CHARACTERISTICS OF REVIEWED STUDIES

National Collaborating Centre for Mental Health (UK)

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National Collaborating Centre for Mental Health (UK). Drug Misuse: Psychosocial Interventions. Leicester (UK): British Psychological Society (UK); 2008. (NICE Clinical Guidelines, No. 51.)

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This publication is provided for historical reference only and the information may be out of date.

Drug Misuse: Psychosocial Interventions.

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APPENDIX 14CHARACTERISTICS OF REVIEWED STUDIES

Characteristics Table for The Clinical Question: Brief Interventions

Comparisons Included in this Clinical Question

CBT: 6 sessions versus TAU ONEILL1996	CM versus outreach MALOTTE1998 MALOTTE1999 MALOTTE2001 SEAL2003 SORENSEN2006	CM versus supportive counselling ROSEN2007	HIV education versus psychoeducation
HIV: computer education versus standard education	HIV: motivational interviewing versus TAU BAKER1993 GIBSON1999 TUCKER2004A	HIV: psychoeducation versus standard education AVANTS2004 COLON1993 ELDRIDGE1997 EPSTEIN2003 HARRIS1998 KOTRANSKI1998 MALOW1994 MARGOLIN2003A SCHILLING1991 SIEGAL1995 SORENSEN1994 STERK2003	HIV: psychoeducation versus waitlist BAKER1994 WECHSBERG2004
HIV: psychoeducation versus women-focused psychoeducation WECHSBERG2004	Motivational enhancement therapy versus HIV risk reduction	Motivational enhancement therapy versus TAU	Motivational interviewing versus TAU BAKER2005 BERNSTEIN2005 CARROLL2006A COPELAND2001 DONOVAN2001 KIDORF2005 MARSDEN2006 MCCAMBRIDGE2004 MILLER2003 MITCHESON2007 STEPHENS2000 STEPHENS2002 STOTTS2001

Characteristics of Included Studies

Methods	Participants				Outcomes	Interventions	Notes

AVANTS2004	n= 220 Age: Mean 37 Sex: 151 males 69 females Diagnosis: 100% opioid dependence by DSM-IV 46% cocaine dependence by DSM-IV Exclusions: - <18 years - injection drug user - actively suicidal, homicidal, psychotic Notes: PRIMARY DIAGNOSIS: MMT participants. 75% misused cocaine (by urine or DSM-IV abuse/dependence) ETHNICITY: 66% white, 15% African American, 17% Hispanic Baseline: (Control/psychoeducation) Years’ opiate use: 12.3/12.8 Years’ cocaine use: 11.5/12.1				Data Used Reduced risk behaviours	Group 1 N= 108 Psychoeducation with outpatient - 90-min harm reduction group weekly sessions for 12 weeks. Focused on information, motivation and skills. Sessions included reducing harm of injection drug use, reducing sexual harm, negotiating harm reduction with partners and preventing relapse to drugs. Group 2 N= 112 Control: standard care with outpatient - 2 hours counselling and case management per month and a single session on HIV risk reduction. This session included a motivational enhancement therapy style, 30-min video on HIV education and a harm reduction kit.	Study quality: 1++

Study Type: RCT (randomised controlled trial) Type of Analysis: ITT (analysed if attended >=1 session) Blindness: Open Duration (days): Setting: US MMT programmes Notes: RANDOMISATION: by computer Info on Screening Process: 251 approached; 224 gave consent (4 dropped out during intake phase); 220 randomised

BAKER1993	n= 95 Age: Mean 31 Sex: 44 males 51 females Diagnosis: 100% opioid dependence by eligibility for/receipt of MMT 100% IDU (injection drug use) by self-report Exclusions: - not injected drugs in last 6 months - not agreed to HIV testing - diagnosis of schizophrenia, bipolar disorder, psychosis, organic brain damage Baseline: HIV status: 6 were HIV-positive				Data Used Reduced risk behaviours	Group 1 N= 31 CBT: RP (relapse prevention) with outpatient - 6 sessions, each 60–90 mins, conducted individually. First session motivational interview. Second to sixth sessions focused on specific techniques to reduce injecting and sexual risk behaviour. Opiate agonist: MMT (methadone maintenance) with outpatient Group 2 N= 31 AMI (adapted motivational interviewing): MI with outpatient - Single session lasting 60–90 mins. Aimed to raise motivation to change needle use and unsafe sexual behaviour. Major aim to have participant express concerns about high risk behaviours and express desire to change. Opiate agonist: MMT (methadone maintenance) with outpatient Group 3 N= 33 Control: TAU (treatment as usual) with outpatient - Advice about HIV risk behaviours normally available from staff at methadone programmes and via an education leaflet. Opiate agonist: MMT (methadone maintenance) with outpatient	Study quality: 1+

Study Type: RCT (randomised controlled trial) Type of Analysis: Per protocol Blindness: Single blind Duration (days): Mean 42 Followup: 6 months Setting: Australia, MMT programme Notes: RANDOMISATION: Stratified on sex and HIV status. Within each couple, both partners allocated to same group to avoid confounding treatment effects.

BAKER1994	n= 200 Age: Mean 29 Sex: 159 males 41 females Diagnosis: 100% IDU (injection drug use) by self-report Exclusions: - had not injected drugs in past 6 months - lack of literacy in English - did not agree to HIV testing Baseline: Drug use in past month: injection drug use = 92.5%; injected heroin = 80.5%; borrowed injection equipment = 19%; re-used injection equipment without bleach = 80.2% Sexual risk behaviour: unprotected sex with regular partner = 72/82 (87.8%); casual partner = 31/67 (46.3%); customer = 3/13 (23.1%)				Data Used Reduced risk behaviours Notes: DROPOUTS at 3 months: MI (motivationa interviewing) = 42/100 (42%); control = 37/100 (37%) 6 months: MI = 58/100 (58%); control = 54/100 (54%)	Group 1 N= 100 Control: TAU (treatment as usual) with outpatient Group 2 N= 100 AMI (adapted motivational interviewing): MI with outpatient - 1 session for 30 mins. Interactive and objective feedback on health and other risks related to their behaviour. Various MI strategies used including: advantages and disadvantages of sharing injection equipment and sexual risk taking, and life goals.	Study quality: 1+

Study Type: RCT (randomised controlled trial) Study Description: Follow-ups conducted by RA blind to study conditions Type of Analysis: Per protocol Blindness: Single blind Duration (days): Mean 1 Followup: 3 and 6 months Setting: Australia: general medical clinic for homeless people, pharmacy Notes: Stratified randomisation

BAKER2005	n= 214 Age: Mean 30 Sex: 134 males 80 females Diagnosis: 100% other stimulant misuse Exclusions: - suicidality - acute psychosis - current treatment for amphetamine use - acquired cognitive impairment - irregular amphetamine use (<once a week) Notes: PRIMARY DIAGNOSIS: Regular amphetamine use, 1/3 in treatment for other drugs, rest recruited through: word of mouth, needle exchange service, GPs, other community agencies Baseline: Duration of regular use = 8.98 (6.99) Mean daily level of amphetamine use (OTI) = 1.50 (1.65)				Data Used Abstinence at 6 months Notes: DROPOUTS: 2-session CBT = 18/74, 4- session CBT = 25/66 Dropouts from 6-month follow-up: 2-session CBT = 20/74, 4-session CBT = 15/66, control = 26/74	Group 1 N= 74 Control: TAU (treatment as usual) with outpatient - received the same self-help booklet as in the intervention groups Group 2 N= 66 CBT (cognitive behavioural therapy) with outpatient - 4 sessions: first session motivational interview, following sessions focused on coping and relapse prevention skills. Second session involved relaxation and coping self-talk, third session controlling thoughts about amphetamines, fourth session on lapses. Group 3 N= 74 CBT (cognitive behavioural therapy) with outpatient - 2 sessions: sessions lasting 45–60 mins included role plays and take- home exercises for practising skills. First session motivational interview, second session learning coping and relapse preventions skills.	Study quality: 1+

Study Type: RCT (randomised controlled trial) Type of Analysis: Intention to treat Blindness: Single blind Duration (days): Mean 1 Followup: 6 months Setting: Australia Notes: RANDOMISATION: independent clinical trials researcher Info on Screening Process: 282 screened, 68 excluded

BERNSTEIN2005	n= 1175 Age: Mean 38 Sex: 829 males 346 females Diagnosis: 100% drug misuse (non-alcohol) by self-report Exclusions: - did not use cocaine and/or heroin in last 30 days - <3 on the DAST - <18 years of age - in drug misuse treatment - unable to speak English, Spanish, Haitian Creole or Portuguese Creole Notes: PRIMARY DIAGNOSIS: Self-reported cocaine and/or heroin use Ethnicity: Motivational interviewing (MI) - Black = 61.5%, White = 13.8%, Hispanic = 24.1%, Other = 0.7%; Control - Black = 62.5%, White = 14.6%, Hispanic = 22.3%, other = 0.5% Baseline: GROUPS: MI/CONTROL DAST scores: 8.0 (1.7)/7.9 (2.6) ASI: Drug: 0.26 (0.13)/0.24 (0.14)				Data Used Abstinence at 6 months Hair analysis	Group 1 N= 590 AMI (adapted motivational interviewing): MI with outpatient - 1 session for average 20 mins (range 10–45 mins). Involved establishing rapport, exploring pros and cons of drug use, and readiness to change. Finally provided a leaflet as in control group. Ten days later booster phone call (5–10 mins). Group 2 N= 585 Control: TAU (treatment as usual) with outpatient - Received a leaflet saying “based on your screening responses you would benefit from help with your drug use” and given a list of treatment options: detox, AA/NA, acupuncture, residential treatment, harm reduction information etc.	Study quality: 1++

Study Type: RCT (randomised controlled trial) Blindness: Single blind Duration (days): Mean 1 Followup: 3 and 6 months Setting: US inner-city walk-in clinic Notes: RANDOMISATION: cards generated by computerised randomisation program and sealed in opaque envelopes Info on Screening Process: 23669 screened, 1232 eligible, 1175 enrolled

CARROLL2006A	n= 423 Age: Mean 33 Sex: 240 males 183 females Diagnosis: Exclusions: - did not speak English - did not seek outpatient treatment for substance use problems at least once in last 28 days - <18 years - not sufficiently medically or psychiatrically stable - seeking detox only, MMT or residential inpatient treatment Baseline: Primary substance: alcohol = 50.3% - exclude?, cocaine = 5.9%, marijuana = 20.2%, opiates = 4.8%, methamphetamine = 18.1%				Data Used Retention: weeks remained in treatment Drug use: days per month Notes: DROPOUTS: 24% dropped out before 1- month follow-up, 27% dropped out before 3- month follow-up	Group 1 N= 202 Control: TAU (treatment as usual) with outpatient - 2-hour assessment collected standard information according to agency guidelines, e.g. participants’ history and current level of substance use, and then referred to standard group treatment Group 2 N= 198 AMI (adapted motivational interviewing): MI with outpatient - 2-hour assessment incorporating MI strategies (empathy, providing choice, removing barriers, providing feedback, clarifying goals).	Study quality: 1+

Study Type: RCT (randomised controlled trial) Blindness: Open Duration (days): Mean 1 Followup: 28 days and 84 days Setting: US, 5 community-based settings Notes: RANDOMISATION: Urn randomisation programme Info on Screening Process: 640 screened 217 excluded: no substance use in last 28 days (n=95); seeking detox, MMT or inpatient treatment (n=34); lack of sufficient housing (n=15); moving or going to jail (n=12); psychiatrically unstable (n=12); not willing to be randomized (n=5)

COLON1993	n= 1866 Age: Mean 33 Sex: 1487 males 378 females Diagnosis: 100% IDU (injection drug use) by self-report Exclusions: - not injected in the previous 6 months - not registered on a drug treatment programme in last 30 days Baseline: GROUPS: Psychoeducation/standard education				Data Used Reduced risk behaviours Condom use Notes: DROPOUTS: Standard = 11.5%, standard + enhanced = 56.4%	Group 1 N= 880 Psychoeducation with outpatient - Standard street outreach and referral programme and 3-sessn educational component. Educational componet delivered by trained ex-addict included: basic information about HIV, taught needle bleaching, obstacles to risk reduction, meaning of HIV test results Group 2 N= 986 Outreach with outpatient - Outreach workers identified networks of IDUs and introduced programme. Provided instrumental and emotional support with risk reduction and help-seeking efforts.	Study quality: 1+

Study Type: RCT (randomised controlled trial) Type of Analysis: Per protocol Blindness: Open Duration (days): Followup: 7 months Setting: Four communities in Puerto Rico, USA Notes: RANDOMISATION: Poor - based on day of admission Info on Screening Process: 2144 enrolled; 1866 available to follow-up at 7 months	Injected for >=10 years:		56%	/54%
	Frequency of injection:		81.3%	/83.1%
	Use of shooting galleries:		79.5%	/78.1%
	Borrowing of needles:		40.5%	/41.8%
	Sharing cookers:		75.7%	/77.7%
	Bleaching needles not always:		91.3%	/93%
	Use of condoms not always:		87.8%	/87.8%

COPELAND2001	n= 229 Age: Mean 32 Sex: 159 males 70 females Diagnosis: 96% cannabis dependence by DSM-IV Exclusions: - no desire to cease cannabis use - > weekly use of drugs other than cannabis, nicotine, or alcohol in past 6 months (AUDIT scores >15) - received formal treatment for cannabis dependence in previous 3 months Baseline: Mean years of weekly cannabis use = 13.9				Data Used Abstinence at 6 months Abstinence: days drug free Drug use: days per month Notes: DROPOUTS at 6-month follow-up: 6 CBT = 20%, 1 MI (motivational interviewing) =25%	Group 1 N= 82 AMI (adapted motivational interviewing): MI with outpatient - 1 session for 90 mins. Combined principles of MI and CBT Group 2 N= 78 CBT (cognitive behavioural therapy) with outpatient - 6 sessions for 1 hour each. First session based on MI principles, 2nd session discussed urge management strategies, 3rd on withdrawal management, 4th on cognitive strategies and skill enhancement, 5th on strategy review and 6th on relapse prevention.	Study quality: 1+

Study Type: RCT (randomised controlled trial) Blindness: Single blind Duration (days): Followup: 24 weeks Setting: Australia Info on Screening Process: 1075 screened, 565 excluded; of 510 eligible, 225 did not make appointments to attend and 47 didn’t turn up for assessment; prior to randomization, 9 exceeded criteria for alcohol misuse

DONOVAN2001	n= 654 Age: Mean 35 Sex: 451 males 203 females Diagnosis: 100% substance misuse (drug or alcohol) by self-report Exclusions: - not financially eligible for receipt of public assistance - severe disability - did not use substances within 90 days prior to screening - not amenable to available treatments - did not complete clinical evaluation - spoke no English - dependent solely on alcohol - pregnant women Baseline: 71% had engaged in heavy drinking and illicit drug use within 90 days of assessment				Data Used Drug and alcohol use: days in past 3 months	Group 1 N= 326 Control: waitlist with outpatient - Waitlist for residential treatment- regular telephone contact with placement office, referall for crises etc. Waitlist for outpatient treatment- present for treatment admission or removed from waitlist. Received booklet that included info on local agency Group 2 N= 328 AMI: MET (motivational enhancement therapy) with outpatient - MI session - 60 to 90 mins involved rapport building, exploration of client concerns, personalised feedback. Routine clinical follow-up - in person/telephone follow-up to encourage treatment entry, day-to-day problems Unscheduled support services	Study quality: 1+

Study Type: RCT (randomised controlled trial) Blindness: Open Duration (days): Setting: US Info on Screening Process: 3396 screened, 1978 excluded: financial (n=59%), alcohol dependent only (23%). Of those eligible, 54% (n= 765) did not participate.

ELDRIDGE1997	n= 104 Age: Mean 34 Sex: all females Diagnosis: Exclusions: - men - HIV seropositive Notes: Ethnicity: White = 54.8%, African American = 43.4%, Native American = 1.9% Baseline: Self-reported STI: past 12 months = 18.6%, lifetime = 52.9% Self-reported drug use: injected drug in past 2 months = 13.6%, crack cocaine = 61.2%				Data Used Condom use Notes: 99/117 (85%) completed, 57 (57%) completed 2-month follow-up	Group 1 N= 48 HIV education with inpatient - Two 90-min sessions of HIV education standard part of drug treatment programme Group 2 N= 51 Psychoeducation with inpatient - Received standard intervention and four additional behavioural skills sessions. This included modelling, rehearsal, feedback on correct use of condom, communication and assertiveness training, and correct needle cleaning.	Study quality: 1+

Study Type: RCT (randomised controlled trial) Study Description: Cluster randomised by 3- week admission blocks Blindness: Duration (days): Followup: 2 months Setting: US, inpatient - criminal justice Info on Screening Process: 117 screened, 13 discharged early or irregularly

EPSTEIN2003	n= 193 Age: Mean 39 Sex: 110 males 83 females Diagnosis: 41% cocaine dependence by DSM-III-R Exclusions: - <18 years or >65 years - not intravenous opiate user - not cocaine user - current psychotic, bipolar or major depressive disorder - current physical dependence on alcohol or sedatives - unstable medical illness - pregancy and breastfeeding Baseline: Mean years of cocaine use = 11 (7.5) Mean cocaine use = 18.3 (10.1) of last 30 days				Data Used Cocaine use: days Notes: DROPOUTS: Control = 12/49, CM = 9/47, CBT = 10/48, CBT + CM = 15/49	Group 1 N= 49 CM: vouchers with outpatient - Earned vouchers for each urine specimen that was negative for cocaine. Vouchers began at $2.50, increasing by $1.50 for each consecutive voucher earned. For three consecutive negative urines a $10 bonus was earned. CBT: RP (relapse prevention) with outpatient - Combined elements of relapse prevention, coping methods, behavioural reinforcement methods and methods of generalising to the environment IDC (individual drug counselling) with outpatient Opiate agonist: MMT (methadone maintenance) with outpatient. Mean dose 70 mg - Within first week participants stabilised on 70 mg/day could request increase of up to 80 mg/day Group 2 N= 47 CM: vouchers with outpatient - Earned vouchers for each urine specimen that was negative for cocaine. Vouchers began at $2.50, increasing by $1.50 for each consecutive voucher earned. For three consecutive negative urines a $10 bonus was earned. IDC (individual drug counselling) with outpatient Opiate agonist: MMT (methadone maintenance) with outpatient. Mean dose 70 mg - Within first week participants stabilised on 70 mg/day could request increase of up to 80 mg/day Control: social support group with outpatient Group 3 N= 48 CBT: RP (relapse prevention) with outpatient - Combined elements of relapse prevention, coping methods, behavioural reinforcement methods and methods of generalising to the environment IDC (individual drug counselling) with outpatient Opiate agonist: MMT (methadone maintenance) with outpatient. Mean dose 70 mg - Within first week participants stabilised on 70 mg/day could request increase of up to 80 mg/day NCM (non-contingent management) with outpatient Group 4 N= 49 IDC (individual drug counselling) with outpatient Opiate agonist: MMT (methadone maintenance) with outpatient. Mean dose 70 mg - Within first week participants stabilised on 70 mg/day could request increase of up to 80 mg/day NCM (non-contingent management) with outpatient Control: social support group with outpatient	Study quality: 1+

Study Type: RCT (randomised controlled trial) Blindness: No mention Duration (days): Mean 84 Followup: 12 months Setting: US Info on Screening Process: 286 screened

GIBSON1999	n= 295 Age: Range 20–49 Sex: 204 males 91 females Diagnosis: 100% opioid dependence by previous participation in treatment Exclusions: None reported Notes: PRIMARY DIAGNOSIS: Just completed opiate detoxification Baseline: (Study 1/Study 2) History of MMT: 34%/40% Traded sex in past month: 13%/25%				Data Used Reduced risk behaviours	Group 1 N= 105 HIV education - 50-min sessn of problem solving. Reviewed situations where participant engaged or tempted to engage in high-risk practices and explored strategies to reduce injection risk (e.g. disinfecting syringes and reducing sharing) and sexual risk (e.g. safer sex). Group 2 N= 115 Control: TAU (treatment as usual) - Provided with a brochure on HIV	Study quality: 1+

Study Type: RCT (randomised controlled trial) Blindness: Open Duration (days): Mean 1 Followup: 3 and 12 months Setting: US, entering detox treatment

HARRIS1998	n= 204 Age: Mean 36 Sex: all females Diagnosis: 100% opioid dependence by eligibility for/receipt of MMT Baseline: Age first had sex: 15.0 (12.7) Two or more current sex partners: 11.5%				Data Used Reduced risk behaviours Notes: DROPOUTS: Treatment group = 9/107, control = 13/97	Group 1 N= 97 Control: standard care with outpatient - Standard services within MMT Group 2 N= 107 HIV education with outpatient - 16-week intervention (first 8 weeks 2 hrs/day, last 8 weeks 1hr/day) developed especially for use with women drug misusers. Designed to empower participants by increasing sense of inner control, improving self- esteem & improving relationships with others.	Study quality: 1+

Study Type: RCT (randomised controlled trial) Type of Analysis: Per protocol Blindness: Open Duration (days): Mean 120 Followup: 3 months Setting: 4 US methadone maintenance clinics Info on Screening Process: 204 screened, 130 included

KIDORF2005	n= 302 Age: Mean 39 Sex: 205 males 97 females Diagnosis: 100% opioid dependence by DSM-IV 79% cocaine dependence by DSM-IV 69% alcohol dependence by DSM-IV Exclusions: - arranged for drug misuse treatment before study - current organic mental disorder - too old or too young Baseline: (MI [motivational interviewing]/job readiness/standard care) Previous methadone treatment: 32%/32%/27% Any opiate treatment: 72%/74%/70% Lifetime comorbid Axis I disorder: 32%/31%/38%				Data Used Engagement in treatment Notes: No data provided - write to authors	Group 1 N= 96 Control: enhanced TAU (treatment as usual) with outpatient - 1 session for 50 mins to address job-seeking readiness. Participants reviewed their work history and discussed jobs they were interested in pursuing. Interventionist and participant worked together to develop a list of jobs. Group 2 N= 98 AMI (adapted motivational interviewing): MI with outpatient - 1 session for 50 mins. Explored the positive and negative aspects of drug use, shared feedback from study assessments and elicited participant response, discussed discrepancy between current level of functioning and future goals. Group 3 N= 108 Control: TAU (treatment as usual) with outpatient - Participants asked to contact the needle exchange programme if they were interested in pursuing substance misuse treatment. Designed as a usual treatment for participants in needle exchange programmes.	Study quality: 1+

Study Type: RCT (randomised controlled trial) Blindness: No mention Duration (days): Mean 1 Followup: 1 year Setting: US, mobile needle exchange programme Info on Screening Process: 532 screened; 193 excluded: not opioid dependent (n=12), arranged other drug treatment (n=32), current mental disorder (n=3), too old or too young (n=2), failed to complete study assessments (n=144). 339 randomized, 37 did not return for study.

KOTRANSKI1998	n= 417 Age: Mean 39 Sex: 265 males 152 females Diagnosis: IDU (injection drug use) drug misuse (non-alcohol) Exclusions: - <18 years of age - not used injected drugs and/or crack (self-report, urinalysis, fresh injection marks) - participated in drug treatment Notes: Ethnicity: African American = 85%				Data Used Reduced risk behaviours Condom use Notes: DROPOUTS at follow-up: enhanced intervention = 233/327 (71%), standard = 184/268 (69%)	Group 1 N= 184 HIV education with outpatient - 2 sessions included HIV pre-test counselling, voluntary HIV test, information on HIV, drug and sexual risk reduction, discussion and rehearsal of condom use. Group 2 N= 233 Psychoeducation with outpatient - Received standard intervention and 1 additional session on the same day as last standard session. Provided info on STI symptoms, prevention and barriers to risk reduction; made STI risk more personal using self-assessment of behaviours and risks.	Study quality: 1+

Study Type: RCT (randomised controlled trial) Type of Analysis: Per protocol Blindness: No mention Duration (days): Mean 21 Followup: 6 months Setting: US Notes: RANDOMISATION: poor - time or arrival (every other person went into enhanced condition) Info on Screening Process: 684 enrolled > 417 completed study	Baseline: GROUPS:		Standard/	Psychoeducation
	Years of cocaine, heroin or speedball:		16.3/	17.3
	Years of crack use:		6.5/	5.5
	Ever had STI:		57%/	55%

MALOTTE1998	n= 1009 Age: Range 18–69 Sex: 684 males 325 females Diagnosis: drug misuse (non-alcohol) by urinalysis Exclusions: Clear history of positive TB skin test Baseline: HIV+: 4% No prior TB exposure: 90% Unemployed: 78% Ever been in drug treatment: 56% Drug use in past 30 days: injection only: 24%, crack only: 41%, crack and injection: 23%				Data Used Completion rate	Group 1 N= 203 AMI (adapted motivational interviewing): MI with outpatient - 5–10-minute motivational educational session based on theory of reasoned action CM (contingency management) with outpatient - $10 cash reward contingent on participant returning for skin-test reading Group 2 N= 198 AMI (adapted motivational interviewing): MI - As per group 1 CM (contingency management) - $5 cash reward contingent on return to skin-test reading Group 3 N= 99 AMI (adapted motivational interviewing): MI - Motivational session only, no incentives Group 4 N= 100 Control: TAU (treatment as usual) - The importance of returning for skin-test reading was stressed, but no motivational session Group 5 N= 204 CM (contingency management) - As per control group, but with $5 cash reward for returning Group 6 N= 200 CM (contingency management) - As per control group, with $10 cash incentive for return	Study quality: 1++

Study Type: RCT (randomised controlled trial) Blindness: Open Duration (days): Setting: Long Beach, CA, USA Notes: Randomisation stratified by recruitment source Info on Screening Process: 1004 enrolled

MALOTTE1999	n= 1078 Age: Sex: 837 males 241 females Diagnosis: 100% drug misuse (non-alcohol) by self-report Exclusions: Not users of injection drugs, crack cocaine or both Notes: ETHNICITY: 2% Native American, 64% African American, 8% Latino, 21% Caucasian, 5% other Baseline: Prior TB exposure: 10% Ever injected: 42% Ever used crack: 97% Ever been in drug treatment: 50% Current drug use (past 90 days): injection: 10.9, crack: 77.0, crack & injection: 12.1				Data Used Engagement in treatment	Group 1 N= 217 CM (contingency management) with outpatient - $10 cash for returning TB skin-test reading Group 2 N= 217 CM (contingency management) with outpatient - $10 of grocery store coupons for returning TB skin-test readings Group 3 N= 218 CM (contingency management) with outpatient - Chose either bus passes or fast-food-chain vouchers worth $10 for returing TB skin-test reading Group 4 N= 211 AMI (adapted motivational interviewing): MI with outpatient - 5–10-minute session based on theory of planned behaviour focused on behavioural beliefs and subjective norms that were most related to their behavioural intention to return for TB testing Group 5 N= 215 Control: TAU (treatment as usual) with outpatient - Just warned of importance of having TB skin tests read	Study quality: 1+

Study Type: RCT (randomised controlled trial) Blindness: Open Duration (days): Mean 1 Setting: US Notes: RANDOMISATION: Method not reported Info on Screening Process: 1078 recruited

MALOTTE2001	n= 163 Age: Mean 42 Range 23–69 Sex: 134 males 29 females Diagnosis: 27% IDU (injection drug use) by self-report 82% other stimulant misuse by self-report Exclusions: Evidence of potential active disease or medical contraindications to isoniazid Notes: PRIMARY DIAGNOSIS: Injection or crack cocaine use ETHNICITY: 71% African American, 9% Hispanic, 14% White, 7% other Baseline: Unemployed: 88% Unstable living status: 29% Prior TB exposure: 12% Some binge drinking in past month: 58% Previous drug/alcohol treatment: 55%				Data Used Completion rate	Group 1 N= 55 Outreach with outpatient - Twice weekly directly observed therapy (DOT) for TB drug, supplied by outreach worker at location chosen by participant CM (contingency management) - $5 cash incentive at each visit Group 2 N= 55 Outreach - As per Group 1, but with no incentives Group 3 N= 53 CM (contingency management) - DOT provided at community site with no active outreach. $5 cash incentive for each visit.	All participants prescribed isoniazid, 15 mg/kg (max 900 mg) twice weekly for 6 or 12 months (depending on HIV status) Study quality: 1++

Study Type: RCT (randomised controlled trial) Study Description: Allocation concealed by opaque sealed envelopes Type of Analysis: Per protocol Blindness: Open Duration (days): Range 180–365 Setting: Storefront facility in California, USA Notes: Randomisation in blocks of 18 Info on Screening Process: 325 had a positive tuberculin test, 224 completed further assessment, 202 offered isoniazid; 169 gave consent to take part in study, 6 excluded (2 previous history of INH therapy, 3 prolonged elevated liver function test readings, 1 positive septum test)

MALOW1994	n= 152 Age: Mean 35 Sex: all males Diagnosis: 100% cocaine dependence by DSM-III-R Exclusions: - not African American male - <20 years or >50 years of age - IQ <80 - visual or hearing deficit - HIV seropositivity - plans to move 60 miles from New Orleans Baseline: No statistics reported				Data Used Reduced risk behaviours Condom use Notes: DROPOUTS: Psychoeducation = 30.3%, information group = 29%	Group 1 N= 76 Psychoeducation with inpatient - Three 2- hour sessions on consecutive days designed to a. foster acceptance of HIV risk reduction b. stress risk reduction can be achieved c. develop communication & behavioural skills for safe sex and syringe use d. address barriers to changing behaviour Group 2 N= 76 Control: enhanced TAU (treatment as usual) with inpatient - Similar content and time frame as psychoeducation condition -- contained pre-recorded audiovisual and printed material but minimal patient-therapist interaction	Study quality: 1+

Study Type: RCT (randomised controlled trial) Blindness: Duration (days): Mean 3 Followup: 3 months Setting: US Veterans Affairs Treatment Program Info on Screening Process: 235 screened, 83 excluded

MARGOLIN2003A	n= 90 Age: Mean 41 Sex: 63 males 27 females Diagnosis: 100% opioid dependence by eligibility for/receipt of MMT 100% cocaine misuse 100% IDU (injection drug use) by self-report Exclusions: - unconfirmed HIV-seropositive status - not IDU Notes: ETHNICITY: 49% African American, 36% White, 16% Hispanic Baseline: 94% unemployed					Group 1 N= 45 Opiate agonist: MMT (methadone maintenance) with outpatient. Mean dose 80 mg/day - Included counselling and case management HIV education with outpatient - 6-session HIV risk reduction intervention: motivational interview, video demonstration of cleaning needles, practice cleaning a needle, harm reduction negotiation role play, harm reduction kit Group 2 N= 45 Opiate agonist: MMT (methadone maintenance) with outpatient. Mean dose 80mg/day - Included counselling and case management Control: TAU (treatment as usual) with outpatient - Group counselling included: relapse prevention, improving emotional, social and spiritual health.	Study quality: 1+

Study Type: RCT (randomised controlled trial) Type of Analysis: ITT: missing data imputed:expectation maximisation Blindness: No mention Duration (days): Mean 180 Followup: 9 months Setting: US, MMT programme Notes: Randomisation procedures not reported

MARSDEN2006	n= 342 Age: Mean 18 Sex: 227 males 115 females Diagnosis: cocaine misuse by self-report other stimulant misuse by self-report Exclusions: - <16 years or >22 years - primary substance not ecstasy, cocaine powder, or crack cocaine - use of either of above susbtances <4 times in last month - not able to provide 2 personal contacts - lifetime treatment for non-medical opioid drug use - current dependence - >1 injection of illicit drugs in last year Notes: PRIMARY DIAGNOSIS: Self-reported cocaine, crack cocaine and/or ecstasy use				Data Used Drug use Abstinence: no use for 3 months Notes: Lost to follow-up: MI (motivational interviewing) = 21/166, control = 22/176	Group 1 N= 166 AMI (adapted motivational interviewing): MI with outpatient - 45–60-min discussion: 1. framing and initiating conversation 2. general lifestyle 3. stimulant and alcohol use 4. perception of good and bad aspects of stimulant use 5. problems with stimulant use 6. plans for behaviour change 8. local health and social support Group 2 N= 176 Control: TAU (treatment as usual) with outpatient - Given same written health- risk information as intervention group	Study quality: 1++

Study Type: RCT (randomised controlled trial) Blindness: Open Duration (days): Mean 1 Followup: 6 months Setting: UK community agencies in Newham, Thamesmead and Sutton Notes: RANDOMISATION: By trial statistician Info on Screening Process: 369 screened, 342 randomised	Baseline: GROUP:	MI/	CONTROL
	Cocaine use (90 days):	101/	111
	Crack use (90 days):	53/	61
	Cannabis use (90 days):	150/	157

MCCAMBRIDGE2004	n= 200 Age: Range 16–20 Sex: 118 males 82 females Diagnosis: cannabis misuse by self-report cocaine misuse by self-report Exclusions: - < weekly use of cannabis or stimulants within previous 3 months - opiate and injecting drug use Notes: Ethnicity: intervention group - White = 32%, Black = 61%, Asian/other = 8%; control - White = 46%, Black = 37%, Asian/other = 20%				Data Used Cannabis use: days in past 3 months Notes: DROPOUTS: 7.5% MI (motivational interviewing), 13.7% control	Group 1 N= 95 Control: TAU (treatment as usual) with outpatient - Education as usual. Completed baseline and follow-up assessments only. Group 2 N= 105 AMI (adapted motivational interviewing): MI with outpatient - 1 session lasting up to 60 mins. Intervention adapted from work by Miller on MI including reflective listening, affirmation, open questions and eliciting ‘change talk’.	Study quality: 1++

Study Type: RCT (randomised controlled trial) Study Description: Colleague not involved in study performed non-computerised randomisation of clusters, stratified by college; interviewer blind to study conditions Type of Analysis: Cluster randomised Blindness: Single blind Duration (days): Mean 1 Followup: 3 months, 12 months Setting: 10 further education colleges in London Notes: Participants recruited by any given individual recruiter were all assigned to the same group	Baseline: GROUPS:	MI/	TAU
	Cannabis use weekly:	35%/	28%
	Cannabis use daily:	49%/	48%
	Simulant use irregularly:	19%/	18%
	Stimulant use monthly:	8%/	23%

MILLER2003	n= 208 Age: Mean 33 Sex: 118 males 90 females Diagnosis: Baseline: Most common drug problem: cocaine (53%), heroin (29%)				Data Used Drug use: days per month Notes: No outcomes extractable	Group 1 N= 104 AMI (adapted motivational interviewing): MI with inpatient and outpatient - A single session lasting up to 2 hours; standard brief motivational intervention format offering feedback in an empathic way. Control: standard care with inpatient and outpatient - Standard care in the treatment services: outpatient - 23% MMT, 76% RP, 88% coping skills training; inpatient - 60% medical detoxification, most received RP, AIDS counselling, 12- step facilitation Group 2 N= 104 Control: standard care with inpatient and outpatient - Standard care in the treatment services: outpatient - 23% MMT, 76% RP, 88% coping skills training; inpatient - 60% medical detoxification, most received RP, AIDS counselling, 12- step facilitation	Study quality: +1

Study Type: RCT (randomised controlled trial) Blindness: No mention Duration (days): Mean 1 Followup: 12 months Setting: US: 56 inpatients, 152 outpatients Info on Screening Process: 294 screened, 129 declined to participate

MITCHESON2007	n= 29 Age: Mean 39 Sex: 19 males 10 females Diagnosis: 100% opioid dependence by eligibility for/receipt of MMT 100% cocaine misuse by urinalysis Exclusions: No cocaine use in past 30 days (by urinalysis) Notes: PRIMARY DIAGNOSIS: Crack cocaine Baseline: (Control/MI) Time in treatment (years): 2.9/4.9 Unemployed: 83%/94%				Data Used Cocaine use: times in past month Cocaine use: max consecutive days Cocaine use: grams, self-report Cocaine use: days Notes: Outcomes are for crack-cocaine use DROPOUTS: None reported	Group 1 N= 12 Control: TAU (treatment as usual) with outpatient - Exposing clients to the crack awareness initiative (leaflets about consequences of crack-cocaine use, poster display in clinic reception) Group 2 N= 17 AMI (adapted motivational interviewing): MI with outpatient. Mean dose 1 session - Engaging in discussion with client about his/her crack cocaine use: eliciting concerns, exploring and amplifying ambivalence about use. If appropriate: at end of session, prompting client to consider whether to change behaviour and options for doing so.	Study quality: 1+

Study Type: RCT (randomised controlled trial) Blindness: Open Duration (days): Notes: Cluster-randomised: clinic staff were randomised to MI (motivational interview)/delayed training; clients of those trained were assigned to MI group

ONEILL1996	n= 92 Age: Mean 26 Sex: all females Diagnosis: 100% IDU (injection drug use) by eligibility for/receipt of MMT Exclusions: Not pregnant women Notes: PRIMARY DIAGNOSIS: Only included IDU in past 6 months Baseline: Age first injected: 17.3 Self-reported drug use in past month: heroin: 85%, other illicit opiates: 16%, alcohol: 32%, cannabis: 59%, cocaine: 15%, amphetamine: 10% HIV+: 0% Sex work: 53% (lifetime), 21% (past 6 months) IDU partner: 76% Pregnancy weeks: 22				Data Used Reduced risk behaviours Notes: DROPOUTS: Treatment group = 7/47, control = 5/45; at follow-up: treatment group = 10/47, control = 9/45	Group 1 N= 40 CBT: RP (relapse prevention) with outpatient - 6 sessions lasting for 60–90 mins. First session motivational interview, 2–6 identifying high-risk situations, problem-solving strategies, coping with craving, relaxation techniques and coping with lapses. Group 2 N= 40 Control: TAU (treatment as usual) with outpatient	Study quality: 1+

Study Type: RCT (randomised controlled trial) Type of Analysis: Completers Blindness: Single blind Duration (days): Mean 42 Setting: ‘Centres’ in Australia. No further details Notes: RANDOMISATION: Adaptive sampling for settling temporary imbalances in group sizes due to practical constraints Info on Screening Process: 92 enrolled

ROSEN2007	n= 56 Age: Mean 44 Sex: 33 males 23 females Diagnosis: Exclusions: - not currently taking antiretroviral medication - no willing or able to use MEMS-compatible bottles - never used an illicit drug weekly for a year - Mini Mental State Score of less than 23 Notes: ETHNICITY: African American 58% Hispanic 28% Caucasian: 14% Baseline:				Data Used Self-report % doses taken Viral load Side effects Compliance with medication Urinalysis: positive for any illicit drug	Group 1 N= 28 CM: prizes - CM prizes earnt each time medication cap opened within 3 hours of schedule. 26.7% chance to earn $1 card, 7.6% chance for $20 card, 0.2% chance for $100 card. Cards exchanged for prizes such as bus tokens, clothing, small appliances. - 1 draw per day when all med taken. Chance to earn 5 more draws when all of wks doses taken. 10 draws for 2 weeks medication completion, 15 draws for 3 wks, 20 draws for 4+ weeks. Draws reset to 5 for noncompliance. Potential total earnings $800 - Weekly counseling attendance encouraged to discuss issues re: missed doses and adherence and offered support. Onsite urine toxicology testing for cannabis, opiate and cocaine metabolites at each session Group 2 N= 28 Supportive Counselling - Counsellor did not review MEMS data with ppts or conduct urine toxicology. Initial review of self-reported substance abuse & referral to available treatment. Monthly letters sent stating ppts self-reported adherence. - Weekly counseling attendance encouraged to discuss issues re: missed doses and adherence and offered support	Study Quality 1+

Study Type: RCT (randomised controlled trial) Type of Analysis: Completers Blindness: No mention Duration (days): Mean 224 Setting: Outpatients Info on Screening Process: 141 ppts assessed, 131 met study inclusion criteria. 99 completed 4 wk baseline assessment. 33 had baseline adherence over 80% dose-time threshold, 10 discontinued for other reasons, 56 randomised			CM	Supportive counseling
	Baseline compliance		58%	58%
	Cocaine use		67%	63%
	Cannabis		33%	37%
	Opiates		44%	37%

SCHILLING1991	n= 91 Age: Range 21–42 Sex: all females Diagnosis: Exclusions: - not Black or Hispanic - < 3 months of MMT Notes: Ethnicity: Hispanic = 64.3%, Black = 35.7%				Data Used Reduced risk behaviours Notes: DROPOUTS: intervention = 2/48 (4.2%), control = 5/43 (12%)	Group 1 N= 48 Psychoeducation with outpatient - Five 2- hr sessions by women drug counsellors. First 2 sessions on providing info on AIDS transmission and prevention enable participants to identify high-risk behaviours. Sessions 3–5 condom use, communication and assertiveness training, problem solving. Group 2 N= 43 HIV education with outpatient - AIDS information routinely provided in the clinic	Study quality: 1+

Study Type: RCT (randomised controlled trial) Blindness: Duration (days): Setting: US methadone maintenance clinics Info on Screening Process: 115 eligible, 24 did not wish to participate	Baseline: GROUPS:	Intervention	/Control
	Heroin use:	15.2%	/15.8%
	Cocaine use:	43.5%	/42.1%
	Injection use:	71.3%	/76.3%
	Unemployed:	91.3%	/89.5%

SEAL2003	n= 96 Age: Mean 43 Sex: 69 males 27 females Diagnosis: 100% IDU (injection drug use) Exclusions: - Not negative for all three HBV seromarkers - No isolated hepatitis B core antigen antibody Notes: Injected in past 30 days: heroin: 74%, speedball: 51%, speed: 16% ETHNICITY: 46% African American, 31% White, 15% Latino, 8% other Baseline: Homeless: 47% Years IDU: 21 Heavy alcohol use (>=5 drinks/day): 15% Had drug treatment in past year: 49%				Data Used Completion rate	Group 1 N= 48 CM (contingency management) with outpatient - Once per month for 6 months: $20 incentive for returning to community site. Second and third doses of hepatitis B virus vaccine given at months 1 and 6. Group 2 N= 48 Outreach with outpatient - Outreach worker attempted weekly contact to provide safe injection information and appointment reminders; duration of each contact not reported. Second and third doses of hepatitis B virus vaccine given at months 1 and 6.	Study quality: 1+

Study Type: RCT (randomised controlled trial) Blindness: Open Duration (days): Mean 180 Setting: Two inner-city neighbourhoods, San Francisco, USA Notes: Block randomisation Info on Screening Process: 366 screened, 149 eligible, 96 returned for enrolment

SIEGAL1995	n= 381 Age: Mean 37 Sex: 282 males 99 females Diagnosis: Exclusions: - had not injected drugs in previous 6 months - <18 years of age - attended a drug treatment programme in last 30 days Notes: Ethnicity: African-American (n= 184), White (n=42), other (n=6) Baseline: 61% heroin injection, 77% cocaine injection, 43% speedball (heroin and cocaine mixture), 68% crack users HIV+: 1.5%				Data Used Reduced risk behaviours Notes: DROPOUTS during treatment: enhanced education = 51%; at follow-up: standard = 113/345 (33%), enhanced = 22/171 (13%)	Group 1 N= 232 Control: enhanced TAU (treatment as usual) with outpatient - 1-hour standard intervention: indepth details on HIV and how it is transmitted behavioural strategies to reduce HIV risk, e.g. proper condom use, needle cleaning with bleach. Received HIV tests results and risk- reduction kit and pamphlets. Group 2 N= 149 Psychoeducation with outpatient - 3 additional education sessions for 1–2 hours: pathology of HIV and AIDS drug addiction safer sex and relationships - men’s version and women’s version	Study quality: 1+

Study Type: RCT (randomised controlled trial) Blindness: Duration (days): Mean 30 Followup: 6 months Setting: Needle exchange programmes in US Notes: RANDOMISATION: Poorly addressed -- by alternation Info on Screening Process: 907 screened, 214 excluded

SORENSEN1994	n= 148 Age: Mean 39 Sex: 89 males 59 females Diagnosis: Exclusions: - <20 years of age - HIV antibody positive Notes: Ethnicity: MMT - White = 54%, Black = 18%, Hispanic = 20%, Other = 8%; detox - White = 44%, Black = 20%, Hispanic = 26%, other = 10%				Data Used Unsterile needle use Condom use Notes: DROPOUTS: MMT: education = 5/25; detox: education = 17/32	Group 1 N= 25 Psychoeducation with outpatient - MMT group: 3 sessions for 2 hours within a week. Involved didactic presentations on AIDS transmission, group discussions designed to personalise the threat of AIDS, and social interaction among members and leaders. Group 2 N= 28 HIV education with outpatient - Control for detox group: information only Group 3 N= 22 HIV education with outpatient - Control for MMT group: information only Group 4 N= 32 Psychoeducation with outpatient - Detox group: 2 sessions - first session for 2 hours and second session for 1 hour. Involved didactic presentations on AIDS transmission, group discussions designed to personalise the threat of AIDS, and social interaction among members and leaders.	Study quality: 1++

Study Type: RCT (randomised controlled trial) Blindness: Duration (days): Mean 7 Followup: 3 months Setting: US Notes: CONCEALMENT OF ALLOCATION: Sealed envelopes	Baseline: SAMPLES:		MMT/	DETOX
	0 years of amphetamine use:		62%/	56%
	3+ years of amphetamine use:		22%/	26%
	0 years of cocaine use:		44%/	38%
	3+ years of cocaine use:		36%/	45%

SORENSEN2006	n= 66 Age: Mean 43 Sex: 35 males 31 females Diagnosis: 100% HIV positive by current participation in treatment 100% opioid dependence by eligibility for/receipt of MMT Exclusions: - not receiving MMT - not HIV+ - not been prescribed HIV antiretroviral medication for at least one month - participating in other adherence improvement - >=80% medication adherence during 4-week baseline phase Notes: ETHNICITY: 36% Caucasian, 32% African- American, 12% Latino, 20% other/mixed 4 ‘female’ participants were male-female transsexual Baseline: (CM/control) Employed full/part time: 9%/0% Homeless/no stable residence: 35%/41% Opiate positive urine: 35%/41% Cocaine positive urine: 53%/50% Methadone dose (mg): 85.4/73.3				Data Used Compliance with medication Notes: Monitoring of adherence twice daily (i.e. via electronic bottle cap at each of two daily antiretroviral doses) DROPOUTS: 12.5% vouchers, 6% control	Group 1 N= 34 CM: vouchers - Voucher earned each time medication cap opened within 2 hours of schedule. $1 per day in first 5 days, $1.40 bonus with each successive day complied. Day 6 onwards: increase of $0.20 per day for each day complied. On any day, reset to $1 if not complying. Control: standard care with outpatient - Medication coaching: meeting with nurse/RA once every 2 wks, who gave copy of electronic bottle cap adherence data; assessment & personalisation of current antiretroviral schedule, providing support to improve adherence. Antiretroviral taken twice daily. Group 2 N= 32 Control: standard care with outpatient - Medication coaching and twice daily antiretroviral, as per CM group	Study quality: 1++

Study Type: RCT (randomised controlled trial) Study Description: Randomised by statistician and placed in sealed envelopes Type of Analysis: ITT - maximum likelihood estimation Blindness: Open Duration (days): Mean 84 Followup: 4 weeks Setting: Two MMT clinics in San Francisco, USA Notes: Computerised stratified randomisation Info on Screening Process: 181 screened -- 78 ineligible (primarily as a result of not being prescribed antiretroviral for >1 month). 86 gave consent; 66 still interested and eligible, and randomised.

