported reductions in average days of alcohol and drug consumption in a case-management-only group, a CM-with-supported-housing group in graduates of short-term in-patient substance-use programme who lacked housing. Homeless alcohol abusers who were offered different intensities of SCM (n = 469) showed no significant between-group differences in days of alcohol use. Similarly, a three-arm trial with homeless women and their intimate partners found no significant differences in substance-use outcomes between groups: a peer-mentored group, a group in a nurse case-managed programme, and one in an SCM programme. Another 12-months trial on homeless men recently released from jails/prisons who were exposed to weekly peer coaching, intermediate peer coaching compared with the usual treatment did not find any significant effects on substance-use outcomes. An RCT with homeless women with alcohol-use problems who received brief guideline-based interventions from primary care providers and referrals to the CM for ongoing follow-up visits for 6 months did not find any significant between-group differences on alcohol-consumption rates, percentages of completely abstained participants, or negative consequences of alcohol use, respectively.\n","PSH interventions improved housing stability for people living with homelessness. High-intensity case management and income-assistance interventions may also benefit housing stability. The majority of included interventions inconsistently detected benefits for mental health, quality of life, substance use, employment and income. These results have important implications for public health, social policy, and community programme implementation. The COVID-19 pandemic has highlighted the urgent need to tackle systemic inequality and address social determinants of health. Our review provides timely evidence on PSH, income assistance, and mental health interventions as a means of improving housing stability. PSH has major cost and policy implications and this approach could play a key role in ending homelessness. Evidence-based reviews like this one can guide practice and outcome research and contribute to advancing international networks committed to solving homelessness."]
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[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This Cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text. Fifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect. One targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects. Among school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]
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[null,"Community setting - Changed attitudes and social norms - Selective interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This Cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text. Fifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect. One targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects. Among school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]
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[null,"Foxcroft DR et al. Motivational interviewing for the prevention of alcohol misuse in young adults. Cochrane Database Syst Rev 2016, Issue 7. Art. No.: CD007025. DOI: 10.1002/14651858.CD007025.pub4.\nAvailable here.\n","Young adults up to 25 years of age (higher risk individuals or settings). ","This Cochrane review aimed to assess the effects of motivational interviewing (MI) interventions for preventing alcohol misuse and alcohol‐related problems in young adults. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nEighty four trials (22,872 participants) were included, with 70/84 studies reporting interventions in higher risk individuals or settings. Studies with follow‐up periods of at least four months were of more interest in assessing the sustainability of intervention effects and were also less susceptible to short‐term reporting or publication bias. Overall, the risk of bias assessment showed that these studies provided moderate or low quality evidence.\n\nAt four or more months follow‐up, effects in favour of MI were found for the quantity of alcohol consumed (standardised mean difference (SMD) −0.11, 95 per cent confidence interval (CI) −0.15 to −0.06 or a reduction from 13.7 drinks/week to 12.5 drinks/week; moderate quality evidence); frequency of alcohol consumption (SMD −0.14, 95 per cent CI −0.21 to −0.07 or a reduction in the number of days/week alcohol was consumed from 2.74 days to 2.52 days; moderate quality evidence); and peak blood alcohol concentration, or BAC (SMD −0.12, 95 per cent CI −0.20 to 0.05, or a reduction from 0.144 per cent to 0.131 per cent; moderate quality evidence).\n\nFurther analyses showed that there was no clear relationship between the duration of the MI intervention (in minutes) and effect size. Subgroup analyses revealed no clear subgroup effects for longer‐term outcomes (four or more months) for assessment only versus alternative intervention controls; for university/college vs other settings; or for higher risk vs all/low risk participants.\n","The results of this review indicate that there are no substantive, meaningful benefits of MI interventions for preventing alcohol use, misuse or alcohol‐related problems. Although the reviewers found some statistically significant effects, the effect sizes were too small, given the measurement scales used in the included studies, to be of relevance to policy or practice. Moreover, the statistically significant effects are not consistent for all misuse measures, and the quality of evidence is not strong, implying that any effects could be inflated by risk of bias."]
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[null,"Community setting - Reduced availability - Selective Interventions - Systematic reviews"]
[null,"Source:","Populations:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]
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[]
[null,"Community setting - Reduced affordability - Selective Interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]
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[]
[null,"Community setting -Behaviour change - Selective interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"Filges T, Dalgaard NT and Viinholt BC. 2022. Outreach programs to improve life circumstances and prevent further adverse developmental trajectories of at‐risk youth in OECD countries: A systematic review. Campbell Systematic Reviews, 18(4), p.e1282.\nAvailable here\n","Young people between 8 and 25 years of age living in OECD countries, who either have experienced or is at-risk of experiencing an adverse outcome such as school failure or drop-out, runaway and homelessness, substance and/or alcohol abuse, unemployment, long-term poverty, delinquency/criminal behaviour were eligible.","This Campbell systematic review examines the effects of outreach programmes on problem/high-risk behaviour of young people between eight and 25 year old, living in OECD countries. The review summarises evidence from five studies undertaken in the USA and Canada that involved 578 participants in total.\n\nFour of the five studies used for meta analysis were from the USA and one was from Canada. The timespan in which included studies were carried out was 32 years, from 1985 to 2017; on average the intervention year was 2005. The average number of participants in the analysed interventions was 116, ranging from 30 to 346 and the average number of controls was 81, ranging from 32 to 321. At most, the results from two studies could be pooled in a single meta-analysis. It was only possible to pool the outcomes drug (other than marijuana) use, marijuana use and alcohol use each at two different time points (one and 3 months follow up). At 1 month follow up the weighted averages varied between zero and 0.05 and at 3 months follow up between −0.17 and 0.07. None of them were statistically significant. In addition, a number of other outcomes were reported in a single study only.","Overall, there were too few studies included in any of the meta-analyses in order for us to draw any conclusion concerning the effectiveness of outreach. The vast majority of studies were undertaken in the USA.\nFurther, because too few studies reported results on the same type of outcome at most two studies could be combined in a particular meta-analysis. Given the limited number of rigorous studies available from countries other than the USA, it would be natural to consider conducting a series of randomised controlled trials evaluating the effectiveness of outreach for at-risk youth in countries outside the USA. The trial(s) should be designed, conducted and reported according to methodological criteria for rigour in respect of internal and external validity to achieve robust results and preferably reporting a larger number of outcomes."]
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[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. \n\nFifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect.\n\nOne targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects.\n\nAmong school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]
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[null,"O'Connor EA et al. Screening and behavioral counseling interventions to reduce unhealthy alcohol use in adolescents and adults: An updated systematic review for the U.S. Preventive Services Task Force. Rockville MD: Agency for Healthcare Research and Quality; 2018. \nAvailable here. ","Adolescents or adults age 12 years or older. ","One hundred and thirteen studies (n=314,466) were included across all Key Questions. The authors did not find any studies that examined the benefits or harms of screening programs to reduce unhealthy alcohol use. For adolescents, data supported the use of the National Institute on Alcohol Abuse and Alcoholism Youth Screen and other similar one- or two-item screeners to detect alcohol use disorder. For adults, brief (1- to 3-item) screeners commonly reported sensitivity and specificity between 0.70 and 0.85, typically having better sensitivity than the full Alcohol Use Disorders Identification Test (AUDIT) for identifying the full spectrum of unhealthy use. However, the AUDIT tended to have higher specificity, particularly at the standard cutoff of 8 or higher.  \n\nIdentified interventions to reduce unhealth alcohol use were generally counselling interventions, with most involving one or two sessions (90% involved ≤ 4 sessions) with a median of 30 minutes contact time (88% involved ≤ 2 hours contact). The most commonly reported intervention element was the use of personalized normative feedback sessions, in which participants were shown how their alcohol use compares to others; this technique was used in more than half of the included trials and almost all trials in younger adults. Motivational techniques were also common, particularly in combination with personalized normative feedback.\n\nEvidence on the effects of interventions to reduce unhealthy alcohol use in adolescents was limited to two trials; both found mixed results for reduced alcohol use and did not report health or related outcomes. \n\nIn adults, interventions reduced the number of drinks per week (weighted mean difference, −1.82 [95% confidence interval {CI}, −2.42 to −1.22]), the proportion exceeding recommended drinking limits (odds ratio [OR], 0.60 [95% CI, 0.53 to 0.67]), and the proportion reporting a heavy use episode (OR, 0.62 [95% CI, 0.55 to 0.71]), and increased the proportion of pregnant women reporting abstinence (OR, 1.92 [95% CI, 1.19 to 3.09]) after 6 to 12 months. \n\nHeterogeneity was high and effect size was associated with a number of study characteristics such as setting, target age of the population, publication year, study size, and average baseline-use levels, but not clearly associated with any intervention characteristics. Data on effectiveness in important subgroups were very limited, but analyses by sex, the most commonly reported subgroup analysis, did not indicate differences in effectiveness of the interventions. Health outcomes were sparsely reported and, with some exceptions, generally did not demonstrate group differences in effect. No evidence of harm was found.","Among adults, screening instruments are available that can effectively identify persons with unhealthy alcohol use and that are feasible for use in primary care settings, and interventions in those who screen positive are associated with reductions in unhealthy alcohol use. There was no evidence that these interventions have unintended harmful effects. More evidence is needed to determine whether screening for unhealthy alcohol use is beneficial for adolescents."]
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[null,"Foxcroft DR et al. Motivational interviewing for the prevention of alcohol misuse in young adults. Cochrane Database Syst Rev 2016, Issue 7. Art. No.: CD007025. DOI: 10.1002/14651858.CD007025.pub4.\nAvailable here.\n","Young adults up to 25 years of age. ","This Cochrane review aimed to assess the effects of motivational interviewing (MI) interventions for preventing alcohol misuse and alcohol‐related problems in young adults.\n\nEighty four trials (22,872 participants) were included, with 70/84 studies reporting interventions in higher risk individuals or settings. Studies with follow‐up periods of at least four months were of more interest in assessing the sustainability of intervention effects and were also less susceptible to short‐term reporting or publication bias. Overall, the risk of bias assessment showed that these studies provided moderate or low quality evidence.\n\nAt four or more months follow‐up, effects in favour of MI were found for the quantity of alcohol consumed (standardised mean difference (SMD) −0.11, 95 per cent confidence interval (CI) −0.15 to −0.06 or a reduction from 13.7 drinks/week to 12.5 drinks/week; moderate quality evidence); frequency of alcohol consumption (SMD −0.14, 95 per cent CI −0.21 to −0.07 or a reduction in the number of days/week alcohol was consumed from 2.74 days to 2.52 days; moderate quality evidence); and peak blood alcohol concentration, or BAC (SMD −0.12, 95 per cent CI −0.20 to 0.05, or a reduction from 0.144 per cent to 0.131 per cent; moderate quality evidence).\nA marginal effect in favour of MI was found for alcohol problems (SMD −0.08, 95 per cent CI −0.17 to 0.00 or a reduction in an alcohol problems scale score from 8.91 to 8.18; low quality evidence) and no effects for binge drinking (SMD −0.04, 95 per cent CI −0.09 to 0.02, moderate quality evidence) or for average BAC (SMD −0.05, 95 per cent CI −0.18 to 0.08; moderate quality evidence). Other alcohol‐related behavioural outcomes were considered, and at four or more month’s follow‐up, we found no effects on drink‐driving (SMD −0.13, 95 per cent CI −0.36 to 0.10; moderate quality of evidence) or other alcohol‐related risky behaviour (SMD −0.15, 95 per cent CI −0.31 to 0.01; moderate quality evidence).\n\nFurther analyses showed that there was no clear relationship between the duration of the MI intervention (in minutes) and effect size. Subgroup analyses revealed no clear subgroup effects for longer‐term outcomes (four or more months) for assessment only versus alternative intervention controls; for university/college vs other settings; or for higher risk vs all/low risk participants.\n","The results of this review indicate that there are no substantive, meaningful benefits of MI interventions for preventing alcohol use, misuse or alcohol‐related problems. Although we found some statistically significant effects, the effect sizes were too small, given the measurement scales used in the included studies, to be of relevance to policy or practice. Moreover, the statistically significant effects are not consistent for all misuse measures, and the quality of evidence is not strong, implying that any effects could be inflated by risk of bias."]
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[null,"Community setting - Families are supported and protected - Selective interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This Cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text. Fifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect. One targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects. Among school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]

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[null,"Community setting - Indicated interventions - NICE Guidance"]
[null,"Source:","Population:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Behaviour change: individual approaches. PH49. London: NICE; 2014. \nAvailable here.\n","Everyone aged 16 years and older","This guideline covers changing health-damaging behaviours among people aged 16 and over using interventions such as goals and planning, feedback and monitoring, and social support. It aims to help tackle a range of behaviours including alcohol misuse, poor eating patterns, lack of physical activity, unsafe sexual behaviour and smoking.\n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n1. Develop a local behaviour change policy and strategy\n2. Ensure organisation policies, strategies, resources and training all support behaviour change\n3. Commission interventions from services willing to share intervention details and data\n4. Commission high quality, effective behaviour change interventions\n5. Plan behaviour change interventions and programmes taking local needs into account\n6. Develop acceptable, practical and sustainable behaviour change interventions and programmes\n7. Use proven behaviour change techniques when designing interventions (Evidence review1 and Evidence review2)\n8. Ensure interventions meet individual needs\n9. Deliver very brief, brief, extended brief and high intensity behaviour change interventions and programmes\n10. Ensure behaviour change is maintained for at least a year (Evidence review1 and Evidence review2)\n11. Commission training for all staff involved in helping to change people's behaviour\n12. Provide training for behaviour change practitioners\n13. Provide training for health and social care practitioners\n14. Assess behaviour change practitioners and provide feedback\n15. Monitor behaviour change interventions\n16. Evaluate behaviour change interventions\n17. National support for behaviour change interventions and programmes\n\nEvidence review1 did not identify any recommendations for further research. Evidence review 2 made the following recommendation for further research:\n5.7 How do behaviour change techniques lead to change? What are the best methods of testing the relationship between the theories that describe change processes and the effectiveness of interventions in practice?"]
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[null,"National Institute for Health and Care Excellence. Nalmefene for reducing alcohol consumption in people with alcohol dependence. TA325. London: NICE; 2014.\nAvailable here.  \n\n","Adults with mild alcohol dependence (as defined in CG115) who have a high drinking risk level (≥ 60 g/day of pure alcohol for men and ≥ 40 g/day for women) without physical withdrawal symptoms and who do not require immediate detoxification","NICE currently make the following recommendation regarding use of Nalmefene for reducing alcohol consumption in people with alcohol dependence (the highlighted recommendation is relevant to the scope of this topic evidence map):\n\n1.1 Nalmefene is recommended within its marketing authorisation, as an option for reducing alcohol consumption, for people with alcohol dependence (Evidence review): \n• Who have a high drinking risk level (defined as alcohol consumption of more than 60 g per day for men and more than 40g per day for women, according to the World Health Organization's drinking risk levels) without physical withdrawal symptoms and;\n• Who do not require immediate detoxification.\n\nThe marketing authorisation states that nalmefene should:\n• Only be prescribed in conjunction with continuous psychosocial support focused on treatment adherence and reducing alcohol consumption and; \n• Be initiated only in patients who continue to have a high drinking risk level 2 weeks after initial assessment.\n\nMarch 2018: NICE reviewed the evidence for TA325. They found found nothing new that affects the recommendations in this guidance. This guidance will be reviewed if there is new evidence that is likely to affect the recommendations."]
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[null,"National Institute for Health and Care Excellence. Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence. CG115. London: NICE; 2011\nAvailable here.\n\n","Adults (>18 years) or young people (10 to 17 years of age) with a diagnosis of alcohol dependence or meeting criteria for harmful alcohol use (30 to 50 units of alcohol per week)","This guideline covers identifying, assessing and managing alcohol-use disorders (harmful drinking and alcohol dependence) in adults and young people aged 10-17 years. It aims to reduce harms (such as liver disease, heart problems, depression and anxiety) from alcohol by improving assessment and setting goals for reducing alcohol consumption. \n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n• Principles of care\n• Identification and assessment \n• Interventions for alcohol misuse (Evidence review 2011)\n\nThe following recommendations for further research were also identified in Evidence reviews underpinning this guidance:\n1 Is contingency management effective in reducing alcohol consumption in people who misuse alcohol compared with standard care?\n2 What methods are most effective for assessing and diagnosing the presence and severity of alcohol misuse in children and young people?\n3 Is acupuncture effective in reducing alcohol consumption compared with standard care?\n4. For which service users who are moderately and severely dependent on alcohol is an assertive community treatment model a clinically and cost-effective intervention compared with standard care?\n5. For people with moderate and severe alcohol dependence who have significant comorbid problems, is an intensive residential rehabilitation programme clinically and cost effective when compared with intensive community-based care?\n6 For people with alcohol dependence, which medication is most likely to improve adherence and thereby promote abstinence and prevent relapse?\n\nOctober 2022: NICE updated the recommendation about behavioural couples therapy to clarify that this is not suitable in cases of domestic abuse and to add a cross reference to the NICE technology appraisal guidance on nalmefene. They also updated information about off-label prescribing, and added cross references to legislation on controlled drugs and driving, to MHRA advice on addiction to benzodiazepines and codeine, and to NICE's guidelines on smoking, on antisocial personality disorder and on coexisting mental illness and substance misuse community health and social care services.\nJuly 2019: NICE have found no new evidence that affects the recommendations."]
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[null,"National Institute for Health and Care Excellence. Coexisting severe mental illness (psychosis) and substance misuse: assessment and management in healthcare settings. CG120. London: NICE; 2011. \nAvailable here.\n","People aged 14 years and over with coexisting severe mental illness (psychosis) and substance misuse","This guideline covers assessing and managing people aged 14 years and over with coexisting severe mental illness (psychosis) and substance misuse. It aims to help healthcare professionals guide people with psychosis with coexisting substance misuse to stabilise, reduce or stop their substance misuse, to improve treatment adherence and outcomes, and to enhance their lives. \n\nThe guideline includes the following recommendations. All the recommendations are relevant to the scope of this topic evidence map. The recommendations are supported by evidence from the underpinning Evidence Review 2011. \n• Principles of care\n• Recognising psychosis with coexisting substance misuse\n• Primary care\n• Secondary care mental health services\n• Substance misuse services\n• Inpatient mental health services and staffed accommodation\n• Specific issues for young people with psychosis and coexisting substance misuse\n\nThe following recommendations for further research were also identified in Evidence reviews underpinning this guidance:\n1. What are the prevalence, risk and protective factors, and course of illness for different combinations of psychosis and coexisting substance misuse (for example, schizophrenia and cannabis misuse or bipolar disorder and alcohol misuse)?\n2. What risk factors predict the onset of substance misuse in young people with psychosis?\n3. Are psychosocial interventions clinically and cost effective when compared with standard care for people with psychosis and coexisting substance misuse?\n4. Are environmental interventions clinically and cost effective when compared with standard care for people with psychosis and coexisting substance misuse?\n5. Is clozapine clinically and cost effective when compared with other pharmacological interventions for people with psychosis and coexisting substance misuse?\n\nNovember 2016: NICE reviewed the evidence and found no new evidence that affects the current recommendations in this guideline."]
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[null,"National Institute for Health and Care Excellence. Alcohol-use disorders: diagnosis and management of physical complications. CG100. London: NICE; 2010. \nAvailable here. \n","People aged 10 years and over with alcohol-use disorders","This guideline covers care for adults and young people (aged 10 years and older) with physical health problems that are completely or partly caused by an alcohol-use disorder. It aims to improve the health of people with alcohol-use disorders by providing recommendations on managing acute alcohol withdrawal and treating alcohol-related conditions. \n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n• Acute alcohol withdrawal (Evidence review 2014)\n• Wernicke’s encephalopathy\n• Alcohol-related liver disease\n• Alcohol-related pancreatitis\n\nThe following recommendations for further research were also identified in Evidence reviews underpinning this guidance:\n2. What is the efficacy and cost effectiveness of clomethiazole compared with chlordiazepoxide or carbamazepine or benzodiazepines for the treatment of acute alcohol withdrawal with regard to the outcomes of withdrawal severity, risk of seizures, risk of delirium tremens, length of treatment and patient satisfaction?\n\nJanuary 2019: NICE checked this guideline and are updating it. For more information, see the surveillance decision."]
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[null,"National Institute for Health and Care Excellence. Behaviour change: general approaches. PH6. London: NICE; 2007\nAvailable here.\n\n\n\n","General population","This guideline covers a set of principles that can be used to help people change their behaviour. The aim is for practitioners to use these principles to encourage people to adopt a healthier lifestyle by, for example, stopping smoking, adopting a healthy diet and being more physically active.\n\nThe guideline includes the following recommendations. All the recommendations are relevant to the scope of this topic evidence map. The recommendations are supported by the underpinning Evidence review 1.\n• Providing education and training for those delivering them\n• Delivery of these activities, including one-to-one and community-based programmes and those aimed at specific populations\n• Evaluation of their effectiveness and cost effectiveness\n\nThe Programme Development Group identified a number of gaps in the evidence related to behaviour change interventions and programmes, based on an assessment of the evidence and made recommendations for research to address the most important gaps in the evidence. Please refer to 4. Recommendations for research' section of the guidance.\n\nNovember 2017: NICE checked this guideline and found no new evidence that affects the recommendations in this guideline."]
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[null,"Community setting - Safe and Supportive Environment - Indicated interventions - Systematic reviews"]
[null,"Source:","Audience:","Recommendations:"]
[null,"No evidence identified."]
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[null,"Community setting - Changed attitudes and social norms - Indicated interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]
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[null,"Community setting - Reduced availability - Indicated interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]
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[null,"Community setting - Reduced affordability - Indicated interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]
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[null,"Community setting -Behaviour change - Indicated interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"Agabio R et al. Baclofen for alcohol use disorder. Cochrane Database Syst Rev 2023, Issue 1. Art.No. CD012557. DOI:0.1002/14651858.CD012557.pub3.\nAvailable here. ","Adults with a diagnosis of alcohol dependence. ","This is an update of a Cochrane Review first published in 2018. The aim of this update was to evaluate the benefits and harms of baclofen on achieving and maintaining abstinence or reducing alcohol consumption in people with AUD compared to placebo, no treatment or any other pharmacological relapse prevention treatment. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nThis update included 17 RCTs (1818 participants). Ten studies compared baclofen to placebo or another medication; seven compared two baclofen doses to placebo or another medication. Globally, 15 studies compared baclofen to placebo, two baclofen to acamprosate and two baclofen to naltrexone. In 16 studies, participants received psychosocial treatments. The authors judged most studies at low risk of selection, performance, detection (subjective outcome), attrition and reporting bias. Ten studies detoxified participants before treatment; in seven studies, participants were still drinking at the beginning of treatment. Treatment duration was 12 weeks for 15 RCTs and longer in two studies. Baclofen daily dose was 30 mg to 300 mg: 10 RCTs used low doses (30 mg or less); eight RCTs medium doses (above 30 and 100 mg or less) and four RCTs high doses (above 100 mg).\n\nCompared to placebo, moderate‐certainty evidence found that baclofen probably decreases the risk to relapse (risk ratio (RR) 0.87, 95% confidence interval (CI) 0.77 to 0.99; 12 studies, 1057 participants). This result was confirmed among detoxified participants but not among other subgroups of participants.\n\nHigh‐certainty evidence found that baclofen increases the percentage of days abstinent (mean difference (MD) 9.07, 95% CI 3.30 to 14.85; 16 studies, 1273 participants). This result was confirmed among all subgroups of participants except non‐detoxified or those who received medium doses.\n\nThere was no difference between baclofen and placebo in the other primary outcomes: heavy drinking days (standardised mean difference (SMD) −0.18, 95% CI −0.48 to 0.11; 13 studies, 840 participants; moderate‐certainty evidence); and number of drinks per drinking days (MD −0.45, 95% CI −1.20 to 0.30; 9 studies, 392 participants; moderate‐certainty evidence).\n\nCompared to acamprosate, one study (60 participants) found no differences in any outcomes but the evidence was very uncertain: relapse (RR 1.25, 95% CI 0.71 to 2.20; very low‐certainty evidence).\n\nCompared to naltrexone, baclofen may increase the risk of relapse (RR 2.50, 95% CI 1.12 to 5.56; 1 study, 60 participants; very low‐certainty evidence) but the evidence is very uncertain.","The authors concluded that baclofen likely reduces the risk of relapse to any drinking and increases the percentage of abstinent days, mainly among detoxified participants. It does not increase the number of participants with at least one adverse event, those who dropout for any reason or due to adverse events. It probably does not reduce number of heavy drinking days and the number of drinks per drinking days. Current evidence suggests that baclofen may help people with AUD in maintaining abstinence. The results of comparisons of baclofen with acamprosate and naltrexone were mainly based on only one study."]
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[null,"McGovern R et al. Effectiveness of psychosocial interventions for reducing parental substance misuse. Cochrane Database of Systematic Reviews 2021, Issue 3. Art. No.: CD012823.\nAvailable here","Participants were parents who use substances; this included mothers and fathers of children (sons and daughters) under the age of 21 years, regardless of custodial or residency status of the children. Same-sex parents and foster parents were eligible for inclusion.","The authors included 22 unique studies with a total of 2274 participants (mean age of parents ranged from 26.3 to 40.9 years), examining 24 experimental interventions. The majority of studies intervened with mothers only (n = 16; 73%). Heroin, cocaine, and alcohol were the most commonly reported substances used by participants. The interventions targeted either parenting only (n = 13; 59%); drug and alcohol use only (n = 5; 23%); or integrated interventions which addressed both (n = 6; 27%).\nThe authors found moderate-quality evidence that psychosocial interventions are probably more effective at reducing the frequency of parental alcohol misuse than comparison conditions at 6-month (mean difference (MD) −0.32, 95% confidence interval (CI) −0.51 to −0.13; 6 studies, 475 participants) and 12-month follow-up (standardised mean difference (SMD) −0.25, 95% CI −0.47 to −0.03; 4 studies, 366 participants). The authors found a significant reduction in frequency of use at 12 months only (SMD −0.21, 95% CI −0.41 to −0.01; 6 studies, 514 participants, moderate-quality evidence).\nThe authors examined the effect of the intervention type. They found low-quality evidence that psychosocial interventions targeting substance use only may not reduce the frequency of alcohol (6 months: SMD −0.35, 95% CI −0.86 to 0.16; 2 studies, 89 participants and 12 months: SMD −0.09, 95% CI −0.86 to 0.61; 1 study, 34 participants)\nA parenting intervention only, without an adjunctive substance use component, may not reduce frequency of alcohol misuse (6 months: SMD −0.21, 95% CI −0.46 to 0.04, 3 studies; 273 participants, low-quality evidence and 12 months: SMD −0.11, 95% CI −0.64 to 0.41; 2 studies; 219 participants, very low-quality evidence).\nParents receiving integrated interventions which combined both parenting- and substance use-targeted components may reduce alcohol misuse with a small effect size (6 months: SMD −0.56, 95% CI −0.96 to −0.16 and 12 months: SMD −0.42, 95% CI −0.82 to −0.03; 2 studies, 113 participants). However, this evidence was of low quality.\nInterventions appeared to be more often beneficial for fathers than for mothers. The authors found low- to very low-quality evidence of a reduction in frequency of alcohol misuse for mothers at six months only (SMD −0.27, 95% CI −0.50 to −0.04; 4 studies, 328 participants), whilst in fathers there was a reduction in frequency of alcohol misuse (6 months: SMD −0.43, 95% CI −0.78 to −0.09; 2 studies, 147 participants and 12 months: SMD −0.34, 95% CI −0.69 to 0.00; 2 studies, 147 participants).","The authors found moderate-quality evidence that psychosocial interventions probably reduce the frequency at which parents use alcohol. Integrated psychosocial interventions which combine parenting skills interventions with a substance use component may show the most promise. \nWhilst it appears that mothers may benefit less than fathers from intervention, caution is advised in the interpretation of this evidence, as the interventions provided to mothers alone typically did not address their substance use and other related needs. \nThe authors found low-quality evidence from few studies that interventions involving children are not beneficial."]
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[null,"Goldberg SB et al. Mindfulness‐based interventions for substance use disorders. Cochrane Database of Systematic Reviews 2021, Issue 10.\nAvailable here.","Patients suffering from Substance use disorders including individuals with alcohol, prescription‐, illicit‐ and poly‐substance use disorders","This Cochrane review aimed to determine the effects of MBIs for SUDs in terms of substance use outcomes, craving and adverse events compared to standard care, further psychotherapeutic, psychosocial or pharmacological interventions, or instructions, waiting list and no treatment.\n\nForty RCTs met the inclusion criteria, with 35 RCTs involving 2825 participants eligible for meta‐analysis. All studies were at high risk of performance bias and most were at high risk of detection bias.\n\nMindfulness‐based interventions (MBIs) versus no treatment: Twenty‐four RCTs included a comparison between MBI and no treatment. The evidence was uncertain about the effects of MBIs relative to no treatment on all primary outcomes: continuous abstinence rate (post: risk ratio (RR) = 0.96, 95% CI 0.44 to 2.14, 1 RCT, 112 participants; follow‐up: RR = 1.04, 95% CI 0.54 to 2.01, 1 RCT, 112 participants); percentage of days with substance use (post‐treatment: standardized mean difference (SMD) = 0.05, 95% CI ‐0.37 to 0.47, 4 RCTs, 248 participants; follow‐up: SMD = 0.21, 95% CI ‐0.12 to 0.54, 3 RCTs, 167 participants); and consumed amount (post‐treatment: SMD = 0.10, 95% CI ‐0.31 to 0.52, 3 RCTs, 221 participants; follow‐up: SMD = 0.33, 95% CI 0.00 to 0.66, 2 RCTs, 142 participants). Evidence was uncertain for craving intensity and serious adverse events. Analysis of treatment acceptability indicated MBIs result in little to no increase in study attrition relative to no treatment (RR = 1.04, 95% CI 0.77 to 1.40, 21 RCTs, 1087 participants). Certainty of evidence for all other outcomes was very low due to imprecision, risk of bias, and/or inconsistency. Data were unavailable to evaluate adverse events.\n\nMindfulness‐based interventions (MBIs) versus other treatments (standard of care, cognitive behavioral therapy, psychoeducation, support group, physical exercise, medication): Nineteen RCTs included a comparison between MBI and another treatment. The evidence was very uncertain about the effects of MBIs relative to other treatments on continuous abstinence rate at post‐treatment (RR = 0.80, 95% CI 0.45 to 1.44, 1 RCT, 286 participants) and follow‐up (RR = 0.57, 95% CI 0.28 to 1.16, 1 RCT, 286 participants), and on consumed amount at post‐treatment (SMD = ‐0.42, 95% CI ‐1.23 to 0.39, 1 RCT, 25 participants) due to imprecision and risk of bias. The evidence suggests that MBIs reduce percentage of days with substance use slightly relative to other treatments at post‐treatment (SMD = ‐0.21, 95% CI ‐0.45 to 0.03, 5 RCTs, 523 participants) and follow‐up (SMD = ‐0.39, 95% CI ‐0.96 to 0.17, 3 RCTs, 409 participants). The evidence was very uncertain about the effects of MBIs relative to other treatments on craving intensity due to imprecision and inconsistency. Analysis of treatment acceptability indicated MBIs result in little to no increase in attrition relative to other treatments (RR = 1.06, 95% CI 0.89 to 1.26, 14 RCTs, 1531 participants). Data were unavailable to evaluate adverse events.","In comparison with no treatment, the evidence is uncertain regarding the impact of MBIs on SUD‐related outcomes. MBIs result in little to no higher attrition than no treatment. In comparison with other treatments, MBIs may slightly reduce days with substance use at post‐treatment and follow‐up (4 to 10 months). The evidence is uncertain regarding the impact of MBIs relative to other treatments on abstinence, consumed substance amount, or craving. MBIs result in little to no higher attrition than other treatments. Few studies reported adverse events."]
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[null,"Kelly  JF, Humphreys  K, Ferri  M. Alcoholics Anonymous and other 12‐step programs for alcohol use disorder. Cochrane Database of Systematic Reviews 2020, Issue 3. Art. No.: CD012880. DOI: 10.1002/14651858.CD012880.pub2.\nAvailable here.","Non‐coerced adults with Alcohol Use Disorder.","AA/TSF (manualized) compared to treatments with a different theoretical orientation (e.g. CBT) (randomized/quasi‐randomized evidence) \nRCTs comparing manualized AA/TSF to other clinical interventions (e.g. CBT), showed AA/TSF improves rates of continuous abstinence at 12 months (risk ratio (RR)) 1.21, 95% confidence interval (CI) 1.03 to 1.42; 2 studies, 1936 participants; high‐certainty evidence). This effect remained consistent at both 24 and 36 months. \nFor percentage days abstinent (PDA), AA/TSF appears to perform as well as other clinical interventions at 12 months (mean difference (MD) 3.03, 95% CI ‐4.36 to 10.43; 4 studies, 1999 participants; very low‐certainty evidence), and better at 24 months (MD 12.91, 95% CI 7.55 to 18.29; 2 studies, 302 participants; very low‐certainty evidence) and 36 months (MD 6.64, 95% CI 1.54 to 11.75; 1 study, 806 participants; very low‐certainty evidence). \nFor longest period of abstinence (LPA), AA/TSF may perform as well as comparison interventions at six months (MD 0.60, 95% CI ‐0.30 to 1.50; 2 studies, 136 participants; low‐certainty evidence). \nFor drinking intensity, AA/TSF may perform as well as other clinical interventions at 12 months, as measured by drinks per drinking day (DDD) (MD ‐0.17, 95% CI ‐1.11 to 0.77; 1 study, 1516 participants; moderate‐certainty evidence) and percentage days heavy drinking (PDHD) (MD ‐5.51, 95% CI ‐14.15 to 3.13; 1 study, 91 participants; low‐certainty evidence). \nFor alcohol‐related consequences, AA/TSF probably performs as well as other clinical interventions at 12 months (MD ‐2.88, 95% CI ‐6.81 to 1.04; 3 studies, 1762 participants; moderate‐certainty evidence). \nFor alcohol addiction severity, one study found evidence of a difference in favor of AA/TSF at 12 months (P < 0.05; low‐certainty evidence). \nThis study examines results for the same outcomes for non-manualized AA/TSF.\n","There is high quality evidence that manualized AA/TSF interventions are more effective than other established treatments, such as CBT, for increasing abstinence. Non‐manualized AA/TSF may perform as well as these other established treatments. AA/TSF interventions, both manualized and non‐manualized, may be at least as effective as other treatments for other alcohol‐related outcomes. AA/TSF probably produces substantial healthcare cost savings among people with alcohol use disorder. "]
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[null,"Hunt G et al.  Psychosocial interventions for people with both severe mental illness and substance misuse. Cochrane Database Syst Rev 2019, Issue 12. Art. No.: CD001088. DOI: 10.1002/14651858.CD001088.pub4\nAvailable here.\n","People diagnosed with a severe mental illness and concurrent problem of substance misuse","This Cochrane review aimed to assess the effects of psychosocial interventions for reduction in substance use in people with a serious mental illness compared with standard care. It updates and replaces the 2013 version of the review.\n\nThe review now includes 41 trials with a total of 4024 participants. The reviewers identified nine comparisons within the included trials. Only two of these reported outcomes meeting the scope of this topic evidence map and have been reported below. For full detail and information on the other outcomes, please refer to the full-text. \n\n1. Integrated models of care versus standard care (36 months): No clear differences were found between treatment groups for alcohol use (RR 1.15, 95% CI 0.84 to 1.56; participants = 143; studies = 1; low‐quality evidence).\n\n5. Motivational interviewing (MI) versus standard care: A clear difference, favouring MI, was observed for abstaining from alcohol (RR 0.36, 95% CI 0.17 to 0.75; participants = 28; studies = 1; very low‐quality evidence).","Authors concluded that they included 41 RCTs but were unable to use much data for analyses. There is currently no high‐quality evidence to support any one psychosocial treatment over standard care for important outcomes such as remaining in treatment, reduction in substance use or improving mental or global state in people with serious mental illnesses and substance misuse. Furthermore, methodological difficulties exist which hinder pooling and interpreting results. Further high‐quality trials are required which address these concerns and improve the evidence in this important area."]
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[null,"Agabio R, Trogu E, Pani PP. Antidepressants for the treatment of people with co‐occurring depression and alcohol dependence. Cochrane Database Syst Rev 2018, Issue 4. Art. No.: CD008581. DOI: 10.1002/14651858.CD008581.pub2.\nAvailable here. \n","Adults with co-occurring depression and alcohol dependence. ","This Cochrane review aimed to assess the benefits and risks of antidepressants for the treatment of people with co‐occurring depression and alcohol dependence. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text\n\nReview authors report that 33 studies were included in the review (2242 participants). Antidepressants were compared to placebo (22 studies), psychotherapy (two studies), other medications (four studies), or other antidepressants (five studies). The mean duration of the trials was 9.9 weeks (range 3 to 26 weeks). Eighteen studies took place in the USA, 12 in Europe, two in Turkey, and one in Australia. The antidepressant included in most of the trials was sertraline; other medications were amitriptyline, citalopram, desipramine, doxepin, escitalopram, fluoxetine, fluvoxamine, imipramine, mianserin, mirtazepine, nefazodone, paroxetine, tianeptine, venlafaxine, and viloxazine. Eighteen studies were conducted in an outpatient setting, nine in an inpatient setting, and six in both settings. Psychosocial treatment was provided in 18 studies. There was high heterogeneity in the selection of outcomes and the rating systems used for diagnosis and outcome assessment.\n\nModerate‐quality evidence found that antidepressants increased the number of participants abstinent from alcohol during the trial (7 studies, 424 participants, RR 1.71, 95 per cent Cl 1.22 to 2.39) and reduced the number of drinks per drinking days (7 studies, 451 participants, mean difference (MD) ‐1.13 drinks per drinking days, 95 per cent Cl ‐1.79 to ‐0.46). After the exclusion of studies with high risk of bias, the number of abstinent remained higher (RR 1.69, 95 per cent CI 1.18 to 2.43) and the number of drinks per drinking days lower (MD ‐1.21 number of drinks per drinking days, 95 per cent CI ‐1.91 to ‐0.51) among participants who received antidepressants compared to those who received placebo. However, other outcomes such as the rate of abstinent days did not differ between antidepressants and placebo (9 studies, 821 participants, MD 1.34, 95 per cent Cl ‐1.66 to 4.34; low‐quality evidence).\n\nThere were few studies comparing one antidepressant versus another antidepressant or antidepressants versus other interventions, and these had a small sample size and were heterogeneous in terms of the types of interventions that were compared, yielding results that were not informative.\n","Authors found low‐quality evidence supporting the clinical use of antidepressants in the treatment of people with co‐occurring depression and alcohol dependence. Antidepressants had positive effects on certain relevant outcomes related to depression and alcohol use but not on other relevant outcomes. Moreover, most of these positive effects were no longer significant when studies with high risk of bias were excluded. Results were limited by the large number of studies showing high or unclear risk of bias and the low number of studies comparing one antidepressant to another or antidepressants to other medication. In people with co‐occurring depression and alcohol dependence, the risk of developing adverse effects appeared to be minimal, especially for the newer classes of antidepressants (such as selective serotonin reuptake inhibitors). According to these results, in people with co‐occurring depression and alcohol dependence, antidepressants may be useful for the treatment of depression, alcohol dependence, or both, although the clinical relevance may be modest."]
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[null,"Kaner E et al. Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev 2018, Issue 2.\nAvailable here. ","People who routinely presented to general practice, emergency care or other primary care settings for a range of health problems, whose alcohol consumption was identified by a screening tool as being excessive, or who had experienced harm as a result of their drinking behaviour","This Cochrane systematic review aimed to assess the effectiveness of screening and brief alcohol intervention to reduce excessive alcohol consumption in hazardous or harmful drinkers in general practice or emergency care settings.\n\nThe reviewers found moderate‐quality evidence that brief alcohol interventions have little impact on frequency of binges per week (MD ‐0.08, 95% CI ‐0.14 to ‐0.02; 15 studies, 6946 participants); drinking days per week (MD ‐0.13, 95% CI ‐0.23 to ‐0.04; 11 studies, 5469 participants); or drinking intensity (‐0.2 g/drinking day, 95% CI ‐3.1 to 2.7; 10 studies, 3128 participants).\n\nThey found moderate‐quality evidence of little difference in quantity of alcohol consumed when extended and no or minimal interventions were compared (‐20 g/week, 95% CI ‐40 to 1; 6 studies, 1296 participants). There was little difference in binges per week (‐0.08, 95% CI ‐0.28 to 0.12; 2 studies, 456 participants; moderate‐quality evidence) or difference in days drinking per week (‐0.45, 95% CI ‐0.81 to ‐0.09; 2 studies, 319 participants; moderate‐quality evidence). Extended versus no or minimal intervention provided little impact on drinking intensity (9 g/drinking day, 95% CI ‐26 to 9; 1 study, 158 participants; low‐quality evidence).\n\nExtended intervention had no greater impact than brief intervention on alcohol consumption, although findings were imprecise (MD 2 g/week, 95% CI ‐42 to 45; 3 studies, 552 participants; low‐quality evidence). Numbers of binges were not reported for this comparison, but one trial suggested a possible drop in days drinking per week (‐0.5, 95% CI ‐1.2 to 0.2; 147 participants; low‐quality evidence). Results from this trial also suggested very little impact on drinking intensity (‐1.7 g/drinking day, 95% CI ‐18.9 to 15.5; 147 participants; very low‐quality evidence).","The authors concluded that they found moderate‐quality evidence that brief interventions can reduce alcohol consumption in hazardous and harmful drinkers compared to minimal or no intervention. Longer counselling duration probably has little additional effect. Future studies should focus on identifying the components of interventions which are most closely associated with effectiveness."]
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[null,"Egholm JWM et al. Perioperative alcohol cessation intervention for postoperative complications Cochrane Database of Syst Rev 2018, Issue 11. Art. No.: CD008343. DOI: 10.1002/14651858.CD008343.pub3\n\nAvailable here.\n","Included participants with risky consumption of alcohol who were undergoing all types of elective or acute surgical procedures under general or regional anaesthesia or sedation, who were offered perioperative alcohol cessation intervention or no intervention. ","This Cochrane systematic review aimed to assess the effects of perioperative alcohol cessation interventions on rates of postoperative complications and alcohol consumption. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nOne new study was included in this updated review, resulting in a total of three RCTs (140 participants who drank 3 to 40 AU/d). All three studies were of moderate to good quality. All studies evaluated the effects of intensive alcohol cessation interventions, including pharmacological strategies for alcohol withdrawal symptoms, patient education, and relapse prophylaxis. The authors identified one ongoing study.\n\nInvestigators describe more successful quitters at the end of the intervention programme than among controls. Forty-one out of 70 participants in the intervention groups successfully quit drinking compared with only five out of 70 participants in the control groups (RR 8.22, 95% CI 1.67 to 40.44). The quality of evidence for this outcome is moderate.\n\nAll three studies reported postoperative alcohol consumption (grams of alcohol/week) at the end of the programme as median and range values; therefore it was not possible to estimate the mean and the SD. We performed no meta-analysis. All three studies reported length of stay, and none of these studies described a significant difference in length of stay. Data were insufficient for review authors to perform a meta-analysis. No studies reported on the prevalence of participants without risky drinking in the longer term.\n\nIncluded studies were few and reported small sample sizes; therefore one should be careful about drawing firm conclusions based on these study results. All three studies were conducted in Denmark, and most participants were men. The included participants may represent a selective group, as they could have been more motivated and/or more interested in participating in clinical research or otherwise different, and effects may have been overestimated for both intervention and control groups in these studies. Trial results indicate that these studies are difficult to perform, that strong research competencies are necessary for future studies, and that further evaluation of perioperative alcohol cessation interventions in high-quality randomised controlled trials is needed. Once published and assessed, the one ’ongoing’ study identified may alter the conclusions of this review.","The authors conclude that all three studies showed a significant reduction in the number of participants who quit drinking alcohol during the intervention period. Intensive alcohol cessation interventions offered for four to eight weeks to participants undergoing all types of surgical procedures to achieve complete alcohol cessation before surgery probably reduced the number of postoperative complications. Data were insufficient for review authors to assess their effects on postoperative mortality. No studies reported an effect on length of stay, and no studies addressed the prevalence of risky drinking in the longer term.\n\n\n"]
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[null,"Klimas J et al. Psychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users. Cochrane Database Syst Rev 2018, Issue 12. Art. No.: CD009269. DOI: 10.1002/14651858.CD009269.pub4.\nAvailable here. \n","Problem alcohol and illicit drug users (principally problem drug users of opiates and stimulants). ","This Cochrane review aimed to assess the effects of psychosocial interventions for problem alcohol use in illicit drug users. \n\nThe psychosocial interventions considered in the studies were: cognitive‐behavioural coping skills training (one study), twelve‐step programme (one study), brief intervention (three studies), motivational interviewing (two studies), and brief motivational interviewing (one study). Two studies were considered in two comparisons. There were no data for the secondary outcome, alcohol‐related harm. The results were as follows. \n\nComparison 1: cognitive‐behavioural coping skills training versus twelve‐step programme (one study, 41 participants): There was no significant difference between groups for either of the primary outcomes (alcohol abstinence assessed with Substance Abuse Calendar and breathalyser at one year: risk ratio (RR) 2.38 (95% confidence interval [CI] 0.10 to 55.06); and retention in treatment, measured at end of treatment: RR 0.89 (95% CI 0.62 to 1.29), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was very low. \n\nComparison 2: brief intervention versus treatment as usual (three studies, 197 participants): There was no significant difference between groups for either of the primary outcomes (alcohol use, measured as scores on the Alcohol Use Disorders Identification Test (AUDIT) or Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) at three months: standardised mean difference (SMD) 0.07 (95% CI ‐0.24 to 0.37); and retention in treatment, measured at three months: RR 0.94 (95% CI 0.78 to 1.13), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was low. \n\nComparison 3: motivational interviewing versus treatment as usual or educational intervention only (three studies, 462 participants): There was no significant difference between groups for either of the primary outcomes (alcohol use, measured as scores on the AUDIT or ASSIST at three months: SMD 0.04 (95% CI ‐0.29 to 0.37); and retention in treatment, measured at three months: RR 0.93 (95% CI 0.60 to 1.43), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was low. \n\nComparison 4: brief motivational intervention (BMI) versus assessment only (one study, 187 participants): More people reduced alcohol use (by seven or more days in the past month, measured at six months) in the BMI group than in the control group (RR 1.67; 95% CI 1.08 to 2.60). There was no difference between groups for the other primary outcome, retention in treatment, measured at end of treatment: RR 0.98 (95% CI 0.94 to 1.02), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was moderate. \n\nComparison 5: motivational interviewing (intensive) versus motivational interviewing (one study, 163 participants): There was no significant difference between groups for either of the primary outcomes (alcohol use, measured using the Addiction Severity Index‐alcohol score (ASI) at two months: MD 0.03 (95% CI 0.02 to 0.08); and retention in treatment, measured at end of treatment: RR 17.63 (95% CI 1.03 to 300.48), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was low. \n\n","The review authors found low to very low‐quality evidence to suggest that there is no difference in effectiveness between different types of psychosocial interventions to reduce alcohol consumption among people who use illicit drugs, and that brief interventions are not superior to assessment‐only or to treatment as usual. No firm conclusions can be made because of the paucity of the data and the low quality of the retrieved studies."]
