Effectiveness of secondary prevention and treatment interventions for crack-cocaine abuse: A comprehensive narrative overview of English-language studies

Effectiveness of secondary prevention and treatment interventions for crack-cocaine abuse: A comprehensive narrative overview of English-language studies

Author Fischer, Benedikt Google Scholar
Blanken, Peter Google Scholar
Da Silveira, Dartiu Autor UNIFESP Google Scholar
Gallassi, Andrea Google Scholar
Goldner, Elliot M. Google Scholar
Rehm, Juergen Google Scholar
Tyndall, Mark Google Scholar
Wood, Evan Google Scholar
Institution Ctr Addict & Mental Hlth
Simon Fraser Univ
Univ Toronto
Parnassia Addict Res Ctr
Universidade Federal de São Paulo (UNIFESP)
Fed Univ Brasilia
British Columbia Ctr Dis Control
Univ British Columbia
BC Ctr Excellence HIV AIDS
Abstract There are an estimated several million crack-cocaine users globally; use is highest in the Americas. Most crack users are socio-economically marginalized (e.g., homeless), and feature elevated risks for morbidity (e.g., blood-borne viruses), mortality and crime/violence involvement, resulting in extensive burdens. No comprehensive reviews of evidence-based prevention and/or treatment interventions specifically for crack use exist. We conducted a comprehensive narrative overview of English-language studies on the efficacy of secondary prevention and treatment interventions for crack (cocaine) abuse/dependence. Literature searches (1990-2014) using pertinent keywords were conducted in main scientific databases. Titles/abstracts were reviewed for relevance, and full studies were included in the review if involving a primary prevention/treatment intervention study comprising a substantive crack user sample. Intervention outcomes considered included drug use, health risks/status (e.g., HIV or sexual risks) and select social outcome indicators. Targeted (e.g., behavioral/community-based) prevention measures show mixed and short-term effects on crack use/HIV risk outcomes. Material (e.g., safer crack use kit distribution) interventions also document modest efficacy in risk reduction; empirical assessments of environmental (e.g., drug consumption facilities) for crack smokers are not available. Diverse psychosocial treatment (including contingency management) interventions for crack abuse/dependence show some positive but also limited/short-term efficacy, yet likely constitute best currently available treatment options. Ancillary treatments show little effects but are understudied. Despite ample studies, pharmacotherapeutic/immunotherapy treatment agents have not produced convincing evidence; select agents may hold potential combined with personalized approaches and/or psycho-social strategies. No comprehensively effective 'gold-standard' prevention/treatment interventions for crack abuse exist; concerted research towards improved interventions is urgently needed. (C) 2015 Elsevier B.V. All rights reserved.
Keywords Crack-cocaine
Language English
Sponsor CIHR/PHAC Chair in Applied Public Health
Association of Universities and Colleges of Canada's (AUCC) LACREG program
Date 2015-04-01
Published in International Journal of Drug Policy. Amsterdam: Elsevier B.V., v. 26, n. 4, p. 352-363, 2015.
ISSN 0955-3959 (Sherpa/Romeo, impact factor)
Publisher Elsevier B.V.
Extent 352-363
Origin http://dx.doi.org/10.1016/j.drugpo.2015.01.002
Access rights Closed access
Type Review
Web of Science ID WOS:000351796200004
URI http://repositorio.unifesp.br/handle/11600/38946

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