STEPHENS2000	n= 291 Age: Mean 34 Sex: 224 males 67 females Diagnosis: Exclusions: - cannabis used <50 times in last 90 days - alcohol or other drug misuse in last 90 days - severe psychological distress - receiving other formal treatment Baseline: Years of use = 17.35 (5.21), days of use past 90 days = 74.64 (18.54)				Data Used Cannabis use: days in past 3 months Notes: DROPOUTS: CBT = 19%, MI (motivational interviewing) = 8%, waitlist = 8%	Group 1 N= 117 CBT: group RP (relapse prevention) with outpatient - 14 x 2-hour CBT: RP group sessions over an 18-week period. Sessions 1–10 weekly, 11–14 every other week. Weeks 1–4 involved building motivation for change and high-risk situations identified, 5–10 building coping skills, 11–14 coping with rationalisations Group 2 N= 88 AMI (adapted motivational interviewing): MI with outpatient - Two 90-min individual sessions. Involved MI (e.g. reflective listening, affirmation and reframing) and CBT techniques (identifying high-risk situations). Second session (1 month after) reviewed previous session and feedback received. Group 3 N= 86 Control: waitlist with outpatient - Waitlist of 4 months until treatment	Study quality: 1+

Study Type: RCT (randomised controlled trial) Blindness: No mention Duration (days): Followup: 1, 4, 7 and 13 months Setting: US Info on Screening Process: 601 screened, 183 excluded (cannabis used <50 times in 90 days (n=24), alcohol or other drug misuse in last 90 days (n=149), severe psychological distress (n=8), other formal treatment (n=2)). Of eligible sample, 127 didn’t complete pre-treatment session.

STEPHENS2002	n= 450 Age: Mean 36 Sex: 306 males 144 females Diagnosis: 100% cannabis dependence by DSM-IV Exclusions: - <18 years - dependence on other drugs or alcohol - inability to provide a person who could assist in contact at follow-up - legal status that would disrupt treatment - currently receiving therapy Notes: Ethnicity: White = 69.3%, Hispanic = 17.3%, African American = 12.2%, Other = 1.1% Baseline: Proportion of days drug used in last 90 days = 0.88, hours high per day = 6.62, ounces of cannabis per week = 0.40, number of joints per day = 2.89				Data Used Cannabis use: days in past 3 months Abstinence: no use for 3 months Notes: DROPOUTS: MI (motivational interviewing) = 18/146 (12.3%), CBT = 23/156 (15%), waitlist =11/148 (7.5%)	Group 1 N= 148 Control: waitlist with outpatient Group 2 N= 146 AMI (adapted motivational interviewing): MI with outpatient - Two 1-hour sessions 1 and 5 weeks after randomisation. Discussed a personal feedback report to motivate participant to make changes -- attitudes favouring and opposing change, treatment goals etc; in second session efforts to reduce cannabis use reviewed. Group 3 N= 156 CBT: coping skills training with outpatient - 9 sessions over a 12-week period. First 8 sessions weekly, 9th session 4 weeks after 8th session to review changes. Combined motivational aspects with CBT and case management.	Study quality: 1+

Study Type: RCT (randomised controlled trial) Blindness: Duration (days): Followup: 4 and 9 months Setting: 3 US urban areas Notes: RANDOMISATION: Conducted centrally at the the Center for Substance Abuse Treatment using urn randomisation programme Info on Screening Process: 1211 screened, 398 excluded (dependence on other drugs (31%), unwilling to accept random assignment (21%), currently receiving therapy (20%), did not provide contact person (20%), legal status (16%)); 363 eligible but did not complete assessment

STERK2003	n= 68 Age: Mean 41 Range 20–54 Sex: all females Diagnosis: 100% IDU (injection drug use) by self-report Exclusions: - <18 years - in drug treatment - not proficient in English - HIV positive - not had sex with a man in last month - intoxicated or high at time of interview Baseline: GROUPS: Standard interventions/motivation intervention/negotiation intervention				Data Used Reduced risk behaviours	Group 1 N= 27 HIV education with outpatient - Standard 2-session: first session emphasised HIV epidemic and the importance of reducing injection and sexual risk. Second session focused on further development of HIV knowledge and risk and protective behaviour. Group 2 N= 20 HIV education with outpatient - 4-session motivational: in first session HIV education & tailored to race and gender issues, in second session short- and long- term goals discussed, in third short-term behaviour change reviewed along with ambivalence & in fourth risk reduction discussed. Group 3 N= 21 HIV education with outpatient - 4-session negotiation: in 1st session HIV education & skills training, in 2nd possible behaviour changes reviewed & general communication & assertiveness discussed, in 3rd short-term goals discussed & in 4th developed negotation and conflict resolution.	Study quality: 1+

Study Type: RCT (randomised controlled trial) Type of Analysis: Per protocol - only those available to follow-up Blindness: Open Duration (days): Mean 30 Setting: US inner-city neighbourhood outreach	Mean days’ crack use:	14.0 (13.3)/	10.0 (12.1)/	10.2 (12.5)
	Mean days’ cocaine powder:	8.3 (11.9)/	10.4 (12.3)/	5.4 (8.1)
	Mean days’ heroin use:	16.6 (12.9)/	14.1 (13.1)/	12.2 (10.7)
	Mean days’ speedball:	12.2 (14.3)/	6.4 (9.7)/	6.7 (10.5)

STOTTS2001	n= 105 Age: Mean 35 Sex: 84 males 21 females Diagnosis: 100% cocaine dependence by DSM-IV Exclusions: - Age outside range 18–50 years - Not in good physical and psychiatric health - Not free of legal problems Notes: - Recruited through radio, television, newspaper advertising - Received 12 weeks of relapse prevention after cocaine detoxification Baseline: Mean duration of cocaine use: 10 years Mean frequency of cocaine use in last 30 days: 12.8				Data Used Completion rate Cocaine use: no use versus some use Notes: Completion of treatment: MI = 50%, no MI = 49%	Group 1 N= 53 AMI (adapted motivational interviewing): MI with outpatient - Two 1-hour interventions on days 1 and 4 of cocaine detoxification. Session 1 focussed on building motivation for change and exploring ambivalence about change; session 2 consisted of personal feedback, reassessing commitment to change. Group 2 N= 52 Control: standard care with outpatient	Study quality: 1+

Study Type: RCT (randomised controlled trial) Type of Analysis: ITT Blindness: Open Duration (days): Mean 10 Setting: University-medical-centre-based research unit, Texas, US Notes: RANDOMISATION: Stratified by MI (motivational interviewing) condition

TUCKER2004A	n= 145 Age: Mean 31 Sex: 107 males 38 females Diagnosis: 100% IDU (injection drug use) by self-report 75% opioid misuse by self-report Exclusions: - <18 years - injecting < once per week for last 6 months - not willing to be contacted for follow-up interview Notes: PRIMARY DIAGNOSIS: heroin was primary drug for 75% Baseline: 64% positive for hepatitis C virus				Data Used Reduced risk behaviours	Group 1 N= 73 Psychoeducation with outpatient - 30-min individually tailored intervention aimed to increase awareness of risk practices in relation to hepatitis C, to enhance motivation and to change high-risk practices. Non-confrontational and supportive style used. Group 2 N= 72 Control: TAU (treatment as usual) with outpatient - Providing the participant with written literature on hepatitis C and briefly highlighting various sections of the booklet	Study quality: 1++

Study Type: RCT (randomised controlled trial) Type of Analysis: Intention to treat Blindness: Single blind Duration (days): Mean 1 Followup: 1 month Setting: Australia Notes: RANDOMISATION: By an independent researcher; randomisation outcome was concealed in a sealed envelope Info on Screening Process: 239 screened, 23 excluded, 70 did not attend interview, 24 excluded after interview

WECHSBERG2004	n= 620 Age: Mean 37 Sex: all females Diagnosis: 100% other stimulant misuse by self-report Exclusions: - not African American women - <18 years - did not engage in unprotected sex during last 90 days - crack use <13 times in last 90 days - enrolled in substance misuse treatment within past 30 days Notes: PRIMARY DIAGNOSIS: Crack misuse Baseline: Drug use behaviours: no. days smoked crack in past 30 days = 17.1; ever injected = 10.7% Sexual risk behaviours: engaged in unprotected sex in past 30 days = 88.5%, ever traded sex for money or drugs = 66.7%, traded sex for money or drugs = 42.8%				Data Used Condom use Notes: DROPOUTS: Woman-focused group = 33%, standard group = 35%	Group 1 N= 207 Control: waitlist with outpatient Group 2 N= 213 Psychoeducation with outpatient - Women focused: 2 individual and 2 group sessions including HIV education, behavioural skills training and printed materials. Intervention was delivered within a gender- and culture-specific focus. Group 3 N= 199 Psychoeducation with outpatient - Standard: contained most of the components of the other interventions, such as HIV education, behavioural skills training and printed materials but did not have the gender-specific and culture- specific focus.	Study quality: 1++

Study Type: RCT (randomised controlled trial) Blindness: No mention Duration (days): Mean 42 Followup: 3 and 6 months Setting: US Info on Screening Process: 938 screened, 176 did not return for second assessment; 762 randomised

Characteristics of Excluded Studies

Reference ID	Reason for Exclusion
BAKER2001	Small sample size
BOATLER1994A	Not an RCT
BOOTH1996	Cluster-randomised; no extractable data (regression analysis)
BOOTH2004	Outcomes not reported by treatment condition
BRAINE2004A	Primary focus on alcohol
CHOOPANYA2003	Cohort study
COMPTON1998A	Cohort study
COMPTON2000A	Cohort study
CONROD2000A	Primarily alcohol misusers
DAVIS2003	Primary focus on alcohol
ELBASSEL2005	Cohort study
FISHER2003	Not psychosocial intervention
HEIL2005A	No relevant outcomes (study reported HIV knowledge)
HERSHBERGER2003	Not an RCT
KWIATKOWSKI1999	Subgroup analysis only
LASH2005	No extractable outcomes
LINDENBERG2002A	Small proportion of sample were drug users
MALOW1992	Did not directly assess harm-reduction outcomes
MARSCH2004A	Not relevant comparison
MARTIN2001A	Did not assess required outcomes
MCCUSKER1992A	Data not broken down by groups
ONDERSMA2005	No drug-use outcomes assessed
RILEY2000A	Not intervention
ROHSENOW2004	Outcomes not reported by assigned groups
SAUNDERS1995	No extractable outcomes
SCOTT2001	Motivational interviewing greater than 2 sessions
SHERMAN2006	No control group
STARK2005	Not a psychosocial intervention
STEIN2002B	Primary focus on alcohol misuse
STEPHENS2004	Did not assess required outcomes
STERK2003B	Subgroup analysis only

References of Included Studies

AVANTS2004 (Published Data Only)

Avants SK, Margolin A, Usubiaga MH, et al. Targeting HIV-related outcomes with intravenous drug users maintained on methadone: a randomized clinical trial of a harm reduction group therapy. Journal of Substance Abuse Treatment. 2004;26:67–78. [PubMed: 15050083]

BAKER1993 (Published Data Only)

Baker A, Heather N, Wodak A, et al. Evaluation of a cognitive-behavioural intervention for HIV prevention among injecting drug users. AIDS. 1993;7:247–256. [PubMed: 8466688]

BAKER1994 (Published Data Only)

Baker A, Kochan N, Dixon J, et al. Controlled evaluation of a brief intervention for HIV prevention among injecting drug users not in treatment. AIDS Care. 1994;6:559–570. [PubMed: 7711089]

BAKER2005 (Published Data Only)

Baker A, Lee NK, Claire M, et al. Brief cognitive behavioural interventions for regular amphetamine users: a step in the right direction. Addiction. 2005;100:367–378. [PubMed: 15733250]

BERNSTEIN2005 (Published Data Only)

Bernstein J, Bernstein E, Tassiopoulos K, et al. Brief motivational intervention at a clinic visit reduces cocaine and heroin use. Drug and Alcohol Dependence. 1907;77:49–59. [PubMed: 15607841]

CARROLL2006A (Published Data Only)

Carroll KM, Easton CJ, Nich C, et al. The use of contingency management and motivational/skills-building therapy to treat young adults with marijuana dependence. Journal of Consulting and Clinical Psychology. 2006;74:955–966. [PMC free article: PMC2148500] [PubMed: 17032099]
Carroll KM, Ball SA, Nich C, et al. Motivational interviewing to improve treatment engagement and outcome in individuals seeking treatment for substance abuse: a multisite effectiveness study. Drug & Alcohol Dependence. 2006;81:28. [PMC free article: PMC2386852] [PubMed: 16169159]

COLON1993 (Published Data Only)

Colon HM, Robles RR, Freeman D, et al. Effects of an HIV risk reduction education program among injection drug users in Puerto Rico. Puerto Rico Health Sciences Journal. 1993;12:27–34. [PubMed: 8511243]

COPELAND2001 (Published Data Only)

Copeland J, Swift W, Roffman R, et al. A randomized controlled trial of brief cognitive-behavioral interventions for cannabis use disorder. Journal of Substance Abuse Treatment. 2001;21:55–64. [PubMed: 11551733]

DONOVAN2001 (Published Data Only)

Donovan DM, Rosengren DB, Downey L, et al. Attrition prevention with individuals awaiting publicly funded drug treatment. Addiction. 2001;96:1149–1160. [PubMed: 11487421]

ELDRIDGE1997 (Published Data Only)

Eldridge GD, St L, Little CE, et al. Evaluation of the HIV risk reduction intervention for women entering inpatient substance abuse treatment. AIDS Education & Prevention. 1997;9:62–76. [PubMed: 9083599]

EPSTEIN2003 (Published Data Only)

*. Epstein DH, Hawkins WE, Covi L, et al. Cognitive-behavioral therapy plus contingency management for cocaine use: findings during treatment and across 12-month follow-up. Psychology of Addictive Behaviors. 2003;17:73–82. [PMC free article: PMC1224747] [PubMed: 12665084]
Schroeder JR, Epstein DH, Umbricht A, et al. Changes in HIV risk behaviors among patients receiving combined pharmacological and behavioral interventions for heroin and cocaine dependence. Addictive Behaviours. 2006;31:868–879. [PubMed: 16085366]

GIBSON1999 (Published Data Only)

Gibson DR, Lovelle-Drache J, Young M, et al. Effectiveness of brief counseling in reducing HIV risk behavior in injecting drug users: final results of randomized trials of counseling with and without HIV testing. AIDS and Behavior. 1999;3:3–12.

HARRIS1998 (Published Data Only)

Harris RM, Bausell RB, Scott DE, et al. An intervention for changing high-risk HIV behaviors of African American drug-dependent women. Research in Nursing and Health. 1998;21:239–250. [PubMed: 9609509]

KIDORF2005 (Published Data Only)

Kidorf M, Disney E, King V, et al. Challenges in motivating treatment enrollment in community syringe exchange participants. Journal of Urban Health. 2005;82:456–467. [PMC free article: PMC3456055] [PubMed: 16014875]

KOTRANSKI1998 (Published Data Only)

Kotranski L, Semaan S, Collier K, et al. Effectiveness of an HIV risk reduction counseling intervention for out-of-treatment drug users. AIDS Education and Prevention. 1998;10:19–33. [PubMed: 9505096]

MALOTTE1998 (Published Data Only)

Malotte CK, Rhodes F, Mais KE. Tuberculosis screening and compliance with return for skin test reading among active drug users. American Journal of Public Health. 1998;88:792–796. [PMC free article: PMC1508952] [PubMed: 9585747]

MALOTTE1999 (Published Data Only)

Malotte CK, Hollingshead JR, Rhodes F. Monetary versus nonmonetary incentives for TB skin test reading among drug users. American Journal of Preventive Medicine. 1999;16:182–188. [PubMed: 10198656]

MALOTTE2001 (Published Data Only)

Malotte CK, Hollingshead JR, Larro M. Incentives vs outreach workers for latent tuberculosis treatment in drug users. American Journal of Preventive Medicine. 2001;20:103–107. [PubMed: 11165450]

MALOW1994 (Published Data Only)

Malow RM, West JA, Corrigan SA, et al. Outcome of psychoeducation for HIV risk reduction. AIDS Education and Prevention. 1994;6:113–125. [PubMed: 8018438]

MARGOLIN2003A (Published Data Only)

Margolin A, Avants SK, Warburton LA, et al. A randomized clinical trial of a manual-guided risk reduction intervention for HIV-positive injection drug users. Health Psychology. 2003;22:223–228. [PubMed: 12683743]

MARSDEN2006 (Published Data Only)

Marsden J, Stillwell G, Barlow H, et al. An evaluation of a brief motivational intervention among young ecstasy and cocaine users: no effect on substance and alcohol use outcomes. Addiction. 2006;101:1014–1026. [PubMed: 16771893]

MCCAMBRIDGE2004 (Published Data Only)

McCambridge J, Strang J. Deterioration over time in effect of Motivational Interviewing in reducing drug consumption and related risk among young people. Addiction. 2005;100:470–478. [PubMed: 15784061]
*. McCambridge, J. & Strang, J. 2004The efficacy of single-session motivational interviewing in reducing drug consumption and perceptions of drug-related risk and harm among young people: results from a multi-site cluster randomized trial Addiction 9939–52. [PubMed: 14678061]

MILLER2003 (Published Data Only)

Miller WR, Yahne CE, Tonigan JS. Motivational interviewing in drug abuse services: a randomized trial. Journal of Consulting and Clinical Psychology. 2003;71:754–763. [PubMed: 12924680]

MITCHESON2007 (Published Data Only)

Mitcheson L, McCambridge J, Byrne S. Pilot cluster-randomised trial of adjunctive motivational interviewing to reduce crack cocaine use in clients on methadone maintenance. European Addiction Research. 2007;13:6–10. [PubMed: 17172773]

ONEILL1996 (Published Data Only)

O’Neill K, Baker A, Cooke M, et al. Evaluation of a cognitive-behavioural intervention for pregnant injecting drug users at risk of HIV infection. Addiction. 1996;91:1115–1125. [PubMed: 8828240]

ROSEN2007 (Published Data Only)

Rosen MI, Dieckhaus K, McMahon TJ, Valdes B, Petry NM, Cramer J, et al. Improved adherence with contingency management. AIDS Patient.Care STDS. 2007;21:30–40. [PubMed: 17263651]

SCHILLING1991 (Published Data Only)

Schilling RF, El-Bassel N, Schinke SP, et al. Building skills of recovering women drug users to reduce heterosexual AIDS transmission. Public Health Reports. 1991;106:297–304. [PMC free article: PMC1580245] [PubMed: 1905051]

SEAL2003 (Published Data Only)

Seal KH, Kral AH, Lorvick J, et al. A randomized controlled trial of monetary incentives vs. outreach to enhance adherence to the hepatitis B vaccine series among injection drug users. Drug & Alcohol Dependence. 2003;71:127–131. [PubMed: 12927650]

SIEGAL1995 (Published Data Only)

Siegal HA, Falck RS, Carlson RG, et al. Reducing HIV needle risk behaviors among injection-drug users in the Midwest: an evaluation of the efficacy of standard and enhanced interventions. AIDS Education and Prevention. 1995;7:308–319. [PubMed: 7577307]

SORENSEN1994 (Published Data Only)

Sorensen JL, London J, Heitzmann C, et al. Psychoeducational group approach: HIV risk reduction in drug users. AIDS Education and Prevention. 1994;6:95–112. [PubMed: 8018443]

SORENSEN2006 (Published Data Only)

Sorensen JL, Haug NA, Delucchi KL, et al. Voucher reinforcement improves medication adherence in HIV-positive methadone patients: a randomized trial. Drug and Alcohol Dependence. 2006 Oct 20; [epub ahead of print] [PMC free article: PMC1976289] [PubMed: 17056206]

STEPHENS2000 (Published Data Only)

Stephens RS, Roffman RA, Curtin L. Comparison of extended versus brief treatments for marijuana use. Journal of Consulting and Clinical Psychology. 2000;68:898–908. [PubMed: 11068976]

STEPHENS2002 (Published Data Only)

Stephens RS, Babor TF, Kadden R, et al. The Marijuana Treatment Project: rationale, design and participant characteristics. Addiction. 2002;97(Suppl 1):109–124. [PubMed: 12460133]

STERK2003 (Published Data Only)

Sterk CE, Theall KP, Elifson KW, et al. HIV risk reduction among African-American women who inject drugs: a randomized controlled trial. AIDS and Behavior. 2003;7:73–86. [PubMed: 14534392]

STOTTS2001 (Published Data Only)

Stotts AL, Schmitz JM, Rhoades HM, et al. Motivational interviewing with cocaine-dependent patients: a pilot study. Journal of Consulting and Clinical Psychology. 2001;69:858–862. [PubMed: 11680565]

TUCKER2004A (Published Data Only)

Tucker T, Fry CL, Lintzeris N, et al. Randomized controlled trial of a brief behavioural intervention for reducing hepatitis C virus risk practices among injecting drug users. Addiction. 2004;99:1157–1166. [PubMed: 15317636]

WECHSBERG2004 (Published Data Only)

Wechsberg WM, Lam WK, Zule WA, et al. Efficacy of a woman-focused intervention to reduce HIV risk and increase self-sufficiency among African American crack abusers. American Journal of Public Health. 2004;94:1165–1173. [PMC free article: PMC1448416] [PubMed: 15226138]

References of Excluded Studies

BAKER2001 (Published Data Only)

Baker A, Boggs TG, Lewin TJ . Randomized controlled trial of brief cognitive-behavioural interventions among regular users of amphetamine. Addiction. 2001;96:1279–1287. [PubMed: 11672492]

BOATLER1994A (Published Data Only)

Boatler JF, Knight K, Simpson DD. Assessment of an AIDS intervention program during drug abuse treatment. Journal of Substance Abuse Treatment. 1994;11:367–372. [PubMed: 7966507]

BOOTH1996 (Published Data Only)

Booth RE, Crowley TJ, Zhang Y. Substance abuse treatment entry, retention and effectiveness: out-of-treatment opiate injection drug users. Drug & Alcohol Dependence. 1996;42:11–20. [PubMed: 8889399]

BOOTH2004 (Published Data Only)

Booth RE, Corsi KF, Mikulich SK. Improving entry to methadone maintenance among out-of-treatment injection drug users. Journal of Substance Abuse Treatment. 2003;24:305–311. [PubMed: 12867204]
*. Booth, R.E., Corsi, K.F. & Mikulich-Gilbertson, S.K. 2004Factors associated with methadone maintenance treatment retention among street-recruited injection drug users Drug and Alcohol Dependence 74177–185. [PubMed: 15099661]

BRAINE2004A (Published Data Only)

Braine N, Des J, Ahmad S, et al. Long-term effects of syringe exchange on risk behavior and HIV prevention. AIDS Education and Prevention. 2004;16:264–275. [PubMed: 15237055]

CHOOPANYA2003 (Published Data Only)

Choopanya K, Des J, Vanichseni S, et al. HIV risk reduction in a cohort of injecting drug users in Bangkok, Thailand. Journal of Acquired Immune Deficiency Syndromes. 2003;33:88–95. [PubMed: 12792360]

COMPTON1998A (Published Data Only)

Compton WM, Cottler LB, Spitznagel EL, et al. Cocaine users with antisocial personality improve HIV risk behaviors as much as those without antisocial personality. Drug and Alcohol Dependence. 1998;49:239–247. [PubMed: 9571388]

COMPTON2000A (Published Data Only)

Compton WM, Cottler LB, Ben-Abdallah A, et al. The effects of psychiatric comorbidity on response to an HIV prevention intervention. Drug and Alcohol Dependence. 2000;58:247–257. [PubMed: 10759035]

CONROD2000A (Published Data Only)

Conrod PJ, Stewart SH, Pihl RO, et al. Efficacy of brief coping skills interventions that match different personality profiles of female substance abusers. Psychology of Addictive Behaviors. 2000;14:231–242. [PubMed: 10998949]

DAVIS2003 (Published Data Only)

Davis TM, Baer JS, Saxon AJ, et al. Brief motivational feedback improves post-incarceration treatment contact among veterans with substance use disorders. Drug and Alcohol Dependence. 2001;69:197–203. [PubMed: 12609701]

ELBASSEL2005

El-Bassel N, Gilbert L, Wu E, et al. HIV and intimate partner violence among methadone-maintained women in New York City. Social Science and Medicine. 2005;61:171–183. [PubMed: 15847970]

FISHER2003 (Published Data Only)

Fisher DG, Fenaughty AM, Cagle HH, et al. Needle exchange and injection drug use frequency: a randomized clinical trial. Journal of Acquired Immune Deficiency Syndromes. 2003;33:199–205. [PubMed: 12794555]

HEIL2005A (Published Data Only)

Heil SH, Sigmon SC, Mongeon JA, et al. Characterizing and improving HIV/AIDS knowledge among cocaine-dependent outpatients. Experimental and Clinical Psychopharmacology. 2005;13:238–243. [PubMed: 16173887]

HERSHBERGER2003 (Published Data Only)

Hershberger SL, Wood MM, Fisher DG. A cognitive-behavioral intervention to reduce HIV risk behaviors in crack and injection drug users. AIDS and Behavior. 2003;7:229–243. [PubMed: 14586186]

KWIATKOWSKI1999 (Published Data Only)

Kwiatkowski CF, Stober DR, Booth RE, et al. Predictors of increased condom use following HIV intervention with heterosexually active drug users. Drug and Alcohol Dependence. 1999;54:57–62. [PubMed: 10101617]

LASH2005

Lash SJ, Gilmore JD, Burden JL, et al. The impact of contracting and prompting substance abuse treatment entry: a pilot trial. Addictive Behaviors. 2005;30:415–422. [PubMed: 15718059]

LINDENBERG2002A (Published Data Only)

Lindenberg CS, Solorzano RM, Bear D, et al. Reducing substance use and risky sexual behavior among young, low-income, Mexican-American women: comparison of two interventions. Applied Nursing Research. 2002;15:137–148. [PubMed: 12173165]

MALOW1992 (Published Data Only)

Malow RM, Corrigan SA, Pena JM, et al. Effectiveness of a psychoeducational approach to HIV risk behavior reduction. Psychology of Addictive Behaviors. 1992;6:120–125.

MARSCH2004A (Published Data Only)

Marsch LA, Bickel WK. Efficacy of computer-based HIV/AIDS education for injection drug users. American Journal of Health Behavior. 2004;28:316–327. [PubMed: 15228968]

MARTIN2001A (Published Data Only)

Martin J, Sabugal GM, Rubio R, et al. Outcomes of a health education intervention in a sample of patients infected by HIV, most of them injection drug users: possibilities and limitations. AIDS Care. 2001;13:467–473. [PubMed: 11454267]

MCCUSKER1992A (Published Data Only)

McCusker J, Bigelow C, Zapka JG, et al. HIV-1 antibody testing among drug users participating in AIDS education. Patient Education and Counseling. 1994;24:267–278. [PubMed: 7753720]
*. McCusker, J., Stoddard, A.M., Zapka, J.G., et al. 1992AIDS education for drug abusers: evaluation of short-term effectiveness American Journal of Public Health 82533–540. [PMC free article: PMC1694110] [PubMed: 1546770]

ONDERSMA2005 (Published Data Only)

Ondersma SJ, Chase SK, Svikis DS, et al. Computer-based brief motivational intervention for perinatal drug use. Journal of Substance Abuse Treatment. 2005;28:305–312. [PMC free article: PMC3836613] [PubMed: 15925264]

RILEY2000A (Published Data Only)

Riley ED, Safaeian M, Strathdee SA, et al. Comparing new participants of a mobile versus a pharmacy-based needle exchange program. Journal of Acquired Immune Deficiency Syndromes. 2000;24:57–61. [PubMed: 10877496]

ROHSENOW2004 (Published Data Only)

Rohsenow DJ, Monti PM, Martin RA, et al. Motivational enhancement and coping skills training for cocaine abusers: effects on substance use outcomes. Addiction. 2004;99:862–874. [PubMed: 15200582]

SAUNDERS1995 (Published Data Only)

Saunders B, Wilkinson C, Phillips M. The impact of a brief motivational intervention with opiate users attending a methadone programme. Addiction. 1995;90:415–424. [PubMed: 7735025]

SCOTT2001

Scott CK, Dennis ML, Foss MA. Utilizing recovery management checkups to shorten the cycle of relapse, treatment reentry, and recovery. Drug and Alcohol Dependence. 2004;78:325–338. [PMC free article: PMC5933845] [PubMed: 15893164]

SHERMAN2006 (Published Data Only)

Sherman SG, German D, Cheng Y, et al. The evaluation of the JEWEL project: an innovative economic enhancement and HIV prevention intervention study targeting drug using women involved in prostitution. AIDS Care. 2006;18:1. [PubMed: 16282070]

STARK2005 (Published Data Only)

Stark K, Herrmann U, Ehrhardt S, et al. A syringe exchange programme in prison as prevention strategy against HIV infection and hepatitis B and C in Berlin, Germany. Epidemiology and Infection. 2005 [epub Dec 22 2005]. [PMC free article: PMC2870452] [PubMed: 16371183]

STEIN2002B (Published Data Only)

*. Stein MD, Anderson B, Charuvastra A, et al. A brief intervention for hazardous drinkers in a needle exchange program. Journal of Substance Abuse Treatment. 2002;22:23–31. [PubMed: 11849904]
Stein MD, Charuvastra A, Maksad J, et al. A randomized trial of a brief alcohol intervention for needle exchangers (BRAINE). Addiction. 2002;97:691–700. [PubMed: 12084138]

STEPHENS2004 (Published Data Only)

Stephens RS, Roffman RA, Fearer SA, et al. The marijuana check-up: reaching users who are ambivalent about change. Addiction. 2004;99:1323–1332. [PubMed: 15369571]

STERK2003B (Published Data Only)

Sterk CE, Theall KP, Elifson KW. Who's getting the message? Intervention response rates among women who inject drugs and/or smoke crack cocaine. Preventive Medicine. 2003;37:119–128. [PubMed: 12855211]

Characteristics Table for The Clinical Question: Brief Interventions Versus Standard Interventions

Comparisons Included in this Clinical Question

Motivational interviewing versus CBT
BAKER1993
BUDNEY2000
COPELAND2001
STEPHENS2000
STEPHENS2002

Characteristics of Included Studies

Methods	Participants	Outcomes	Interventions	Notes
BAKER1993	n= 95 Age: Mean 31 Sex: 44 males 51 females Diagnosis: 100% opioid dependence by eligibility for/receipt of MMT 100% IDU (injection drug use) by self-report Exclusions: - not injected drugs in last 6 months - not agreed to HIV testing - diagnosis of schizophrenia, bipolar disorder, psychosis, organic brain damage Baseline: HIV status: 6 were HIV-positive	Data Used Reduced risk behaviours	Group 1 N= 31 CBT: RP (relapse prevention) with outpatient - 6 sessions, each 60–90 mins, conducted individually. First session motivational interview. Second to sixth sessions focused on specific techniques to reduce injecting and sexual risk behaviour. Opiate agonist: MMT (methadone maintenance) with outpatient Group 2 N= 31 AMI (adapted motivational interviewing): MI with outpatient - Single session lasting 60–90 mins. Aimed to raise motivation to change needle use and unsafe sexual behaviour. Major aim to have participant express concerns about high risk behaviours and express desire to change. Opiate agonist: MMT (methadone maintenance) with outpatient Group 3 N= 33 Control: TAU (treatment as usual) with outpatient - Advice about HIV risk behaviours normally available from staff at methadone programmes and via an education leaflet. Opiate agonist: MMT (methadone maintenance) with outpatient	Study quality: 1+
Study Type: RCT (randomised controlled trial) Type of Analysis: Per protocol Blindness: Single blind Duration (days): Mean 42 Followup: 6 months Setting: Australia, MMT programme Notes: RANDOMISATION: Stratified on sex and HIV status. Within each couple, both partners allocated to same group to avoid confounding treatment effects.		Data Used Reduced risk behaviours		Study quality: 1+
BUDNEY2000	n= 60 Age: Mean 33 Sex: 50 males 10 females Diagnosis: 100% cannabis dependence by DSM-III-R Exclusions: - <18 years of age - not used cannabis in the last 30 days - current dependence on alcohol or any other drug except nicotine - active psychosis or severe psychiatric or medical disorder - legal problems or incarceration imminent Baseline: GROUP: MET/MET + CBT/MET + CBT + CM Years of regular cannabis use: 15.5/15.9/14.3 ASPD (%): 20/30/30	Data Used ASI (Addiction Severity Index): drug use Abstinence: weeks drug free Notes: DROPOUTS: MET (motivational enhancement therapy) = 55%, MET + CBT = 35%, MET + CBT + CM = 45%	Group 1 N= 20 CBT: coping skills training - 13 sessions: sessions 2–8, skills directly related to achieving and maintaining abstinence (dealing with urges and drug refusal); 9–14, coping skills indirectly related to drug use (managing mood and enhancing social networks). CM: vouchers - Vouchers received for each negative urine sample from weeks 3–14: first negative sample = $1.50; increased by $1.50 for each consecutive negative sample; $10 bonus for 2 consecutive negative urines; positive sample reset vouchers to $1.50. AMI: MET (motivational enhancement therapy) with outpatient - 1 session same as session 1 of MET Group 2 N= 20 CBT: coping skills training - 13 sessions: sessions 2–8, skills directly related to achieving and maintaining abstinence (dealing with urges and drug refusal); 9–14 coping skills indirectly related to drug use (managing mood and enhancing social networks). AMI: MET (motivational enhancement therapy) with outpatient - 1 session identical to first session of MET group Group 3 N= 20 AMI: MET (motivational enhancement therapy) with outpatient - Four 60–90-min sessions on weeks 1, 2, 6 and 12 based on Project Match. Session 1: non-judgemental feedback. Session 2: review of first and confirmation of commitment to change. Session 3 and 4: booster sessions.	Study quality: 1+
Study Type: RCT (randomised controlled trial) Blindness: No mention Duration (days): Mean 98 Info on Screening Process: 10 people excluded after intake process: 5 for alcohol dependence, 3 for not meeting DSM criteria for cannabis dependence, 1 for cocaine dependence; 5 did not return after intake assessment				Study quality: 1+
COPELAND2001	n= 229 Age: Mean 32 Sex: 159 males 70 females Diagnosis: 96% cannabis dependence by DSM-IV Exclusions: - no desire to cease cannabis use - > weekly use of drugs other than cannabis, nicotine, or alcohol in past 6 months (AUDIT scores >15) - received formal treatment for cannabis dependence in previous 3 months Baseline: Mean years of weekly cannabis use = 13.9	Data Used Abstinence at 6 months Abstinence: days drug free Drug use: days per month Notes: DROPOUTS at 6-month follow-up: 6 CBT = 20%, 1 MI (motivational interviewing) =25%	Group 1 N= 82 AMI (adapted motivational interviewing): MI with outpatient - 1 session for 90 mins. Combined principles of MI and CBT Group 2 N= 78 CBT (cognitive behavioural therapy) with outpatient - 6 sessions for 1 hour each. First session based on MI principles, 2nd session discussed urge management strategies, 3rd on withdrawal management, 4th on cognitive strategies and skill enhancement, 5th on strategy review and 6th on relapse prevention.	Study quality: 1+
Study Type: RCT (randomised controlled trial) Blindness: Single blind Duration (days): Followup: 24 weeks Setting: Australia Info on Screening Process: 1075 screened, 565 excluded; of 510 eligible, 225 did not make appointments to attend and 47 didn't turn up for assessment; prior to randomization, 9 exceeded criteria for alcohol misuse				Study quality: 1+
STEPHENS2000	n= 291 Age: Mean 34 Sex: 224 males 67 females Diagnosis: Exclusions: - cannabis used <50 times in last 90 days - alcohol or other drug misuse in last 90 days - severe psychological distress - receiving other formal treatment Baseline: Years of use = 17.35 (5.21), days of use past 90 days = 74.64 (18.54)	Data Used Cannabis use: days in past 3 months Notes: DROPOUTS: CBT = 19%, MI (motivational interviewing) = 8%, waitlist = 8%	Group 1 N= 117 CBT: group RP (relapse prevention) with outpatient - 14 x 2-hour CBT: RP group sessions over an 18-week period. Sessions 1–10 weekly, 11–14 every other week. Weeks 1–4 involved building motivation for change and high-risk situations identified, 5–10 building coping skills, 11–14 coping with rationalisations Group 2 N= 88 AMI (adapted motivational interviewing): MI with outpatient - Two 90-min individual sessions. Involved MI (e.g. reflective listening, affirmation and reframing) and CBT techniques (identifying high-risk situations). Second session (1 month after) reviewed previous session and feedback received. Group 3 N= 86 Control: waitlist with outpatient - Waitlist of 4 months until treatment	Study quality: 1+
Study Type: RCT (randomised controlled trial) Blindness: No mention Duration (days): Followup: 1, 4, 7 and 13 months Setting: US Info on Screening Process: 601 screened, 183 excluded (cannabis used <50 times in 90 days (n=24), alcohol or other drug misuse in last 90 days (n=149), severe psychological distress (n=8), other formal treatment (n=2)). Of eligible sample, 127 didn't complete pre-treatment session.				Study quality: 1+
STEPHENS2002	n= 450 Age: Mean 36 Sex: 306 males 144 females Diagnosis: 100% cannabis dependence by DSM-IV Exclusions: - <18 years - dependence on other drugs or alcohol - inability to provide a person who could assist in contact at follow-up - legal status that would disrupt treatment - currently receiving therapy Notes: Ethnicity: White = 69.3%, Hispanic = 17.3%, African American = 12.2%, Other = 1.1% Baseline: Proportion of days drug used in last 90 days = 0.88, hours high per day = 6.62, ounces of cannabis per week = 0.40, number of joints per day = 2.89	Data Used Cannabis use: days in past 3 months Abstinence: no use for 3 months Notes: DROPOUTS: MI (motivational interviewing) = 18/146 (12.3%), CBT = 23/156 (15%), waitlist =11/148 (7.5%)	Group 1 N= 148 Control: waitlist with outpatient Group 2 N= 146 AMI (adapted motivational interviewing): MI with outpatient - Two 1-hour sessions 1 and 5 weeks after randomisation. Discussed a personal feedback report to motivate participant to make changes -- attitudes favouring and opposing change, treatment goals etc; in second session efforts to reduce cannabis use reviewed. Group 3 N= 156 CBT: coping skills training with outpatient - 9 sessions over a 12-week period. First 8 sessions weekly, 9th session 4 weeks after 8th session to review changes. Combined motivational aspects with CBT and case management.	Study quality: 1+
Study Type: RCT (randomised controlled trial) Blindness: Duration (days): Followup: 4 and 9 months Setting: 3 US urban areas Notes: RANDOMISATION: Conducted centrally at the the Center for Substance Abuse Treatment using urn randomisation programme Info on Screening Process: 1211 screened, 398 excluded (dependence on other drugs (31%), unwilling to accept random assignment (21%), currently receiving therapy (20%), did not provide contact person (20%), legal status (16%)); 363 eligible but did not complete assessment				Study quality: 1+