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[null,"Canadian Agency for Drugs and Technology in Health. Concurrent treatment for substance use disorder and trauma-related comorbidities: a review of clinical effectiveness and guidelines. Ottawa: CADTH; 2017. \nAvailable here. ","Adults with substance use disorder and trauma-related comorbidities (PTSD, anxiety or depression). \n\nSubgroup of interest: military veterans","The purpose of this report by CADTH was to review treatment options for patients with comorbid substance use disorder (SUD) and post-traumatic stress disorder, anxiety, or depression by comparing concurrent treatments for SUD and the mental disorders with no treatment, usual care or active treatment for one condition only and treatment for a single condition (SUD or the mental disorders) with no treatment, usual care or active treatment for the second disorder. Additionally, this review aimed to review evidence-based guidelines regarding the treatments for patients with these comorbidities. \n\nThe review addressed three main research questions. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\n1. What is clinical effectiveness of concurrent treatment for patients with substance use disorders and comorbid post-traumatic stress disorder, anxiety, or depression?\nPatients with comorbid SUD and PTSD: In summary, findings with respect to SUD outcomes for integrated treatments addressing both PTSD and SUD, were inconsistent.\nPatients with comorbid SUD and depression: In summary, there is a suggestion that integrated treatments are more effective than control treatments or treatments addressing a single condition, but findings were not always consistent.\nPatients with SUD and anxiety disorder: One RCT showed that fewer patients relapsed to any drinking in the CBT group compared to the PMRT group. Another RCT showed that the nine hour anxiety-sensitivity focused intervention plus TAU over TAU alone, showed improvement in percent days abstinent in both groups, but showed no significant between group difference.\nPatients with SUD and depression or anxiety disorder: An RCT showed that ICBT appeared to be more effective than usual care with respect to most measures of alcohol consumption.\n\n2. What is the clinical effectiveness of the treatment of one condition for the improvement of all symptoms in patients with substance use disorder and comorbid post-traumatic stress disorder, anxiety, or depression?\nA systematic review included six studies that evaluated addiction based interventions. Two studies comparing the experimental contingency management (CM) treatment with control treatment found slightly better early treatment gains with respect to substance use with CM, however the differences did not remain significant in the long term as shown in one study. Results from three studies (other than CM) showed within-group improvement in SUD outcomes over time even for minimal or no treatment. One study showed that the care management program was associated with better alcohol outcomes compared to the AUD treatment that patients identified on their own.\nAnother systematic review included one study comparing technology-based treatment (TAU plus web based intervention targeting alcohol use) with TAU alone, reported no findings with respect to substance use.\n\n3. What are the evidence-based guidelines regarding the treatment of patients with substance use disorders and comorbid post-traumatic stress disorder, anxiety, or depression?\nOne relevant evidence-based guideline was identified. For comorbid anxiety and alcohol use disorder or for comorbid PTSD and alcohol use disorder, an integrated approach was recommended (Recommendation grade: CCP i.e. “Clinical consent point”). For comorbid depression and alcohol use disorder, CBT was recommended to improve both depressive symptoms and drinking problems.","Report authors found there was a suggestion that integrated treatments offered greater improvement with respect to PTSD symptoms, depression or anxiety compared to no treatment or minimal treatment for patients with comorbid substance use disorder (SUD) and posttraumatic stress syndrome (PTSD), depression or anxiety disorder. However results were not always consistent. In patients with comorbid SUD and PTSD, there was a suggestion that addiction based interventions were more effective with respect to controlling substance use than control treatments. One evidence-based guideline recommended an integrated treatment approach for patients with comorbid alcohol use disorder and PTSD, or comorbid alcohol use disorder and anxiety disorder, and cognitive behavioural therapy for comorbid alcohol use disorder and depression."]
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[null,"Canadian Agency for Drugs and Technology in Health. Inpatient and outpatient treatment programs for substance use disorder: a review of clinical effectiveness and guidelines. Ottawa: CADTH; 2017a. \nAvailable here. \n","Adults 18 to 65 years with substance use disorder/addiction disorder (e.g., abuse of prescription medications or cocaine, heroin, cannabis, alcohol)\n","This Rapid Response report by CADTH aimed to review the clinical effectiveness of inpatient and outpatient treatment programs for adults with substance use disorders involving prescription medications such as analgesics or non-prescription substances such as cocaine, opioids such as heroine, marijuana (cannabis), or alcohol. Evidence-based guidelines associated with inpatient and outpatient treatment programs in adults with substance use disorders were also examined.\n\nThe review addressed two main research questions. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\n1. What is the clinical effectiveness of inpatient and outpatient treatment programs in adults with substance use disorders?\nOne narrative review concluded that evidence supports the case for community detoxification in patients with alcohol dependence. One RCT with long-term follow-up (18 months) concluded that the evidence found initial but decreasing benefit of inpatient over outpatient care across time. One prospective study found inpatients consumed significantly less alcohol in the year after entering treatment than outpatients as measured by the Graduated Frequency Scale questionnaire, and had significantly greater engagement with Alcohol Anonymous program than outpatients in the year after treatment. One retrospective study reported that inpatients with substance use disorders are three times more likely to complete treatment than outpatients.\n\n2. What are the evidence-based guidelines associated with inpatient and outpatients treatment programs in adults with substance use disorders?\nThe evidence-based guidelines from British Columbia Ministry of Health on opioids use disorder recommend that withdrawal management, if needed, can be provided more safely in an outpatient setting rather than in an inpatient setting in most patients. For patients who wish to avoid long-term opioid agonist treatment, supervised slow (longer than one month) outpatient or residential opioid agonist taper can be provided rather than rapid (less than one week) inpatient opioid agonist taper. The slow approach may permit a more flexible and individualised approach to tapered agonist reduction, which allows dose adjustment and stabilisation in case withdrawal symptoms occur.\n\n","For patients with alcohol use disorders, better detoxification completion and abstinence rates, and similar adverse event rates, were found in outpatient care compared to inpatient care in a couple of studies with short follow-up periods (one to two months). One study with a longer follow-up period found inpatients consumed less alcohol than outpatients in the year after entering treatment. This may be explained by the controlled environment of inpatient care that avoids the distractions that could be present in an outpatient care situation. In patients with severe alcohol dependence, data from one study found initial but decreasing benefit of inpatient over outpatient care across time in alcohol abstinence. For patients with substance use disorders, data from one study showed inpatients are more likely to complete treatment than outpatients. The small number of studies found and their heterogeneity in design and reported outcomes cautioned the interpretation of the findings. \n\n\n"]
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[null,"Roberts NP et al. Psychological therapies for post‐traumatic stress disorder and comorbid substance use disorder. Cochrane Database Syst Rev 2016, Issue 4. Art. No.: CD010204. DOI: 10.1002/14651858.CD010204.pub2.\nAvailable here. \n","Individuals with comorbid PTSD and SUD","This Cochrane review aimed to determine the efficacy of psychological therapies aimed at treating traumatic stress symptoms, substance misuse symptoms, or both in people with comorbid PTSD and SUD in comparison with control conditions (usual care, waiting‐list conditions, and no treatment) and other psychological therapies. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nFourteen studies with 1506 participants were included, of which 13 studies were included in the quantitative synthesis. Most studies involved adult populations. Studies were conducted in a variety of settings. Four comparisons were undertaken investigating the effects of psychological therapies with a trauma‐focused component and non‐trauma‐focused interventions against treatment as usual/minimal intervention and other active psychological therapies. Comparisons were stratified for individual‐ or group‐based therapies. All active interventions were based on CBT.\n\nIndividual‐based psychological therapies with a trauma‐focused component plus adjunctive SUD intervention: There was no evidence of an effect for level of drug/alcohol use post‐treatment (SMD ‐0.13; 95% CI ‐0.41 to 0.15; 3 studies; n = 388; very low‐quality evidence), but there was a small effect in favour of individual psychological therapy at 5 to 7 months (SMD ‐0.28; 95% CI ‐0.48 to ‐0.07; 3 studies; n = 388) when compared against TAU.\n\nIndividual‐based psychological therapy with a trauma‐focused component: did not perform better than psychological therapy for SUD only for drug/alcohol use (MD ‐1.27; 95% CI ‐5.76 to 3.22; 1 study; n = 46; low‐quality evidence). Findings were based on one small study.\n\nNon‐trauma‐focused psychological therapies: did not perform better than TAU/minimal intervention. There were no data on the effects on drug/alcohol use for individual therapy. There was no evidence of an effect on the level of drug/alcohol use for group‐based therapy (SMD ‐0.03; 95% CI ‐0.37 to 0.31; 4 studies; n = 414; very low‐quality evidence). A post‐hoc analysis for full dose of a widely established group therapy called Seeking Safety showed reduced drug/alcohol use post‐treatment (SMD ‐0.67; 95% CI ‐1.14 to ‐0.19; 2 studies; n = 111), but not at subsequent follow‐ups.\nThese also did not perform better than psychological therapy for SUD only for drug/alcohol use (SMD 0.22; 95% CI ‐0.13 to 0.57; 2 studies; n = 128; low‐quality evidence).\n","The reviewers assessed the evidence in this review as mostly low to very low quality. Evidence showed that individual trauma‐focused psychological therapy delivered alongside SUD therapy did better than TAU/minimal intervention in reducing PTSD severity post‐treatment and at long‐term follow‐up, but only reduced SUD at long‐term follow‐up. All effects were small, and follow‐up periods were generally quite short. There was evidence that fewer participants receiving trauma‐focused therapy completed treatment. There was very little evidence to support use of non‐trauma‐focused individual‐ or group‐based integrated therapies. Individuals with more severe and complex presentations (e.g. serious mental illness, individuals with cognitive impairment, and suicidal individuals) were excluded from most studies in this review, and so the findings from this review are not generalisable to such individuals. Some studies suffered from significant methodological problems and some were underpowered, limiting the conclusions that can be drawn. Further research is needed in this area."]
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[null,"Canadian agency for Drugs and Technology in Health. Mindfulness interventions for the treatment of post-traumatic stress disorder, generalized anxiety disorder, depression and substance use disorders: a review of the clinical effectiveness and guidelines. Ottawa: CADTH; 2015. Available here. ","Adults with post-traumatic stress disorder (PTSD), generalised anxiety disorder (GAD), depression, or substance use disorders.","The objective of this review was to summarise the clinical effectiveness and guidelines for the use of mindfulness interventions for the treatment of PTSD, GAD, depression, and substance use disorders in adults. The review addressed two main research questions. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\n1. What is the clinical effectiveness of mindfulness interventions for the treatment of adults with PTSD, GAD, Depression, or substance use disorders?\nA study reported, that compared with treatment as usual, participants assigned to mindfulness-based relapse prevention reported significantly lower risk of heavy drinking, significantly fewer days of heavy drinking at the 6-month follow-up. At the 12-month follow-up, mindfulness-based relapse prevention participants reported significantly decreased heavy drinking compared with relapse prevention and treatment as usual.\n\n2. What are the evidence-based guidelines regarding the use of mindfulness interventions for the treatment of adults with PTSD, GAD, Depression, or substance use disorders?\nThe guideline by the New South Wales Department of Health suggested that mindfulness could be used to treat problematic drug and alcohol users.\n\n","The evidence for the efficacy of mindfulness as a treatment for individuals with substance use disorders was limited. One RCT of low methodological quality suggested that mindfulness intervention is more effective than treatment as usual in lowering risk of relapse to substance use and heavy drinking. One guideline suggested that mindfulness can be used to treat problematic drug and alcohol use problems by suitably trained and experienced drug and alcohol professionals.\n"]
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[null,"Canadian agency for Drugs and Technology in Health. Yoga for the Treatment of Post-Traumatic Stress Disorder, Generalized Anxiety Disorder, Depression, and Substance Abuse: A Review of the Clinical Effectiveness and Guidelines. Ottawa: CADTH; 2015a. Available here. ","Adults with PTSD, GAD, depression, or substance use disorders.","The objective of this Rapid Response report is to review the clinical effectiveness of yoga for treating PTSD, GAD, depression and substance abuse, and to summarize the guidelines that are associated with the use of yoga for these conditions.The review addressed two main research questions. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\n1. What is the clinical effectiveness of yoga as an intervention for the treatment of PTSD, GAD, depression, or substance use disorders?\nOne study found that yoga was a feasible adjunct treatment for treating alcohol dependence. Patients in the yoga intervention group had a higher baseline level of drinking compared to the control group and there were positive, non-significant changes in alcohol consumption at six month follow-up, numerically greater than that experienced by the control. \ngroup\n\n2. What are the evidence-based guidelines regarding the use of mindfulness interventions for the treatment of adults with PTSD, GAD, Depression, or substance use disorders?\nFive evidence-based guidelines were included in this report, two of which did not find enough evidence for yoga to provide a recommendation. None of the recommendations focused specifically on alcohol consumption.\n\n","Three RCTs of low methodological quality suggested that patients with substance abuse improved with respect to some symptoms with yoga. Five evidence based guideline documents considered the use of yoga in clinical practice. Three suggested that yoga may be useful as an adjunctive treatment for treating major depressive disorder (MDD), PTSD and GAD, if available. "]
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[null,"Ipser JC et al. Pharmacotherapy for anxiety and comorbid alcohol use disorders. Cochrane Database Syst Rev 2015, Issue 1. Art. No.: CD007505. DOI: 10.1002/14651858.CD007505.pub2\nAvailable here. \n","People diagnosed with alcohol dependence or abuse and an anxiety disorder according to DSM‐III, DSM‐IV, or DSM‐IV‐TR criteria.","This Cochrane review aimed to assess the effects of pharmacotherapy for treating anxiety in people with comorbid alcohol use disorders. Five placebo‐controlled pharmacotherapy RCTs (with 290 participants) were included in the review. Most of the trials provided little information on how randomisation was performed or on whether both participants and study personnel were blinded to the intervention. \n\nStudy participants had DSM) III‐ and DSM IV‐diagnosed alcohol use disorders and post‐traumatic stress disorder (two studies), social anxiety disorder (SAD; two studies) or generalized anxiety disorder (GAD; one study). Four trials assessed the efficacy of the selective serotonin re‐uptake inhibitors (SSRIs: sertraline, paroxetine); one RCT investigated the efficacy of buspirone, a 5‐hydroxytryptamine (5‐HT) partial agonist. Treatment duration lasted between eight and 24 weeks. Overall, 70% of participants included in the review were male. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nThere was no evidence of an effect for any of the medications tested on abstinence from alcohol use or depression symptoms.","The evidence‐base for the effectiveness of medication in treating anxiety disorders and comorbid alcohol use disorders is currently inconclusive. There was no evidence that alcohol use was responsive to medication. Large, rigorously conducted RCTs would help supplement the small evidence‐base for the efficacy and tolerability of pharmacotherapy for anxiety and comorbid alcohol use disorders. Further research on patient subgroups who may benefit from pharmacological treatment, as well as novel pharmacological interventions, is warranted. \n"]
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[null,"Pani PP et al. Anticonvulsants for alcohol dependence. Cochrane Database Syst Rev 2014, Issue 2. Art. No.: CD008544. DOI: 10.1002/14651858.CD008544.pub2.\nAvailable here. \n","Alcohol dependent adults. ","The primary aim of this Cochrane review is to assess the benefits/risks of anticonvulsants for the treatment of alcohol dependence. \n\nA total of 25 studies were included in the review (2641 participants). Most participants were male, with an average age of 44 years. Anticonvulsants were compared with placebo (17 studies), other medications (seven studies) and no medication (two studies). The mean duration of the trials was 17 weeks (range four to 52 weeks). The studies took place in the USA, Europe, South America, India and Thailand. Variation was reported in the characteristics of the studies, including their design and the rating instruments used. For many key outcomes, the risk of bias associated with unclear or unconcealed allocation and lack of blinding affected the quality of the evidence. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nAnticonvulsants versus placebo: For continuous abstinence (eight studies, 634 participants, RR 1.21, 95% Cl 95 per cent 0.97 to 1.52, moderate‐quality evidence), results showed no evidence of differences. Moderate‐quality evidence suggested that anticonvulsants reduced drinks/drinking days (11 studies, 1126 participants, mean difference (MD) ‐1.49, 95% Cl ‐2.32 to ‐0.65) and heavy drinking (12 studies, 1129 participants, standardised mean difference (SMD) ‐0.35, 95% Cl ‐0.51 to ‐0.19). The direction of results was confirmed by subgroup analyses for topiramate and partially for gabapentin and valproate. \n\nAnticonvulsants versus naltrexone: No evidence of difference was shown in severe relapse rates (four studies, 427 participants, RR 0.69, 95% Cl 0.44 to 1.07) and continuous abstinence rates (five studies, 528 participants, RR 1.21, 95% Cl 0.99 to 1.49); anticonvulsants were associated with fewer heavy drinking days (three studies, 308 participants, MD ‐5.21, 95% Cl ‐8.58 to ‐1.83) and more days to severe relapse (three studies, 244 participants, MD 11.88, 95% Cl 3.29 to 20.46).\n","The authors concluded that at the current stage of research, randomised evidence supporting the clinical use of anticonvulsants to treat alcohol dependence is insufficient. Results are conditioned by heterogeneity and by the low number and quality of studies comparing anticonvulsants with other medications. The uncertainty associated with these results leaves to clinicians the need to balance possible benefits/risks of treatment with anticonvulsants versus other medications as supported by evidence of efficacy."]
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[null,"Jonas DE et al. Pharmacotherapy for adults with alcohol-use disorders in outpatient settings. Rockville MD: Agency for Healthcare Research and Quality; 2014. \nAvailable here. \n\nThis report has been archived by AHRQ and is being updated. The update protocol can be accessed here.","Adults with alcohol-use disorders. ","The aim of this report was to conduct a systematic review and meta-analysis of the efficacy, comparative effectiveness, and harms of medications (both FDA approved and others) for adults with alcohol-use disorders, and to evaluate the evidence from primary care settings.\n\nOne hundred and thirty five studies were included. Most patients met criteria for alcohol dependence; mean ages were in the 40s. Studies typically included psychosocial cointerventions; effect sizes reflect the added benefits of medications. For acamprosate and oral naltrexone (50 mg per day), numbers needed to treat (NNTs) to prevent 1 person from returning to any drinking were 12 and 20, respectively (moderate SOE); NNT to prevent 1 person from returning to heavy drinking was 12 for oral naltrexone (50 mg per day) (moderate SOE). Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nMeta-analyses of four head-to-head trials found no statistically significant difference between the two medications for consumption outcomes (moderate SOE). For injectable naltrexone, meta-analyses found no significant benefit for return to any or heavy drinking, but found a reduction in heavy drinking days (low SOE). Evidence from well-controlled trials does not support efficacy of disulfiram, except possibly for patients with excellent adherence. Among medications used off label, moderate evidence supports the efficacy of nalmefene and topiramate for improving some consumption outcomes, and limited evidence supports the efficacy of valproic acid. Evidence from primary care settings was scant. There was insufficient direct evidence to conclude whether medications for alcohol-use disorders are effective for improving health outcomes.","Authors concluded that acamprosate and oral naltrexone have the best evidence for improving alcohol consumption outcomes for patients with alcohol-use disorders. Head-to-head trials have not consistently established the superiority of one medication. Thus, other factors may guide medication choices, such as frequency of administration, potential adverse events, coexisting symptoms, and availability of treatments.\n\n"]
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[null,"Community setting -Families are supported and protected - Indicated interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"McGovern R et al. Effectiveness of psychosocial interventions for reducing parental substance misuse. Cochrane Database of Systematic Reviews 2021, Issue 3. Art. No.: CD012823.\nAvailable here","Participants were parents who use substances; this included mothers and fathers of children (sons and daughters) under the age of 21 years, regardless of custodial or residency status of the children. Same-sex parents and foster parents were eligible for inclusion.","The authors included 22 unique studies with a total of 2274 participants (mean age of parents ranged from 26.3 to 40.9 years), examining 24 experimental interventions. The majority of studies intervened with mothers only (n = 16; 73%). Heroin, cocaine, and alcohol were the most commonly reported substances used by participants. The interventions targeted either parenting only (n = 13; 59%); drug and alcohol use only (n = 5; 23%); or integrated interventions which addressed both (n = 6; 27%).\nThe authors found moderate-quality evidence that psychosocial interventions are probably more effective at reducing the frequency of parental alcohol misuse than comparison conditions at 6-month (mean difference (MD) −0.32, 95% confidence interval (CI) −0.51 to −0.13; 6 studies, 475 participants) and 12-month follow-up (standardised mean difference (SMD) −0.25, 95% CI −0.47 to −0.03; 4 studies, 366 participants). The authors found a significant reduction in frequency of use at 12 months only (SMD −0.21, 95% CI −0.41 to −0.01; 6 studies, 514 participants, moderate-quality evidence).\nThe authors examined the effect of the intervention type. They found low-quality evidence that psychosocial interventions targeting substance use only may not reduce the frequency of alcohol (6 months: SMD −0.35, 95% CI −0.86 to 0.16; 2 studies, 89 participants and 12 months: SMD −0.09, 95% CI −0.86 to 0.61; 1 study, 34 participants)\nA parenting intervention only, without an adjunctive substance use component, may not reduce frequency of alcohol misuse (6 months: SMD −0.21, 95% CI −0.46 to 0.04, 3 studies; 273 participants, low-quality evidence and 12 months: SMD −0.11, 95% CI −0.64 to 0.41; 2 studies; 219 participants, very low-quality evidence).\nParents receiving integrated interventions which combined both parenting- and substance use-targeted components may reduce alcohol misuse with a small effect size (6 months: SMD −0.56, 95% CI −0.96 to −0.16 and 12 months: SMD −0.42, 95% CI −0.82 to −0.03; 2 studies, 113 participants). However, this evidence was of low quality.\nInterventions appeared to be more often beneficial for fathers than for mothers. The authors found low- to very low-quality evidence of a reduction in frequency of alcohol misuse for mothers at six months only (SMD −0.27, 95% CI −0.50 to −0.04; 4 studies, 328 participants), whilst in fathers there was a reduction in frequency of alcohol misuse (6 months: SMD −0.43, 95% CI −0.78 to −0.09; 2 studies, 147 participants and 12 months: SMD −0.34, 95% CI −0.69 to 0.00; 2 studies, 147 participants).","The authors found moderate-quality evidence that psychosocial interventions probably reduce the frequency at which parents use alcohol. Integrated psychosocial interventions which combine parenting skills interventions with a substance use component may show the most promise. \nWhilst it appears that mothers may benefit less than fathers from intervention, caution is advised in the interpretation of this evidence, as the interventions provided to mothers alone typically did not address their substance use and other related needs. \nThe authors found low-quality evidence from few studies that interventions involving children are not beneficial."]

{"sheet":"set fam uni","index":41,"n_rows":149,"n_cols":5,"rows_kept":149,"cut":false,"hidden":false,"merged":[[51,1,51,4],[53,1,78,1],[53,2,78,2],[22,1,22,4],[24,1,49,1],[24,2,49,2],[24,3,49,3],[24,4,49,4],[53,3,78,3],[53,4,78,4],[80,1,80,4],[82,1,84,1],[86,1,86,4],[121,1,121,4],[92,1,92,4],[94,1,119,1],[94,2,119,2],[94,3,119,3],[94,4,119,4],[148,1,173,1],[148,2,173,2],[148,3,173,3],[148,4,173,4],[123,1,138,1],[123,2,126,2],[123,3,147,3],[123,4,147,4]]}
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[null,"Family setting - Safe and Supportive Environment - Universal interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' Conclusions:"]
[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This Cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text. Fifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect. One targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects. Among school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]
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[null,"Family setting - Changed attitudes and social norms - Universal interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This Cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text. Fifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect. One targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects. Among school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]
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[null,"Family setting - Reduced availability - Universal interventions - Systematic reviews"]
[null,"Source:","Populations:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]
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[null,"Family setting - Reduced affordability - Universal interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]
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[]
[null,"Family setting - Behaviour change - Universal interventions - Systematic reviews"]
[null,"Source:","Audience: ","Findings:","Authors' conclusions:"]
[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This Cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text. Fifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect. One targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects. Among school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]
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[null,"Family setting - Families are supported and protected - Universal interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"Gilligan C, et al. Family‐based prevention programmes for alcohol use in young people. Cochrane Database of Systematic Reviews 2019, Issue 3. Art. No.: CD012287. DOI: 10.1002/14651858.CD012287.pub2.\nAvailable here.","School age children (up to 18 years of age)","This Cochrane review aimed to assess the effectiveness of universal, selective, and indicated family-based prevention programmes in preventing alcohol use or problem drinking in school-aged children (up to 18 years of age). \n\nForty six studies (39,822 participants) were included in the review, with 27 classified as universal, 12 as selective, and seven as indicated. Meta‐analyses were performed according to outcome, including studies reporting on the prevalence, frequency, or volume of alcohol use. The overall quality of evidence was low or very low, and there was high, unexplained heterogeneity. \n\nUpon comparing any family intervention to no intervention/standard care, the authors found no intervention effect on the prevalence (SMD) 0.00, 95% CI ‐0.08 to 0.08; studies = 12; participants = 7490; I² = 57%; low‐quality evidence) or frequency (SMD ‐0.31, 95% CI ‐0.83 to 0.21; studies = 8; participants = 1835; I² = 96%; very low‐quality evidence) of alcohol use in comparison with no intervention/standard care. The effect of any parent/family interventions on alcohol consumption volume compared with no intervention/standard care was very small (SMD ‐0.14, 95% CI ‐0.27 to 0.00; studies = 5; participants = 1825; I² = 42%; low‐quality evidence). \n\nWhen comparing parent/family and adolescent interventions versus interventions with young people alone, authors found no difference in alcohol use prevalence (SMD ‐0.39, 95% CI ‐0.91 to 0.14; studies = 4; participants = 5640; I² = 99%; very low‐quality evidence) or frequency (SMD ‐0.16, 95% CI ‐0.42 to 0.09; studies = 4; participants = 915; I² = 73%; very low‐quality evidence). For this comparison, no trials reporting on the volume of alcohol use could be pooled in meta‐analysis. \n\nIn general, the results remained consistent in separate subgroup analyses of universal, selective, and indicated interventions. No adverse effects were reported. \n","The results of this review indicate that there are no clear benefits of family‐based programmes for alcohol use among young people. Patterns differ slightly across outcomes, but overall, the variation, heterogeneity, and number of analyses performed preclude any conclusions about intervention effects. Additional independent studies are required to strengthen the evidence and clarify the marginal effects observed. "]
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[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This Cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text. Fifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect. One targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects. Among school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]

{"sheet":"set fam sel","index":42,"n_rows":149,"n_cols":5,"rows_kept":149,"cut":false,"hidden":false,"merged":[[22,1,22,4],[24,1,49,1],[24,2,49,2],[24,3,49,3],[24,4,49,4],[51,1,51,4],[53,1,78,1],[53,2,78,2],[53,3,78,3],[53,4,78,4],[80,1,80,4],[82,1,84,1],[86,1,86,4],[92,1,92,4],[94,1,119,1],[94,2,119,2],[94,3,119,3],[94,4,119,4],[148,1,173,1],[148,2,173,2],[148,3,173,3],[148,4,173,4],[121,1,121,4],[123,1,138,1],[123,2,126,2],[123,3,147,3],[123,4,147,4]]}
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[null,"Family setting - Safe and Supportive Environment - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' Conclusions:"]
[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This Cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text. Fifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect. One targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects. Among school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]
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[null,"Family setting - Changed attitudes and social norms - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This Cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text. Fifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect. One targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects. Among school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]
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[null,"Family setting - Reduced availability - Systematic reviews"]
[null,"Source:","Populations:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]
[]
[]
[]
[null,"Family setting - Reduced affordability - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]
[]
[]
[]
[null,"Family setting - Behaviour change - Systematic reviews"]
[null,"Source:","Audience: ","Findings:","Authors' conclusions:"]
[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This Cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text. Fifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect. One targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects. Among school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]
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[null,"Family setting - Families are supported and protected - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"Gilligan C, et al. Family‐based prevention programmes for alcohol use in young people. Cochrane Database of Systematic Reviews 2019, Issue 3. Art. No.: CD012287. DOI: 10.1002/14651858.CD012287.pub2.\nAvailable here.","School age children (up to 18 years of age)","This Cochrane review aimed to assess the effectiveness of universal, selective, and indicated family-based prevention programmes in preventing alcohol use or problem drinking in school-aged children (up to 18 years of age). \n\nForty six studies (39,822 participants) were included in the review, with 27 classified as universal, 12 as selective, and seven as indicated. Meta‐analyses were performed according to outcome, including studies reporting on the prevalence, frequency, or volume of alcohol use. The overall quality of evidence was low or very low, and there was high, unexplained heterogeneity. \n\nUpon comparing any family intervention to no intervention/standard care, the authors found no intervention effect on the prevalence (SMD) 0.00, 95% CI ‐0.08 to 0.08; studies = 12; participants = 7490; I² = 57%; low‐quality evidence) or frequency (SMD ‐0.31, 95% CI ‐0.83 to 0.21; studies = 8; participants = 1835; I² = 96%; very low‐quality evidence) of alcohol use in comparison with no intervention/standard care. The effect of any parent/family interventions on alcohol consumption volume compared with no intervention/standard care was very small (SMD ‐0.14, 95% CI ‐0.27 to 0.00; studies = 5; participants = 1825; I² = 42%; low‐quality evidence). \n\nWhen comparing parent/family and adolescent interventions versus interventions with young people alone, authors found no difference in alcohol use prevalence (SMD ‐0.39, 95% CI ‐0.91 to 0.14; studies = 4; participants = 5640; I² = 99%; very low‐quality evidence) or frequency (SMD ‐0.16, 95% CI ‐0.42 to 0.09; studies = 4; participants = 915; I² = 73%; very low‐quality evidence). For this comparison, no trials reporting on the volume of alcohol use could be pooled in meta‐analysis. \n\nIn general, the results remained consistent in separate subgroup analyses of universal, selective, and indicated interventions. No adverse effects were reported. \n","The results of this review indicate that there are no clear benefits of family‐based programmes for alcohol use among young people. Patterns differ slightly across outcomes, but overall, the variation, heterogeneity, and number of analyses performed preclude any conclusions about intervention effects. Additional independent studies are required to strengthen the evidence and clarify the marginal effects observed. "]
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[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This Cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text. Fifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect. One targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects. Among school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]

{"sheet":"set fam ind","index":43,"n_rows":159,"n_cols":5,"rows_kept":159,"cut":false,"hidden":false,"merged":[[23,1,23,4],[25,1,29,1],[25,2,29,2],[25,3,29,3],[25,4,29,4],[31,1,31,4],[33,1,37,1],[33,2,37,2],[33,3,37,3],[33,4,37,4],[39,1,39,4],[41,1,43,1],[45,1,45,4],[51,1,51,4],[53,1,83,1],[53,2,83,2],[53,3,83,3],[53,4,83,4],[84,1,103,1],[84,2,103,2],[84,3,103,3],[84,4,103,4],[105,1,105,4],[158,1,173,1],[158,2,161,2],[158,3,182,3],[158,4,182,4],[107,1,137,1],[107,2,137,2],[107,3,137,3],[107,4,137,4],[138,1,157,1],[138,2,157,2],[138,3,157,3],[138,4,157,4]]}
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[null,"Family setting - Safe and Supportive Environment - Indicated interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' Conclusions:"]
[null,"No evidence identified."]
[]
[]
[]
[]
[]
[null,"Family setting - Changed attitudes and social norms - Indicated interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]
[]
[]
[]
[]
[]
[null,"Family setting - Reduced availability - Indicated interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]
[]
[]
[]
[null,"Family setting - Reduced affordability - Indicated interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]
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[]
[null,"Family setting - Behaviour change - Indicated interventions - Systematic reviews"]
[null,"Source:","Audience: ","Findings:","Authors' conclusions:"]
[null,"McGovern R et al. Effectiveness of psychosocial interventions for reducing parental substance misuse. Cochrane Database of Systematic Reviews 2021, Issue 3. Art. No.: CD012823.\nAvailable here","Participants were parents who use substances; this included mothers and fathers of children (sons and daughters) under the age of 21 years, regardless of custodial or residency status of the children. Same-sex parents and foster parents were eligible for inclusion.","The authors included 22 unique studies with a total of 2274 participants (mean age of parents ranged from 26.3 to 40.9 years), examining 24 experimental interventions. The majority of studies intervened with mothers only (n = 16; 73%). Heroin, cocaine, and alcohol were the most commonly reported substances used by participants. The interventions targeted either parenting only (n = 13; 59%); drug and alcohol use only (n = 5; 23%); or integrated interventions which addressed both (n = 6; 27%).\nThe authors found moderate-quality evidence that psychosocial interventions are probably more effective at reducing the frequency of parental alcohol misuse than comparison conditions at 6-month (mean difference (MD) −0.32, 95% confidence interval (CI) −0.51 to −0.13; 6 studies, 475 participants) and 12-month follow-up (standardised mean difference (SMD) −0.25, 95% CI −0.47 to −0.03; 4 studies, 366 participants). The authors found a significant reduction in frequency of use at 12 months only (SMD −0.21, 95% CI −0.41 to −0.01; 6 studies, 514 participants, moderate-quality evidence).\nThe authors examined the effect of the intervention type. They found low-quality evidence that psychosocial interventions targeting substance use only may not reduce the frequency of alcohol (6 months: SMD −0.35, 95% CI −0.86 to 0.16; 2 studies, 89 participants and 12 months: SMD −0.09, 95% CI −0.86 to 0.61; 1 study, 34 participants)\nA parenting intervention only, without an adjunctive substance use component, may not reduce frequency of alcohol misuse (6 months: SMD −0.21, 95% CI −0.46 to 0.04, 3 studies; 273 participants, low-quality evidence and 12 months: SMD −0.11, 95% CI −0.64 to 0.41; 2 studies; 219 participants, very low-quality evidence).\nParents receiving integrated interventions which combined both parenting- and substance use-targeted components may reduce alcohol misuse with a small effect size (6 months: SMD −0.56, 95% CI −0.96 to −0.16 and 12 months: SMD −0.42, 95% CI −0.82 to −0.03; 2 studies, 113 participants). However, this evidence was of low quality.\nInterventions appeared to be more often beneficial for fathers than for mothers. The authors found low- to very low-quality evidence of a reduction in frequency of alcohol misuse for mothers at six months only (SMD −0.27, 95% CI −0.50 to −0.04; 4 studies, 328 participants), whilst in fathers there was a reduction in frequency of alcohol misuse (6 months: SMD −0.43, 95% CI −0.78 to −0.09; 2 studies, 147 participants and 12 months: SMD −0.34, 95% CI −0.69 to 0.00; 2 studies, 147 participants).","The authors found moderate-quality evidence that psychosocial interventions probably reduce the frequency at which parents use alcohol. Integrated psychosocial interventions which combine parenting skills interventions with a substance use component may show the most promise. \nWhilst it appears that mothers may benefit less than fathers from intervention, caution is advised in the interpretation of this evidence, as the interventions provided to mothers alone typically did not address their substance use and other related needs. \nThe authors found low-quality evidence from few studies that interventions involving children are not beneficial."]
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[null,"Steele DW, et al. Interventions for Substance Use Disorders in Adolescents: A Systematic Review. Comparative Effectiveness Review No. 225.  AHRQ Publication No. 20-EHC014. Rockville, MD: Agency for Healthcare Research and Quality. May 2020.\nAvailable here.","Adolescents ages 12 to 20 years with problematic substance use or substance use disorder.","The authors included interventions designed to achieve abstinence, reduce use quantity and frequency, improve functional outcomes, and reduce substance-related harms. Interventions were categorised into seven primary intervention components: motivational interviewing (MI), family focused therapy (Fam), cognitive behavioral therapy (CBT), psychoeducation, contingency management (CM), peer group therapy, and intensive case management. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nMotivational interviewing reduced heavy alcohol use days by 0.7 days/month, alcohol use days by 1.2 days/month compared with treatment as usual. Across multiple intensive interventions, family focussed therapy was most effective, reducing alcohol use days by 3.5 days/month compared with treatment as usual.\n\n","Reviewers conclude that :\nBrief interventions: motivational interviewing reduces heavy alcohol use, low Strength of Evidence (SoE) and alcohol use days (moderate SoE). \nFamily focussed therapy: may be most effective in reducing alcohol use (low SoE). More research is needed to identify other effective intensive behavioral interventions for alcohol use disorder. Both motivational interviewing and CBT reduce combined alcohol and other drug use (low SoE).\nPharmacological interventions: systematic reviews in the college settings support use of brief interventions for students with any use, heavy or problematic use. More research is needed to identify the most effective combinations of behavioral and pharmacologic treatments for alcohol use disorders."]
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[null,"Family setting - Families are supported and protected - Indicated interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"McGovern R et al. Effectiveness of psychosocial interventions for reducing parental substance misuse. Cochrane Database of Systematic Reviews 2021, Issue 3. Art. No.: CD012823.\nAvailable here","Participants were parents who use substances; this included mothers and fathers of children (sons and daughters) under the age of 21 years, regardless of custodial or residency status of the children. Same-sex parents and foster parents were eligible for inclusion.","The authors included 22 unique studies with a total of 2274 participants (mean age of parents ranged from 26.3 to 40.9 years), examining 24 experimental interventions. The majority of studies intervened with mothers only (n = 16; 73%). Heroin, cocaine, and alcohol were the most commonly reported substances used by participants. The interventions targeted either parenting only (n = 13; 59%); drug and alcohol use only (n = 5; 23%); or integrated interventions which addressed both (n = 6; 27%).\nThe authors found moderate-quality evidence that psychosocial interventions are probably more effective at reducing the frequency of parental alcohol misuse than comparison conditions at 6-month (mean difference (MD) −0.32, 95% confidence interval (CI) −0.51 to −0.13; 6 studies, 475 participants) and 12-month follow-up (standardised mean difference (SMD) −0.25, 95% CI −0.47 to −0.03; 4 studies, 366 participants). The authors found a significant reduction in frequency of use at 12 months only (SMD −0.21, 95% CI −0.41 to −0.01; 6 studies, 514 participants, moderate-quality evidence).\nThe authors examined the effect of the intervention type. They found low-quality evidence that psychosocial interventions targeting substance use only may not reduce the frequency of alcohol (6 months: SMD −0.35, 95% CI −0.86 to 0.16; 2 studies, 89 participants and 12 months: SMD −0.09, 95% CI −0.86 to 0.61; 1 study, 34 participants)\nA parenting intervention only, without an adjunctive substance use component, may not reduce frequency of alcohol misuse (6 months: SMD −0.21, 95% CI −0.46 to 0.04, 3 studies; 273 participants, low-quality evidence and 12 months: SMD −0.11, 95% CI −0.64 to 0.41; 2 studies; 219 participants, very low-quality evidence).\nParents receiving integrated interventions which combined both parenting- and substance use-targeted components may reduce alcohol misuse with a small effect size (6 months: SMD −0.56, 95% CI −0.96 to −0.16 and 12 months: SMD −0.42, 95% CI −0.82 to −0.03; 2 studies, 113 participants). However, this evidence was of low quality.\nInterventions appeared to be more often beneficial for fathers than for mothers. The authors found low- to very low-quality evidence of a reduction in frequency of alcohol misuse for mothers at six months only (SMD −0.27, 95% CI −0.50 to −0.04; 4 studies, 328 participants), whilst in fathers there was a reduction in frequency of alcohol misuse (6 months: SMD −0.43, 95% CI −0.78 to −0.09; 2 studies, 147 participants and 12 months: SMD −0.34, 95% CI −0.69 to 0.00; 2 studies, 147 participants).","The authors found moderate-quality evidence that psychosocial interventions probably reduce the frequency at which parents use alcohol. Integrated psychosocial interventions which combine parenting skills interventions with a substance use component may show the most promise. \nWhilst it appears that mothers may benefit less than fathers from intervention, caution is advised in the interpretation of this evidence, as the interventions provided to mothers alone typically did not address their substance use and other related needs. \nThe authors found low-quality evidence from few studies that interventions involving children are not beneficial."]
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[null,"Steele DW, et al. Interventions for Substance Use Disorders in Adolescents: A Systematic Review. Comparative Effectiveness Review No. 225.  AHRQ Publication No. 20-EHC014. Rockville, MD: Agency for Healthcare Research and Quality. May 2020.\nAvailable here.","Adolescents ages 12 to 20 years with problematic substance use or substance use disorder.","The authors included interventions designed to achieve abstinence, reduce use quantity and frequency, improve functional outcomes, and reduce substance-related harms. Interventions were categorised into seven primary intervention components: motivational interviewing (MI), family focused therapy (Fam), cognitive behavioral therapy (CBT), psychoeducation, contingency management (CM), peer group therapy, and intensive case management. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nMotivational interviewing reduced heavy alcohol use days by 0.7 days/month, alcohol use days by 1.2 days/month compared with treatment as usual. Across multiple intensive interventions, family focussed therapy was most effective, reducing alcohol use days by 3.5 days/month compared with treatment as usual.\n\n","Reviewers conclude that :\nBrief interventions: motivational interviewing reduces heavy alcohol use, low Strength of Evidence (SoE) and alcohol use days (moderate SoE). \nFamily focussed therapy: may be most effective in reducing alcohol use (low SoE). More research is needed to identify other effective intensive behavioral interventions for alcohol use disorder. Both motivational interviewing and CBT reduce combined alcohol and other drug use (low SoE).\nPharmacological interventions: systematic reviews in the college settings support use of brief interventions for students with any use, heavy or problematic use. More research is needed to identify the most effective combinations of behavioral and pharmacologic treatments for alcohol use disorders."]
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[null,"Gilligan C, et al. Family‐based prevention programmes for alcohol use in young people. Cochrane Database of Systematic Reviews 2019, Issue 3. Art. No.: CD012287. DOI: 10.1002/14651858.CD012287.pub2.\nAvailable here.","School age children (up to 18 years of age)","This Cochrane review aimed to assess the effectiveness of universal, selective, and indicated family-based prevention programmes in preventing alcohol use or problem drinking in school-aged children (up to 18 years of age). \n\nForty six studies (39,822 participants) were included in the review, with 27 classified as universal, 12 as selective, and seven as indicated. Meta‐analyses were performed according to outcome, including studies reporting on the prevalence, frequency, or volume of alcohol use. The overall quality of evidence was low or very low, and there was high, unexplained heterogeneity. \n\nUpon comparing any family intervention to no intervention/standard care, the authors found no intervention effect on the prevalence (SMD) 0.00, 95% CI ‐0.08 to 0.08; studies = 12; participants = 7490; I² = 57%; low‐quality evidence) or frequency (SMD ‐0.31, 95% CI ‐0.83 to 0.21; studies = 8; participants = 1835; I² = 96%; very low‐quality evidence) of alcohol use in comparison with no intervention/standard care. The effect of any parent/family interventions on alcohol consumption volume compared with no intervention/standard care was very small (SMD ‐0.14, 95% CI ‐0.27 to 0.00; studies = 5; participants = 1825; I² = 42%; low‐quality evidence). \n\nWhen comparing parent/family and adolescent interventions versus interventions with young people alone, authors found no difference in alcohol use prevalence (SMD ‐0.39, 95% CI ‐0.91 to 0.14; studies = 4; participants = 5640; I² = 99%; very low‐quality evidence) or frequency (SMD ‐0.16, 95% CI ‐0.42 to 0.09; studies = 4; participants = 915; I² = 73%; very low‐quality evidence). For this comparison, no trials reporting on the volume of alcohol use could be pooled in meta‐analysis. \n\nIn general, the results remained consistent in separate subgroup analyses of universal, selective, and indicated interventions. No adverse effects were reported. \n","The results of this review indicate that there are no clear benefits of family‐based programmes for alcohol use among young people. Patterns differ slightly across outcomes, but overall, the variation, heterogeneity, and number of analyses performed preclude any conclusions about intervention effects. Additional independent studies are required to strengthen the evidence and clarify the marginal effects observed. "]

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[null,"Population - Children and young people - NICE Guidance"]
[null,"Source:","Population:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Behaviour change: digital and mobile health interventions. NG183. London: NICE; 2020.\nAvailable here.\n\n\n","Everyone, including Young People under 16 (and their families or 16 carers)\n• Pre-existing health conditions:\nOverweight/ obesity\nHypertension and cardiovascular disease\nRespiratory diseases\nCancers for which managing smoking may improve health outcomes\nMental health conditions\nSpecific consideration will also be given to people with learning disabilities and people with neurodevelopmental disorders such as autism.","This guideline covers interventions that use a digital or mobile platform to help people eat more healthily, become more active, stop smoking, reduce their alcohol intake or practise safer sex. The interventions include those delivered by text message, apps, wearable devices or the internet. The guideline only includes those that are delivered by the technology itself and not by healthcare professionals using technology to deliver interventions.\n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n1.1 Developing digital and mobile health interventions\n1.2 Commissioning digital and mobile health interventions\n1.3 Using digital and mobile health interventions\n1.4 Interventions for diet and physical activity\n1.5 Interventions for smoking\n1.6 Interventions for alcohol use (Based on Evidence Review B: alcohol)\n1.7 Interventions for unsafe sexual behaviour\n\nThe following recommendations for further research were also identified in evidence review B on alcohol:\n1. How can providers and healthcare professionals identify groups that do not initially engage, or do not stay engaged, with digital and mobile health behaviour change interventions?\n2. What components and characteristics of digital and mobile health behaviour change interventions are most effective, separately and in combination, to achieve behaviour change?\n3. What is the effectiveness and cost effectiveness of digital and mobile health behaviour change interventions in low socioeconomic and other underserved groups?\n4. Are digital and mobile health behaviour change interventions as effective as face-to-face, standard care, or combination approaches for some populations?\n5. What are the harms and adverse effects associated with different digital and mobile health behaviour change interventions?"]
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[null,"National Institute for Health and Care Excellence. Alcohol interventions in secondary and further education. NG135. London: NICE; 2019. \nAvailable here.\n","• CYP (11 to 18years) in full time education.\n• YP (18 to 25 years) with an Education, health and care (EHC) plan.\n• CYP (11 to 18years) in full time education considered ‘at risk’.\n• YP (18 to 25 years) EHC plan considered ‘at risk’.","This guideline covers interventions in secondary and further education to prevent and reduce alcohol use among children and young people aged 11 up to and including 18. It also covers people aged 11 to 25 with special educational needs or disabilities in full-time education. It will also be relevant to children aged 11 in year 6 of primary school.\n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n1.1 Planning alcohol education\n1.2 Delivering universal alcohol education (Evidence Review A: Universal interventions)\n1.3 Targeted interventions (Evidence review B: Targeted interventions)\n\nThe following recommendations for further research were also identified in Evidence review A and B:\n1. What components of alcohol education delivery contribute to its effectiveness for children and young people aged 11 to 18 in full-time education, and those with special educational needs and disabilities (SEND) up to the age of 25? (Evidence review A: universal interventions)\n2. How effective and cost effective are individual, compared with group, education-based interventions for children and young people aged 11 to 18 in full-time education who are thought to be vulnerable to alcohol misuse? (Evidence review B: targeted interventions)\n3. How effective and cost effective are universal, education-based alcohol interventions for children and young people aged 11 to 25 with SEND? (Evidence review A: universal interventions)\n4. How effective and cost effective are education-based alcohol interventions targeted at children and young people aged 11 to 25 with SEND who are thought to be vulnerable to alcohol misuse? (Evidence review B: targeted interventions)\n5. How effective are education-based alcohol prevention interventions (universal or targeted) for children and young people aged 11 to 25 with SEND in full-time education? (Evidence review A: universal interventions and Evidence review B: targeted interventions)\n6. What methods and techniques help secondary schools and providers to effectively engage with parents and carers as part of a whole-school approach to promote and support alcohol education? (Evidence review A: universal interventions)\n"]
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[null,"National Institute for Health and Care Excellence. Behaviour change: individual approaches. PH49. London: NICE; 2014. \nAvailable here.\n","Everyone aged 16 years and older","This guideline covers changing health-damaging behaviours among people aged 16 and over using interventions such as goals and planning, feedback and monitoring, and social support. It aims to help tackle a range of behaviours including alcohol misuse, poor eating patterns, lack of physical activity, unsafe sexual behaviour and smoking.\n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n1. Develop a local behaviour change policy and strategy\n2. Ensure organisation policies, strategies, resources and training all support behaviour change\n3. Commission interventions from services willing to share intervention details and data\n4. Commission high quality, effective behaviour change interventions\n5. Plan behaviour change interventions and programmes taking local needs into account\n6. Develop acceptable, practical and sustainable behaviour change interventions and programmes\n7. Use proven behaviour change techniques when designing interventions (Evidence review1 and Evidence review2)\n8. Ensure interventions meet individual needs\n9. Deliver very brief, brief, extended brief and high intensity behaviour change interventions and programmes\n10. Ensure behaviour change is maintained for at least a year (Evidence review1 and Evidence review2)\n11. Commission training for all staff involved in helping to change people's behaviour\n12. Provide training for behaviour change practitioners\n13. Provide training for health and social care practitioners\n14. Assess behaviour change practitioners and provide feedback\n15. Monitor behaviour change interventions\n16. Evaluate behaviour change interventions\n17. National support for behaviour change interventions and programmes\n\nEvidence review1 did not identify any recommendations for further research. Evidence review 2 made the following recommendation for further research:\n5.7 How do behaviour change techniques lead to change? What are the best methods of testing the relationship between the theories that describe change processes and the effectiveness of interventions in practice?"]