Characteristics of Excluded Studies

Reference ID	Reason for Exclusion
BAKER2002	Psychiatric population

References of Included Studies

BAKER1993 (Published Data Only)

Baker A, Heather N, Wodak A, et al. Evaluation of cognitive-behavioural intervention for HIV prevention among injecting drug users. AIDS. 1993;7:247–256. [PubMed: 8466688]

BUDNEY2000 (Published Data Only)

Budney AJ, Higgins ST, Radonovich KJ, et al. Adding voucher-based incentives to coping skills and motivational enhancement improves outcomes during treatment for marijuana dependence. Journal of Consulting and Clinical Psychology. 2000;68:1051–1061. [PubMed: 11142539]

COPELAND2001 (Published Data Only)

Copeland J, Swift W, Roffman R, et al. A randomized controlled trial of brief cognitive-behavioral interventions for cannabis use disorder. Journal of Substance Abuse Treatment. 2001;21:55–64. [PubMed: 11551733]

STEPHENS2000 (Published Data Only)

Stephens RS, Roffman RA, Curtin L. Comparison of extended versus brief treatments for marijuana use. Journal of Consulting and Clinical Psychology. 2000;68:898–908. [PubMed: 11068976]

STEPHENS2002 (Published Data Only)

Stephens RS, Babor TF, Kadden R, et al. The Marijuana Treatment Project: rationale, design and participant characteristics. Addiction. 2002;97(Suppl 1):109–124. [PubMed: 12460133]

References of Excluded Studies

BAKER2002

Baker A, Lewin T, Reichler H, et al. Evaluation of a motivational interview for substance use within psychiatric in-patient services. Addiction. 2002;97:1329–1337. [PubMed: 12359037]

Characteristics Table for The Clinical Question: Structured Psychosocial Interventions

Comparisons Included in this Clinical Question

(Desipramine + CBT) versus control	(Motivational enhancement therapy + CBT) versus control	12-step versus control FINNEY1998	Behavioural counselling versus facilitative counselling MCKAY2004
Case management versus standard care COVIELLO2006 MARTIN1993 MEJTA1997 MORGENSTERN2006 NEEDELS2005 SALEH2002 SORENSEN2005	CBT versus control BROWN2002 BUDNEY2006 CARROLL1991 CARROLL2006B CRITSCHRISTOPH1999 KADDEN2006 MAUDEGRIFFIN1998 MCKAY2004 MONTI1997 RAWSON2006 SHOPTAW2005 STEPHENS1994 STEPHENS2000 STEPHENS2002 WALDRON2001	CBT: enhanced versus standard	CBT: frequency of sessions
CBT: group versus individual	CM versus CBT BUDNEY2006 KADDEN2006 RAWSON2006 SHOPTAW2005	CM versus community reinforcement approach HIGGINS2003
CM versus control BUDNEY2006 CARROLL2006B CRITSCHRISTOPH1999 HIGGINS1993 HIGGINS1994 JONES2004 KADDEN2006 PETRY2004 PETRY2005A PETRY2005B PETRY2006 RAWSON2006 ROLL2006 SHOPTAW2005 SHOPTAW2006	CM: high frequency versus low frequency CHUTUAPE2001	CM: high reward versus low reward PETRY2004	CM: qualitative contingency versus quantitative contingency PETRY2002
Counselling versus control CRITSCHRISTOPH1999	Family intervention versus control DENNIS2004 FALSSTEWART1996 HENGGELER1999 KELLEY2002 LIDDLE2001 WALDRON2001 WINTERS2002	Family intervention: with family versus individual	Intensive referral versus standard referral JOANNING1992 STRATHDEE2006 ZANIS1996
Pre-vocational interventions versus control HALL1977 ZANIS2001	Supportive-expressive psychotherapy versus control	Telephone intervention versus control

Characteristics of Included Studies

Methods	Participants				Outcomes	Interventions	Notes
BROWN2002	n= 131 Age: Mean 38 Sex: 90 males 41 females Diagnosis: 100% substance dependence (drug or alcohol) by DSM-III-R Exclusions: Severe psychosis or organic brain syndrome Notes: PRIMARY DIAGNOSIS: 71.4% had 'alcohol and drug dependence'. The remainder were dependent on only alcohol. REFERRALS: Newly-admitted patients at treatment centres Baseline: (GROUPS: 12-step/RP/treatment as usual) Days of use in past 90 days: 46.1/46.0/45.3 ASI (alcohol): 0.31/0.33/0.42 ASI (drug): 0.16/0.14/0.12				Data Used B-PRPI Brown-Peterson Recovery Progress Inventory ASI (Addiction Severity Index): drug use ADUSE (Alcohol and Drug Use Self-Efficacy Scale) ASI (Addiction Severity Index): alcohol use Notes: FOLLOW-UPS: At intake for intensive treatment, at completion of intensive treatment, after 10 sessions of aftercare and 6 mnths' post-intensive treatment DROPOUTS: 41.4% 12-step/41.4% RP/44.3% usual treatment lost to follow-up after 10 sessions	Group 1 N= 61 CBT: RP (relapse prevention) with residential rehabilitation - 90 minutes per week for 10 weeks; closed group format; assessing high-risk situations, initiating and maintaining change Group 2 N= 70 TSF (12-step facilitation) with residential rehabilitation - 90-minute session weekly for 10 weeks; closed group format; emphasis on working the first 3 steps	Study quality: 1+

Study Type: RCT (randomised controlled trial) Type of Analysis: No mention Blindness: No mention Duration (days): Mean 70 Followup: 180 Setting: 3 treatment centres in Canada Notes: RANDOMISATION: Computer-assisted urn randomisation with matching. Usual treatment group were self-selected. Info on Screening Process: 383 approached: 47 refused consent, 266 randomised, 70 refused randomisation but consented to subsequent assessment (= usual treatment group)

BUDNEY2006	n= 90 Age: Mean 33 Sex: 69 males 21 females Diagnosis: 100% cannabis dependence by DSM-IV Exclusions: - < 18 years of age - lived further than 45 mins from clinic - current dependence on alcohol or any other drug except nicotine - active psychosis or severe other psychiatric condition Baseline: GROUPS: CBT/CBT + CM/CM Years of use: 14.7 ( 9.3)/11.3 (9.8)/15.3 (8.7) Use in past 30 days: 25.5 (7.4)/25.3 (8.0)/26.0 (6.2)				Data Used Abstinence at 6 months Abstinence: longest consecutive period Drug use: days per month	Group 1 N= 30 CBT (cognitive behavioural therapy) with outpatient - 50-min sessions of individual CBT for 14 weeks. Sessions 1–2, motivational interviewing. Sessions 3–8 focused on skills directly related to achieving and maintaining abstinence. Sessions 9–14 focused on coping skills indirectly related to abstinence. Group 2 N= 30 CM: vouchers with outpatient - $1.50 for first negative urine, increased by $1.50 for each subsequent negative urine, $10 bonus for 2 consecutive negative samples. Positive sample resulted in vouchers reset to $1.50. CBT (cognitive behavioural therapy) with outpatient - 50-min sessions of individual CBT for 14 weeks. Sessions 1–2, motivational interviewing. Sessions 3–8 focused on skills directly related to achieving and maintaining abstinence. Sessions 9–14 focused on coping skills indirectly related to abstinence. Group 3 N= 30 CM: vouchers with outpatient - $1.50 for first negative urine, increased by $1.50 for each subsequent negative urine, $10 bonus for 2 consecutive negative samples. Positive sample resulted in vouchers reset to $1.50.	Study quality: 1++

Study Type: RCT (randomised controlled trial) Type of Analysis: ITT (mixed models analysis) Blindness: No mention Duration (days): Mean 98 Followup: 12 months Setting: US Notes: RANDOMISATION: minimum likelihood allocation Info on Screening Process: 19 excluded (6 didn't meet DSM criteria, 6 alcohol dependent, 2 opiate dependent, 2 likely to be incarcerated in near future, 1 with active psychosis, 1 with head injury, 1 unable to provide address or phone no.); 19 eligible but didn't return for study

CARROLL1991	n= 42 Age: Mean 27 Sex: 31 males 11 females Diagnosis: 100% cocaine misuse by DSM-III Exclusions: - cocaine not primary drug of misuse, dependence on another drug or use of any other psychotropic medication - current or lifetime diagnosis of schizophrenia or mania - suicide ideation to the extent that hospitalisation is required - pending drug-related legal proceedings or treatment stipulated as condition of probation Notes: REFERRALS: People who applied for treatment at the SATU cocaine clinic Baseline: (GROUP: IPT/RP) Years of education: 12.8/12.6 Weekly cocaine use (g): 4.3/3.6 Months of regular cocaine use: 45.4/34.2 Any depressive disorder: 4%/4% Generalised anxiety disorder: 0/1% APD: 5%/7% Alcoholism: 7%/6%				Data Used Abstinence: no use for any 3 consecutive weeks ASI (Addiction Severity Index) Cocaine craving: VAS (visual analogue scale) Abstinence: no use for 3 consecutive weeks at end Cocaine use: grams, self-report Notes: FOLLOW-UPS: study weeks 1, 2, 4, 6, 8 and 12 DROPOUTS: 19/42 did not complete >=9 sessions. One subject (among completers?) removed from study because of 'no substantial reduction in cocaine use')	Group 1 N= 21 IPT (interpersonal therapy) with outpatient. Mean dose 12 sessions - 50–60 minutes once a week; manual-guided and individualised; thought to be closely related to TAU at many cocaine programmes where supportive-expressive psycotherapy is used Group 2 N= 21 CBT: RP (relapse prevention) with outpatient. Mean dose 12 sessions - 50–60 minutes once a week; manual-guided and individualised; identifying high-risk situations and developing coping strategies	Study quality: 1+

Study Type: RCT (randomised controlled trial) Type of Analysis: LOCF Blindness: No mention Duration (days): Mean 84 Followup: 0 Setting: USA Notes: RANDOMISATION: No details given Info on Screening Process: 42 enrolled

CARROLL2006B	n= 136 Age: Mean 21 Range 18–25 Sex: 122 males 14 females Diagnosis: 100% cannabis dependence by DSM-IV Exclusions: - age outside range 18–25 - opiate or alcohol dependence - severe substance dependence requiring inpatient treatment or detoxification - current psychotic disorder - previous treatment for cannabis use in past 60 days - current homicidal risk - MMSE <2 - not referred by criminal justice system - severe medical problems Notes: ETHNICITY: 60% African American, 13% Latin American, 23% European American Baseline: (CM/motivational enhancement therapy + CBT/standard counselling) Lifetime arrests: 5.9/5.0/5.2 Age first alcohol use: 14.3/17.5/14.9 Age first cannabis use: 14.4/14.9/14.7 Days' cannabis use in past month: 13.7/12.4/12.5				Data Used Urinalysis: positive for cannabis Abstinence: longest consecutive period	Group 1 N= 33 CM: vouchers with outpatient. Mean dose 8 weeks - Two-track reward system: $25 for first session attended, increased by $5 per session thereafter; $50 for first cannabis −ve urine (tested at each session), increased by $5 per −ve thereafter. Non-attendance/missing/+ve urine reset respective schedule. Group 2 N= 34 AMI: MET (motivational enhancement therapy) CM: vouchers Group 3 N= 36 AMI: MET (motivational enhancement therapy) with outpatient. Mean dose 8 sessions - Motivational interviewing style (MTP) to address initial ambivalence, then continued as CBT/skills training techniques incorporated (coping with craving, problem solving, avoiding high- risk situations, decision making etc.) Group 4 N= 33 Control: standard care with outpatient. Mean dose 8 sessions - 8 weekly sessions. Standard individual drug counselling (Baker, Mercer/Woody) with strong emphasis on cannabis and other drug abstinence, through use of self-help groups and concepts compatible with 12- step; education regarding cannabis use.	Study quality: 1+

Study Type: RCT (randomised controlled trial) Type of Analysis: ITT (all randomised included in analyses) Blindness: Open Duration (days): Mean 56 Followup: 6 months Setting: Conneticut, USA Notes: Randomisation procedure not reported Info on Screening Process: 208 screened; 174 eligible. 36 dropped out prior to randomisation, so 136 randomised

CHUTUAPE2001	n= 53 Age: Sex: Diagnosis: 100% opioid dependence by eligibility for/receipt of MMT Exclusions: - opiate-negative samples at intake - no signs of intravenous use - self-reported opiate use (<= 21 of 30 days) for 6 or more months of previous year - history of addiction <1 year - serious medical or psychiatric illness - pregnancy Baseline: GROUPS: CM weekly/CM monthly/non-contingent management				Data Used Response: abstinent >= 8 weeks Abstinence: weeks drug free Notes: DROPOUTS: Weekly CM = 6/16, monthly CM = 3/18, NCM (non-contingent management) = 1/19	Group 1 N= 19 NCM (non-contingent management) with outpatient - Received take-home doses based on individual weekly drawings rather than drug-free urine results -- probability of earning take homes was 50% Group 2 N= 18 CM: methadone with outpatient - Urinalysis results randomly selected monthly -- a negative sample resulted in 3 take-home doses till the next test. A positive sample resulted in cancellation of take-home doses. Group 3 N= 16 CM: methadone with outpatient - Urinalysis results randomly selected weekly -- a negative sample resulted in 3 take-home doses till the next test. A positive sample resulted in cancellation of take-home doses.	Study quality: 1+

Study Type: RCT (randomised controlled trial) Blindness: No mention Duration (days): Mean 238 Setting: US Info on Screening Process: 231 screened, 15 did not complete baseline phase, 9 were opiate and cocaine free, submitted greater than 80% drug positive urines	Lifetime heroin use (months)	89	82	113
	Lifetime cocaine use (months)	23	23	28

COVIELLO2006	n= 128 Age: Mean 45 Sex: 111 males 17 females Diagnosis: 100% opioid dependence by eligibility for/receipt of MMT Exclusions: - reported using no drugs in past 30 days - already in drug treatment - not wishing to enrol in treatment Notes: 56% African American, 41% Caucasian POPULATION: Patients discharged from MMT Baseline: (Case management/passive referral) Years' heroin use: 17.4/18.0 Days' heroin use in past month: 17.9/16.2 Previous treatment episodes: 5.6/7.6 IDU: 68%/65%				Data Used Condom use Urinalysis: positive for opiates Urinalysis: positive for cocaine Urinalysis: positive for benzodiazepines Urinalysis: positive for cannabis Drug use: days per month Engagement in treatment Notes: 6-week endpoint, 20-week post- intervention follow-up	Group 1 N= 76 Case management with outpatient. Mean dose 6 weeks - 45-min initial session: assessment of needs and motivation, brief counselling and development of an action plan for treatment. Subsequent telephone contact, focused on actions and problem solving, over 6 weeks (and personal contact as necessary). Group 2 N= 52 Control: standard care with outpatient - Passive referral: 10 mins' advice and referral to re-enrolment; participants given an updated list of available treatment resources, with no further assistance or contact.	Study quality: 1+

Study Type: RCT (randomised controlled trial) Blindness: Open Duration (days): Mean 42 Followup: 20 weeks after end of programme Setting: Three MMT programmes in Philadelphia, USA Notes: Randomisation method not reported Info on Screening Process: 409 discharged from MMT; 260 interviewed and 132 ineligible (102 already in treatment, 30 used no drugs in past 30 days). 128 randomised.

CRITSCHRISTOPH1999	n= 487 Age: Mean 34 Sex: 374 males 113 females Diagnosis: 100% cocaine dependence by DSM-IV Exclusions: - age outside range 18–60 - no cocaine use in past 30 days Notes: ETHNICITY: 58% White Baseline: ASI drug-use composite: 0.24 Days' cocaine use in past 30 days: 10.4 Years' cocaine use: 6.9 Days' alcohol use past 30 days: 7.4				Data Used ASI (Addiction Severity Index): drug use Completion rate Cannabis use: times in past month Retention: sessions attended Abstinence: no use for 3 months Notes: DROPOUTS: High (77% individual drug counselling, 66% CBT, 67% supportive-expressive psychotherapy, 77% group drug counselling)	Group 1 N= 124 IDC (individual drug counselling) with outpatient - 50-min sessions twice weekly for first 12 weeks, weekly during weeks 10–24 and monthly during last 3 months. Manual with specific stages, tasks and goals based on 12-step philosophy Group therapy - 90 mins weekly for first 6 months of group drug counselling Group 2 N= 121 CBT: CT (cognitive therapy) with outpatient - 50-min sessions twice weekly for first 12 weeks, weekly during weeks 10–24 and monthly during last 3 months. Followed McLellan's manual for CT of substance misuse. Group therapy - 90 mins weekly for first 6 months of group drug counselling Group 3 N= 123 Group therapy with outpatient - 90-min sessions weekly for first 6 months, 30 mins monthly during last 3 months. Group drug counselling following a manual designed to educate patients about stages of recovery and encourage 12- step participation. Group 4 N= 119 SE (supportive-expressive psychotherapy) with outpatient - 50-min sessions twice weekly for first 12 weeks, weekly during weeks 10–24 and monthly during last 3 months. Psychodynamic therapy following manual by Luborsky, adapted for cocaine treatment Group therapy - 90 mins weekly for first 6 months of group drug counselling	Study quality: 1++

Study Type: RCT (randomised controlled trial) Study Description: ASI interviewers blind to treatment condition Type of Analysis: ITT for months' cocaine use Blindness: Single blind Duration (days): Mean 270 Followup: 9 months Setting: 5 hospitals in USA Notes: Computerised urn randomisation at coordinating centre. Info on Screening Process: 2197 screened by telephone, 1777 eligible. Of these, 937 attended intake visit (13 ineligible, 54 didn't return). 870 attended orientation phase; 487 completed attendance and assessment requirements and randomised.

DENNIS2004	n= 600 Age: Range 13–18 Sex: 498 males 102 females Diagnosis: 100% cannabis misuse by DSM-IV Exclusions: - Age outside range 12–18 - Not used cannabis in past 90 days, or 90 days prior to being in controlled environment - Inappropriate for short term outpatient treatment - Use of alcohol on >=45 of past 90 days - Use of other drugs on >=13 of past 90 days - Acute medical or psychological condition likely to interfere with full participation - History of repeated violent behaviour or severe conduct disorder Notes: ETHNICITY: 61% white, 30% African American, 4% Hispanic, 6% other Baseline: Single parent family: 50% Current CJS involvement: 62% Age of first use under 18: 85%				Data Used Completion rate Retention: days remained in treatment Abstinence: days drug free Notes: FOLLOWUPS: Pre/post, 12 months from baseline DROPOUTS: Trial 1 - CBT5 13%, CBT12 33%, FSN 21%; Trial 2 - CBT5 40%, CRA 39%, MDFT 30%	Group 1 N= 100 CBT: coping skills training - MET + CBT 5 as per Group 1 AMI: MET (motivational enhancement therapy) with outpatient Group 2 N= 96 CBT: coping skills training - 12 group sessions. Contents as per CBT5, with additional sessions addressing interpersonal problems, negative affect, problem solving, anger management, resisting craving, managing depression and thoughts about cannabis. AMI: MET (motivational enhancement therapy) with outpatient Group 3 N= 100 Case management - Limited case management over a period of 12–14 weeks. FI: MDFT (multidimensional family therapy) with outpatient - 12–15 sessions. 3 phases: engagement, working the themes and sealing the changes. Integrates drug use treatment into FT through improving communication, shifting from high conflict to affective issues, and developing positive experiences. Group 4 N= 100 FI (family intervention) with outpatient - 10 individual sessions with the adolescent, 4 sessions with caregivers (2 of which the whole family). Core procedures are identification of antecedents and consequences, goals of treatment and further goal planning, communication and problem solving. Case management - Limited case management over a period of 12–14 weeks. Group 5 N= 102 CBT: coping skills training - 5 group sessions (CBT5). Teaches basic skills for cannabis refusal, establishing a social network, replacing cannabis use with pleasant nondrug related activities, coping with high-risk situations, recovering from relapse AMI: MET (motivational enhancement therapy) with outpatient - 2 individual sessions, aims to reduce adolescents' ambivalence about their drug use, and to motivate them to stop using cannabis. Group 6 N= 102 Psychoeducation - Provided info on adolescent development and parents' role, substance abuse and dependence, recovery process and relapse signs, family development and organisation CBT: coping skills training - CBT12 AMI: MET (motivational enhancement therapy) with outpatient Case management - Facilitate treatment attendance, assess family needs and referrals to other community services. FI: FSN (family support network) - Family support groups

Study Type: RCT (randomised controlled trial) Study Description: For each adolescent, the parent or other collateral asked to participate in study Type of Analysis: ITT Blindness: No mention Duration (days): Range 42–98 Followup: 12 mths from baseline trial) Trial 1: Groups 1, 2 & 3 Trial 2: Groups 4, 5 & 6 Notes: RANDOMISATION: Occurred across sites in each trial Info on Screening Process: 85% of those eligible gave consent > 600 adolescents and their families enrolled and randomised

FALSSTEWART1996	n= 86 Age: Mean 34 Sex: all males Diagnosis: 100% drug misuse (non-alcohol) by DSM-III-R Exclusions: Husbands: - age range outside 20–60 years - not married for >=1 year or not living with a significant other in a stable common-law relationship for >= 2 years - seeking additional substance abuse treatment, except self-help meetings - primary drug of misuse is alcoholCouples: - wife met criteria for DSM-III-R substance misuse in past 6 mths - either partner met DSM-III-R criteria for organic mental disorder, schizophrenia, delusional (paranoid disorder) or other psychotic disorders - either partner in MMT Notes: PRIMARY DIAGNOSIS: Husbands were non-alcohol drug misusing or dependent ETHNICITY: 67% White, 10% African American, 3% Hispanic REFERRALS: CJS: 85%, self: 10%, physician/mental health care provider etc: 5% Baseline: (GROUPS: BCT/CBT) Primary drug Cocaine: 24/20 Opiates: 10/16 Cannabis: 4/3 Other: 2/1				Data Used ASI (Addiction Severity Index) Abstinence: percentage of days Abstinence: days drug free Urinalysis: positive for any drug Notes: FOLLOW-UPS: Weekly random urine screening DROPOUTS: 3/43 couples from CBT group and 3/43 from BCT group failed to complete	Group 1 N= 40 CBT: coping skills training with outpatient - 60-min individual sessions twice weekly. Goals: cognitive-behavioural restructuring, problem-solving for alternatives to drug use, relaxation training, anger management, refusal skills, assertiveness training and enhancing social support networks. CBT: group with outpatient - Groups of 6–8 patients meeting for 90 mins per week. Goals as above. Group 2 N= 40 CBT: coping skills training with outpatient - 60-min individual sessions once weekly FI: BCT (behavioural couples therapy) with outpatient - Couples met therapist for 60 mins once a week for 12 weeks. Goals: rewarding abstinence, constructive communication for conflict resolution, coping with cravings, crisis intervention and positive behavioural exchanges. CBT: group with outpatient - Groups of 6–8 patients meeting for 90 mins once weekly. Goals as above.	Study quality: 1+

Study Type: RCT (randomised controlled trial) Study Description: Husbands recruited alongside partners. Data given here for husbands only Blindness: Open Duration (days): Mean 168 Setting: USA Notes: RANDOMISATION: No details Info on Screening Process: 524 screened; 154 married or cohabiting recruited for interview. Of these, 51 refused consent and 17 met exclusion criteria (2 husbands alcohol dependent, 12 wives substance dependent, 3 had a psychiatric disorder). 86 couples were enrolled and randomised

FINNEY1998	n= 3228 Age: Sex: all males Diagnosis: 100% substance misuse (drug or alcohol) by ICD-10 Exclusions: - not in a standard VA treatment programme - female - had not completed detoxification Notes: PRIMARY DIAGNOSIS: 36% alcohol misuse/dependence only; 51% alcohol and drug misuse, 13% drug misuse only ETHNICITY: 48% Black, 46% White Baseline: 76% unemployed Past month drug use: 48% cocaine/crack, 39% cannabis, 13% opiates					Group 1 N= 970 12-step with inpatient Group 2 N= 106 12-step with inpatient CBT (cognitive behavioural therapy) with inpatient Group 3 N= 119 CBT (cognitive behavioural therapy) with inpatient	Content of interventions not reported - in secondary study? Study quality: 2+

Study Type: Cohort Blindness: Open Duration (days): Range 21–28 Setting: 15 inpatient substance misuse programmes from 13 Veteran Affairs (VA) treatment centres in USA Info on Screening Process: 4659 screened, 4193 eligible, 494 refused consent; of 3699 intake sample 3278 completed intake evaluation

HALL1977	n= 49 Age: Mean 30 Sex: 34 males 15 females Diagnosis: Exclusions: - ppts who were expected to serve jail time within 3 months - psychotic - illiterate Notes: ETHNICITY: Caucasian (n=28) Black (n=13) Latin descent (n=8)				Data Used Rating of written application Rating of employability Employment at follow-up Notes: DROP OUT: 4/23 experimental group 3/26 control group 3 month follow up - ppts contacted and asked if they had found a job or been placed in training program.	Group 1 N= 23 Vocational training - 2wk workshop consisted 3–6ppts who met on 2 days for approx. 5hrs, and 1 day for 3hrs. Sessions videotaped. 10–15 min relaxation technique training. Role play in int’v situation. Exploration of difficulties with application forms. Simulation of real int’v Group 2 N= 26 Control: TAU (treatment as usual) - Ppts given appointment for assessment interview (chance to practice interviews and complete application forms). Written note sent day prior to day of interview to remind ppts of appointment. No other intervention.	Study quality: 1+

Study Type: RCT (randomised controlled trial) Type of Analysis: Completers Blindness: Single blind Duration (days): Mean 14 Followup: 3 months Setting: US Outpatient (community) Info on Screening Process: 49 MMT ppts referred by vocational rehabilitation service none excluded

HENGGELER1999	n= 118 Age: Mean 16 Sex: 93 males 25 females Diagnosis: 100% substance misuse (drug or alcohol) by DSM-III-R Exclusions: - Age outside range 12–17 - Not on probation - Not in residence with a parent figure - Already involved in substance abuse treatment, or is sibling of a study participant Notes: PRIMARY DIAGNOSIS: 44% substance dependent; 60% polysubstance misuse; 87% alcohol misuse; 72% dual or multiple diagnoses REFERRALS: Juvenile offenders ETHNICITY: 50% African American, 47% Caucasian, 3% other Baseline: Lived with 2 parents (of which >=1 biological parent): 50% Lived with 1 parent: 40% Previous arrests: 2.9 Received previous treatment: 25% Had >=1 out of home placement: 33%				Data Used Crime: engaging in criminal activities Drug use: PEI (Personal Experience Inventory Urinalysis: matching self-report	Group 1 N= 58 FI: MST (multisystemic therapy) with outpatient - Targets problem behaviour at the individual, family, school and community levels; treatment intensity titrated by clinical need. Home-based delivery with 24–7 availability. Integrated with pharmcological monitoring as necessary. Group 2 N= 60 Day treatment: intensive (>60hr/wk) with outpatient - TAU condition: youths referred by probation officer to local substance abuse treatment services, typically weekly attendance of 12-step programme. Families received few substance abuse or mental health services.	Treatment and control groups significantly different in self-reported drug and alcohol usage (but favours control)

Study Type: RCT (randomised controlled trial) Study Description: Families received intervention alongside youths Type of Analysis: Per protocol Blindness: No mention Duration (days): Setting: USA Notes: RANDOMISATION: No details. Info on Screening Process: 423 screened > 140 met inclusion criteria > 118 gave consent

HIGGINS1993	n= 38 Age: Mean 29 Sex: Diagnosis: 100% cocaine dependence by DSM-III-R 55% alcohol dependence by DSM-III-R 42% cannabis dependence by DSM-III-R Exclusions: - <18 years - opiate or sedative dependence - psychosis - dementia - medical condition precluding employment - plans to leave area within 6 months Baseline: GROUPS: Behavioural/12-steps Weekly cocaine use: 4.0g/4.7g ASI (drug): 0.22/0.27				Data Used Abstinence: percentage of days	Group 1 N= 19 Day treatment: intensive (>60hr/wk) with outpatient - $5 for each urine sample provided. Counselling: one 2.5-hour group session and one 1-hour individual session/week for first 12 weeks. Then one group or individual therapy session per week for weeks 13–24. Based on a 12- step model. Group 2 N= 19 CM: CRA (community reinforcement approach) with outpatient - CM: First 12 wks: $2.50 first −ve, increase of $1.25 for consecutive −ve, $10 bonus for 3 consecutive. Second 12 wks: $1 lottery tickets, CRA: 1hr x 2/wk for 12 wks, then 1hr/wk. CRA: skills training, relationship and employment counselling, recreation.	Study quality: 1+

Study Type: RCT (randomised controlled trial) Blindness: Duration (days): Mean 168 Setting: US Notes: RANDOMISATION: Balanced for gender, route of administration, residence with significant other, legal matters pending, employment status etc Info on Screening Process: 13 did not meet inclusion criteria

HIGGINS1994	n= 40 Age: Mean 31 Sex: 27 males 13 females Diagnosis: 100% cocaine dependence by DSM-III-R 55% alcohol dependence by DSM-III-R 12% cannabis dependence by DSM-III-R Exclusions: - <18 years of age - no use of cocaine within previous 30 days - opiate dependence - sedative dependence - psychosis - pregnancy - dementia - recent inpatient treatment for cocaine - medical condition precluding employment				Data Used Abstinence: weeks drug free	Group 1 N= 20 CM: vouchers with outpatient - Weeks 1–12: started with $2.50, increase of $1.25 each consecutive negative sample, bonus of $10 for 3 consecutive negative samples. Weeks 13–24: $1 lottery ticket for negative sample. CM: CRA (community reinforcement approach) with outpatient - 1hr twice a week for weeks 1–12 and 1hr/week for weeks 13–24. Sessions included relationship counselling, recognising antecedents and consequences of cocaine use, skills training, employment counselling and helping to develop new recreational activities. Group 2 N= 20 CM: CRA (community reinforcement approach) - 1hr twice a week for weeks 1–12 and 1h/week for weeks 13–24. Sessions included relationship counselling, recognising antecedents and consequences of cocaine use, skills training, employment counselling and helping to develop new recreational activities. CM control: no vouchers with outpatient - Weeks 1–12: slips of paper given with result for each urine sample. Weeks 13–24: $1 lottery ticket for each negative sample.	Study quality: 1+

Study Type: RCT (randomised controlled trial) Blindness: Duration (days): Mean 168 Setting: US Notes: RANDOMISATION: groups balanced for gender, primary route of cocaine administration, ASI score etc	Baseline: GROUPS:	CRA + CM/	CRA
	ASI (drug):	0.25/	0.23
	BDI:	21.1/	19.4

HIGGINS2003	n= 100 Age: Mean 34 Sex: 38 males 62 females Diagnosis: 100% cocaine dependence by DSM-III-R 29% alcohol dependence by DSM-III-R 10% cannabis dependence by DSM-III-R Exclusions: - no use of cocaine in previous 30 days - opiate or sedative dependence - psychosis - dementia - pregnancy - plans to leave the geographic area within 6 months - pending incarceration - significant other in the trial				Data Used Urinalysis: positive for cocaine Retention at 12 weeks Retention rate Notes: DROPOUTS: CRA = approx 30%, CM = approx 65%	Group 1 N= 49 CM: CRA (community reinforcement approach) with outpatient - Same as CM group but therapist approved all purchases and integrated them into a treatment plan. Twice weekly sessions 1–1.5hrs in weeks 1–12 and once weekly in 13–24. Included skills training, planning recreational activities, employment counselling etc. Group 2 N= 51 CM: vouchers with outpatient - First cocaine-negative sample received $2.50, increased by $1.25 for each consecutive negative, $10 bonus for 3 consecutive negative. Positive samples reset value of vouchers. Weeks 13–24, negative sample earned $1 lottery ticket, $10 voucher per sample.	Ethnicity: 48% White

Study Type: RCT (randomised controlled trial) Blindness: No mention Duration (days): Mean 168 Followup: 6 months’ aftercare, 3-year follow-up Setting: US Notes: Follow-up reported at 9, 12, 15 and 24 months	Baseline: GROUPS:	CRA + vouchers/	vouchers
	Preferred route: intranasal	15%/	19%
	Preferred route: smoked	31%/	26%
	Preferred route: intravenous	3%/	4%

JOANNING1992	n= 134 Age: Mean 15 Range 11–20 Sex: Diagnosis: 100% substance misuse (drug or alcohol) Exclusions: - Did not admit drug use or display physical and behavioural signs of drug use; or has not been identified as drug user by school officials, parents or through drug-related crimes - Did not use at least one controlled substance in addition to alcohol - Used narcotics, injected, abused solvents or “showing obvious signs of addiction” Notes: Number of participants refers to number of families included PRIMARY DRUG: Cannabis, alcohol, amphetamines, barbiturates, hallucinogens. Proportions not reported Baseline: No systematic group differences in demographic variables				Data Used Drug use Urinalysis: positive for any drug Notes: Drug use from best estimate of urinalysis, and reports from law enforcement officers, schoo and parents	Group 1 N= 40 FI (family intervention) with outpatient - Family systems therapy integrated structural and strategic FT. Weekly 60–90 min sessions; families received 7–15 sessions Group 2 N= 52 Group therapy with outpatient - Weekly for 1 family + 11 individual sessions of 90 minutes. Representative of outpatient groups offered by hospitals and mental health centres. Designed to integrate social skills training with cognitive development and role theory Group 3 N= 42 Psychoeducation with outpatient - Twice weekly for six 2.5hr sessions with 3–4 families together. Formal presentation and films of drug-related topics, and effects of family functioning. Discussion of personal or other concerns unique to a particular family was discouraged

Study Type: RCT (randomised controlled trial) Study Description: Families were recruited; both parents of adolescents were involved in treatment where possible Type of Analysis: Per protocol (>=6 sessions and avail for followup) Blindness: Open Duration (days): Mean 84 Followup: 6 mths Setting: USA Notes: Families randomly assigned with replacement until >=23 families in each condition had completed the intervention and been post-tested Info on Screening Process: 3 adolescents excluded and referred to inpatient treatment because they showed “physical and emotional signs of addiction”

JONES2004	n= 183 Age: Mean 36 Sex: 102 males 81 females Diagnosis: 100% cocaine dependence by DSM-IV Exclusions: - no pre-admission cocaine-positive urine sample - no self-reported cocaine use - positive pregnancy test - diagnosis of a medical or severe psychiatric illness requiring chronic medication - breath test positive for alcohol - urine sample positive for opiates or sedatives/hypnotics				Data Used Abstinence: negative urinalysis Cocaine use: self-report Notes: SELF-REPORT MEASURES: Non- intravenous and intravenous questionnaires, safety data from Weekly Symptom Checklist DROPOUTS: Tryptophan + CM (31/42 = 68.9%), tryptophan + no CM (42/49 = 75%), placebo + CM (41/55 = 70.7%), placebo + no CM (29/37 = 72.5%)	Group 1 N= 49 Tryptophan with outpatient. Mean dose 8 g/day - 4–9 days in residential setting where stabilised on medication and achieved cocaine abstinence, then 16 weeks in outpatient setting. Participants received tryptophan plus 2 teaspoons of confectioner’s sugar plus 4 grams of powdered cocoa mix. NCM (non-contingent management) with outpatient - Received voucher schedule generated by a participant in the contingent condition -- to control for the amount and pattern of payments received Group 2 N= 37 Placebo with outpatient - Lactose monohydrate plus 0.14 mg of denatonium benzoate to mimic bitter taste of tryptophan, 4 grams of cocoa mix also added to produce equivalent taste, 5 mg diphenhydramine hydrochloride NCM (non-contingent management) with outpatient - Received voucher schedule generated by a participant in the contingent condition -- to control for the amount and pattern of payments received Group 3 N= 42 CM: vouchers with outpatient - Received $2.50 voucher for first cocaine-negative sample, vouchers for subsequent negative samples increased by $1.50, $10 bonus for 3 consecutive negative samples. A cocaine-positive sample reset payment schedule to initial value ($2.50). Maximum $1155. Tryptophan with outpatient. Mean dose 8 g/day - 4–9 days in residential setting where stabilised on medication and achieved cocaine abstinence, then 16 weeks in outpatient setting. Participants received tryptophan plus 2 teaspoons of confectioner’s sugar plus 4 grams of powdered cocoa mix. Group 4 N= 55 CM: vouchers with outpatient - Received $2.50 voucher for first cocaine-negative sample, vouchers for subsequent negative samples increased by $1.50, $10 bonus for 3 consecutive negative samples. A cocaine-positive sample reset payment schedule to initial value ($2.50). Maximum $1155. Placebo with outpatient - Lactose monohydrate + 0.14 mg of denatonium benzoate to mimic bitter taste of tryptophan, 4 grams of cocoa mix also added to produce equivalent taste, 5 mg diphenhydramine hydrochloride.	Placebo + CM versus placebo + non-contingent management only analysed

Study Type: RCT (randomised controlled trial) Blindness: No mention Duration (days): Mean 112 Setting: US Notes: RANDOMISATION: Modified dynamic balanced randomisation by computer; 7 participants who were assigned to control were forced into voucher condition Info on Screening Process: 1174 screened, 200 signed consent, 199 randomised

KADDEN2006	n= 240 Age: Mean 32 Sex: 170 males 70 females Diagnosis: 100% cannabis dependence by DSM-IV Exclusions: - age < 18 - not cannabis dependent - acute medical/psychiatric condition requiring inpatient treatment - current dependence on alcohol/other drugs - reading ability below 5th grade level Baseline: (Case management/motivational enhancement therapy + CBT/CM) Cannabis problems: 15.19/13.97/12.62 Joints per day: 5.2/4.67/3.24 Proportion days abstinent: 0.08/0.08/0.15				Data Used ASI (Addiction Severity Index) Abstinence: longest consecutive period Cannabis use: times per day Abstinence: percentage of days Notes: All groups had weekly urine tests and were informed of results, but only CM conditions provided rewards, and motivational enhancement therapy plus CBT conditions provided suggestions to improve drug-use behaviour.	Group 1 N= 62 Control: standard care with outpatient. Mean dose 9 sessions - Case management (i.e. standard counselling): supportive therapy to establish goals and address problems with participants’ daily living (e.g. psychiatric referrals). Minimal motivational/skills-training/reinforcing techniques. Group 2 N= 61 AMI: MET (motivational enhancement therapy) with outpatient. Mean dose 9 sessions - 2 sessions MET plus 9 sessions CBT skills from Project MATCH manual. MET addressed ambivalence to change and set goals; CBT provided functional analysis of problems, coping with craving, problem solving, avoiding high-risk situations etc. Group 3 N= 54 CM: vouchers with outpatient - Beginning week 3, $10 voucher for each −ve urine, increasing by $15 per week for each successive −ve urine (total possible, $385). +ve urines reset voucher value to $10, but two consecutive −ve urines would reinstate previous highest value. Group 4 N= 63 CM: vouchers AMI: MET (motivational enhancement therapy)	Study quality: 1+

Study Type: RCT (randomised controlled trial) Type of Analysis: Completers Blindness: Open Duration (days): Mean 63 Followup: 1 year Setting: Connecticut, USA Notes: Computerised urn randomisation Info on Screening Process: 606 screened, 486 eligible. Of these, 246 lost to follow-up/refused consent. 240 randomised.