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[null,"National Institute for Health and Care Excellence. Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence. CG115. London: NICE; 2011\nAvailable here.\n\n","Adults (>18 years) or young people (10 to 17 years of age) with a diagnosis of alcohol dependence or meeting criteria for harmful alcohol use (30 to 50 units of alcohol per week)","This guideline covers identifying, assessing and managing alcohol-use disorders (harmful drinking and alcohol dependence) in adults and young people aged 10-17 years. It aims to reduce harms (such as liver disease, heart problems, depression and anxiety) from alcohol by improving assessment and setting goals for reducing alcohol consumption. \n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n• Principles of care\n• Identification and assessment \n• Interventions for alcohol misuse (Evidence review 2011)\n\nThe following recommendations for further research were also identified in Evidence reviews underpinning this guidance:\n1 Is contingency management effective in reducing alcohol consumption in people who misuse alcohol compared with standard care?\n2 What methods are most effective for assessing and diagnosing the presence and severity of alcohol misuse in children and young people?\n3 Is acupuncture effective in reducing alcohol consumption compared with standard care?\n4. For which service users who are moderately and severely dependent on alcohol is an assertive community treatment model a clinically and cost-effective intervention compared with standard care?\n5. For people with moderate and severe alcohol dependence who have significant comorbid problems, is an intensive residential rehabilitation programme clinically and cost effective when compared with intensive community-based care?\n6 For people with alcohol dependence, which medication is most likely to improve adherence and thereby promote abstinence and prevent relapse?\n\nOctober 2022: NICE updated the recommendation about behavioural couples therapy to clarify that this is not suitable in cases of domestic abuse and to add a cross reference to the NICE technology appraisal guidance on nalmefene. They also updated information about off-label prescribing, and added cross references to legislation on controlled drugs and driving, to MHRA advice on addiction to benzodiazepines and codeine, and to NICE's guidelines on smoking, on antisocial personality disorder and on coexisting mental illness and substance misuse community health and social care services.\nJuly 2019: NICE have found no new evidence that affects the recommendations."]
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[null,"National Institute for Health and Care Excellence. Coexisting severe mental illness (psychosis) and substance misuse: assessment and management in healthcare settings. CG120. London: NICE; 2011. \nAvailable here.\n","People aged 14 years and over with coexisting severe mental illness (psychosis) and substance misuse","This guideline covers assessing and managing people aged 14 years and over with coexisting severe mental illness (psychosis) and substance misuse. It aims to help healthcare professionals guide people with psychosis with coexisting substance misuse to stabilise, reduce or stop their substance misuse, to improve treatment adherence and outcomes, and to enhance their lives. \n\nThe guideline includes the following recommendations. All the recommendations are relevant to the scope of this topic evidence map. The recommendations are supported by evidence from the underpinning Evidence Review 2011. \n• Principles of care\n• Recognising psychosis with coexisting substance misuse\n• Primary care\n• Secondary care mental health services\n• Substance misuse services\n• Inpatient mental health services and staffed accommodation\n• Specific issues for young people with psychosis and coexisting substance misuse\n\nThe following recommendations for further research were also identified in Evidence reviews underpinning this guidance:\n1. What are the prevalence, risk and protective factors, and course of illness for different combinations of psychosis and coexisting substance misuse (for example, schizophrenia and cannabis misuse or bipolar disorder and alcohol misuse)?\n2. What risk factors predict the onset of substance misuse in young people with psychosis?\n3. Are psychosocial interventions clinically and cost effective when compared with standard care for people with psychosis and coexisting substance misuse?\n4. Are environmental interventions clinically and cost effective when compared with standard care for people with psychosis and coexisting substance misuse?\n5. Is clozapine clinically and cost effective when compared with other pharmacological interventions for people with psychosis and coexisting substance misuse?\n\nNovember 2016: NICE reviewed the evidence and found no new evidence that affects the current recommendations in this guideline."]
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[null,"National Institute for Health and Care Excellence. Alcohol-use disorders: diagnosis and management of physical complications. CG100. London: NICE; 2010. \nAvailable here. \n","People aged 10 years and over with alcohol-use disorders","This guideline covers care for adults and young people (aged 10 years and older) with physical health problems that are completely or partly caused by an alcohol-use disorder. It aims to improve the health of people with alcohol-use disorders by providing recommendations on managing acute alcohol withdrawal and treating alcohol-related conditions. \n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n• Acute alcohol withdrawal (Evidence review 2014)\n• Wernicke’s encephalopathy\n• Alcohol-related liver disease\n• Alcohol-related pancreatitis\n\nThe following recommendations for further research were also identified in Evidence reviews underpinning this guidance:\n2. What is the efficacy and cost effectiveness of clomethiazole compared with chlordiazepoxide or carbamazepine or benzodiazepines for the treatment of acute alcohol withdrawal with regard to the outcomes of withdrawal severity, risk of seizures, risk of delirium tremens, length of treatment and patient satisfaction?\n\nJanuary 2019: NICE checked this guideline and are updating it. For more information, see the surveillance decision."]
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[null,"National Institute for Health and Care Excellence. Alcohol-use disorders: prevention. PH24. London: NICE; 2010\nAvailable here.\n\n\n\n","Children, young people and adults aged 10 years and above","This guideline covers alcohol problems among people over 10. It aims to prevent and identify such problems as early as possible using a mix of policy and practice.\n\nThe guideline includes the following recommendations. All the recommendations are relevant to the scope of this topic evidence map. The recommendations are supported by the underpinning Evidence reviews 1-3 and Evidence reviews 4-6:\n• Price, availability and marketing\n• Licencing\n• Supporting children and young people aged 10 to 15 years\n• Screening young people aged 16 and 17 years and offering them extended brief interventions\n• Screening adults and offering them brief advice and interventions\n• Referral\n\nThe underpinning evidence reviews in this report identifed several gaps in the evidence and made recommendations for further research with the following overarching question:\nHow does advertising by industry and health agencies affect the drinking behaviour of the population as whole? (This includes the use of new media.)\n\nJuly 2019: NICE checked this guideline and are updating it. For further information, see the surveillance decision."]
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[null,"National Institute for Health and Care Excellence. Behaviour change: general approaches. PH6. London: NICE; 2007\nAvailable here.\n\n\n\n","General population","This guideline covers a set of principles that can be used to help people change their behaviour. The aim is for practitioners to use these principles to encourage people to adopt a healthier lifestyle by, for example, stopping smoking, adopting a healthy diet and being more physically active.\n\nThe guideline includes the following recommendations. All the recommendations are relevant to the scope of this topic evidence map. The recommendations are supported by the underpinning Evidence review 1.\n• Providing education and training for those delivering them\n• Delivery of these activities, including one-to-one and community-based programmes and those aimed at specific populations\n• Evaluation of their effectiveness and cost effectiveness\n\nThe Programme Development Group identified a number of gaps in the evidence related to behaviour change interventions and programmes, based on an assessment of the evidence and made recommendations for research to address the most important gaps in the evidence. Please refer to 4. Recommendations for research' section of the guidance.\n\nNovember 2017: NICE checked this guideline and found no new evidence that affects the recommendations in this guideline."]
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[null,"Population - Children and young people - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' Conclusions:"]
[null,"Wolfenden L et al. Strategies for enhancing the implementation of school‐based policies or practices targeting diet, physical activity, obesity, tobacco or alcohol use. Cochrane Database of Systematic Reviews 2022, Issue 8.\nAvailable here.","School age children (between 5 to 18 years of age)","This Cochrane review aimed to to find out how effective strategies were in supporting the implementation of school‐based interventions to address student diet, physical activity, unhealthy weight gain, and tobacco or alcohol use. Examples of strategies include methods of improving quality, education and training, feedback on how the school was doing, prompts and reminders, and educational resources (e.g. manuals).\n\nThe reviewers included an additional 11 trials in this update bringing the total number of included studies in the review to 38. Of these, 22 were conducted in the USA. Twenty‐six studies used RCT designs. Seventeen trials tested strategies to implement healthy eating, 12 physical activity and six a combination of risk factors. Just one trial sought to increase the implementation of interventions to delay initiation or reduce the consumption of alcohol. All trials used multiple implementation strategies, the most common being educational materials, educational outreach and educational meetings. The overall certainty of evidence was low and ranged from very low to moderate for secondary review outcomes. Only findings relevant to this evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nPooled analyses of RCTs found, relative to a control, the use of implementation strategies may result in a large increase in the implementation of interventions in schools (SMD 1.04, 95% CI 0.74 to 1.34; 22 RCTs, 1917 participants; low‐certainty evidence). One RCT assessed measures of student alcohol use and found strategies to support implementation may result in a slight increase in use (odds ratio 1.10, 95% CI 0.77 to 1.56; P = 0.60; 2105 participants).","The use of implementation strategies may result in large increases in implementation of interventions, and slight improvements in measures of student diet, and physical activity. Further research is required to assess the impact of implementation strategies on such behavioural‐ and obesity‐related outcomes, including on measures of alcohol use, where the findings of one trial suggest it may slightly increase student risk. Given the low certainty of the available evidence for most measures further research is required to guide efforts to facilitate the translation of evidence into practice in this setting."]
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[null,"Filges T, Dalgaard NT and Viinholt BC. 2022. Outreach programs to improve life circumstances and prevent further adverse developmental trajectories of at‐risk youth in OECD countries: A systematic review. Campbell Systematic Reviews, 18(4), p.e1282.\nAvailable here\n","Young people between 8 and 25 years of age living in OECD countries, who either have experienced or is at-risk of experiencing an adverse outcome such as school failure or drop-out, runaway and homelessness, substance and/or alcohol abuse, unemployment, long-term poverty, delinquency/criminal behaviour were eligible.","This Campbell systematic review examines the effects of outreach programmes on problem/high-risk behaviour of young people between eight and 25 year old, living in OECD countries. The review summarises evidence from five studies undertaken in the USA and Canada that involved 578 participants in total.\n\nFour of the five studies used for meta analysis were from the USA and one was from Canada. The timespan in which included studies were carried out was 32 years, from 1985 to 2017; on average the intervention year was 2005. The average number of participants in the analysed interventions was 116, ranging from 30 to 346 and the average number of controls was 81, ranging from 32 to 321. At most, the results from two studies could be pooled in a single meta-analysis. It was only possible to pool the outcomes drug (other than marijuana) use, marijuana use and alcohol use each at two different time points (one and 3 months follow up). At 1 month follow up the weighted averages varied between zero and 0.05 and at 3 months follow up between −0.17 and 0.07. None of them were statistically significant. In addition, a number of other outcomes were reported in a single study only.","Overall, there were too few studies included in any of the meta-analyses in order for us to draw any conclusion concerning the effectiveness of outreach. The vast majority of studies were undertaken in the USA.\nFurther, because too few studies reported results on the same type of outcome at most two studies could be combined in a particular meta-analysis. Given the limited number of rigorous studies available from countries other than the USA, it would be natural to consider conducting a series of randomised controlled trials evaluating the effectiveness of outreach for at-risk youth in countries outside the USA. The trial(s) should be designed, conducted and reported according to methodological criteria for rigour in respect of internal and external validity to achieve robust results and preferably reporting a larger number of outcomes."]
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[null,"Steele DW, et al. Interventions for Substance Use Disorders in Adolescents: A Systematic Review. Comparative Effectiveness Review No. 225.  AHRQ Publication No. 20-EHC014. Rockville, MD: Agency for Healthcare Research and Quality. May 2020.\nAvailable here.","Adolescents ages 12 to 20 years with problematic substance use or substance use disorder.","The authors included interventions designed to achieve abstinence, reduce use quantity and frequency, improve functional outcomes, and reduce substance-related harms. Interventions were categorised into seven primary intervention components: motivational interviewing (MI), family focused therapy (Fam), cognitive behavioral therapy (CBT), psychoeducation, contingency management (CM), peer group therapy, and intensive case management. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nMotivational interviewing reduced heavy alcohol use days by 0.7 days/month, alcohol use days by 1.2 days/month compared with treatment as usual. Across multiple intensive interventions, family focussed therapy was most effective, reducing alcohol use days by 3.5 days/month compared with treatment as usual.\n\n","Reviewers conclude that :\nBrief interventions: motivational interviewing reduces heavy alcohol use, low Strength of Evidence (SoE) and alcohol use days (moderate SoE). \nFamily focussed therapy: may be most effective in reducing alcohol use (low SoE). More research is needed to identify other effective intensive behavioral interventions for alcohol use disorder. Both motivational interviewing and CBT reduce combined alcohol and other drug use (low SoE).\nPharmacological interventions: systematic reviews in the college settings support use of brief interventions for students with any use, heavy or problematic use. More research is needed to identify the most effective combinations of behavioral and pharmacologic treatments for alcohol use disorders."]
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[null,"Gilligan C, et al. Family‐based prevention programmes for alcohol use in young people. Cochrane Database of Systematic Reviews 2019, Issue 3. Art. No.: CD012287. DOI: 10.1002/14651858.CD012287.pub2.\nAvailable here.","School age children (up to 18 years of age)","This Cochrane review aimed to assess the effectiveness of universal, selective, and indicated family-based prevention programmes in preventing alcohol use or problem drinking in school-aged children (up to 18 years of age). \n\nForty six studies (39,822 participants) were included in the review, with 27 classified as universal, 12 as selective, and seven as indicated. Meta‐analyses were performed according to outcome, including studies reporting on the prevalence, frequency, or volume of alcohol use. The overall quality of evidence was low or very low, and there was high, unexplained heterogeneity. \n\nUpon comparing any family intervention to no intervention/standard care, the authors found no intervention effect on the prevalence (SMD) 0.00, 95% CI ‐0.08 to 0.08; studies = 12; participants = 7490; I² = 57%; low‐quality evidence) or frequency (SMD ‐0.31, 95% CI ‐0.83 to 0.21; studies = 8; participants = 1835; I² = 96%; very low‐quality evidence) of alcohol use in comparison with no intervention/standard care. The effect of any parent/family interventions on alcohol consumption volume compared with no intervention/standard care was very small (SMD ‐0.14, 95% CI ‐0.27 to 0.00; studies = 5; participants = 1825; I² = 42%; low‐quality evidence). \n\nWhen comparing parent/family and adolescent interventions versus interventions with young people alone, authors found no difference in alcohol use prevalence (SMD ‐0.39, 95% CI ‐0.91 to 0.14; studies = 4; participants = 5640; I² = 99%; very low‐quality evidence) or frequency (SMD ‐0.16, 95% CI ‐0.42 to 0.09; studies = 4; participants = 915; I² = 73%; very low‐quality evidence). For this comparison, no trials reporting on the volume of alcohol use could be pooled in meta‐analysis. \n\nIn general, the results remained consistent in separate subgroup analyses of universal, selective, and indicated interventions. No adverse effects were reported. \n","The results of this review indicate that there are no clear benefits of family‐based programmes for alcohol use among young people. Patterns differ slightly across outcomes, but overall, the variation, heterogeneity, and number of analyses performed preclude any conclusions about intervention effects. Additional independent studies are required to strengthen the evidence and clarify the marginal effects observed. "]
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[null,"Hollands  GJ et al. Altering the availability or proximity of food, alcohol, and tobacco products to change their selection and consumption. Cochrane Database of Systematic Reviews 2019, Issue 9. Art. No.: CD012573. DOI: 10.1002/14651858.CD012573.pub3.\nAvailable here.","Adults","This Cochrane review aimed to:\n1. To assess the impact on selection and consumption of altering the availability or proximity of (a) food (including non‐alcoholic beverages), (b) alcohol, and (c) tobacco products.\n2. To assess the extent to which the impact of these interventions is modified by characteristics of: i. studies, ii. interventions, and iii. participants.\n\nThe reviewers included 24 studies, with the majority (20/24) giving concerns about risk of bias. All of the included studies investigated food products; none investigated alcohol or tobacco. ","The authors concluded that:\n- Further research is warranted in real‐world settings, intervening across a wider range of foods as well as alcohol and tobacco products and over sustained time periods"]
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[null,"Stead M, Angus K, Langley T, Katikireddi SV, Hinds K, Hilton S,  et al. Mass media to communicate public health messages in six health topic areas: a systematic review and other reviews of the evidence. Public Health Res 2019;7(8)\nAvailable here.","General population","This systematic review by NIHR aimed to (1) review evidence on the effective use of mass media in six health topic areas (alcohol, diet, illicit drugs, physical activity, sexual and reproductive health and tobacco), (2) examine whether or not effectiveness varies with different target populations, (3) identify characteristics of mass media campaigns associated with effectiveness and (4) identify key research gaps.There was limited evidence of impact on alcohol use. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nChapter 3. What is the impact of mass media campaigns on alcohol-related behaviour and other outcomes? Findings from the review of primary studies of alcohol campaigns (review B).\nThe objective was to conduct a systematic review of evidence of the effectiveness of mass media public health campaigns to reduce alcohol consumption and related harms. Twenty-nine papers were included in the review. They reported 24 different studies that had a range of designs (11 controlled longitudinal and 13 uncontrolled or cross-sectional) and countries (eight in the USA, five in Australia, two in Finland, two in New Zealand, two in the UK, one in Canada, one in Denmark, one in Italy, one in the Netherlands and one in Sri Lanka). Television and/or radio were used in 18 studies. Other media channels that were used were posters, newspapers, pamphlets, e-mails and online video. On EPHPP study quality ratings, two were strong, four were moderate and 18 were weak.\n\nAlcohol consumption: There was little evidence of reductions in alcohol consumption associated with exposure to campaigns (13 studies). Six of these studies compared exposed and non-exposed groups, or exposed groups over time; five reported no statistically significant differences in consumption. One study found that participants in a group exposed to a television and mailed letter campaign decreased their consumption on a typical day by 47%, contrasting with increases in the groups receiving either the television or letter components or neither. Other studies examined associations between campaign viewing or awareness and consumption: one reported that increases in awareness in older adolescence, but not younger adolescence, was associated with decreases in binge drinking, one reported that campaign viewing significantly predicted drinks consumed and two found no significant difference in consumption.","Reviewers conclude that mass media public health campaigns about alcohol can often be recalled by individuals, and are associated with changes in knowledge, attitudes and beliefs about alcohol. There is little evidence that campaigns reduced alcohol consumption but most studies did not report consumption as an outcome. Mass media can, however, have an impact on outcomes that could lead to support for other public health actions to reduce alcohol consumption and harm."]
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[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This Cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text. Fifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect. One targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects. Among school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]
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[null,"Hennessy EA et al. Recovery schools for improving behavioral and academic outcomes among students in recovery from substance use disorders: a systematic review. Campbell Systematic Reviews 2018; 9. \nAvailable here. ","Students in recovery from substance use who were enrolled part-time or full-time in secondary (high school) or postsecondary (college or university) educational institutions. ","The review focused on two types of recover schools: recovery high schools (RHSs), which are schools that award secondary school dipolmas and offer a range of therapeutic services in addition to standard educational curricula; and collegiate recovery communities (CRCs), which offer therapeutic and sober support services on college campuses. \n\nOnly one study met the criteria for inclusion in the review. The study used a quasi-experimental design to examine the effects of RHSs on high school students' academic and substance use outcomes. No eligible studies examining CRCs were identified. \n\nThe results from the one eligible RHS study indicated that after adjusting for pretest values, students in the RHS condition reported levels of grade point averages (g = 0.26, 95% CI [-0.04, 0.56]), truancy (g = 0.01, 95% CI [-0.29, 0.31]), and alcohol use (g = 0.23, 95% CI [-0.07, 0.53]) similar to participants in the comparison condition. However, students in the RHS condition reported improvements in absenteeism (g = 0.56, 95% CI [0.25, 0.87]), abstinence from alcohol/drugs (OR = 4.36, 95% CI [1.19, 15.98]), marijuana use (g = 0.51, 95% CI [0.20, 0.82]), and other drug use (g = 0.45, 95% CI [0.14, 0.76]).\n\nOverall, there was a serious risk of bias in the one included study. The study had a serious risk of bias due to confounding, low risk of bias due to selection of participants into the study, moderate risk of bias due to classification of interventions, inconclusive risk of bias due to deviations from intended interventions, inconclusive risk of bias due to missing data, moderate risk of bias in measurement of outcomes, and low risk of bias in selection of reported results.","There is insufficient evidence regarding the effectiveness of RHSs and CRCs for improving academic and substance use outcomes among students in recovery from SUDs. Only one identified study examined the effectiveness of RHSs. Although the study reported some beneficial effects, the results must be interpreted with caution given the study's potential risk of bias due to confounding and limited external validity. The paucity of evidence on the effectiveness of recovery schools, as documented in this review, thus suggest the need for caution in the widespread adoption of recovery schools for students in recovery from SUDs. Given the lack of empirical support for these recovery schools, additional rigorous evaluation studies are needed to replicate the findings from the one study included in this review. Furthermore, additional research examining the costs of recovery schools may be needed, to help school administrators determine the potential cost-benefits associated with recovery schools. "]
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[null,"O'Connor EA et al. Screening and behavioral counseling interventions to reduce unhealthy alcohol use in adolescents and adults: An updated systematic review for the U.S. Preventive Services Task Force. Rockville MD: Agency for Healthcare Research and Quality; 2018. \nAvailable here. ","Adolescents or adults age 12 years or older. ","One hundred and thirteen studies (n=314,466) were included across all Key Questions. The authors did not find any studies that examined the benefits or harms of screening programs to reduce unhealthy alcohol use. For adolescents, data supported the use of the National Institute on Alcohol Abuse and Alcoholism Youth Screen and other similar one- or two-item screeners to detect alcohol use disorder. For adults, brief (1- to 3-item) screeners commonly reported sensitivity and specificity between 0.70 and 0.85, typically having better sensitivity than the full Alcohol Use Disorders Identification Test (AUDIT) for identifying the full spectrum of unhealthy use. However, the AUDIT tended to have higher specificity, particularly at the standard cutoff of 8 or higher.  \n\nIdentified interventions to reduce unhealth alcohol use were generally counselling interventions, with most involving one or two sessions (90% involved ≤ 4 sessions) with a median of 30 minutes contact time (88% involved ≤ 2 hours contact). The most commonly reported intervention element was the use of personalized normative feedback sessions, in which participants were shown how their alcohol use compares to others; this technique was used in more than half of the included trials and almost all trials in younger adults. Motivational techniques were also common, particularly in combination with personalized normative feedback.\n\nEvidence on the effects of interventions to reduce unhealthy alcohol use in adolescents was limited to two trials; both found mixed results for reduced alcohol use and did not report health or related outcomes. \n\nIn adults, interventions reduced the number of drinks per week (weighted mean difference, −1.82 [95% confidence interval {CI}, −2.42 to −1.22]), the proportion exceeding recommended drinking limits (odds ratio [OR], 0.60 [95% CI, 0.53 to 0.67]), and the proportion reporting a heavy use episode (OR, 0.62 [95% CI, 0.55 to 0.71]), and increased the proportion of pregnant women reporting abstinence (OR, 1.92 [95% CI, 1.19 to 3.09]) after 6 to 12 months. \n\nHeterogeneity was high and effect size was associated with a number of study characteristics such as setting, target age of the population, publication year, study size, and average baseline-use levels, but not clearly associated with any intervention characteristics. Data on effectiveness in important subgroups were very limited, but analyses by sex, the most commonly reported subgroup analysis, did not indicate differences in effectiveness of the interventions. Health outcomes were sparsely reported and, with some exceptions, generally did not demonstrate group differences in effect. No evidence of harm was found.","Among adults, screening instruments are available that can effectively identify persons with unhealthy alcohol use and that are feasible for use in primary care settings, and interventions in those who screen positive are associated with reductions in unhealthy alcohol use. There was no evidence that these interventions have unintended harmful effects. More evidence is needed to determine whether screening for unhealthy alcohol use is beneficial for adolescents."]
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[null,"Smedslund G et al. Effect of early, brief computerized interventions on risky alcohol and cannabis use among young people. Campbell systematic reviews 2017; 6:(13). Available here. ","Young people (aged 15-25) who abuse alcohol or cannabis. ","The review focused on the effects of brief interventions, provided by electronic devices. Sixty studies were included in the review that had randomised a total of 33,316 participants. \n\nModerate quality evidence was found that multi-dose assessment and feedback was more effective than single-dose assessment for alcohol. A meta-analysis of four studies by the same first author found a 16 per cent significant short-term reduction in drinking after a repeated assessment and feedback compared to a single assessment and feedback (Rate ratio: 0.84, 95 per cent CI: 0.78 to 0.91). However, a study by Anderson (2015) found an SMD of 0.10 (in favour of single dose, 95 per cent CI: -0.07 to 0.27). A study by Kypri (2008) found a long-term significant reduction in drinking after multi-dose feedback compared to single-dose feedback (Rate ratio: 0.77, 95 per cent CI: 0.63 to 0.94). \n\nLow quality evidence was found that assessment and feedback might be more effective than no intervention (Short term effect, 15 studies; SMD: -0.17, 95 per cent CI: -0.27 TO -0.08, I2 = 52 per cent. Long term effect, 3 studies; SMD: -0.17, 95 per cent CI: -0.30 to -0.04).\n\nAssessment and feedback might also be more effective than assessment alone (low quality evidence. Short-term effect, 24 studies; SMD: -0.15, 95 per cent CI: -0.25 to -0.06, I2 = 64 per cent. Long-term effect, 3 studies; SMD: -0.03, 95 per cent CI: -0.19 to 0.12). \n\nShort term effects (<6 months) were mostly larger than long-term (≥ 6 months) effects. \n","Computerized brief interventions are easy to administer, and the evidence from this review indicates that such brief interventions might reduce drinking for several months after the intervention. Additionally, there is no evidence for adverse effects. This means that brief, computerized interventions could be feasible ways of dealing with risky alcohol use among young people. The evidence on cannabis consumption is scarcer, suggesting the need for more research. "]
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[null,"Foxcroft DR et al. Motivational interviewing for the prevention of alcohol misuse in young adults. Cochrane Database Syst Rev 2016, Issue 7. Art. No.: CD007025. DOI: 10.1002/14651858.CD007025.pub4.\nAvailable here.\n","Young adults up to 25 years of age (higher risk individuals or settings). ","This Cochrane review aimed to assess the effects of motivational interviewing (MI) interventions for preventing alcohol misuse and alcohol‐related problems in young adults. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nEighty four trials (22,872 participants) were included, with 70/84 studies reporting interventions in higher risk individuals or settings. Studies with follow‐up periods of at least four months were of more interest in assessing the sustainability of intervention effects and were also less susceptible to short‐term reporting or publication bias. Overall, the risk of bias assessment showed that these studies provided moderate or low quality evidence.\n\nAt four or more months follow‐up, effects in favour of MI were found for the quantity of alcohol consumed (standardised mean difference (SMD) −0.11, 95 per cent confidence interval (CI) −0.15 to −0.06 or a reduction from 13.7 drinks/week to 12.5 drinks/week; moderate quality evidence); frequency of alcohol consumption (SMD −0.14, 95 per cent CI −0.21 to −0.07 or a reduction in the number of days/week alcohol was consumed from 2.74 days to 2.52 days; moderate quality evidence); and peak blood alcohol concentration, or BAC (SMD −0.12, 95 per cent CI −0.20 to 0.05, or a reduction from 0.144 per cent to 0.131 per cent; moderate quality evidence).\n\nFurther analyses showed that there was no clear relationship between the duration of the MI intervention (in minutes) and effect size. Subgroup analyses revealed no clear subgroup effects for longer‐term outcomes (four or more months) for assessment only versus alternative intervention controls; for university/college vs other settings; or for higher risk vs all/low risk participants.\n","The results of this review indicate that there are no substantive, meaningful benefits of MI interventions for preventing alcohol use, misuse or alcohol‐related problems. Although the reviewers found some statistically significant effects, the effect sizes were too small, given the measurement scales used in the included studies, to be of relevance to policy or practice. Moreover, the statistically significant effects are not consistent for all misuse measures, and the quality of evidence is not strong, implying that any effects could be inflated by risk of bias."]
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[null,"Brown TJ, Todd A, O'Malley CL, Moore HJ, Husband AK, Bambra C, et al. Community pharmacy interventions for public health priorities: a systematic review of community pharmacy-delivered smoking, alcohol and weight management interventions. Public Health Res 2016;4(2)\nAvailable here.","People of all ages and in any country","This review aimed to systematically review the effectiveness of community pharmacy interventions to manage alcohol misuse, smoking cessation and weight loss; to explore if and how age, sex, ethnicity and socioeconomic status moderate effectiveness; and to describe how the interventions have been organised, implemented and delivered.\n\nTwenty-four studies were included: two alcohol, 12 smoking cessation, five weight loss and five multicomponent interventions that included pharmacotherapy and lifestyle changes in participants with diabetes mellitus, dyslipidaemia or hypertension. Nine of the studies were UK based; seven of the studies were rated ‘strong’ for quality. All studies were of adults. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nAlcohol outcomes: There were two RCTs of brief alcohol interventions in adults compared with usual care or leaflet-only control; global ratings were strong for one study and weak for the other. Table 8 in full-text summarises the results. Both studies had change in alcohol consumption as the primary outcome; however, different tools were used in each. Eligibility criteria for both studies were scores that indicated ‘possible harmful or hazardous alcohol consumption, but not alcohol dependence’. There were insufficient data to conduct meta-analyses.\n\nAt 12 weeks there was no evidence in effectiveness of community pharmacist delivery of brief alcohol intervention. The AUDIT total change score did not differ significantly between the two groups and did not change significantly between baseline and follow-up in either the intervention or control group. The 12-week AUDIT between-group difference adjusted for pharmacist, sex, age, ethnicity and education was –0.57 [95% confidence interval (CI) –1.59 to 0.45]. There was no significant difference between FAST score for the intervention group compared with control at 3 or 6 months and adjusted for baseline FAST. The 6-month FAST between-group difference was –1.84 (95% CI –4.49 to 0.82). At 6 months there was substantially lower follow-up of intervention clients (22.2%) than of control clients (33.3%).\n\nNeither study evaluated differential effects by demographic or socioeconomic factors. One study reported change in FAST scores by sex; however, the numbers of participants were very small and the study was not powered to detect differences between the two groups.","There was insufficient evidence for the effectiveness of community pharmacy-based brief alcohol interventions.\n\nEvaluations of interventions to manage alcohol misuse and obesity, set within the community pharmacy, are needed.\n\nThe effect of community pharmacy interventions on health inequalities is unclear. Future research in this area is warranted, and trials should include the assessment of age, sex, ethnicity, socioeconomic status and contextual factors, and present analysis of how these factors moderate effectiveness.\n"]
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[null,"Carney T, Myers BJ, Louw J, Okwundu CI. Brief school‐based interventions and behavioural outcomes for substance‐using adolescents. Cochrane Database Syst Rev 2016; Issue 1. Art. No.: CD008969. DOI: 10.1002/14651858.CD008969.pub3\nAvailable here.\n","Substance using adolescents.","The authors included six RCTs which evaluated the effects of brief school-based interventions for substance-using adolescents. Three studies with 732 adolescents compared brief interventions (Bls) with information provision only, and three studies with 444 adolescents compared Bls with assessment only. Reasons for downgrading the quality of evidence included risk of bias of the included studies, imprecision, and inconsistency. For outcomes that concern substance abuse, the retrieved studies only assessed alcohol and cannabis. \n\nGenerally, moderate quality evidence was found that, compared to information provision only, BIs did not have a significant effect on any of the substance use outcomes at short‐, medium‐, or long‐term follow‐up. \n\nWhen compared to assessment-only controls, BIs were found to significantly reduce the frequency of alcohol use (SMD ‐0.91; 95 per cent CI ‐1.21 to ‐0.61, n = 242), alcohol abuse (SMD ‐0.38; 95 per cent CI ‐0.7 to ‐0.07, n = 190) and dependence (SMD ‐0.58; 95 per cent CI ‐0.9 to ‐0.26, n = 190) at medium-term follow-up in one study. And, at long-term follow-up BI’s also reduced alcohol abuse (SMD ‐0.72; 95 per cent CI ‐1.05 to ‐0.40, n = 181) in one study. However, the evidence from studies that compared brief interventions to assessment‐only conditions was generally of low quality.\n","We found low or very low‐quality evidence that brief school‐based interventions may be more effective in reducing alcohol and cannabis use than the assessment‐only condition and that these reductions were sustained at long‐term follow‐up. We found moderate‐quality evidence that, when compared to information provision, brief interventions probably did not have a significant effect on substance use outcomes. It is premature to make definitive statements about the effectiveness of brief school‐based interventions for reducing adolescent substance use. Further high‐quality studies examining the relative effectiveness of BIs for substance use and other problem behaviours need to be conducted, particularly in low‐ and middle‐income countries."]
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[null,"Tansil KA et al. Alcohol Electronic Screening and Brief Intervention A Community Guide Systematic Review. Am J Prev Med 2016;51(5):801–811). \nAvailable here. \n","Unspecified","This Community Guide review focused on e-screening and brief interventions (e-SBIs) that are similar in structure and intent to Alcohol screening and brief intervention (ASBI) and examined how e-SBI effectiveness varied by key intervention characteristics, in contrast to previous systematic reviews of e-SBI. This review is unique in that it excluded highly interactive interventions (i.e., those with more than three human-to-human sessions); those that were part of a treatment program for alcohol use disorders; those that were primarily educational programs (e.g., Alcohol Edu, College Alc); and those that only used an electronic device for monitoring drinking following traditional ASBI.\n\nTwenty-four studies (28 study arms) provided results for excessive drinkers only and seven studies (eight study arms) reported results for all drinkers. Nearly all studies found that e-SBI reduced excessive alcohol consumption and related harms: nine study arms reported a median 23.9% reduction in binge-drinking intensity (maximum drinks/binge episode) and nine study arms reported a median 16.5% reduction in binge-drinking frequency. Reductions in drinking measures were sustained for up to 12 months.","The authors conclude that, according to Community Guide rules of evidence, e-SBI is an effective method for reducing excessive alcohol consumption and related harms among intervention participants. Implementation of e-SBI could complement population-level strategies previously recommended by the Community Preventive Services Task Force for reducing excessive drinking (e.g., increasing alcohol taxes and regulating alcohol outlet density)."]
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[null,"Foxcroft DR et al. Social norms information for alcohol misuse in university and college students. Cochrane Database Syst Rev 2015, Issue 12. Art. No.: CD006748. DOI: 10.1002/14651858.CD006748.pub4.\nAvailable here. \n","University or college students. ","This Cochrane review aimed to determine whether social norms interventions reduce alcohol‐related negative consequences, alcohol misuse or alcohol consumption when compared with a control (ranging from assessment only/no intervention to other educational or psychosocial interventions) among university and college students.\n\nSeventy studies (44,958 participants) were included in the review, and 63 studies (42,784 participants) in the meta‐analyses. Overall, the risk of bias assessment showed that these studies provided moderate or low quality evidence. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nBinge drinking at four or more months (results pooled across delivery modes): SMD ‐0.06, 95 per cent CI ‐0.11 to ‐0.02 (participants = 11,292; studies = 16; moderate quality evidence), equivalent to 2.7 per cent fewer binge drinkers if 30‐day prevalence is 43.9 per cent.\n\nDrinking quantity at four or more months (results pooled across delivery modes): SMD ‐0.08, 95 per cent CI ‐0.12 to ‐0.04 (participants = 21,169; studies = 32; moderate quality evidence), equivalent to a reduction of 0.9 drinks consumed each week, from a baseline of 13.7 drinks per week.\n\nDrinking frequency at four or more months: WF SMD ‐0.11, 95 per cent CI ‐0.17 to ‐0.04 (participants = 9929; studies = 10; moderate quality evidence), equivalent to a decrease of 0.17 drinking days/wk, from a baseline of 2.74 days/wk; individual face‐to‐face normative feedback SMD ‐0.21, 95 per cent CI ‐0.31 to ‐0.10 (participants = 1464; studies = 8; moderate quality evidence), equivalent to a decrease of 0.32 drinking days/wk, from a baseline of 2.74 days/wk. No effects were found for group face‐to‐face normative feedback or normative marketing campaign.\n\nEstimated blood alcohol concentration (BAC) at four or more months: (Peak BAC results pooled across delivery modes) SMD ‐0.08, 95 per cent CI ‐0.17 to 0.00 (participants = 7198; studies = 11; low quality evidence), equivalent to a reduction in peak BAC from an average of 0.144 per cent to 0.135 per cent. No effects were found for typical BAC with individual face‐to‐face normative feedback.\n","The results of this review indicate that no substantive meaningful benefits are associated with social norms interventions for prevention of alcohol misuse among college/university students. Although some significant effects were found, we interpret the effect sizes as too small, given the measurement scales used in the studies included in this review, to be of relevance for policy or practice. Moreover, the significant effects are not consistent for all misuse measures, heterogeneity was a problem in some analyses and bias cannot be discounted as a potential cause of these findings. "]
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[null,"Langford R et al. The WHO Health Promoting School framework for improving the health and well‐being of students and their academic achievement. Cochrane Database Syst Rev 2014, Issue 4. Art. No.: CD008958. DOI: 10.1002/14651858.CD008958.pub2 \nAvailable here. ","School aged children (aged 4-18).","This Cochrane review aimed to assess the effectiveness of the Health Promoting Schools (HPS) framework in improving the health and well‐being of students and their academic achievement.\n\nSixty seven eligible cluster trials, randomising 1,443 schools or districts were included. This is made up of 1,345 schools and 98 districts. The studies tackled a range of health issues: physical activity (4), nutrition (12), physical activity and nutrition combined (18), bullying (7), tobacco (5), alcohol (2), sexual health (2), violence (2), mental health (2), hand‐washing (2), multiple risk behaviours (7), cycle‐helmet use (1), eating disorders (1), sun protection (1), and oral health (1). Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nReview authors report that the quality of evidence overall was low to moderate as determined by the GRADE approach. Risk of bias assessments identified methodological limitations, including heavy reliance on self‐reported data and high attrition rates for some studies. In addition, there was a lack of long‐term follow‐up data for most studies.\n\nEight studies provided data on alcohol use and all but one were included in the meta‐analysis. Overall, there was no evidence that any of the different intervention approaches were effective in reducing alcohol intake.","The results of this review provide evidence for the effectiveness of some interventions based on the HPS framework for improving certain health outcomes but not others. More well‐designed research is required to establish the effectiveness of this approach for other health topics and academic achievement."]
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[null,"Siegfried N et al. Restricting or banning alcohol advertising to reduce alcohol consumption in adults and adolescents. Cochrane Database Syst Rev 2014, Issue 11. Art. No.: CD010704. DOI: 10.1002/14651858.CD010704.pub2.\nAvailable here. \n","Adults of any age and adolescents (defined by WHO as aged 10 to 19 years)","The aim of this Cochrane review was to evaluate the benefits, harms and costs of restricting or banning the advertising of alcohol, via any format, compared with no restrictions or counter‐advertising, on alcohol consumption in adults and adolescents.\n\nOne small RCT (80 male student participants conducted in the Netherlands and published in 2009) and three ITS studies (general population studies in Canadian provinces conducted in the 1970s and 80s) were examined. The RCT found that young men exposed to movies with a low‐alcohol content drank less than men exposed to movies with a high‐alcohol content (MD ‐0.65 drinks; 95 per cent CI ‐1.2, ‐0.07; p value = 0.03, very‐low‐quality evidence). Young men exposed to commercials with a neutral content compared with those exposed to commercials for alcohol drank less (MD ‐0.73 drinks; 95 per cent CI ‐1.30, ‐0.16; p value = 0.01, very‐low‐quality evidence). Outcomes were assessed immediately after the end of the intervention (lasting 1.5 hours), so no follow‐up data were available.\n\nTwo of the ITS studies evaluated the implementation of an advertising ban and one study evaluated the lifting of such a ban (GRADE: very‐low‐quality evidence). Each of the three ITS studies evaluated a different type of ban (partial or full) compared with different degrees of restrictions or no restrictions during the control period. The results from the three ITS studies were inconsistent. A meta‐analysis of the two studies that evaluated the implementation of a ban showed an overall mean non‐significant increase in beer consumption in the general population of 1.10 per cent following the ban (95 per cent CI ‐5.26, 7.47; p value = 0.43; I2 = 83 per cent, very‐low‐quality evidence). This finding is consistent with an increase, no difference, or a decrease in alcohol consumption. In the study evaluating the lifting of a total ban on all forms of alcohol advertising to a partial ban on spirits advertising only, which utilised an Abrupt Auto‐regressive Integrated Moving Average model, the volume of all forms of alcohol sales decreased by 11.11 kilolitres (95 per cent CI ‐27.56, 5.34; p value = 0.19) per month after the ban was lifted. In this model, beer and wine sales increased per month by 14.89 kilolitres (95 per cent CI 0.39, 29.39; p value = 0.04) and 1.15 kilolitres (95 per cent CI ‐0.91, 3.21; p value = 0.27), respectively, and spirits sales decreased statistically significantly by 22.49 kilolitres (95 per cent CI ‐36.83, ‐8.15; p value = 0.002).\n\nNone of the studies were funded by the alcohol or advertising industries.\n","Authors conclude that there is a lack of robust evidence for or against recommending the implementation of alcohol advertising restrictions. Advertising restrictions should be implemented within a high‐quality, well‐monitored research programme to ensure the evaluation over time of all relevant outcomes in order to build the evidence base. "]

{"sheet":"CYP uni","index":45,"n_rows":351,"n_cols":5,"rows_kept":351,"cut":false,"hidden":false,"merged":[[81,1,81,4],[259,1,259,4],[265,1,265,4],[267,3,277,3],[267,4,277,4],[213,1,229,1],[213,2,241,2],[213,3,241,3],[213,4,232,4],[83,1,109,1],[83,2,109,2],[83,3,109,3],[83,4,109,4],[111,1,111,4],[113,1,128,1],[113,2,116,2],[278,1,301,1],[278,2,301,2],[278,3,301,3],[278,4,301,4],[267,1,277,1],[267,2,277,2],[24,1,24,4],[26,1,48,1],[26,2,48,2],[26,3,48,4],[65,1,71,1],[65,2,79,2],[65,3,79,4],[76,1,79,1],[49,1,55,1],[49,2,64,2],[49,3,64,4],[113,3,134,3],[113,4,134,4],[163,4,184,4],[193,1,206,1],[193,2,194,2],[193,3,212,3],[193,4,212,4],[350,1,376,1],[350,2,376,2],[350,3,376,3],[350,4,376,4],[135,1,162,1],[135,2,162,2],[135,3,162,3],[135,4,162,4],[243,1,243,4],[245,1,257,1],[245,2,257,2],[245,3,257,3],[245,4,257,4],[163,1,175,1],[163,2,164,2],[163,3,192,3],[302,4,320,4],[322,1,322,4],[324,1,339,1],[324,2,327,2],[324,3,349,3],[324,4,349,4],[302,1,320,1],[302,2,320,2],[302,3,320,3]]}
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[null,"Children and young people - Universal interventions - NICE Guidance"]
[null,"Source:","Population:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Alcohol interventions in secondary and further education. NG135. London: NICE; 2019. \nAvailable here.\n","• CYP (11 to 18years) in full time education.\n• YP (18 to 25 years) with an Education, health and care (EHC) plan.\n• CYP (11 to 18years) in full time education considered ‘at risk’.\n• YP (18 to 25 years) EHC plan considered ‘at risk’.","This guideline covers interventions in secondary and further education to prevent and reduce alcohol use among children and young people aged 11 up to and including 18. It also covers people aged 11 to 25 with special educational needs or disabilities in full-time education. It will also be relevant to children aged 11 in year 6 of primary school.\n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n1.1 Planning alcohol education\n1.2 Delivering universal alcohol education (Evidence Review A: Universal interventions)\n1.3 Targeted interventions (Evidence review B: Targeted interventions)\n\nThe following recommendations for further research were also identified in Evidence review A and B:\n1. What components of alcohol education delivery contribute to its effectiveness for children and young people aged 11 to 18 in full-time education, and those with special educational needs and disabilities (SEND) up to the age of 25? (Evidence review A: universal interventions)\n2. How effective and cost effective are individual, compared with group, education-based interventions for children and young people aged 11 to 18 in full-time education who are thought to be vulnerable to alcohol misuse? (Evidence review B: targeted interventions)\n3. How effective and cost effective are universal, education-based alcohol interventions for children and young people aged 11 to 25 with SEND? (Evidence review A: universal interventions)\n4. How effective and cost effective are education-based alcohol interventions targeted at children and young people aged 11 to 25 with SEND who are thought to be vulnerable to alcohol misuse? (Evidence review B: targeted interventions)\n5. How effective are education-based alcohol prevention interventions (universal or targeted) for children and young people aged 11 to 25 with SEND in full-time education? (Evidence review A: universal interventions and Evidence review B: targeted interventions)\n6. What methods and techniques help secondary schools and providers to effectively engage with parents and carers as part of a whole-school approach to promote and support alcohol education? (Evidence review A: universal interventions)\n"]
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[null,"National Institute for Health and Care Excellence. Alcohol-use disorders: prevention. PH24. London: NICE; 2010\nAvailable here.\n\n\n\n","Children, young people and adults aged 10 years and above","This guideline covers alcohol problems among people over 10. It aims to prevent and identify such problems as early as possible using a mix of policy and practice.\n\nThe guideline includes the following recommendations. All the recommendations are relevant to the scope of this topic evidence map. The recommendations are supported by the underpinning Evidence reviews 1-3 and Evidence reviews 4-6:\n• Price, availability and marketing\n• Licencing\n• Supporting children and young people aged 10 to 15 years\n• Screening young people aged 16 and 17 years and offering them extended brief interventions\n• Screening adults and offering them brief advice and interventions\n• Referral\n\nThe underpinning evidence reviews in this report identifed several gaps in the evidence and made recommendations for further research with the following overarching question:\nHow does advertising by industry and health agencies affect the drinking behaviour of the population as whole? (This includes the use of new media.)\n\nJuly 2019: NICE checked this guideline and are updating it. For further information, see the surveillance decision."]
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[null,"National Institute for Health and Care Excellence. Behaviour change: general approaches. PH6. London: NICE; 2007\nAvailable here.\n\n\n\n","General population","This guideline covers a set of principles that can be used to help people change their behaviour. The aim is for practitioners to use these principles to encourage people to adopt a healthier lifestyle by, for example, stopping smoking, adopting a healthy diet and being more physically active.\n\nThe guideline includes the following recommendations. All the recommendations are relevant to the scope of this topic evidence map. The recommendations are supported by the underpinning Evidence review 1.\n• Providing education and training for those delivering them\n• Delivery of these activities, including one-to-one and community-based programmes and those aimed at specific populations\n• Evaluation of their effectiveness and cost effectiveness\n\nThe Programme Development Group identified a number of gaps in the evidence related to behaviour change interventions and programmes, based on an assessment of the evidence and made recommendations for research to address the most important gaps in the evidence. Please refer to 4. Recommendations for research' section of the guidance.\n\nNovember 2017: NICE checked this guideline and found no new evidence that affects the recommendations in this guideline."]