KELLEY2002	n= 64 Age: Mean 36 Sex: all males Diagnosis: 100% substance misuse (drug or alcohol) by DSM-III-R Exclusions: - outside age range 20–60 - not heterosexual - not married for >=1 year or not living with significant other for >=2 years - female partner met DSM-III-R criteria for substance misuse/dependence in past 6 months - either partner met DSM-III-R criteria for an organic mental disorder or psychotic disorder - seeking additional substance misuse treatment except self-help meetings, unless recommended by primary physician - either partner in MMT Notes: PRIMARY DIAGNOSIS: Alcohol and drug misusing samples recruited separately; drug misusing sample given here. Men were recruited with their female partners as couples; data given above for men only. Baseline: (GROUPS: BCT/CBT/psychoeducation) Primary drug: Cocaine: 8/8/8 Opiates: 10/10/11 Cannabis: 1/1/1 Other: 3/2/1				Data Used Abstinence: percentage of days Notes: FOLLOW-UPS: Baseline, end of treatment and every 3 months thereafter for 1 year DROPOUTS: Not reported	Group 1 N= 21 Psychoeducation with outpatient - Both partners attended 12 lectures about the epidemiology, aetiology and effects of substance misuse CBT (cognitive behavioural therapy) with outpatient - 20 weekly individual-based sessions, drawn from Project MATCH protocol Group 2 N= 22 CBT (cognitive behavioural therapy) with outpatient - 20 weekly individual-based sessions, drawn from Project MATCH protocol FI: BCT (behavioural couples therapy) with outpatient - Both partners attended 12 weekly sessions: reinforcing abstinence through verbal contract, teaching more effective communication skills, increasing positive behavioural exchange and reducing aggression between partners Group 3 N= 21 CBT: coping skills training with outpatient - 12 weekly individual sessions, modified from Monti et al (1989) for alcohol CBT (cognitive behavioural therapy) with outpatient - 20 weekly individual-based sessions, drawn from Project MATCH protocol

Study Type: RCT (randomised controlled trial) Study Description: For missing data, last most distressed datapoint carried forward Type of Analysis: Per protocol Blindness: No mention Duration (days): Mean 140 Followup: 12 months Setting: Two clinics in USA Notes: RANDOMISATION: No details Info on Screening Process: 329 men approached: 64 refused consent, 31 couples met exclusion criteria, 99 had no children

LIDDLE2001	n= 182 Age: Mean 16 Sex: 146 males 36 females Diagnosis: 100% drug misuse (non-alcohol) by self-report Exclusions: - Age outside range 13–18 - History of mental retardation or organic dysfunction - Requires inpatient detox - Involved in another form of psychotherapy oriented treatment, or 12-step groups Notes: PRIMARY DIAGNOSIS: Any illegal drug >=3 times per week ETHNICITY: 51% white non-Hispanic, 18% African American, 15% Hispanic, 6% Asian, 10% other REFFERALS: CJS, clinical (schools, health and mental health agencies) Baseline: Polydrug: 51% Alcohol and cannabis only: 49% Years of drug use: 2.5				Data Used Completion rate Drug use: clinically significant reduction Notes: FOLLOWUPS: Pre/post, 6 months, 12 months DROPOUTS: MDFT 30%, education 35%, group therapy 47%	Group 1 N= 52 Psychoeducation with outpatient - 90 min sessions: multifamily groups (3–4 families) with focused discussions, didactic presentations, skills-building, family problem solving and homework assignments. Up to two crisis sessions available to families on request or in emergencies Group 2 N= 53 Group therapy with outpatient - 90 min weekly sessions with groups of 6–8, adapted from Beck’s group therapy model. Began with 2 family sessions to enlist cooperation. Developing social skills, self-control and acceptance, problem solving skills and building social support. Group 3 N= 47 FI: MDFT (multidimensional family therapy) with outpatient - 16 weekly sessions over 5 months. Individual and family sessions used throughout Focus on adolescent, parent, and parent- adolescent interaction. Three phases: engagement, promoting change and transitioning changes into real world environments

Study Type: RCT (randomised controlled trial) Type of Analysis: Per protocol Blindness: No mention Duration (days): Mean 150 Followup: 12 months Setting: USA Notes: RANDOMISATION: No details

MARTIN1993	n= 263 Age: Mean 29 Sex: 191 males 72 females Diagnosis: 100% drug misuse (non-alcohol) 60% IDU (injection drug use) Exclusions: - not an inmate released on parole - no history of drug use associated with an HIV risk factor Notes: ETHNICITY: 68% Black, 32% “non-Black” All were ex-inmates on parole Baseline: (Assertive community treatment/control) Health: excellent 33%/41%, good 41%/38%, fair or poor 26%/21% Delinquent activity: low 36%/46%, medium 39%/25%, high 25%/29% >1 time in prison: 77%/75% Drug use in 6 months prior to incarceration: low 28%/30%, medium 36%/35%, high 36%/35%				Data Used Urinalysis: positive for any drug Drug use Notes: Urinalysis: proportion of parolees will have been reincarcerated by endpoint thus would have been expected to be likely to give a negative sample	Group 1 N= 130 ACT (assertive community treatment) with outpatient - Five stages: intake assessment, intensive treatment, moderate (educational treatment), relapse prevention and case management designed to support transition into normal community life Group 2 N= 133 Control: standard care with outpatient - Standard parole: in practice, unless parolee actively seeks attention, there is little help offered or sanctions on the parolee. Referrals to treatment programmes may be voluntary or mandated, and may be more or less intensive than ACT.	Study quality: 1+

Study Type: RCT (randomised controlled trial) Type of Analysis: Per protocol Blindness: No mention Duration (days): Mean 182 Followup: 12 months Setting: Parole in Delaware, US Notes: Details of randomisation procedure not reported Info on Screening Process: 400 randomised; 263 completed assessment and included

MAUDEGRIFFIN1998	n= 128 Age: Sex: 126 males 2 females Diagnosis: 100% cocaine misuse by DSM-III-R Exclusions: - current or history of opiate dependence - current or history of schizophrenia - medical or psychiatric contraindication for outpatient treatment Notes: PRIMARY DIAGNOSIS: 100% smoked crack cocaine as primary route of administration REFERRALS: Recruited from 3 veterans programmes Baseline: Age not reported (but all veterans) 82% had major depressive disorder, post-traumatic stress disorder or antisocial personality disorder History of regular cocaine use: 19 months Bingeing on cocaine: 64% Alcohol use in past 30 days: 10 days (of which 6 to the point of intoxication)				Data Used Abstinence: no use for any 4 consecutive weeks Retention: sessions attended Notes: FOLLOW-UP: Baseline and at weeks 4, 6 8, 12 and 26 DROPOUTS: Not reported. 92% completed assessment at 12 weeks (end of treatment); 17/128 attended >=75% of treatment sessions.	Group 1 N= 59 CBT: group with outpatient - 3 group sessions and 1 individual session per week over 12 weeks; manual-guided: identifying and dealing with craving, irrational thoughts and negative moods, and preventing relapse Group 2 N= 69 TSF (12-step facilitation) with outpatient - 3 group sessions and 1 individual session per week over 12 weeks; manual-guided, encouraging working the first 4 steps	Study quality: 1+

Study Type: RCT (randomised controlled trial) Study Description: Missing or discrepant urine samples coded as positive Type of Analysis: ITT Blindness: No mention Duration (days): Mean 84 Followup: 6 months from baseline Setting: 3 centres in USA Notes: RANDOMISATION: No further details Info on Screening Process: 159 screened, 31 excluded (6 refused consent, 25 ineligible)

MCKAY2004	n= 359 Age: Mean 42 Sex: 297 males 62 females Diagnosis: 75% cocaine dependence by DSM-IV 25% alcohol dependence by DSM-IV Exclusions: - age outside 18–65 range - psychiatric or medical condition precluding treatment (e.g. dementia, hallucinations) - unstable living situation - intravenous heroin use in past 12 months - not having completed a first phase of treatment or not having been abstinent for the last week of that treatment Notes: PRIMARY DIAGNOSIS: Cocaine or alcohol only ETHNICITY: 77% African American Baseline: Days cocaine abstinent in past 4 months: 39%				Data Used Abstinence: percentage of days Alcohol use: heavy drinking days Abstinence: no use for 3 months Notes: FOLLOW-UP: Baseline, 3, 6, 9 and 12 months post baseline DROPOUTS: 37% standard care, 47% RP and 57% telephone did not complete >=75% of sessions	Group 1 N= 102 Telephone-based intervention with outpatient - One 15-minute phone call per week with counsellor; support group during first 4 weeks to ease transition from face-to-face counselling Group 2 N= 135 CBT: RP (relapse prevention) with outpatient - One individual session and one group session per week; manual guided: identifying and anticipating high- risk situations, improving coping responses Group 3 N= 122 Control: TAU (treatment as usual) with outpatient - Two sessions per week; group therapy with a mix of addictions counselling and 12-step practices	Study quality: 1+

Study Type: RCT (randomised controlled trial) Study Description: Rolling admissions policy Blindness: No mention Duration (days): Mean 90 Followup: 12 months Setting: 2 sites: clinical research programme modelled on community substance abuse clinics and Veterans’ Affairs programme Notes: RANDOMISATION: Urn randomisation balanced on 6 factors Info on Screening Process: 602 screened, 243 excluded (refused consent, failed to meet inclusion criteria or failed to complete baseline assessment)

MEJTA1997	n= 316 Age: Mean 41 Sex: 218 males 98 females Diagnosis: 100% opioid dependence by current participation in treatment Exclusions: None reported Notes: PRIMARY DIAGNOSIS: Chronic intravenous opiate users ETHNICITY: 91% ‘minority’ POPULATION: IDUs not in treatment and seeking treatment Baseline: >=1 previous treatment episode: 75% >=3 previous treatment episodes: 38%				Data Used Retention: days remained in treatment Engagement in treatment Notes: Monthly follow-up for 3 years	Group 1 N= 156 Control: standard care with outpatient - Patients given contact details of drug misuse clinics within their locality. They were primarily responsible for arranging their own appointments. Group 2 N= 160 Case management with outpatient - Case manager performed initial assessment, identified treatment needs, located treatment provider and facilitated admission. Remained engaged with client throughout referral and admission process. Frequency of contact not reported.	Study quality: 1+

Study Type: RCT (randomised controlled trial) Type of Analysis: Per protocol Blindness: Open Duration (days): Mean 1095 Followup: N/A Setting: USA Notes: Randomisation procedures not reported Info on Screening Process: Not reported

MONTI1997	n= 128 Age: Mean 28 Sex: 88 males 40 females Diagnosis: 98% cocaine dependence by DSM-III-R 73% alcohol dependence by DSM-III-R 2% cocaine misuse by DSM-III-R Exclusions: - did not use cocaine at least once in 6 months prior to treatment - actively psychotic Baseline: Route of drug use: smoking freebase = 72%, smoking crack = 21%, using intranasally = 51%, intravenous use = 12% Days of use last 6 months: 56.9 (45.9) days				Data Used Abstinence: no use for 3 months Notes: DROPOUTS: post treatment = 21/128, follow-up = 36/128 Self-report data on abstinence confirmed by urinalysis	Group 1 N= 68 Control: enhanced TAU (treatment as usual) with inpatient - 8 x 1h sessions with 3–5 sessions per week based on length of stay. Manualised meditation and relaxation training. Participants assigned to this condition practiced full body relaxation using directed focus procedures and pleasant visual imagery. Group 2 N= 60 CBT: RP (relapse prevention) with inpatient - 8 x 1h sessions with 3–5 sessions per week based on length of stay. Approach involved analysing the antecedent and consequent events surrounding use and developing a repertoire of alternative cognitive and behavioural skills to reduce risk of cocaine use.	Study quality: 1++

Study Type: RCT (randomised controlled trial) Type of Analysis: ITT Blindness: No mention Duration (days): Mean 14 Followup: 3 months Setting: US, 1 urban and 1 rural hospital Notes: RANDOMISATION: random number selection

MORGENSTERN2006	n= 302 Age: Mean 36 Sex: all females Diagnosis: 100% substance dependence (drug or alcohol) by DSM-IV Exclusions: - not eligible for TANF (Temporary Assistance for Needy Families) - not in New Jersey’s welfare-to-work programme - psychotic - receiving or seeking MMT - stably engaged in substance misuse treatment Notes: ETHNICITY: 96% Black, 3% Hispanic PRIMARY DIAGNOSIS: 35% cocaine, 36% heroin, 6% cannabis (remainder alcohol) POPULATION: Drug-dependent women, not in drug treatment and receiving welfare benefits Baseline: (Intensive case management/standard care) Years on welfare since age of 18: 12.90/11.28 No. of children: 3.25/3.16				Data Used Abstinence: negative urinalysis Retention rate Engagement in treatment Completion rate	Group 1 N= 161 Case management: intensive with outpatient. Mean dose 15 months - Assessment of treatment plus other needs; motivational counselling; extensive outreach with regular weekly contact (up to daily during crisis periods). Vouchers for toys, cosmetics etc. for attending treatment. Group 2 N= 141 Control: standard care with outpatient. Mean dose 15 months - Clinical coordinator reviewed substance misuse treatment needs, and initial appointments scheduled. Counsellors in contact with treatment staff but minimal case management of client. Outreach was limited to several calls/letters for missed appointments.	Study quality: 1++

Study Type: RCT (randomised controlled trial) Study Description: Allocation sealed in envelope Blindness: Duration (days): Mean 245 Followup: N/A Setting: Welfare offices in New Jersey, USA Notes: Randomisation by random number generator Info on Screening Process: 595 screened, 293 excluded (13 refused consent, 56 no DSM-IV diagnosis, 135 on MMT, 89 other); 302 randomised

NEEDELS2005	n= 1416 Age: Range 17–34 Sex: 706 males 704 females Diagnosis: 87% drug misuse (non-alcohol) by self-report Exclusions: - not incarcerated - not an adolescent male (16–18 years), or not an adult female - did not show a commitment to receiving post-discharge case management services - did not expect to be released into the community within 1 year Notes: Data comprised of 2 samples: male adolescent prisoners and female prisoners POPULATION: Discharged female/male-adolescent former inmates, not in drug treatment Baseline: (Females/Males) Homeless or stayed in shelter in past year: 35.7%/8.2% Primary source of income from illegal activities: 39%/47% Drug use in past 6 months: 88%/85% Received substance misuse treatment in 12 months prior to incarceration: 48%/11% HIV+: 17%/0%				Data Used Drug use Reincarceration rates Reduced risk behaviours Crime: engaging in criminal activities Retention rate Notes: Follow-up interviews at 15 months; caseworkers reported only 6.5 hours (females)/9.5 hours (male adolescents) of contact over 12 months	Group 1 N= 706 Control: standard care with outpatient - ‘Less intensive’ discharge services. Ineligible for Health Link’s community care case management services Group 2 N= 704 Case management with outpatient - Case management to encourage use of drug/physical health treatment, engaging in social networks, and reducing drug use, rearrest and HIV risk behaviours. Voluntary empowerment groups; individual counselling; referrals to services and crisis interventions.	Study quality: 1++

Study Type: RCT (randomised controlled trial) Type of Analysis: Per protocol Blindness: Open Duration (days): Mean 365 Setting: Prisons and community of New York City, USA Notes: Randomisation procedures not reported Info on Screening Process: Not reported

PETRY2002	n= 42 Age: Mean 39 Sex: 12 males 30 females Diagnosis: cocaine dependence by DSM-IV Exclusions: - not receiving a stable dose of methadone in past 3 months - not English speaking - MMSE <21 - active, uncontrolled psychosis or bipolar disorder Notes: Standard treatment = 91.3%, CM = 100% cocaine dependence Baseline: GROUPS: TAU/CM Years of heroin use: 13.8 (1.9)/14.9 (1.6) Years of cocaine use: 12.0 (1.8)/15.0 (1.7)				Data Used Abstinence: longest consecutive period Abstinence: days drug free Notes: DROPOUTS: CM = 1/19, TAU (treatment as usual) = 2/23	Group 1 N= 23 Control: TAU (treatment as usual) with outpatient Group 2 N= 19 CM: prizes with outpatient - Negative sample for opiates or cocaine earned a draw from the bowl, negative for opiates and cocaine earned 4 draws. Negative samples on consecutive days earned bonus draws. Bowl had 250 slips of paper, 1/2 non-winning, 109 small prizes, 15 large prizes.	Study quality: 1+

Study Type: RCT (randomised controlled trial) Type of Analysis: ITT Blindness: No mention Duration (days): Mean 84 Followup: 6 months Setting: US Notes: RANDOMISATION: Probabilistic balancing techniques to control for gender, race, age etc Info on Screening Process: 5 excluded: 1 withdrew consent, 4 uncontrolled psychosis

PETRY2004	n= 120 Age: Mean 35 Sex: 53 males 67 females Diagnosis: 85% cocaine dependence by DSM-IV 60% alcohol dependence by DSM-IV 100% cocaine misuse by DSM-IV Exclusions: - 18 years of age - no cocaine use (self-report/urinalysis) - not English speaking - dementia (MMSE <21) - opiate dependent - active uncontrolled bipolar disorder - pathological gambling Notes: Ethnicity: African American = 64%, White = 23%, Hispanic = 10%, Other = 3% Baseline: GROUP: Group therapy/$80 CM/$240 CM Years of regular cocaine use: 11.0/9.8/11.9				Data Used ASI (Addiction Severity Index) Retention: days remained in treatment Abstinence: weeks drug free Notes: DROPOUTS: Group therapy = 13.5%, CM: $80 = 20%, CM: $240 = 31.6%	Group 1 N= 45 CM: prizes with outpatient. Mean dose $80 - Drew slips from a bowl, 50% of slips said ‘good job’ but provided no prize, 50% of slips provided prizes: 43.6% mini prizes ($0.33), 6% medium prizes ($5), 0.4% jumbo prize ($100) Group 2 N= 37 Group therapy with outpatient - 3–5 days/week for 3–4 weeks, then 2–3 days/week for weeks 4–6, 1 day/week for last 6 weeks. Sessions included 12-step oriented treatment, CBT, health education, AIDS prevention and life skills training. Group 3 N= 38 CM: prizes with outpatient. Mean dose $240 - Drew slips from a bowl, 50% of slips said ‘good job’ but provided no prize, 50% of slips provided prizes: 43.6% mini prizes ($1), 6% medium prizes ($20), 0.4% jumbo prize ($100)	Study quality: 1+

Study Type: RCT (randomised controlled trial) Type of Analysis: ITT Blindness: Open Duration (days): Mean 84 Setting: US, 2 outpatient centres Info on Screening Process: 135 screened, 9 refused, 5 failed to return to clinic, 1 non-stabilised bipolar disorder

PETRY2005A	n= 415 Age: Mean 35 Sex: 185 males 230 females Diagnosis: 84% other stimulant misuse by DSM-IV Exclusions: - did not report stimulant use and/or did not submit stimulant-positive urine sample within 2 weeks of study entry Notes: PRIMARY DIAGNOSIS: Cocaine, amphetamine or methamphetamine OTHER DIAGNOSES: alcohol 42%, cannabis 21%, opiates 9% Baseline: (CM/usual care) Unemployed: 67%/63% On probation or parole: 36%/35%				Data Used Retention: days remained in treatment Abstinence: negative urinalysis Notes: DROPOUTS: CM = 51%, TAU = 65%	Group 1 N= 209 CM: prizes with outpatient - Chances to win prizes for negative sample for cocaine, (meth)amphetamine and alcohol. Drew from container of 500 chips: 50% stated ‘good job’, 8% small ($1) prizes, 8% large ($20) prizes, 0.2% jumbo ($80–100) prizes. Draws increased by 1 each consec. Week Group 2 N= 206 Control: enhanced TAU (treatment as usual) with outpatient - Primarily group counselling but in some clinics also individual and family counselling. Also received immediate feedback on urinalysis results.	Study quality: 1+

Study Type: RCT (randomised controlled trial) Blindness: Open Duration (days): Mean 84 Setting: US, 8 different clinics Info on Screening Process: 30 excluded before data analysis because didn’t meet inclusion criteria

PETRY2005B	n= 142 Age: Mean 36 Sex: 65 males 77 females Diagnosis: cocaine dependence by DSM-IV opioid dependence by DSM-IV Exclusions: - active psychotic/bipolar disorder that was not adequately controlled by medication - current suicidality - in recovery for pathological gambling Notes: PRIMARY DIAGNOSIS: Cocaine or opiate dependence. 20% were on MMT. Baseline: (TAU/CM vouchers/CM prizes) HIV+ (%): 5.6/7.5/15.2 Full or part-time employed (%): 6/10/6 Years' cocaine use: 11.1/12.8/10.0 Years' heroin use (among users): 10.2/6.9/9.5 Substance dependence in past year (%): Cocaine: 94.7/84.9/82.4 Heroin: 31.6/30.2/39.2 Alcohol: 55.3/56.6/39.2 Previous treatment attempts: 20.0/11.5/15.0				Data Used Drug use ASI (Addiction Severity Index) Abstinence: longest consecutive period Retention: weeks remained in treatment Notes: All participants submitted breath and urine samples 3 days/week weeks 1–3 and 2 days/week weeks 4–6	Group 1 N= 38 Control: standard care with outpatient - Intensive outpatient: indiv/group therapy, RP, coping/life skills training, focus groups for depression/anxiety, AIDS education, 12-step. Up to 5hrs/day, 4days/wk lasting 2–4wks depending on need with gradual reductions. Aftercare: 1 grp/wk for 6–12 mths. Control: enhanced TAU (treatment as usual) with outpatient - 15-min weekly contact with RA who provided educational materials on health and drugs, AIDS, family, the law, etc. Intended as an attentional control (cf CM conditions). Group 2 N= 53 Control: standard care with outpatient - As per control group CM (contingency management) with outpatient - Goods vouchers for breath and urine samples −ve for opiates, cocaine AND alcohol. Starting at $1, increased by $1.50 for each consecutive − ve sample. $10 bonus each week if all samples −ve that weeek. Any missing/+ve sample reset reward to $1. CM: vouchers with outpatient - Vouchers for completing treatment-related activities, e.g.attending doctor's appointment or college course. $3 for each activity completed, $10 bonus + $1 increase for 3 activities completed within any week. Reset to $3 for any activity not completed. Group 3 N= 51 Control: standard care - As per control group CM (contingency management) with outpatient - 1 draw from a prize draw for each set of −ve specimens. Increased by 1 draw for each successive −ve, with a bonus of 5 for samples −ve over entire week. Draws also awarded for completing treatment activities. 37% chance of winning prize in any 1 draw.	Intensive standard care (but all groups received this) Study quality: 1++

Study Type: RCT (randomised controlled trial) Type of Analysis: ITT Blindness: Open Duration (days): Mean 84 Followup: 3- and 6-month follow-up Setting: 3 community-based treatment centres in US Notes: Urn randomisation Info on Screening Process: 161 screened, 38 excluded (19 ineligible, 14 refused consent, 5 did not complete evaluation); 142 randomised

PETRY2006	n= 131 Age: Mean 37 Sex: 79 males 52 females Diagnosis: 1% cocaine dependence by DSM-IV 22% opioid dependence by DSM-IV Exclusions: - unable to comprehend study details - active psychotic disorder - currently suicidal - recovery from pathological gambling Baseline: Cocaine use = 11.3 years Heroin use = 2.57 years				Data Used Abstinence: longest consecutive period	Group 1 N= 44 CM: prizes with outpatient - Prize draws contingent on submitting urine samples negative for drug. 500 cards in a prize bowl - 55% no monetary value, 39.8% worth up to $1, 5% worth up to $20, 0.2% worth up to $100 Group 2 N= 47 CM: prizes with outpatient - Prize draws contingent on completing scheduled activities. 500 cards in a prize bowl - 55% no monetary value, 39.8% worth up to $1, 5% worth up to $20, 0.2% worth up to $100. Group 3 N= 40 Control: standard care with outpatient - Standard intensive outpatient treatment: RP, coping and life skill training, AIDS education, 12-step treatment	Study quality: +1

Study Type: RCT (randomised controlled trial) Blindness: No mention Duration (days): Mean 84 Setting: US Notes: RANDOMISATION: Computerised urn randomisation Info on Screening Process: 186 screened, 27 excluded

RAWSON2006	n= 177 Age: Mean 36 Sex: 135 males 42 females Diagnosis: 10% other stimulant dependence by DSM-IV 90% cocaine dependence by DSM-IV Exclusions: - no positive urine for cocaine or methamphetamine during 2-week screening period - dependent on alcohol or benzodiazepines - court-mandated to treatment Notes: Other stimulant is methamphetamine				Data Used ASI (Addiction Severity Index): drug use Retention: weeks remained in treatment Abstinence: negative urinalysis Notes: DROPOUTS: CM = 15/60, CBT = 11/58, CM + CBT = 13/59	Group 1 N= 59 CM (contingency management) with outpatient - Voucher value started at $2.50, $1.25 increase for consecutive negative samples, $10 for 3 consecutive negative samples. CBT: group with outpatient - Three 90- minute sessions per week guided by a worksheet from a manual. Group 2 N= 60 CM: vouchers with outpatient - Voucher value started at $2.50, $1.25 increase for consecutive negative samples, $10 for 3 consecutive negative samples. Group 3 N= 58 CBT: group with outpatient - Three 90- minute sessions a week guided by a worksheet from a manual.	Study quality: 1+

Study Type: RCT (randomised controlled trial) Blindness: Open Duration (days): Mean 112 Followup: 26 weeks and 52 weeks Setting: US Info on Screening Process: 420 screened

ROLL2006	n= 113 Age: Mean 30 Sex: 56 males 57 females Diagnosis: 100% other stimulant dependence by DSM-IV Exclusions: None reported Notes: PRIMARY DIAGNOSIS: Methamphetamine dependence ETHNICITY: 59% White, 20% Hispanic, 21% other Baseline: (CM/TAU) Unemployed: 53%/47% Probation/parole: 47%/37% DSM-IV misuse/dependence: alcohol 24%/21%, cannabis 29%/23%, opiate 8%/7%				Data Used Abstinence: longest consecutive period Retention rate Notes: Twice weekly observed urine samples. Breath test (for alcohol) at each visit.	Group 1 N= 51 CM (contingency management) with outpatient - At each urine test −ve for all 4 target drugs (cocaine, meth/amphetamine & alcohol) allowed chance to draw chips denoting prizes of various values. Each − ve sample gained 1 extra chip, reset to 1 for any +ve. Large prize for first 2 consec wks' abstinence Group 2 N= 62 Control: TAU (treatment as usual) with outpatient - Varied between sites. Most participants received Matrix model, others received mix of CBT and RP. All sites encouraged 12-step participation.	Fairly intensive control treatment Study quality: 1+

Study Type: RCT (randomised controlled trial) Study Description: Sub-sample of Clinical Trials Network study Blindness: Open Duration (days): Mean 84 Followup: 3 and 6 months Setting: Four sites in western USA Notes: Stratified randomisation Info on Screening Process: Not reported

SALEH2002	n= 662 Age: Mean 33 Sex: 391 males 271 females Diagnosis: Exclusions: - not meeting any of following criteria: more than one drug/alcohol-related offence - breathalyser test with blood alcohol content >0.2 - involved in drug or alcohol-related accident - under 21 years of age Notes: ETHNICITY: 83% White, 13% Black, 1% Hispanic, 2% Indian, 1% other POPULATION: Individuals with substance problems, entering residential treatment				Data Used Abstinence: days drug free ASI (Addiction Severity Index) Notes: Follow-ups at 3 and 6 months during intervention, and at 12 months (end of intervention) Frequency of contact for case management not reported	Group 1 N= 167 Case management with residential rehabilitation - On-site strengths-based case management with social worker who met patients at the primary treatment facility. Group 2 N= 160 Case management with residential rehabilitation - Off-site strengths-based case management with social worker who met patients at an off-site social services agency Group 3 N= 147 Case management with residential rehabilitation - Case management with one session of contact and rest of case management delivered over telecommunications system. Group 4 N= 188 Control: standard care with residential rehabilitation - No case management	Study quality: 1+

Study Type: RCT (randomised controlled trial) Blindness: Open Duration (days): Mean 365 Followup: N/A Setting: Residential treatment centre providing treatment for 2 urban and 1 rural Iowa counties, USA Info on Screening Process: 1109 invited, 662 consented, 278 followed up at 3 months

SHOPTAW2005	n= 162 Age: Mean 37 Sex: all males Diagnosis: 100% other stimulant dependence by current participation in treatment Exclusions: - age outside 18–65 range - medical or psychiatric condition precluding safe participation - methamphetamine dependence requiring more intensive intervention than outpatient treatment Notes: PRIMARY DIAGNOSIS: Methamphetamine- dependent users seeking treatment ETHNICITY: Caucasian 80%, Hispanic 13%, African American 5%, other 2% REFERRALS: Community recruitment from gay-bisexual venues (bathhouses, sex clubs, dance clubs), media outlets Baseline: (GROUPS: CBT/CM/CBT + CM/culture- specific CBT) Years' amphetamine use: 4.9/4.2/5.5/5.6 Days' amphetamine use in past 30 days: 8.9/9.2/9.9/10.4 Days using >1 drug in past 30 days: 2.7/5.0/5.0/4.0 Intravenous methamphetamine use: 50%/36%/30%/40%				Data Used Unprotected anal intercourse: number of occasions Urinalysis: TES (Treatment Effectiveness Score) Urinalysis: positive for cocaine Notes: FOLLOW-UP: baseline, 6 months, 12 months DROPOUTS: Data for sessions attended only: CBT = 41%, CBT + CM = 74%, culture-specific CBT = 56%	Group 1 N= 40 CM: vouchers with outpatient - As per CM group CBT: matrix model with outpatient - As per CBT group Group 2 N= 42 CM: vouchers with outpatient - Contingencies placed on 3 wkly urine samples: each successive methamphetamine-negative sample yielded $2.50, with 3 consecutive negative samples yielding a $10 bonus. Vouchers exchanged for goods or services promoting a pro-social, non- dependent lifestyle Group 3 N= 40 CBT: matrix model with outpatient - Group format, 90 minutes 3 times per week. Based on Matrix model, with education on internal and external triggers, stages of recovery, identification of emotional states that can signal relapse, craving management and adoption of healthy lifestyles. Group 4 N= 40 CBT: culture-specific (gay/bisexual men) with outpatient - Manual guided. Integrated core concepts from standard CBT with culture-specific elements, addressing HIV sexual risk behaviours and gay referents associated with methamphetamine use (e.g. sex parties).	Study quality: 1+

Study Type: RCT (randomised controlled trial) Type of Analysis: ITT (those who have completed 2 weeks' baseline) Blindness: No mention Duration (days): Mean 102 Followup: 6 months postbaseline Setting: USA Notes: RANDOMISATION: Urn randomisation based on level of drug use and ethnicity Info on Screening Process: 263 screened, 101 excluded (90% didn't complete 2-week baseline period and 10% required more intensive treatment); 162 randomised

SHOPTAW2006	n= 229 Age: Sex: Diagnosis: 100% other stimulant misuse by DSM-IV Exclusions: - pregnant or lactating - age outside range 18–65 - primary medical condition that might interfere with safe study participation - contraindications to SSRI treatment - SCID-diagnosed psychiatric condition that required pharmacological/behavioural treatment - SCID-diagnosed dependence on other substances Notes: PRIMARY DIAGNOSIS: Methamphetamine					Group 1 N= 54 CM (contingency management) with outpatient. Mean dose 12 weeks - 3 weekly urine tests, $2.50 vouchers for initial methamphetamine −ve sample, increasing by $1.25 per consecutive −ve. Each 3rd consecutive −ve earned $10 bonus. Missing/+ve urine reset value to $2.50, only reinstated to previous max after 3 −ve urines. CBT: matrix model. Mean dose 36 sessions - Thrice weekly 90-min Matrix Model RP groups, based on social learning theory, CBT, psychological and HIV education to teach abstinence and relapse prevention skills Placebo Group 2 N= 55 Placebo with outpatient CBT: matrix model with outpatient. Mean dose 36 sessions - As per CM group	Two treatment groups received sertraline - only placebo groups (with/without CM) reported in this analysis 'Treatment as usual' fairly intensive Study quality: 1+

Study Type: RCT (randomised controlled trial) Blindness: Duration (days): Setting: Clinical research unit, LA, USA Info on Screening Process: 414 screened: 185 excluded (169 lost to follow-up, 15 medical reasons, 1 referred to inpatient), 229 randomised

SORENSEN2005	n= 126 Age: Mean 43 Sex: 97 males 29 females Diagnosis: 100% opioid dependence by eligibility for/receipt of MMT Exclusions: - outside age range 18–65 - not currently receiving medical treatment at study sites - unwilling to enrol in case management or MMT - less than 2 years' heroin dependence - fewer than 2 prior treatment attempts that ended >7 days prior to screening date - not currently injecting heroin (with confirmatory urinalysis), or used heroin <15 days out of past 30 - unable to provide consent due to psychosis, intoxication, sedation or medical complications - in police custody or expecting incarceration - scheduled for or currently engaging in case management or substance misuse treatment Notes: ETHNICITY: 48% Caucasian, 29% African American, 10% Latino, 2% Asian, 13% other POPULATION: Dependent opiate users not in treatment Baseline: (Case management/usual care) Age first heroin use: 28.7/25.0 Years' heroin use: 14.0/17.9 Previous treatment episodes: 10.4/9.0				Data Used Reduced risk behaviours Urinalysis: positive for heroin Heroin use: times in past month Engagement in treatment Notes: Follow-ups at 3 months (during treatment) and 6 months (end of treatment) Planned frequency of contact not reported	Group 1 N= 32 Case management - Linkage model encouraging client's use of a network of social, medical and drug misuse treatment services: needs assessment, monitoring, planning, accessing resources and advocacy. Variety of settings. Caseload of 15 patients per worker. Group 2 N= 30 Opiate agonist: MMT (methadone maintenance) - Vouchers redeemable for free MMT for 6 months. Methadone dose titrated to individual needs; monthly drug testing and minimum of 50 mins counselling per month. Group 3 N= 32 Case management - As per case management group Opiate agonist: MMT (methadone maintenance) - As per voucher group Group 4 N= 32 Control: standard care - Interviewer offered to arrange for a consultant to meet participant for a counselling and referral session. Appointment slip for next research interview (3 months).	Study quality: 1+

Study Type: RCT (randomised controlled trial) Blindness: Open Duration (days): Mean 180 Followup: N/A Setting: San Francisco General Hospital, USA Notes: Randomisation by computer-generated list Info on Screening Process: 314 screened, 218 eligible, of whom 82 did not attend baseline interview and 10 were unwilling to participate for other reasons; 126 enrolled

STEPHENS1994	n= 212 Age: Mean 32 Range 18–65 Sex: 161 males 51 females Diagnosis: 100% cannabis misuse Exclusions: Self-reported dependence on alcohol or another drug, or reported adverse consequences and pathological symptoms of use Notes: PRIMARY DIAGNOSIS: People 'seeking treatment' for cannabis use. Full details in Stephens (1993) REFERRALS: Media announcements Baseline: Age of first use: 16.2 Age of daily use: 20.0 Years of use: 15.4 Days of use, past 90 days: 80.7 DAST: 8.88				Data Used Cannabis use: days in past 3 months Cannabis use: times per day Drug and alcohol use: days in past 3 months Notes: FOLLOW-UP: Baseline, completion, 3 months, 6 months DROPOUTS: 31% failed to attend >5 sessions	Group 1 N= 106 CBT: RP (relapse prevention) with outpatient. Mean dose 20 sessions - Weekly for first 8 weeks, once per fortnight for next 4 weeks, booster session at 3 months and 6 months afterwards. Groups of 12–15 participants, manual-guided, problem-focused psychoeducational style. Group 2 N= 106 Control: social support group with outpatient. Mean dose 20 sessions - Weekly for first 8 weeks, once per fortnight for next 4 weeks, booster session at 3 months and 6 months. Getting and giving support, dealing with mood swings, peer experiences. Therapists did not give advice or training but facilitated discussion.	Study quality: 1+

Study Type: RCT (randomised controlled trial) Study Description: Therapists blind to contents of alternate treatment and study hypotheses Type of Analysis: Follow-up completers Blindness: No mention Duration (days): Mean 84 Followup: 6 months Setting: USA Notes: RANDOMISATION: Blocked on sex Info on Screening Process: 382 screened, 85 excluded (73 recently misused alcohol or other drugs, 9 used cannabis fewer than 50 times in past 90 days, 2 currently in other treatment, 1 psychotic). Of 297 eligible, 85 failed to complete baseline assessment.

STEPHENS2000	n= 291 Age: Mean 34 Sex: 224 males 67 females Diagnosis: Exclusions: - cannabis used <50 times in last 90 days - alcohol or other drug misuse in last 90 days - severe psychological distress - receiving other formal treatment Baseline: Years of use = 17.35 (5.21), days of use past 90 days = 74.64 (18.54)				Data Used Cannabis use: days in past 3 months Notes: DROPOUTS: CBT = 19%, MI (motivational interviewing) = 8%, waitlist = 8%	Group 1 N= 117 CBT: group RP (relapse prevention) with outpatient - 14 x 2-hour CBT: RP group sessions over an 18-week period. Sessions 1–10 weekly, 11–14 every other week. Weeks 1–4 involved building motivation for change and high-risk situations identified, 5–10 building coping skills, 11–14 coping with rationalisations Group 2 N= 88 AMI (adapted motivational interviewing): MI with outpatient - Two 90-min individual sessions. Involved MI (e.g. reflective listening, affirmation and reframing) and CBT techniques (identifying high-risk situations). Second session (1 month after) reviewed previous session and feedback received. Group 3 N= 86 Control: waitlist with outpatient - Waitlist of 4 months until treatment	Study quality: 1+

Study Type: RCT (randomised controlled trial) Blindness: No mention Duration (days): Followup: 1, 4, 7 and 13 months Setting: US Info on Screening Process: 601 screened, 183 excluded (cannabis used <50 times in 90 days (n=24), alcohol or other drug misuse in last 90 days (n=149), severe psychological distress (n=8), other formal treatment (n=2)). Of eligible sample, 127 didn't complete pre-treatment session.

STEPHENS2002	n= 450 Age: Mean 36 Sex: 306 males 144 females Diagnosis: 100% cannabis dependence by DSM-IV Exclusions: - <18 years - dependence on other drugs or alcohol - inability to provide a person who could assist in contact at follow-up - legal status that would disrupt treatment - currently receiving therapy Notes: Ethnicity: White = 69.3%, Hispanic = 17.3%, African American = 12.2%, Other = 1.1% Baseline: Proportion of days drug used in last 90 days = 0.88, hours high per day = 6.62, ounces of cannabis per week = 0.40, number of joints per day = 2.89				Data Used Cannabis use: days in past 3 months Abstinence: no use for 3 months Notes: DROPOUTS: MI (motivational interviewing) = 18/146 (12.3%), CBT = 23/156 (15%), waitlist =11/148 (7.5%)	Group 1 N= 148 Control: waitlist with outpatient Group 2 N= 146 AMI (adapted motivational interviewing): MI with outpatient - Two 1-hour sessions 1 and 5 weeks after randomisation. Discussed a personal feedback report to motivate participant to make changes -- attitudes favouring and opposing change, treatment goals etc; in second session efforts to reduce cannabis use reviewed. Group 3 N= 156 CBT: coping skills training with outpatient - 9 sessions over a 12-week period. First 8 sessions weekly, 9th session 4 weeks after 8th session to review changes. Combined motivational aspects with CBT and case management.	Study quality: 1+

Study Type: RCT (randomised controlled trial) Blindness: Duration (days): Followup: 4 and 9 months Setting: 3 US urban areas Notes: RANDOMISATION: Conducted centrally at the the Center for Substance Abuse Treatment using urn randomisation programme Info on Screening Process: 1211 screened, 398 excluded (dependence on other drugs (31%), unwilling to accept random assignment (21%), currently receiving therapy (20%), did not provide contact person (20%), legal status (16%)); 363 eligible but did not complete assessment

STRATHDEE2006	n= 245 Age: Mean 42 Sex: 169 males 76 females Diagnosis: 100% IDU (injection drug use) by current participation in treatment Exclusions: All except IDUs requesting referral at NEP Notes: 77% African American Baseline: (Control/case management) Prior treatment or detox: 25%/22% Employed: 8%/9% HIV+: 21%/17% ASI composite score: 0.09/0.12				Data Used Engagement in treatment Notes: Followed up 7 days after referral session	Group 1 N= 117 Control: standard care with outpatient - Received only a voucher printed with date/time of intake appointment in accordance with standard operating procedures at Baltimore NEP Group 2 N= 128 Case management with outpatient - Brief case management: developing collaborative relationship; assessment of client strengths and building upon them; identifying goals and linkage to services to address those goals. Duration/frequency of contact driven by client needs.	Study quality: 1+

Study Type: RCT (randomised controlled trial) Type of Analysis: ITT Blindness: Open Duration (days): Followup: 7 days Setting: 10 needle exchange programme (NEP) sites in Baltimore, USA Notes: Randomisation is by site but counterbalanced acrossed two recruitment phases Info on Screening Process: 247 invited; 245 consented, completed baseline interview and randomised

WALDRON2001	n= 120 Age: Mean 16 Sex: 96 males 24 females Diagnosis: 100% drug misuse (non-alcohol) by DSM-IV Exclusions: - Age outside 13–17 range - Not living with a primary caretaker who's willing to participate - Need services other than outpatient treatment (e.g. dangerous to self or others, requires detox) - Evidence of a psychotic or organic state - Sibling taking part in study Notes: REFERRALS: Most mandated to treatment by court order, probation or schools Baseline: (GROUPS: FFT/CBT/FFT+CBT/Group ed) % days drug use: 56.3/55.6/59.9/68.1 Age at first use: 12.13/11.97/11.10/11.53 No of offences: 1.18/0.97/0.93/1.48 No of comorbid diagnoses: 0.75/1.59/1.76/1.33				Data Used Completion rate Drug use: clinically significant reduction Abstinence: percentage of days Abstinence: used on <10% of days Notes: FOLLOWUPS: Pre/post, 3 months	Group 1 N= 30 FI: FFT (functional family therapy) - 12 sessions. Aims to alter dysfunctional family patterns contributing to adolescent drug use Phase 1: engaging, motivating change Phase 2: behavioural changes in the family Group 2 N= 29 FI: FFT (functional family therapy) - 12 sessions. Aims to alter dysfunctional family patterns contributing to adolescent drug use Phase 1: engaging, motivating change Phase 2: behavioural changes in the family CBT: coping skills training - 10 sessions modelled on Project MATCH, designed to teach self-control and coping skills useful in avoiding drug use. Includes communication, problem solving, peer refusal, mood management, social support and relapse prevention AMI: MET (motivational enhancement therapy) - 2 sessions at start. Nonconfrontational strategies to maximise motivation for change, prioritise and plan treatment goals, and enhance self-efficacy Group 3 N= 30 Psychoeducation - Info about drugs and alcohol, expectancies and consequences of substance use, alternatives Some skills training; but more structured and focused on group participation and sharing of experiences, less on individual skill building in CBT. Group 4 N= 31 CBT: coping skills training - 10 sessions modelled on Project MATCH, designed to teach self-control and coping skills useful in avoiding drug use. Includes communication, problem solving, peer refusal, mood management, social support and relapse prevention AMI: MET (motivational enhancement therapy) - 2 sessions at start. Nonconfrontational strategies to maximise motivation for change, prioritise and plan treatment goals, and enhance self-efficacy	All interventions manualised and videotaped

Study Type: RCT (randomised controlled trial) Type of Analysis: ITT, missing values estimated via regression Blindness: No mention Duration (days): Mean 120 Followup: 3 months Setting: USA Notes: Urn randomisation balanced on sex, age, level of drug use, ethnicity, psychiatric severity and family constitution Info on Screening Process: 235 screened > 115 excluded > 120 randomised and completed >=1 session

WINTERS2002	n= 75 Age: Mean 33 Sex: all females Diagnosis: 100% drug misuse (non-alcohol) by DSM-IV Exclusions: - age outside range 20–60 - not married >=1 year or stable cohabiting >=2 years - primary substance was alcohol - undergoing MMT and/or seeking treatment for adjunctive outpatient support - male partner met DSM-IV criteria for psychoactive substance use disorder in past 6 months - either partner met DSM-IV critera for an organic mental disorder, schizophrenia and other psychotic disorders Notes: PRIMARY DRUG: 8% cannabis, 52% cocaine, 28% opiates, 12% other ETHNICITY: 69% White, 24% African American, 7% Hispanic Baseline: Groups: BCT/CBT Years' problematic alcohol use: 8.0 (5.0)/7.7 (4.3) Years' cannabis use: 6.0 (2.8)/6.2 (4.4) Years' cocaine use: 5.1 (3.6)/5.4 (2.1) Years' opiate use: 4.5 (3.9)/5.0 (4.2) Years' cocaine use: 5.1 (3.6)/5.4 (2.1) Years' opiate use: 4.5 (3.9)/5.0 (4.2)				Data Used Abstinence: % with negative urine sample per day Urinalysis: positive for any drug Notes: FOLLOW-UPS: 3, 6, 9 and 12 months DROPOUTS: 3% BCT, 5% CBT	Group 1 N= 37 CBT: coping skills training with outpatient. Mean dose 24 weeks - Weekly 60-min individual and 90-min group counselling sessions which did not include partners, based on Carroll model: avoiding exposure, understanding consequences, identifying high-risk situations, coping with craving, refusal skills etc. FI: BCT (behavioural couples therapy) with outpatient. Mean dose 24 weeks - Couples met conjointly with therapist for weekly 60-min sessions, focusing on the woman's drug use: sobriety contract, effective communication skills, increasing positive behavioural exchanges. O'Farrell & Fals-Stewart model. Group 2 N= 38 CBT: coping skills training with outpatient. Mean dose 24 weeks - 24 weekly 60-min individual and 90-min group counselling sessions which did not include partners, based on Carroll model: avoiding exposure, understanding consequences, identifying high-risk situations, coping with craving, refusal skills etc.	Study quality: 1+

Study Type: RCT (randomised controlled trial) Type of Analysis: ITT (missing data imputed) Blindness: Open Duration (days): Mean 168 Followup: Every 3 months for 12 months Setting: Two outpatient clinics in northeastern USA Notes: Randomisation method not reported; women were randomised alongside their male partners Info on Screening Process: 277 couples screened; 246 agreed to be interviewed; 171 excluded (male partner also misused drugs); 75 couples randomised

ZANIS1996	n= 41 Age: Mean 41 Range 26–67 Sex: all males Diagnosis: 100% opioid dependence by eligibility for/receipt of MMT Exclusions: - did not previously drop out of MMT - currently in MMT Notes: ETHNICITY: 51% African American, 44% Caucasian, 5% Latino POPULATION: Patients discharged from MMT programme, relapsed into drug use and not currently in treatment Baseline: 83% used opiates at least 25 days in previous month				Data Used Engagement in treatment	Group 1 N= 27 Case management with outpatient. Mean dose 2 weeks - 15-min session to assess problems & needs, establish rapport, motivate clients into engaging in treatment, identify & refer clients to services, cover brief problem solving strategies & plan treatment. Ongoing support phone calls over following 2 weeks. Group 2 N= 14 Control: standard care with outpatient - Clients given contact details of treatment admissions coordinator and instructed to walk to next building to register for services. No further contact over next 2 weeks.	Study quality: 1+

Study Type: RCT (randomised controlled trial) Blindness: Open Duration (days): Followup: 2 weeks Setting: Veterans Adminstration methadone clinic, Philadelphia, USA Info on Screening Process: 85 interviewed, 37 already re-enrolled onto MMT, 7 reported no drug use in past month, 41 randomised

ZANIS2001	n= 109 Age: Mean 43 Range 24–67 Sex: 66 males 43 females Diagnosis: Exclusions: - Currently employed/working more than 10hrs/wk - Not stabilized on methadone - Currently enrolled on MMT program for less than 3 months - no interest or capacity to workat least 20 hrs/wk - not actively seeking treatment as defined by Bureau of Labour Statistics Notes: ETHNICITY: White 37.5%; Black 61.5%; Hispanic 2% Baseline:				Data Used Employment at follow-up ASI (Addiction Severity Index) Data Not Used TSR (Treatment services review) VEA (Vocational/Educational assessement Notes: All ppts received 30-min counseling session each week as part of standard treatment services, focused on generic drug counselling issues Outcomes taken at baseline, biweekly for 12 weeks and at 6 months post baseline plus independent urine samples	Group 1 N= 62 Vocational problem solving - Ten 30–60 min session over 12 wks. Aims help ppts understand why they want to work how to overcome barriers set realistic vocational goals help locate job opportunities take appropriate actions to obtain work Group 2 N= 47 IPT: interpersonal problem solving - Ten 30–60 min session over 12 wks. Aim:reduce/eliminate illicit drug use/maintain abstinence plan 2. understand utility of social supports in recovery 3. examine un/successful attempts at recovery 4. get realistic recovery plans 5. do activities	Study quality 1+

Study Type: RCT (randomised controlled trial) Study Description: Radnomisation: 3:2 ratio experimental to control Type of Analysis: completers Blindness: No mention Duration (days): Followup: 6 month Setting: US Outpatient Info on Screening Process: 109 ppts voluntarily recruited from 2 MMT programs recruited			Experimental	Control
	High School diploma		66%	53%
	Employed		25%	19%
	Married		20%	13%
	Divorced		36%	38%
	Single		34%	43%
	Widowed		10%	6%
	Previous hospitalisation		37%	47%
	Incarcerated>30days		50%	49%
	Currently on probation		10%	9%
	Illegal activity in past 30days		23%	21%

Characteristics of Excluded Studies

Reference ID	Reason for Exclusion
AZRIN1994	Did not meet criteria for adequate study quality
BARROWCLOUGH2001A	No indication that drug misuse is primary focus
BOWMAN1996	No drug-use outcomes
CHUTUAPE1999	n<10 per group
CONRAD1998	No extractable data
COVI2002	Not required comparison
COVIELLO2004	No drug-use outcomes
CZUCHRY1995	Not required outcomes
DANSEREAU1995	No relevant outcomes
EISEN2000	Not an RCT
ELK1998	n <10 per arm
FISHER1996A	Sample sizes not reported (appears to be <10 in each group)
FRIEDMAN1989	No extractable outcome data
GAINEY1995	Sample size not reported No relevant outcomes
GOTTHEIL2002	Not required comparison
HALL1999	No extractable outcomes
HENGGELER1991	Unclear what proportion of sample were misusing drugs Intervention not specifically targeted at drug misuse
HENGGELER2006	Mean age < 15.5
HIEN2004A	Comorbid PTSD
HIGGINS1991	Not relevant intervention; poor-quality study
HIGGINS2000	No extractable outcomes
HOFFMAN1996	No details of how many participants assigned to each group
HUBER2003	No relevant drug-use outcomes
JANSSON2005	Pregnant women
JOANNING1992	Mean age < 15.5
JOE1994	Analysis performed on subgroup only
JOE1997	sub-group analysis only
KAMINER2002	Mean age = 15
KANG1991	Data not broken down by group
KASHNER2002	No work outcomes reported
KATZ2002	Not required comparison
KIDORF1994	Small sample size
KIRBY1998	Not required comparison
KIRBY1999	n in each group not reported
LEWIS1990	Unlikely that majority of sample were drug users
LIDDLE2004	Mean age <= 15.5
LINEHAN1999A	Primary focus not drug misuse (borderline personality disorder)
MCCOLLUM2003	No extractable outcome data
MCKAY1997	Alcohol misuse primary problem
MEYERS2002	Intervention not for service users
MILBY1979	Pre-1980
MILBY1980A	Not applicable to current treatment
NURCO1995	Not required outcomes
ONEILL1996	No drug use outcomes
PETRY1998	No relevant outcomes
POLLACK2002	Women and men analysed separately - not extractable
PRESTON2001B	Not relevant comparison
ROHSENOW2004	Outcomes not reported by assigned groups
ROOZEN2003	Not an RCT
ROSENBLUM2005A	Not required comparison
ROSENBLUM2005B	Not required comparison
ROWANSZAL1994	No extractable outcomes
SANTISTEBAN2003	Drug misuse not a specific inclusion criterion - only 52% of sample used drugs or alcohol, only only 30% used cannabis in past month
SCHMITZ2005A	No placebo group therefore can't use CBT comparison
SIEGAL1996	No drug-use outcomes
SIEGAL1997	Only case management outcomes reported (cluster analysis)
SIGMON2004	Control group data not extractable
SILVERMAN1999	Comparing different schedules of CM
SLESNICK2005	Young age group 12–17 years old, no extractable outcome data
SOSIN1995	Regression analysis - not extractable
STAINES2004	No drug-use outcomes
STEPHENS2000	Brief versus standard comparison
SZAPOCZNIK1983	No extractable outcome data
THORNTON1987	Not relevant intervention
THORNTON1998	Subgroup analysis
THORNTON2003	No extractable data
TRIFFLEMAN2000	No treatment comparison data
VAUGHANSARRAZIN2000	No extractable outcomes
VAUGHANSARRAZIN2004	No extractable outcomes
WASHINGTON1999	Not an RCT
WASHINGTON2001	No drug-use outcomes
WONG2003	Not required outcomes
ZIEGLERDRISCOLL1977	Insufficient reporting of methdology

References of Included Studies

BROWN2002 (Published Data Only)

Brown TG, Seraganian P, Tremblay J, et al. Matching substance abuse aftercare treatments to client characteristics. Addictive Behaviors. 2002;27:585–604. [PubMed: 12188594]
*. Brown, T.G., Seraganian, P., Tremblay, J., et al. 2002Process and outcome changes with relapse prevention versus 12-step aftercare programs for substance abusers Addiction 97677–689. [PubMed: 12084137]

BUDNEY2006 (Published Data Only)

Budney AJ, Moore BA, Rocha HL, et al. Clinical trial of abstinence-based vouchers and cognitive-behavioral therapy for cannabis dependence. Journal of Consulting and Clinical Psychology. 2006;74:307–316. [PubMed: 16649875]

CARROLL1991 (Published Data Only)

Carroll KM, Rounsaville BJ, Gawin FH. A comparative trial of psychotherapies for ambulatory cocaine abusers: relapse prevention and interpersonal psychotherapy. American Journal of Drug & Alcohol Abuse. 1991;17:229–247. [PubMed: 1928019]

CARROLL2006B (Published Data Only)

Carroll KM, Easton CJ, Nich C, et al. The use of contingency management and motivational/skills-building therapy to treat young adults with marijuana dependence. Journal of Consulting & Clinical Psychology. 2006;74:955–966. [PMC free article: PMC2148500] [PubMed: 17032099]

CHUTUAPE2001 (Published Data Only)

Chutuape MA, Silverman K, Stitzer ML. Effects of urine testing frequency on outcome in a methadone take-home contingency program. Drug and Alcohol Dependence. 2001;62:69–76. [PubMed: 11173169]

COVIELLO2006 (Published Data Only)

Coviello DM, Zanis DA, Wesnoski SA, et al. The effectiveness of outreach case management in re-enrolling discharged methadone patients. Drug & Alcohol Dependence. 2006;85:56–65. [PubMed: 16675163]

CRITSCHRISTOPH1999 (Published Data Only)

Weiss RD, Griffin ML, Gallop RJ, et al. The effect of 12-step self-help group attendance and participation on drug use outcomes among cocaine-dependent patients. Drug & Alcohol Dependence. 2005;77:177–184. [PubMed: 15664719]
*. Crits-Christoph, P., Siqueland, L., Blaine, J., et al. 1999Psychosocial treatments for cocaine dependence: National Institute on Drug Abuse. Collaborative Cocaine Treatment Study Archives of General Psychiatry 56493–502. [PubMed: 10359461]

DENNIS2004 (Published Data Only)

Dennis M, Titus JC, Diamond G, Donaldson J, Godley SH, Tims FM, et al. The Cannabis Youth Treatment (CYT) experiment: rationale, study design and analysis plans. Addiction. 2002;97(Suppl 1):16–34. [PubMed: 12460126]
**. Dennis, M., Godley, S. H., Diamond, G., Tims, F. M., Babor, T., Donaldson, J. et al. 2004The Cannabis Youth Treatment (CYT) Study: main findings from two randomized trials.[see comment] Journal of Substance Abuse Treatment. 27197–213. [PubMed: 15501373]

FALSSTEWART1996 (Published Data Only)

Fals-Stewart W, Birchler GR, O'Farrell TJ. Behavioral couples therapy for male substance-abusing patients: effects on relationship adjustment and drug-using behavior. Journal of Consulting & Clinical Psychology. 1996;64:959–972. [PubMed: 8916625]

FINNEY1998 (Published Data Only)

Finney JW, Noyes CA, Coutts AI, et al. Evaluating substance abuse treatment process models: I. Changes on proximal outcome variables during 12-step and cognitive-behavioral treatment. Journal of Studies on Alcohol. 1998;59:371–380. [PubMed: 9647419]

HALL1977 (Published Data Only)

Hall SM, Loeb P, Norton J, Yang R. Improving vocational placement in drug treatment clients: a pilot study. Addictive Behaviors. 1977;2:227–234. [PubMed: 343521]

HENGGELER1999 (Published Data Only)

*. Henggeler SW, Pickrel SG, Brondino MJ. Multisystemic treatment of substance-abusing and dependent delinquents: outcomes, treatment fidelity, and transportability. Mental Health Services Research. 1999;1:171–184. [PubMed: 11258740]
Henggeler SW, Pickrel SG, Brondino MJ, Crouch JL. Eliminating (almost) treatment dropout of substance abusing or dependent delinquents through home-based multisystemic therapy. American Journal of Psychiatry. 1996;153:427–428. [PubMed: 8610836]

HIGGINS1993 (Published Data Only)

*. Higgins ST, Budney AJ, Bickel WK, et al. Achieving cocaine abstinence with a behavioral approach. American Journal of Psychiatry. 1993;150:763–769. [PubMed: 8480823]
Higgins ST, Budney AJ, Bickel WK, et al. Outpatient behavioral treatment for cocaine dependence: one-year outcome. Experimental & Clinical Psychopharmacology. 1995;3

HIGGINS1994 (Published Data Only)

Higgins ST, Budney AJ, Bickel WK, et al. Incentives improve outcome in outpatient behavioral treatment of cocaine dependence. Archives of General Psychiatry. 1994;51:568–576. [PubMed: 8031230]

HIGGINS2003 (Published Data Only)

Higgins ST, Sigmon SC, Wong CJ, et al. Community reinforcement therapy for cocaine-dependent outpatients. Archives of General Psychiatry. 2003;60:1043–1052. [PubMed: 14557150]

JOANNING1992 (Published Data Only)

Joanning H, Thomas F, Quinn W, Mullen R. Treating adolescent drug abuse: A comparison of family systems therapy, group therapy, and family drug education. Journal of Martial & Family Therapy. 1992;18(4):345–356.
Joanning H, Thomas F, Quinn W, Mullen R. Treating adolescent drug abuse: A comparison of family systems therapy, group therapy, and family drug education. Journal of Martial & Family Therapy. 1992;18(4):345–356.

JONES2004 (Published Data Only)

Jones HE, Johnson RE, Bigelow GE, et al. Safety and efficacy of L-tryptophan and behavioral incentives for treatment of cocaine dependence: a randomized clinical trial. American Journal on Addictions. 2004;13:421–437. [PubMed: 15764421]

KADDEN2006 (Published Data Only)

Kadden RM, Litt MD, Kabela-Cormier E, et al. Abstinence rates following behavioral treatments for marijuana dependence. Addictive Behaviors. 2006 2006 Sep;20 Epub ahead of print] [PMC free article: PMC1903379] [PubMed: 16996224]

KELLEY2002 (Published Data Only)

Kelley ML, Fals-Stewart W. Couples- versus individual-based therapy for alcohol and drug abuse: effects on children's psychosocial functioning. Journal of Consulting & Clinical Psychology. 2002;70:417–427. [PubMed: 11952200]

LIDDLE2001 (Published Data Only)

Liddle HA, Dakof GA, Parker K, Diamond GS, Barrett K, Tejeda M. Multidimensional family therapy for adolescent drug abuse: results of a randomized clinical trial. American Journal of Drug & Alcohol Abuse. 2001;27:651–688. [PubMed: 11727882]

MARTIN1993 (Published Data Only)

Martin SS, Scarpitti FR. An intensive case management approach for paroled IV drug users. Journal of Drug Issues. 1993;23:43–59.

MAUDEGRIFFIN1998 (Published Data Only)

Maude-Griffin PM, Hohenstein JM, Humfleet GL, et al. Superior efficacy of cognitive-behavioral therapy for urban crack cocaine abusers: main and matching effects. Journal of Consulting and Clinical Psychology. 1998;66:832–837. [PubMed: 9803702]

MCKAY2004 (Published Data Only)

McKay JR, Lynch KG, Shepard DS, et al. The effectiveness of telephone-based continuing care for alcohol and cocaine dependence: 24-month outcomes. Archives of General Psychiatry. 2005;62:199–207. [PubMed: 15699297]
McKay JR, Lynch KG, Shepard DS, et al. Do patient characteristics and initial progress in treatment moderate the effectiveness of telephone-based continuing care for substance use disorders? Addiction. 2005;100:216–226. [PubMed: 15679751]
*. McKay, J.R., Lynch, K.G., Shepard, D.S., et al. 2004The effectiveness of telephone-based continuing care in the clinical management of alcohol and cocaine use disorders: 12-month outcomes Journal of Consulting and Clinical Psychology 72967–979. [PubMed: 15612844]

MEJTA1997 (Published Data Only)

Mejta CL, Bokos PJ, Mickenberg J, et al. Improving substance abuse treatment access and retention using a case management approach. Journal of Drug Issues. 1997;27:329–340.

MONTI1997 (Published Data Only)

Monti PM, Rohsenow DJ, Michalec E, et al. Brief coping skills treatment for cocaine abuse: substance use outcomes at three months. Addiction. 1997;92:1717–1728. [PubMed: 9581004]
Rohsenow DJ, Monti PM, Martin RA, et al. Brief coping skills treatment for cocaine abuse: 12-month substance use outcomes. Journal of Consulting and Clinical Psychology. 2000;68:515–520. [PubMed: 10883569]
*. Monti, P.M., Rohsenow, D.J., Michalec, E., et al. 1997Brief coping skills treatment for cocaine abuse: substance use outcomes at three months Addiction 921717–1728. [PubMed: 9581004]

MORGENSTERN2006 (Published Data Only)

Morgenstern J, Blanchard KA, McCrady BS, et al. Effectiveness of intensive case management for substance-dependent women receiving temporary assistance for needy families. American Journal of Public Health. 2006;96:2016–2023. [PMC free article: PMC1751803] [PubMed: 17018819]

NEEDELS2005 (Published Data Only)

Needels K, James-Burdumy S, Burghardt J. Community case management for former jail inmates: its impacts on rearrest, drug use, and HIV risk. Journal of Urban Health. 2005;82:420–433. [PMC free article: PMC3456061] [PubMed: 16014874]

PETRY2002 (Published Data Only)

Petry NM, Martin B. Low-cost contingency management for treating cocaine- and opioid-abusing methadone patients. Journal of Consulting and Clinical Psychology. 2002;70:398–405. [PubMed: 11952198]

PETRY2004 (Published Data Only)

Lewis MW, Petry NM. Contingency management treatments that reinforce completion of goal-related activities: Participation in family activities and its association with outcomes. Drug & Alcohol Dependence. 2005;79 Date. [PubMed: 16002037]
*. Petry NM, Tedford J , Austin M, et al. Prize reinforcement contingency management for treating cocaine users: how low can we go, and with whom? Addiction. 2004;99:349–360. [PMC free article: PMC3709247] [PubMed: 14982548]

PETRY2005A (Published Data Only)

Petry NM, Peirce JM, Stitzer ML, et al. Effect of prize-based incentives on outcomes in stimulant abusers in outpatient psychosocial treatment programs: a national drug abuse treatment clinical trials network study. Archives of General Psychiatry. 2005;62:1148–1156. [PubMed: 16203960]

PETRY2005B (Published Data Only)

Petry NM, Alessi SM, Marx J, et al. Vouchers versus prizes: contingency management treatment of substance abusers in community settings. Journal of Consulting and Clinical Psychology. 2005;73:1005–1014. [PubMed: 16392974]

PETRY2006 (Published Data Only)

Petry NM, Alessi SM, Carroll KM, et al. Contingency management treatments: reinforcing abstinence versus adherence with goal-related activities. Journal of Consulting and Clinical Psychology. 2006;74:592–601. [PubMed: 16822115]

RAWSON2006 (Published Data Only)

Rawson RA, McCann MJ, Flammino F, et al. A comparison of contingency management and cognitive-behavioral approaches for stimulant-dependent individuals. Addiction. 2006;101:267–274. [PubMed: 16445555]

ROLL2006 (Published Data Only)

Roll JM, Petry NM, Stitzer ML, et al. Contingency management for the treatment of methamphetamine use disorders. American Journal of Psychiatry. 2006;163:1993–1999. [PubMed: 17074952]

SALEH2002 (Published Data Only)

Saleh SS, Vaughn T, Hall J, et al. Effectiveness of case management in substance abuse treatment. Care Management Journals: Journal of Case Management, The Journal of Long Term Home Health Care. 2002;3:172–177. [PubMed: 12847933]

SHOPTAW2005 (Published Data Only)

Shoptaw S, Reback CJ, Peck JA, et al. Behavioral treatment approaches for methamphetamine dependence and HIV-related sexual risk behaviors among urban gay and bisexual men. Drug and Alcohol Dependence. 2005;78:125–134. [PubMed: 15845315]

SHOPTAW2006 (Published Data Only)

Shoptaw S, Huber A, Peck J, et al. Randomized, placebo-controlled trial of sertraline and contingency management for the treatment of methamphetamine dependence. Drug and Alcohol Dependence. 2006;85:12–18. [PubMed: 16621339]

SORENSEN2005 (Published Data Only)

Sorensen JL, Masson CL, Delucchi K, et al. Randomized trial of drug abuse treatment-linkage strategies. Journal of Consulting and Clinical Psychology. 2005;73:1026–1035. [PubMed: 16392976]

STEPHENS1994 (Published Data Only)

*. Stephens RS, Roffman RA, Simpson EE. Treating adult marijuana dependence: a test of the relapse prevention model. Journal of Consulting and Clinical Psychology. 1994;62:92–99. [PubMed: 8034835]
Stephens RS, Wertz JS, Roffman RA. Self-efficacy and marijuana cessation: a construct validity analysis. Journal of Consulting and Clinical Psychology. 1995;63:1022–1031. [PubMed: 8543705]

STEPHENS2000 (Published Data Only)

Stephens RS, Roffman RA, Curtin L. Comparison of extended versus brief treatments for marijuana use. Journal of Consulting and Clinical Psychology. 2000;68:898–908. [PubMed: 11068976]

STEPHENS2002 (Published Data Only)

Stephens RS, Babor TF, Kadden R, et al. The Marijuana Treatment Project: rationale, design and participant characteristics. Addiction. 2002;97(Suppl 1):109–124. [PubMed: 12460133]

STRATHDEE2006 (Published Data Only)

Strathdee SA, Ricketts EP, Huettner S, et al. Facilitating entry into drug treatment among injection drug users referred from a needle exchange program: results from a community-based behavioral intervention trial. Drug and Alcohol Dependence. 2006;83:225–232. [PMC free article: PMC2196224] [PubMed: 16364566]

WALDRON2001 (Published Data Only)

Waldron HB, Slesnick N, Brody JL, Turner CW, Peterson TR. Treatment outcomes for adolescent substance abuse at 4- and 7-month assessments. Journal of Consulting & Clinical Psychology. 2001;69:802–813. [PubMed: 11680557]

WINTERS2002 (Published Data Only)

Winters J, Fals-Stewart W, O’Farrell TJ, et al. Behavioral couples therapy for female substance-abusing patients: effects on substance use and relationship adjustment. Journal of Consulting and Clinical Psychology. 2002;70:344–355. [PubMed: 11952192]

ZANIS1996 (Published Data Only)

Zanis DA, McLellan AT, Alterman AI, et al. Efficacy of enhanced outreach counseling to reenroll high-risk drug users 1 year after discharge from treatment. American Journal of Psychiatry. 1996;153:1095–1096. [PubMed: 8678182]

ZANIS2001 (Published Data Only)

Zanis DA, Coviello D, Alterman AI, Appling SE. A community-based trial of vocational problem-solving to increase employment among methadone patients. Journal of Substance Abuse Treatment. 2001;21:19–26. [PubMed: 11516923]
Zanis DA, Coviello D, Alterman AI, Appling SE. A community-based trial of vocational problem-solving to increase employment among methadone patients. Journal of Substance Abuse Treatment. 2001;21:19–26. [PubMed: 11516923]
Zanis DA, Coviello D, Alterman AI, Appling SE. A community-based trial of vocational problem-solving to increase employment among methadone patients. Journal of Substance Abuse Treatment. 2001;21:19–26. [PubMed: 11516923]
Zanis DA, Coviello D, Alterman AI, Appling SE. A community-based trial of vocational problem-solving to increase employment among methadone patients. Journal of Substance Abuse Treatment. 2001;21:19–26. [PubMed: 11516923]

References of Excluded Studies

AZRIN1994 (Published Data Only)

Azrin NH, McMahon PT, Donohue B, et al. Behavior therapy for drug abuse: a controlled treatment outcome study. Behaviour Research and Therapy. 1994;32:857–866. [PubMed: 7993330]

BARROWCLOUGH2001A

Barrowclough C, Haddock G, Tarrier N, et al. Randomized controlled trial of motivational interviewing, cognitive behavior therapy, and family intervention for patients with comorbid schizophrenia and substance use disorders. American Journal of Psychiatry. 2001;158:1706–1713. [PubMed: 11579006]

BOWMAN1996

Bowman V, Ward LC, Bowman D, et al. Self-examination therapy as an adjunct treatment for depressive symptoms in substance abusing patients. Addictive Behaviors. 1996;21:129–133. [PubMed: 8729714]

CHUTUAPE1999 (Published Data Only)

Chutuape MA, Silverman K, Stitzer M. Contingent reinforcement sustains post-detoxification abstinence from multiple drugs: a preliminary study with methadone patients. Drug and Alcohol Dependence. 1999;54:69–81. [PubMed: 10101619]

CONRAD1998 (Published Data Only)

Conrad KJ, Hultman CI, Pope AR, et al. Case managed residential care for homeless addicted veterans. Results of a true experiment. Medical Care. 1998;36:40–53. [PubMed: 9431330]

COVI2002 (Published Data Only)

Covi L, Hess JM, Schroeder JR, et al. A dose response study of cognitive behavioral therapy in cocaine abusers. Journal of Substance Abuse Treatment. 2002;23:191–197. [PubMed: 12392805]

COVIELLO2004 (Published Data Only)

Coviello DM, Zanis DA, Lynch K. Effectiveness of vocational problem-solving skills on motivation and job-seeking action steps. Substance Use and Misuse. 2004;39:2309–2324. [PubMed: 15603006]

CZUCHRY1995

Czuchry M, Dansereau DF, Dees SM, et al. The use of node-link mapping in drug abuse counseling: the role of attentional factors. Journal of Psychoactive Drugs. 1995;27:161–166. [PubMed: 7562263]

DANSEREAU1995 (Published Data Only)

Dansereau DF, Joe GW, Simpson DD. Attentional difficulties and the effectiveness of a visual representation strategy for counseling drug-addicted clients. International Journal of the Addictions. 1995;30:371–386. [PubMed: 7541782]

EISEN2000

Eisen M, Keyser-Smith J, Dampeer J, et al. Evaluation of substance use outcomes in demonstration projects for pregnant and postpartum women and their infants: findings from a quasi-experiment. Addictive Behaviors. 2000;25:123–129. [PubMed: 10708327]

ELK1998 (Published Data Only)

Elk R, Mangus L, Rhoades H, et al. Cessation of cocaine use during pregnancy: effects of contingency management interventions on maintaining abstinence and complying with prenatal care. Addictive Behaviors. 1998;23:57–64. [PubMed: 9468743]

FISHER1996A (Published Data Only)

Fisher MSS, Bentley KJ. Two group therapy models for clients with a dual diagnosis of substance abuse and personality disorder. Psychiatric Services. 1996;47:1244–1250. [PubMed: 8916244]

FRIEDMAN1989

Friedman AS. Family therapy vs parent groups: Effects on adolescent drug abusers. American Journal of Family Therapy. 1989;17(4):335–347.

GAINEY1995 (Published Data Only)

Gainey RR, Catalano RF, Haggerty KP, et al. Participation in a parent training program for methadone clients. Addictive Behaviors. 1995;20:117–125. [PubMed: 7785477]

GOTTHEIL2002 (Published Data Only)

Gottheil E, Thornton C, Weinstein S. Effectiveness of high versus low structure individual counseling for substance abuse. American Journal on Addictions. 2002;11:279–290. [PubMed: 12584871]

HALL1999 (Published Data Only)

Hall JA, Vaughan MS, Vaughn T, et al. Iowa Case Management for Rural Drug Abuse: preliminary results. Care Management Journals: Journal of Case Management, The Journal of Long Term Home Health Care. 1999;1:232–243. [PubMed: 10879210]

HENGGELER1991

Effects of multisystemic therapy on drug use and abuse in juvenile offenders: A progress report from two outcome studies. Family Dynamics of Addiction Quarterly. 1991;1(3):40–51.

HENGGELER2006

Henggeler SW, Halliday-Boykins CA, Cunningham PB, Randall J, Shapiro SB, Chapman JE. Juvenile drug court: enhancing outcomes by integrating evidence-based treatments. Journal of Consulting & Clinical Psychology. 2006;74:42–54. [PubMed: 16551142]

HIEN2004A (Published Data Only)

Hien DA, Cohen LR, Miele GM, et al. Promising treatments for women with comorbid PTSD and substance use disorders. American Journal of Psychiatry. 2004;161:1426–1432. [PubMed: 15285969]

HIGGINS1991 (Published Data Only)

Higgins ST, Delaney DD, Budney AJ, et al. A behavioral approach to achieving initial cocaine abstinence. American Journal of Psychiatry. 1991;148:1218–1224. [PubMed: 1883001]

HIGGINS2000 (Published Data Only)

Higgins ST, Wong CJ, Badger GJ, et al. Contingent reinforcement increases cocaine abstinence during outpatient treatment and 1 year of follow-up. Journal of Consulting and Clinical Psychology. 2000;68:64–72. [PubMed: 10710841]

HOFFMAN1996

Hoffman JA, Caudill BD, Koman JJ, et al. Psychosocial treatments for cocaine abuse. 12-month treatment outcomes. Journal of Substance Abuse Treatment. 1996;13:3–11. [PubMed: 8699540]

HUBER2003

Huber DL, Sarrazin MV, Vaughn T, et al. Evaluating the impact of case management dosage. Nursing Research. 2003;52:276–288. [PubMed: 14501542]

JANSSON2005 (Published Data Only)

Jansson LM, Svikis DS, Breon D, et al. Intensity of case management services: does more equal better for drug-dependent women and their children? Social Work in Mental Health. 2005;3:63–78.

JOANNING1992 (Published Data Only)

Joanning H, Thomas F, Quinn W, Mullen R. Treating adolescent drug abuse: A comparison of family systems therapy, group therapy, and family drug education. Journal of Martial & Family Therapy. 1992;18(4):345–356.
Joanning H, Thomas F, Quinn W, Mullen R. Treating adolescent drug abuse: A comparison of family systems therapy, group therapy, and family drug education. Journal of Martial & Family Therapy. 1992;18(4):345–356.

JOE1994 (Published Data Only)

Joe GW, Dansereau DF, Simpson DD. Node-link mapping for counseling cocaine users in methadone treatment. Journal of Substance Abuse. 1994;6:393–406. [PubMed: 7780297]

JOE1997 (Published Data Only)

Joe GW, Dansereau DF, Pitre U, et al. Effectiveness of node-link mapping enhanced counseling for opiate addicts: a 12-month posttreatment follow-up. Journal of Nervous and Mental Disease. 1997;185:306–313. [PubMed: 9171807]

KAMINER2002 (Published Data Only)

Kaminer Y, Burleson JA, Goldberger R. Cognitive-behavioral coping skills and psychoeducation therapies for adolescent substance abuse. Journal of Nervous and Mental Disease. 2002:737–745. [PubMed: 12436013]

KANG1991 (Published Data Only)

Kang SY, Kleinman PH, Woody GE, et al. Outcomes for cocaine abusers after once-a-week psychosocial therapy. American Journal of Psychiatry. 1991;148:630–635. [PubMed: 1850208]

KASHNER2002

Kashner TM, Rosenheck R, Campinell AB, Suris A, Crandall R, Garfield NJ, et al. Impact of work therapy on health status among homeless, substance-dependent veterans: a randomized controlled trial. Archives of General Psychiatry. 2002;59:938–944. [PubMed: 12365881]
Kashner TM, Rosenheck R, Campinell AB, Suris A, Crandall R, Garfield NJ, et al. Impact of work therapy on health status among homeless, substance-dependent veterans: a randomized controlled trial. Archives of General Psychiatry. 2002;59:938–944. [PubMed: 12365881]
Kashner TM, Rosenheck R, Campinell AB, Suris A, Crandall R, Garfield NJ, et al. Impact of work therapy on health status among homeless, substance-dependent veterans: a randomized controlled trial. Archives of General Psychiatry. 2002;59:938–944. [PubMed: 12365881]

KATZ2002 (Published Data Only)

Katz EC, Chutuape MA, Jones HE, et al. Voucher reinforcement for heroin and cocaine abstinence in an outpatient drug-free program. Experimental and Clinical Psychopharmacology. 2002;10:136–143. [PubMed: 12022799]

KIDORF1994 (Published Data Only)

Kidorf M, Stitzer ML, Brooner RK, et al. Contingent methadone take-home doses reinforce adjunct therapy attendance of methadone maintenance patients. Drug and Alcohol Dependence. 1994;36:221–226. [PubMed: 7889813]

KIRBY1998 (Published Data Only)

Kirby KC, Marlowe DB, Festinger DS, et al. Schedule of voucher delivery influences initiation of cocaine abstinence. Journal of Consulting and Clinical Psychology. 1998;66:761–767. [PubMed: 9803694]

KIRBY1999 (Published Data Only)

Kirby KC, Marlowe DB, Festinger DS, et al. Community reinforcement training for family and significant others of drug abusers: a unilateral intervention to increase treatment entry of drug users. Drug and Alcohol Dependence. 1999;56:85–96. [PubMed: 10462097]

LEWIS1990

Lewis RA, Piercy FP, Sprenkle DH, Trepper TS. Family-based interventions for helping drug-abusing ad0lescents. Journal of Adolescent Research. 1990;5:82–95.

LIDDLE2004 (Published Data Only)

Liddle HA, Rowe CL, Dakof GA, Ungaro RA, Henderson CE. Early Intervention for Adolescent Substance Abuse: Pretreatment to Posttreatment Outcomes of a Randomized Clinical Trial Comparing Multidimensional Family Therapy and Peer Group Treatment. Journal of Psychoactive Drugs. 2004;36 [PubMed: 15152709]

LINEHAN1999A (Published Data Only)

Linehan MM, Schmidt H, Dimeff LA, et al. Dialectical behavior therapy for patients with borderline personality disorder and drug-dependence. American Journal on Addictions. 1999;8:279–292. [PubMed: 10598211]

MCCOLLUM2003

McCollum EE, Lewis RA, Nelson TS, Trepper TS, Wetchler JL. Couple treatment for drug abusing women: effects on drug-use and need for treatment. Journal of Couple & Relationship Therapy. 2003;2:1–18.