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[null,"Children and young people - Safe and Supportive Environment - Universal Interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' Conclusions:"]
[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This Cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text. Fifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect. One targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects. Among school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]
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[null,"Children and young people - Changed attitudes and social norms- Universal interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"Wolfenden L et al. Strategies for enhancing the implementation of school‐based policies or practices targeting diet, physical activity, obesity, tobacco or alcohol use. Cochrane Database of Systematic Reviews 2022, Issue 8.\nAvailable here.","School age children (between 5 to 18 years of age)","This Cochrane review aimed to to find out how effective strategies were in supporting the implementation of school‐based interventions to address student diet, physical activity, unhealthy weight gain, and tobacco or alcohol use. Examples of strategies include methods of improving quality, education and training, feedback on how the school was doing, prompts and reminders, and educational resources (e.g. manuals).\n\nThe reviewers included an additional 11 trials in this update bringing the total number of included studies in the review to 38. Of these, 22 were conducted in the USA. Twenty‐six studies used RCT designs. Seventeen trials tested strategies to implement healthy eating, 12 physical activity and six a combination of risk factors. Just one trial sought to increase the implementation of interventions to delay initiation or reduce the consumption of alcohol. All trials used multiple implementation strategies, the most common being educational materials, educational outreach and educational meetings. Only findings relevant to this evidence map have been reported below.\n\nThe overall certainty of evidence was low and ranged from very low to moderate for secondary review outcomes.\n\nPooled analyses of RCTs found, relative to a control, the use of implementation strategies may result in a large increase in the implementation of interventions in schools (SMD 1.04, 95% CI 0.74 to 1.34; 22 RCTs, 1917 participants; low‐certainty evidence). One RCT assessed measures of student alcohol use and found strategies to support implementation may result in a slight increase in use (odds ratio 1.10, 95% CI 0.77 to 1.56; P = 0.60; 2105 participants).","The use of implementation strategies may result in large increases in implementation of interventions, and slight improvements in measures of student diet, and physical activity. Further research is required to assess the impact of implementation strategies on such behavioural‐ and obesity‐related outcomes, including on measures of alcohol use, where the findings of one trial suggest it may slightly increase student risk. Given the low certainty of the available evidence for most measures further research is required to guide efforts to facilitate the translation of evidence into practice in this setting."]
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[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This Cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text. Fifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect. One targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects. Among school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]
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[null,"Foxcroft DR et al. Social norms information for alcohol misuse in university and college students. Cochrane Database Syst Rev 2015, Issue 12. Art. No.: CD006748. DOI: 10.1002/14651858.CD006748.pub4.\nAvailable here. \n","University or college students. ","This Cochrane review aimed to determine whether social norms interventions reduce alcohol‐related negative consequences, alcohol misuse or alcohol consumption when compared with a control (ranging from assessment only/no intervention to other educational or psychosocial interventions) among university and college students.\n\nSeventy studies (44,958 participants) were included in the review, and 63 studies (42,784 participants) in the meta‐analyses. Overall, the risk of bias assessment showed that these studies provided moderate or low quality evidence. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nBinge drinking at four or more months (results pooled across delivery modes): SMD ‐0.06, 95 per cent CI ‐0.11 to ‐0.02 (participants = 11,292; studies = 16; moderate quality evidence), equivalent to 2.7 per cent fewer binge drinkers if 30‐day prevalence is 43.9 per cent.\n\nDrinking quantity at four or more months (results pooled across delivery modes): SMD ‐0.08, 95 per cent CI ‐0.12 to ‐0.04 (participants = 21,169; studies = 32; moderate quality evidence), equivalent to a reduction of 0.9 drinks consumed each week, from a baseline of 13.7 drinks per week.\n\nDrinking frequency at four or more months: WF SMD ‐0.11, 95 per cent CI ‐0.17 to ‐0.04 (participants = 9929; studies = 10; moderate quality evidence), equivalent to a decrease of 0.17 drinking days/wk, from a baseline of 2.74 days/wk; individual face‐to‐face normative feedback SMD ‐0.21, 95 per cent CI ‐0.31 to ‐0.10 (participants = 1464; studies = 8; moderate quality evidence), equivalent to a decrease of 0.32 drinking days/wk, from a baseline of 2.74 days/wk. No effects were found for group face‐to‐face normative feedback or normative marketing campaign.\n\nEstimated blood alcohol concentration (BAC) at four or more months: (Peak BAC results pooled across delivery modes) SMD ‐0.08, 95 per cent CI ‐0.17 to 0.00 (participants = 7198; studies = 11; low quality evidence), equivalent to a reduction in peak BAC from an average of 0.144 per cent to 0.135 per cent. No effects were found for typical BAC with individual face‐to‐face normative feedback.\n","The results of this review indicate that no substantive meaningful benefits are associated with social norms interventions for prevention of alcohol misuse among college/university students. Although some significant effects were found, we interpret the effect sizes as too small, given the measurement scales used in the studies included in this review, to be of relevance for policy or practice. Moreover, the significant effects are not consistent for all misuse measures, heterogeneity was a problem in some analyses and bias cannot be discounted as a potential cause of these findings. "]
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[null,"Langford R et al. The WHO Health Promoting School framework for improving the health and well‐being of students and their academic achievement. Cochrane Database Syst Rev 2014, Issue 4. Art. No.: CD008958. DOI: 10.1002/14651858.CD008958.pub2 \nAvailable here. ","School aged children (aged 4-18).","This Cochrane review aimed to assess the effectiveness of the Health Promoting Schools (HPS) framework in improving the health and well‐being of students and their academic achievement.\n\nSixty seven eligible cluster trials, randomising 1,443 schools or districts were included. This is made up of 1,345 schools and 98 districts. The studies tackled a range of health issues: physical activity (4), nutrition (12), physical activity and nutrition combined (18), bullying (7), tobacco (5), alcohol (2), sexual health (2), violence (2), mental health (2), hand‐washing (2), multiple risk behaviours (7), cycle‐helmet use (1), eating disorders (1), sun protection (1), and oral health (1). Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nReview authors report that the quality of evidence overall was low to moderate as determined by the GRADE approach. Risk of bias assessments identified methodological limitations, including heavy reliance on self‐reported data and high attrition rates for some studies. In addition, there was a lack of long‐term follow‐up data for most studies.\n\nEight studies provided data on alcohol use and all but one were included in the meta‐analysis. Overall, there was no evidence that any of the different intervention approaches were effective in reducing alcohol intake.","The results of this review provide evidence for the effectiveness of some interventions based on the HPS framework for improving certain health outcomes but not others. More well‐designed research is required to establish the effectiveness of this approach for other health topics and academic achievement."]
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[null,"Siegfried N et al. Restricting or banning alcohol advertising to reduce alcohol consumption in adults and adolescents. Cochrane Database Syst Rev 2014, Issue 11. Art. No.: CD010704. DOI: 10.1002/14651858.CD010704.pub2.\nAvailable here. \n","Adults of any age and adolescents (defined by WHO as aged 10 to 19 years)","The aim of this Cochrane review was to evaluate the benefits, harms and costs of restricting or banning the advertising of alcohol, via any format, compared with no restrictions or counter‐advertising, on alcohol consumption in adults and adolescents.\n\nOne small RCT (80 male student participants conducted in the Netherlands and published in 2009) and three ITS studies (general population studies in Canadian provinces conducted in the 1970s and 80s) were examined. The RCT found that young men exposed to movies with a low‐alcohol content drank less than men exposed to movies with a high‐alcohol content (MD ‐0.65 drinks; 95 per cent CI ‐1.2, ‐0.07; p value = 0.03, very‐low‐quality evidence). Young men exposed to commercials with a neutral content compared with those exposed to commercials for alcohol drank less (MD ‐0.73 drinks; 95 per cent CI ‐1.30, ‐0.16; p value = 0.01, very‐low‐quality evidence). Outcomes were assessed immediately after the end of the intervention (lasting 1.5 hours), so no follow‐up data were available.\n\nTwo of the ITS studies evaluated the implementation of an advertising ban and one study evaluated the lifting of such a ban (GRADE: very‐low‐quality evidence). Each of the three ITS studies evaluated a different type of ban (partial or full) compared with different degrees of restrictions or no restrictions during the control period. The results from the three ITS studies were inconsistent. A meta‐analysis of the two studies that evaluated the implementation of a ban showed an overall mean non‐significant increase in beer consumption in the general population of 1.10 per cent following the ban (95 per cent CI ‐5.26, 7.47; p value = 0.43; I2 = 83 per cent, very‐low‐quality evidence). This finding is consistent with an increase, no difference, or a decrease in alcohol consumption. In the study evaluating the lifting of a total ban on all forms of alcohol advertising to a partial ban on spirits advertising only, which utilised an Abrupt Auto‐regressive Integrated Moving Average model, the volume of all forms of alcohol sales decreased by 11.11 kilolitres (95 per cent CI ‐27.56, 5.34; p value = 0.19) per month after the ban was lifted. In this model, beer and wine sales increased per month by 14.89 kilolitres (95 per cent CI 0.39, 29.39; p value = 0.04) and 1.15 kilolitres (95 per cent CI ‐0.91, 3.21; p value = 0.27), respectively, and spirits sales decreased statistically significantly by 22.49 kilolitres (95 per cent CI ‐36.83, ‐8.15; p value = 0.002).\n\nNone of the studies were funded by the alcohol or advertising industries.\n","Authors conclude that there is a lack of robust evidence for or against recommending the implementation of alcohol advertising restrictions. Advertising restrictions should be implemented within a high‐quality, well‐monitored research programme to ensure the evaluation over time of all relevant outcomes in order to build the evidence base. "]
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[null,"Children and young people - Reduced availability- Universal interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"Hollands  GJ et al. Altering the availability or proximity of food, alcohol, and tobacco products to change their selection and consumption. Cochrane Database of Systematic Reviews 2019, Issue 9. Art. No.: CD012573. DOI: 10.1002/14651858.CD012573.pub3.\nAvailable here.","General population","This Cochrane review aimed to:\n1. To assess the impact on selection and consumption of altering the availability or proximity of (a) food (including non‐alcoholic beverages), (b) alcohol, and (c) tobacco products.\n2. To assess the extent to which the impact of these interventions is modified by characteristics of: i. studies, ii. interventions, and iii. participants.\n\nThe reviewers included 24 studies, with the majority (20/24) giving concerns about risk of bias. All of the included studies investigated food products; none investigated alcohol or tobacco. ","The authors concluded that:\n- Further research is warranted in real‐world settings, intervening across a wider range of foods as well as alcohol and tobacco products and over sustained time periods"]
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[null,"Children and young people - Reduced affordability- Universal interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]
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[null,"Children and young people - Behaviour change- Universal interventions - Systematic reviews"]
[null,"Source:","Audience: ","Findings:","Authors' conclusions:"]
[null,"Stead M, Angus K, Langley T, Katikireddi SV, Hinds K, Hilton S,  et al. Mass media to communicate public health messages in six health topic areas: a systematic review and other reviews of the evidence. Public Health Res 2019;7(8)\nAvailable here.","General population.","There was limited evidence of impact on alcohol use\nMass media campaigns were found to increase knowledge and awareness across several topics.\nAlthough there was limited evidence on characteristics associated with effectiveness, longer or greater intensity campaigns were found to be more effective. \nThe evidence suggested that targeting messages to target audiences can be effective. \nThere was little evidence regarding the role that theory or media channels may play in campaign effectiveness, and also limited evidence on new media.","Overall, the evidence is mixed but suggests that longer and more intensive campaigns are likely to be more effective and message design and targeting campaigns to particular population groups can be effective."]
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[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. \n\nFifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect.\n\nOne targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects.\n\nAmong school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]
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[null,"Brown TJ, Todd A, O'Malley CL, Moore HJ, Husband AK, Bambra C,  et al. Community pharmacy interventions for public health priorities: a systematic review of community pharmacy-delivered smoking, alcohol and weight management interventions. Public Health Res 2016;4(2)\nAvailable here. ","Adults","The searches identified over 14,000 records, of which 24 studies were included. There were two alcohol, 12 smoking cessation, five weight loss and five multicomponent interventions that included pharmacotherapy and lifestyle changes in participants with diabetes mellitus, dyslipidaemia or hypertension. Nine of the studies were UK based; seven of the studies were rated ‘strong’ for quality. All studies were of adults. \nThere was insufficient evidence for the effectiveness of community pharmacy-based brief alcohol interventions.\nNone of the five multicomponent studies demonstrated an improvement compared with control for anthropometric outcomes in participants with comorbidities, but they did show improvement in measures associated with the comorbidities. Very few studies explored if and how sociodemographic or socioeconomic variables moderated the effect of interventions. In two studies based in areas of high deprivation, where participants chose the intervention, the sociodemographic characteristics of participants differed between intervention settings. There were also differences in recruitment, attendance and retention of participants by type of setting. The evidence suggests that a distinct group of people might access pharmacies compared with other settings for alcohol management, smoking cessation and weight loss. There is insufficient evidence to examine the relationship between behaviour change strategies and effectiveness; or evidence of consistent implementation factors or training components that underpin effective interventions.","Evaluations of interventions to manage alcohol misuse and obesity, set within the community pharmacy, are needed. \nThe effect of community pharmacy interventions on health inequalities is unclear. Future research in this area is warranted, and trials should include the assessment of age, sex, ethnicity, socioeconomic status and contextual factors, and present analysis of how these factors moderate effectiveness."]
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[null,"Children and young people - Families are supported and protected - Universal interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"Gilligan C, et al. Family‐based prevention programmes for alcohol use in young people. Cochrane Database of Systematic Reviews 2019, Issue 3. Art. No.: CD012287. DOI: 10.1002/14651858.CD012287.pub2.\nAvailable here.","School age children (up to 18 years of age)","This Cochrane review aimed to assess the effectiveness of universal, selective, and indicated family-based prevention programmes in preventing alcohol use or problem drinking in school-aged children (up to 18 years of age). \n\nForty six studies (39,822 participants) were included in the review, with 27 classified as universal, 12 as selective, and seven as indicated. Meta‐analyses were performed according to outcome, including studies reporting on the prevalence, frequency, or volume of alcohol use. The overall quality of evidence was low or very low, and there was high, unexplained heterogeneity. \n\nUpon comparing any family intervention to no intervention/standard care, the authors found no intervention effect on the prevalence (SMD) 0.00, 95% CI ‐0.08 to 0.08; studies = 12; participants = 7490; I² = 57%; low‐quality evidence) or frequency (SMD ‐0.31, 95% CI ‐0.83 to 0.21; studies = 8; participants = 1835; I² = 96%; very low‐quality evidence) of alcohol use in comparison with no intervention/standard care. The effect of any parent/family interventions on alcohol consumption volume compared with no intervention/standard care was very small (SMD ‐0.14, 95% CI ‐0.27 to 0.00; studies = 5; participants = 1825; I² = 42%; low‐quality evidence). \n\nWhen comparing parent/family and adolescent interventions versus interventions with young people alone, authors found no difference in alcohol use prevalence (SMD ‐0.39, 95% CI ‐0.91 to 0.14; studies = 4; participants = 5640; I² = 99%; very low‐quality evidence) or frequency (SMD ‐0.16, 95% CI ‐0.42 to 0.09; studies = 4; participants = 915; I² = 73%; very low‐quality evidence). For this comparison, no trials reporting on the volume of alcohol use could be pooled in meta‐analysis. \n\nIn general, the results remained consistent in separate subgroup analyses of universal, selective, and indicated interventions. No adverse effects were reported. \n","The results of this review indicate that there are no clear benefits of family‐based programmes for alcohol use among young people. Patterns differ slightly across outcomes, but overall, the variation, heterogeneity, and number of analyses performed preclude any conclusions about intervention effects. Additional independent studies are required to strengthen the evidence and clarify the marginal effects observed. "]
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[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This Cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text. Fifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect. One targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects. Among school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]

{"sheet":"CYP sel","index":46,"n_rows":330,"n_cols":5,"rows_kept":330,"cut":false,"hidden":false,"merged":[[103,1,103,4],[171,4,193,4],[194,1,217,1],[194,2,217,2],[194,3,217,3],[194,4,217,4],[157,1,157,4],[159,1,161,1],[163,1,163,4],[169,1,169,4],[171,1,193,1],[171,2,193,2],[171,3,193,3],[105,1,132,1],[105,2,132,2],[105,3,132,3],[23,1,23,4],[24,3,24,4],[25,1,47,1],[25,2,47,2],[25,3,47,4],[48,1,71,1],[48,2,71,2],[48,3,71,4],[73,1,73,4],[75,1,101,1],[75,2,101,2],[75,3,101,3],[75,4,101,4],[105,4,132,4],[133,1,144,1],[133,2,135,2],[133,3,155,3],[133,4,155,4],[218,2,252,2],[218,3,252,3],[218,4,252,4],[253,1,267,1],[253,3,267,3],[253,4,267,4],[218,1,252,1],[268,1,279,1],[268,2,270,2],[268,3,298,3],[268,4,284,4],[300,1,300,4],[302,1,317,1],[302,2,305,2],[302,3,328,3],[302,4,328,4],[329,1,356,1],[329,2,356,2],[329,3,356,3],[329,4,356,4]]}
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[null,"Children and young people - Selective interventions - NICE Guidance"]
[null,"Source:","Population:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Behaviour change: digital and mobile health interventions. NG183. London: NICE; 2020.\nAvailable here.\n\n\n","Everyone, including Young People under 16 (and their families or 16 carers)\n• Pre-existing health conditions:\nOverweight/ obesity\nHypertension and cardiovascular disease\nRespiratory diseases\nCancers for which managing smoking may improve health outcomes\nMental health conditions\nSpecific consideration will also be given to people with learning disabilities and people with neurodevelopmental disorders such as autism.","This guideline covers interventions that use a digital or mobile platform to help people eat more healthily, become more active, stop smoking, reduce their alcohol intake or practise safer sex. The interventions include those delivered by text message, apps, wearable devices or the internet. The guideline only includes those that are delivered by the technology itself and not by healthcare professionals using technology to deliver interventions.\n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n1.1 Developing digital and mobile health interventions\n1.2 Commissioning digital and mobile health interventions\n1.3 Using digital and mobile health interventions\n1.4 Interventions for diet and physical activity\n1.5 Interventions for smoking\n1.6 Interventions for alcohol use (Based on Evidence Review B: alcohol)\n1.7 Interventions for unsafe sexual behaviour\n\nThe following recommendations for further research were also identified in evidence review B on alcohol:\n1. How can providers and healthcare professionals identify groups that do not initially engage, or do not stay engaged, with digital and mobile health behaviour change interventions?\n2. What components and characteristics of digital and mobile health behaviour change interventions are most effective, separately and in combination, to achieve behaviour change?\n3. What is the effectiveness and cost effectiveness of digital and mobile health behaviour change interventions in low socioeconomic and other underserved groups?\n4. Are digital and mobile health behaviour change interventions as effective as face-to-face, standard care, or combination approaches for some populations?\n5. What are the harms and adverse effects associated with different digital and mobile health behaviour change interventions?"]
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[null,"National Institute for Health and Care Excellence. Alcohol interventions in secondary and further education. NG135. London: NICE; 2019. \nAvailable here.\n","• CYP (11 to 18years) in full time education.\n• YP (18 to 25 years) with an Education, health and care (EHC) plan.\n• CYP (11 to 18years) in full time education considered ‘at risk’.\n• YP (18 to 25 years) EHC plan considered ‘at risk’.","This guideline covers interventions in secondary and further education to prevent and reduce alcohol use among children and young people aged 11 up to and including 18. It also covers people aged 11 to 25 with special educational needs or disabilities in full-time education. It will also be relevant to children aged 11 in year 6 of primary school.\n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n1.1 Planning alcohol education\n1.2 Delivering universal alcohol education (Evidence Review A: Universal interventions)\n1.3 Targeted interventions (Evidence review B: Targeted interventions)\n\nThe following recommendations for further research were also identified in Evidence review A and B:\n1. What components of alcohol education delivery contribute to its effectiveness for children and young people aged 11 to 18 in full-time education, and those with special educational needs and disabilities (SEND) up to the age of 25? (Evidence review A: universal interventions)\n2. How effective and cost effective are individual, compared with group, education-based interventions for children and young people aged 11 to 18 in full-time education who are thought to be vulnerable to alcohol misuse? (Evidence review B: targeted interventions)\n3. How effective and cost effective are universal, education-based alcohol interventions for children and young people aged 11 to 25 with SEND? (Evidence review A: universal interventions)\n4. How effective and cost effective are education-based alcohol interventions targeted at children and young people aged 11 to 25 with SEND who are thought to be vulnerable to alcohol misuse? (Evidence review B: targeted interventions)\n5. How effective are education-based alcohol prevention interventions (universal or targeted) for children and young people aged 11 to 25 with SEND in full-time education? (Evidence review A: universal interventions and Evidence review B: targeted interventions)\n6. What methods and techniques help secondary schools and providers to effectively engage with parents and carers as part of a whole-school approach to promote and support alcohol education? (Evidence review A: universal interventions)\n"]
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[null,"Children and young people - Safe and Supportive Environment - Selective Interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' Conclusions:"]
[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This Cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text. Fifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect. One targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects. Among school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]
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[null,"Children and young people - Changed attitudes and social norms- Selective interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This Cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text. Fifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect. One targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects. Among school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]
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[null,"Foxcroft DR et al. Motivational interviewing for the prevention of alcohol misuse in young adults. Cochrane Database Syst Rev 2016, Issue 7. Art. No.: CD007025. DOI: 10.1002/14651858.CD007025.pub4.\nAvailable here.\n","Young adults up to 25 years of age (higher risk individuals or settings). ","This Cochrane review aimed to assess the effects of motivational interviewing (MI) interventions for preventing alcohol misuse and alcohol‐related problems in young adults. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nEighty four trials (22,872 participants) were included, with 70/84 studies reporting interventions in higher risk individuals or settings. Studies with follow‐up periods of at least four months were of more interest in assessing the sustainability of intervention effects and were also less susceptible to short‐term reporting or publication bias. Overall, the risk of bias assessment showed that these studies provided moderate or low quality evidence.\n\nAt four or more months follow‐up, effects in favour of MI were found for the quantity of alcohol consumed (standardised mean difference (SMD) −0.11, 95 per cent confidence interval (CI) −0.15 to −0.06 or a reduction from 13.7 drinks/week to 12.5 drinks/week; moderate quality evidence); frequency of alcohol consumption (SMD −0.14, 95 per cent CI −0.21 to −0.07 or a reduction in the number of days/week alcohol was consumed from 2.74 days to 2.52 days; moderate quality evidence); and peak blood alcohol concentration, or BAC (SMD −0.12, 95 per cent CI −0.20 to 0.05, or a reduction from 0.144 per cent to 0.131 per cent; moderate quality evidence).\n\nFurther analyses showed that there was no clear relationship between the duration of the MI intervention (in minutes) and effect size. Subgroup analyses revealed no clear subgroup effects for longer‐term outcomes (four or more months) for assessment only versus alternative intervention controls; for university/college vs other settings; or for higher risk vs all/low risk participants.\n","The results of this review indicate that there are no substantive, meaningful benefits of MI interventions for preventing alcohol use, misuse or alcohol‐related problems. Although the reviewers found some statistically significant effects, the effect sizes were too small, given the measurement scales used in the included studies, to be of relevance to policy or practice. Moreover, the statistically significant effects are not consistent for all misuse measures, and the quality of evidence is not strong, implying that any effects could be inflated by risk of bias."]
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[null,"Children and young people - Reduced availability - Selective Interventions - Systematic reviews"]
[null,"Source:","Populations:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]
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[null,"Children and young people - Reduced affordability - Selective Interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]
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[null,"Children and young people - Behaviour change - Selective interventions - Systematic reviews"]
[null,"Source:","Audience: ","Findings:","Authors' conclusions:"]
[null,"Filges T, Dalgaard NT and Viinholt BC. 2022. Outreach programs to improve life circumstances and prevent further adverse developmental trajectories of at‐risk youth in OECD countries: A systematic review. Campbell Systematic Reviews, 18(4), p.e1282.\nAvailable here\n","Young people between 8 and 25 years of age living in OECD countries, who either have experienced or is at-risk of experiencing an adverse outcome such as school failure or drop-out, runaway and homelessness, substance and/or alcohol abuse, unemployment, long-term poverty, delinquency/criminal behaviour were eligible.","This Campbell systematic review examines the effects of outreach programmes on problem/high-risk behaviour of young people between eight and 25 year old, living in OECD countries. The review summarises evidence from five studies undertaken in the USA and Canada that involved 578 participants in total.\n\nFour of the five studies used for meta analysis were from the USA and one was from Canada. The timespan in which included studies were carried out was 32 years, from 1985 to 2017; on average the intervention year was 2005. The average number of participants in the analysed interventions was 116, ranging from 30 to 346 and the average number of controls was 81, ranging from 32 to 321. At most, the results from two studies could be pooled in a single meta-analysis. It was only possible to pool the outcomes drug (other than marijuana) use, marijuana use and alcohol use each at two different time points (one and 3 months follow up). At 1 month follow up the weighted averages varied between zero and 0.05 and at 3 months follow up between −0.17 and 0.07. None of them were statistically significant. In addition, a number of other outcomes were reported in a single study only.","Overall, there were too few studies included in any of the meta-analyses in order for us to draw any conclusion concerning the effectiveness of outreach. The vast majority of studies were undertaken in the USA.\nFurther, because too few studies reported results on the same type of outcome at most two studies could be combined in a particular meta-analysis. Given the limited number of rigorous studies available from countries other than the USA, it would be natural to consider conducting a series of randomised controlled trials evaluating the effectiveness of outreach for at-risk youth in countries outside the USA. The trial(s) should be designed, conducted and reported according to methodological criteria for rigour in respect of internal and external validity to achieve robust results and preferably reporting a larger number of outcomes."]
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[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. \n\nFifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect.\n\nOne targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects.\n\nAmong school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]
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[null,"O'Connor EA et al. Screening and behavioral counseling interventions to reduce unhealthy alcohol use in adolescents and adults: An updated systematic review for the U.S. Preventive Services Task Force. Rockville MD: Agency for Healthcare Research and Quality; 2018. \nAvailable here. ","Adolescents or adults age 12 years or older. ","One hundred and thirteen studies (n=314,466) were included across all Key Questions. The authors did not find any studies that examined the benefits or harms of screening programs to reduce unhealthy alcohol use. For adolescents, data supported the use of the National Institute on Alcohol Abuse and Alcoholism Youth Screen and other similar one- or two-item screeners to detect alcohol use disorder. For adults, brief (1- to 3-item) screeners commonly reported sensitivity and specificity between 0.70 and 0.85, typically having better sensitivity than the full Alcohol Use Disorders Identification Test (AUDIT) for identifying the full spectrum of unhealthy use. However, the AUDIT tended to have higher specificity, particularly at the standard cutoff of 8 or higher.  \n\nIdentified interventions to reduce unhealth alcohol use were generally counselling interventions, with most involving one or two sessions (90% involved ≤ 4 sessions) with a median of 30 minutes contact time (88% involved ≤ 2 hours contact). The most commonly reported intervention element was the use of personalized normative feedback sessions, in which participants were shown how their alcohol use compares to others; this technique was used in more than half of the included trials and almost all trials in younger adults. Motivational techniques were also common, particularly in combination with personalized normative feedback.\n\nEvidence on the effects of interventions to reduce unhealthy alcohol use in adolescents was limited to two trials; both found mixed results for reduced alcohol use and did not report health or related outcomes. \n\nIn adults, interventions reduced the number of drinks per week (weighted mean difference, −1.82 [95% confidence interval {CI}, −2.42 to −1.22]), the proportion exceeding recommended drinking limits (odds ratio [OR], 0.60 [95% CI, 0.53 to 0.67]), and the proportion reporting a heavy use episode (OR, 0.62 [95% CI, 0.55 to 0.71]), and increased the proportion of pregnant women reporting abstinence (OR, 1.92 [95% CI, 1.19 to 3.09]) after 6 to 12 months. \n\nHeterogeneity was high and effect size was associated with a number of study characteristics such as setting, target age of the population, publication year, study size, and average baseline-use levels, but not clearly associated with any intervention characteristics. Data on effectiveness in important subgroups were very limited, but analyses by sex, the most commonly reported subgroup analysis, did not indicate differences in effectiveness of the interventions. Health outcomes were sparsely reported and, with some exceptions, generally did not demonstrate group differences in effect. No evidence of harm was found.","Among adults, screening instruments are available that can effectively identify persons with unhealthy alcohol use and that are feasible for use in primary care settings, and interventions in those who screen positive are associated with reductions in unhealthy alcohol use. There was no evidence that these interventions have unintended harmful effects. More evidence is needed to determine whether screening for unhealthy alcohol use is beneficial for adolescents."]
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[null,"Tansil KA et al. Alcohol Electronic Screening and Brief Intervention A Community Guide Systematic Review. Am J Prev Med 2016;51(5):801–811). \nAvailable here. \n","Unspecified","This Community Guide review focused on e-screening and brief interventions (e-SBIs) that are similar in structure and intent to Alcohol screening and brief intervention (ASBI) and examined how e-SBI effectiveness varied by key intervention characteristics, in contrast to previous systematic reviews of e-SBI. This review is unique in that it excluded highly interactive interventions (i.e., those with more than three human-to-human sessions); those that were part of a treatment program for alcohol use disorders; those that were primarily educational programs (e.g., Alcohol Edu, College Alc); and those that only used an electronic device for monitoring drinking following traditional ASBI.\n\nTwenty-four studies (28 study arms) provided results for excessive drinkers only and seven studies (eight study arms) reported results for all drinkers. Nearly all studies found that e-SBI reduced excessive alcohol consumption and related harms: nine study arms reported a median 23.9% reduction in binge-drinking intensity (maximum drinks/binge episode) and nine study arms reported a median 16.5% reduction in binge-drinking frequency. Reductions in drinking measures were sustained for up to 12 months.","The authors conclude that, according to Community Guide rules of evidence, e-SBI is an effective method for reducing excessive alcohol consumption and related harms among intervention participants. Implementation of e-SBI could complement population-level strategies previously recommended by the Community Preventive Services Task Force for reducing excessive drinking (e.g., increasing alcohol taxes and regulating alcohol outlet density)."]
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[null,"Foxcroft DR et al. Motivational interviewing for the prevention of alcohol misuse in young adults. Cochrane Database Syst Rev 2016, Issue 7. Art. No.: CD007025. DOI: 10.1002/14651858.CD007025.pub4.\nAvailable here.\n","Young adults up to 25 years of age. ","This Cochrane review aimed to assess the effects of motivational interviewing (MI) interventions for preventing alcohol misuse and alcohol‐related problems in young adults.\n\nEighty four trials (22,872 participants) were included, with 70/84 studies reporting interventions in higher risk individuals or settings. Studies with follow‐up periods of at least four months were of more interest in assessing the sustainability of intervention effects and were also less susceptible to short‐term reporting or publication bias. Overall, the risk of bias assessment showed that these studies provided moderate or low quality evidence.\n\nAt four or more months follow‐up, effects in favour of MI were found for the quantity of alcohol consumed (standardised mean difference (SMD) −0.11, 95 per cent confidence interval (CI) −0.15 to −0.06 or a reduction from 13.7 drinks/week to 12.5 drinks/week; moderate quality evidence); frequency of alcohol consumption (SMD −0.14, 95 per cent CI −0.21 to −0.07 or a reduction in the number of days/week alcohol was consumed from 2.74 days to 2.52 days; moderate quality evidence); and peak blood alcohol concentration, or BAC (SMD −0.12, 95 per cent CI −0.20 to 0.05, or a reduction from 0.144 per cent to 0.131 per cent; moderate quality evidence).\nA marginal effect in favour of MI was found for alcohol problems (SMD −0.08, 95 per cent CI −0.17 to 0.00 or a reduction in an alcohol problems scale score from 8.91 to 8.18; low quality evidence) and no effects for binge drinking (SMD −0.04, 95 per cent CI −0.09 to 0.02, moderate quality evidence) or for average BAC (SMD −0.05, 95 per cent CI −0.18 to 0.08; moderate quality evidence). Other alcohol‐related behavioural outcomes were considered, and at four or more month’s follow‐up, we found no effects on drink‐driving (SMD −0.13, 95 per cent CI −0.36 to 0.10; moderate quality of evidence) or other alcohol‐related risky behaviour (SMD −0.15, 95 per cent CI −0.31 to 0.01; moderate quality evidence).\n\nFurther analyses showed that there was no clear relationship between the duration of the MI intervention (in minutes) and effect size. Subgroup analyses revealed no clear subgroup effects for longer‐term outcomes (four or more months) for assessment only versus alternative intervention controls; for university/college vs other settings; or for higher risk vs all/low risk participants.\n","The results of this review indicate that there are no substantive, meaningful benefits of MI interventions for preventing alcohol use, misuse or alcohol‐related problems. Although we found some statistically significant effects, the effect sizes were too small, given the measurement scales used in the included studies, to be of relevance to policy or practice. Moreover, the statistically significant effects are not consistent for all misuse measures, and the quality of evidence is not strong, implying that any effects could be inflated by risk of bias."]
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[null,"Children and young people - Families are supported and protected - Selective interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"Gilligan C, et al. Family‐based prevention programmes for alcohol use in young people. Cochrane Database of Systematic Reviews 2019, Issue 3. Art. No.: CD012287. DOI: 10.1002/14651858.CD012287.pub2.\nAvailable here.","School age children (up to 18 years of age)","This Cochrane review aimed to assess the effectiveness of universal, selective, and indicated family-based prevention programmes in preventing alcohol use or problem drinking in school-aged children (up to 18 years of age). \n\nForty six studies (39,822 participants) were included in the review, with 27 classified as universal, 12 as selective, and seven as indicated. Meta‐analyses were performed according to outcome, including studies reporting on the prevalence, frequency, or volume of alcohol use. The overall quality of evidence was low or very low, and there was high, unexplained heterogeneity. \n\nUpon comparing any family intervention to no intervention/standard care, the authors found no intervention effect on the prevalence (SMD) 0.00, 95% CI ‐0.08 to 0.08; studies = 12; participants = 7490; I² = 57%; low‐quality evidence) or frequency (SMD ‐0.31, 95% CI ‐0.83 to 0.21; studies = 8; participants = 1835; I² = 96%; very low‐quality evidence) of alcohol use in comparison with no intervention/standard care. The effect of any parent/family interventions on alcohol consumption volume compared with no intervention/standard care was very small (SMD ‐0.14, 95% CI ‐0.27 to 0.00; studies = 5; participants = 1825; I² = 42%; low‐quality evidence). \n\nWhen comparing parent/family and adolescent interventions versus interventions with young people alone, authors found no difference in alcohol use prevalence (SMD ‐0.39, 95% CI ‐0.91 to 0.14; studies = 4; participants = 5640; I² = 99%; very low‐quality evidence) or frequency (SMD ‐0.16, 95% CI ‐0.42 to 0.09; studies = 4; participants = 915; I² = 73%; very low‐quality evidence). For this comparison, no trials reporting on the volume of alcohol use could be pooled in meta‐analysis. \n\nIn general, the results remained consistent in separate subgroup analyses of universal, selective, and indicated interventions. No adverse effects were reported. \n","The results of this review indicate that there are no clear benefits of family‐based programmes for alcohol use among young people. Patterns differ slightly across outcomes, but overall, the variation, heterogeneity, and number of analyses performed preclude any conclusions about intervention effects. Additional independent studies are required to strengthen the evidence and clarify the marginal effects observed. "]
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[null,"MacArthur G. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database Syst Rev 2018, Issue 10. Art. No.: CD009927. DOI: 10.1002/14651858.CD009927.pub2. \nAvailable here. ","Children and adolescents up to 18 years of age.","This Cochrane review aimed to examine the effects of interventions up to 18 years of age for the primary or secondary prevention of multiple risk behaviours among young people. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text. Fifty-five studies (79%) addressed alcohol use, however 17 of these could not be included in any meta-analysis. \n\nThere was moderate-quality evidence that universal interventions at the individual level have little or no effect in relation to alcohol use (OR 0.80, 95% CI 0.58 to 1.11; p = 0.18, n=4 studies; 1911 participants, I2=0%). \n\nThere was moderate-quality evidence that targeted interventions at the individual level have little or no effect in relation to alcohol use (OR 1.02, 95% CI 0.80 to 1.31; p = 0.87, n=4 studies; 1204 participants). \n\nThere was moderate-quality evidence that targeted family-level interventions have little or no effect in relation to alcohol use (OR 0.83, 95% CI 0.47 to 1.46; p = 0.52, n=3 studies; 417 participants). \n\nThere was moderate-quality evidence that universal school-level interventions reduced alcohol use (OR 0.72, 95% CI 0.56 to 0.92, p = 0.009; n=8; 8751 participants, I2=58%). \n\nAmong the studies that could not be included in the meta-analysis with follow-up data up to 12 months, one providing a targeted individual-level intervention reported beneficial effects, and three exploring targeted individual-level interventions reported no effect. One targeted family-level intervention showed beneficial effects; one universal family-based intervention and three targeted family-level interventions showed null effects. Among school-based interventions, one universal school-level intervention showed beneficial effects, and one universal school-level intervention showed benefit of one active intervention arm for boys only.\n","Available evidence is strongest for universal school‐based interventions that target multiple‐ risk behaviours, demonstrating that they may be effective in preventing engagement in tobacco use, alcohol use, illicit drug use, and antisocial behaviour, and in improving physical activity among young people, but not in preventing other risk behaviours. Results of this review do not provide strong evidence of benefit for family‐ or individual‐level interventions across the risk behaviours studied. However, poor reporting and concerns around the quality of evidence highlight the need for high‐quality multiple‐ risk behaviour intervention studies to further strengthen the evidence base in this field.  "]

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[null,"Children and young people - Indicated interventions - NICE Guidance"]
[null,"Source:","Population:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Behaviour change: individual approaches. PH49. London: NICE; 2014. \nAvailable here.\n","Everyone aged 16 years and older","This guideline covers changing health-damaging behaviours among people aged 16 and over using interventions such as goals and planning, feedback and monitoring, and social support. It aims to help tackle a range of behaviours including alcohol misuse, poor eating patterns, lack of physical activity, unsafe sexual behaviour and smoking.\n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n1. Develop a local behaviour change policy and strategy\n2. Ensure organisation policies, strategies, resources and training all support behaviour change\n3. Commission interventions from services willing to share intervention details and data\n4. Commission high quality, effective behaviour change interventions\n5. Plan behaviour change interventions and programmes taking local needs into account\n6. Develop acceptable, practical and sustainable behaviour change interventions and programmes\n7. Use proven behaviour change techniques when designing interventions (Evidence review1 and Evidence review2)\n8. Ensure interventions meet individual needs\n9. Deliver very brief, brief, extended brief and high intensity behaviour change interventions and programmes\n10. Ensure behaviour change is maintained for at least a year (Evidence review1 and Evidence review2)\n11. Commission training for all staff involved in helping to change people's behaviour\n12. Provide training for behaviour change practitioners\n13. Provide training for health and social care practitioners\n14. Assess behaviour change practitioners and provide feedback\n15. Monitor behaviour change interventions\n16. Evaluate behaviour change interventions\n17. National support for behaviour change interventions and programmes\n\nEvidence review1 did not identify any recommendations for further research. Evidence review 2 made the following recommendation for further research:\n5.7 How do behaviour change techniques lead to change? What are the best methods of testing the relationship between the theories that describe change processes and the effectiveness of interventions in practice?"]
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[null,"National Institute for Health and Care Excellence. Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence. CG115. London: NICE; 2011\nAvailable here.\n\n","Adults (>18 years) or young people (10 to 17 years of age) with a diagnosis of alcohol dependence or meeting criteria for harmful alcohol use (30 to 50 units of alcohol per week)","This guideline covers identifying, assessing and managing alcohol-use disorders (harmful drinking and alcohol dependence) in adults and young people aged 10-17 years. It aims to reduce harms (such as liver disease, heart problems, depression and anxiety) from alcohol by improving assessment and setting goals for reducing alcohol consumption. \n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n• Principles of care\n• Identification and assessment \n• Interventions for alcohol misuse (Evidence review 2011)\n\nThe following recommendations for further research were also identified in Evidence reviews underpinning this guidance:\n1 Is contingency management effective in reducing alcohol consumption in people who misuse alcohol compared with standard care?\n2 What methods are most effective for assessing and diagnosing the presence and severity of alcohol misuse in children and young people?\n3 Is acupuncture effective in reducing alcohol consumption compared with standard care?\n4. For which service users who are moderately and severely dependent on alcohol is an assertive community treatment model a clinically and cost-effective intervention compared with standard care?\n5. For people with moderate and severe alcohol dependence who have significant comorbid problems, is an intensive residential rehabilitation programme clinically and cost effective when compared with intensive community-based care?\n6 For people with alcohol dependence, which medication is most likely to improve adherence and thereby promote abstinence and prevent relapse?\n\nOctober 2022: NICE updated the recommendation about behavioural couples therapy to clarify that this is not suitable in cases of domestic abuse and to add a cross reference to the NICE technology appraisal guidance on nalmefene. They also updated information about off-label prescribing, and added cross references to legislation on controlled drugs and driving, to MHRA advice on addiction to benzodiazepines and codeine, and to NICE's guidelines on smoking, on antisocial personality disorder and on coexisting mental illness and substance misuse community health and social care services.\nJuly 2019: NICE have found no new evidence that affects the recommendations."]
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[null,"National Institute for Health and Care Excellence. Coexisting severe mental illness (psychosis) and substance misuse: assessment and management in healthcare settings. CG120. London: NICE; 2011. \nAvailable here.\n","People aged 14 years and over with coexisting severe mental illness (psychosis) and substance misuse","This guideline covers assessing and managing people aged 14 years and over with coexisting severe mental illness (psychosis) and substance misuse. It aims to help healthcare professionals guide people with psychosis with coexisting substance misuse to stabilise, reduce or stop their substance misuse, to improve treatment adherence and outcomes, and to enhance their lives. \n\nThe guideline includes the following recommendations. All the recommendations are relevant to the scope of this topic evidence map. The recommendations are supported by evidence from the underpinning Evidence Review 2011. \n• Principles of care\n• Recognising psychosis with coexisting substance misuse\n• Primary care\n• Secondary care mental health services\n• Substance misuse services\n• Inpatient mental health services and staffed accommodation\n• Specific issues for young people with psychosis and coexisting substance misuse\n\nThe following recommendations for further research were also identified in Evidence reviews underpinning this guidance:\n1. What are the prevalence, risk and protective factors, and course of illness for different combinations of psychosis and coexisting substance misuse (for example, schizophrenia and cannabis misuse or bipolar disorder and alcohol misuse)?\n2. What risk factors predict the onset of substance misuse in young people with psychosis?\n3. Are psychosocial interventions clinically and cost effective when compared with standard care for people with psychosis and coexisting substance misuse?\n4. Are environmental interventions clinically and cost effective when compared with standard care for people with psychosis and coexisting substance misuse?\n5. Is clozapine clinically and cost effective when compared with other pharmacological interventions for people with psychosis and coexisting substance misuse?\n\nNovember 2016: NICE reviewed the evidence and found no new evidence that affects the current recommendations in this guideline."]
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[null,"National Institute for Health and Care Excellence. Alcohol-use disorders: diagnosis and management of physical complications. CG100. London: NICE; 2010. \nAvailable here. \n","People aged 10 years and over with alcohol-use disorders","This guideline covers care for adults and young people (aged 10 years and older) with physical health problems that are completely or partly caused by an alcohol-use disorder. It aims to improve the health of people with alcohol-use disorders by providing recommendations on managing acute alcohol withdrawal and treating alcohol-related conditions. \n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n• Acute alcohol withdrawal (Evidence review 2014)\n• Wernicke’s encephalopathy\n• Alcohol-related liver disease\n• Alcohol-related pancreatitis\n\nThe following recommendations for further research were also identified in Evidence reviews underpinning this guidance:\n2. What is the efficacy and cost effectiveness of clomethiazole compared with chlordiazepoxide or carbamazepine or benzodiazepines for the treatment of acute alcohol withdrawal with regard to the outcomes of withdrawal severity, risk of seizures, risk of delirium tremens, length of treatment and patient satisfaction?\n\nJanuary 2019: NICE checked this guideline and are updating it. For more information, see the surveillance decision."]
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[null,"National Institute for Health and Care Excellence. Behaviour change: general approaches. PH6. London: NICE; 2007\nAvailable here.\n\n\n\n","General population","This guideline covers a set of principles that can be used to help people change their behaviour. The aim is for practitioners to use these principles to encourage people to adopt a healthier lifestyle by, for example, stopping smoking, adopting a healthy diet and being more physically active.\n\nThe guideline includes the following recommendations. All the recommendations are relevant to the scope of this topic evidence map. The recommendations are supported by the underpinning Evidence review 1.\n• Providing education and training for those delivering them\n• Delivery of these activities, including one-to-one and community-based programmes and those aimed at specific populations\n• Evaluation of their effectiveness and cost effectiveness\n\nThe Programme Development Group identified a number of gaps in the evidence related to behaviour change interventions and programmes, based on an assessment of the evidence and made recommendations for research to address the most important gaps in the evidence. Please refer to 4. Recommendations for research' section of the guidance.\n\nNovember 2017: NICE checked this guideline and found no new evidence that affects the recommendations in this guideline."]
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[null,"Children and young people - Safe and Supportive Environment - Indicated interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' Conclusions:"]
[null,"Hennessy EA et al. Recovery schools for improving behavioral and academic outcomes among students in recovery from substance use disorders: a systematic review. Campbell Systematic Reviews 2018; 9. \nAvailable here. ","Students in recovery from substance use who were enrolled part-time or full-time in secondary (high school) or postsecondary (college or university) educational institutions. ","The review focused on two types of recover schools: recovery high schools (RHSs), which are schools that award secondary school dipolmas and offer a range of therapeutic services in addition to standard educational curricula; and collegiate recovery communities (CRCs), which offer therapeutic and sober support services on college campuses. \n\nOnly one study met the criteria for inclusion in the review. The study used a quasi-experimental design to examine the effects of RHSs on high school students' academic and substance use outcomes. No eligible studies examining CRCs were identified. \n\nThe results from the one eligible RHS study indicated that after adjusting for pretest values, students in the RHS condition reported levels of grade point averages (g = 0.26, 95% CI [-0.04, 0.56]), truancy (g = 0.01, 95% CI [-0.29, 0.31]), and alcohol use (g = 0.23, 95% CI [-0.07, 0.53]) similar to participants in the comparison condition. However, students in the RHS condition reported improvements in absenteeism (g = 0.56, 95% CI [0.25, 0.87]), abstinence from alcohol/drugs (OR = 4.36, 95% CI [1.19, 15.98]), marijuana use (g = 0.51, 95% CI [0.20, 0.82]), and other drug use (g = 0.45, 95% CI [0.14, 0.76]).\n\nOverall, there was a serious risk of bias in the one included study. The study had a serious risk of bias due to confounding, low risk of bias due to selection of participants into the study, moderate risk of bias due to classification of interventions, inconclusive risk of bias due to deviations from intended interventions, inconclusive risk of bias due to missing data, moderate risk of bias in measurement of outcomes, and low risk of bias in selection of reported results.","There is insufficient evidence regarding the effectiveness of RHSs and CRCs for improving academic and substance use outcomes among students in recovery from SUDs. Only one identified study examined the effectiveness of RHSs. Although the study reported some beneficial effects, the results must be interpreted with caution given the study's potential risk of bias due to confounding and limited external validity. No identified studies examined the effectiveness of CRCs across the outcomes of interest in this review, so it is unclear what effects these programs may have on students' academic and behavioural outcomes. \n\nThe paucity of evidence on the effectiveness of recovery schools, as documented in this review, thus suggest the need for caution in the widespread adoption of recovery schools for students in recovery from SUDs. Given the lack of empirical support for these recovery schools, additional rigorous evaluation studies are needed to replicate the findings from the one study included in this review. Furthermore, additional research examining the costs of recovery schools may be needed, to help school administrators determine the potential cost-benefits associated with recovery schools. "]
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[null,"Educational setting - Changed attitudes and social norms - Indicated interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]
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[null,"Children and young people - Reduced availability - Indicated interventions - Systematic reviews"]
[null,"Source:","Populations:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]
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[null,"Children and young people - Reduced affordability - Indicated interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]
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[null,"Children and young people - Behaviour change - Indicated interventions - Systematic reviews"]
[null,"Source:","Audience: ","Findings:","Authors' conclusions:"]
[null,"Steele DW, et al. Interventions for Substance Use Disorders in Adolescents: A Systematic Review. Comparative Effectiveness Review No. 225.  AHRQ Publication No. 20-EHC014. Rockville, MD: Agency for Healthcare Research and Quality. May 2020.\nAvailable here.","Adolescents ages 12 to 20 years with problematic substance use or substance use disorder.","The authors included interventions designed to achieve abstinence, reduce use quantity and frequency, improve functional outcomes, and reduce substance-related harms. Interventions were categorised into seven primary intervention components: motivational interviewing (MI), family focused therapy (Fam), cognitive behavioral therapy (CBT), psychoeducation, contingency management (CM), peer group therapy, and intensive case management. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nMotivational interviewing reduced heavy alcohol use days by 0.7 days/month, alcohol use days by 1.2 days/month compared with treatment as usual. Across multiple intensive interventions, family focussed therapy was most effective, reducing alcohol use days by 3.5 days/month compared with treatment as usual.\n\n","Reviewers conclude that :\nBrief interventions: motivational interviewing reduces heavy alcohol use, low Strength of Evidence (SoE) and alcohol use days (moderate SoE). \nFamily focussed therapy: may be most effective in reducing alcohol use (low SoE). More research is needed to identify other effective intensive behavioral interventions for alcohol use disorder. Both motivational interviewing and CBT reduce combined alcohol and other drug use (low SoE).\nPharmacological interventions: systematic reviews in the college settings support use of brief interventions for students with any use, heavy or problematic use. More research is needed to identify the most effective combinations of behavioral and pharmacologic treatments for alcohol use disorders."]