MCKAY1997 (Published Data Only)

McKay JR, Alterman AI, Cacciola JS, et al. Prognostic significance of antisocial personality disorder in cocaine-dependent patients entering continuing care. Journal of Nervous and Mental Disease. 2000;188:287–296. [PubMed: 10830566]
McKay JR, Merikle E, Mulvaney FD, et al. Factors accounting for cocaine use two years following initiation of continuing care. Addiction. 2001;96:213–225. [PubMed: 11182866]
McKay JR, Alterman AI, Cacciola JS, et al. Continuing care for cocaine dependence: comprehensive 2-year outcomes. Journal of Consulting and Clinical Psychology. 1999;67:420–427. [PubMed: 10369063]
*. McKay, J.R., Alterman, A.I., Cacciola, J. S., et al. 1997Group counseling versus individualized relapse prevention aftercare following intensive outpatient treatment for cocaine dependence: initial results Journal of Consulting and Clinical Psychology 65778–788. [PubMed: 9337497]
McKay JR, Pettinati HM, Gallop R, et al. Relation of depression diagnoses to 2-year outcomes in cocaine-dependent patients in a randomized continuing care study. Psychology of Addictive Behaviors. 2002;16:225–235. [PubMed: 12236457]

MEYERS2002 (Published Data Only)

Meyers RJ, Miller WR, Smith JE, et al. A randomized trial of two methods for engaging treatment-refusing drug users through concerned significant others. Journal of Consulting and Clinical Psychology. 2002;70:1182–1185. [PubMed: 12362968]

MILBY1979

Milby JB, Toro C, Thronton S, et al. Some urine surveillance effects on drug abusers in psychotherapy. British Journal of Addiction to Alcohol and Other Drugs. 1979;74:199–200. [PubMed: 287513]

MILBY1980A

Milby JB, Clarke C, Toro C, et al. Effectiveness of urine surveillance as an adjunct to outpatient psychotherapy for drug abusers. International Journal of the Addictions. 1980;15:993–1001. [PubMed: 7450954]

NURCO1995 (Published Data Only)

Nurco DN, Primm BJ, Lerner M, et al. Changes in locus-of-control attitudes about drug misuse in a self-help group in a methadone maintenance clinic. International Journal of the Addictions. 1995;30:765–778. [PubMed: 7657402]

ONEILL1996 (Published Data Only)

O’Neill K, Baker A, Cooke M, et al. Evaluation of a cognitive-behavioural intervention for pregnant injecting drug users at risk of HIV infection. Addiction. 1996;91:1115–1125. [PubMed: 8828240]

PETRY1998 (Published Data Only)

Petry NM, Bickel WK, Tzanis E, et al. A behavioral intervention for improving verbal behaviors of heroin addicts in a treatment clinic. Journal of Applied Behavior Analysis. 1998;31:291–297. [PMC free article: PMC1284117] [PubMed: 9652105]

POLLACK2002 (Published Data Only)

Pollack MH, Penava SA, Bolton E, et al. A novel cognitive-behavioral approach for treatment-resistant drug dependence. Journal of Substance Abuse Treatment. 2002;23:335–342. [PubMed: 12495795]

PRESTON2001B (Published Data Only)

Preston KL, Umbricht A, Wong CJ, et al. Shaping cocaine abstinence by successive approximation. Journal of Consulting and Clinical Psychology. 2001;69:643–654. [PubMed: 11550730]

ROHSENOW2004 (Published Data Only)

Rohsenow DJ, Monti PM, Martin RA, et al. Motivational enhancement and coping skills training for cocaine abusers: effects on substance use outcomes. Addiction. 2004;99:862–874. [PubMed: 15200582]

ROOZEN2003 (Published Data Only)

Roozen HG, Kerkhof AJFM, Van Den Brink W. Experiences with an outpatient relapse program (community reinforcement approach) combined with naltrexone in the treatment of opioid-dependence: effect on addictive behaviors and the predictive value of psychiatric comorbidity. European Addiction Research. 2003;9:53–58. [PubMed: 12644730]

ROSENBLUM2005A (Published Data Only)

Rosenblum A, Magura S, Kayman DJ, et al. Motivationally enhanced group counseling for substance users in a soup kitchen: a randomized clinical trial. Drug and Alcohol Dependence. 2005;80:91–103. [PubMed: 16157232]

ROSENBLUM2005B (Published Data Only)

Rosenblum A, Foote J, Cleland C, et al. Moderators of effects of motivational enhancements to cognitive behavioral therapy. [Erratum appears in American. Journal of Drug and Alcohol Abuse. 2005;2005;31:357. [PubMed: 15768570]
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ROWANSZAL1994 (Published Data Only)

Rowan-Szal G, Joe GW, Chatham LR, et al. A simple reinforcement system for methadone clients in a community-based treatment program. Journal of Substance Abuse Treatment. 1994;11:217–223. [PubMed: 8072049]

SANTISTEBAN2003

Santisteban DA, Coatsworth JD, Perez-Vidal A, Kurtines WM, Schwartz SJ, LaPerriere A, et al. Efficacy of brief strategic family therapy in modifying Hispanic adolescent behavior problems and substance use. Journal of Family Psychology. 2003;17:121–133. [PMC free article: PMC1480818] [PubMed: 12666468]

SCHMITZ2005A (Published Data Only)

Schmitz J, Averill P, Sayre S, et al. Cognitive-behavioral treatment of bipolar disorder and substance abuse: a preliminary randomized study. Addictive Disorders and Their Treatment. 2002;1:17–24.

SIEGAL1996 (Published Data Only)

Siegal HA, Fisher JH, Rapp RC, et al. Enhancing substance abuse treatment with case management. Its impact on employment. Journal of Substance Abuse Treatment. 1996;13:93–98. [PubMed: 8880666]

SIEGAL1997

Siegal HA, Rapp RC, Li L, et al. The role of case management in retaining clients in substance abuse treatment: an exploratory analysis. Journal of Drug Issues. 1997;27:821–831.

SIGMON2004 (Published Data Only)

Sigmon SC, Correia CJ, Stitzer ML. Cocaine abstinence during methadone maintenance: effects of repeated brief exposure to voucher-based reinforcement. Experimental and Clinical Psychopharmacology. 2004;12:269–275. [PubMed: 15571444]

SILVERMAN1999 (Published Data Only)

Silverman K, Chutuape MA, Bigelow GE, et al. Voucher-based reinforcement of cocaine abstinence in treatment-resistant methadone patients: effects of reinforcement magnitude. Psychopharmacology. 1999;146:128–138. [PubMed: 10525747]

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Slesnick N, Prestopnik JL. Ecologically based family therapy outcome with substance abusing runaway adolescents. Journal of Adolescence. 2005;28:277–298. [PMC free article: PMC1933523] [PubMed: 15878048]

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Sosin MR, Bruni M, Reidy M. Paths and impacts in the progressive independence model: a homelessness and substance abuse intervention in Chicago. Journal of Addictive Diseases. 1995;14:1–20. [PubMed: 8929930]

STAINES2004 (Published Data Only)

Staines GL, Blankertz L, Magura S, et al. Efficacy of the customized employment supports (CES) model of vocational rehabilitation for unemployed methadone patients: preliminary results. Substance Use and Misuse. 2004;39:2261–2285. [PubMed: 15603004]

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Stephens RS, Roffman RA, Curtin L. Comparison of extended versus brief treatments for marijuana use. Journal of Consulting and Clinical Psychology. 2000;68:898–908. [PubMed: 11068976]

SZAPOCZNIK1983 (Published Data Only)

*. Szapocznik J, Kurtines WM, Foote FH, Perez-Vidal A, Hervis O. Conjoint versus one-person family therapy: some evidence for the effectiveness of conducting family therapy through one person. Journal of Consulting & Clinical Psychology. 1983;51:889–899. [PubMed: 6655103]
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Thornton PI, Igleheart HC, Silverman LH. Subliminal stimulation of symbiotic fantasies as an aid in the treatment of drug abusers. International Journal of the Addictions. 1987;22:751–765. [PubMed: 3316063]

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Thornton CC, Gottheil E, Weinstein SP, et al. Patient-treatment matching in substance abuse. Drug addiction severity. Journal of Substance Abuse Treatment. 1998;15:505–511. [PubMed: 9845864]

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Thornton CC, Patkar AA, Murray HW, et al. High- and low-structure treatments for substance dependence: role of learned helplessness. American Journal of Drug and Alcohol Abuse. 2003;29:567–584. [PubMed: 14510041]

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Triffleman E. Gender differences in a controlled pilot study of psychosocial treatments in substance dependent patients with post-traumatic stress disorder: design considerations and outcomes. Alcoholism Treatment Quarterly. 2000;18:113–126.

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Vaughan Sarrazin MS, Hall JA, Rick GS. Impact of case management on use of health services by rural clients in substance abuse treatment. Journal of Drug Issues. 2000;30

VAUGHANSARRAZIN2004

Vaughan Sarrazin MS, Hall JA. Impact of Iowa case management on provisions of social support for substance abuse clients. Care Management Journals. 2004;5:3–11. [PubMed: 15792325]

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Washington OG M. Effects of group therapy on chemically dependent women’s self-efficacy. Journal of Nursing Scholarship. 2000;32:347–352. [PubMed: 11140198]
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Washington OG. Using brief therapeutic interventions to create change in self-efficacy and personal control of chemically dependent women. Archives of Psychiatric Nursing. 2001;15:32–40. [PubMed: 11172237]

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Wong CJ, Sheppard JM, Dallery J, et al. Effects of reinforcer magnitude on data-entry productivity in chronically unemployed drug abusers participating in a Therapeutic Workplace. Experimental and Clinical Psychopharmacology. 2003;11:46–55. [PubMed: 12622343]

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Ziegler-Driscoll G. Family research study at Eagleville Hospital and Rehabilitation Center. Family Process. 1977;16:175–189. [PubMed: 872910]

Characteristics Table for The Clinical Question: Structured Psychosocial + Pharmacological Interventions

Comparisons Included in this Clinical Question

		(Bipolar medication + CBT) versus control	(Buprenorphine + CM) versus control DOWNEY2000 GROSS2006 KOSTEN2003 SCHOTTENFELD2005
(Desipramine + CBT) versus control	(Desipramine + CM) versus control	(LAAM + DBT) versus (LAAM + CVT + 12-step)	(MMT + CBT) versus control EPSTEIN2003 RAWSON2002 UKCBTMM2004 WOODY1983
(MMT + CM) versus control CARROLL2002 CHUTUAPE2001 EPSTEIN2003 MCLELLAN1993 PEIRCE2006 PETRY2002 PETRY2005C PRESTON1999 PRESTON2000 RAWSON2002 SCHOTTENFELD2005 SILVERMAN1998 SILVERMAN2004 STITZER1992	(MMT + CM) versus MMT + (non-contingent management)	(MMT + family therapy) versus control CATALANO1999 FALSSTEWART2001	(MMT + intensive treatment) versus control AVANTS1999 MCLELLAN1993
(MMT + supportive-expressive pschotherapy) versus (MMT + CBT) WOODY1983	(MMT + supportive-expressive pschotherapy) versus control WOODY1983 WOODY1995	(Naltrexone + CBT) versus control RAWSON2001 TUCKER2004B	(Naltrexone + CM) versus control CARROLL2001B
(Naltrexone + family therapy) versus control FALSSTEWART2003	(Tryptophan + CM) versus control	CBT versus control	Telephone intervention versus control

Characteristics of Included Studies

Methods	Participants					Outcomes	Interventions	Notes

AVANTS1999	n= 291 Age: Mean 36 Sex: 205 males 86 females Diagnosis: 46% cocaine dependence by DSM-III-R 5% cocaine misuse by DSM-III-R Exclusions: Not reported Baseline: Years of opiate use = 12.7 (8.3); injection use = 74%; years of cocaine use = 8.9					Data Used Abstinence: % with negative urine sample per day Notes: DROPOUTS: CBT = 28/146, day treatment = 26/145	Group 1 N= 145 Structured day treatment with outpatient. Mean dose 81.7 mg/day - 5 hours per day, 5 days per week; manual guided programme in 5 general areas: substance abuse treatment physical and emotional health community development development of alternative reinforcers basic daily living skills. Group 2 N= 146 CBT: group with outpatient. Mean dose 78.1 mg - 2 hours per week; manual-guided group CBT intervention. Used 9 sessions from Monti’s manual and 3 additional sessions on physical health, vocational skills and community resources.	Study quality: 1+

Study Type: RCT (randomised controlled trial) Type of Analysis: Per protocol Blindness: Open Duration (days): Mean 84 Followup: 6 months Setting: US Info on Screening Process: 308 eligible, 291 enrolled

CARROLL2001B	n= 55 Age: Mean 34 Sex: 36 males 19 females Diagnosis: 100% opioid dependence by DSM-IV Exclusions: Not meeting DSM-IV criteria for opioid dependence, not completing detox, significant medical conditions (e.g. abnormal liver function or active hepatitis), meeting DSM-IV criteria for schizophrenia or bipolar disorder, inability to provide names and locator information of at least 3 individuals who would know whereabouts of participant during follow-up.					Data Used Abstinence: negative urinalysis	Group 1 N= 20 Naltrexone maintenance with outpatient. Mean dose 100 mg - Received naltrexone 3 times/week (Monday, 100 mg; Wednesday, 100 mg; Friday, 150 mg), urine samples collected 3 times/week, and weekly group therapy sessions CM: vouchers with outpatient - High-value CM: received vouchers contingent on compliance with naltrexone maintenance and urine samples negative for opiates, cocaine and BDZs. Maximum earning of $1,152 (increase in value for each negative sample but reset to minimum if positive sample). Group 2 N= 17 Naltrexone maintenance with outpatient. Mean dose 100 mg - Received naltrexone 3 times/week (Monday, 100 mg; Wednesday, 100 mg; Friday, 150 mg), urine samples collected 3 times/week, and weekly group therapy sessions CM: vouchers with outpatient - Low-value CM: received vouchers contingent on compliance with naltrexone maintenance and urine samples negative for opiates, cocaine and BZDs. Maximum earning of $561.60 (increase in value for each negative sample but reset to minimum if positive sample). Group 3 N= 18 Naltrexone maintenance with outpatient. Mean dose 100 mg - Received naltrexone 3 times/week (Monday, 100 mg; Wednesday, 100 mg; Friday, 150 mg), urine samples collected 3 times/week, and weekly group therapy sessions	Study quality: 1++

Study Type: RCT (randomised controlled trial) Blindness: No mention Duration (days): Mean 84 Followup: 6 months Setting: US Notes: RANDOMISATION: Urn randomisation programme Info on Screening Process: 70 screened, 11 excluded (3 already receiving drug treatment, 6 didn’t complete detox, 2 needed inpatient hospitalisation). 4 dropped out at screening stage. Mean number of treatment weeks completed = 7.3; 1 completed 0 sessions, 32 completed <12 sessions	Baseline: Group:		naltrexone/	naltrexone + low-value vouchers/	naltrexone + high-value vouchers
	Years of opioid use:		4.9 (5.0)/	7.5 (6.2)	/4.9 (4.1)
	Previous opioid detoxes:		2.7 (2.6)/	3.2 (5.0)	/1.5

CARROLL2002	n= 55 Age: Mean 34 Sex: 36 males 19 females Diagnosis: 100% opioid dependence by DSM-IV Exclusions: - did not complete detoxification - significant medical conditions (e.g. of the liver, or any condition that contraindicates naltrexone) - DSM-IV lifetime schizophrenia or bipolar disorder - could not provide contact details of at least 3 individuals who would know of participant’s whereabouts during 6- month follow-up Notes: ETHNICITY: 6% African American, 9% Hispanic, 84% Caucasian Baseline: (Control / Low CM / High CM) Days’ opiate use in past 28: 8.3 / 11.1 / 12.8 Years’ regular opiate use: 4.9 / 7.5 / 4.9 Previous detox attempts: 2.7 / 3.2 / 1.5 Unemployed: 61.1% / 70.6% / 55.0% Receiving public assistance: 16.7% / 11.8% / 5.0% On probation/parole: 27.8% / 41.2% / 25.0% Previous MMT: 5.6% / 29.4% / 15.0% Previous naltrexone: 22.2% / 23.5% / 20.0% Lifetime DSM-IV cocaine dependence: 66.7% / 58.8% / 65.0% Lifetime DSM-IV alcohol dependence: 50.0% / 64.7% / 40.0%					Data Used Abstinence: longest consecutive period Retention: weeks remained in treatment Abstinence: % with negative urine sample per day Compliance: naltrexone doses taken Notes: 3 times weekly urine sample, coinciding with medication visits DROPOUTS: 32/55	Group 1 N= 18 Naltrexone maintenance with outpatient. Mean dose 100–150 mg - Naltrexone 3 times weekly (100 mg, 150 mg on Fridays) supervised by clinic nurse Group therapy with outpatient - Weekly group therapy sessions at clinic Group 2 N= 17 Naltrexone maintenance - As per control group Group therapy - As per control group CM: vouchers with outpatient - Two-track contingency: first -ve urine or naltrexone ingestion earned $0.80, increased by $0.40 for each successive reward. Any +ve/missing urine or missed naltrexone visit reset reward to $0.80. Earnings exchanged for goods supporting drug-free lifestyle Group 3 N= 20 Naltrexone maintenance with outpatient - As per control group Group therapy - As per control group CM: vouchers with outpatient - As per low CM group but with $2.00 initial voucher value and $0.80 addition for each negative urine/naltrexone dose ingested.	Study quality: 1+

Study Type: RCT (randomised controlled trial) Type of Analysis: ITT (all those randomised were analysed) Blindness: Open Duration (days): Mean 84 Followup: 1, 3 and 6 months Setting: New Haven, Connecticut, USA Notes: Urn randomisation Info on Screening Process: 70 screened, 11 excluded (3 already receiving treatment, 6 did not complete detox, 2 required hospitalisation) and 4 dropped out during screening phase. 55 randomised.

CATALANO1999	n= 144 Age: Mean 35 Sex: 42 males 102 females Diagnosis: 100% opioid dependence by eligibility for/receipt of MMT Exclusions: - had not been in MMT for >=90 days - did not have >=1 child aged 3–14 who lived with them >=50% of the time Notes: ETHNICITY: 105/132 White, 25/132 African American, 7/132 other Baseline: Age at first opiate use: 19.1 Previous months in MMT: 15.0					Data Used Cocaine use: times in past month Cannabis use: times in past month Heroin use: times in past month	Group 1 N= 74 FI: family training with outpatient - Initial 5- hour family retreat and 32 twice-weekly 90-min sessions, in groups of 6–10 families; children attended 12 sessions. Skills training in relapse prevention and coping, anger management, child development, communication, refusal skills etc. Opiate agonist: MMT (methadone maintenance) with outpatient - Standard methadone dispensing with ‘some individual and group counselling’ Case management - Home-based case management to help parents and children generalise and maintain the skills learned in group sessions, for about 9 months (beginning 1 month before group training period) Group 2 N= 58 Opiate agonist: MMT (methadone maintenance) with outpatient - Standard methadone dispensing with ‘some individual and group counselling’	Study quality: 1+

Study Type: RCT (randomised controlled trial) Type of Analysis: ITT Blindness: No mention Duration (days): Mean 365 Setting: Two methadone clinics in USA Notes: RANDOMISATION: Blocked on race, parents’ age at first drug use, parents’ partnership status and ages of children Info on Screening Process: 78% of those eligible participated

CHUTUAPE2001	n= 53 Age: Sex: Diagnosis: 100% opioid dependence by eligibility for/receipt of MMT Exclusions: - opiate-negative samples at intake - no signs of intravenous use - self-reported opiate use (<= 21 of 30 days) for 6 or more months of previous year - history of addiction <1 year - serious medical or psychiatric illness - pregnancy					Data Used Response: abstinent >= 8 weeks Abstinence: weeks drug free Notes: DROPOUTS: Weekly CM = 6/16, monthly CM = 3/18, NCM (non-contingent management) = 1/19	Group 1 N= 19 NCM (non-contingent management) with outpatient - Received take-home doses based on individual weekly drawings rather than drug-free urine results -- probability of earning take homes was 50% Group 2 N= 18 CM: methadone with outpatient - Urinalysis results randomly selected monthly -- a negative sample resulted in 3 take-home doses till the next test. A positive sample resulted in cancellation of take-home doses. Group 3 N= 16 CM: methadone with outpatient - Urinalysis results randomly selected weekly -- a negative sample resulted in 3 take-home doses till the next test. A positive sample resulted in cancellation of take-home doses.	Study quality: 1+

Study Type: RCT (randomised controlled trial) Blindness: No mention Duration (days): Mean 238 Setting: US Info on Screening Process: 231 screened, 15 did not complete baseline phase, 9 were opiate and cocaine free, submitted greater than 80% drug positive urines	Baseline: GROUPS:		CM weekly/	CM monthly /	non-contingent management
	Lifetime heroin use (months)		89	82	113
	Lifetime cocaine use (months)		23	23	28

DOWNEY2000	n= 41 Age: Mean 40 Range 18–55 Sex: 25 males 16 females Diagnosis: opioid dependence by DSM-IV Exclusions: <18 years >55 years, people with schizophrenia, bipolar disorder, dementia and delirium					Data Used ASI (Addiction Severity Index) Abstinence: negative urinalysis Notes: DROP OUTS: 7/20 (35%) in CM group 13/21 (62%) in non-contingent group	Group 1 N= 20 CM (contingency management) with outpatient - At week 6 intervention commenced. Received voucher worth $2.50 for first negative urine (for all drugs) and breathalyzer samples. Each negative sample resulted in increase of $1.25, and $10 bonus for 3 consecutive negative. Positive samples reset to $2.50 Opiate agonist: buprenorphine-naloxone with outpatient - Used the combined Buprenorphine-Naloxone tablet (4:1 ratio). Participants were maintained on doses up to 32mg sublingually visits spaced 48hrs apart and 48mg visits 72hrs apart. Initially maintained on 16-16-24 mg M-W-F schedule and increased before CM. Group 2 N= 21 NCM (non-contingent management) with outpatient - Each participant linked to CM participant and received sample value and frequency as that individual but independent of their own urinalysis results. Opiate agonist: buprenorphine-naloxone - Used the combined Buprenorphine- Naloxone tablet (4:1 ratio). Participants were maintained on doses up to 32mg sublingually visits spaced 48hrs apart and 48mg visits 72hrs apart. Initially maintained on 16-16-24 mg M-W-F schedule and increased before CM.	All participants received weekly individual CBT+ MET and 12 sessions of group therapy ( based on relapse prevention)

Study Type: RCT (randomised controlled trial) Blindness: No mention Duration (days): Mean 84 Setting: US Notes: RANDOMISATION: problematic first 4 participants to reach week 6 entered treatment group thereafter participants randomly assigned Info on Screening Process: 120 screened, 24 did not meet inclusion criteria, 29 dropped out before starting medication, 22 dropped out before CM, 3 excluded because they were random halves of couples	Baseline: Group:			CM /	Control
	ASPD:			15% /	24%
	Alcohol abuse/dependence			80% /	50%
	Cocaine abuse/dependence			80% /	86%

EPSTEIN2003	n= 193 Age: Mean 39 Sex: 110 males 83 females Diagnosis: 41% cocaine dependence by DSM-III-R Exclusions: - <18 years or >65 years - not intravenous opiate user - not cocaine user - current psychotic, bipolar or major depressive disorder - current physical dependence on alcohol or sedatives - unstable medical illness - pregancy and breastfeeding Baseline: Mean years of cocaine use = 11 (7.5) Mean cocaine use = 18.3 (10.1) of last 30 days					Data Used Cocaine use: days Notes: DROPOUTS: Control = 12/49, CM = 9/47, CBT = 10/48, CBT + CM = 15/49	Group 1 N= 49 CM: vouchers with outpatient - Earned vouchers for each urine specimen that was negative for cocaine. Vouchers began at $2.50, increasing by $1.50 for each consecutive voucher earned. For three consecutive negative urines a $10 bonus was earned. CBT: RP (relapse prevention) with outpatient - Combined elements of relapse prevention, coping methods, behavioural reinforcement methods and methods of generalising to the environment IDC (individual drug counselling) with outpatient Opiate agonist: MMT (methadone maintenance) with outpatient. Mean dose 70 mg - Within first week participants stabilised on 70 mg/day could request increase of up to 80 mg/day Group 2 N= 47 CM: vouchers with outpatient - Earned vouchers for each urine specimen that was negative for cocaine. Vouchers began at $2.50, increasing by $1.50 for each consecutive voucher earned. For three consecutive negative urines a $10 bonus was earned. IDC (individual drug counselling) with outpatient Opiate agonist: MMT (methadone maintenance) with outpatient. Mean dose 70 mg - Within first week participants stabilised on 70 mg/day could request increase of up to 80 mg/day Control: social support group with outpatient Group 3 N= 48 CBT: RP (relapse prevention) with outpatient - Combined elements of relapse prevention, coping methods, behavioural reinforcement methods and methods of generalising to the environment IDC (individual drug counselling) with outpatient Opiate agonist: MMT (methadone maintenance) with outpatient. Mean dose 70 mg - Within first week participants stabilised on 70 mg/day could request increase of up to 80 mg/day NCM (non-contingent management) with outpatient Group 4 N= 49 IDC (individual drug counselling) with outpatient Opiate agonist: MMT (methadone maintenance) with outpatient. Mean dose 70 mg - Within first week participants stabilised on 70 mg/day could request increase of up to 80 mg/day NCM (non-contingent management) with outpatient Control: social support group with outpatient	Study quality: 1+

Study Type: RCT (randomised controlled trial) Blindness: No mention Duration (days): Mean 84 Followup: 12 months Setting: US Info on Screening Process: 286 screened

FALSSTEWART2001	n= 42 Age: Mean 38 Sex: all males Diagnosis: 100% opioid dependence by eligibility for/receipt of MMT opioid misuse Exclusions: - Male partner's age outside 21–60 range - Not married for >=1 year or living with a female significant other in a stable common-law relationship for >= 2 years - Ineligible for MMT - Seeking additional substance misuse treatment other than self-help meetings, unless recommended by primary therapist - Female partner meeting DSM-III-R criteria for substance use in past 6 months - Either partner meeting DSM-III-R criteria for an organic, schizophrenic, delusional or other psychotic disorder Notes: PRIMARY DIAGNOSIS: Intravenous opiate users ETHNICITY: 18/36 White, 15/36 African American, 3/36 Hispanic Baseline: (GROUPS: BCT [behavioural couples therapy] versus CBT) Problematic alcohol use (years): 8.2 / 7.8 Problematic opiate use (years): 10.0 / 10.6 Problematic cocaine use (years): 5.8 / 5.6					Data Used ASI (Addiction Severity Index) Urinalysis: positive for opiates Urinalysis: positive for cocaine Notes: DROPOUTS: CBT = 5/22, BCT = 2/21	Group 1 N= 21 CBT: coping skills training - Once weekly 60-min individual sessions for males FI: BCT (behavioural couples therapy) with outpatient - One 60-min wkly session for 12 wks: male and female partners met jointly with therapist. Involved crisis intervention, sobriety trust discussion, reinforcing compliance, coping strategies for craving, communication skills, positive behavioural exchanges. Opiate agonist: MMT (methadone maintenance) - 60 mg/day standard dose, increased at patient's request or opiate- positive urine sample. After 6 weeks of treatment, up to 2 take-home doses per week allowed if patient employed >=20 hours per week. Group 2 N= 22 CBT: coping skills training with outpatient - Twice weekly 60-min individual sessions for males with the aim of developing skills that would assist in drug-use reduction efforts through cognitive restructuring, problem-solving, alternatives to drug use, anger management, assertiveness training etc. Opiate agonist: MMT (methadone maintenance) with outpatient - 60 mg/day standard dose, increased at patient's request or opiate positive urine sample. After 6 weeks of treatment, up to 2 take- home doses per week allowed if patient employed >= 20 hours per week.	Study quality: 1+

Study Type: RCT (randomised controlled trial) Study Description: Male patients participated with female significant others Type of Analysis: Per protocol Blindness: No mention Duration (days): Mean 105 Setting: Two MMT clinics in USA Notes: RANDOMISATION: No details Info on Screening Process: 371 applicants (89 married or cohabiting) interviewed, 19 refused consent and 27 met exclusion critera. 43 enrolled and were randomised.

FALSSTEWART2003	n= 124 Age: Mean 33 Sex: all males Diagnosis: 100% opioid dependence by DSM-III-R Exclusions: - female - did not demonstrate lack of 'physiological' opiate dependence by naloxone challenge - not living with a family member willing to participate, who also did not have substance use disorder, schizophrenia, bipolar disorder or psychosis by DSM-III-R - physical condition which would make participation hazardous (e.g. acute hepatitis) - suicidal or homicidal - in MMT within past 30 days Notes: ETHNICITY: 66% White, 25% African American, 4% Hispanic, 6% other Baseline: (GROUPS: family / individual) Opiate use (years): 6.6 / 5.9 Problematic substance use: 12.7 / 11.3 Cocaine dependence: 61% / 56% Alcohol dependence: 65% / 60%					Data Used TLFB (Timeline follow-back) ASI (Addiction Severity Index) Urinalysis: positive for any drug Retention rate	Group 1 N= 62 Naltrexone maintenance with outpatient. Mean dose 50 mg/day - For first 2 weeks, 2 brief weekly visits with physician (also for first 3 weeks, 3 visits to agency nurse); biweekly thereafter. Nurse and physician encouraged compliance and asked about side effects. No family involvement or compliance contract. CBT: coping skills training with outpatient - Twice weekly 60-min individual sessions for first 16 weeks, weekly for last 8 weeks. Cognitive behavioural restructuring, problem solving, anger management, refusal skills, enhancing social support networks etc. Adapted from CBT programmes for alcoholism. Group therapy - 90 mins per week for first 16 weeks. No other details. Group 2 N= 62 Naltrexone maintenance. Mean dose 50 mg/day - For first 2 weeks, 2 brief weekly visits with physician (also for first 3 weeks, 3 visits to agency nurse); biweekly thereafter. Nurse and physician encouraged compliance and asked about side effects. Naltrexone taken under supervision of family member. CBT: coping skills training with outpatient - Twice weekly 60-min individual sessions for first 16 weeks, weekly for last 8 weeks. Cognitive behavioural restructuring, problem solving, anger management, refusal skills, enhancing social support networks etc. Adapted from CBT programmes for alcoholism. Group therapy - 90 mins per week for first 16 weeks. No other details. FBT (family behavioural therapy) - Behavioural family counselling. Patient and family member met jointly with counsellor for 16 weekly sessions of 60 mins. Established behavioural contract, instructions and behavioural rehearsal to reduce conflict and improve communication.	Study quality: 1+

Study Type: RCT (randomised controlled trial) Type of Analysis: Missing data addressed. Unclear if ITT Blindness: No mention Duration (days): Mean 168 Followup: 12 months Setting: Two outpatient clinics in USA Notes: RANDOMISATION: No details Info on Screening Process: 459 screened, 17 met exclusion criteria and 318 refused to take naltrexone. 124 were enrolled and randomised.

GROSS2006	n= 60 Age: Mean 32 Sex: 33 males 27 females Diagnosis: 100% opioid dependence by DSM-IV Exclusions: - age <18 - not in good health - acute psychosis or serious medical illness - pregnant Notes: ETHNICITY: 91% White Baseline: (CM voucher / CM buprenorphine / control) Full-time employed: 65% / 60% / 35% Years' regular opiate use: 9.34 / 7.16 / 12.39 Age at first opiate use: 21.4 / 19.32 / 20.25 Years' cocaine use: 7.15 / 3.81 / 5.55					Data Used ASI (Addiction Severity Index) Abstinence: longest consecutive period Abstinence: weeks drug free Notes: 3 times weekly buprenorphine dose and observed urine sample	Group 1 N= 20 Opiate agonist: buprenorphine maintenance - Standard care as per control group CM: negative reinforcement with outpatient - Participants received 2 half- doses of buprenorphine each day (3 half- doses on Fridays). Whenever urine was cocaine/opiate positive, only received 1 half-dose that day (or 2 half-doses on Fridays). Group 2 N= 20 CM: vouchers with outpatient - Participants received vouchers for each negative urine sample. The first voucher was worth $3.63 and increased in value for each consecutive negative urine. Opiate agonist: buprenorphine maintenance with outpatient Group 3 N= 20 Control: standard care with outpatient - Behavioural counselling 1 hour/week. Discussion of personal relationships, causes and effects of opiate use, developing recreational activities & HIV education. Counsellors also provided assistance in job-finding, stable housing and other treatment needs. Opiate agonist: buprenorphine maintenance with outpatient	2-week buprenorphine induction + 8-week stabilisation period preceding study Study quality: 1+

Study Type: RCT (randomised controlled trial) Type of Analysis: ITT (missing urines as positive) Blindness: Open Duration (days): Mean 84 Setting: USA? Notes: Randomisation by minimum likelihood allocation stratified on 5 variables Info on Screening Process: 95 enrolled, 35 failed to complete 8-week baseline phase; 60 randomised.

KOSTEN2003	n= 160 Age: Mean 37 Sex: 105 males 55 females Diagnosis: 100% opioid dependence by DSM-IV 100% cocaine dependence by DSM-IV Exclusions: - medical reasons for not taking desipramine (e.g. pregnancy, cardiac problems, acute hepatitis) - current suicidality or psychosis - inability to read or understand the symptom checklists - current alcohol or sedative dependence - use of non-diuretic anti-hypertensives or other medications that would interact with study medications Notes: Ethnicity: White = 84, African American = 58, Hispanic = 11, Native American = 2					Data Used Urinalysis: positive for heroin Urinalysis: positive for cocaine Notes: DROPOUTS = 85/160 (53%) after 12 weeks	Group 1 N= 40 Desipramine with outpatient - Started in week 2 at 50 mg daily and increased by 50 mg every 2 days up to 150 mg total dosage NCM (non-contingent management) with outpatient - Received vouchers not contingent on illicit cocaine and opiate use. Vouchers were worth the average value of the contingency subjects for the previous week. Opiate agonist: buprenorphine maintenance with outpatient - All participants stabilised on a median dose of 16 mg before randomisation. Sublingual buprenorphine started at 4 mg daily, shifting to 8 mg then 12 mg by week 1, and to 16 mg by week 2. Group 2 N= 40 CM: vouchers with outpatient - 1–12 wks: received $3 for first cocaine- and opiate- negative urine, increased by $1 with every consecutive negative urine, but reset after a positive sample. 13–16 wks: each negative sample $3. 17–20 wks: $6 for 2 negative samples. 21–24 wks: $9 for 3 Placebo with outpatient Opiate agonist: buprenorphine maintenance with outpatient - All participants stabilised on a median dose of 16 mg before randomisation. Sublingual buprenorphine started at 4 mg daily, shifting to 8 mg then 12 mg by week 1, and to 16 mg by week 2. Group 3 N= 40 Placebo with outpatient NCM (non-contingent management) with outpatient - Received vouchers not contingent on illicit cocaine and opiate use. Vouchers were worth the average value of the contingency subjects for the previous week. Opiate agonist: buprenorphine maintenance with outpatient - All participants stabilised on a median dose of 16 mg before randomisation. Sublingual buprenorphine started at 4 mg daily, shifting to 8 mg then 12 mg by week 1, and to 16 mg by week 2. Group 4 N= 40 CM: vouchers with outpatient - 1–12 wks: received $3 for first cocaine- and opiate- negative urine, increased by $1 with every consecutive negative urine, but reset after a positive sample. 13–16 wks: $3 each negative sample. 17–20 wks: $6 for 2 negative samples. 21–24 wks: $9 for 3. Desipramine with outpatient - Started in week 2 at 50 mg daily and increased 50 mg every 2 days up to 150 mg total dosage Opiate agonist: buprenorphine maintenance with outpatient - All participants stabilised on a median dose of 16 mg before randomisation. Sublingual buprenorphine started at 4 mg daily, shifting to 8 mg then 12 mg by week 1, and to 16mg by week 2.	All participants received weekly individual and group CBT (RP) Only placebo groups included in meta-analysis Study quality: 1+

Study Type: RCT (randomised controlled trial) Study Description: ITT analysis up to 12 weeks, then completers analysis 13–24 weeks when CM was reduced. Blindness: Double blind Duration (days): Mean 168 Setting: US	Baseline: GROUP:	desipramine + CM /	desipramine + NCM	placebo + CM /	placebo + NCM
	Heroin use (no. days/month):	28.8/	27.2/	29.1/	27.0
	Cocaine use(no. days/month):	13.8/	13.4 /	16.5 /	14.0

MCLELLAN1993	n= 92 Age: Mean 41 Sex: all males Diagnosis: 100% opioid dependence by eligibility for/receipt of MMT Exclusions: - serious medical/psychiatric disorder - plans for immediate move from area near clinic Notes: All were intravenous users Baseline: Years of substance use: opiates = 11, cocaine = 3, problematic alcohol = 7					Data Used ASI (Addiction Severity Index)	Group 1 N= 29 CM: methadone with outpatient - Combination of take-home methadone doses contingent on negative urines and CBT. First month weekly counselling, then over 2–6 months could reduce number of sessions (biweekly) if client showed signs of positive change. Opiate agonist: MMT (methadone maintenance) with outpatient. Mean dose 60–90 mg Group 2 N= 31 Opiate agonist: MMT (methadone maintenance) with outpatient. Mean dose 60–90 mg Structured day treatment with outpatient - Consisted of contingent take-home doses, CBT counselling and access to extra professional resources: family therapy, employment counselling, psychiatrist. Group 3 N= 32 Control: TAU (treatment as usual) with outpatient - Minimal treatment -- 15-min session/month Opiate agonist: MMT (methadone maintenance) with outpatient. Mean dose 60–90 mg	Study quality: 1+

Study Type: RCT (randomised controlled trial) Type of Analysis: Per protocol Blindness: Open Duration (days): Mean 180 Setting: US veterans Info on Screening Process: 144 screened; 13 excluded (medical or psychiatric conditions (n=6), did not follow through initial study procedures (n=7)); 29 refused to participate; 2 dropped out after <2 weeks' treatment; 5 could not be contacted for follow-up.

PEIRCE2006	n= 388 Age: Mean 42 Sex: 211 males 177 females Diagnosis: 100% opioid dependence by eligibility for/receipt of MMT 100% other stimulant misuse by urinalysis Exclusions: - not enrolled in MMT for 30 days – 3 years - no stimulant-positive urine sample within 2 weeks of study entry - not currently recovering from a gambling problem Notes: PRIMARY DIAGNOSIS: 74.9% cocaine misuse/dependence, 3.6% amph/methamphetamine misuse/dependence, 3.9% both drugs Baseline: (CM / usual care) Unemployed: 69% / 68% DSM abuse/dependence diagnosis for past 90 days: stimulant: 84.3% / 80.5%, alcohol: 16.7% / 17.4%, cannabis: 7.9% / 8.7% Days in treatment: 269 / 274 Methadone dose (mg): 86.6 / 85.1					Data Used Abstinence: longest consecutive period Retention rate Notes: Twice weekly urine and breath samples on non-consecutive days	Group 1 N= 198 CM (contingency management) with outpatient - Prize draw for each sample −ve for cocaine, amph/methamphetamine AND alcohol. For each week with all samples −ve, 1 additional draw. Any positive sample reset to 1 draw. Bonus prize for first 2 weeks' consecutive −ve samples. Max $400 prizes + $20 bonus. Opiate agonist: MMT (methadone maintenance) - Daily methadone dose with standard individual/group counselling, ranging from 3 times per week to once per month. Group 2 N= 190 Opiate agonist: MMT (methadone maintenance) - Daily methadone dose with standard individual/group counselling, ranging from 3 times per week to once per month	Study quality: 1+

Study Type: RCT (randomised controlled trial) Study Description: Research staff 'unaware' of allocation assignment Type of Analysis: Missing urine samples as positive Blindness: Open Duration (days): Mean 84 Followup: 1, 3 and 6 months Setting: 6 MMT programmes across USA Notes: Computerised stratified randomisation Info on Screening Process: 402 randomised, 14 later found to be ineligible. 388 in final study sample.