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[null,"Smedslund G et al. Effect of early, brief computerized interventions on risky alcohol and cannabis use among young people. Campbell systematic reviews 2017; 6:(13). Available here. ","Young people (aged 15-25) who abuse alcohol or cannabis. ","The review focused on the effects of brief interventions, provided by electronic devices. Sixty studies were included in the review that had randomised a total of 33,316 participants. \n\nModerate quality evidence was found that multi-dose assessment and feedback was more effective than single-dose assessment for alcohol. A meta-analysis of four studies by the same first author found a 16 per cent significant short-term reduction in drinking after a repeated assessment and feedback compared to a single assessment and feedback (Rate ratio: 0.84, 95 per cent CI: 0.78 to 0.91). However, a study by Anderson (2015) found an SMD of 0.10 (in favour of single dose, 95 per cent CI: -0.07 to 0.27). A study by Kypri (2008) found a long-term significant reduction in drinking after multi-dose feedback compared to single-dose feedback (Rate ratio: 0.77, 95 per cent CI: 0.63 to 0.94). \n\nLow quality evidence was found that assessment and feedback might be more effective than no intervention (Short term effect, 15 studies; SMD: -0.17, 95 per cent CI: -0.27 TO -0.08, I2 = 52 per cent. Long term effect, 3 studies; SMD: -0.17, 95 per cent CI: -0.30 to -0.04).\n\nAssessment and feedback might also be more effective than assessment alone (low quality evidence. Short-term effect, 24 studies; SMD: -0.15, 95 per cent CI: -0.25 to -0.06, I2 = 64 per cent. Long-term effect, 3 studies; SMD: -0.03, 95 per cent CI: -0.19 to 0.12). \n\nShort term effects (<6 months) were mostly larger than long-term (≥ 6 months) effects. \n","Computerized brief interventions are easy to administer, and the evidence from this review indicates that such brief interventions might reduce drinking for several months after the intervention. Additionally, there is no evidence for adverse effects. This means that brief, computerized interventions could be feasible ways of dealing with risky alcohol use among young people. The evidence on cannabis consumption is scarcer, suggesting the need for more research. "]
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[null,"Carney T, Myers BJ, Louw J, Okwundu CI. Brief school‐based interventions and behavioural outcomes for substance‐using adolescents. Cochrane Database Syst Rev 2016; Issue 1. Art. No.: CD008969. DOI: 10.1002/14651858.CD008969.pub3\nAvailable here.\n","Substance using adolescents.","The authors included six RCTs which evaluated the effects of brief school-based interventions for substance-using adolescents. Three studies with 732 adolescents compared brief interventions (Bls) with information provision only, and three studies with 444 adolescents compared Bls with assessment only. Reasons for downgrading the quality of evidence included risk of bias of the included studies, imprecision, and inconsistency. For outcomes that concern substance abuse, the retrieved studies only assessed alcohol and cannabis. \n\nGenerally, moderate quality evidence was found that, compared to information provision only, BIs did not have a significant effect on any of the substance use outcomes at short‐, medium‐, or long‐term follow‐up. \n\nWhen compared to assessment-only controls, BIs were found to significantly reduce the frequency of alcohol use (SMD ‐0.91; 95 per cent CI ‐1.21 to ‐0.61, n = 242), alcohol abuse (SMD ‐0.38; 95 per cent CI ‐0.7 to ‐0.07, n = 190) and dependence (SMD ‐0.58; 95 per cent CI ‐0.9 to ‐0.26, n = 190) at medium-term follow-up in one study. And, at long-term follow-up BI’s also reduced alcohol abuse (SMD ‐0.72; 95 per cent CI ‐1.05 to ‐0.40, n = 181) in one study. However, the evidence from studies that compared brief interventions to assessment‐only conditions was generally of low quality.\n","We found low or very low‐quality evidence that brief school‐based interventions may be more effective in reducing alcohol and cannabis use than the assessment‐only condition and that these reductions were sustained at long‐term follow‐up. We found moderate‐quality evidence that, when compared to information provision, brief interventions probably did not have a significant effect on substance use outcomes. It is premature to make definitive statements about the effectiveness of brief school‐based interventions for reducing adolescent substance use. Further high‐quality studies examining the relative effectiveness of BIs for substance use and other problem behaviours need to be conducted, particularly in low‐ and middle‐income countries."]
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[null,"Children and young people - Families are supported and protected - Indicated interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"Steele DW, et al. Interventions for Substance Use Disorders in Adolescents: A Systematic Review. Comparative Effectiveness Review No. 225.  AHRQ Publication No. 20-EHC014. Rockville, MD: Agency for Healthcare Research and Quality. May 2020.\nAvailable here.","Adolescents ages 12 to 20 years with problematic substance use or substance use disorder.","The authors included interventions designed to achieve abstinence, reduce use quantity and frequency, improve functional outcomes, and reduce substance-related harms. Interventions were categorised into seven primary intervention components: motivational interviewing (MI), family focused therapy (Fam), cognitive behavioral therapy (CBT), psychoeducation, contingency management (CM), peer group therapy, and intensive case management. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nMotivational interviewing reduced heavy alcohol use days by 0.7 days/month, alcohol use days by 1.2 days/month compared with treatment as usual. Across multiple intensive interventions, family focussed therapy was most effective, reducing alcohol use days by 3.5 days/month compared with treatment as usual.\n\n","Reviewers conclude that :\nBrief interventions: motivational interviewing reduces heavy alcohol use, low Strength of Evidence (SoE) and alcohol use days (moderate SoE). \nFamily focussed therapy: may be most effective in reducing alcohol use (low SoE). More research is needed to identify other effective intensive behavioral interventions for alcohol use disorder. Both motivational interviewing and CBT reduce combined alcohol and other drug use (low SoE).\nPharmacological interventions: systematic reviews in the college settings support use of brief interventions for students with any use, heavy or problematic use. More research is needed to identify the most effective combinations of behavioral and pharmacologic treatments for alcohol use disorders."]
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[null,"Gilligan C, et al. Family‐based prevention programmes for alcohol use in young people. Cochrane Database of Systematic Reviews 2019, Issue 3. Art. No.: CD012287. DOI: 10.1002/14651858.CD012287.pub2.\nAvailable here.","School age children (up to 18 years of age)","This Cochrane review aimed to assess the effectiveness of universal, selective, and indicated family-based prevention programmes in preventing alcohol use or problem drinking in school-aged children (up to 18 years of age). \n\nForty six studies (39,822 participants) were included in the review, with 27 classified as universal, 12 as selective, and seven as indicated. Meta‐analyses were performed according to outcome, including studies reporting on the prevalence, frequency, or volume of alcohol use. The overall quality of evidence was low or very low, and there was high, unexplained heterogeneity. \n\nUpon comparing any family intervention to no intervention/standard care, the authors found no intervention effect on the prevalence (SMD) 0.00, 95% CI ‐0.08 to 0.08; studies = 12; participants = 7490; I² = 57%; low‐quality evidence) or frequency (SMD ‐0.31, 95% CI ‐0.83 to 0.21; studies = 8; participants = 1835; I² = 96%; very low‐quality evidence) of alcohol use in comparison with no intervention/standard care. The effect of any parent/family interventions on alcohol consumption volume compared with no intervention/standard care was very small (SMD ‐0.14, 95% CI ‐0.27 to 0.00; studies = 5; participants = 1825; I² = 42%; low‐quality evidence). \n\nWhen comparing parent/family and adolescent interventions versus interventions with young people alone, authors found no difference in alcohol use prevalence (SMD ‐0.39, 95% CI ‐0.91 to 0.14; studies = 4; participants = 5640; I² = 99%; very low‐quality evidence) or frequency (SMD ‐0.16, 95% CI ‐0.42 to 0.09; studies = 4; participants = 915; I² = 73%; very low‐quality evidence). For this comparison, no trials reporting on the volume of alcohol use could be pooled in meta‐analysis. \n\nIn general, the results remained consistent in separate subgroup analyses of universal, selective, and indicated interventions. No adverse effects were reported. \n","The results of this review indicate that there are no clear benefits of family‐based programmes for alcohol use among young people. Patterns differ slightly across outcomes, but overall, the variation, heterogeneity, and number of analyses performed preclude any conclusions about intervention effects. Additional independent studies are required to strengthen the evidence and clarify the marginal effects observed. "]

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[null,"Adult population - NICE Guidance"]
[null,"Source:","Population:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Behaviour change: digital and mobile health interventions. NG183. London: NICE; 2020.\nAvailable here.\n\n\n","Everyone, including Young People under 16 (and their families or 16 carers)\n• Pre-existing health conditions:\nOverweight/ obesity\nHypertension and cardiovascular disease\nRespiratory diseases\nCancers for which managing smoking may improve health outcomes\nMental health conditions\nSpecific consideration will also be given to people with learning disabilities and people with neurodevelopmental disorders such as autism.","This guideline covers interventions that use a digital or mobile platform to help people eat more healthily, become more active, stop smoking, reduce their alcohol intake or practise safer sex. The interventions include those delivered by text message, apps, wearable devices or the internet. The guideline only includes those that are delivered by the technology itself and not by healthcare professionals using technology to deliver interventions.\n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n1.1 Developing digital and mobile health interventions\n1.2 Commissioning digital and mobile health interventions\n1.3 Using digital and mobile health interventions\n1.4 Interventions for diet and physical activity\n1.5 Interventions for smoking\n1.6 Interventions for alcohol use (Based on Evidence Review B: alcohol)\n1.7 Interventions for unsafe sexual behaviour\n\nThe following recommendations for further research were also identified in evidence review B on alcohol:\n1. How can providers and healthcare professionals identify groups that do not initially engage, or do not stay engaged, with digital and mobile health behaviour change interventions?\n2. What components and characteristics of digital and mobile health behaviour change interventions are most effective, separately and in combination, to achieve behaviour change?\n3. What is the effectiveness and cost effectiveness of digital and mobile health behaviour change interventions in low socioeconomic and other underserved groups?\n4. Are digital and mobile health behaviour change interventions as effective as face-to-face, standard care, or combination approaches for some populations?\n5. What are the harms and adverse effects associated with different digital and mobile health behaviour change interventions?"]
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[null,"National Institute for Health and Care Excellence. Behaviour change: individual approaches. PH49. London: NICE; 2014. \nAvailable here.\n","Everyone aged 16 years and older","This guideline covers changing health-damaging behaviours among people aged 16 and over using interventions such as goals and planning, feedback and monitoring, and social support. It aims to help tackle a range of behaviours including alcohol misuse, poor eating patterns, lack of physical activity, unsafe sexual behaviour and smoking.\n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n1. Develop a local behaviour change policy and strategy\n2. Ensure organisation policies, strategies, resources and training all support behaviour change\n3. Commission interventions from services willing to share intervention details and data\n4. Commission high quality, effective behaviour change interventions\n5. Plan behaviour change interventions and programmes taking local needs into account\n6. Develop acceptable, practical and sustainable behaviour change interventions and programmes\n7. Use proven behaviour change techniques when designing interventions (Evidence review1 and Evidence review2)\n8. Ensure interventions meet individual needs\n9. Deliver very brief, brief, extended brief and high intensity behaviour change interventions and programmes\n10. Ensure behaviour change is maintained for at least a year (Evidence review1 and Evidence review2)\n11. Commission training for all staff involved in helping to change people's behaviour\n12. Provide training for behaviour change practitioners\n13. Provide training for health and social care practitioners\n14. Assess behaviour change practitioners and provide feedback\n15. Monitor behaviour change interventions\n16. Evaluate behaviour change interventions\n17. National support for behaviour change interventions and programmes\n\nEvidence review1 did not identify any recommendations for further research. Evidence review 2 made the following recommendation for further research:\n5.7 How do behaviour change techniques lead to change? What are the best methods of testing the relationship between the theories that describe change processes and the effectiveness of interventions in practice?"]
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[null,"National Institute for Health and Care Excellence. Nalmefene for reducing alcohol consumption in people with alcohol dependence. TA325. London: NICE; 2014.\nAvailable here.  \n\n","Adults with mild alcohol dependence (as defined in CG115) who have a high drinking risk level (≥ 60 g/day of pure alcohol for men and ≥ 40 g/day for women) without physical withdrawal symptoms and who do not require immediate detoxification","NICE currently make the following recommendation regarding use of Nalmefene for reducing alcohol consumption in people with alcohol dependence (the highlighted recommendation is relevant to the scope of this topic evidence map):\n\n1.1 Nalmefene is recommended within its marketing authorisation, as an option for reducing alcohol consumption, for people with alcohol dependence (Evidence review): \n• Who have a high drinking risk level (defined as alcohol consumption of more than 60 g per day for men and more than 40g per day for women, according to the World Health Organization's drinking risk levels) without physical withdrawal symptoms and;\n• Who do not require immediate detoxification.\n\nThe marketing authorisation states that nalmefene should:\n• Only be prescribed in conjunction with continuous psychosocial support focused on treatment adherence and reducing alcohol consumption and; \n• Be initiated only in patients who continue to have a high drinking risk level 2 weeks after initial assessment.\n\nMarch 2018: NICE reviewed the evidence for TA325. They found found nothing new that affects the recommendations in this guidance. This guidance will be reviewed if there is new evidence that is likely to affect the recommendations."]
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[null,"National Institute for Health and Care Excellence. Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence. CG115. London: NICE; 2011\nAvailable here.\n\n","Adults (>18 years) or young people (10 to 17 years of age) with a diagnosis of alcohol dependence or meeting criteria for harmful alcohol use (30 to 50 units of alcohol per week)","This guideline covers identifying, assessing and managing alcohol-use disorders (harmful drinking and alcohol dependence) in adults and young people aged 10-17 years. It aims to reduce harms (such as liver disease, heart problems, depression and anxiety) from alcohol by improving assessment and setting goals for reducing alcohol consumption. \n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n• Principles of care\n• Identification and assessment \n• Interventions for alcohol misuse (Evidence review 2011)\n\nThe following recommendations for further research were also identified in Evidence reviews underpinning this guidance:\n1 Is contingency management effective in reducing alcohol consumption in people who misuse alcohol compared with standard care?\n2 What methods are most effective for assessing and diagnosing the presence and severity of alcohol misuse in children and young people?\n3 Is acupuncture effective in reducing alcohol consumption compared with standard care?\n4. For which service users who are moderately and severely dependent on alcohol is an assertive community treatment model a clinically and cost-effective intervention compared with standard care?\n5. For people with moderate and severe alcohol dependence who have significant comorbid problems, is an intensive residential rehabilitation programme clinically and cost effective when compared with intensive community-based care?\n6 For people with alcohol dependence, which medication is most likely to improve adherence and thereby promote abstinence and prevent relapse?\n\nOctober 2022: NICE updated the recommendation about behavioural couples therapy to clarify that this is not suitable in cases of domestic abuse and to add a cross reference to the NICE technology appraisal guidance on nalmefene. They also updated information about off-label prescribing, and added cross references to legislation on controlled drugs and driving, to MHRA advice on addiction to benzodiazepines and codeine, and to NICE's guidelines on smoking, on antisocial personality disorder and on coexisting mental illness and substance misuse community health and social care services.\nJuly 2019: NICE have found no new evidence that affects the recommendations."]
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[null,"National Institute for Health and Care Excellence. Coexisting severe mental illness (psychosis) and substance misuse: assessment and management in healthcare settings. CG120. London: NICE; 2011. \nAvailable here.\n","People aged 14 years and over with coexisting severe mental illness (psychosis) and substance misuse","This guideline covers assessing and managing people aged 14 years and over with coexisting severe mental illness (psychosis) and substance misuse. It aims to help healthcare professionals guide people with psychosis with coexisting substance misuse to stabilise, reduce or stop their substance misuse, to improve treatment adherence and outcomes, and to enhance their lives. \n\nThe guideline includes the following recommendations. All the recommendations are relevant to the scope of this topic evidence map. The recommendations are supported by evidence from the underpinning Evidence Review 2011. \n• Principles of care\n• Recognising psychosis with coexisting substance misuse\n• Primary care\n• Secondary care mental health services\n• Substance misuse services\n• Inpatient mental health services and staffed accommodation\n• Specific issues for young people with psychosis and coexisting substance misuse\n\nThe following recommendations for further research were also identified in Evidence reviews underpinning this guidance:\n1. What are the prevalence, risk and protective factors, and course of illness for different combinations of psychosis and coexisting substance misuse (for example, schizophrenia and cannabis misuse or bipolar disorder and alcohol misuse)?\n2. What risk factors predict the onset of substance misuse in young people with psychosis?\n3. Are psychosocial interventions clinically and cost effective when compared with standard care for people with psychosis and coexisting substance misuse?\n4. Are environmental interventions clinically and cost effective when compared with standard care for people with psychosis and coexisting substance misuse?\n5. Is clozapine clinically and cost effective when compared with other pharmacological interventions for people with psychosis and coexisting substance misuse?\n\nNovember 2016: NICE reviewed the evidence and found no new evidence that affects the current recommendations in this guideline."]
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[null,"National Institute for Health and Care Excellence. Alcohol-use disorders: diagnosis and management of physical complications. CG100. London: NICE; 2010. \nAvailable here. \n","People aged 10 years and over with alcohol-use disorders","This guideline covers care for adults and young people (aged 10 years and older) with physical health problems that are completely or partly caused by an alcohol-use disorder. It aims to improve the health of people with alcohol-use disorders by providing recommendations on managing acute alcohol withdrawal and treating alcohol-related conditions. \n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n• Acute alcohol withdrawal (Evidence review 2014)\n• Wernicke’s encephalopathy\n• Alcohol-related liver disease\n• Alcohol-related pancreatitis\n\nThe following recommendations for further research were also identified in Evidence reviews underpinning this guidance:\n2. What is the efficacy and cost effectiveness of clomethiazole compared with chlordiazepoxide or carbamazepine or benzodiazepines for the treatment of acute alcohol withdrawal with regard to the outcomes of withdrawal severity, risk of seizures, risk of delirium tremens, length of treatment and patient satisfaction?\n\nJanuary 2019: NICE checked this guideline and are updating it. For more information, see the surveillance decision."]
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[null,"National Institute for Health and Care Excellence. Alcohol-use disorders: prevention. PH24. London: NICE; 2010\nAvailable here.\n\n\n\n","Children, young people and adults aged 10 years and above","This guideline covers alcohol problems among people over 10. It aims to prevent and identify such problems as early as possible using a mix of policy and practice.\n\nThe guideline includes the following recommendations. All the recommendations are relevant to the scope of this topic evidence map. The recommendations are supported by the underpinning Evidence reviews 1-3 and Evidence reviews 4-6:\n• Price, availability and marketing\n• Licencing\n• Supporting children and young people aged 10 to 15 years\n• Screening young people aged 16 and 17 years and offering them extended brief interventions\n• Screening adults and offering them brief advice and interventions\n• Referral\n\nThe underpinning evidence reviews in this report identifed several gaps in the evidence and made recommendations for further research with the following overarching question:\nHow does advertising by industry and health agencies affect the drinking behaviour of the population as whole? (This includes the use of new media.)\n\nJuly 2019: NICE checked this guideline and are updating it. For further information, see the surveillance decision."]
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[null,"National Institute for Health and Care Excellence. Behaviour change: general approaches. PH6. London: NICE; 2007\nAvailable here.\n\n\n\n","General population","This guideline covers a set of principles that can be used to help people change their behaviour. The aim is for practitioners to use these principles to encourage people to adopt a healthier lifestyle by, for example, stopping smoking, adopting a healthy diet and being more physically active.\n\nThe guideline includes the following recommendations. All the recommendations are relevant to the scope of this topic evidence map. The recommendations are supported by the underpinning Evidence review 1.\n• Providing education and training for those delivering them\n• Delivery of these activities, including one-to-one and community-based programmes and those aimed at specific populations\n• Evaluation of their effectiveness and cost effectiveness\n\nThe Programme Development Group identified a number of gaps in the evidence related to behaviour change interventions and programmes, based on an assessment of the evidence and made recommendations for research to address the most important gaps in the evidence. Please refer to 4. Recommendations for research' section of the guidance.\n\nNovember 2017: NICE checked this guideline and found no new evidence that affects the recommendations in this guideline."]
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[null,"Adult population - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' Conclusions:"]
[null,"Agabio R et al. Baclofen for alcohol use disorder. Cochrane Database Syst Rev 2023, Issue 1. Art.No. CD012557. DOI:0.1002/14651858.CD012557.pub3.\nAvailable here. ","Adults with a diagnosis of alcohol dependence. ","This is an update of a Cochrane Review first published in 2018. The aim of this update was to evaluate the benefits and harms of baclofen on achieving and maintaining abstinence or reducing alcohol consumption in people with AUD compared to placebo, no treatment or any other pharmacological relapse prevention treatment. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nThis update included 17 RCTs (1818 participants). Ten studies compared baclofen to placebo or another medication; seven compared two baclofen doses to placebo or another medication. Globally, 15 studies compared baclofen to placebo, two baclofen to acamprosate and two baclofen to naltrexone. In 16 studies, participants received psychosocial treatments. The authors judged most studies at low risk of selection, performance, detection (subjective outcome), attrition and reporting bias. Ten studies detoxified participants before treatment; in seven studies, participants were still drinking at the beginning of treatment. Treatment duration was 12 weeks for 15 RCTs and longer in two studies. Baclofen daily dose was 30 mg to 300 mg: 10 RCTs used low doses (30 mg or less); eight RCTs medium doses (above 30 and 100 mg or less) and four RCTs high doses (above 100 mg).\n\nCompared to placebo, moderate‐certainty evidence found that baclofen probably decreases the risk to relapse (risk ratio (RR) 0.87, 95% confidence interval (CI) 0.77 to 0.99; 12 studies, 1057 participants). This result was confirmed among detoxified participants but not among other subgroups of participants.\n\nHigh‐certainty evidence found that baclofen increases the percentage of days abstinent (mean difference (MD) 9.07, 95% CI 3.30 to 14.85; 16 studies, 1273 participants). This result was confirmed among all subgroups of participants except non‐detoxified or those who received medium doses.\n\nThere was no difference between baclofen and placebo in the other primary outcomes: heavy drinking days (standardised mean difference (SMD) −0.18, 95% CI −0.48 to 0.11; 13 studies, 840 participants; moderate‐certainty evidence); and number of drinks per drinking days (MD −0.45, 95% CI −1.20 to 0.30; 9 studies, 392 participants; moderate‐certainty evidence).\n\nCompared to acamprosate, one study (60 participants) found no differences in any outcomes but the evidence was very uncertain: relapse (RR 1.25, 95% CI 0.71 to 2.20; very low‐certainty evidence).\n\nCompared to naltrexone, baclofen may increase the risk of relapse (RR 2.50, 95% CI 1.12 to 5.56; 1 study, 60 participants; very low‐certainty evidence) but the evidence is very uncertain.","The authors concluded that baclofen likely reduces the risk of relapse to any drinking and increases the percentage of abstinent days, mainly among detoxified participants. It does not increase the number of participants with at least one adverse event, those who dropout for any reason or due to adverse events. It probably does not reduce number of heavy drinking days and the number of drinks per drinking days. Current evidence suggests that baclofen may help people with AUD in maintaining abstinence. The results of comparisons of baclofen with acamprosate and naltrexone were mainly based on only one study."]
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[null,"Meiksin R et al. E-health interventions targeting STIs, sexual risk, substance use and mental health among men who have sex with men: four systematic reviews. Public Health Research. 2022;10(4):1-322. \nAvailable here.","Gay, bisexual and other men (including trans men) who have sex with men, including those who have been diagnosed as HIV positive, as well as those whose last HIV test was negative or who have never tested for HIV","This review aimed to  synthesise evidence addressing the following: (1) What approaches and theories of change do existing e-health interventions employ to prevent human immunodeficiency virus/sexually transmitted infections, sexual risk, alcohol/drug use or mental ill health among men who have sex with men? (2) What factors influence implementation? (3) What are the effects of such interventions on the aforementioned epidemics? (4) Are such interventions cost-effective? Only information relevant to this topic evidence map has been extracted below.\n\nEffects on alcohol and drug use: Two studies presented estimates for drug use (table 8 in the full report), both focused on open-ended interventions. Neither quantified outcomes on alcohol use specifically. Although both studies presented short-term results, only one study presented mid-term results. However, the primary method of analysis in that study was a longitudinal regression model; the authors present these estimates as well. Across studies, there was no consistent evidence of effectiveness of interventions in reducing drug use.\n\nMeta-analysis: Effect sizes for alcohol and drug use are presented in the full report in Figure 14 for outcomes of < 3 months post intervention and in Figure 15 for outcomes between 3 months and 1 year post intervention. In both plots, negative effect sizes represent benefits. The review authors do not present a pooled effect size for these estimates as meta-analyses included both substantial heterogeneity (I2 = 95% both overall and only including effect sizes of up to 3 months’ follow-up) and too few studies to explore this heterogeneity.","The authors concluded that the findings for drug use could not be meta-analysed because of study heterogeneity. Studies addressing this outcome did not present consistent evidence of effectiveness. Trials did not report effects on alcohol use or mental health."]
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[null,"Moledina A et al (2021). A comprehensive review of prioritised interventions to improve the health and wellbeing of persons with lived experience of homelessness. Campbell Systematic Reviews, 17, e1154.\nAvailable here. ","Populations experiencing homelessness, defined as those who lack stable, permanent, appropriate housing, or who may be without immediate prospects, means, and ability to acquire it","The objective of this systematic review is to identify, appraise, and synthesise the best available evidence on the benefits and cost-effectiveness of interventions to improve the health and social outcomes of people experiencing homelessness.\n\nEligible interventions included permanent supportive housing (PSH), income assistance, standard case management (SCM), peer support, mental health interventions such as assertive community treatment (ACT), intensive case management (ICM), critical time intervention (CTI) and injectable antipsychotics, and substance-use interventions, including supervised consumption facilities (SCFs), managed alcohol programmes and opioid agonist therapy. Outcomes of interest were housing stability, mental health, quality of life, substance use, hospitalisations, employment and income. Only results relevant to this topic evidence map have been extracted below.\n\nManaged alcohol programmes: The review did not identify any eligible studies.\n\nPermanent supportive housing: The effect of permanent housing on substance use was reported in nine trials. Out of these three studies reported improvements in alcohol and drug use in both groups, over time, but no differential benefit of the HF initiative. One study on homeless clients with problematic substance reported no group differences in problems associated with alcohol use, though both groups decreased their alcohol consumption over time. Hybrid approaches to housing (“integrative” versus “parallel” housing) were investigated in a single study. It found no statistically significant difference in the reported days of alcohol use or reported days of drug use both between groups as well as over time. Of note, analysis for this outcome had a lower statistical power as it was restricted to individuals who reported use at the baseline.\n\nIncome-assistance intervention: Four studies examined the effects of income-assistance intervention on substance use. For homeless veterans with substance dependence, CWT immediately reduced the consumption of alcohol and drugs within the first 3 months (β = −44.7%; 95% CI, −69.7% to −19.7%; t = 3.51; p = .001). The addition of priority access to housing vouchers for veterans with a diagnosis of a major psychiatric disorder or an alcohol/drug disorder, compared to existing case management, led to decreased days of drinking to intoxication (1.46 vs. 1.95, t = 0.73, p = .0053) and fewer days of alcohol use over the 3-year study period. However, no significant association was identified between priority access to housing subsidies and differences in the scores of the Addiction Severity Index (ASI). For homeless families with children aged 15 or younger, rental subsidies without case management did not lead to decreased use of substance compared to the usual community housing services.\n\nSCM and peer support interventions: Six studies reported on substance-use outcomes with different SCM treatments. Homeless male veterans with addictions problems with three to 6 months of hospital stays plus case management showed better improvements in the alcohol- and drug-use composite scores, but these were short-lived compared to TAU after 24 months. A three-arm trial reported reductions in average days of alcohol and drug consumption in a case-management-only group, a CM-with-supported-housing group in graduates of short-term in-patient substance-use programme who lacked housing. Homeless alcohol abusers who were offered different intensities of SCM (n = 469) showed no significant between-group differences in days of alcohol use. Similarly, a three-arm trial with homeless women and their intimate partners found no significant differences in substance-use outcomes between groups: a peer-mentored group, a group in a nurse case-managed programme, and one in an SCM programme. Another 12-months trial on homeless men recently released from jails/prisons who were exposed to weekly peer coaching, intermediate peer coaching compared with the usual treatment did not find any significant effects on substance-use outcomes. An RCT with homeless women with alcohol-use problems who received brief guideline-based interventions from primary care providers and referrals to the CM for ongoing follow-up visits for 6 months did not find any significant between-group differences on alcohol-consumption rates, percentages of completely abstained participants, or negative consequences of alcohol use, respectively.\n","PSH interventions improved housing stability for people living with homelessness. High-intensity case management and income-assistance interventions may also benefit housing stability. The majority of included interventions inconsistently detected benefits for mental health, quality of life, substance use, employment and income. These results have important implications for public health, social policy, and community programme implementation. The COVID-19 pandemic has highlighted the urgent need to tackle systemic inequality and address social determinants of health. Our review provides timely evidence on PSH, income assistance, and mental health interventions as a means of improving housing stability. PSH has major cost and policy implications and this approach could play a key role in ending homelessness. Evidence-based reviews like this one can guide practice and outcome research and contribute to advancing international networks committed to solving homelessness."]
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[null,"McGovern R et al. Effectiveness of psychosocial interventions for reducing parental substance misuse. Cochrane Database of Systematic Reviews 2021, Issue 3. Art. No.: CD012823.\nAvailable here\n","Participants were parents who use substances; this included mothers and fathers of children (sons and daughters) under the age of 21 years, regardless of custodial or residency status of the children. Same-sex parents and foster parents were eligible for inclusion.","The authors included 22 unique studies with a total of 2274 participants (mean age of parents ranged from 26.3 to 40.9 years), examining 24 experimental interventions. The majority of studies intervened with mothers only (n = 16; 73%). Heroin, cocaine, and alcohol were the most commonly reported substances used by participants. The interventions targeted either parenting only (n = 13; 59%); drug and alcohol use only (n = 5; 23%); or integrated interventions which addressed both (n = 6; 27%).\n\nThe authors found moderate-quality evidence that psychosocial interventions are probably more effective at reducing the frequency of parental alcohol misuse than comparison conditions at 6-month (mean difference (MD) −0.32, 95% confidence interval (CI) −0.51 to −0.13; 6 studies, 475 participants) and 12-month follow-up (standardised mean difference (SMD) −0.25, 95% CI −0.47 to −0.03; 4 studies, 366 participants). The authors found a significant reduction in frequency of use at 12 months only (SMD −0.21, 95% CI −0.41 to −0.01; 6 studies, 514 participants, moderate-quality evidence).\n\nThe authors examined the effect of the intervention type. They found low-quality evidence that psychosocial interventions targeting substance use only may not reduce the frequency of alcohol (6 months: SMD −0.35, 95% CI −0.86 to 0.16; 2 studies, 89 participants and 12 months: SMD −0.09, 95% CI −0.86 to 0.61; 1 study, 34 participants).\n\nA parenting intervention only, without an adjunctive substance use component, may not reduce frequency of alcohol misuse (6 months: SMD −0.21, 95% CI −0.46 to 0.04, 3 studies; 273 participants, low-quality evidence and 12 months: SMD −0.11, 95% CI −0.64 to 0.41; 2 studies; 219 participants, very low-quality evidence).\n\nParents receiving integrated interventions which combined both parenting- and substance use-targeted components may reduce alcohol misuse with a small effect size (6 months: SMD −0.56, 95% CI −0.96 to −0.16 and 12 months: SMD −0.42, 95% CI −0.82 to −0.03; 2 studies, 113 participants). However, this evidence was of low quality.\n\nInterventions appeared to be more often beneficial for fathers than for mothers. The authors found low- to very low-quality evidence of a reduction in frequency of alcohol misuse for mothers at six months only (SMD −0.27, 95% CI −0.50 to −0.04; 4 studies, 328 participants), whilst in fathers there was a reduction in frequency of alcohol misuse (6 months: SMD −0.43, 95% CI −0.78 to −0.09; 2 studies, 147 participants and 12 months: SMD −0.34, 95% CI −0.69 to 0.00; 2 studies, 147 participants).","The authors found moderate-quality evidence that psychosocial interventions probably reduce the frequency at which parents use alcohol. Integrated psychosocial interventions which combine parenting skills interventions with a substance use component may show the most promise. \nWhilst it appears that mothers may benefit less than fathers from intervention, caution is advised in the interpretation of this evidence, as the interventions provided to mothers alone typically did not address their substance use and other related needs. \nThe authors found low-quality evidence from few studies that interventions involving children are not beneficial."]
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[null,"Goldberg SB et al. Mindfulness‐based interventions for substance use disorders. Cochrane Database of Systematic Reviews 2021, Issue 10.\nAvailable here.","Patients suffering from substance use disorders including individuals with alcohol, prescription‐, illicit‐ and poly‐substance use disorders","This Cochrane review aimed to determine the effects of MBIs for SUDs in terms of substance use outcomes, craving and adverse events compared to standard care, further psychotherapeutic, psychosocial or pharmacological interventions, or instructions, waiting list and no treatment.\n\nForty RCTs met the inclusion criteria, with 35 RCTs involving 2825 participants eligible for meta‐analysis. All studies were at high risk of performance bias and most were at high risk of detection bias. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nMindfulness‐based interventions (MBIs) versus no treatment (24 RCTs): The evidence was uncertain about the effects of MBIs relative to no treatment on all primary outcomes: continuous abstinence rate (post: risk ratio (RR) = 0.96, 95% CI 0.44 to 2.14, 1 RCT, 112 participants; follow‐up: RR = 1.04, 95% CI 0.54 to 2.01, 1 RCT, 112 participants); percentage of days with substance use (post‐treatment: standardized mean difference (SMD) = 0.05, 95% CI ‐0.37 to 0.47, 4 RCTs, 248 participants; follow‐up: SMD = 0.21, 95% CI ‐0.12 to 0.54, 3 RCTs, 167 participants); and consumed amount (post‐treatment: SMD = 0.10, 95% CI ‐0.31 to 0.52, 3 RCTs, 221 participants; follow‐up: SMD = 0.33, 95% CI 0.00 to 0.66, 2 RCTs, 142 participants).\n\nMBIs versus other treatments (standard of care, cognitive behavioral therapy, psychoeducation, support group, physical exercise, medication; 19 RCTs): The evidence was very uncertain about the effects of MBIs relative to other treatments on continuous abstinence rate at post‐treatment (RR = 0.80, 95% CI 0.45 to 1.44, 1 RCT, 286 participants) and follow‐up (RR = 0.57, 95% CI 0.28 to 1.16, 1 RCT, 286 participants), and on consumed amount at post‐treatment (SMD = ‐0.42, 95% CI ‐1.23 to 0.39, 1 RCT, 25 participants) due to imprecision and risk of bias. The evidence suggests that MBIs reduce percentage of days with substance use slightly relative to other treatments at post‐treatment (SMD = ‐0.21, 95% CI ‐0.45 to 0.03, 5 RCTs, 523 participants) and follow‐up (SMD = ‐0.39, 95% CI ‐0.96 to 0.17, 3 RCTs, 409 participants).","Authors conclude that in comparison with no treatment, the evidence is uncertain regarding the impact of MBIs on SUD‐related outcomes. MBIs result in little to no higher attrition than no treatment. In comparison with other treatments, MBIs may slightly reduce days with substance use at post‐treatment and follow‐up (4 to 10 months). The evidence is uncertain regarding the impact of MBIs relative to other treatments on abstinence, consumed substance amount, or craving. MBIs result in little to no higher attrition than other treatments. Few studies reported adverse events."]
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[null,"Kelly  JF, Humphreys  K, Ferri  M. Alcoholics Anonymous and other 12‐step programs for alcohol use disorder. Cochrane Database of Systematic Reviews 2020, Issue 3. Art. No.: CD012880. DOI: 10.1002/14651858.CD012880.pub2.\nAvailable here.","Non-coerced adults with Alcohol Use Disorder.","Alcoholics annonymous Twelve-Step Facilitation (AA/TSF) (manualized) compared to treatments with a different theoretical orientation (e.g. CBT) (randomized/quasi‐randomized evidence), RCTs comparing manualized AA/TSF to other clinical interventions (e.g. CBT), showed AA/TSF improves rates of continuous abstinence at 12 months (risk ratio (RR)) 1.21, 95% confidence interval (CI) 1.03 to 1.42; 2 studies, 1936 participants; high‐certainty evidence). This effect remained consistent at both 24 and 36 months.\n\nFor percentage days abstinent (PDA), AA/TSF appears to perform as well as other clinical interventions at 12 months (mean difference (MD) 3.03, 95% CI ‐4.36 to 10.43; 4 studies, 1999 participants; very low‐certainty evidence), and better at 24 months (MD 12.91, 95% CI 7.55 to 18.29; 2 studies, 302 participants; very low‐certainty evidence) and 36 months (MD 6.64, 95% CI 1.54 to 11.75; 1 study, 806 participants; very low‐certainty evidence). \nFor longest period of abstinence (LPA), AA/TSF may perform as well as comparison interventions at six months (MD 0.60, 95% CI ‐0.30 to 1.50; 2 studies, 136 participants; low‐certainty evidence).\n\nFor drinking intensity, AA/TSF may perform as well as other clinical interventions at 12 months, as measured by drinks per drinking day (DDD) (MD ‐0.17, 95% CI ‐1.11 to 0.77; 1 study, 1516 participants; moderate‐certainty evidence) and percentage days heavy drinking (PDHD) (MD ‐5.51, 95% CI ‐14.15 to 3.13; 1 study, 91 participants; low‐certainty evidence). \nFor alcohol‐related consequences, AA/TSF probably performs as well as other clinical interventions at 12 months (MD ‐2.88, 95% CI ‐6.81 to 1.04; 3 studies, 1762 participants; moderate‐certainty evidence).\n\nFor alcohol addiction severity, one study found evidence of a difference in favor of AA/TSF at 12 months (P < 0.05; low‐certainty evidence). \nThis study examines results for the same outcomes for non-manualized AA/TSF.\n","There is high quality evidence that manualized AA/TSF interventions are more effective than other established treatments, such as CBT, for increasing abstinence. Non‐manualized AA/TSF may perform as well as these other established treatments. AA/TSF interventions, both manualized and non‐manualized, may be at least as effective as other treatments for other alcohol‐related outcomes. AA/TSF probably produces substantial healthcare cost savings among people with alcohol use disorder."]
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[null,"Hunt G et al.  Psychosocial interventions for people with both severe mental illness and substance misuse. Cochrane Database Syst Rev 2019, Issue 12. Art. No.: CD001088. DOI: 10.1002/14651858.CD001088.pub4\nAvailable here.\n","People diagnosed with a severe mental illness and concurrent problem of substance misuse","This Cochrane review aimed to assess the effects of psychosocial interventions for reduction in substance use in people with a serious mental illness compared with standard care. It updates and replaces the 2013 version of the review.\n\nThe review now includes 41 trials with a total of 4024 participants. The reviewers identified nine comparisons within the included trials. Only two of these reported outcomes meeting the scope of this topic evidence map and have been reported below. For full detail and information on the other outcomes, please refer to the full-text. \n\n1. Integrated models of care versus standard care (36 months): No clear differences were found between treatment groups for alcohol use (RR 1.15, 95% CI 0.84 to 1.56; participants = 143; studies = 1; low‐quality evidence).\n\n5. Motivational interviewing (MI) versus standard care: A clear difference, favouring MI, was observed for abstaining from alcohol (RR 0.36, 95% CI 0.17 to 0.75; participants = 28; studies = 1; very low‐quality evidence).","Authors concluded that they included 41 RCTs but were unable to use much data for analyses. There is currently no high‐quality evidence to support any one psychosocial treatment over standard care for important outcomes such as remaining in treatment, reduction in substance use or improving mental or global state in people with serious mental illnesses and substance misuse. Furthermore, methodological difficulties exist which hinder pooling and interpreting results. Further high‐quality trials are required which address these concerns and improve the evidence in this important area."]
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[null,"Hollands  GJ et al. Altering the availability or proximity of food, alcohol, and tobacco products to change their selection and consumption. Cochrane Database of Systematic Reviews 2019, Issue 9. Art. No.: CD012573. DOI: 10.1002/14651858.CD012573.pub3.\nAvailable here.","Adults","This Cochrane review aimed to:\n1. To assess the impact on selection and consumption of altering the availability or proximity of (a) food (including non‐alcoholic beverages), (b) alcohol, and (c) tobacco products.\n2. To assess the extent to which the impact of these interventions is modified by characteristics of: i. studies, ii. interventions, and iii. participants.\n\nThe reviewers included 24 studies, with the majority (20/24) giving concerns about risk of bias. All of the included studies investigated food products; none investigated alcohol or tobacco. ","The authors concluded that:\n- Further research is warranted in real‐world settings, intervening across a wider range of foods as well as alcohol and tobacco products and over sustained time periods"]
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[null,"Stead M, Angus K, Langley T, Katikireddi SV, Hinds K, Hilton S,  et al. Mass media to communicate public health messages in six health topic areas: a systematic review and other reviews of the evidence. Public Health Res 2019;7(8)\nAvailable here.","General population","This systematic review by NIHR aimed to (1) review evidence on the effective use of mass media in six health topic areas (alcohol, diet, illicit drugs, physical activity, sexual and reproductive health and tobacco), (2) examine whether or not effectiveness varies with different target populations, (3) identify characteristics of mass media campaigns associated with effectiveness and (4) identify key research gaps.There was limited evidence of impact on alcohol use. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nChapter 3. What is the impact of mass media campaigns on alcohol-related behaviour and other outcomes? Findings from the review of primary studies of alcohol campaigns (review B).\nThe objective was to conduct a systematic review of evidence of the effectiveness of mass media public health campaigns to reduce alcohol consumption and related harms. Twenty-nine papers were included in the review. They reported 24 different studies that had a range of designs (11 controlled longitudinal and 13 uncontrolled or cross-sectional) and countries (eight in the USA, five in Australia, two in Finland, two in New Zealand, two in the UK, one in Canada, one in Denmark, one in Italy, one in the Netherlands and one in Sri Lanka). Television and/or radio were used in 18 studies. Other media channels that were used were posters, newspapers, pamphlets, e-mails and online video. On EPHPP study quality ratings, two were strong, four were moderate and 18 were weak.\n\nAlcohol consumption: There was little evidence of reductions in alcohol consumption associated with exposure to campaigns (13 studies). Six of these studies compared exposed and non-exposed groups, or exposed groups over time; five reported no statistically significant differences in consumption. One study found that participants in a group exposed to a television and mailed letter campaign decreased their consumption on a typical day by 47%, contrasting with increases in the groups receiving either the television or letter components or neither. Other studies examined associations between campaign viewing or awareness and consumption: one reported that increases in awareness in older adolescence, but not younger adolescence, was associated with decreases in binge drinking, one reported that campaign viewing significantly predicted drinks consumed and two found no significant difference in consumption.","Reviewers conclude that mass media public health campaigns about alcohol can often be recalled by individuals, and are associated with changes in knowledge, attitudes and beliefs about alcohol. There is little evidence that campaigns reduced alcohol consumption but most studies did not report consumption as an outcome. Mass media can, however, have an impact on outcomes that could lead to support for other public health actions to reduce alcohol consumption and harm."]
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[null,"Wolfenden, L. Strategies to improve the implementation of workplace-based policies or practices targeting tobacco, alcohol, diet, physical activity and obesity. Cochrane database Syst Rev 2018, Issue 11. Art. No.: CD012439. DOI: 10.1002/14651858.CD012439.pub2\nAvailable here. ","Adults in the workplace.","This review aimed to assess the effects of strategies for improving the implementation of workplace-based policies or practices targeting diet, physical activity, obesity, tobacco use and alcohol use. Six trials were included, four of which took place in the USA. Four trials employed randomised controlled trial (RCT) designs. Trials were conducted in workplaces from the manufacturing, industrial and services‐based sectors. The sample sizes of workplaces ranged from 12 to 114. Workplace policies and practices targeted included: healthy catering policies; point‐of‐purchase nutrition labelling; environmental supports for healthy eating and physical activity; tobacco control policies; weight management programmes; and adherence to guidelines for staff health promotion. All implementation interventions utilised multiple implementation strategies, the most common of which were educational meetings, tailored interventions and local consensus processes. \n\nOne included trial reported the effects of a workplace health promotion intervention on employee alcohol use (Parker 2010). However, as the implementation strategy and policies and practices targeted by the intervention did not include those addressing alcohol use, the effects on employee alcohol use reported in this trial were not included in the review. None of the other included trials reported effects of implementation strategies on this outcome. \n","Available evidence regarding the effectiveness of implementation strategies for improving implementation of health‐promoting policies and practices in the workplace setting is sparse and inconsistent. Low certainty evidence suggests that such strategies may make little or no difference on measures of implementation fidelity or different employee health behaviour outcomes. It is also unclear if such strategies are cost‐effective or have potential unintended adverse consequences. The limited number of trials identified suggests implementation research in the workplace setting is in its infancy, warranting further research to guide evidence translation in this setting."]
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[null,"Hennessy EA et al. Recovery schools for improving behavioral and academic outcomes among students in recovery from substance use disorders: a systematic review. Campbell Systematic Reviews 2018; 9. \nAvailable here. ","Students in recovery from substance use who were enrolled part-time or full-time in secondary (high school) or postsecondary (college or university) educational institutions. ","The review focused on two types of recover schools: recovery high schools (RHSs), which are schools that award secondary school dipolmas and offer a range of therapeutic services in addition to standard educational curricula; and collegiate recovery communities (CRCs), which offer therapeutic and sober support services on college campuses. \n\nOnly one study met the criteria for inclusion in the review. The study used a quasi-experimental design to examine the effects of RHSs on high school students' academic and substance use outcomes. No eligible studies examining CRCs were identified. \n\nThe results from the one eligible RHS study indicated that after adjusting for pretest values, students in the RHS condition reported levels of grade point averages (g = 0.26, 95% CI [-0.04, 0.56]), truancy (g = 0.01, 95% CI [-0.29, 0.31]), and alcohol use (g = 0.23, 95% CI [-0.07, 0.53]) similar to participants in the comparison condition. However, students in the RHS condition reported improvements in absenteeism (g = 0.56, 95% CI [0.25, 0.87]), abstinence from alcohol/drugs (OR = 4.36, 95% CI [1.19, 15.98]), marijuana use (g = 0.51, 95% CI [0.20, 0.82]), and other drug use (g = 0.45, 95% CI [0.14, 0.76]).\n\nOverall, there was a serious risk of bias in the one included study. The study had a serious risk of bias due to confounding, low risk of bias due to selection of participants into the study, moderate risk of bias due to classification of interventions, inconclusive risk of bias due to deviations from intended interventions, inconclusive risk of bias due to missing data, moderate risk of bias in measurement of outcomes, and low risk of bias in selection of reported results.","There is insufficient evidence regarding the effectiveness of RHSs and CRCs for improving academic and substance use outcomes among students in recovery from SUDs. Only one identified study examined the effectiveness of RHSs. Although the study reported some beneficial effects, the results must be interpreted with caution given the study's potential risk of bias due to confounding and limited external validity. The paucity of evidence on the effectiveness of recovery schools, as documented in this review, thus suggest the need for caution in the widespread adoption of recovery schools for students in recovery from SUDs. Given the lack of empirical support for these recovery schools, additional rigorous evaluation studies are needed to replicate the findings from the one study included in this review. Furthermore, additional research examining the costs of recovery schools may be needed, to help school administrators determine the potential cost-benefits associated with recovery schools. "]
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[null,"O'Connor EA et al. Screening and behavioral counseling interventions to reduce unhealthy alcohol use in adolescents and adults: An updated systematic review for the U.S. Preventive Services Task Force. Rockville MD: Agency for Healthcare Research and Quality; 2018. \nAvailable here. ","Adolescents or adults age 12 years or older. ","One hundred and thirteen studies (n=314,466) were included across all Key Questions. The authors did not find any studies that examined the benefits or harms of screening programs to reduce unhealthy alcohol use. For adolescents, data supported the use of the National Institute on Alcohol Abuse and Alcoholism Youth Screen and other similar one- or two-item screeners to detect alcohol use disorder. For adults, brief (1- to 3-item) screeners commonly reported sensitivity and specificity between 0.70 and 0.85, typically having better sensitivity than the full Alcohol Use Disorders Identification Test (AUDIT) for identifying the full spectrum of unhealthy use. However, the AUDIT tended to have higher specificity, particularly at the standard cutoff of 8 or higher.  \n\nIdentified interventions to reduce unhealth alcohol use were generally counselling interventions, with most involving one or two sessions (90% involved ≤ 4 sessions) with a median of 30 minutes contact time (88% involved ≤ 2 hours contact). The most commonly reported intervention element was the use of personalized normative feedback sessions, in which participants were shown how their alcohol use compares to others; this technique was used in more than half of the included trials and almost all trials in younger adults. Motivational techniques were also common, particularly in combination with personalized normative feedback.\n\nEvidence on the effects of interventions to reduce unhealthy alcohol use in adolescents was limited to two trials; both found mixed results for reduced alcohol use and did not report health or related outcomes. \n\nIn adults, interventions reduced the number of drinks per week (weighted mean difference, −1.82 [95% confidence interval {CI}, −2.42 to −1.22]), the proportion exceeding recommended drinking limits (odds ratio [OR], 0.60 [95% CI, 0.53 to 0.67]), and the proportion reporting a heavy use episode (OR, 0.62 [95% CI, 0.55 to 0.71]), and increased the proportion of pregnant women reporting abstinence (OR, 1.92 [95% CI, 1.19 to 3.09]) after 6 to 12 months. \n\nHeterogeneity was high and effect size was associated with a number of study characteristics such as setting, target age of the population, publication year, study size, and average baseline-use levels, but not clearly associated with any intervention characteristics. Data on effectiveness in important subgroups were very limited, but analyses by sex, the most commonly reported subgroup analysis, did not indicate differences in effectiveness of the interventions. Health outcomes were sparsely reported and, with some exceptions, generally did not demonstrate group differences in effect. No evidence of harm was found.","Among adults, screening instruments are available that can effectively identify persons with unhealthy alcohol use and that are feasible for use in primary care settings, and interventions in those who screen positive are associated with reductions in unhealthy alcohol use. There was no evidence that these interventions have unintended harmful effects. More evidence is needed to determine whether screening for unhealthy alcohol use is beneficial for adolescents."]
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[null,"Canadian Agency for Drugs and Technologies in Health. E-therapy interventions for treatments of substance use disorders and other addictions: a review of clinical effectiveness. Ottawa: CADTH; 2018. \nAvailable here.\n","Adults with diagnosed substance use disorders or with a diagnosed addiction disorder, with or without co-morbid mental health conditions. ","The purpose of this CADTH Rapid Response was to review the comparative effectiveness of therapist-guided e-therapy interventions versus other options for the treatment of adults with substance use disorders and other addictions. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nWhat is the clinical effectiveness of e-therapy for the treatment of patients with substance use disorders and other addictions? \nOne SR examined the efficacy of internet-delivered interventions for alcohol addiction. The difference in alcohol consumption between the e-therapy with therapist guidance and no treatment groups at the post-treatment follow-up was statistically significant (with the e-therapy group having less consumption) and the effect of guided e-therapy was found to be small. The authors concluded that internet-delivered interventions were effective in reducing alcohol consumption and that the effect was small.\n","Evidence on e-therapy for the treatment of substance use disorders and other addictions was from a small number of SRs and RCTs. Findings consistently showed that therapist-guided e-therapy was superior to no treatment and wait list in reducing alcohol consumption or cannabis use, and the effect was small. With respect to substances, evidence was limited to the treatment of problematic alcohol and cannabis use and it is therefore unclear if the results generalize to the misuse of other substances."]
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[null,"Egholm JWM et al. Perioperative alcohol cessation intervention for postoperative complications Cochrane Database of Syst Rev 2018, Issue 11. Art. No.: CD008343. DOI: 10.1002/14651858.CD008343.pub3\n\nAvailable here.\n","Included participants with risky consumption of alcohol who were undergoing all types of elective or acute surgical procedures under general or regional anaesthesia or sedation, who were offered perioperative alcohol cessation intervention or no intervention. ","This Cochrane systematic review aimed to assess the effects of perioperative alcohol cessation interventions on rates of postoperative complications and alcohol consumption. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nOne new study was included in this updated review, resulting in a total of three RCTs (140 participants who drank 3 to 40 AU/d). All three studies were of moderate to good quality. All studies evaluated the effects of intensive alcohol cessation interventions, including pharmacological strategies for alcohol withdrawal symptoms, patient education, and relapse prophylaxis. The authors identified one ongoing study.\n\nInvestigators describe more successful quitters at the end of the intervention programme than among controls. Forty-one out of 70 participants in the intervention groups successfully quit drinking compared with only five out of 70 participants in the control groups (RR 8.22, 95% CI 1.67 to 40.44). The quality of evidence for this outcome is moderate.\n\nAll three studies reported postoperative alcohol consumption (grams of alcohol/week) at the end of the programme as median and range values; therefore it was not possible to estimate the mean and the SD. We performed no meta-analysis. All three studies reported length of stay, and none of these studies described a significant difference in length of stay. Data were insufficient for review authors to perform a meta-analysis. No studies reported on the prevalence of participants without risky drinking in the longer term.\n\nIncluded studies were few and reported small sample sizes; therefore one should be careful about drawing firm conclusions based on these study results. All three studies were conducted in Denmark, and most participants were men. The included participants may represent a selective group, as they could have been more motivated and/or more interested in participating in clinical research or otherwise different, and effects may have been overestimated for both intervention and control groups in these studies. Trial results indicate that these studies are difficult to perform, that strong research competencies are necessary for future studies, and that further evaluation of perioperative alcohol cessation interventions in high-quality randomised controlled trials is needed. Once published and assessed, the one ’ongoing’ study identified may alter the conclusions of this review.","The authors conclude that all three studies showed a significant reduction in the number of participants who quit drinking alcohol during the intervention period. Intensive alcohol cessation interventions offered for four to eight weeks to participants undergoing all types of surgical procedures to achieve complete alcohol cessation before surgery probably reduced the number of postoperative complications. Data were insufficient for review authors to assess their effects on postoperative mortality. No studies reported an effect on length of stay, and no studies addressed the prevalence of risky drinking in the longer term.\n\n\n"]
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[null,"Klimas J et al. Psychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users. Cochrane Database Syst Rev 2018, Issue 12. Art. No.: CD009269. DOI: 10.1002/14651858.CD009269.pub4.\nAvailable here. \n","Problem alcohol and illicit drug users (principally problem drug users of opiates and stimulants). ","This Cochrane review aimed to assess the effects of psychosocial interventions for problem alcohol use in illicit drug users. \n\nThe psychosocial interventions considered in the studies were: cognitive‐behavioural coping skills training (one study), twelve‐step programme (one study), brief intervention (three studies), motivational interviewing (two studies), and brief motivational interviewing (one study). Two studies were considered in two comparisons. There were no data for the secondary outcome, alcohol‐related harm. The results were as follows. \n\nComparison 1: cognitive‐behavioural coping skills training versus twelve‐step programme (one study, 41 participants): There was no significant difference between groups for either of the primary outcomes (alcohol abstinence assessed with Substance Abuse Calendar and breathalyser at one year: risk ratio (RR) 2.38 (95% confidence interval [CI] 0.10 to 55.06); and retention in treatment, measured at end of treatment: RR 0.89 (95% CI 0.62 to 1.29), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was very low. \n\nComparison 2: brief intervention versus treatment as usual (three studies, 197 participants): There was no significant difference between groups for either of the primary outcomes (alcohol use, measured as scores on the Alcohol Use Disorders Identification Test (AUDIT) or Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) at three months: standardised mean difference (SMD) 0.07 (95% CI ‐0.24 to 0.37); and retention in treatment, measured at three months: RR 0.94 (95% CI 0.78 to 1.13), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was low. \n\nComparison 3: motivational interviewing versus treatment as usual or educational intervention only (three studies, 462 participants): There was no significant difference between groups for either of the primary outcomes (alcohol use, measured as scores on the AUDIT or ASSIST at three months: SMD 0.04 (95% CI ‐0.29 to 0.37); and retention in treatment, measured at three months: RR 0.93 (95% CI 0.60 to 1.43), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was low. \n\nComparison 4: brief motivational intervention (BMI) versus assessment only (one study, 187 participants): More people reduced alcohol use (by seven or more days in the past month, measured at six months) in the BMI group than in the control group (RR 1.67; 95% CI 1.08 to 2.60). There was no difference between groups for the other primary outcome, retention in treatment, measured at end of treatment: RR 0.98 (95% CI 0.94 to 1.02), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was moderate. \n\nComparison 5: motivational interviewing (intensive) versus motivational interviewing (one study, 163 participants): There was no significant difference between groups for either of the primary outcomes (alcohol use, measured using the Addiction Severity Index‐alcohol score (ASI) at two months: MD 0.03 (95% CI 0.02 to 0.08); and retention in treatment, measured at end of treatment: RR 17.63 (95% CI 1.03 to 300.48), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was low. \n\n","The review authors found low to very low‐quality evidence to suggest that there is no difference in effectiveness between different types of psychosocial interventions to reduce alcohol consumption among people who use illicit drugs, and that brief interventions are not superior to assessment‐only or to treatment as usual. No firm conclusions can be made because of the paucity of the data and the low quality of the retrieved studies."]
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[null,"Agabio R, Trogu E, Pani PP. Antidepressants for the treatment of people with co‐occurring depression and alcohol dependence. Cochrane Database Syst Rev 2018, Issue 4. Art. No.: CD008581. DOI: 10.1002/14651858.CD008581.pub2.\nAvailable here. \n","Adults with co-occurring depression and alcohol dependence. ","This Cochrane review aimed to assess the benefits and risks of antidepressants for the treatment of people with co‐occurring depression and alcohol dependence. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text\n\nReview authors report that 33 studies were included in the review (2242 participants). Antidepressants were compared to placebo (22 studies), psychotherapy (two studies), other medications (four studies), or other antidepressants (five studies). The mean duration of the trials was 9.9 weeks (range 3 to 26 weeks). Eighteen studies took place in the USA, 12 in Europe, two in Turkey, and one in Australia. The antidepressant included in most of the trials was sertraline; other medications were amitriptyline, citalopram, desipramine, doxepin, escitalopram, fluoxetine, fluvoxamine, imipramine, mianserin, mirtazepine, nefazodone, paroxetine, tianeptine, venlafaxine, and viloxazine. Eighteen studies were conducted in an outpatient setting, nine in an inpatient setting, and six in both settings. Psychosocial treatment was provided in 18 studies. There was high heterogeneity in the selection of outcomes and the rating systems used for diagnosis and outcome assessment.\n\nModerate‐quality evidence found that antidepressants increased the number of participants abstinent from alcohol during the trial (7 studies, 424 participants, RR 1.71, 95 per cent Cl 1.22 to 2.39) and reduced the number of drinks per drinking days (7 studies, 451 participants, mean difference (MD) ‐1.13 drinks per drinking days, 95 per cent Cl ‐1.79 to ‐0.46). After the exclusion of studies with high risk of bias, the number of abstinent remained higher (RR 1.69, 95 per cent CI 1.18 to 2.43) and the number of drinks per drinking days lower (MD ‐1.21 number of drinks per drinking days, 95 per cent CI ‐1.91 to ‐0.51) among participants who received antidepressants compared to those who received placebo. However, other outcomes such as the rate of abstinent days did not differ between antidepressants and placebo (9 studies, 821 participants, MD 1.34, 95 per cent Cl ‐1.66 to 4.34; low‐quality evidence).\n\nThere were few studies comparing one antidepressant versus another antidepressant or antidepressants versus other interventions, and these had a small sample size and were heterogeneous in terms of the types of interventions that were compared, yielding results that were not informative.\n","Authors found low‐quality evidence supporting the clinical use of antidepressants in the treatment of people with co‐occurring depression and alcohol dependence. Antidepressants had positive effects on certain relevant outcomes related to depression and alcohol use but not on other relevant outcomes. Moreover, most of these positive effects were no longer significant when studies with high risk of bias were excluded. Results were limited by the large number of studies showing high or unclear risk of bias and the low number of studies comparing one antidepressant to another or antidepressants to other medication. In people with co‐occurring depression and alcohol dependence, the risk of developing adverse effects appeared to be minimal, especially for the newer classes of antidepressants (such as selective serotonin reuptake inhibitors). According to these results, in people with co‐occurring depression and alcohol dependence, antidepressants may be useful for the treatment of depression, alcohol dependence, or both, although the clinical relevance may be modest."]
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[null,"Kaner E et al. Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev 2018, Issue 2.\nAvailable here. ","People who routinely presented to general practice, emergency care or other primary care settings for a range of health problems, whose alcohol consumption was identified by a screening tool as being excessive, or who had experienced harm as a result of their drinking behaviour","This Cochrane systematic review aimed to assess the effectiveness of screening and brief alcohol intervention to reduce excessive alcohol consumption in hazardous or harmful drinkers in general practice or emergency care settings.\n\nThe reviewers found moderate‐quality evidence that brief alcohol interventions have little impact on frequency of binges per week (MD ‐0.08, 95% CI ‐0.14 to ‐0.02; 15 studies, 6946 participants); drinking days per week (MD ‐0.13, 95% CI ‐0.23 to ‐0.04; 11 studies, 5469 participants); or drinking intensity (‐0.2 g/drinking day, 95% CI ‐3.1 to 2.7; 10 studies, 3128 participants).\n\nThey found moderate‐quality evidence of little difference in quantity of alcohol consumed when extended and no or minimal interventions were compared (‐20 g/week, 95% CI ‐40 to 1; 6 studies, 1296 participants). There was little difference in binges per week (‐0.08, 95% CI ‐0.28 to 0.12; 2 studies, 456 participants; moderate‐quality evidence) or difference in days drinking per week (‐0.45, 95% CI ‐0.81 to ‐0.09; 2 studies, 319 participants; moderate‐quality evidence). Extended versus no or minimal intervention provided little impact on drinking intensity (9 g/drinking day, 95% CI ‐26 to 9; 1 study, 158 participants; low‐quality evidence).\n\nExtended intervention had no greater impact than brief intervention on alcohol consumption, although findings were imprecise (MD 2 g/week, 95% CI ‐42 to 45; 3 studies, 552 participants; low‐quality evidence). Numbers of binges were not reported for this comparison, but one trial suggested a possible drop in days drinking per week (‐0.5, 95% CI ‐1.2 to 0.2; 147 participants; low‐quality evidence). Results from this trial also suggested very little impact on drinking intensity (‐1.7 g/drinking day, 95% CI ‐18.9 to 15.5; 147 participants; very low‐quality evidence).","The authors concluded that they found moderate‐quality evidence that brief interventions can reduce alcohol consumption in hazardous and harmful drinkers compared to minimal or no intervention. Longer counselling duration probably has little additional effect. Future studies should focus on identifying the components of interventions which are most closely associated with effectiveness."]
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[null,"Kaner E et al. Personalised digital interventions for reducing hazardous and harmful alcohol consumption in community-dwelling populations. Cochrane Database Syst Rev 2017, Issue 9, Art. No.: CD011479. DOI: 10.1002/14651858.CD011479.pub2. \nAvailable here. \n","People living in the community whose alcohol consumption had been screened as hazardous or harmful. ","This Cochrane review aimed to assess the effectiveness and cost‐effectiveness of digital interventions for reducing hazardous and harmful alcohol consumption, alcohol‐related problems, or both, in people living in the community.\n\nFifty-seven studies which randomised a total of 34,390 participants were included in the review. The main sources of bias were from attrition and participant blinding (36 per cent and 21 per cent of studies respectively, high risk of bias). Forty one studies (42 comparisons, 19,241 participants) provided data for the primary meta‐analysis, which demonstrated that participants using a digital intervention drank approximately 23g alcohol weekly (95 per cent CI 15 to 30) (about 3 UK units) less than participants who received no or minimal interventions at end of follow up (moderate‐quality evidence). \n\nFifteen studies (16 comparisons, 10,862 participants) demonstrated that participants who engaged with digital interventions had less than one drinking day per month fewer than no intervention controls (moderate‐quality evidence), 15 studies (3587 participants) showed about one binge drinking session less per month in the intervention group compared to no intervention controls (moderate‐quality evidence), and in 15 studies (9791 participants) intervention participants drank one unit per occasion less than no intervention control participants (moderate‐quality evidence). \n\nOnly five small studies (390 participants) compared digital and face‐to‐face interventions. There was no difference in alcohol consumption at end of follow up (MD 0.52 g/week, 95 per cent CI ‐24.59 to 25.63; low‐quality evidence). \n\nThe most frequently mentioned theories or models in the included studies were Motivational Interviewing Theory (7/20), Transtheoretical Model (6/20) and Social Norms Theory (6/20). Over half of the interventions (n = 21, 51per cent) made no mention of theory. Only two studies used theory to select participants or tailor the intervention. There was no evidence of an association between reporting theory use and intervention effectiveness.\n","There is moderate‐quality evidence that digital interventions may lower alcohol consumption, with an average reduction of up to three (UK) standard drinks per week compared to control participants. Substantial heterogeneity and risk of performance and publication bias may mean the reduction was lower. Low‐quality evidence from fewer studies suggested there may be little or no difference in impact on alcohol consumption between digital and face‐to‐face interventions. \n\nThe BCTs of behaviour substitution, problem solving and credible source were associated with the effectiveness of digital interventions to reduce alcohol consumption and warrant further investigation in an experimental context. \n\nReporting of theory use was very limited and often unclear when present. Over half of the interventions made no reference to any theories. Limited reporting of theory use was unrelated to heterogeneity in intervention effectiveness. \n"]
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[null,"Canadian Agency for Drugs and Technology in Health. Concurrent treatment for substance use disorder and trauma-related comorbidities: a review of clinical effectiveness and guidelines. Ottawa: CADTH; 2017. \nAvailable here. ","Adults with substance use disorder and trauma-related comorbidities (PTSD, anxiety or depression). \n\nSubgroup of interest: military veterans","The purpose of this report by CADTH was to review treatment options for patients with comorbid substance use disorder (SUD) and post-traumatic stress disorder, anxiety, or depression by comparing concurrent treatments for SUD and the mental disorders with no treatment, usual care or active treatment for one condition only and treatment for a single condition (SUD or the mental disorders) with no treatment, usual care or active treatment for the second disorder. Additionally, this review aimed to review evidence-based guidelines regarding the treatments for patients with these comorbidities. \n\nThe review addressed three main research questions. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\n1. What is clinical effectiveness of concurrent treatment for patients with substance use disorders and comorbid post-traumatic stress disorder, anxiety, or depression?\nPatients with comorbid SUD and PTSD: In summary, findings with respect to SUD outcomes for integrated treatments addressing both PTSD and SUD, were inconsistent.\nPatients with comorbid SUD and depression: In summary, there is a suggestion that integrated treatments are more effective than control treatments or treatments addressing a single condition, but findings were not always consistent.\nPatients with SUD and anxiety disorder: One RCT showed that fewer patients relapsed to any drinking in the CBT group compared to the PMRT group. Another RCT showed that the nine hour anxiety-sensitivity focused intervention plus TAU over TAU alone, showed improvement in percent days abstinent in both groups, but showed no significant between group difference.\nPatients with SUD and depression or anxiety disorder: An RCT showed that ICBT appeared to be more effective than usual care with respect to most measures of alcohol consumption.\n\n2. What is the clinical effectiveness of the treatment of one condition for the improvement of all symptoms in patients with substance use disorder and comorbid post-traumatic stress disorder, anxiety, or depression?\nA systematic review included six studies that evaluated addiction based interventions. Two studies comparing the experimental contingency management (CM) treatment with control treatment found slightly better early treatment gains with respect to substance use with CM, however the differences did not remain significant in the long term as shown in one study. Results from three studies (other than CM) showed within-group improvement in SUD outcomes over time even for minimal or no treatment. One study showed that the care management program was associated with better alcohol outcomes compared to the AUD treatment that patients identified on their own.\nAnother systematic review included one study comparing technology-based treatment (TAU plus web based intervention targeting alcohol use) with TAU alone, reported no findings with respect to substance use.\n\n3. What are the evidence-based guidelines regarding the treatment of patients with substance use disorders and comorbid post-traumatic stress disorder, anxiety, or depression?\nOne relevant evidence-based guideline was identified. For comorbid anxiety and alcohol use disorder or for comorbid PTSD and alcohol use disorder, an integrated approach was recommended (Recommendation grade: CCP i.e. “Clinical consent point”). For comorbid depression and alcohol use disorder, CBT was recommended to improve both depressive symptoms and drinking problems.","Report authors found there was a suggestion that integrated treatments offered greater improvement with respect to PTSD symptoms, depression or anxiety compared to no treatment or minimal treatment for patients with comorbid substance use disorder (SUD) and posttraumatic stress syndrome (PTSD), depression or anxiety disorder. However results were not always consistent. In patients with comorbid SUD and PTSD, there was a suggestion that addiction based interventions were more effective with respect to controlling substance use than control treatments. One evidence-based guideline recommended an integrated treatment approach for patients with comorbid alcohol use disorder and PTSD, or comorbid alcohol use disorder and anxiety disorder, and cognitive behavioural therapy for comorbid alcohol use disorder and depression."]
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[null,"Canadian Agency for Drugs and Technology in Health. Inpatient and outpatient treatment programs for substance use disorder: a review of clinical effectiveness and guidelines. Ottawa: CADTH; 2017a. \nAvailable here. \n","Adults 18 to 65 years with substance use disorder/addiction disorder (e.g., abuse of prescription medications or cocaine, heroin, cannabis, alcohol)\n","This Rapid Response report by CADTH aimed to review the clinical effectiveness of inpatient and outpatient treatment programs for adults with substance use disorders involving prescription medications such as analgesics or non-prescription substances such as cocaine, opioids such as heroine, marijuana (cannabis), or alcohol. Evidence-based guidelines associated with inpatient and outpatient treatment programs in adults with substance use disorders were also examined.\n\nThe review addressed two main research questions. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\n1. What is the clinical effectiveness of inpatient and outpatient treatment programs in adults with substance use disorders?\nOne narrative review concluded that evidence supports the case for community detoxification in patients with alcohol dependence. One RCT with long-term follow-up (18 months) concluded that the evidence found initial but decreasing benefit of inpatient over outpatient care across time. One prospective study found inpatients consumed significantly less alcohol in the year after entering treatment than outpatients as measured by the Graduated Frequency Scale questionnaire, and had significantly greater engagement with Alcohol Anonymous program than outpatients in the year after treatment. One retrospective study reported that inpatients with substance use disorders are three times more likely to complete treatment than outpatients.\n\n2. What are the evidence-based guidelines associated with inpatient and outpatients treatment programs in adults with substance use disorders?\nThe evidence-based guidelines from British Columbia Ministry of Health on opioids use disorder recommend that withdrawal management, if needed, can be provided more safely in an outpatient setting rather than in an inpatient setting in most patients. For patients who wish to avoid long-term opioid agonist treatment, supervised slow (longer than one month) outpatient or residential opioid agonist taper can be provided rather than rapid (less than one week) inpatient opioid agonist taper. The slow approach may permit a more flexible and individualised approach to tapered agonist reduction, which allows dose adjustment and stabilisation in case withdrawal symptoms occur.\n\n","For patients with alcohol use disorders, better detoxification completion and abstinence rates, and similar adverse event rates, were found in outpatient care compared to inpatient care in a couple of studies with short follow-up periods (one to two months). One study with a longer follow-up period found inpatients consumed less alcohol than outpatients in the year after entering treatment. This may be explained by the controlled environment of inpatient care that avoids the distractions that could be present in an outpatient care situation. In patients with severe alcohol dependence, data from one study found initial but decreasing benefit of inpatient over outpatient care across time in alcohol abstinence. For patients with substance use disorders, data from one study showed inpatients are more likely to complete treatment than outpatients. The small number of studies found and their heterogeneity in design and reported outcomes cautioned the interpretation of the findings. \n\n\n"]
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[null,"Brown TJ, Todd A, O'Malley CL, Moore HJ, Husband AK, Bambra C, et al. Community pharmacy interventions for public health priorities: a systematic review of community pharmacy-delivered smoking, alcohol and weight management interventions. Public Health Res 2016;4(2)\nAvailable here.","People of all ages and in any country","This review aimed to systematically review the effectiveness of community pharmacy interventions to manage alcohol misuse, smoking cessation and weight loss; to explore if and how age, sex, ethnicity and socioeconomic status moderate effectiveness; and to describe how the interventions have been organised, implemented and delivered.\n\nTwenty-four studies were included: two alcohol, 12 smoking cessation, five weight loss and five multicomponent interventions that included pharmacotherapy and lifestyle changes in participants with diabetes mellitus, dyslipidaemia or hypertension. Nine of the studies were UK based; seven of the studies were rated ‘strong’ for quality. All studies were of adults. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nAlcohol outcomes: There were two RCTs of brief alcohol interventions in adults compared with usual care or leaflet-only control; global ratings were strong for one study and weak for the other. Table 8 in full-text summarises the results. Both studies had change in alcohol consumption as the primary outcome; however, different tools were used in each. Eligibility criteria for both studies were scores that indicated ‘possible harmful or hazardous alcohol consumption, but not alcohol dependence’. There were insufficient data to conduct meta-analyses.\n\nAt 12 weeks there was no evidence in effectiveness of community pharmacist delivery of brief alcohol intervention. The AUDIT total change score did not differ significantly between the two groups and did not change significantly between baseline and follow-up in either the intervention or control group. The 12-week AUDIT between-group difference adjusted for pharmacist, sex, age, ethnicity and education was –0.57 [95% confidence interval (CI) –1.59 to 0.45]. There was no significant difference between FAST score for the intervention group compared with control at 3 or 6 months and adjusted for baseline FAST. The 6-month FAST between-group difference was –1.84 (95% CI –4.49 to 0.82). At 6 months there was substantially lower follow-up of intervention clients (22.2%) than of control clients (33.3%).\n\nNeither study evaluated differential effects by demographic or socioeconomic factors. One study reported change in FAST scores by sex; however, the numbers of participants were very small and the study was not powered to detect differences between the two groups.","There was insufficient evidence for the effectiveness of community pharmacy-based brief alcohol interventions.\n\nEvaluations of interventions to manage alcohol misuse and obesity, set within the community pharmacy, are needed.\n\nThe effect of community pharmacy interventions on health inequalities is unclear. Future research in this area is warranted, and trials should include the assessment of age, sex, ethnicity, socioeconomic status and contextual factors, and present analysis of how these factors moderate effectiveness.\n"]
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[null,"Roberts NP et al. Psychological therapies for post‐traumatic stress disorder and comorbid substance use disorder. Cochrane Database Syst Rev 2016, Issue 4. Art. No.: CD010204. DOI: 10.1002/14651858.CD010204.pub2.\nAvailable here. \n","Individuals with comorbid PTSD and SUD","This Cochrane review aimed to determine the efficacy of psychological therapies aimed at treating traumatic stress symptoms, substance misuse symptoms, or both in people with comorbid PTSD and SUD in comparison with control conditions (usual care, waiting‐list conditions, and no treatment) and other psychological therapies. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nFourteen studies with 1506 participants were included, of which 13 studies were included in the quantitative synthesis. Most studies involved adult populations. Studies were conducted in a variety of settings. Four comparisons were undertaken investigating the effects of psychological therapies with a trauma‐focused component and non‐trauma‐focused interventions against treatment as usual/minimal intervention and other active psychological therapies. Comparisons were stratified for individual‐ or group‐based therapies. All active interventions were based on CBT.\n\nIndividual‐based psychological therapies with a trauma‐focused component plus adjunctive SUD intervention: There was no evidence of an effect for level of drug/alcohol use post‐treatment (SMD ‐0.13; 95% CI ‐0.41 to 0.15; 3 studies; n = 388; very low‐quality evidence), but there was a small effect in favour of individual psychological therapy at 5 to 7 months (SMD ‐0.28; 95% CI ‐0.48 to ‐0.07; 3 studies; n = 388) when compared against TAU.\n\nIndividual‐based psychological therapy with a trauma‐focused component: did not perform better than psychological therapy for SUD only for drug/alcohol use (MD ‐1.27; 95% CI ‐5.76 to 3.22; 1 study; n = 46; low‐quality evidence). Findings were based on one small study.\n\nNon‐trauma‐focused psychological therapies: did not perform better than TAU/minimal intervention. There were no data on the effects on drug/alcohol use for individual therapy. There was no evidence of an effect on the level of drug/alcohol use for group‐based therapy (SMD ‐0.03; 95% CI ‐0.37 to 0.31; 4 studies; n = 414; very low‐quality evidence). A post‐hoc analysis for full dose of a widely established group therapy called Seeking Safety showed reduced drug/alcohol use post‐treatment (SMD ‐0.67; 95% CI ‐1.14 to ‐0.19; 2 studies; n = 111), but not at subsequent follow‐ups.\nThese also did not perform better than psychological therapy for SUD only for drug/alcohol use (SMD 0.22; 95% CI ‐0.13 to 0.57; 2 studies; n = 128; low‐quality evidence).\n","The reviewers assessed the evidence in this review as mostly low to very low quality. Evidence showed that individual trauma‐focused psychological therapy delivered alongside SUD therapy did better than TAU/minimal intervention in reducing PTSD severity post‐treatment and at long‐term follow‐up, but only reduced SUD at long‐term follow‐up. All effects were small, and follow‐up periods were generally quite short. There was evidence that fewer participants receiving trauma‐focused therapy completed treatment. There was very little evidence to support use of non‐trauma‐focused individual‐ or group‐based integrated therapies. Individuals with more severe and complex presentations (e.g. serious mental illness, individuals with cognitive impairment, and suicidal individuals) were excluded from most studies in this review, and so the findings from this review are not generalisable to such individuals. Some studies suffered from significant methodological problems and some were underpowered, limiting the conclusions that can be drawn. Further research is needed in this area."]
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[null,"Tansil KA et al. Alcohol Electronic Screening and Brief Intervention A Community Guide Systematic Review. Am J Prev Med 2016;51(5):801–811). \nAvailable here. \n","Unspecified","This Community Guide review focused on e-screening and brief interventions (e-SBIs) that are similar in structure and intent to Alcohol screening and brief intervention (ASBI) and examined how e-SBI effectiveness varied by key intervention characteristics, in contrast to previous systematic reviews of e-SBI. This review is unique in that it excluded highly interactive interventions (i.e., those with more than three human-to-human sessions); those that were part of a treatment program for alcohol use disorders; those that were primarily educational programs (e.g., Alcohol Edu, College Alc); and those that only used an electronic device for monitoring drinking following traditional ASBI.\n\nTwenty-four studies (28 study arms) provided results for excessive drinkers only and seven studies (eight study arms) reported results for all drinkers. Nearly all studies found that e-SBI reduced excessive alcohol consumption and related harms: nine study arms reported a median 23.9% reduction in binge-drinking intensity (maximum drinks/binge episode) and nine study arms reported a median 16.5% reduction in binge-drinking frequency. Reductions in drinking measures were sustained for up to 12 months.","The authors conclude that, according to Community Guide rules of evidence, e-SBI is an effective method for reducing excessive alcohol consumption and related harms among intervention participants. Implementation of e-SBI could complement population-level strategies previously recommended by the Community Preventive Services Task Force for reducing excessive drinking (e.g., increasing alcohol taxes and regulating alcohol outlet density)."]
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[null,"Foxcroft DR et al. Social norms information for alcohol misuse in university and college students. Cochrane Database Syst Rev 2015, Issue 12. Art. No.: CD006748. DOI: 10.1002/14651858.CD006748.pub4.\nAvailable here. \n","University or college students. ","This Cochrane review aimed to determine whether social norms interventions reduce alcohol‐related negative consequences, alcohol misuse or alcohol consumption when compared with a control (ranging from assessment only/no intervention to other educational or psychosocial interventions) among university and college students.\n\nSeventy studies (44,958 participants) were included in the review, and 63 studies (42,784 participants) in the meta‐analyses. Overall, the risk of bias assessment showed that these studies provided moderate or low quality evidence. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nBinge drinking at four or more months (results pooled across delivery modes): SMD ‐0.06, 95 per cent CI ‐0.11 to ‐0.02 (participants = 11,292; studies = 16; moderate quality evidence), equivalent to 2.7 per cent fewer binge drinkers if 30‐day prevalence is 43.9 per cent.\n\nDrinking quantity at four or more months (results pooled across delivery modes): SMD ‐0.08, 95 per cent CI ‐0.12 to ‐0.04 (participants = 21,169; studies = 32; moderate quality evidence), equivalent to a reduction of 0.9 drinks consumed each week, from a baseline of 13.7 drinks per week.\n\nDrinking frequency at four or more months: WF SMD ‐0.11, 95 per cent CI ‐0.17 to ‐0.04 (participants = 9929; studies = 10; moderate quality evidence), equivalent to a decrease of 0.17 drinking days/wk, from a baseline of 2.74 days/wk; individual face‐to‐face normative feedback SMD ‐0.21, 95 per cent CI ‐0.31 to ‐0.10 (participants = 1464; studies = 8; moderate quality evidence), equivalent to a decrease of 0.32 drinking days/wk, from a baseline of 2.74 days/wk. No effects were found for group face‐to‐face normative feedback or normative marketing campaign.\n\nEstimated blood alcohol concentration (BAC) at four or more months: (Peak BAC results pooled across delivery modes) SMD ‐0.08, 95 per cent CI ‐0.17 to 0.00 (participants = 7198; studies = 11; low quality evidence), equivalent to a reduction in peak BAC from an average of 0.144 per cent to 0.135 per cent. No effects were found for typical BAC with individual face‐to‐face normative feedback.\n","The results of this review indicate that no substantive meaningful benefits are associated with social norms interventions for prevention of alcohol misuse among college/university students. Although some significant effects were found, we interpret the effect sizes as too small, given the measurement scales used in the studies included in this review, to be of relevance for policy or practice. Moreover, the significant effects are not consistent for all misuse measures, heterogeneity was a problem in some analyses and bias cannot be discounted as a potential cause of these findings. "]
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[null,"Canadian agency for Drugs and Technology in Health. Mindfulness interventions for the treatment of post-traumatic stress disorder, generalized anxiety disorder, depression and substance use disorders: a review of the clinical effectiveness and guidelines. Ottawa: CADTH; 2015. Available here. ","Adults with post-traumatic stress disorder (PTSD), generalised anxiety disorder (GAD), depression, or substance use disorders.","The objective of this review was to summarise the clinical effectiveness and guidelines for the use of mindfulness interventions for the treatment of PTSD, GAD, depression, and substance use disorders in adults. The review addressed two main research questions. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\n1. What is the clinical effectiveness of mindfulness interventions for the treatment of adults with PTSD, GAD, Depression, or substance use disorders?\nA study reported, that compared with treatment as usual, participants assigned to mindfulness-based relapse prevention reported significantly lower risk of heavy drinking, significantly fewer days of heavy drinking at the 6-month follow-up. At the 12-month follow-up, mindfulness-based relapse prevention participants reported significantly decreased heavy drinking compared with relapse prevention and treatment as usual.\n\n2. What are the evidence-based guidelines regarding the use of mindfulness interventions for the treatment of adults with PTSD, GAD, Depression, or substance use disorders?\nThe guideline by the New South Wales Department of Health suggested that mindfulness could be used to treat problematic drug and alcohol users.\n\n","The evidence for the efficacy of mindfulness as a treatment for individuals with substance use disorders was limited. One RCT of low methodological quality suggested that mindfulness intervention is more effective than treatment as usual in lowering risk of relapse to substance use and heavy drinking. One guideline suggested that mindfulness can be used to treat problematic drug and alcohol use problems by suitably trained and experienced drug and alcohol professionals.\n"]
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[null,"Canadian agency for Drugs and Technology in Health. Yoga for the Treatment of Post-Traumatic Stress Disorder, Generalized Anxiety Disorder, Depression, and Substance Abuse: A Review of the Clinical Effectiveness and Guidelines. Ottawa: CADTH; 2015a. Available here. ","Adults with PTSD, GAD, depression, or substance use disorders.","The objective of this Rapid Response report is to review the clinical effectiveness of yoga for treating PTSD, GAD, depression and substance abuse, and to summarize the guidelines that are associated with the use of yoga for these conditions.The review addressed two main research questions. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\n1. What is the clinical effectiveness of yoga as an intervention for the treatment of PTSD, GAD, depression, or substance use disorders?\nOne study found that yoga was a feasible adjunct treatment for treating alcohol dependence. Patients in the yoga intervention group had a higher baseline level of drinking compared to the control group and there were positive, non-significant changes in alcohol consumption at six month follow-up, numerically greater than that experienced by the control. \ngroup\n\n2. What are the evidence-based guidelines regarding the use of mindfulness interventions for the treatment of adults with PTSD, GAD, Depression, or substance use disorders?\nFive evidence-based guidelines were included in this report, two of which did not find enough evidence for yoga to provide a recommendation. None of the recommendations focused specifically on alcohol consumption.\n\n","Three RCTs of low methodological quality suggested that patients with substance abuse improved with respect to some symptoms with yoga. Five evidence based guideline documents considered the use of yoga in clinical practice. Three suggested that yoga may be useful as an adjunctive treatment for treating major depressive disorder (MDD), PTSD and GAD, if available. "]
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[null,"Ipser JC et al. Pharmacotherapy for anxiety and comorbid alcohol use disorders. Cochrane Database Syst Rev 2015, Issue 1. Art. No.: CD007505. DOI: 10.1002/14651858.CD007505.pub2\nAvailable here. \n","People diagnosed with alcohol dependence or abuse and an anxiety disorder according to DSM‐III, DSM‐IV, or DSM‐IV‐TR criteria.","This Cochrane review aimed to assess the effects of pharmacotherapy for treating anxiety in people with comorbid alcohol use disorders. Five placebo‐controlled pharmacotherapy RCTs (with 290 participants) were included in the review. Most of the trials provided little information on how randomisation was performed or on whether both participants and study personnel were blinded to the intervention. \n\nStudy participants had DSM) III‐ and DSM IV‐diagnosed alcohol use disorders and post‐traumatic stress disorder (two studies), social anxiety disorder (SAD; two studies) or generalized anxiety disorder (GAD; one study). Four trials assessed the efficacy of the selective serotonin re‐uptake inhibitors (SSRIs: sertraline, paroxetine); one RCT investigated the efficacy of buspirone, a 5‐hydroxytryptamine (5‐HT) partial agonist. Treatment duration lasted between eight and 24 weeks. Overall, 70% of participants included in the review were male. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nThere was no evidence of an effect for any of the medications tested on abstinence from alcohol use or depression symptoms.","The evidence‐base for the effectiveness of medication in treating anxiety disorders and comorbid alcohol use disorders is currently inconclusive. There was no evidence that alcohol use was responsive to medication. Large, rigorously conducted RCTs would help supplement the small evidence‐base for the efficacy and tolerability of pharmacotherapy for anxiety and comorbid alcohol use disorders. Further research on patient subgroups who may benefit from pharmacological treatment, as well as novel pharmacological interventions, is warranted. \n"]
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[null,"Siegfried N et al. Restricting or banning alcohol advertising to reduce alcohol consumption in adults and adolescents. Cochrane Database Syst Rev 2014, Issue 11. Art. No.: CD010704. DOI: 10.1002/14651858.CD010704.pub2.\nAvailable here. \n","Adults of any age and adolescents (defined by WHO as aged 10 to 19 years)","The aim of this Cochrane review was to evaluate the benefits, harms and costs of restricting or banning the advertising of alcohol, via any format, compared with no restrictions or counter‐advertising, on alcohol consumption in adults and adolescents.\n\nOne small RCT (80 male student participants conducted in the Netherlands and published in 2009) and three ITS studies (general population studies in Canadian provinces conducted in the 1970s and 80s) were examined. The RCT found that young men exposed to movies with a low‐alcohol content drank less than men exposed to movies with a high‐alcohol content (MD ‐0.65 drinks; 95 per cent CI ‐1.2, ‐0.07; p value = 0.03, very‐low‐quality evidence). Young men exposed to commercials with a neutral content compared with those exposed to commercials for alcohol drank less (MD ‐0.73 drinks; 95 per cent CI ‐1.30, ‐0.16; p value = 0.01, very‐low‐quality evidence). Outcomes were assessed immediately after the end of the intervention (lasting 1.5 hours), so no follow‐up data were available.\n\nTwo of the ITS studies evaluated the implementation of an advertising ban and one study evaluated the lifting of such a ban (GRADE: very‐low‐quality evidence). Each of the three ITS studies evaluated a different type of ban (partial or full) compared with different degrees of restrictions or no restrictions during the control period. The results from the three ITS studies were inconsistent. A meta‐analysis of the two studies that evaluated the implementation of a ban showed an overall mean non‐significant increase in beer consumption in the general population of 1.10 per cent following the ban (95 per cent CI ‐5.26, 7.47; p value = 0.43; I2 = 83 per cent, very‐low‐quality evidence). This finding is consistent with an increase, no difference, or a decrease in alcohol consumption. In the study evaluating the lifting of a total ban on all forms of alcohol advertising to a partial ban on spirits advertising only, which utilised an Abrupt Auto‐regressive Integrated Moving Average model, the volume of all forms of alcohol sales decreased by 11.11 kilolitres (95 per cent CI ‐27.56, 5.34; p value = 0.19) per month after the ban was lifted. In this model, beer and wine sales increased per month by 14.89 kilolitres (95 per cent CI 0.39, 29.39; p value = 0.04) and 1.15 kilolitres (95 per cent CI ‐0.91, 3.21; p value = 0.27), respectively, and spirits sales decreased statistically significantly by 22.49 kilolitres (95 per cent CI ‐36.83, ‐8.15; p value = 0.002).\n\nNone of the studies were funded by the alcohol or advertising industries.\n","Authors conclude that there is a lack of robust evidence for or against recommending the implementation of alcohol advertising restrictions. Advertising restrictions should be implemented within a high‐quality, well‐monitored research programme to ensure the evaluation over time of all relevant outcomes in order to build the evidence base. "]
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[null,"Pani PP et al. Anticonvulsants for alcohol dependence. Cochrane Database Syst Rev 2014, Issue 2. Art. No.: CD008544. DOI: 10.1002/14651858.CD008544.pub2.\nAvailable here. \n","Alcohol dependent adults. ","The primary aim of this Cochrane review is to assess the benefits/risks of anticonvulsants for the treatment of alcohol dependence. \n\nA total of 25 studies were included in the review (2641 participants). Most participants were male, with an average age of 44 years. Anticonvulsants were compared with placebo (17 studies), other medications (seven studies) and no medication (two studies). The mean duration of the trials was 17 weeks (range four to 52 weeks). The studies took place in the USA, Europe, South America, India and Thailand. Variation was reported in the characteristics of the studies, including their design and the rating instruments used. For many key outcomes, the risk of bias associated with unclear or unconcealed allocation and lack of blinding affected the quality of the evidence. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nAnticonvulsants versus placebo: For continuous abstinence (eight studies, 634 participants, RR 1.21, 95% Cl 95 per cent 0.97 to 1.52, moderate‐quality evidence), results showed no evidence of differences. Moderate‐quality evidence suggested that anticonvulsants reduced drinks/drinking days (11 studies, 1126 participants, mean difference (MD) ‐1.49, 95% Cl ‐2.32 to ‐0.65) and heavy drinking (12 studies, 1129 participants, standardised mean difference (SMD) ‐0.35, 95% Cl ‐0.51 to ‐0.19). The direction of results was confirmed by subgroup analyses for topiramate and partially for gabapentin and valproate. \n\nAnticonvulsants versus naltrexone: No evidence of difference was shown in severe relapse rates (four studies, 427 participants, RR 0.69, 95% Cl 0.44 to 1.07) and continuous abstinence rates (five studies, 528 participants, RR 1.21, 95% Cl 0.99 to 1.49); anticonvulsants were associated with fewer heavy drinking days (three studies, 308 participants, MD ‐5.21, 95% Cl ‐8.58 to ‐1.83) and more days to severe relapse (three studies, 244 participants, MD 11.88, 95% Cl 3.29 to 20.46).\n","The authors concluded that at the current stage of research, randomised evidence supporting the clinical use of anticonvulsants to treat alcohol dependence is insufficient. Results are conditioned by heterogeneity and by the low number and quality of studies comparing anticonvulsants with other medications. The uncertainty associated with these results leaves to clinicians the need to balance possible benefits/risks of treatment with anticonvulsants versus other medications as supported by evidence of efficacy."]