PETRY2002	n= 42 Age: Mean 39 Sex: 12 males 30 females Diagnosis: cocaine dependence by DSM-IV Exclusions: - not receiving a stable dose of methadone in past 3 months - not English speaking - MMSE <21 - active, uncontrolled psychosis or bipolar disorder Notes: Standard treatment = 91.3%, CM = 100% cocaine dependence Baseline: GROUPS: TAU/CM Years of heroin use: 13.8 (1.9) / 14.9 (1.6) Years of cocaine use: 12.0 (1.8) / 15.0 (1.7)					Data Used Abstinence: longest consecutive period Abstinence: days drug free Notes: DROPOUTS: CM = 1/19, TAU (treatment as usual) = 2/23	Group 1 N= 23 Control: TAU (treatment as usual) with outpatient Group 2 N= 19 CM: prizes with outpatient - Negative sample for opiates or cocaine earned a draw from the bowl, negative for opiates and cocaine earned 4 draws. Negative samples on consecutive days earned bonus draws. Bowl had 250 slips of paper, 1/2 non-winning, 109 small prizes, 15 large prizes.	Study quality: 1+

Study Type: RCT (randomised controlled trial) Type of Analysis: ITT Blindness: No mention Duration (days): Mean 84 Followup: 6 months Setting: US Notes: RANDOMISATION: Probabilistic balancing techniques to control for gender, race, age etc Info on Screening Process: 5 excluded: 1 withdrew consent, 4 uncontrolled psychosis

PETRY2005C	n= 77 Age: Mean 40 Sex: 21 males 56 females Diagnosis: cocaine dependence by DSM-IV Exclusions: - unstable methadone dose: changes in dose in last 3 months - not English speaking - MMSE <21 - in recovery fom pathological gambling - inability to attend groups Baseline: GROUPS: CM / TAU Years of heroin use: 15.9 (1.2) / 17.7 (1.2) Years of cocaine use: 13.2 (1.5) / 12.7 (1.3)					Data Used Abstinence: longest consecutive period Notes: DROPOUTS: CM = 5/40, TAU (treatment as ususal) = 6/37	Group 1 N= 40 Control: TAU (treatment as usual) with outpatient - 1 hour/week, rotating schedule of 12 topics: facts about cocaine, HIV education, stress management etc. CM: prizes with outpatient - Draw earned for each group therapy session attended and for cocaine-negative samples. Prize bowl contained 500 slips of paper, half of slips non-winning, 219 slips small prizes (e.g. $1 coupon), 30 large prizes (e.g. walkmans, watches), 1 jumbo prize (TV) Group 2 N= 37 Control: TAU (treatment as usual) with outpatient - 1 hour/week, rotating schedule of 12 topics: facts about cocaine, HIV education, stress management etc.	Study quality: 1+

Study Type: RCT (randomised controlled trial) Blindness: No mention Duration (days): Mean 84 Followup: 6 months Setting: US Notes: RANDOMISATION: Minimum likelihood allocation balanced by age, gender etc Info on Screening Process: 5 excluded

PRESTON1999	n= 57 Age: Mean 33 Sex: 36 males 21 females Diagnosis: 100% opioid dependence by DSM-III-R Exclusions: - <18 or >65 years of age - current major psychiatric disorder - severe current medical illness - pregnant or lactating - in an institutional residence (e.g. jail) - know allergy to naltrexone or naloxone Notes: Used within the past 60 days but not currently dependent on opiates					Data Used Retention: days remained in treatment Abstinence: negative urinalysis Notes: DROPOUTS: CM = 50%, NCM = 80%, no voucher group = 95%	Group 1 N= 19 Naltrexone maintenance with outpatient - Received naltrexone 3 days a week under staff observation. Doses were 100 mg on Monday and Wednesday and 150 mg on Friday. Group 2 N= 19 Naltrexone maintenance with outpatient - Received naltrexone 3 days a week under staff observation. Doses were 100 mg on Monday and Wednesday and 150 mg on Friday. CM: vouchers with outpatient - Value of vouchers began at $2.50 for a dose of naltrexone, increasing in value by $1.50 for each consecutive dose; $10 bonus for 3 consecutive doses, if did not receive dose did not get voucher and next voucher reset to $2.50. Maximum of $1155. Group 3 N= 19 Naltrexone maintenance with outpatient - Received naltrexone 3 days a week under staff observation. Doses were 100 mg on Monday and Wednesday and 150 mg on Friday. NCM (non-contingent management) with outpatient - Each participant randomly linked to participant in contingent group. Had to attend clinic and provide urine sample to receive a voucher. The value of the voucher was equal to that received by the linked contingent participant.	All received weekly 'interpersonal/cognitive/behavioural' counselling for cocaine misuse Study quality: 1+

Study Type: RCT (randomised controlled trial) Blindness: No mention Duration (days): Mean 84 Setting: US consent, 1 did not return after giving consent, 1 experienced withdrawal symptoms after naloxone challenge	Baseline: GROUPS:		CM /	NCM /	no voucher
	Self-reported years' drug use: heroin		7.5 /	5.3 /	7.8
	Self-reported years' drug use: cocaine		2.6 /	4.0 /	5.1
	% marijuana dependence (DSM-III-R)		26 /	0 /	0
	% cocaine dependence (DSM-III-R)		47 /	32 /	50
	% alcohol dependence (DSM-III-R)		37 /	21 /	60

PRESTON2000	n= 120 Age: Mean 38 Sex: 81 males 39 females Diagnosis: 100% opioid dependence by eligibility for/receipt of MMT Exclusions: - age outside 18–65 range - not qualified for MMT under FDA guidelines - no history of intravenous drug use - Current major psychiatric or unstable serious medical illness - Alcohol or benzodiazepine dependence - <3-opiate positive urine samples out of 15 during 5-week baseline period Notes: PRIMARY DIAGNOSIS: Opiates ETHNICITY: 42% African American, 58% White REFERRALS: Admission to MMT Baseline: (GROUP: MMT+ NCM / MMT+ CM / MMT-high + NCM / MMT-high + CM) Employed: 44% / 38% / 55% / 33% Years of heroin use: 13.3 / 12.6 / 13.3 / 11.8 Days' heroin use in past 30: 25.9 / 28.8 / 26.4 / 26.9					Data Used Urinalysis: positive for benzodiazepines Urinalysis: positive for opiates Abstinence: longest consecutive period Retention: weeks remained in treatment Urinalysis: positive for cocaine Urinalysis: positive for cannabis Data Not Used Urinalysis: positive for alcohol Notes: FOLLOW-UP: Baseline, endpoint DROPOUTS: 4% / 7% / 13% / 3%	Group 1 N= 32 CM: vouchers with outpatient - Vouchers contigent on opiate-negative urine specimens from 3 times weekly urine tests and exchangeable for goods and services (requested via and purchased by staff) that would support a drug-free lifestyle. Opiate agonist maintenance with outpatient. Mean dose 70 mg - High dose. 60 mg on days 1–3, 70 mg from day 4. Group 2 N= 31 Opiate agonist: MMT (methadone maintenance) with outpatient. Mean dose 70 mg - High dose. 60 mg on days 1–3, 70 mg from day 4. NCM (non-contingent management) with outpatient - Received vouchers not contingent on urine samples; randomly linked to a participant in CM group. Group 3 N= 28 Opiate agonist: MMT (methadone maintenance) with outpatient. Mean dose 50% - Standard dose NCM (non-contingent management) with outpatient - Received vouchers not contingent on urine samples; randomly linked a participant in CM group. Group 4 N= 29 CM: vouchers with outpatient - Vouchers contingent on opiate-negative urine specimens from 3 times weekly urine tests. Exchangeable for goods and services (requested via and purchased by staff) that would support a drug-free lifestyle. Opiate agonist: MMT (methadone maintenance) with outpatient. Mean dose 50 mg - Standard dose	Study quality: 1+

Study Type: RCT (randomised controlled trial) Study Description: Blindness for methadone dosing Type of Analysis: ITT Blindness: Double blind Duration (days): Mean 56 Setting: USA Notes: RANDOMISATION: First 10 participants manually assigned to CM group to allow NCM yoking. Remaining participants randomised using random number table. Info on Screening Process: 285 enrolled, 253 completed baseline; 219 met criteria for opiate use, 120 randomised (exclusion reasons not given)

RAWSON2001	n= 81 Age: Mean 33 Sex: 49 males 32 females Diagnosis: 100% opioid dependence by DSM-IV Exclusions: - did not complete opiate detoxification - liver enzyme values 5 times above normal - if female: pregnant, lactating or not using effective method of birth control Notes: ETHNICITY: Caucasian 79%, Hispanic 10%, African American 3.7%, Other 7% Baseline: (GROUPS: enhanced / standard) Years' opiate use: 9.4 / 10.1 Days' opiate use in past 30: 21.5 / 23.4 Intravenous opiate use: 52.5% / 58.5% Previous treatment: 80% / 75.6% Previous methadone treatment: 55% / 58.5%					Data Used ASI (Addiction Severity Index) Urinalysis: TES (Treatment Effectiveness Score) Abstinence: no use for 3 consecutive weeks at end Urinalysis: positive for opiates Retention: weeks remained in treatment Compliance: naltrexone doses taken Retention: sessions attended	Group 1 N= 41 Control: standard care with outpatient - Weekly data/urine collection; visit to study physician every 30 days to collect naltrexone, with additional appointments allowed for discussing side effects or other medication issues. Provision of booklet giving info about local drug treatment resources. Group 2 N= 40 CBT: matrix model with outpatient - CBT approach with specific behav. techniques, educational materials and encouraging 12- step involvement. 60-min individual session + 2 x 90-min group sessns + 60- min cue exposure sessn wks 1–12; individual sessn semi-weekly and group sessns wks 13–26.	Study quality: 1++

Study Type: RCT (randomised controlled trial) Study Description: Randomisation code generated independently off site Type of Analysis: Per protocol Blindness: Open Duration (days): Mean 365 Setting: 2 outpatient clinics, LA, USA Notes: RANDOMISATION: Sealed envelopes Info on Screening Process: 183 successfully detoxified; 81 induced onto naltrexone and randomised

RAWSON2002	n= 120 Age: Mean 44 Sex: 66 males 54 females Diagnosis: 100% opioid dependence by eligibility for/receipt of MMT 100% cocaine misuse by DSM-IV Exclusions: - not in MMT for >=90 days - no evidence of cocaine use in past month - alcohol or benzodiazepine dependence requiring medical withdrawal - Court-mandated treatment Notes: ETHNICITY: White 39%, African American 32%, Hispanic 26%, other 3% Baseline: (GROUPS: CBT / CM / CBT+CM / control) ASI drug: 0.37 / 0.31 / 0.33 / 0.36 Methadone dose (mg): 82 / 78 / 83 / 82					Data Used ASI (Addiction Severity Index): drug use Urinalysis: positive for opiates Retention: weeks remained in treatment Urinalysis: positive for cocaine Abstinence: no use for 3 consecutive weeks at end	Group 1 N= 30 CM (contingency management) - As per CM group Opiate agonist: MMT (methadone maintenance) - As per MMT group CBT: group - As per CBT group Group 2 N= 30 CM (contingency management) with outpatient - 3 urine samples/week. Voucher value starting at $2.50 for a negative sample, increasing by $1.25 per successive negative sample (up to $20 max). $10 bonus for 3 consecutive negative samples. Positive or missing sample reset schedule to $2.50. Opiate agonist: MMT (methadone maintenance) with outpatient - As per MMT group Group 3 N= 30 Opiate agonist: MMT (methadone maintenance) with outpatient. Mean dose 82 mg - Standard MMT: daily clinic visits for methadone, twice-monthly counselling, medical care and case management as needed. 3 urine samples/week. Group 4 N= 30 Opiate agonist: MMT (methadone maintenance) - As per standard MMT group CBT: group - Three 90-min group sessions (4–8 people) per week for 16 weeks, guided by Rawson CBT manual. Each worksheet/exercise explained or illustrated an aspect of CBT. Group 5 N=	Study quality: 1+

Study Type: RCT (randomised controlled trial) Type of Analysis: No evidence of ITT Blindness: Open Duration (days): Mean 102 Followup: 36 weeks Setting: 2 methadone clinics in USA Info on Screening Process: 180 volunteered; 120 eligible, enrolled and randomised

SCHOTTENFELD2005	n= 162 Age: Mean 36 Sex: 107 males 55 females Diagnosis: 100% opioid dependence by DSM-IV 100% cocaine misuse by DSM-IV Exclusions: - less than 1 year's history of DSM-IV opiate dependence and cocaine misuse/ dependence, or current alcohol or sedative dependence - significant medical condition - current psychotic/bipolar disorder or major depression/suicidality - pregnancy Notes: ETHNICITY: 21% White Baseline: (MMT+ CM / MMT / buprenorphine + CM / buprenorphine) Employed full-time: 40% / 45% / 41% / 41.9% IDU: 62.5% / 52.5% / 43.6% / 32.6% Years' heroin use: 9.4 / 9.6 / 9.7 / 8.3 Years' cocaine use: 8.0 / 10.1 / 11.2 / 9.4 Days' cocaine use (past 30 days): 7.6 / 11.6 / 14.5 / 10.7					Data Used Abstinence: longest consecutive period Abstinence: % with negative urine sample per day Notes: Three times weekly urine testing	Group 1 N= 40 IDC (individual drug counselling) with outpatient - Manualised individual sessions with CRA (community reinforcement approach) (behavioural skills, engaging in non-drug activities): twice weekly weeks 1–12, weekly weeks 13–24. Opiate agonist: MMT (methadone maintenance) with outpatient - 35 mg increased to 65 mg over weeks 1–2, increased further to max 85 mg over rest of study. Daily observed dispensing. CM: vouchers with outpatient - Monetary voucher for each opiate & cocaine -ve urine. Escalating schedule wks 1–12 ($2.50 initial + $1.25 per consec. −ve sample; reset to $2.50 for a +ve; $10 bonus for 3 consec −ve samples). Wks 13–24, fixed $1 per −ve sample. Max total reward $1033.50. Group 2 N= 40 IDC (individual drug counselling) with outpatient - Manualised individual sessions with CRA (behavioural skills, engaging in non-drug activities): twice weekly weeks 1–12, weekly weeks 13–24 Opiate agonist maintenance - 35 mg increased to 65 mg over weeks 1–2, increased further to max 85 mg over rest of study. Daily observed dispensing. Control: TAU (treatment as usual) with outpatient - Received piece of paper at each urine test indicating whether sample was positive or negative Group 3 N= 39 IDC (individual drug counselling) with outpatient - Manualised individual sessions with CRA approach (behavioural skills, engaging in non-drug activities): twice weekly weeks 1–12, weekly weeks 13–24 Opiate agonist: buprenorphine maintenance - 4 mg sublingual buprenorphine, increasing to 12 mg by end of week 2. Up to max 16 mg for remainder of study. CM: vouchers - Monetary voucher for each opiate & cocaine -ve urine. Escalating schedule wks 1–12 ($2.50 initial + $1.25 per consec -ve sample; reset to $2.50 for a +ve; $10 bonus for 3 consec. -ve samples). Wks 13–24, fixed $1 per -ve sample. Max total reward $1033.50 Group 4 N= 43 IDC (individual drug counselling) with outpatient - Manualised individual sessions with CRA approach (behavioural skills, engaging in non-drug activities): twice weekly weeks 1–12, weekly weeks 13–24. Daily observed dispensing. Opiate agonist: buprenorphine maintenance with outpatient - 4mg sublingual buprenorphine, increased to 12mg by end of week 2. Up to max 16mg for remaining of study. Daily observed dispensing. Control: TAU (treatment as usual) - Received piece of paper at each urine test indicating whether sample was positive or negative	Study quality: 1+

Study Type: RCT (randomised controlled trial) Study Description: Medications were double- blind/double-dummy, CM was not. Researchers and subjects aware of allocation at time of randomisation. Blindness: Double blind Duration (days): Mean 168 Setting: New Haven, CT, USA Notes: Computerised urn randomisation Info on Screening Process: 169 referred, 6 excluded (primarily failed to attend admission session). 163 randomised (1 participant received one dose of medication but provided no addition data and was excluded from analysis).

SILVERMAN1998	n= 59 Age: Mean 38 Sex: 39 males 20 females Diagnosis: 100% opioid dependence by eligibility for/receipt of MMT 100% cocaine misuse by urinalysis Exclusions: - age outside 18–65 range - not qualified for MMT under FDA guidelines - no history of intravenous opiate use - current major psychiatric or unstable serious medical illness - alcohol or benzodiazepine dependence - <3 cocaine-positive urine samples out of 15 during 5-week baseline period Notes: PRIMARY DIAGNOSIS: MMT patients who had misused cocaine in past 5 weeks ETHNICITY: Black 63%, White 37% REFERRALS: MMT admissions Baseline: (GROUPS: CM with bonus/CM/NCM) Employed: 15%/20%/5% Drug use (past 30 days): heroin: 95%/100%/95%, cocaine: 100%/100%/95%, alcohol: 50%/65%/68% Alcohol dependence: 20%/20%/21% Cocaine dependence: 65%/45%/42%					Data Used Abstinence: % with negative urine sample per day Abstinence: longest consecutive period Retention: weeks remained in treatment Cocaine craving: VAS (visual analogue scale) Notes: FOLLOW-UP: Baseline, endpoint (12 months) DROPOUTS: ?	Group 1 N= 19 Opiate agonist: MMT (methadone maintenance) with outpatient. Mean dose Up to 80 mg - Daily methadone and 45 mins per week individual counselling and medication monitoring NCM (non-contingent management) with outpatient - Vouchers yoked to reinforcement schedule of another participant in CM group (only available when participant attended clinic) Group 2 N= 20 CM: vouchers with outpatient - Identical to CM condition except $1.50 is rewarded for each successive negative sample. Additionally, $50 bonus for each of the first 6 negative samples provided, and each time 2 consecutive negative samples provided. Opiate agonist: MMT (methadone maintenance) with outpatient. Mean dose Up to 80 mg - Daily methadone and 45 mins per week individual counselling and medication monitoring Group 3 N= 20 CM: vouchers with outpatient. Mean dose Max $1950 - Schedule of escalating reinforcement for each successive cocaine-negative urine sample ($2.50 initial, +$2.96 per sample up to 6). Vouchers exchangeable for goods/services considered consistent with the participant’s goals. Total value of vouchers: $1950. Opiate agonist: MMT (methadone maintenance) - Daily methadone and 45 mins per week individual counselling and medication monitoring	Study quality: 1+

Study Type: RCT (randomised controlled trial) Type of Analysis: Per protocol Blindness: No mention Duration (days): Mean 84 Followup: 12 months Setting: USA Notes: RANDOMISATION: Incomplete due to yoking for CM conditions Info on Screening Process: 94 enrolled in MMT, 90 completed baseline assessment; 59 eligible (used cocaine) and randomised

SILVERMAN2004	n= 78 Age: Mean 39 Sex: 43 males 35 females Diagnosis: 100% opioid dependence by DSM-III-R 81% cocaine dependence by DSM-III-R Exclusions: - <18 or >50 years of age - opiate-negative sample at intake - did not report regular use in 30 days before intake and for 6 months before intake - <1 year of regular MMT - participated in a CM study before - did not have objective signs of injection drug use - pregnant - medical condition that contraindicated MMT - serious psychiatric condition (e.g. schizophrenia ) Baseline: GROUPS: CM: take home + voucher/CM: take home/TAU Days used heroin in last 30 days: 28 (5.7)/29 (2.3)/29 (3.5) Days used cocaine in last 30 days:15 (11.6)/14 (12.3)/11 (11.3)					Data Used Abstinence at 6 months Retention: weeks remained in treatment Abstinence: weeks drug free Notes: DROPOUTS: CM take home + vouchers = 7/26, CM take home = 10/26, TAU = 12/26	Group 1 N= 26 CM: methadone with outpatient - After 3 consecutive negative urine samples, a take-home dose for following day was given; after that, take-home dose given for each consecutive urine sample. If positive urine provided, required 3 consecutive negative urines for next take- home dose. Opiate agonist: MMT (methadone maintenance) with outpatient. Mean dose 60 mg - 10-week stabilisation period before main intervention: starting dose of 20 mg increased to 60 mg per day. If participant provided opiate-positive urine sample during weeks 3, 4 and 5 of baseline period dose increased to 100 mg. Group 2 N= 26 CM: vouchers with outpatient - $2.50 for first cocaine-negative urine, increase of $1.50 for each consecutive cocaine- negative urine up to maximum of $40 for each negative urine, $10 bonus for 3 consecutive negative urines. Cocaine- positive sample led to voucher reset to $2.50. CM: methadone with outpatient - After 3 consecutive negative urine samples a take-home dose for following day was given; after that, take-home dose given for each consecutive urine sample. If positive urine provided, 3 consecutive negative urines required for next take-home dose. Opiate agonist: MMT (methadone maintenance) with outpatient. Mean dose 60 mg - 10-week stabilisation period before main intervention: starting dose of 20 mg increased to 60 mg per day. If participant provided opiate-positive urine sample during weeks 3, 4 and 5 of baseline period dose increased to 100 mg. Group 3 N= 26 Control: TAU (treatment as usual) with outpatient - Standard services including weekly individual and group counselling Opiate agonist: MMT (methadone maintenance) with outpatient - 10-week stabilisation period before main intervention: starting dose of 20 mg increased to 60 mg per day. If participant provided opiate-positive urine sample during weeks 3, 4 and 5 of baseline period dose increased to 100 mg.	Study quality: 1+

Study Type: RCT (randomised controlled trial) Type of Analysis: ITT and completers Blindness: No mention Duration (days): Mean 365 Followup: 9 weeks Setting: US Notes: RANDOMISATION: Computer program

STITZER1992	n= 53 Age: Mean 34 Sex: 38 males 15 females Diagnosis: 100% opioid dependence by eligibility for/receipt of MMT Exclusions: - no evidence of intravenous drug use - did not provide 3 consecutive opiate-positive urines Baseline: Participants had an average of 15 years of opiate use Mean methadone dose: 51.4 mg/day					Data Used Response: abstinent >=4 weeks Retention: weeks remained in treatment Abstinence: negative urinalysis Notes: DROPOUTS: CM = 10/26, NCM (non-contingent management) = 7/27	Group 1 N= 26 CM: methadone with outpatient - Could earn a maximum of 3 take-home doses per week. First take-home methadone after 6 consecutive drug-free urines, additional take-home day authorized after 2 weeks drug free, then a further take-home day authorized after 2 more weeks drug free. Opiate agonist: MMT (methadone maintenance) with outpatient. Mean dose 51.4 mg Group 2 N= 27 Opiate agonist: MMT (methadone maintenance) with outpatient. Mean dose 51.4 mg NCM (non-contingent management) with outpatient - Randomly assigned to receive 0, 1, 2 or 3 take-home doses per week for the month, delivered independent of test results	Study quality: 1+

Study Type: RCT (randomised controlled trial) Blindness: Open Duration (days): Mean 180 Setting: US Info on Screening Process: 1 dropped out before randomisation

TUCKER2004B	n= 97 Age: Mean 30 Sex: 62 males 35 females Diagnosis: 100% opioid dependence by DSM-IV Exclusions: - <18 years - <5 days’ abstinence from opiates - severe medical or psychiatric illness - dependence on another substance (other than tobacco, cannabis and prescribed benzodiazepines) - pregnant or breastfeeding - 3-fold elevation of serum transaminases - likely incarceration or surgery in next 3 months - currently receiving naltrexone from another source					Data Used Dug use: days	Group 1 N= 45 Control: enhanced TAU (treatment as usual) with outpatient - Case management and option of participating in voluntary psychosocial interventions e.g. individual counselling and self-help groups Group 2 N= 52 Naltrexone maintenance with outpatient. Mean dose 50 mg - Initial dose of 25 mg, daily dose of 50 mg under supervision in week 1, then given enough naltrexone to self-administer on a weekly basis CBT: group RP (relapse prevention) with outpatient - Based on 4 modules (3 sessions each): preventing relapse, emotions, relationships, naltrexone and global lifestyle change. Participants could begin at any of the sessions and rotated through all 12 to successfully complete programme.	Study quality: 1+

Study Type: RCT (randomised controlled trial) Blindness: Single blind Duration (days): Mean 84 Followup: 3 months Setting: Australia Notes: RANDOMISATION: Computer randomised at a central site outside of treatment centre Info on Screening Process: 316 screened, 44 excluded; 147 did not return for study	Baseline: GROUPS:		naltrexone + CBT/	naltrexone + control
	Heroin days (0–28):		13.46 (5.8)/	13.62 (5.74)
	Polydrug use (0–9):		4.87 (1.01)/	5.40 (1.44)

UKCBTMM2004	n= 60 Age: Mean 32 Sex: 45 males 15 females Diagnosis: 100% opioid dependence by ICD-10 Exclusions: - age outside 18–70 range - current severe mental or physical illness - not on stable dose; MMT >=30 mg - no MMT or opiate detoxification in past 3 months - did not attend >=3 of past 6 MMT keyworker sessions - pending imprisonment - severe brain damage or mental impairment - unstable residence Notes: PRIMARY DIAGNOSIS: Opiates ETHNICITY: White 93%, Bangladeshi 2%, Black 3%, other 2% Baseline: (GROUPS: MMT/MMT+ CBT) European ASI overall: 0.27/0.31 Days’ heroin use in past 30 days: 9.0/14.6 £ spent on heroin in past 6 months: 2052/2367 Polydrug use in past 30 days: 7.4/8.1 Injection drug use in past 30 days: 7.2/8.6 £ spent on drugs in past 30 days: 154.84/350.17					Data Used E-ASI (European Addiction Severity Index) Notes: FOLLOW-UP: Baseline, 6 months and 12 months DROPOUTS: 7% MMT + CBT and 16% MMT unavailable to follow-up at 6 months	Group 1 N= 29 CBT (cognitive behavioural therapy) with outpatient. Mean dose Max 24 sessions - 40min individual weekly sessions over 6 months. Consisted of core (identifying negative thoughts that maintain drug use, high-risk situations and coping strategies) and elective (addressing other problems such as depression, anxiety, criminality) sessions Opiate agonist: MMT (methadone maintenance) with outpatient - Fortnightly (as minimum) 30-min manual guided sessions with keyworker. Focused on identifying specific needs and giving advice in areas of health, housing, relationships and legal problems, with individualised care plan. Prescription of oral methadone. Group 2 N= 31 Opiate agonist: MMT (methadone maintenance) with outpatient - Fortnightly (as minimum) 30-min manual guided sessions with keyworker. Focused on identifying specific needs and giving advice in areas of health, housing, relationships and legal problems, with individualised care plan. Prescription of oral methadone.	Study quality: 1++

Study Type: RCT (randomised controlled trial) Study Description: Not true ITT-- 6-month and 12-month analysis only included those available to follow-up Type of Analysis: ITT Blindness: Single blind Duration (days): Mean 365 Setting: 10 community clinics offering MMT in England Notes: RANDOMISATION: Concealed (remote randomisation service). Stratified by SDS severity, Drug Treatment and Testing Order status and treatment centre. Info on Screening Process: 842 screened, 369 eligible. Main reasons for exclusion: too low/unstable methadone dose, not engaged in treatment and unstable housing. 309 not enrolled: main reasons: unable to approach, not interested, lack of time. 60 randomised.

WOODY1983	n= 110 Age: Mean 33 Range 18–55 Sex: all males Diagnosis: 100% opioid dependence by eligibility for/receipt of MMT Exclusions: - psychosis - persistent or clinically significant organic brain syndrome - <2 weeks or >6 months MMT during current treatment episode					Data Used ASI (Addiction Severity Index): drug use	Group 1 N= 39 Control: TAU (treatment as usual) with outpatient - Major focus on providing external services and not dealing with psychological processes Group 2 N= 39 CBT: CT (cognitive therapy) with outpatient - Focused on changing participant’s beliefs, and feelings of helplessness or worthlessness Group 3 N= 32 SE (supportive-expressive psychotherapy) with outpatient - Analytically oriented focal psychotherapy. Aimed to help participant identify and work through problematic relationship themes. Special attention was paid to the meanings that the patient attached to the drug dependence.	Study quality: 1+

Study Type: RCT (randomised controlled trial) Type of Analysis: Per protocol Blindness: Open Duration (days): Mean 168 Followup: 7 and 12 months Setting: US Notes: RANDOMISATION: Not reported	Baseline: GROUPS:		SE (supportive-expressive therapy)/	CBT/	DC
	Years of regular heroin use:		7/	10/	11
	Years of regular stimulant use:		2/	1/	1

WOODY1995	n= 84 Age: Mean 41 Sex: 89 males 34 females Diagnosis: drug misuse (non-alcohol) Exclusions: - severe medical or psychiatric disorders - pending incarceration or move from area - BDI <40 - Symptom Checklist-90 <40 - ASI: Psychiatry <5 Baseline: GROUPS: SE (supportive-expressive psychotherapy)/TAU Mean years’ opiate use: 7 (6)/11 (7) Longest period in months of abstinence: 13 (22)/6 (9)					Data Used ASI (Addiction Severity Index): drug use Abstinence: % with negative urine sample per day Notes: DROPOUTS: SE = 5/62, standard care = 4/31	Group 1 N= 57 SE (supportive-expressive psychotherapy) with outpatient - Analytically oriented focal psychotherapy adapted to drug dependent people. Supportive techniques aim to help participants feel comfortable discussing personal problems; expressive techniques aim to help identify core relationship pattern and themes. Group 2 N= 27 Control: standard care with outpatient - Drug counselling - exploring currrent problems and providing support; referral to medical, social and legal services	Study quality: 1+

Study Type: RCT (randomised controlled trial) Blindness: Duration (days): Mean 180 Followup: 6 months Setting: US Info on Screening Process: Initially 350 screened, 178 excluded; 172 underwent more formal screening and 23 were excluded; at third stage of screening, 26 out of 149 were excluded

Characteristics of Excluded Studies

Reference ID	Reason for Exclusion
ABBOTT1998	CRA (community reinforcement approach) and CRA + RP combined; no breakdown of results for each group
BROONER1998A	No relevant outcomes
BROONER2004	Poor quality
CALLAHAN1976	No extractable data
CALLAHAN1980	No extractable data
CALSYN1994	No extractable outcomes
CARROLL2004	Data not extractable
CHUTUAPE1999B	n <10 for control group
COVI1995	No control condition for counselling group
DEES1997	No useful outcome data
FARABEE2002	No extractable outcomes
GOLDSTEIN2002	No drug-use outcomes
HAVASSY1979	Pre-1980
HOUSTON1983	Intervention does not meet inclusion criteria
IGUCHI1988	n<10 per arm
IGUCHI1996	Does not compare CM with a different intervention/control; urine data not extractable
IGUCHI1997	Required outcomes not extractable
JONES2001A	Pregnant women; no extractable data
KIDORF1995	Not an intervention
MILBY1978	Pre-1980
MONTOYA2005	No psychotherapy comparator
RAWSON1984	No extractable data
RHODES2003	Not required outcomes
ROSENBLUM1999	Poor methodological rigour
ROUNSAVILLE1983A	No extractable data
SCHERBAUM2005	No required outcomes
SCHMITZ2001A	No extractable data
SCHOTTENFELD2000	Not an RCT
SIMPSON1997	No extractable data
STEIN2005	Anti-depression with psychological versus minimal control: primary focus is depression
STITZER1980	n <10 per arm
STITZER1983	n <10

References of Included Studies

AVANTS1999 (Published Data Only)

Avants SK, Margolin A, Kosten TR, et al. When is less treatment better? The role of social anxiety in matching methadone patients to psychosocial treatments. Journal of Consulting and Clinical Psychology. 1998;66:924–931. [PubMed: 9874905]
*. Avants, S.K., Margolin, A., Sindelar, J.L., et al. 1999Day treatment versus enhanced standard methadone services for opioid-dependent patients: a comparison of clinical efficacy and cost American Journal of Psychiatry 15627–33. [PubMed: 9892294]

CARROLL2001B (Published Data Only)

*. Carroll KM, Sinha R, Nich C, et al. Contingency management to enhance naltrexone treatment of opioid dependence: a randomized clinical trial of reinforcement magnitude. Experimental and Clinical Psychopharmacology. 2002;10:54–63. [PubMed: 11866252]
Carroll KM, Ball SA, Nich C, et al. Targeting behavioral therapies to enhance naltrexone treatment of opioid dependence: efficacy of contingency management and significant other involvement. Archives of General Psychiatry. 2001;58:755–761. [PMC free article: PMC3651594] [PubMed: 11483141]

CARROLL2002 (Published Data Only)

Carroll KM, Sinha R, Nich C, et al. Contingency management to enhance naltrexone treatment of opioid dependence: a randomized clinical trial of reinforcement magnitude. Experimental and Clinical Psychopharmacology. 2002;10:54–63. [PubMed: 11866252]

CATALANO1999 (Published Data Only)

Catalano RF, Gainey RR, Fleming CB, et al. An experimental intervention with families of substance abusers: one-year follow-up of the focus on families project. Addiction. 1999;94:241–254. [PubMed: 10396792]

CHUTUAPE2001 (Published Data Only)

Chutuape MA, Silverman K, Stitzer ML. Effects of urine testing frequency on outcome in a methadone take-home contingency program. Drug and Alcohol Dependence. 2001;62:69–76. [PubMed: 11173169]

DOWNEY2000 (Published Data Only)

Downey KK, Helmus TC, Schuster CR. Treatment of heroin-dependent poly-drug abusers with contingency management and buprenorphine maintenance. Experimental and Clinical Psychopharmacology. 2000;8:176–184. [PubMed: 10843300]

EPSTEIN2003 (Published Data Only)

*. Epstein DH, Hawkins WE, Covi L, et al. Cognitive-behavioral therapy plus contingency management for cocaine use: findings during treatment and across 12-month follow-up. Psychology of Addictive Behaviors. 2003;17:73–82. [PMC free article: PMC1224747] [PubMed: 12665084]
Schroeder JR, Epstein DH, Umbricht A, et al. Changes in HIV risk behaviors among patients receiving combined pharmacological and behavioral interventions for heroin and cocaine dependence. Addictive Behaviours. 2006;31:868–879. [PubMed: 16085366]

FALSSTEWART2001 (Published Data Only)

Fals-Stewart W, O’Farrell TJ, Birchler GR. Behavioral couples therapy for male methadone maintenance patients: effects on drug-using behavior and relationship adjustment. Behavior Therapy. 2001;32:391–411. [PubMed: 8916625]

FALSSTEWART2003 (Published Data Only)

Fals-Stewart W, O’Farrell TJ. Behavioral family counseling and naltrexone for male opioid-dependent patients. Journal of Consulting & Clinical Psychology. 2003;71:432–442. [PubMed: 12795568]

GROSS2006 (Published Data Only)

Gross A, Marsch LA, Badger GJ, et al. A comparison between low-magnitude voucher and buprenorphine medication contingencies in promoting abstinence from opioids and cocaine. Experimental and Clinical Psychopharmacology. 2006;14:148–156. [PubMed: 16756418]

KOSTEN2003 (Published Data Only)

Gonzalez G, Feingold A, Oliveto A, et al. Comorbid major depressive disorder as a prognostic factor in cocaine-abusing buprenorphine-maintained patients treated with desipramine and contingency management. American Journal of Drug and Alcohol Abuse. 2003;29:497–514. [PubMed: 14510037]
Sofuoglu M, Gonzalez G, Poling J, et al. Prediction of treatment outcome by baseline urine cocaine results and self-reported cocaine use for cocaine and opioid dependence. American Journal of Drug & Alcohol Abuse. 2003;29:713–727. [PubMed: 14713135]
*. Kosten, T., Oliveto, A., Feingold, A., Poling, J., et al. 2003Desipramine and contingency management for cocaine and opiate dependence in buprenorphine-maintained patients Drug and Alcohol Dependence 70315–325. [PubMed: 12757969]
Kosten T, Poling J, Oliveto A. Effects of reducing contingency management values on heroin and cocaine use for buprenorphine- and desipramine-treated patients. Addiction. 2003;98:665–671. [PubMed: 12751984]

MCLELLAN1993 (Published Data Only)

Kraft MK, Rothbard AB, Hadley TR, et al. Are supplementary services provided during methadone maintenance really cost-effective? American Journal of Psychiatry. 1997;154:1214–1219. [PubMed: 9286179]
*. McLellan, A.T., Arndt, I.O., Metzger, D.S., et al. 1993The effects of psychosocial services in substance abuse treatment The Journal of the American Medical Association 269, 1953–1959. [PubMed: 8385230]

PEIRCE2006 (Published Data Only)

Peirce JM, Petry NM, Stitzer ML, et al. Effects of lower-cost incentives on stimulant abstinence in methadone maintenance treatment: a National Drug Abuse Treatment Clinical Trials Network study. Archives of General Psychiatry. 2006;63:201–208. [PubMed: 16461864]

PETRY2002 (Published Data Only)

Petry NM, Martin B. Low-cost contingency management for treating cocaine-and opioid-abusing methadone patients. Journal of Consulting and Clinical Psychology. 2002;70:398–405. [PubMed: 11952198]

PETRY2005C (Published Data Only)

Petry NM, Martin B, Simcic FJ. Prize reinforcement contingency management for cocaine dependence: integration with group therapy in a methadone clinic. Journal of Consulting and Clinical Psychology. 2005;73:354–359. [PubMed: 15796645]

PRESTON1999 (Published Data Only)

Preston KL, Umbricht A, Epstein DH. Abstinence reinforcement maintenance contingency and one-year follow-up. Drug and Alcohol Dependence. 2001;67:125–137. [PubMed: 12095662]
*. Preston, K.L., Silverman, K., Umbricht, A., et al. 1999Improvement in naltrexone treatment compliance with contingency management Drug and Alcohol Dependence 54127–135. [PubMed: 10217552]

PRESTON2000 (Published Data Only)

*. Schroeder JR, Gupman AE, Epstein DH, et al. Do noncontingent vouchers increase drug use? Experimental and Clinical Psychopharmacology. 2003;11:195–201. [PubMed: 12940498]
Preston KL, Umbricht A, Epstein DH. Methadone dose increase and abstinence reinforcement for treatment of continued heroin use during methadone maintenance. Archives of General Psychiatry. 2000;57:395–404. [PubMed: 10768702]

RAWSON2001 (Published Data Only)

Rawson RA, McCann MJ, Shoptaw SJ, et al. Naltrexone for opioid dependence: evaluation of a manualized psychosocial protocol to enhance treatment response. Drug and Alcohol Review. 2001;20:67–78.

RAWSON2002 (Published Data Only)

Messina N, Farabee D, Rawson R. Treatment responsivity of cocaine-dependent patients with antisocial personality disorder to cognitive-behavioral and contingency management interventions. Journal of Consulting and Clinical Psychology. 2003;71:320–329. [PubMed: 12699026]
*. Rawson, R.A., Huber, A., McCann, M., et al. 2002A comparison of contingency management and cognitive-behavioral approaches during methadone maintenance treatment for cocaine dependence Archives of General Psychiatry 59817–824. [PubMed: 12215081]

SCHOTTENFELD2005 (Published Data Only)

Schottenfeld RS, Chawarski MC, Pakes JR, et al. Methadone versus buprenorphine with contingency management or performance feedback for cocaine and opioid dependence. American Journal of Psychiatry. 2005;162:340–349. [PubMed: 15677600]

SILVERMAN1998 (Published Data Only)

Silverman K, Wong CJ, Umbricht-Schneiter A, et al. Broad beneficial effects of cocaine abstinence reinforcement among methadone patients. Journal of Consulting and Clinical Psychology. 1998;66:811–824. [PubMed: 9803700]

SILVERMAN2004 (Published Data Only)

Silverman K, Robles E, Mudric T, et al. A randomized trial of long-term reinforcement of cocaine abstinence in methadone-maintained patients who inject drugs. Journal of Consulting and Clinical Psychology. 2004;72:839–854. [PubMed: 15482042]

STITZER1992 (Published Data Only)

Stitzer ML, Iguchi MY, Felch LJ. Contingent take-home incentive: effects on drug use of methadone maintenance patients. Journal of Consulting and Clinical Psychology. 1992;60:927–934. [PubMed: 1460154]

TUCKER2004B (Published Data Only)

Tucker T, Ritter A, Maher C, et al. A randomized control trial of group counseling in a naltrexone treatment program. Journal of Substance Abuse Treatment. 2004;27:277–288. [PubMed: 15610829]

UKCBTMM2004 (Published Data Only)

UKCBTMM Project Group. The effectiveness and cost effectiveness of cognitive behaviour therapy for opiate misusers in methadone maintenance treatment: a multicentre, randomised, controlled trial. Final report to the funding organisation: R&D Directorate of the Department of Health as part of the Drug Misuse Research Initiative. 2004

WOODY1983 (Published Data Only)

Woody GE, Luborsky L, McLellan AT, et al. Psychotherapy for opiate addicts. Does it help? Archives of General Psychiatry. 1983;40:639–645. [PubMed: 6847332]
Woody GE, Luborsky L, McLellan AT, et al. Psychotherapy for opiate addicts. NIDA Research Monograph. 1983:43, 59–70. [PubMed: 6410280]
Woody GE, McLellan AT, Luborsky L, et al. Severity of psychiatric symptoms as a predictor of benefits from psychotherapy: the Veterans Administration-Penn study. American Journal of Psychiatry. 1984;141:1172–1177. [PubMed: 6486249]
Woody GE, O’Brien CP, McLellan AT, et al. Psychotherapy for opiate addiction: some preliminary results. Annals of the New York Academy of Sciences. 1981:362, 91–100. [PubMed: 6942715]

WOODY1995 (Published Data Only)

Woody GE, McLellan AT, Luborsky L, et al. Psychotherapy in community methadone programs: a validation study. American Journal of Psychiatry. 1995;152:1302–1308. [PubMed: 7653685]

References of Excluded Studies

ABBOTT1998 (Published Data Only)

Abbott PJ, Weller SB, Delaney HD, et al. Community reinforcement approach in the treatment of opiate addicts. American Journal of Drug and Alcohol Abuse. 1998;24:17–30. [PubMed: 9513627]

BROONER1998A (Published Data Only)

Brooner RK, Kidorf M, King VL, et al. Preliminary evidence of good treatment response in antisocial drug abusers. Drug and Alcohol Dependence. 1998;49:249–260. [PubMed: 9571389]

BROONER2004 (Published Data Only)

Brooner RK, Kidorf MS, King VL, et al. Behavioral contingencies improve counseling attendance in an adaptive treatment model. Journal of Substance Abuse Treatment. 2004;27:223–232. [PubMed: 15501375]

CALLAHAN1976 (Published Data Only)

Callahan E, Rawson R, Glazer M, et al. Comparison of two naltrexone treatment programs: naltrexone alone versus naltrexone plus behavior therapy. NIDA Research Monograph. 1976 [PubMed: 794716]

CALLAHAN1980 (Published Data Only)

Callahan EJ, Rawson RA, McCleave B. The treatment of heroin addiction: naltrexone alone and with behavior therapy. International Journal of the Addictions. 1980;15:795–807. [PubMed: 7461877]

CALSYN1994 (Published Data Only)

Calsyn DA, Wells EA, Saxon AJ, et al. Contingency management of urinalysis results and intensity of counseling services have an interactive impact on methadone maintenance treatment outcome. Journal of Addictive Diseases. 1994;13:47–63. [PubMed: 7734459]

CARROLL2004 (Published Data Only)

Carroll KM, Fenton LR, Ball SA, et al. Efficacy of disulfiram and cognitive behavior therapy in cocaine-dependent outpatients: a randomized placebo-controlled trial. Archives of General Psychiatry. 2004;61:264–272. [PMC free article: PMC3675448] [PubMed: 14993114]

CHUTUAPE1999B (Published Data Only)

Chutuape MA, Silverman K, Stitzer ML. Use of methadone take-home contingencies with persistent opiate and cocaine abusers. Journal of Substance Abuse Treatment. 1999;16:23–30. [PubMed: 9888118]

COVI1995

Covi L, Hess JM, Kreiter NA, et al. Effects of combined fluoxetine and counseling in the outpatient treatment of cocaine abusers. American Journal of Drug and Alcohol Abuse. 1995;21:327–344. [PubMed: 7484983]

DEES1997

Dees SM, Dansereau DF, Simpson DD. Mapping-enhanced drug abuse counseling: urinalysis results in the first year of methadone treatment. Journal of Substance Abuse Treatment. 1997;14:45–54. [PubMed: 9218236]

FARABEE2002 (Published Data Only)

Farabee D, Rawson R, McCann M. Adoption of drug avoidance activities among patients in contingency management and cognitive-behavioral treatments. Journal of Substance Abuse Treatment. 2002;23:343–350. [PubMed: 12495796]

GOLDSTEIN2002 (Published Data Only)

Goldstein MF, Deren S, Kang SY, et al. Evaluation of an alternative program for MMTP drop-outs: impact on treatment re-entry. Drug and Alcohol Dependence. 2002;66:181–187. [PubMed: 11906805]

HAVASSY1979 (Published Data Only)

Havassy B, Hargreaves W. Self-regulation of dose in methadone maintenance with contingent privileges. Addictive Behaviors. 1979;4:31–38. [PubMed: 420043]

HOUSTON1983 (Published Data Only)

Houston CC, Milby JB. Drug-seeking behavior and its mediation: effects of aversion therapy with narcotic addicts on methadone. International Journal of the Addictions. 1983;18:1171–1177. [PubMed: 6671847]

IGUCHI1988 (Published Data Only)

Iguchi MY, Stitzer ML, Bigelow GE, et al. Contingency management in methadone maintenance: effects of reinforcing and aversive consequences on illicit polydrug use. Drug and Alcohol Dependence. 1988;22:1–7. [PubMed: 2906863]

IGUCHI1996 (Published Data Only)

Iguchi MY, Lamb RJ, Belding MA, et al. Contingent reinforcement of group participation versus abstinence in a methadone maintenance program. Experimental and Clinical Psychopharmacology. 1996;4:315–321.