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[null,"Dedert E et al. e-interventions for alcohol misuse. Durham NC: Evidence-based Synthesis Program Center; 2014.\nAvailable here.\n","Adults with alcohol use disorders (AUD). ","This review evaluates computer-based interventions for alcohol misuse. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nEffects of E-Interventions Compared with Inactive Controls in Adults who Misuse Alcohol: Twenty-two studies with 13,929 participants and judged to be low (n=7) or moderate (n=12) risk of bias. Overall, the available data suggest that long-term effects of e-interventions on alcohol outcomes are modest or absent.\n\nEffects of E-Interventions Compared with Inactive Controls in Adults at High Risk of AUD (eg, AUDIT-C ≥8) or with a Diagnosis of AUD: 3 studies (2 moderate, 1 high risk of bias) in 533 patients with a diagnosis of AUD. Neither computerized feedback plus telephone counseling nor an interactive voice response system decreased alcohol consumption or risk of relapse. A multicomponent smartphone program used to support recovery following residential treatment increased abstinence (OR 1.94; 95% CI, 1.14 to 3.31) and decreased risky drinking days at 12-month follow-up.\n\n Effects of E-Interventions Alone or Used in Combination with Face-to-Face Therapy Compared with Face-to-Face Therapy Alone in Adults who Misuse Alcohol: Six trials with 1090 participants. Overall, this diverse group of studies did not find a benefit of e-interventions alone or as an adjunct to face-to-face  brief MI compared with face-to-face brief MI alone for college students or midlife primary care patients who misuse alcohol.","The authors reported that they found limited evidence for small or no effects of e-interventions compared with controls on long-term (≥6 months) alcohol outcomes in participants who screened positive for alcohol misuse. Findings were even more limited for participants with AUD or comparisons of e-interventions to face-to-face treatment. Further research is needed to determine with higher confidence whether e-interventions can produce long-term benefits for alcohol-related outcomes. In particular, given the limited number and duration of intervention episodes in the studies reviewed, it is possible that these e-interventions were not designed to be robust enough to produce significant, enduring effects on alcohol misuse. As reported in previous reviews, brief in-person interventions produce sustained reductions in alcohol consumption in participants with alcohol misuse. Current evidence does not support substitution of e-interventions for brief, in-person treatment. Future research on e-interventions should include evaluations of more intensive or longer duration e-interventions for alcohol misuse. "]
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[null,"Jonas DE et al. Pharmacotherapy for adults with alcohol-use disorders in outpatient settings. Rockville MD: Agency for Healthcare Research and Quality; 2014. \nAvailable here. \n\nThis report has been archived by AHRQ and is being updated. The update protocol can be accessed here.","Adults with alcohol-use disorders. ","The aim of this report was to conduct a systematic review and meta-analysis of the efficacy, comparative effectiveness, and harms of medications (both FDA approved and others) for adults with alcohol-use disorders, and to evaluate the evidence from primary care settings.\n\nOne hundred and thirty five studies were included. Most patients met criteria for alcohol dependence; mean ages were in the 40s. Studies typically included psychosocial cointerventions; effect sizes reflect the added benefits of medications. For acamprosate and oral naltrexone (50 mg per day), numbers needed to treat (NNTs) to prevent 1 person from returning to any drinking were 12 and 20, respectively (moderate SOE); NNT to prevent 1 person from returning to heavy drinking was 12 for oral naltrexone (50 mg per day) (moderate SOE). Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nMeta-analyses of four head-to-head trials found no statistically significant difference between the two medications for consumption outcomes (moderate SOE). For injectable naltrexone, meta-analyses found no significant benefit for return to any or heavy drinking, but found a reduction in heavy drinking days (low SOE). Evidence from well-controlled trials does not support efficacy of disulfiram, except possibly for patients with excellent adherence. Among medications used off label, moderate evidence supports the efficacy of nalmefene and topiramate for improving some consumption outcomes, and limited evidence supports the efficacy of valproic acid. Evidence from primary care settings was scant. There was insufficient direct evidence to conclude whether medications for alcohol-use disorders are effective for improving health outcomes.","Authors concluded that acamprosate and oral naltrexone have the best evidence for improving alcohol consumption outcomes for patients with alcohol-use disorders. Head-to-head trials have not consistently established the superiority of one medication. Thus, other factors may guide medication choices, such as frequency of administration, potential adverse events, coexisting symptoms, and availability of treatments.\n\n"]

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[null,"Adult population - Universal interventions - NICE Guidance"]
[null,"Source:","Population:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Alcohol-use disorders: prevention. PH24. London: NICE; 2010\nAvailable here.\n\n\n\n","Children, young people and adults aged 10 years and above","This guideline covers alcohol problems among people over 10. It aims to prevent and identify such problems as early as possible using a mix of policy and practice.\n\nThe guideline includes the following recommendations. All the recommendations are relevant to the scope of this topic evidence map. The recommendations are supported by the underpinning Evidence reviews 1-3 and Evidence reviews 4-6:\n• Price, availability and marketing\n• Licencing\n• Supporting children and young people aged 10 to 15 years\n• Screening young people aged 16 and 17 years and offering them extended brief interventions\n• Screening adults and offering them brief advice and interventions\n• Referral\n\nThe underpinning evidence reviews in this report identifed several gaps in the evidence and made recommendations for further research with the following overarching question:\nHow does advertising by industry and health agencies affect the drinking behaviour of the population as whole? (This includes the use of new media.)\n\nJuly 2019: NICE checked this guideline and are updating it. For further information, see the surveillance decision."]
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[null,"National Institute for Health and Care Excellence. Behaviour change: general approaches. PH6. London: NICE; 2007\nAvailable here.\n\n\n\n","General population","This guideline covers a set of principles that can be used to help people change their behaviour. The aim is for practitioners to use these principles to encourage people to adopt a healthier lifestyle by, for example, stopping smoking, adopting a healthy diet and being more physically active.\n\nThe guideline includes the following recommendations. All the recommendations are relevant to the scope of this topic evidence map. The recommendations are supported by the underpinning Evidence review 1.\n• Providing education and training for those delivering them\n• Delivery of these activities, including one-to-one and community-based programmes and those aimed at specific populations\n• Evaluation of their effectiveness and cost effectiveness\n\nThe Programme Development Group identified a number of gaps in the evidence related to behaviour change interventions and programmes, based on an assessment of the evidence and made recommendations for research to address the most important gaps in the evidence. Please refer to 4. Recommendations for research' section of the guidance.\n\nNovember 2017: NICE checked this guideline and found no new evidence that affects the recommendations in this guideline."]
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[null,"Adult population - Safe and Supportive Environment - Universal Interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' Conclusions:"]
[null,"Wolfenden, L. Strategies to improve the implementation of workplace-based policies or practices targeting tobacco, alcohol, diet, physical activity and obesity. Cochrane database Syst Rev 2018, Issue 11. Art. No.: CD012439. DOI: 10.1002/14651858.CD012439.pub2\nAvailable here. ","Adults in the workplace.","This review aimed to assess the effects of strategies for improving the implementation of workplace-based policies or practices targeting diet, physical activity, obesity, tobacco use and alcohol use. Six trials were included, four of which took place in the USA. Four trials employed randomised controlled trial (RCT) designs. Trials were conducted in workplaces from the manufacturing, industrial and services‐based sectors. The sample sizes of workplaces ranged from 12 to 114. Workplace policies and practices targeted included: healthy catering policies; point‐of‐purchase nutrition labelling; environmental supports for healthy eating and physical activity; tobacco control policies; weight management programmes; and adherence to guidelines for staff health promotion. All implementation interventions utilised multiple implementation strategies, the most common of which were educational meetings, tailored interventions and local consensus processes. \n\nOne included trial reported the effects of a workplace health promotion intervention on employee alcohol use (Parker 2010). However, as the implementation strategy and policies and practices targeted by the intervention did not include those addressing alcohol use, the effects on employee alcohol use reported in this trial were not included in the review. None of the other included trials reported effects of implementation strategies on this outcome. \n","Available evidence regarding the effectiveness of implementation strategies for improving implementation of health‐promoting policies and practices in the workplace setting is sparse and inconsistent. Low certainty evidence suggests that such strategies may make little or no difference on measures of implementation fidelity or different employee health behaviour outcomes. It is also unclear if such strategies are cost‐effective or have potential unintended adverse consequences. The limited number of trials identified suggests implementation research in the workplace setting is in its infancy, warranting further research to guide evidence translation in this setting."]
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[null,"Adult population - Changed attitudes and social norms- Universal interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"Foxcroft DR et al. Social norms information for alcohol misuse in university and college students. Cochrane Database Syst Rev 2015, Issue 12. Art. No.: CD006748. DOI: 10.1002/14651858.CD006748.pub4.\nAvailable here. \n","University or college students. ","This Cochrane review aimed to determine whether social norms interventions reduce alcohol‐related negative consequences, alcohol misuse or alcohol consumption when compared with a control (ranging from assessment only/no intervention to other educational or psychosocial interventions) among university and college students.\n\nSeventy studies (44,958 participants) were included in the review, and 63 studies (42,784 participants) in the meta‐analyses. Overall, the risk of bias assessment showed that these studies provided moderate or low quality evidence. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nBinge drinking at four or more months (results pooled across delivery modes): SMD ‐0.06, 95 per cent CI ‐0.11 to ‐0.02 (participants = 11,292; studies = 16; moderate quality evidence), equivalent to 2.7 per cent fewer binge drinkers if 30‐day prevalence is 43.9 per cent.\n\nDrinking quantity at four or more months (results pooled across delivery modes): SMD ‐0.08, 95 per cent CI ‐0.12 to ‐0.04 (participants = 21,169; studies = 32; moderate quality evidence), equivalent to a reduction of 0.9 drinks consumed each week, from a baseline of 13.7 drinks per week.\n\nDrinking frequency at four or more months: WF SMD ‐0.11, 95 per cent CI ‐0.17 to ‐0.04 (participants = 9929; studies = 10; moderate quality evidence), equivalent to a decrease of 0.17 drinking days/wk, from a baseline of 2.74 days/wk; individual face‐to‐face normative feedback SMD ‐0.21, 95 per cent CI ‐0.31 to ‐0.10 (participants = 1464; studies = 8; moderate quality evidence), equivalent to a decrease of 0.32 drinking days/wk, from a baseline of 2.74 days/wk. No effects were found for group face‐to‐face normative feedback or normative marketing campaign.\n\nEstimated blood alcohol concentration (BAC) at four or more months: (Peak BAC results pooled across delivery modes) SMD ‐0.08, 95 per cent CI ‐0.17 to 0.00 (participants = 7198; studies = 11; low quality evidence), equivalent to a reduction in peak BAC from an average of 0.144 per cent to 0.135 per cent. No effects were found for typical BAC with individual face‐to‐face normative feedback.\n","The results of this review indicate that no substantive meaningful benefits are associated with social norms interventions for prevention of alcohol misuse among college/university students. Although some significant effects were found, we interpret the effect sizes as too small, given the measurement scales used in the studies included in this review, to be of relevance for policy or practice. Moreover, the significant effects are not consistent for all misuse measures, heterogeneity was a problem in some analyses and bias cannot be discounted as a potential cause of these findings. "]
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[null,"Siegfried N et al. Restricting or banning alcohol advertising to reduce alcohol consumption in adults and adolescents. Cochrane Database Syst Rev 2014, Issue 11. Art. No.: CD010704. DOI: 10.1002/14651858.CD010704.pub2.\nAvailable here. \n","Adults of any age and adolescents (defined by WHO as aged 10 to 19 years)","The aim of this Cochrane review was to evaluate the benefits, harms and costs of restricting or banning the advertising of alcohol, via any format, compared with no restrictions or counter‐advertising, on alcohol consumption in adults and adolescents.\n\nOne small RCT (80 male student participants conducted in the Netherlands and published in 2009) and three ITS studies (general population studies in Canadian provinces conducted in the 1970s and 80s) were examined. The RCT found that young men exposed to movies with a low‐alcohol content drank less than men exposed to movies with a high‐alcohol content (MD ‐0.65 drinks; 95 per cent CI ‐1.2, ‐0.07; p value = 0.03, very‐low‐quality evidence). Young men exposed to commercials with a neutral content compared with those exposed to commercials for alcohol drank less (MD ‐0.73 drinks; 95 per cent CI ‐1.30, ‐0.16; p value = 0.01, very‐low‐quality evidence). Outcomes were assessed immediately after the end of the intervention (lasting 1.5 hours), so no follow‐up data were available.\n\nTwo of the ITS studies evaluated the implementation of an advertising ban and one study evaluated the lifting of such a ban (GRADE: very‐low‐quality evidence). Each of the three ITS studies evaluated a different type of ban (partial or full) compared with different degrees of restrictions or no restrictions during the control period. The results from the three ITS studies were inconsistent. A meta‐analysis of the two studies that evaluated the implementation of a ban showed an overall mean non‐significant increase in beer consumption in the general population of 1.10 per cent following the ban (95 per cent CI ‐5.26, 7.47; p value = 0.43; I2 = 83 per cent, very‐low‐quality evidence). This finding is consistent with an increase, no difference, or a decrease in alcohol consumption. In the study evaluating the lifting of a total ban on all forms of alcohol advertising to a partial ban on spirits advertising only, which utilised an Abrupt Auto‐regressive Integrated Moving Average model, the volume of all forms of alcohol sales decreased by 11.11 kilolitres (95 per cent CI ‐27.56, 5.34; p value = 0.19) per month after the ban was lifted. In this model, beer and wine sales increased per month by 14.89 kilolitres (95 per cent CI 0.39, 29.39; p value = 0.04) and 1.15 kilolitres (95 per cent CI ‐0.91, 3.21; p value = 0.27), respectively, and spirits sales decreased statistically significantly by 22.49 kilolitres (95 per cent CI ‐36.83, ‐8.15; p value = 0.002).\n\nNone of the studies were funded by the alcohol or advertising industries.\n","Authors conclude that there is a lack of robust evidence for or against recommending the implementation of alcohol advertising restrictions. Advertising restrictions should be implemented within a high‐quality, well‐monitored research programme to ensure the evaluation over time of all relevant outcomes in order to build the evidence base. "]
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[null,"Adult population - Reduced availability- Universal interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"Hollands  GJ et al. Altering the availability or proximity of food, alcohol, and tobacco products to change their selection and consumption. Cochrane Database of Systematic Reviews 2019, Issue 9. Art. No.: CD012573. DOI: 10.1002/14651858.CD012573.pub3.\nAvailable here.","General population","This Cochrane review aimed to:\n1. To assess the impact on selection and consumption of altering the availability or proximity of (a) food (including non‐alcoholic beverages), (b) alcohol, and (c) tobacco products.\n2. To assess the extent to which the impact of these interventions is modified by characteristics of: i. studies, ii. interventions, and iii. participants.\n\nThe reviewers included 24 studies, with the majority (20/24) giving concerns about risk of bias. All of the included studies investigated food products; none investigated alcohol or tobacco. ","The authors concluded that:\n- Further research is warranted in real‐world settings, intervening across a wider range of foods as well as alcohol and tobacco products and over sustained time periods"]
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[null,"Adult population - Reduced affordability- Universal interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]
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[null,"Adult population -Behaviour change - Universal interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"Stead M, Angus K, Langley T, Katikireddi SV, Hinds K, Hilton S,  et al. Mass media to communicate public health messages in six health topic areas: a systematic review and other reviews of the evidence. Public Health Res 2019;7(8)\nAvailable here.","General population.","There was limited evidence of impact on alcohol use\nMass media campaigns were found to increase knowledge and awareness across several topics.\nAlthough there was limited evidence on characteristics associated with effectiveness, longer or greater intensity campaigns were found to be more effective. \nThe evidence suggested that targeting messages to target audiences can be effective. \nThere was little evidence regarding the role that theory or media channels may play in campaign effectiveness, and also limited evidence on new media.","Overall, the evidence is mixed but suggests that longer and more intensive campaigns are likely to be more effective and message design and targeting campaigns to particular population groups can be effective."]
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[null,"Brown TJ, Todd A, O'Malley CL, Moore HJ, Husband AK, Bambra C,  et al. Community pharmacy interventions for public health priorities: a systematic review of community pharmacy-delivered smoking, alcohol and weight management interventions. Public Health Res 2016;4(2)\nAvailable here. ","Adults","The searches identified over 14,000 records, of which 24 studies were included. There were two alcohol, 12 smoking cessation, five weight loss and five multicomponent interventions that included pharmacotherapy and lifestyle changes in participants with diabetes mellitus, dyslipidaemia or hypertension. Nine of the studies were UK based; seven of the studies were rated ‘strong’ for quality. All studies were of adults. \nThere was insufficient evidence for the effectiveness of community pharmacy-based brief alcohol interventions.\nNone of the five multicomponent studies demonstrated an improvement compared with control for anthropometric outcomes in participants with comorbidities, but they did show improvement in measures associated with the comorbidities. Very few studies explored if and how sociodemographic or socioeconomic variables moderated the effect of interventions. In two studies based in areas of high deprivation, where participants chose the intervention, the sociodemographic characteristics of participants differed between intervention settings. There were also differences in recruitment, attendance and retention of participants by type of setting. The evidence suggests that a distinct group of people might access pharmacies compared with other settings for alcohol management, smoking cessation and weight loss. There is insufficient evidence to examine the relationship between behaviour change strategies and effectiveness; or evidence of consistent implementation factors or training components that underpin effective interventions.","Evaluations of interventions to manage alcohol misuse and obesity, set within the community pharmacy, are needed. \nThe effect of community pharmacy interventions on health inequalities is unclear. Future research in this area is warranted, and trials should include the assessment of age, sex, ethnicity, socioeconomic status and contextual factors, and present analysis of how these factors moderate effectiveness."]
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[null,"Adult population -Families are supported and protected - Universal interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]

{"sheet":"Adult sel","index":50,"n_rows":197,"n_cols":5,"rows_kept":197,"cut":false,"hidden":false,"merged":[[178,1,192,1],[178,3,192,3],[178,4,192,4],[194,1,194,4],[127,4,145,4],[146,1,177,1],[146,2,177,2],[146,3,177,3],[146,4,177,4],[50,1,50,4],[52,1,105,1],[52,2,76,2],[52,3,105,3],[52,4,105,4],[24,1,24,4],[25,3,25,4],[26,1,48,1],[26,2,48,2],[26,3,48,4],[125,1,125,4],[127,1,145,1],[127,2,145,2],[127,3,145,3],[107,1,107,4],[113,1,113,4],[115,1,117,1],[119,1,119,4],[109,1,111,1]]}
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[null,"Adult population - Selective interventions - NICE Guidance"]
[null,"Source:","Population:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Behaviour change: digital and mobile health interventions. NG183. London: NICE; 2020.\nAvailable here.\n\n\n","Everyone, including Young People under 16 (and their families or 16 carers)\n• Pre-existing health conditions:\nOverweight/ obesity\nHypertension and cardiovascular disease\nRespiratory diseases\nCancers for which managing smoking may improve health outcomes\nMental health conditions\nSpecific consideration will also be given to people with learning disabilities and people with neurodevelopmental disorders such as autism.","This guideline covers interventions that use a digital or mobile platform to help people eat more healthily, become more active, stop smoking, reduce their alcohol intake or practise safer sex. The interventions include those delivered by text message, apps, wearable devices or the internet. The guideline only includes those that are delivered by the technology itself and not by healthcare professionals using technology to deliver interventions.\n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n1.1 Developing digital and mobile health interventions\n1.2 Commissioning digital and mobile health interventions\n1.3 Using digital and mobile health interventions\n1.4 Interventions for diet and physical activity\n1.5 Interventions for smoking\n1.6 Interventions for alcohol use (Based on Evidence Review B: alcohol)\n1.7 Interventions for unsafe sexual behaviour\n\nThe following recommendations for further research were also identified in evidence review B on alcohol:\n1. How can providers and healthcare professionals identify groups that do not initially engage, or do not stay engaged, with digital and mobile health behaviour change interventions?\n2. What components and characteristics of digital and mobile health behaviour change interventions are most effective, separately and in combination, to achieve behaviour change?\n3. What is the effectiveness and cost effectiveness of digital and mobile health behaviour change interventions in low socioeconomic and other underserved groups?\n4. Are digital and mobile health behaviour change interventions as effective as face-to-face, standard care, or combination approaches for some populations?\n5. What are the harms and adverse effects associated with different digital and mobile health behaviour change interventions?"]
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[null,"Adult population - Safe and Supportive Environment - Selective interventions - Systematic reviews"]
[null,"Source:","Audience:","Recommendations:"]
[null,"Moledina A et al (2021). A comprehensive review of prioritised interventions to improve the health and wellbeing of persons with lived experience of homelessness. Campbell Systematic Reviews, 17, e1154.\nAvailable here. ","Populations experiencing homelessness, defined as those who lack stable, permanent, appropriate housing, or who may be without immediate prospects, means, and ability to acquire it","The objective of this systematic review is to identify, appraise, and synthesise the best available evidence on the benefits and cost-effectiveness of interventions to improve the health and social outcomes of people experiencing homelessness.\n\nEligible interventions included permanent supportive housing (PSH), income assistance, standard case management (SCM), peer support, mental health interventions such as assertive community treatment (ACT), intensive case management (ICM), critical time intervention (CTI) and injectable antipsychotics, and substance-use interventions, including supervised consumption facilities (SCFs), managed alcohol programmes and opioid agonist therapy. Outcomes of interest were housing stability, mental health, quality of life, substance use, hospitalisations, employment and income. Only results relevant to this topic evidence map have been extracted below.\n\nManaged alcohol programmes: The review did not identify any eligible studies.\n\nPermanent supportive housing: The effect of permanent housing on substance use was reported in nine trials. Out of these three studies reported improvements in alcohol and drug use in both groups, over time, but no differential benefit of the HF initiative. One study on homeless clients with problematic substance reported no group differences in problems associated with alcohol use, though both groups decreased their alcohol consumption over time. Hybrid approaches to housing (“integrative” versus “parallel” housing) were investigated in a single study. It found no statistically significant difference in the reported days of alcohol use or reported days of drug use both between groups as well as over time. Of note, analysis for this outcome had a lower statistical power as it was restricted to individuals who reported use at the baseline.\n\nIncome-assistance intervention: Four studies examined the effects of income-assistance intervention on substance use. For homeless veterans with substance dependence, CWT immediately reduced the consumption of alcohol and drugs within the first 3 months (β = −44.7%; 95% CI, −69.7% to −19.7%; t = 3.51; p = .001). The addition of priority access to housing vouchers for veterans with a diagnosis of a major psychiatric disorder or an alcohol/drug disorder, compared to existing case management, led to decreased days of drinking to intoxication (1.46 vs. 1.95, t = 0.73, p = .0053) and fewer days of alcohol use over the 3-year study period. However, no significant association was identified between priority access to housing subsidies and differences in the scores of the Addiction Severity Index (ASI). For homeless families with children aged 15 or younger, rental subsidies without case management did not lead to decreased use of substance compared to the usual community housing services.\n\nSCM and peer support interventions: Six studies reported on substance-use outcomes with different SCM treatments. Homeless male veterans with addictions problems with three to 6 months of hospital stays plus case management showed better improvements in the alcohol- and drug-use composite scores, but these were short-lived compared to TAU after 24 months. A three-arm trial reported reductions in average days of alcohol and drug consumption in a case-management-only group, a CM-with-supported-housing group in graduates of short-term in-patient substance-use programme who lacked housing. Homeless alcohol abusers who were offered different intensities of SCM (n = 469) showed no significant between-group differences in days of alcohol use. Similarly, a three-arm trial with homeless women and their intimate partners found no significant differences in substance-use outcomes between groups: a peer-mentored group, a group in a nurse case-managed programme, and one in an SCM programme. Another 12-months trial on homeless men recently released from jails/prisons who were exposed to weekly peer coaching, intermediate peer coaching compared with the usual treatment did not find any significant effects on substance-use outcomes. An RCT with homeless women with alcohol-use problems who received brief guideline-based interventions from primary care providers and referrals to the CM for ongoing follow-up visits for 6 months did not find any significant between-group differences on alcohol-consumption rates, percentages of completely abstained participants, or negative consequences of alcohol use, respectively.\n","PSH interventions improved housing stability for people living with homelessness. High-intensity case management and income-assistance interventions may also benefit housing stability. The majority of included interventions inconsistently detected benefits for mental health, quality of life, substance use, employment and income. These results have important implications for public health, social policy, and community programme implementation. The COVID-19 pandemic has highlighted the urgent need to tackle systemic inequality and address social determinants of health. Our review provides timely evidence on PSH, income assistance, and mental health interventions as a means of improving housing stability. PSH has major cost and policy implications and this approach could play a key role in ending homelessness. Evidence-based reviews like this one can guide practice and outcome research and contribute to advancing international networks committed to solving homelessness."]
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[null,"Adult population - Changed attitudes and social norms - Selective Interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]
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[null,"Adult population - Reduced availability - Selective Interventions - Systematic reviews"]
[null,"Source:","Populations:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]
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[null,"Adult population - Reduced affordability - Selective Interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]
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[null,"Adult population - Behaviour change - Selective Interventions - Systematic reviews"]
[null,"Source:","Audience:","Findings:","Authors' conclusions:"]
[null,"Meiksin R et al. E-health interventions targeting STIs, sexual risk, substance use and mental health among men who have sex with men: four systematic reviews. Public Health Research. 2022;10(4):1-322. \nAvailable here.","Gay, bisexual and other men (including trans men) who have sex with men, including those who have been diagnosed as HIV positive, as well as those whose last HIV test was negative or who have never tested for HIV","This review aimed to  synthesise evidence addressing the following: (1) What approaches and theories of change do existing e-health interventions employ to prevent human immunodeficiency virus/sexually transmitted infections, sexual risk, alcohol/drug use or mental ill health among men who have sex with men? (2) What factors influence implementation? (3) What are the effects of such interventions on the aforementioned epidemics? (4) Are such interventions cost-effective? Only information relevant to this topic evidence map has been extracted below.\n\nEffects on alcohol and drug use: Two studies presented estimates for drug use (table 8 in the full report), both focused on open-ended interventions. Neither quantified outcomes on alcohol use specifically. Although both studies presented short-term results, only one study presented mid-term results. However, the primary method of analysis in that study was a longitudinal regression model; the authors present these estimates as well. Across studies, there was no consistent evidence of effectiveness of interventions in reducing drug use.\n\nMeta-analysis: Effect sizes for alcohol and drug use are presented in the full report in Figure 14 for outcomes of < 3 months post intervention and in Figure 15 for outcomes between 3 months and 1 year post intervention. In both plots, negative effect sizes represent benefits. The review authors do not present a pooled effect size for these estimates as meta-analyses included both substantial heterogeneity (I2 = 95% both overall and only including effect sizes of up to 3 months’ follow-up) and too few studies to explore this heterogeneity.","The authors concluded that the findings for drug use could not be meta-analysed because of study heterogeneity. Studies addressing this outcome did not present consistent evidence of effectiveness. Trials did not report effects on alcohol use or mental health."]
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[null,"O'Connor EA et al. Screening and behavioral counseling interventions to reduce unhealthy alcohol use in adolescents and adults: An updated systematic review for the U.S. Preventive Services Task Force. Rockville MD: Agency for Healthcare Research and Quality; 2018. \nAvailable here. ","Adolescents or adults age 12 years or older. ","One hundred and thirteen studies (n=314,466) were included across all Key Questions. The authors did not find any studies that examined the benefits or harms of screening programs to reduce unhealthy alcohol use. For adolescents, data supported the use of the National Institute on Alcohol Abuse and Alcoholism Youth Screen and other similar one- or two-item screeners to detect alcohol use disorder. For adults, brief (1- to 3-item) screeners commonly reported sensitivity and specificity between 0.70 and 0.85, typically having better sensitivity than the full Alcohol Use Disorders Identification Test (AUDIT) for identifying the full spectrum of unhealthy use. However, the AUDIT tended to have higher specificity, particularly at the standard cutoff of 8 or higher.  \n\nIdentified interventions to reduce unhealth alcohol use were generally counselling interventions, with most involving one or two sessions (90% involved ≤ 4 sessions) with a median of 30 minutes contact time (88% involved ≤ 2 hours contact). The most commonly reported intervention element was the use of personalized normative feedback sessions, in which participants were shown how their alcohol use compares to others; this technique was used in more than half of the included trials and almost all trials in younger adults. Motivational techniques were also common, particularly in combination with personalized normative feedback.\n\nEvidence on the effects of interventions to reduce unhealthy alcohol use in adolescents was limited to two trials; both found mixed results for reduced alcohol use and did not report health or related outcomes. \n\nIn adults, interventions reduced the number of drinks per week (weighted mean difference, −1.82 [95% confidence interval {CI}, −2.42 to −1.22]), the proportion exceeding recommended drinking limits (odds ratio [OR], 0.60 [95% CI, 0.53 to 0.67]), and the proportion reporting a heavy use episode (OR, 0.62 [95% CI, 0.55 to 0.71]), and increased the proportion of pregnant women reporting abstinence (OR, 1.92 [95% CI, 1.19 to 3.09]) after 6 to 12 months. \n\nHeterogeneity was high and effect size was associated with a number of study characteristics such as setting, target age of the population, publication year, study size, and average baseline-use levels, but not clearly associated with any intervention characteristics. Data on effectiveness in important subgroups were very limited, but analyses by sex, the most commonly reported subgroup analysis, did not indicate differences in effectiveness of the interventions. Health outcomes were sparsely reported and, with some exceptions, generally did not demonstrate group differences in effect. No evidence of harm was found.","Among adults, screening instruments are available that can effectively identify persons with unhealthy alcohol use and that are feasible for use in primary care settings, and interventions in those who screen positive are associated with reductions in unhealthy alcohol use. There was no evidence that these interventions have unintended harmful effects. More evidence is needed to determine whether screening for unhealthy alcohol use is beneficial for adolescents."]
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[null,"Tansil KA et al. Alcohol Electronic Screening and Brief Intervention A Community Guide Systematic Review. Am J Prev Med 2016;51(5):801–811). \nAvailable here. \n","Unspecified","This Community Guide review focused on e-screening and brief interventions (e-SBIs) that are similar in structure and intent to Alcohol screening and brief intervention (ASBI) and examined how e-SBI effectiveness varied by key intervention characteristics, in contrast to previous systematic reviews of e-SBI. This review is unique in that it excluded highly interactive interventions (i.e., those with more than three human-to-human sessions); those that were part of a treatment program for alcohol use disorders; those that were primarily educational programs (e.g., Alcohol Edu, College Alc); and those that only used an electronic device for monitoring drinking following traditional ASBI.\n\nTwenty-four studies (28 study arms) provided results for excessive drinkers only and seven studies (eight study arms) reported results for all drinkers. Nearly all studies found that e-SBI reduced excessive alcohol consumption and related harms: nine study arms reported a median 23.9% reduction in binge-drinking intensity (maximum drinks/binge episode) and nine study arms reported a median 16.5% reduction in binge-drinking frequency. Reductions in drinking measures were sustained for up to 12 months.","The authors conclude that, according to Community Guide rules of evidence, e-SBI is an effective method for reducing excessive alcohol consumption and related harms among intervention participants. Implementation of e-SBI could complement population-level strategies previously recommended by the Community Preventive Services Task Force for reducing excessive drinking (e.g., increasing alcohol taxes and regulating alcohol outlet density)."]
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[null,"Adult population -Families are supported and protected - Selective interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]

{"sheet":"Adul ind","index":51,"n_rows":734,"n_cols":5,"rows_kept":734,"cut":false,"hidden":false,"merged":[[410,4,442,4],[443,1,456,1],[443,2,448,2],[443,3,485,3],[443,4,485,4],[142,1,145,1],[328,1,340,1],[328,2,331,2],[328,3,343,3],[328,4,343,4],[344,1,363,1],[344,2,350,2],[344,3,373,3],[344,4,373,4],[236,1,266,1],[236,2,266,2],[236,3,266,3],[236,4,266,4],[267,1,303,1],[267,2,303,2],[267,3,303,3],[24,1,24,4],[149,1,153,1],[149,2,153,2],[149,3,153,3],[149,4,153,4],[90,1,114,1],[90,2,100,2],[90,3,114,4],[115,1,130,1],[115,2,130,2],[115,3,130,4],[26,1,49,1],[26,2,49,2],[26,3,49,4],[50,1,64,1],[50,2,64,2],[50,3,64,4],[65,1,89,1],[65,2,89,2],[65,3,89,4],[147,1,147,4],[131,1,137,1],[131,2,145,2],[131,3,145,4],[267,4,303,4],[304,1,327,1],[304,2,327,2],[304,3,327,3],[304,4,327,4],[681,3,706,3],[681,4,700,4],[374,1,385,1],[374,2,383,2],[374,3,386,3],[374,4,386,4],[387,1,409,1],[387,2,409,2],[387,3,409,3],[387,4,409,4],[617,3,636,3],[617,4,636,4],[637,1,648,1],[637,2,652,2],[637,3,652,3],[637,4,652,4],[410,1,442,1],[410,2,442,2],[410,3,442,3],[707,1,729,1],[707,2,729,2],[707,3,729,3],[707,4,729,4],[486,1,532,1],[486,2,532,2],[486,3,532,3],[486,4,532,4],[533,1,563,1],[533,2,563,2],[533,3,563,3],[533,4,563,4],[564,1,578,1],[564,2,566,2],[564,3,597,3],[564,4,597,4],[598,1,613,1],[598,2,605,2],[598,3,616,3],[598,4,616,4],[617,1,632,1],[617,2,624,2],[731,1,731,4],[733,1,761,1],[733,2,763,2],[733,3,763,3],[733,4,763,4],[155,1,155,4],[157,1,170,1],[157,2,162,2],[157,3,182,3],[157,4,182,4],[184,1,184,4],[186,1,188,1],[190,1,190,4],[196,1,196,4],[198,1,235,1],[198,2,235,2],[198,3,235,3],[198,4,235,4],[653,1,660,1],[653,2,655,2],[653,3,680,3],[653,4,680,4],[681,1,695,1],[681,2,684,2]]}
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[null,"Adult population - NICE Guidance"]
[null,"Source:","Population:","Recommendations:"]
[null,"National Institute for Health and Care Excellence. Behaviour change: individual approaches. PH49. London: NICE; 2014. \nAvailable here.\n","Everyone aged 16 years and older","This guideline covers changing health-damaging behaviours among people aged 16 and over using interventions such as goals and planning, feedback and monitoring, and social support. It aims to help tackle a range of behaviours including alcohol misuse, poor eating patterns, lack of physical activity, unsafe sexual behaviour and smoking.\n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n1. Develop a local behaviour change policy and strategy\n2. Ensure organisation policies, strategies, resources and training all support behaviour change\n3. Commission interventions from services willing to share intervention details and data\n4. Commission high quality, effective behaviour change interventions\n5. Plan behaviour change interventions and programmes taking local needs into account\n6. Develop acceptable, practical and sustainable behaviour change interventions and programmes\n7. Use proven behaviour change techniques when designing interventions (Evidence review1 and Evidence review2)\n8. Ensure interventions meet individual needs\n9. Deliver very brief, brief, extended brief and high intensity behaviour change interventions and programmes\n10. Ensure behaviour change is maintained for at least a year (Evidence review1 and Evidence review2)\n11. Commission training for all staff involved in helping to change people's behaviour\n12. Provide training for behaviour change practitioners\n13. Provide training for health and social care practitioners\n14. Assess behaviour change practitioners and provide feedback\n15. Monitor behaviour change interventions\n16. Evaluate behaviour change interventions\n17. National support for behaviour change interventions and programmes\n\nEvidence review1 did not identify any recommendations for further research. Evidence review 2 made the following recommendation for further research:\n5.7 How do behaviour change techniques lead to change? What are the best methods of testing the relationship between the theories that describe change processes and the effectiveness of interventions in practice?"]
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[null,"National Institute for Health and Care Excellence. Nalmefene for reducing alcohol consumption in people with alcohol dependence. TA325. London: NICE; 2014.\nAvailable here.  \n\n","Adults with mild alcohol dependence (as defined in CG115) who have a high drinking risk level (≥ 60 g/day of pure alcohol for men and ≥ 40 g/day for women) without physical withdrawal symptoms and who do not require immediate detoxification","NICE currently make the following recommendation regarding use of Nalmefene for reducing alcohol consumption in people with alcohol dependence (the highlighted recommendation is relevant to the scope of this topic evidence map):\n\n1.1 Nalmefene is recommended within its marketing authorisation, as an option for reducing alcohol consumption, for people with alcohol dependence (Evidence review): \n• Who have a high drinking risk level (defined as alcohol consumption of more than 60 g per day for men and more than 40g per day for women, according to the World Health Organization's drinking risk levels) without physical withdrawal symptoms and;\n• Who do not require immediate detoxification.\n\nThe marketing authorisation states that nalmefene should:\n• Only be prescribed in conjunction with continuous psychosocial support focused on treatment adherence and reducing alcohol consumption and; \n• Be initiated only in patients who continue to have a high drinking risk level 2 weeks after initial assessment.\n\nMarch 2018: NICE reviewed the evidence for TA325. They found found nothing new that affects the recommendations in this guidance. This guidance will be reviewed if there is new evidence that is likely to affect the recommendations."]
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[null,"National Institute for Health and Care Excellence. Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence. CG115. London: NICE; 2011\nAvailable here.\n\n","Adults (>18 years) or young people (10 to 17 years of age) with a diagnosis of alcohol dependence or meeting criteria for harmful alcohol use (30 to 50 units of alcohol per week)","This guideline covers identifying, assessing and managing alcohol-use disorders (harmful drinking and alcohol dependence) in adults and young people aged 10-17 years. It aims to reduce harms (such as liver disease, heart problems, depression and anxiety) from alcohol by improving assessment and setting goals for reducing alcohol consumption. \n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n• Principles of care\n• Identification and assessment \n• Interventions for alcohol misuse (Evidence review 2011)\n\nThe following recommendations for further research were also identified in Evidence reviews underpinning this guidance:\n1 Is contingency management effective in reducing alcohol consumption in people who misuse alcohol compared with standard care?\n2 What methods are most effective for assessing and diagnosing the presence and severity of alcohol misuse in children and young people?\n3 Is acupuncture effective in reducing alcohol consumption compared with standard care?\n4. For which service users who are moderately and severely dependent on alcohol is an assertive community treatment model a clinically and cost-effective intervention compared with standard care?\n5. For people with moderate and severe alcohol dependence who have significant comorbid problems, is an intensive residential rehabilitation programme clinically and cost effective when compared with intensive community-based care?\n6 For people with alcohol dependence, which medication is most likely to improve adherence and thereby promote abstinence and prevent relapse?\n\nOctober 2022: NICE updated the recommendation about behavioural couples therapy to clarify that this is not suitable in cases of domestic abuse and to add a cross reference to the NICE technology appraisal guidance on nalmefene. They also updated information about off-label prescribing, and added cross references to legislation on controlled drugs and driving, to MHRA advice on addiction to benzodiazepines and codeine, and to NICE's guidelines on smoking, on antisocial personality disorder and on coexisting mental illness and substance misuse community health and social care services.\nJuly 2019: NICE have found no new evidence that affects the recommendations."]
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[null,"National Institute for Health and Care Excellence. Coexisting severe mental illness (psychosis) and substance misuse: assessment and management in healthcare settings. CG120. London: NICE; 2011. \nAvailable here.\n","People aged 14 years and over with coexisting severe mental illness (psychosis) and substance misuse","This guideline covers assessing and managing people aged 14 years and over with coexisting severe mental illness (psychosis) and substance misuse. It aims to help healthcare professionals guide people with psychosis with coexisting substance misuse to stabilise, reduce or stop their substance misuse, to improve treatment adherence and outcomes, and to enhance their lives. \n\nThe guideline includes the following recommendations. All the recommendations are relevant to the scope of this topic evidence map. The recommendations are supported by evidence from the underpinning Evidence Review 2011. \n• Principles of care\n• Recognising psychosis with coexisting substance misuse\n• Primary care\n• Secondary care mental health services\n• Substance misuse services\n• Inpatient mental health services and staffed accommodation\n• Specific issues for young people with psychosis and coexisting substance misuse\n\nThe following recommendations for further research were also identified in Evidence reviews underpinning this guidance:\n1. What are the prevalence, risk and protective factors, and course of illness for different combinations of psychosis and coexisting substance misuse (for example, schizophrenia and cannabis misuse or bipolar disorder and alcohol misuse)?\n2. What risk factors predict the onset of substance misuse in young people with psychosis?\n3. Are psychosocial interventions clinically and cost effective when compared with standard care for people with psychosis and coexisting substance misuse?\n4. Are environmental interventions clinically and cost effective when compared with standard care for people with psychosis and coexisting substance misuse?\n5. Is clozapine clinically and cost effective when compared with other pharmacological interventions for people with psychosis and coexisting substance misuse?\n\nNovember 2016: NICE reviewed the evidence and found no new evidence that affects the current recommendations in this guideline."]
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[null,"National Institute for Health and Care Excellence. Alcohol-use disorders: diagnosis and management of physical complications. CG100. London: NICE; 2010. \nAvailable here. \n","People aged 10 years and over with alcohol-use disorders","This guideline covers care for adults and young people (aged 10 years and older) with physical health problems that are completely or partly caused by an alcohol-use disorder. It aims to improve the health of people with alcohol-use disorders by providing recommendations on managing acute alcohol withdrawal and treating alcohol-related conditions. \n\nThe guideline includes the following recommendations (the highlighted recommendations are relevant to the scope of this topic evidence map):\n• Acute alcohol withdrawal (Evidence review 2014)\n• Wernicke’s encephalopathy\n• Alcohol-related liver disease\n• Alcohol-related pancreatitis\n\nThe following recommendations for further research were also identified in Evidence reviews underpinning this guidance:\n2. What is the efficacy and cost effectiveness of clomethiazole compared with chlordiazepoxide or carbamazepine or benzodiazepines for the treatment of acute alcohol withdrawal with regard to the outcomes of withdrawal severity, risk of seizures, risk of delirium tremens, length of treatment and patient satisfaction?\n\nJanuary 2019: NICE checked this guideline and are updating it. For more information, see the surveillance decision."]
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[null,"National Institute for Health and Care Excellence. Behaviour change: general approaches. PH6. London: NICE; 2007\nAvailable here.\n\n\n\n","General population","This guideline covers a set of principles that can be used to help people change their behaviour. The aim is for practitioners to use these principles to encourage people to adopt a healthier lifestyle by, for example, stopping smoking, adopting a healthy diet and being more physically active.\n\nThe guideline includes the following recommendations. All the recommendations are relevant to the scope of this topic evidence map. The recommendations are supported by the underpinning Evidence review 1.\n• Providing education and training for those delivering them\n• Delivery of these activities, including one-to-one and community-based programmes and those aimed at specific populations\n• Evaluation of their effectiveness and cost effectiveness\n\nThe Programme Development Group identified a number of gaps in the evidence related to behaviour change interventions and programmes, based on an assessment of the evidence and made recommendations for research to address the most important gaps in the evidence. Please refer to 4. Recommendations for research' section of the guidance.\n\nNovember 2017: NICE checked this guideline and found no new evidence that affects the recommendations in this guideline."]
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[null,"Adult population - Safe and Supportive Environment - Indicated interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' Conclusions:"]
[null,"No evidence identified."]
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[null,"Adult population - Changed attitudes and social norms - Indicated interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"Kaner E et al. Personalised digital interventions for reducing hazardous and harmful alcohol consumption in community-dwelling populations. Cochrane Database Syst Rev 2017, Issue 9, Art. No.: CD011479. DOI: 10.1002/14651858.CD011479.pub2. \nAvailable here. \n","People living in the community whose alcohol consumption had been screened as hazardous or harmful. ","This Cochrane review aimed to assess the effectiveness and cost‐effectiveness of digital interventions for reducing hazardous and harmful alcohol consumption, alcohol‐related problems, or both, in people living in the community.\n\nFifty-seven studies which randomised a total of 34,390 participants were included in the review. The main sources of bias were from attrition and participant blinding (36 per cent and 21 per cent of studies respectively, high risk of bias). Forty one studies (42 comparisons, 19,241 participants) provided data for the primary meta‐analysis, which demonstrated that participants using a digital intervention drank approximately 23g alcohol weekly (95 per cent CI 15 to 30) (about 3 UK units) less than participants who received no or minimal interventions at end of follow up (moderate‐quality evidence). \n\nFifteen studies (16 comparisons, 10,862 participants) demonstrated that participants who engaged with digital interventions had less than one drinking day per month fewer than no intervention controls (moderate‐quality evidence), 15 studies (3587 participants) showed about one binge drinking session less per month in the intervention group compared to no intervention controls (moderate‐quality evidence), and in 15 studies (9791 participants) intervention participants drank one unit per occasion less than no intervention control participants (moderate‐quality evidence). \n\nOnly five small studies (390 participants) compared digital and face‐to‐face interventions. There was no difference in alcohol consumption at end of follow up (MD 0.52 g/week, 95 per cent CI ‐24.59 to 25.63; low‐quality evidence). \n\nThe most frequently mentioned theories or models in the included studies were Motivational Interviewing Theory (7/20), Transtheoretical Model (6/20) and Social Norms Theory (6/20). Over half of the interventions (n = 21, 51per cent) made no mention of theory. Only two studies used theory to select participants or tailor the intervention. There was no evidence of an association between reporting theory use and intervention effectiveness.\n","There is moderate‐quality evidence that digital interventions may lower alcohol consumption, with an average reduction of up to three (UK) standard drinks per week compared to control participants. Substantial heterogeneity and risk of performance and publication bias may mean the reduction was lower. Low‐quality evidence from fewer studies suggested there may be little or no difference in impact on alcohol consumption between digital and face‐to‐face interventions. \n\nThe BCTs of behaviour substitution, problem solving and credible source were associated with the effectiveness of digital interventions to reduce alcohol consumption and warrant further investigation in an experimental context. \n\nReporting of theory use was very limited and often unclear when present. Over half of the interventions made no reference to any theories. Limited reporting of theory use was unrelated to heterogeneity in intervention effectiveness. \n"]
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[null,"Adult population - Reduced availability - Indicated interventions - Systematic reviews"]
[null,"Source:","Populations:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]
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[null,"Adult population - Reduced affordability - Indicated interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"No evidence identified."]
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[null,"Adult population - Behaviour change - Indicated interventions - Systematic reviews"]
[null,"Source:","Audience: ","Findings:","Authors' conclusions:"]
[null,"Agabio R et al. Baclofen for alcohol use disorder. Cochrane Database Syst Rev 2023, Issue 1. Art.No. CD012557. DOI:0.1002/14651858.CD012557.pub3.\nAvailable here. ","Adults with a diagnosis of alcohol dependence. ","This is an update of a Cochrane Review first published in 2018. The aim of this update was to evaluate the benefits and harms of baclofen on achieving and maintaining abstinence or reducing alcohol consumption in people with AUD compared to placebo, no treatment or any other pharmacological relapse prevention treatment. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nThis update included 17 RCTs (1818 participants). Ten studies compared baclofen to placebo or another medication; seven compared two baclofen doses to placebo or another medication. Globally, 15 studies compared baclofen to placebo, two baclofen to acamprosate and two baclofen to naltrexone. In 16 studies, participants received psychosocial treatments. The authors judged most studies at low risk of selection, performance, detection (subjective outcome), attrition and reporting bias. Ten studies detoxified participants before treatment; in seven studies, participants were still drinking at the beginning of treatment. Treatment duration was 12 weeks for 15 RCTs and longer in two studies. Baclofen daily dose was 30 mg to 300 mg: 10 RCTs used low doses (30 mg or less); eight RCTs medium doses (above 30 and 100 mg or less) and four RCTs high doses (above 100 mg).\n\nCompared to placebo, moderate‐certainty evidence found that baclofen probably decreases the risk to relapse (risk ratio (RR) 0.87, 95% confidence interval (CI) 0.77 to 0.99; 12 studies, 1057 participants). This result was confirmed among detoxified participants but not among other subgroups of participants.\n\nHigh‐certainty evidence found that baclofen increases the percentage of days abstinent (mean difference (MD) 9.07, 95% CI 3.30 to 14.85; 16 studies, 1273 participants). This result was confirmed among all subgroups of participants except non‐detoxified or those who received medium doses.\n\nThere was no difference between baclofen and placebo in the other primary outcomes: heavy drinking days (standardised mean difference (SMD) −0.18, 95% CI −0.48 to 0.11; 13 studies, 840 participants; moderate‐certainty evidence); and number of drinks per drinking days (MD −0.45, 95% CI −1.20 to 0.30; 9 studies, 392 participants; moderate‐certainty evidence).\n\nCompared to acamprosate, one study (60 participants) found no differences in any outcomes but the evidence was very uncertain: relapse (RR 1.25, 95% CI 0.71 to 2.20; very low‐certainty evidence).\n\nCompared to naltrexone, baclofen may increase the risk of relapse (RR 2.50, 95% CI 1.12 to 5.56; 1 study, 60 participants; very low‐certainty evidence) but the evidence is very uncertain.","The authors concluded that baclofen likely reduces the risk of relapse to any drinking and increases the percentage of abstinent days, mainly among detoxified participants. It does not increase the number of participants with at least one adverse event, those who dropout for any reason or due to adverse events. It probably does not reduce number of heavy drinking days and the number of drinks per drinking days. Current evidence suggests that baclofen may help people with AUD in maintaining abstinence. The results of comparisons of baclofen with acamprosate and naltrexone were mainly based on only one study."]
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[null,"McGovern R et al. Effectiveness of psychosocial interventions for reducing parental substance misuse. Cochrane Database of Systematic Reviews 2021, Issue 3. Art. No.: CD012823.\nAvailable here","Participants were parents who use substances; this included mothers and fathers of children (sons and daughters) under the age of 21 years, regardless of custodial or residency status of the children. Same-sex parents and foster parents were eligible for inclusion.","The authors included 22 unique studies with a total of 2274 participants (mean age of parents ranged from 26.3 to 40.9 years), examining 24 experimental interventions. The majority of studies intervened with mothers only (n = 16; 73%). Heroin, cocaine, and alcohol were the most commonly reported substances used by participants. The interventions targeted either parenting only (n = 13; 59%); drug and alcohol use only (n = 5; 23%); or integrated interventions which addressed both (n = 6; 27%).\nThe authors found moderate-quality evidence that psychosocial interventions are probably more effective at reducing the frequency of parental alcohol misuse than comparison conditions at 6-month (mean difference (MD) −0.32, 95% confidence interval (CI) −0.51 to −0.13; 6 studies, 475 participants) and 12-month follow-up (standardised mean difference (SMD) −0.25, 95% CI −0.47 to −0.03; 4 studies, 366 participants). The authors found a significant reduction in frequency of use at 12 months only (SMD −0.21, 95% CI −0.41 to −0.01; 6 studies, 514 participants, moderate-quality evidence).\nThe authors examined the effect of the intervention type. They found low-quality evidence that psychosocial interventions targeting substance use only may not reduce the frequency of alcohol (6 months: SMD −0.35, 95% CI −0.86 to 0.16; 2 studies, 89 participants and 12 months: SMD −0.09, 95% CI −0.86 to 0.61; 1 study, 34 participants)\nA parenting intervention only, without an adjunctive substance use component, may not reduce frequency of alcohol misuse (6 months: SMD −0.21, 95% CI −0.46 to 0.04, 3 studies; 273 participants, low-quality evidence and 12 months: SMD −0.11, 95% CI −0.64 to 0.41; 2 studies; 219 participants, very low-quality evidence).\nParents receiving integrated interventions which combined both parenting- and substance use-targeted components may reduce alcohol misuse with a small effect size (6 months: SMD −0.56, 95% CI −0.96 to −0.16 and 12 months: SMD −0.42, 95% CI −0.82 to −0.03; 2 studies, 113 participants). However, this evidence was of low quality.\nInterventions appeared to be more often beneficial for fathers than for mothers. The authors found low- to very low-quality evidence of a reduction in frequency of alcohol misuse for mothers at six months only (SMD −0.27, 95% CI −0.50 to −0.04; 4 studies, 328 participants), whilst in fathers there was a reduction in frequency of alcohol misuse (6 months: SMD −0.43, 95% CI −0.78 to −0.09; 2 studies, 147 participants and 12 months: SMD −0.34, 95% CI −0.69 to 0.00; 2 studies, 147 participants).","The authors found moderate-quality evidence that psychosocial interventions probably reduce the frequency at which parents use alcohol. Integrated psychosocial interventions which combine parenting skills interventions with a substance use component may show the most promise. \nWhilst it appears that mothers may benefit less than fathers from intervention, caution is advised in the interpretation of this evidence, as the interventions provided to mothers alone typically did not address their substance use and other related needs. \nThe authors found low-quality evidence from few studies that interventions involving children are not beneficial."]
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[null,"Goldberg SB et al. Mindfulness‐based interventions for substance use disorders. Cochrane Database of Systematic Reviews 2021, Issue 10.\nAvailable here.","Patients suffering from Substance use disorders including individuals with alcohol, prescription‐, illicit‐ and poly‐substance use disorders","This Cochrane review aimed to determine the effects of MBIs for SUDs in terms of substance use outcomes, craving and adverse events compared to standard care, further psychotherapeutic, psychosocial or pharmacological interventions, or instructions, waiting list and no treatment.\n\nForty RCTs met the inclusion criteria, with 35 RCTs involving 2825 participants eligible for meta‐analysis. All studies were at high risk of performance bias and most were at high risk of detection bias.\n\nMindfulness‐based interventions (MBIs) versus no treatment: Twenty‐four RCTs included a comparison between MBI and no treatment. The evidence was uncertain about the effects of MBIs relative to no treatment on all primary outcomes: continuous abstinence rate (post: risk ratio (RR) = 0.96, 95% CI 0.44 to 2.14, 1 RCT, 112 participants; follow‐up: RR = 1.04, 95% CI 0.54 to 2.01, 1 RCT, 112 participants); percentage of days with substance use (post‐treatment: standardized mean difference (SMD) = 0.05, 95% CI ‐0.37 to 0.47, 4 RCTs, 248 participants; follow‐up: SMD = 0.21, 95% CI ‐0.12 to 0.54, 3 RCTs, 167 participants); and consumed amount (post‐treatment: SMD = 0.10, 95% CI ‐0.31 to 0.52, 3 RCTs, 221 participants; follow‐up: SMD = 0.33, 95% CI 0.00 to 0.66, 2 RCTs, 142 participants). Evidence was uncertain for craving intensity and serious adverse events. Analysis of treatment acceptability indicated MBIs result in little to no increase in study attrition relative to no treatment (RR = 1.04, 95% CI 0.77 to 1.40, 21 RCTs, 1087 participants). Certainty of evidence for all other outcomes was very low due to imprecision, risk of bias, and/or inconsistency. Data were unavailable to evaluate adverse events.\n\nMindfulness‐based interventions (MBIs) versus other treatments (standard of care, cognitive behavioral therapy, psychoeducation, support group, physical exercise, medication): Nineteen RCTs included a comparison between MBI and another treatment. The evidence was very uncertain about the effects of MBIs relative to other treatments on continuous abstinence rate at post‐treatment (RR = 0.80, 95% CI 0.45 to 1.44, 1 RCT, 286 participants) and follow‐up (RR = 0.57, 95% CI 0.28 to 1.16, 1 RCT, 286 participants), and on consumed amount at post‐treatment (SMD = ‐0.42, 95% CI ‐1.23 to 0.39, 1 RCT, 25 participants) due to imprecision and risk of bias. The evidence suggests that MBIs reduce percentage of days with substance use slightly relative to other treatments at post‐treatment (SMD = ‐0.21, 95% CI ‐0.45 to 0.03, 5 RCTs, 523 participants) and follow‐up (SMD = ‐0.39, 95% CI ‐0.96 to 0.17, 3 RCTs, 409 participants). The evidence was very uncertain about the effects of MBIs relative to other treatments on craving intensity due to imprecision and inconsistency. Analysis of treatment acceptability indicated MBIs result in little to no increase in attrition relative to other treatments (RR = 1.06, 95% CI 0.89 to 1.26, 14 RCTs, 1531 participants). Data were unavailable to evaluate adverse events.","In comparison with no treatment, the evidence is uncertain regarding the impact of MBIs on SUD‐related outcomes. MBIs result in little to no higher attrition than no treatment. In comparison with other treatments, MBIs may slightly reduce days with substance use at post‐treatment and follow‐up (4 to 10 months). The evidence is uncertain regarding the impact of MBIs relative to other treatments on abstinence, consumed substance amount, or craving. MBIs result in little to no higher attrition than other treatments. Few studies reported adverse events."]
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[null,"Kelly  JF, Humphreys  K, Ferri  M. Alcoholics Anonymous and other 12‐step programs for alcohol use disorder. Cochrane Database of Systematic Reviews 2020, Issue 3. Art. No.: CD012880. DOI: 10.1002/14651858.CD012880.pub2.\nAvailable here.","Non‐coerced adults with Alcohol Use Disorder.","AA/TSF (manualized) compared to treatments with a different theoretical orientation (e.g. CBT) (randomized/quasi‐randomized evidence) \nRCTs comparing manualized AA/TSF to other clinical interventions (e.g. CBT), showed AA/TSF improves rates of continuous abstinence at 12 months (risk ratio (RR)) 1.21, 95% confidence interval (CI) 1.03 to 1.42; 2 studies, 1936 participants; high‐certainty evidence). This effect remained consistent at both 24 and 36 months. \nFor percentage days abstinent (PDA), AA/TSF appears to perform as well as other clinical interventions at 12 months (mean difference (MD) 3.03, 95% CI ‐4.36 to 10.43; 4 studies, 1999 participants; very low‐certainty evidence), and better at 24 months (MD 12.91, 95% CI 7.55 to 18.29; 2 studies, 302 participants; very low‐certainty evidence) and 36 months (MD 6.64, 95% CI 1.54 to 11.75; 1 study, 806 participants; very low‐certainty evidence). \nFor longest period of abstinence (LPA), AA/TSF may perform as well as comparison interventions at six months (MD 0.60, 95% CI ‐0.30 to 1.50; 2 studies, 136 participants; low‐certainty evidence). \nFor drinking intensity, AA/TSF may perform as well as other clinical interventions at 12 months, as measured by drinks per drinking day (DDD) (MD ‐0.17, 95% CI ‐1.11 to 0.77; 1 study, 1516 participants; moderate‐certainty evidence) and percentage days heavy drinking (PDHD) (MD ‐5.51, 95% CI ‐14.15 to 3.13; 1 study, 91 participants; low‐certainty evidence). \nFor alcohol‐related consequences, AA/TSF probably performs as well as other clinical interventions at 12 months (MD ‐2.88, 95% CI ‐6.81 to 1.04; 3 studies, 1762 participants; moderate‐certainty evidence). \nFor alcohol addiction severity, one study found evidence of a difference in favor of AA/TSF at 12 months (P < 0.05; low‐certainty evidence). \nThis study examines results for the same outcomes for non-manualized AA/TSF.\n","There is high quality evidence that manualized AA/TSF interventions are more effective than other established treatments, such as CBT, for increasing abstinence. Non‐manualized AA/TSF may perform as well as these other established treatments. AA/TSF interventions, both manualized and non‐manualized, may be at least as effective as other treatments for other alcohol‐related outcomes. AA/TSF probably produces substantial healthcare cost savings among people with alcohol use disorder. "]
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[null,"Hunt G et al.  Psychosocial interventions for people with both severe mental illness and substance misuse. Cochrane Database Syst Rev 2019, Issue 12. Art. No.: CD001088. DOI: 10.1002/14651858.CD001088.pub4\nAvailable here.\n","People diagnosed with a severe mental illness and concurrent problem of substance misuse","This Cochrane review aimed to assess the effects of psychosocial interventions for reduction in substance use in people with a serious mental illness compared with standard care. It updates and replaces the 2013 version of the review.\n\nThe review now includes 41 trials with a total of 4024 participants. The reviewers identified nine comparisons within the included trials. Only two of these reported outcomes meeting the scope of this topic evidence map and have been reported below. For full detail and information on the other outcomes, please refer to the full-text. \n\n1. Integrated models of care versus standard care (36 months): No clear differences were found between treatment groups for alcohol use (RR 1.15, 95% CI 0.84 to 1.56; participants = 143; studies = 1; low‐quality evidence).\n\n5. Motivational interviewing (MI) versus standard care: A clear difference, favouring MI, was observed for abstaining from alcohol (RR 0.36, 95% CI 0.17 to 0.75; participants = 28; studies = 1; very low‐quality evidence).","Authors concluded that they included 41 RCTs but were unable to use much data for analyses. There is currently no high‐quality evidence to support any one psychosocial treatment over standard care for important outcomes such as remaining in treatment, reduction in substance use or improving mental or global state in people with serious mental illnesses and substance misuse. Furthermore, methodological difficulties exist which hinder pooling and interpreting results. Further high‐quality trials are required which address these concerns and improve the evidence in this important area."]
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[null,"Agabio R, Trogu E, Pani PP. Antidepressants for the treatment of people with co‐occurring depression and alcohol dependence. Cochrane Database Syst Rev 2018, Issue 4. Art. No.: CD008581. DOI: 10.1002/14651858.CD008581.pub2.\nAvailable here. \n","Adults with co-occurring depression and alcohol dependence. ","This Cochrane review aimed to assess the benefits and risks of antidepressants for the treatment of people with co‐occurring depression and alcohol dependence. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text\n\nReview authors report that 33 studies were included in the review (2242 participants). Antidepressants were compared to placebo (22 studies), psychotherapy (two studies), other medications (four studies), or other antidepressants (five studies). The mean duration of the trials was 9.9 weeks (range 3 to 26 weeks). Eighteen studies took place in the USA, 12 in Europe, two in Turkey, and one in Australia. The antidepressant included in most of the trials was sertraline; other medications were amitriptyline, citalopram, desipramine, doxepin, escitalopram, fluoxetine, fluvoxamine, imipramine, mianserin, mirtazepine, nefazodone, paroxetine, tianeptine, venlafaxine, and viloxazine. Eighteen studies were conducted in an outpatient setting, nine in an inpatient setting, and six in both settings. Psychosocial treatment was provided in 18 studies. There was high heterogeneity in the selection of outcomes and the rating systems used for diagnosis and outcome assessment.\n\nModerate‐quality evidence found that antidepressants increased the number of participants abstinent from alcohol during the trial (7 studies, 424 participants, RR 1.71, 95 per cent Cl 1.22 to 2.39) and reduced the number of drinks per drinking days (7 studies, 451 participants, mean difference (MD) ‐1.13 drinks per drinking days, 95 per cent Cl ‐1.79 to ‐0.46). After the exclusion of studies with high risk of bias, the number of abstinent remained higher (RR 1.69, 95 per cent CI 1.18 to 2.43) and the number of drinks per drinking days lower (MD ‐1.21 number of drinks per drinking days, 95 per cent CI ‐1.91 to ‐0.51) among participants who received antidepressants compared to those who received placebo. However, other outcomes such as the rate of abstinent days did not differ between antidepressants and placebo (9 studies, 821 participants, MD 1.34, 95 per cent Cl ‐1.66 to 4.34; low‐quality evidence).\n\nThere were few studies comparing one antidepressant versus another antidepressant or antidepressants versus other interventions, and these had a small sample size and were heterogeneous in terms of the types of interventions that were compared, yielding results that were not informative.\n","Authors found low‐quality evidence supporting the clinical use of antidepressants in the treatment of people with co‐occurring depression and alcohol dependence. Antidepressants had positive effects on certain relevant outcomes related to depression and alcohol use but not on other relevant outcomes. Moreover, most of these positive effects were no longer significant when studies with high risk of bias were excluded. Results were limited by the large number of studies showing high or unclear risk of bias and the low number of studies comparing one antidepressant to another or antidepressants to other medication. In people with co‐occurring depression and alcohol dependence, the risk of developing adverse effects appeared to be minimal, especially for the newer classes of antidepressants (such as selective serotonin reuptake inhibitors). According to these results, in people with co‐occurring depression and alcohol dependence, antidepressants may be useful for the treatment of depression, alcohol dependence, or both, although the clinical relevance may be modest."]
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[null,"Canadian Agency for Drugs and Technologies in Health. E-therapy interventions for treatments of substance use disorders and other addictions: a review of clinical effectiveness. Ottawa: CADTH; 2018. \nAvailable here.\n","Adults with diagnosed substance use disorders or with a diagnosed addiction disorder, with or without co-morbid mental health conditions. ","The purpose of this CADTH Rapid Response was to review the comparative effectiveness of therapist-guided e-therapy interventions versus other options for the treatment of adults with substance use disorders and other addictions. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nWhat is the clinical effectiveness of e-therapy for the treatment of patients with substance use disorders and other addictions? \nOne SR examined the efficacy of internet-delivered interventions for alcohol addiction. The difference in alcohol consumption between the e-therapy with therapist guidance and no treatment groups at the post-treatment follow-up was statistically significant (with the e-therapy group having less consumption) and the effect of guided e-therapy was found to be small. The authors concluded that internet-delivered interventions were effective in reducing alcohol consumption and that the effect was small.\n","Evidence on e-therapy for the treatment of substance use disorders and other addictions was from a small number of SRs and RCTs. Findings consistently showed that therapist-guided e-therapy was superior to no treatment and wait list in reducing alcohol consumption or cannabis use, and the effect was small. With respect to substances, evidence was limited to the treatment of problematic alcohol and cannabis use and it is therefore unclear if the results generalize to the misuse of other substances."]
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[null,"Kaner E et al. Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev 2018, Issue 2.\nAvailable here. ","People who routinely presented to general practice, emergency care or other primary care settings for a range of health problems, whose alcohol consumption was identified by a screening tool as being excessive, or who had experienced harm as a result of their drinking behaviour","This Cochrane systematic review aimed to assess the effectiveness of screening and brief alcohol intervention to reduce excessive alcohol consumption in hazardous or harmful drinkers in general practice or emergency care settings.\n\nThe reviewers found moderate‐quality evidence that brief alcohol interventions have little impact on frequency of binges per week (MD ‐0.08, 95% CI ‐0.14 to ‐0.02; 15 studies, 6946 participants); drinking days per week (MD ‐0.13, 95% CI ‐0.23 to ‐0.04; 11 studies, 5469 participants); or drinking intensity (‐0.2 g/drinking day, 95% CI ‐3.1 to 2.7; 10 studies, 3128 participants).\n\nThey found moderate‐quality evidence of little difference in quantity of alcohol consumed when extended and no or minimal interventions were compared (‐20 g/week, 95% CI ‐40 to 1; 6 studies, 1296 participants). There was little difference in binges per week (‐0.08, 95% CI ‐0.28 to 0.12; 2 studies, 456 participants; moderate‐quality evidence) or difference in days drinking per week (‐0.45, 95% CI ‐0.81 to ‐0.09; 2 studies, 319 participants; moderate‐quality evidence). Extended versus no or minimal intervention provided little impact on drinking intensity (9 g/drinking day, 95% CI ‐26 to 9; 1 study, 158 participants; low‐quality evidence).\n\nExtended intervention had no greater impact than brief intervention on alcohol consumption, although findings were imprecise (MD 2 g/week, 95% CI ‐42 to 45; 3 studies, 552 participants; low‐quality evidence). Numbers of binges were not reported for this comparison, but one trial suggested a possible drop in days drinking per week (‐0.5, 95% CI ‐1.2 to 0.2; 147 participants; low‐quality evidence). Results from this trial also suggested very little impact on drinking intensity (‐1.7 g/drinking day, 95% CI ‐18.9 to 15.5; 147 participants; very low‐quality evidence).","The authors concluded that they found moderate‐quality evidence that brief interventions can reduce alcohol consumption in hazardous and harmful drinkers compared to minimal or no intervention. Longer counselling duration probably has little additional effect. Future studies should focus on identifying the components of interventions which are most closely associated with effectiveness."]
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[null,"Egholm JWM et al. Perioperative alcohol cessation intervention for postoperative complications Cochrane Database of Syst Rev 2018, Issue 11. Art. No.: CD008343. DOI: 10.1002/14651858.CD008343.pub3\n\nAvailable here.\n","Included participants with risky consumption of alcohol who were undergoing all types of elective or acute surgical procedures under general or regional anaesthesia or sedation, who were offered perioperative alcohol cessation intervention or no intervention. ","This Cochrane systematic review aimed to assess the effects of perioperative alcohol cessation interventions on rates of postoperative complications and alcohol consumption. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nOne new study was included in this updated review, resulting in a total of three RCTs (140 participants who drank 3 to 40 AU/d). All three studies were of moderate to good quality. All studies evaluated the effects of intensive alcohol cessation interventions, including pharmacological strategies for alcohol withdrawal symptoms, patient education, and relapse prophylaxis. The authors identified one ongoing study.\n\nInvestigators describe more successful quitters at the end of the intervention programme than among controls. Forty-one out of 70 participants in the intervention groups successfully quit drinking compared with only five out of 70 participants in the control groups (RR 8.22, 95% CI 1.67 to 40.44). The quality of evidence for this outcome is moderate.\n\nAll three studies reported postoperative alcohol consumption (grams of alcohol/week) at the end of the programme as median and range values; therefore it was not possible to estimate the mean and the SD. We performed no meta-analysis. All three studies reported length of stay, and none of these studies described a significant difference in length of stay. Data were insufficient for review authors to perform a meta-analysis. No studies reported on the prevalence of participants without risky drinking in the longer term.\n\nIncluded studies were few and reported small sample sizes; therefore one should be careful about drawing firm conclusions based on these study results. All three studies were conducted in Denmark, and most participants were men. The included participants may represent a selective group, as they could have been more motivated and/or more interested in participating in clinical research or otherwise different, and effects may have been overestimated for both intervention and control groups in these studies. Trial results indicate that these studies are difficult to perform, that strong research competencies are necessary for future studies, and that further evaluation of perioperative alcohol cessation interventions in high-quality randomised controlled trials is needed. Once published and assessed, the one ’ongoing’ study identified may alter the conclusions of this review.","The authors conclude that all three studies showed a significant reduction in the number of participants who quit drinking alcohol during the intervention period. Intensive alcohol cessation interventions offered for four to eight weeks to participants undergoing all types of surgical procedures to achieve complete alcohol cessation before surgery probably reduced the number of postoperative complications. Data were insufficient for review authors to assess their effects on postoperative mortality. No studies reported an effect on length of stay, and no studies addressed the prevalence of risky drinking in the longer term.\n\n\n"]
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[null,"Klimas J et al. Psychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users. Cochrane Database Syst Rev 2018, Issue 12. Art. No.: CD009269. DOI: 10.1002/14651858.CD009269.pub4.\nAvailable here. \n","Problem alcohol and illicit drug users (principally problem drug users of opiates and stimulants). ","This Cochrane review aimed to assess the effects of psychosocial interventions for problem alcohol use in illicit drug users. \n\nThe psychosocial interventions considered in the studies were: cognitive‐behavioural coping skills training (one study), twelve‐step programme (one study), brief intervention (three studies), motivational interviewing (two studies), and brief motivational interviewing (one study). Two studies were considered in two comparisons. There were no data for the secondary outcome, alcohol‐related harm. The results were as follows. \n\nComparison 1: cognitive‐behavioural coping skills training versus twelve‐step programme (one study, 41 participants): There was no significant difference between groups for either of the primary outcomes (alcohol abstinence assessed with Substance Abuse Calendar and breathalyser at one year: risk ratio (RR) 2.38 (95% confidence interval [CI] 0.10 to 55.06); and retention in treatment, measured at end of treatment: RR 0.89 (95% CI 0.62 to 1.29), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was very low. \n\nComparison 2: brief intervention versus treatment as usual (three studies, 197 participants): There was no significant difference between groups for either of the primary outcomes (alcohol use, measured as scores on the Alcohol Use Disorders Identification Test (AUDIT) or Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) at three months: standardised mean difference (SMD) 0.07 (95% CI ‐0.24 to 0.37); and retention in treatment, measured at three months: RR 0.94 (95% CI 0.78 to 1.13), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was low. \n\nComparison 3: motivational interviewing versus treatment as usual or educational intervention only (three studies, 462 participants): There was no significant difference between groups for either of the primary outcomes (alcohol use, measured as scores on the AUDIT or ASSIST at three months: SMD 0.04 (95% CI ‐0.29 to 0.37); and retention in treatment, measured at three months: RR 0.93 (95% CI 0.60 to 1.43), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was low. \n\nComparison 4: brief motivational intervention (BMI) versus assessment only (one study, 187 participants): More people reduced alcohol use (by seven or more days in the past month, measured at six months) in the BMI group than in the control group (RR 1.67; 95% CI 1.08 to 2.60). There was no difference between groups for the other primary outcome, retention in treatment, measured at end of treatment: RR 0.98 (95% CI 0.94 to 1.02), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was moderate. \n\nComparison 5: motivational interviewing (intensive) versus motivational interviewing (one study, 163 participants): There was no significant difference between groups for either of the primary outcomes (alcohol use, measured using the Addiction Severity Index‐alcohol score (ASI) at two months: MD 0.03 (95% CI 0.02 to 0.08); and retention in treatment, measured at end of treatment: RR 17.63 (95% CI 1.03 to 300.48), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was low. \n\n","The review authors found low to very low‐quality evidence to suggest that there is no difference in effectiveness between different types of psychosocial interventions to reduce alcohol consumption among people who use illicit drugs, and that brief interventions are not superior to assessment‐only or to treatment as usual. No firm conclusions can be made because of the paucity of the data and the low quality of the retrieved studies."]
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[null,"Canadian Agency for Drugs and Technology in Health. Concurrent treatment for substance use disorder and trauma-related comorbidities: a review of clinical effectiveness and guidelines. Ottawa: CADTH; 2017. \nAvailable here. ","Adults with substance use disorder and trauma-related comorbidities (PTSD, anxiety or depression). \n\nSubgroup of interest: military veterans","The purpose of this report by CADTH was to review treatment options for patients with comorbid substance use disorder (SUD) and post-traumatic stress disorder, anxiety, or depression by comparing concurrent treatments for SUD and the mental disorders with no treatment, usual care or active treatment for one condition only and treatment for a single condition (SUD or the mental disorders) with no treatment, usual care or active treatment for the second disorder. Additionally, this review aimed to review evidence-based guidelines regarding the treatments for patients with these comorbidities. \n\nThe review addressed three main research questions. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\n1. What is clinical effectiveness of concurrent treatment for patients with substance use disorders and comorbid post-traumatic stress disorder, anxiety, or depression?\nPatients with comorbid SUD and PTSD: In summary, findings with respect to SUD outcomes for integrated treatments addressing both PTSD and SUD, were inconsistent.\nPatients with comorbid SUD and depression: In summary, there is a suggestion that integrated treatments are more effective than control treatments or treatments addressing a single condition, but findings were not always consistent.\nPatients with SUD and anxiety disorder: One RCT showed that fewer patients relapsed to any drinking in the CBT group compared to the PMRT group. Another RCT showed that the nine hour anxiety-sensitivity focused intervention plus TAU over TAU alone, showed improvement in percent days abstinent in both groups, but showed no significant between group difference.\nPatients with SUD and depression or anxiety disorder: An RCT showed that ICBT appeared to be more effective than usual care with respect to most measures of alcohol consumption.\n\n2. What is the clinical effectiveness of the treatment of one condition for the improvement of all symptoms in patients with substance use disorder and comorbid post-traumatic stress disorder, anxiety, or depression?\nA systematic review included six studies that evaluated addiction based interventions. Two studies comparing the experimental contingency management (CM) treatment with control treatment found slightly better early treatment gains with respect to substance use with CM, however the differences did not remain significant in the long term as shown in one study. Results from three studies (other than CM) showed within-group improvement in SUD outcomes over time even for minimal or no treatment. One study showed that the care management program was associated with better alcohol outcomes compared to the AUD treatment that patients identified on their own.\nAnother systematic review included one study comparing technology-based treatment (TAU plus web based intervention targeting alcohol use) with TAU alone, reported no findings with respect to substance use.\n\n3. What are the evidence-based guidelines regarding the treatment of patients with substance use disorders and comorbid post-traumatic stress disorder, anxiety, or depression?\nOne relevant evidence-based guideline was identified. For comorbid anxiety and alcohol use disorder or for comorbid PTSD and alcohol use disorder, an integrated approach was recommended (Recommendation grade: CCP i.e. “Clinical consent point”). For comorbid depression and alcohol use disorder, CBT was recommended to improve both depressive symptoms and drinking problems.","Report authors found there was a suggestion that integrated treatments offered greater improvement with respect to PTSD symptoms, depression or anxiety compared to no treatment or minimal treatment for patients with comorbid substance use disorder (SUD) and posttraumatic stress syndrome (PTSD), depression or anxiety disorder. However results were not always consistent. In patients with comorbid SUD and PTSD, there was a suggestion that addiction based interventions were more effective with respect to controlling substance use than control treatments. One evidence-based guideline recommended an integrated treatment approach for patients with comorbid alcohol use disorder and PTSD, or comorbid alcohol use disorder and anxiety disorder, and cognitive behavioural therapy for comorbid alcohol use disorder and depression."]
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[null,"Canadian Agency for Drugs and Technology in Health. Inpatient and outpatient treatment programs for substance use disorder: a review of clinical effectiveness and guidelines. Ottawa: CADTH; 2017a. \nAvailable here. \n","Adults 18 to 65 years with substance use disorder/addiction disorder (e.g., abuse of prescription medications or cocaine, heroin, cannabis, alcohol)\n","This Rapid Response report by CADTH aimed to review the clinical effectiveness of inpatient and outpatient treatment programs for adults with substance use disorders involving prescription medications such as analgesics or non-prescription substances such as cocaine, opioids such as heroine, marijuana (cannabis), or alcohol. Evidence-based guidelines associated with inpatient and outpatient treatment programs in adults with substance use disorders were also examined.\n\nThe review addressed two main research questions. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\n1. What is the clinical effectiveness of inpatient and outpatient treatment programs in adults with substance use disorders?\nOne narrative review concluded that evidence supports the case for community detoxification in patients with alcohol dependence. One RCT with long-term follow-up (18 months) concluded that the evidence found initial but decreasing benefit of inpatient over outpatient care across time. One prospective study found inpatients consumed significantly less alcohol in the year after entering treatment than outpatients as measured by the Graduated Frequency Scale questionnaire, and had significantly greater engagement with Alcohol Anonymous program than outpatients in the year after treatment. One retrospective study reported that inpatients with substance use disorders are three times more likely to complete treatment than outpatients.\n\n2. What are the evidence-based guidelines associated with inpatient and outpatients treatment programs in adults with substance use disorders?\nThe evidence-based guidelines from British Columbia Ministry of Health on opioids use disorder recommend that withdrawal management, if needed, can be provided more safely in an outpatient setting rather than in an inpatient setting in most patients. For patients who wish to avoid long-term opioid agonist treatment, supervised slow (longer than one month) outpatient or residential opioid agonist taper can be provided rather than rapid (less than one week) inpatient opioid agonist taper. The slow approach may permit a more flexible and individualised approach to tapered agonist reduction, which allows dose adjustment and stabilisation in case withdrawal symptoms occur.\n\n","For patients with alcohol use disorders, better detoxification completion and abstinence rates, and similar adverse event rates, were found in outpatient care compared to inpatient care in a couple of studies with short follow-up periods (one to two months). One study with a longer follow-up period found inpatients consumed less alcohol than outpatients in the year after entering treatment. This may be explained by the controlled environment of inpatient care that avoids the distractions that could be present in an outpatient care situation. In patients with severe alcohol dependence, data from one study found initial but decreasing benefit of inpatient over outpatient care across time in alcohol abstinence. For patients with substance use disorders, data from one study showed inpatients are more likely to complete treatment than outpatients. The small number of studies found and their heterogeneity in design and reported outcomes cautioned the interpretation of the findings. \n\n\n"]
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[null,"Roberts NP et al. Psychological therapies for post‐traumatic stress disorder and comorbid substance use disorder. Cochrane Database Syst Rev 2016, Issue 4. Art. No.: CD010204. DOI: 10.1002/14651858.CD010204.pub2.\nAvailable here. \n","Individuals with comorbid PTSD and SUD","This Cochrane review aimed to determine the efficacy of psychological therapies aimed at treating traumatic stress symptoms, substance misuse symptoms, or both in people with comorbid PTSD and SUD in comparison with control conditions (usual care, waiting‐list conditions, and no treatment) and other psychological therapies. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nFourteen studies with 1506 participants were included, of which 13 studies were included in the quantitative synthesis. Most studies involved adult populations. Studies were conducted in a variety of settings. Four comparisons were undertaken investigating the effects of psychological therapies with a trauma‐focused component and non‐trauma‐focused interventions against treatment as usual/minimal intervention and other active psychological therapies. Comparisons were stratified for individual‐ or group‐based therapies. All active interventions were based on CBT.\n\nIndividual‐based psychological therapies with a trauma‐focused component plus adjunctive SUD intervention: There was no evidence of an effect for level of drug/alcohol use post‐treatment (SMD ‐0.13; 95% CI ‐0.41 to 0.15; 3 studies; n = 388; very low‐quality evidence), but there was a small effect in favour of individual psychological therapy at 5 to 7 months (SMD ‐0.28; 95% CI ‐0.48 to ‐0.07; 3 studies; n = 388) when compared against TAU.\n\nIndividual‐based psychological therapy with a trauma‐focused component: did not perform better than psychological therapy for SUD only for drug/alcohol use (MD ‐1.27; 95% CI ‐5.76 to 3.22; 1 study; n = 46; low‐quality evidence). Findings were based on one small study.\n\nNon‐trauma‐focused psychological therapies: did not perform better than TAU/minimal intervention. There were no data on the effects on drug/alcohol use for individual therapy. There was no evidence of an effect on the level of drug/alcohol use for group‐based therapy (SMD ‐0.03; 95% CI ‐0.37 to 0.31; 4 studies; n = 414; very low‐quality evidence). A post‐hoc analysis for full dose of a widely established group therapy called Seeking Safety showed reduced drug/alcohol use post‐treatment (SMD ‐0.67; 95% CI ‐1.14 to ‐0.19; 2 studies; n = 111), but not at subsequent follow‐ups.\nThese also did not perform better than psychological therapy for SUD only for drug/alcohol use (SMD 0.22; 95% CI ‐0.13 to 0.57; 2 studies; n = 128; low‐quality evidence).\n","The reviewers assessed the evidence in this review as mostly low to very low quality. Evidence showed that individual trauma‐focused psychological therapy delivered alongside SUD therapy did better than TAU/minimal intervention in reducing PTSD severity post‐treatment and at long‐term follow‐up, but only reduced SUD at long‐term follow‐up. All effects were small, and follow‐up periods were generally quite short. There was evidence that fewer participants receiving trauma‐focused therapy completed treatment. There was very little evidence to support use of non‐trauma‐focused individual‐ or group‐based integrated therapies. Individuals with more severe and complex presentations (e.g. serious mental illness, individuals with cognitive impairment, and suicidal individuals) were excluded from most studies in this review, and so the findings from this review are not generalisable to such individuals. Some studies suffered from significant methodological problems and some were underpowered, limiting the conclusions that can be drawn. Further research is needed in this area."]
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[null,"Canadian agency for Drugs and Technology in Health. Mindfulness interventions for the treatment of post-traumatic stress disorder, generalized anxiety disorder, depression and substance use disorders: a review of the clinical effectiveness and guidelines. Ottawa: CADTH; 2015. Available here. ","Adults with post-traumatic stress disorder (PTSD), generalised anxiety disorder (GAD), depression, or substance use disorders.","The objective of this review was to summarise the clinical effectiveness and guidelines for the use of mindfulness interventions for the treatment of PTSD, GAD, depression, and substance use disorders in adults. The review addressed two main research questions. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\n1. What is the clinical effectiveness of mindfulness interventions for the treatment of adults with PTSD, GAD, Depression, or substance use disorders?\nA study reported, that compared with treatment as usual, participants assigned to mindfulness-based relapse prevention reported significantly lower risk of heavy drinking, significantly fewer days of heavy drinking at the 6-month follow-up. At the 12-month follow-up, mindfulness-based relapse prevention participants reported significantly decreased heavy drinking compared with relapse prevention and treatment as usual.\n\n2. What are the evidence-based guidelines regarding the use of mindfulness interventions for the treatment of adults with PTSD, GAD, Depression, or substance use disorders?\nThe guideline by the New South Wales Department of Health suggested that mindfulness could be used to treat problematic drug and alcohol users.\n\n","The evidence for the efficacy of mindfulness as a treatment for individuals with substance use disorders was limited. One RCT of low methodological quality suggested that mindfulness intervention is more effective than treatment as usual in lowering risk of relapse to substance use and heavy drinking. One guideline suggested that mindfulness can be used to treat problematic drug and alcohol use problems by suitably trained and experienced drug and alcohol professionals.\n"]
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[null,"Canadian agency for Drugs and Technology in Health. Yoga for the Treatment of Post-Traumatic Stress Disorder, Generalized Anxiety Disorder, Depression, and Substance Abuse: A Review of the Clinical Effectiveness and Guidelines. Ottawa: CADTH; 2015a. Available here. ","Adults with PTSD, GAD, depression, or substance use disorders.","The objective of this Rapid Response report is to review the clinical effectiveness of yoga for treating PTSD, GAD, depression and substance abuse, and to summarize the guidelines that are associated with the use of yoga for these conditions.The review addressed two main research questions. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\n1. What is the clinical effectiveness of yoga as an intervention for the treatment of PTSD, GAD, depression, or substance use disorders?\nOne study found that yoga was a feasible adjunct treatment for treating alcohol dependence. Patients in the yoga intervention group had a higher baseline level of drinking compared to the control group and there were positive, non-significant changes in alcohol consumption at six month follow-up, numerically greater than that experienced by the control. \ngroup\n\n2. What are the evidence-based guidelines regarding the use of mindfulness interventions for the treatment of adults with PTSD, GAD, Depression, or substance use disorders?\nFive evidence-based guidelines were included in this report, two of which did not find enough evidence for yoga to provide a recommendation. None of the recommendations focused specifically on alcohol consumption.\n\n","Three RCTs of low methodological quality suggested that patients with substance abuse improved with respect to some symptoms with yoga. Five evidence based guideline documents considered the use of yoga in clinical practice. Three suggested that yoga may be useful as an adjunctive treatment for treating major depressive disorder (MDD), PTSD and GAD, if available. "]
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[null,"Ipser JC et al. Pharmacotherapy for anxiety and comorbid alcohol use disorders. Cochrane Database Syst Rev 2015, Issue 1. Art. No.: CD007505. DOI: 10.1002/14651858.CD007505.pub2\nAvailable here. \n","People diagnosed with alcohol dependence or abuse and an anxiety disorder according to DSM‐III, DSM‐IV, or DSM‐IV‐TR criteria.","This Cochrane review aimed to assess the effects of pharmacotherapy for treating anxiety in people with comorbid alcohol use disorders. Five placebo‐controlled pharmacotherapy RCTs (with 290 participants) were included in the review. Most of the trials provided little information on how randomisation was performed or on whether both participants and study personnel were blinded to the intervention. \n\nStudy participants had DSM) III‐ and DSM IV‐diagnosed alcohol use disorders and post‐traumatic stress disorder (two studies), social anxiety disorder (SAD; two studies) or generalized anxiety disorder (GAD; one study). Four trials assessed the efficacy of the selective serotonin re‐uptake inhibitors (SSRIs: sertraline, paroxetine); one RCT investigated the efficacy of buspirone, a 5‐hydroxytryptamine (5‐HT) partial agonist. Treatment duration lasted between eight and 24 weeks. Overall, 70% of participants included in the review were male. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nThere was no evidence of an effect for any of the medications tested on abstinence from alcohol use or depression symptoms.","The evidence‐base for the effectiveness of medication in treating anxiety disorders and comorbid alcohol use disorders is currently inconclusive. There was no evidence that alcohol use was responsive to medication. Large, rigorously conducted RCTs would help supplement the small evidence‐base for the efficacy and tolerability of pharmacotherapy for anxiety and comorbid alcohol use disorders. Further research on patient subgroups who may benefit from pharmacological treatment, as well as novel pharmacological interventions, is warranted. \n"]
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[null,"Dedert E et al. e-interventions for alcohol misuse. Durham NC: Evidence-based Synthesis Program Center; 2014.\nAvailable here.\n","Adults with alcohol use disorders (AUD). ","This review evaluates computer-based interventions for alcohol misuse. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nEffects of E-Interventions Compared with Inactive Controls in Adults who Misuse Alcohol: Twenty-two studies with 13,929 participants and judged to be low (n=7) or moderate (n=12) risk of bias. Overall, the available data suggest that long-term effects of e-interventions on alcohol outcomes are modest or absent.\n\nEffects of E-Interventions Compared with Inactive Controls in Adults at High Risk of AUD (eg, AUDIT-C ≥8) or with a Diagnosis of AUD: 3 studies (2 moderate, 1 high risk of bias) in 533 patients with a diagnosis of AUD. Neither computerized feedback plus telephone counseling nor an interactive voice response system decreased alcohol consumption or risk of relapse. A multicomponent smartphone program used to support recovery following residential treatment increased abstinence (OR 1.94; 95% CI, 1.14 to 3.31) and decreased risky drinking days at 12-month follow-up.\n\n Effects of E-Interventions Alone or Used in Combination with Face-to-Face Therapy Compared with Face-to-Face Therapy Alone in Adults who Misuse Alcohol: Six trials with 1090 participants. Overall, this diverse group of studies did not find a benefit of e-interventions alone or as an adjunct to face-to-face  brief MI compared with face-to-face brief MI alone for college students or midlife primary care patients who misuse alcohol.","The authors reported that they found limited evidence for small or no effects of e-interventions compared with controls on long-term (≥6 months) alcohol outcomes in participants who screened positive for alcohol misuse. Findings were even more limited for participants with AUD or comparisons of e-interventions to face-to-face treatment. Further research is needed to determine with higher confidence whether e-interventions can produce long-term benefits for alcohol-related outcomes. In particular, given the limited number and duration of intervention episodes in the studies reviewed, it is possible that these e-interventions were not designed to be robust enough to produce significant, enduring effects on alcohol misuse. As reported in previous reviews, brief in-person interventions produce sustained reductions in alcohol consumption in participants with alcohol misuse. Current evidence does not support substitution of e-interventions for brief, in-person treatment. Future research on e-interventions should include evaluations of more intensive or longer duration e-interventions for alcohol misuse. "]
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[null,"Pani PP et al. Anticonvulsants for alcohol dependence. Cochrane Database Syst Rev 2014, Issue 2. Art. No.: CD008544. DOI: 10.1002/14651858.CD008544.pub2.\nAvailable here. \n","Alcohol dependent adults. ","The primary aim of this Cochrane review is to assess the benefits/risks of anticonvulsants for the treatment of alcohol dependence. \n\nA total of 25 studies were included in the review (2641 participants). Most participants were male, with an average age of 44 years. Anticonvulsants were compared with placebo (17 studies), other medications (seven studies) and no medication (two studies). The mean duration of the trials was 17 weeks (range four to 52 weeks). The studies took place in the USA, Europe, South America, India and Thailand. Variation was reported in the characteristics of the studies, including their design and the rating instruments used. For many key outcomes, the risk of bias associated with unclear or unconcealed allocation and lack of blinding affected the quality of the evidence. Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nAnticonvulsants versus placebo: For continuous abstinence (eight studies, 634 participants, RR 1.21, 95% Cl 95 per cent 0.97 to 1.52, moderate‐quality evidence), results showed no evidence of differences. Moderate‐quality evidence suggested that anticonvulsants reduced drinks/drinking days (11 studies, 1126 participants, mean difference (MD) ‐1.49, 95% Cl ‐2.32 to ‐0.65) and heavy drinking (12 studies, 1129 participants, standardised mean difference (SMD) ‐0.35, 95% Cl ‐0.51 to ‐0.19). The direction of results was confirmed by subgroup analyses for topiramate and partially for gabapentin and valproate. \n\nAnticonvulsants versus naltrexone: No evidence of difference was shown in severe relapse rates (four studies, 427 participants, RR 0.69, 95% Cl 0.44 to 1.07) and continuous abstinence rates (five studies, 528 participants, RR 1.21, 95% Cl 0.99 to 1.49); anticonvulsants were associated with fewer heavy drinking days (three studies, 308 participants, MD ‐5.21, 95% Cl ‐8.58 to ‐1.83) and more days to severe relapse (three studies, 244 participants, MD 11.88, 95% Cl 3.29 to 20.46).\n","The authors concluded that at the current stage of research, randomised evidence supporting the clinical use of anticonvulsants to treat alcohol dependence is insufficient. Results are conditioned by heterogeneity and by the low number and quality of studies comparing anticonvulsants with other medications. The uncertainty associated with these results leaves to clinicians the need to balance possible benefits/risks of treatment with anticonvulsants versus other medications as supported by evidence of efficacy."]
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[null,"Jonas DE et al. Pharmacotherapy for adults with alcohol-use disorders in outpatient settings. Rockville MD: Agency for Healthcare Research and Quality; 2014. \nAvailable here. \n\nThis report has been archived by AHRQ and is being updated. The update protocol can be accessed here.","Adults with alcohol-use disorders. ","The aim of this report was to conduct a systematic review and meta-analysis of the efficacy, comparative effectiveness, and harms of medications (both FDA approved and others) for adults with alcohol-use disorders, and to evaluate the evidence from primary care settings.\n\nOne hundred and thirty five studies were included. Most patients met criteria for alcohol dependence; mean ages were in the 40s. Studies typically included psychosocial cointerventions; effect sizes reflect the added benefits of medications. For acamprosate and oral naltrexone (50 mg per day), numbers needed to treat (NNTs) to prevent 1 person from returning to any drinking were 12 and 20, respectively (moderate SOE); NNT to prevent 1 person from returning to heavy drinking was 12 for oral naltrexone (50 mg per day) (moderate SOE). Only outcomes meeting the scope of this topic evidence map have been reported below. For full detail and information on the other outcomes, please refer to the full-text.\n\nMeta-analyses of four head-to-head trials found no statistically significant difference between the two medications for consumption outcomes (moderate SOE). For injectable naltrexone, meta-analyses found no significant benefit for return to any or heavy drinking, but found a reduction in heavy drinking days (low SOE). Evidence from well-controlled trials does not support efficacy of disulfiram, except possibly for patients with excellent adherence. Among medications used off label, moderate evidence supports the efficacy of nalmefene and topiramate for improving some consumption outcomes, and limited evidence supports the efficacy of valproic acid. Evidence from primary care settings was scant. There was insufficient direct evidence to conclude whether medications for alcohol-use disorders are effective for improving health outcomes.","Authors concluded that acamprosate and oral naltrexone have the best evidence for improving alcohol consumption outcomes for patients with alcohol-use disorders. Head-to-head trials have not consistently established the superiority of one medication. Thus, other factors may guide medication choices, such as frequency of administration, potential adverse events, coexisting symptoms, and availability of treatments.\n\n"]
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[null,"Adult population -Families are supported and protected - Indicated interventions - Systematic reviews"]
[null,"Source:","Population:","Findings:","Authors' conclusions:"]
[null,"McGovern R et al. Effectiveness of psychosocial interventions for reducing parental substance misuse. Cochrane Database of Systematic Reviews 2021, Issue 3. Art. No.: CD012823.\nAvailable here","Participants were parents who use substances; this included mothers and fathers of children (sons and daughters) under the age of 21 years, regardless of custodial or residency status of the children. Same-sex parents and foster parents were eligible for inclusion.","The authors included 22 unique studies with a total of 2274 participants (mean age of parents ranged from 26.3 to 40.9 years), examining 24 experimental interventions. The majority of studies intervened with mothers only (n = 16; 73%). Heroin, cocaine, and alcohol were the most commonly reported substances used by participants. The interventions targeted either parenting only (n = 13; 59%); drug and alcohol use only (n = 5; 23%); or integrated interventions which addressed both (n = 6; 27%).\nThe authors found moderate-quality evidence that psychosocial interventions are probably more effective at reducing the frequency of parental alcohol misuse than comparison conditions at 6-month (mean difference (MD) −0.32, 95% confidence interval (CI) −0.51 to −0.13; 6 studies, 475 participants) and 12-month follow-up (standardised mean difference (SMD) −0.25, 95% CI −0.47 to −0.03; 4 studies, 366 participants). The authors found a significant reduction in frequency of use at 12 months only (SMD −0.21, 95% CI −0.41 to −0.01; 6 studies, 514 participants, moderate-quality evidence).\nThe authors examined the effect of the intervention type. They found low-quality evidence that psychosocial interventions targeting substance use only may not reduce the frequency of alcohol (6 months: SMD −0.35, 95% CI −0.86 to 0.16; 2 studies, 89 participants and 12 months: SMD −0.09, 95% CI −0.86 to 0.61; 1 study, 34 participants)\nA parenting intervention only, without an adjunctive substance use component, may not reduce frequency of alcohol misuse (6 months: SMD −0.21, 95% CI −0.46 to 0.04, 3 studies; 273 participants, low-quality evidence and 12 months: SMD −0.11, 95% CI −0.64 to 0.41; 2 studies; 219 participants, very low-quality evidence).\nParents receiving integrated interventions which combined both parenting- and substance use-targeted components may reduce alcohol misuse with a small effect size (6 months: SMD −0.56, 95% CI −0.96 to −0.16 and 12 months: SMD −0.42, 95% CI −0.82 to −0.03; 2 studies, 113 participants). However, this evidence was of low quality.\nInterventions appeared to be more often beneficial for fathers than for mothers. The authors found low- to very low-quality evidence of a reduction in frequency of alcohol misuse for mothers at six months only (SMD −0.27, 95% CI −0.50 to −0.04; 4 studies, 328 participants), whilst in fathers there was a reduction in frequency of alcohol misuse (6 months: SMD −0.43, 95% CI −0.78 to −0.09; 2 studies, 147 participants and 12 months: SMD −0.34, 95% CI −0.69 to 0.00; 2 studies, 147 participants).","The authors found moderate-quality evidence that psychosocial interventions probably reduce the frequency at which parents use alcohol. Integrated psychosocial interventions which combine parenting skills interventions with a substance use component may show the most promise. \nWhilst it appears that mothers may benefit less than fathers from intervention, caution is advised in the interpretation of this evidence, as the interventions provided to mothers alone typically did not address their substance use and other related needs. \nThe authors found low-quality evidence from few studies that interventions involving children are not beneficial."]