IGUCHI1997 (Published Data Only)

Belding MA, Iguchi MY, Morral AR, et al. Assessing the helping alliance and its impact in the treatment of opiate dependence. Drug and Alcohol Dependence. 1997;48:51–59. [PubMed: 9330921]
*. Iguchi, M.Y., Belding, M.A., Morral, A.R., et al. 1997Reinforcing operants other than abstinence in drug abuse treatment: an effective alternative for reducing drug use Journal of Consulting and Clinical Psychology 65421–428. [PubMed: 9170765]

JONES2001A

Jones HE, Haug NA, Stitzer ML, et al. Improving treatment outcomes for pregnant drug-dependent women using low-magnitude voucher incentives. Addictive Behaviors. 2000;25:263–267. [PubMed: 10795950]
*. Jones, H.E., Haug, N., Silverman, K., et al. 2001The effectiveness of incentives in enhancing treatment attendance and drug abstinence in methadone-maintained pregnant women Drug and Alcohol Dependence 61297–306. [PubMed: 11164694]

KIDORF1995 (Published Data Only)

Kidorf M, Stitzer ML, Griffiths RR. Evaluating the reinforcement value of clinic-based privileges through a multiple choice procedure. Drug and Alcohol Dependence. 1995;39:167–172. [PubMed: 8556964]

MILBY1978 (Published Data Only)

Milby JB, Garrett C, English C, et al. Take-home methadone: contingency effects on drug-seeking and productivity of narcotic addicts. Addictive Behaviors. 1978;3:215–220. [PubMed: 735908]

MONTOYA2005

Montoya I, Schroeder J, Preston K, et al. Influence of psychotherapy attendance on buprenorphine treatment outcome. Journal of Substance Abuse Treatment. 2005;28:247–254. [PMC free article: PMC2633651] [PubMed: 15857725]

RAWSON1984 (Published Data Only)

Rawson RA, Tennant FS Jr. Five-year follow-up of opiate addicts with naltrexone and behavior therapy. NIDA Research Monograph. 1984:49, 289–295. [PubMed: 6434974]

RHODES2003 (Published Data Only)

Rhodes GL, Saules KK, Helmus TC, et al. Improving on-time counseling attendance in a methadone treatment program: a contingency management approach. American Journal of Drug and Alcohol Abuse. 2003;29:759–773. [PubMed: 14713138]

ROSENBLUM1999

Rosenblum A, Magura S, Palij M, et al. Enhanced treatment outcomes for cocaine-using methadone patients. Drug and Alcohol Dependence. 1999;54:207–218. [PubMed: 10372794]

ROUNSAVILLE1983A (Published Data Only)

Rounsaville BJ, Glazer W, Wilber CH, et al. Short-term interpersonal psychotherapy in methadone-maintained opiate addicts. Archives of General Psychiatry. 1983;40:629–636. [PubMed: 6342563]

SCHERBAUM2005 (Published Data Only)

Scherbaum N, Kluwig J, Specka M, et al. Group psychotherapy for opiate addicts in methadone maintenance treatment - a controlled trial. European Addiction Research. 2005;11:163–171. [PubMed: 16110222]

SCHMITZ2001A (Published Data Only)

Schmitz JM, Stotts AL, Rhoades HM, et al. Naltrexone and relapse prevention treatment for cocaine-dependent patients. Addictive Behaviors. 2001;26:167–180. [PubMed: 11316375]

SCHOTTENFELD2000 (Published Data Only)

Schottenfeld RS, Pantalon MV, Chawarski MC, et al. Community reinforcement approach for combined opioid and cocaine dependence. Patterns of engagement in alternate activities. Journal of Substance Abuse Treatment. 2000;18:255–261. [PubMed: 10742639]

SIMPSON1997

Simpson DD, Joe GW, Rowan-Szal GA, et al. Drug abuse treatment process components that improve retention. Journal of Substance Abuse Treatment. 1997;14:565–572. [PubMed: 9437628]

STEIN2005

Stein MD, Anderson BJ, Solomon DA, et al. Reductions in HIV risk behaviors among depressed drug injectors. American Journal of Drug and Alcohol Abuse. 2005;31:417–432. [PubMed: 16161727]

STITZER1980 (Published Data Only)

Stitzer ML, Bigelow GE, Liebson I. Reducing drug use among methadone maintenance clients: contingent reinforcement for morphine-free urines. Addictive Behaviors. 1980;5:333–340. [PubMed: 7211531]

STITZER1983 (Published Data Only)

Stitzer ML, McCaul ME, Bigelow GE, et al. Oral methadone self-administration: effects of dose and alternative reinforcers. Clinical Pharmacology and Therapeutics. 1983;34 [PubMed: 6861436]

Characteristics Table for The Clinical Question: Intensities of Multimodal Care Package

Comparisons Included in this Clinical Question

Day treatment versus standard outpatient AVANTS1999 MARLOWE2003	Day treatment with CM housing versus day treatment with no housing	Intensive outpatient versus standard outpatient COVIELLO2001 MCLELLAN1993 VOLPICELLI2000 WEINSTEIN1997	Intensive outpatient with reinforcement-based work therapy versus standard care JONES2005 SILVERMAN2001 SILVERMANinpress
Standard versus intensive group therapy

Characteristics of Included Studies

Methods	Participants	Outcomes	Interventions	Notes
AVANTS1999	n= 291 Age: Mean 36 Sex: 205 males 86 females Diagnosis: 46% cocaine dependence by DSM-III-R 5% cocaine misuse by DSM-III-R Exclusions: Not reported Baseline: Years of opiate use = 12.7 (8.3); injection use = 74%; years of cocaine use = 8.9	Data Used Abstinence: % with negative urine sample per day Notes: DROPOUTS: CBT = 28/146, day treatment = 26/145	Group 1 N= 145 Structured day treatment with outpatient. Mean dose 81.7 mg/day - 5 hours per day, 5 days per week; manual guided programme in 5 general areas: substance abuse treatment physical and emotional health community development development of alternative reinforcers basic daily living skills. Group 2 N= 146 CBT: group with outpatient. Mean dose 78.1 mg - 2 hours per week; manual- guided group CBT intervention. Used 9 sessions from Monti’s manual and 3 additional sessions on physical health, vocational skills and community resources.	Study quality: 1+
Study Type: RCT (randomised controlled trial) Type of Analysis: Per protocol Blindness: Open Duration (days): Mean 84 Followup: 6 months Setting: US Info on Screening Process: 308 eligible, 291 enrolled				Study quality: 1+
COVIELLO2001	n= 94 Age: Mean 40 Sex: all males Diagnosis: 100% cocaine dependence by DSM-III-R Exclusions: - psychiatrically or medically unstable - no cocaine use in past 3 months - literacy problems - unable to provide follow-up locator information - not living in the metropolitan area Notes: ETHNICITY: 92% African American Baseline: ASI drug score: 0.18 Days’ cocaine use in past 30: 9.9 Years’ cocaine use: 8.4 Previous treatment attempts: 2.7	Data Used ASI (Addiction Severity Index) Abstinence: negative urinalysis Abstinence: no use for any 4 consecutive weeks Engagement in treatment Retention: days remained in treatment Completion rate Notes: Supervised urines at baseline, during treatment (twice weekly), 4 months’ and 6 months’ follow-up DROPOUTS: 40% day programme, 40% outpatient	Group 1 N= 46 Intensive outpatient treatment (~10hr/wk) with outpatient - 12 hours per week at day hospital: 7 hours’ group therapy, 3 hours’ education, 2 hours’ counselling/case management over 5 weekdays. Group 2 N= 48 Group therapy with outpatient - 6 hours per week over 3 weekdays: 4 hours’ group therapy, 1 hour’s education, 1 hour’s counselling/case management	Study quality: 1+
Study Type: RCT (randomised controlled trial) Type of Analysis: ITT: missing urines as positive Blindness: Open Duration (days): Mean 28 Setting: Addictions unit for veterans, Philadelphia, USA Info on Screening Process: 26% of those screened were excluded due to no cocaine use in past 3 months				Study quality: 1+
JONES2005	n= 130 Age: Mean 38 Sex: 76 males 54 females Diagnosis: 100% opioid dependence by DSM-IV Exclusions: - currently prescribed or discharged with a prescription for opiate medication - diagnosis of serious medical or psychiatric illness - pregnant Notes: PRIMARY DIAGNOSIS: Just completed opiate detoxification Baseline: GROUPS: RBT/TAU Current probation/parole: 23%/31% Cocaine-positive urine sample at detox intake: 70%/66% 40% entered after completing a 3-day detox, the remaining 60% after a 7–14 day detox	Data Used ASI (Addiction Severity Index) Heroin use: times in past month Cocaine use: times in past month Abstinence: % with negative urine sample per day	Group 1 N= 66 Day treatment (>20hr/wk) with inpatient and outpatient - Group counselling with skills building, job club, recreational activities, social club, option of living in recovery house. All contingent on daily − ve urine samples. +ve sample resulted in individual RP sessions and withdrawal of housing/other activities Group 2 N= 64 Control: standard care with outpatient - Referral and initiation (where possible) to aftercare and other services available in the community	Study quality: 1++
Study Type: RCT (randomised controlled trial) Type of Analysis: ITT: GEE (generalised estimated equation) analysis Blindness: Open Duration (days): Mean 180 Followup: For 1 year after detox Setting: Baltimore, USA Notes: RANDOMISATION: Stratified on 5 variables for modified dynamic balanced randomisation; performed by staff with no participant contact Info on Screening Process: 268 referred; 199 gave consent; 25 dropped out of detoxification; 44 dropped out prior to randomisation; 130 randomised				Study quality: 1++
MARLOWE2003	n= 79 Age: Mean 34 Sex: 62 males 17 females Diagnosis: 100% cocaine dependence by DSM-III-R Exclusions: - cocaine not primary drug misused - no use of cocaine in past 30 days Notes: Primary route of administration: 87% smoking crack Baseline: 44% homeless, 19% probation or parole	Data Used Abstinence: negative urinalysis Abstinence: longest consecutive period Retention rate	Group 1 N= 39 CBT: RP (relapse prevention) with outpatient - Twice weekly individual sessions based on Bux (1992) manual CBT: group - Weekly groups sessions on “training in interpersonal problem solving” (TIPS) Case management - Initial evaluation session with social worker with further sessions, as needed, for referrals and aftercare planning Group 2 N= 40 Day treatment (>20hr/wk) - As per standard outpatient group, plus: 20hrs/wk psychoeducational & recreational groups (manualised RP, drug education, HIV/AIDS education, art & recreational therapy, manualised vocational training & other didactic groups). Free breakfast & lunch	Study quality: 1+
Study Type: RCT (randomised controlled trial) Type of Analysis: ITT Blindness: Open Duration (days): Mean 120 Setting: Poor, urban outpatient population, Philadelphia, USA Notes: No details on randomisation procedures Info on Screening Process: 94 screened; 79 eligible				Study quality: 1+
MCLELLAN1993	n= 92 Age: Mean 41 Sex: all males Diagnosis: 100% opioid dependence by eligibility for/receipt of MMT Exclusions: - serious medical/psychiatric disorder - plans for immediate move from area near clinic Notes: All were intravenous users Baseline: Years of substance use: opiates = 11, cocaine = 3, problematic alcohol = 7	Data Used ASI (Addiction Severity Index)	Group 1 N= 29 CM: methadone with outpatient - Combination of take-home methadone doses contingent on negative urines and CBT. First month weekly counselling, then over 2–6 months could reduce number of sessions (biweekly) if client showed signs of positive change. Opiate agonist: MMT (methadone maintenance) with outpatient. Mean dose 60–90 mg Group 2 N= 31 Opiate agonist: MMT (methadone maintenance) with outpatient. Mean dose 60–90 mg Structured day treatment with outpatient - Consisted of contingent take-home doses, CBT counselling and access to extra professional resources: family therapy, employment counselling, psychiatrist. Group 3 N= 32 Control: TAU (treatment as usual) with outpatient - Minimal treatment -- 15-min session/month Opiate agonist: MMT (methadone maintenance) with outpatient. Mean dose 60–90 mg	Study quality: 1+
Study Type: RCT (randomised controlled trial) Type of Analysis: Per protocol Blindness: Open Duration (days): Mean 180 Setting: US veterans Info on Screening Process: 144 screened; 13 excluded (medical or psychiatric conditions (n=6), did not follow through initial study procedures (n=7)); 29 refused to participate; 2 dropped out after <2 weeks’ treatment; 5 could not be contacted for follow-up.		Data Used ASI (Addiction Severity Index)		Study quality: 1+
SILVERMAN2001	n= 40 Age: Mean 31 Sex: all females Diagnosis: 100% opioid dependence by eligibility for/receipt of MMT Exclusions: - men and non-pregnant women - age outside range 18–50 - employed - not receiving MMT - no opiate- or cocaine-positive urine sample in past 6 weeks - suicide risk might disrupt workplace functioning Notes: ETHNICITY: 83% Black, 17% White POLYDRUG (dependence): 75% cocaine, 13% alcohol, 8% cannabis, 3% sedatives, 3% other Baseline: Full-time employed: 0% 12 years of education: 65%	Data Used Abstinence: % with negative urine sample per day Retention: sessions attended Completion rate Notes: 3 times weekly urine samples, $3.50 paid per sample regardless of result	Group 1 N= 20 Opiate agonist: MMT (methadone maintenance) with outpatient - CAP: MMT programme for pregnant women, with individual + group therapy for drug misuse, and on-site obstetric, gynaecological and family planning services. Certified nurse/midwives and obstetricians available 24 hours. Group 2 N= 20 Opiate agonist: MMT (methadone maintenance) - As per usual care group CM: RBT (reinforcement-based work therapy) - Therapeutic workplace 3 hours/day, contingent on opiate and cocaine negative urine sample that day. Additional voucher reinforcement contingencies for abstinence and workplace attendance, punctuality and professional demeanour.	Study quality: 1+
Study Type: RCT (randomised controlled trial) Type of Analysis: ITT: missing urine samples as positive Blindness: Open Duration (days): Mean 180 Setting: Baltimore, USA Notes: Urn randomisation				Study quality: 1+
SILVERMANinpress	n= 56 Age: Mean 45 Sex: Diagnosis: 100% opioid dependence by eligibility for/receipt of MMT 100% IDU (injection drug use) by self-report 100% cocaine misuse by self-report Exclusions: - age < 18 - in any taxable part- or full-time employment - not currently enrolled in MMT - not a heroin or cocaine injector - no visible ‘track’ marks - did not use cocaine or crack cocaine in past 30 days - reported suicidal ideation or hallucinations Notes: ETHNICITY: 91% Black, 7% White, 2% other Baseline: (Work only/RBT + work) HIV+: 25.0%/21.4% Usually unemployed in past 3 years: 42.9%/60.7% Living in poverty: 100%/100% Days used in past 30 days: cocaine 16.1/22.3, heroin 8.5/9.5 Previous drug treatment attempts: 6.5/5.3 Current parole or probation: 14.3/17.9	Data Used Abstinence at 6 months Engagement: sessions attended Data Not Used Abstinence: negative urinalysis	Group 1 N= 28 CM: RBT (reinforcement-based work therapy) with outpatient. Mean dose 28 - Attended workplace 4 hrs per weekday for 26 weeks, with base ($8/hr) and performance pay. 3x weekly urinalysis; if cocaine +ve, not allowed to work that day and pay dropped to $1/hr. This was increased by $1 per day (up to $8) for each −ve urine provided. Group 2 N= 28 Control: standard care with outpatient - Allowed to work regardless of urinalysis results	Workplace involved computerised typing, keypad and data entry programs. Payments were by electronic vouchers exchangeable for goods and services in the community, as well as food from cafeteria Study quality: 1+
Study Type: RCT (randomised controlled trial) Study Description: Allocation by study coordinator, who had no direct contact with participants Type of Analysis: ITT; missing urines assumed positive Blindness: Open Duration (days): Mean 182 Followup: 6 months Setting: Treatment research unit, Baltimore, USA Notes: Computerised, stratified randomisation
VOLPICELLI2000	n= 84 Age: Mean 32 Sex: all females Diagnosis: 100% cocaine dependence by DSM-IV Exclusions: - not currently pregnant or in custody of child aged <4 - psychotic, homicidal or suicidal - unstable medical condition - opiate dependent Baseline: Groups: CM/PET Days’ cocaine use in past 30 days: 13.1/10.6 Years’ cocaine use: 6.52/6.29 ASI composite score: 0.25/0.25	Data Used ASI (Addiction Severity Index) Cocaine use: days Abstinence: negative urinalysis Retention: weeks remained in treatment	Group 1 N= 42 Intensive outpatient treatment (~10hr/wk) with outpatient - Twice wkly group drug counselling; on-site childcare & women- only group therapy sessions available 5 days per week. Additional access to parenting classes, General Educational Devpt classes & staff psychiatrist, & unlimited access to individual therapist. Group 2 N= 42 Case management with outpatient - Twice weekly group drug counselling; on- site childcare and women-only group therapy sessions available 5 days per week. Social worker as case manager; single 15-min appointment per week for check-up and making external referrals as needed.	Study quality: 1+
Study Type: RCT (randomised controlled trial) Type of Analysis: Per protocol Blindness: Open Duration (days): Setting: Outpatient, USA Notes: No details on randomisation procedures Info on Screening Process: 205 phone- screened as eligible; 109 attended intake; 16 failed to complete intake forms; 6 ineligible, 3 elected to go into other treatment programmes; 84 randomised				Study quality: 1+
WEINSTEIN1997	n= 423 Age: Sex: Diagnosis: 100% cocaine dependence by DSM-III-R Exclusions: - not first admission - age <18 - ‘overly’ psychotic or actively suicidal - cognitive impairment precluding informed consent or programme participation Notes: Demographic data not reported Baseline: ASI drug: 6.3 No. prior treatments: 1.0 Most common secondary drug: alcohol (33%) Current intravenous cocaine use: 3.3%	Data Used ASI (Addiction Severity Index) Urinalysis: positive for cocaine Cocaine use: times in past month Retention: days remained in treatment Completion rate	Group 1 N= 144 IDC (individual drug counselling) - 1 hour weekly individual counselling for 3 months. Problem focused, exploratory, supportive, expressive as needed. Adhered to no single therapeutic model. Group 2 N= 142 IDC (individual drug counselling) - 1 hour weekly individual counselling for 3 months. Problem focused, exploratory, supportive, expressive as needed. Adhered to no single therapeutic model. Group therapy - Once weekly group session. Problem focused, exploratory, supportive, expressive as needed. Adhered to no single therapeutic model. Group 3 N= 137 Group therapy - Intensive group treatment involving group meetings and educational activities, for 3 hours on 3 days per week for 3 months. Post-treatment referral to continuing care.	Study quality: 1+
Study Type: RCT (randomised controlled trial) Blindness: Open Duration (days): Mean 84 Followup: 6 months post treatment Setting: Outpatient cocaine clinic, PA, USA Notes: RANDOMISATION: No details Info on Screening Process: 450 randomised; 448 admitted to treatment; 423 admitted in time to complete 3 months in study programme				Study quality: 1+

Characteristics of Excluded Studies

Reference ID	Reason for Exclusion
BELL1997	No comparison data
GRUBER2000	Not relevant intervention
MARLOWE1997A	No extractable outcome data
SCHUMACHER1995	No extractable outcomes

References of Included Studies

AVANTS1999 (Published Data Only)

Avants SK, Margolin A, Kosten TR, et al. When is less treatment better? The role of social anxiety in matching methadone patients to psychosocial treatments. Journal of Consulting and Clinical Psychology. 1998;66:924–931. [PubMed: 9874905]
*. Avants, S.K., Margolin, A., Sindelar, J.L., et al. 1999Day treatment versus enhanced standard methadone services for opioid-dependent patients: a comparison of clinical efficacy and cost American Journal of Psychiatry 15627–33. [PubMed: 9892294]

COVIELLO2001 (Published Data Only)

Coviello DM, Alterman AI, Rutherford MJ, et al. The effectiveness of two intensities of psychosocial treatment for cocaine dependence. Drug and Alcohol Dependence. 2001;61:145–154. [PubMed: 11137279]

JONES2005 (Published Data Only)

Jones HE, Wong CJ, Tuten M, et al. Reinforcement-based therapy: 12-month evaluation of an outpatient drug-free treatment for heroin abusers. Drug and Alcohol Dependence. 2005;79:119–128. [PubMed: 16002021]

MARLOWE2003 (Published Data Only)

Marlowe DB, Kirby KC, Festinger DS, et al. Day treatment for cocaine dependence: incremental utility over outpatient counseling and voucher incentives. Addictive Behaviors. 2003;28:387–398. [PubMed: 12573690]

MCLELLAN1993 (Published Data Only)

Kraft MK, Rothbard AB, Hadley TR, et al. Are supplementary services provided during methadone maintenance really cost-effective? American Journal of Psychiatry. 1997;154:1214–1219. [PubMed: 9286179]
*. McLellan, A.T., Arndt, I.O., Metzger, D.S., et al. 1993The effects of psychosocial services in substance abuse treatment The Journal of the American Medical Association 269, 1953–1959. [PubMed: 8385230]

SILVERMAN2001 (Published Data Only)

Silverman K, Svikis D, Robles E, et al. A reinforcement-based therapeutic workplace for the treatment of drug abuse: six-month abstinence outcomes. Experimental and Clinical Psychopharmacology. 2001;9:14–23. [PubMed: 11519628]

SILVERMANinpress (Unpublished Data Only)

Silverman K, Wong CJ, Needham M, et al. A randomized trial of employment-based reinforcement of cocaine abstinence in injection drug users. Journal of Applied Behavior Analysis. in press. [PMC free article: PMC1986688] [PubMed: 17970256]

VOLPICELLI2000 (Published Data Only)

Volpicelli JR, Markman I, Monterosso J, et al. Psychosocially enhanced treatment for cocaine-dependent mothers: evidence of efficacy. Journal of Substance Abuse Treatment. 2000;18:41–49. [PubMed: 10636605]

WEINSTEIN1997 (Published Data Only)

Weinstein SP, Gottheil E, Sterling RC. Randomized comparison of intensive outpatient vs. individual therapy for cocaine abusers. Journal of Addictive Diseases. 1997;16:41–56. [PubMed: 9083824]

References of Excluded Studies

BELL1997

Bell K, Cramer-Benjamin D, Anastas J. Predicting length of stay of substance-using pregnant and postpartum women in day treatment. Journal of Substance Abuse Treatment. 1997;14:393–400. [PubMed: 9368217]

GRUBER2000 (Published Data Only)

Gruber K, Chutuape MA, Stitzer ML. Reinforcement-based intensive outpatient treatment for inner city opiate abusers: a short-term evaluation. Drug and Alcohol Dependence. 2000;57:211–223. [PubMed: 10661672]

MARLOWE1997A

Marlowe DB, Kirby KC, Festinger DS, et al. Impact of comorbid personality disorders and personality disorder symptoms on outcomes of behavioral treatment for cocaine dependence. Journal of Nervous and Mental Disease. 1997;185:483–490. [PubMed: 9284861]

SCHUMACHER1995

Schumacher JE, Milby JB, Caldwell E, et al. Treatment outcome as a function of treatment attendance with homeless persons abusing cocaine. Journal of Addictive Diseases. 1995;14:73–85. [PubMed: 8929934]

Characteristics Table for The Clinical Question: Settings

Comparisons Included in this Clinical Question

Inpatient versus outpatient

Residential versus day treatment
ALTERMAN1993
GREENWOOD2001
SCHNEIDER1996

TC versus relapse prevention

Characteristics of Included Studies

Methods	Participants	Outcomes	Interventions	Notes
ALTERMAN1993	n= 94 Age: Mean 34 Sex: all males Diagnosis: 100% cocaine dependence by DSM-III Exclusions: - Older than 59 years - Not willing to accept either inpatient or day hospital rehab treatment for approx 1month - Unstable residence/unable to be contacted at follow-up - History of psychotic disorder - Indication of dementia - Possibility of medical problems requiring inpatient treatment - Not meeting current DMS-III diagnosis of cocaine abuse - No current substance absuse problems - Female Notes: ETHNICITY: 96.8% Black, Baseline: (Day hospital/Inpatient) Years of cocaine use: 2.7 (2.4)/3.2 (2.9) Years of marijuana use: 9.2 (7.7)/7.5 (17.1)	Data Used Abstinence: from alcohol Cocaine use: times in past month Treatment completion ASI (Addiction Severity Index)	Group 1 N= 48 Day Hospital - Grp meetings focus on overcoming denial & helping ppts to cope with everyday problems/stresses. Individual counselling &ancillary psychotropic med on as-needed basis. Education re:effects of addiction. Recreational therapy & self help groups encouraged. -Ppts paid $15 for completing baseline assessment and $10 for providing urine samples and completing each follow-up interview and given tokens for daily weekend travel to program plus lunch coupons. Group 2 N= 46 Inpatient treatment - Ppts received exactly the same intervention as those in the Day treatment condition, the only difference is setting. More medical care is usually provided in the inpatient program.	Study Quality 1+
Study Type: RCT (randomised controlled trial) Study Description: Gellerman series randomisation Type of Analysis: Completers Blindness: No mention Duration (days): Mean 28 Setting: COUNTRY: US Day hospital vs inpatient Info on Screening Process: 94 men seeking treatment for cocaine abuse and dependence at a medical centre included in study.				Study Quality 1+
GREENWOOD2001	n= 215 Age: Mean 33 Sex: 183 males 78 females Diagnosis: 13% opioid dependence 10% alcohol dependence 67% stimulant dependence Notes: Crack cocaine (stimulant dependence) Baseline: Crack use = 67%, heroin use = 13%, alcohol = 10%	Data Used Abstinence at 6 months Completion rate Urinalysis: positive for any drug Notes: DROPOUTS: Residential TC = 42%, community TC = 55%	Group 1 N= 115 TC (therapeutic community) with residential rehabilitation - Four phases: orientation (education about TC rules), treatment (focus on drug misuse problems), re-entry (focus shifted to setting up employment) and aftercare (outpatient follow-up) Group 2 N= 101 TC (therapeutic community) with outpatient - Four phases: orientation (education about TC rules), treatment (focus on drug misuse problems), re-entry (focus shifted to setting up employment) and aftercare (outpatient follow up)	All participants seeking treatment 58% African, 24% Caucasian, 18% other backgrounds Study quality: 1+
Study Type: RCT (randomised controlled trial) Study Description: Residential clients housed whereas day clients returned home at the end of day Blindness: Open Duration (days): Mean 180 Followup: 6, 12 and 18 months Setting: US Notes: RANDOMISATION: method not reported; baseline taken at 2 weeks post-randomisation Info on Screening Process: Total of 534 participants randomly assigned
SCHNEIDER1996	n= 74 Age: Mean 34 Sex: 54 males 20 females Diagnosis: 100% cocaine dependence by DSM-III-R Exclusions: - intravenous heroin use - medically unstable - coexisting Axis I disorder Notes: PRIMARY DIAGNOSIS: Undergoing detoxification from cocaine at intake Baseline: (Residential/day treatment) Years’ cocaine use: 6.5/7.2 Freebase use: 73%/81% Previous inpatient treatment: 48%/50%	Data Used Abstinence: no use for 3 consecutive weeks at end ASI (Addiction Severity Index) Notes: DROPOUTS (defined as those who missed first appointment or dropped out after 1 day): residential 5%, day treatment 53%	Group 1 N= 32 Day treatment (>20hr/wk) with outpatient - 5 hours/day for 5 days/wk over 2 wks. Focused primarily on group work: psychoeducation groups, discussion groups to address denial and feelings, CBT (RP) groups, family meetings, individual support for other issues and aftercare plans. NA/AA encouraged. Group 2 N= 42 Residential rehabilitation with residential rehabilitation - 6 hours/day of treatment in a private, inpatient non-hospital facility. Content of treatment similar to day treatment group. At discharge, referred to another appropriate treatment programme (e.g. halfway house) or back to primary mental health provider.
Study Type: RCT (randomised controlled trial) Study Description: Blinding of research assistant at intake assessment and of treatment providers Blindness: Single blind Duration (days): Mean 14 Followup: 3 and 6 months Setting: Recruitment from two private hospitals in the US Notes: Randomisation procedures not described Info on Screening Process: 364 eligible and admitted for detoxification; 290 refused consent (had specific aftercare preference or wanted no aftercare); 22 left detoxification early or previously participated in study; 74 enrolled

Characteristics of Excluded Studies

Reference ID	Reason for Exclusion
CZUCHRY2003	No drug-use outcomes
DRAKE1998A	Dual diagnosis
FISHER1996A	Sample sizes not reported (appear to be <10 in each group)
HAWKINS1986	No drug-use outcomes
KASKUTAS2005	‘Hospital’ setting was not residential
NUTTBROCK1998	High proportion were psychotic
ZULE2000	No intervention

References of Included Studies

ALTERMAN1993 (Published Data Only)

Alterman AI, O’Brien CP, Droba M. Day hospital vs inpatient rehabilitation of cocaine abusers: an interim report. NIDA Res Monogr. 1993;135:150–162. [PubMed: 8289895]

GREENWOOD2001 (Published Data Only)

Guydish J, Bucardo J, Clark G, et al. Evaluating needle exchange: a description of client characteristics, health status, program utilization, and HIV risk behavior. Substance Use and Misuse. 1998;33:1173–1196. [PubMed: 9596382]
*. Greenwood GL, Woods WJ, Guydish J, et al. Relapse outcomes in a randomized trial of residential and day drug abuse treatment. Journal of Substance Abuse Treatment. 2001;20:15–23. [PubMed: 11239724]

SCHNEIDER1996 (Published Data Only)

Schneider R, Mittelmeier C, Gadish D. Day versus inpatient treatment for cocaine dependence: an experimental comparison. Journal of Mental Health Administration. 1996;23:234–245. [PubMed: 10172622]

References of Excluded Studies

CZUCHRY2003

Czuchry M, Dansereau DF. Cognitive skills training: impact on drug abuse counseling and readiness for treatment. American Journal of Drug and Alcohol Abuse. 2003;29:1–18. [PubMed: 12731679]

DRAKE1998A

Drake RE, McHugo GJ, Clark RE, et al. Assertive community treatment for patients with co-occurring severe mental illness and substance use disorder: a clinical trial. American Journal of Orthopsychiatry. 1998;68:201–215. [PubMed: 9589759]

FISHER1996A (Published Data Only)

Fisher MSS, Bentley KJ. Two group therapy models for clients with a dual diagnosis of substance abuse and personality disorder. Psychiatric Services. 1996;47:1244–1250. [PubMed: 8916244]

HAWKINS1986

Hawkins JD, Catalano RFJ, Wells EA. Measuring effects of a skills training intervention for drug abusers. Journal of Consulting and Clinical Psychology. 1986;54:661–664. [PubMed: 3771883]

KASKUTAS2005 (Published Data Only)

Kaskutas LA, Zhang L, French MT, et al. Women’s programs versus mixed-gender day treatment: results from a randomized study. Addiction. 2005;100:60–69. [PubMed: 15598193]

NUTTBROCK1998 (Published Data Only)

Nuttbrock LA, Rahav M, Rivera JJ, et al. Outcomes of homeless mentally ill chemical abusers in community residences and a therapeutic community. Psychiatric Services. 1998;49:68–76. [PubMed: 9444683]

ZULE2000

Zule WA, Desmond DP. Factors predicting entry of injecting drug users into substance abuse treatment. American Journal of Drug and Alcohol Abuse. 2000;26:247–261. [PubMed: 10852359]

Characteristics Table for The Clinical Question: Therapeutic Communities (TCs)

Comparisons Included in this Clinical Question

Standard inpatient programme versus abbreviated inpatient programme
NEMES1999

TC plus aftercare versus control
NIELSEN1996
SACKS2004
WEXLER1999

TC versus chemical dependency programme

TC versus relapse prevention
FINNEY1998

Characteristics of Included Studies

Methods	Participants	Outcomes	Interventions	Notes
FINNEY1998	n= 3228 Age: Sex: all males Diagnosis: 100% substance misuse (drug or alcohol) by ICD-10 Exclusions: - not in a standard VA treatment programme - female - had not completed detoxification Notes: PRIMARY DIAGNOSIS: 36% alcohol misuse/dependence only; 51% alcohol and drug misuse, 13% drug misuse only ETHNICITY: 48% Black, 46% White Baseline: 76% unemployed Past month drug use: 48% cocaine/crack, 39% cannabis, 13% opiates		Group 1 N= 970 12-step with inpatient Group 2 N= 106 12-step with inpatient CBT (cognitive behavioural therapy) with inpatient Group 3 N= 119 CBT (cognitive behavioural therapy) with inpatient	Content of interventions not reported - in secondary study? Study quality: 2+
Study Type: Cohort Blindness: Open Duration (days): Range 21–28 Setting: 15 inpatient substance misuse programmes from 13 Veteran Affairs (VA) treatment centres in USA Info on Screening Process: 4659 screened, 4193 eligible, 494 refused consent; of 3699 intake sample 3278 completed intake evaluation
NEMES1999	n= 412 Age: Mean 30 Sex: 295 males 117 females Diagnosis: substance misuse (drug or alcohol) Exclusions: None described Notes: Crack most serious problem among sample, followed by alcohol; fewer than half reported heroin use Baseline: Approx half had received previous treatment for alcohol or drug problems	Data Used Employment at follow-up Urinalysis: positive for any illicit drug	Group 1 N= 218 TC (therapeutic community) with inpatient - Abbreviated inpatient programme offered for 6 months followed by 6 months of outpatient services. More clinical staff per client and more female beds at this site. Group 2 N= 194 TC (therapeutic community) with inpatient - Standard inpatient care programme: 10 months of inpatient care followed by 2 months of outpatient services	Study quality: 1+
Study Type: RCT (randomised controlled trial) Type of Analysis: Cluster randomised Blindness: No mention Duration (days): Setting: US Notes: Randomisation procedure not described Info on Screening Process: 470 screened, 9 found to be ineligible, 412 randomly assigned				Study quality: 1+
NIELSEN1996	n= 689 Age: Sex: 545 males 144 females Diagnosis: 92% substance misuse (drug or alcohol) by self- report Exclusions: - not in prison or eligible for release - no history of drug use Notes: PRIMARY DIAGNOSIS: 8% none, 13% alcohol, 11% cannabis, 11% crack, 40% cocaine, 13% heroin, 4% other ETHNICITY: 29% White, 67% Black, 4% Other Baseline: (CREST/standard work release) Previous treatment attempt: 79.0%/73.5%	Data Used Drug use Rates of incarceration	Group 1 N= 248 TC (therapeutic community) with outpatient - CREST: 1-mth orientation to peer-based TC; 2mths treatment involving indiv/group counselling, group activities, holding duties in the house; 3mths work-release w/opportunity to seek work upon progress in treatment, continual group meetings for work issues Group 2 N= 441 Control: standard care with outpatient - Delaware’s conventional work release programme. No details given.	Study quality: 1+
Study Type: RCT (randomised controlled trial) Type of Analysis: Per protocol - those lost to follow-up excluded Blindness: Open Duration (days): Mean 180 Followup: 12 months Setting: Wilmington, Delaware, USA Info on Screening Process: 1002 inmates eligible for work release or parole; 689 enrolled		Data Used Drug use Rates of incarceration		Study quality: 1+
SACKS2004	n= 139 Age: Mean 34 Sex: all males Diagnosis: 100% drug misuse (non-alcohol) Exclusions: - not an inmate with a dual diagnosis (mental illness and substance misuse) - inmates who represented a clear danger to themselves or others Notes: PRIMARY DIAGNOSIS: Mental illness with co- occurring chemical misuse. Alcohol was primary substance for 32%. Ethnicity: Caucasian 49%, African American/Black = 30%, Hispanic = 16.5%, other = 4% Baseline: 37% had antisocial personality disorder, 90% had a substance misuse disorder Lifetime primary substance: 32% alcohol, 34.5% cannabis, 21% crack cocaine	Data Used Rates of incarceration Crime: engaging in criminal activities	Group 1 N= 93 Control: standard care with prison - Intensified psychiatric services with medication, weekly individual therapy and counselling. Substance misuse services: 72 hours of CBT. Aftercare with inpatient and outpatient - Psychiatric assessment, medication, crisis intervention and individual counselling. Case management directed towards employment and housing. Attendence: twice a week for total of 4 hours. Group 2 N= 92 TC (therapeutic community) with prison - Programme includes: psychoeducational classes, cognitive behavioural protocols, medication and therapeutic interventions. Programme duration: 12 months, 5 days per week for 4–5 hours per day. Aftercare with residential rehabilitation - Mastering community living and integration and gaining employment. Formal programme activities attended 3–7 days per week for 3–5 hours per day over 6 months; supervision bi-weekly with community correction officer.	Study quality: 1+
Study Type: RCT (randomised controlled trial) Type of Analysis: ITT Blindness: No mention Duration (days): Setting: US prison Notes: Randomisation: not described Info on Screening Process: 236 male inmates randomly assigned to either modified therapeutic group (MTC: 142 participants) or mental health treatment (control group = 94 participants). 51 crossover cases excluded from analysis. Total sample size = 185.				Study quality: 1+
WEXLER1999	n= 715 Age: Mean 31 Range 30–31 Sex: all males Diagnosis: 95% stimulant dependence by DSM-III-R Exclusions: Inmates convicted of arson or sexual crimes involving minors Notes: Cocaine, methamphetamine, crack (stimulant dependence) Baseline: Drug-use behaviours: 60% engaged in intravenous drug use, 25% shared needles with strangers Psychiatric disorders: 51.5% antisocial personality disorder, 33% adult attention-deficit hyperactivity disorder	Data Used Reincarceration rates	Group 1 N= 290 Control: waitlist with prison - Participants remained on waitlist until bed space became available. Participants removed from waitlist when they had less than 9 months to serve. Group 2 N= 425 TC (therapeutic community) with prison - 3-phase treatment programme: Initial phase (2–3 months): orientation, planning and treatment goals Second phase: (5–6 months) counselling sessions, increased responsibility Third phase: (1–3 months) spent strengthening plan for return to community Aftercare with TC (therapeutic community) - Residents continued to work and maintain programme curriculum initiated in prison under staff supervision. Aftercare TC also provided services for wives and children of residents.	Study quality: 1+ Ethnicity: African American = 22.4%, White = 37.8%, Hispanic = 30.1%, other= 9.7%
Study Type: RCT (randomised controlled trial) Type of Analysis: ITT for 12-month outcomes only Blindness: No mention Duration (days): Followup: 12 and 24 months Setting: US prison Info on Screening Process: 715 male inmate volunteers		Data Used Reincarceration rates

Characteristics of Excluded Studies

Reference ID	Reason for Exclusion
CONDELLI2000	No extractable outcomes
MCCUSKER1995	No extractable outcomes

References of Included Studies

FINNEY1998 (Published Data Only)

Finney JW, Noyes CA, Coutts AI, et al. Evaluating substance abuse treatment process models: I. Changes on proximal outcome variables during 12-step and cognitive-behavioral treatment. Journal of Studies on Alcohol. 1998;59:371–380. [PubMed: 9647419]

NEMES1999 (Published Data Only)

Nemes S, Wish ED, Messina N. Comparing the impact of standard and abbreviated treatment in a therapeutic community. Findings from the district of Columbia treatment initiative experiment. Journal of Substance Abuse Treatment. 1999;17:339–347. [PubMed: 10587936]

NIELSEN1996 (Published Data Only)

Nielsen AL, Scarpitti FR, Inciardi JA. Integrating the therapeutic community and work release for drug-involved offenders. The CREST Program. Journal of Substance Abuse Treatment. 1996;13:349–358. [PubMed: 9076653]

SACKS2004 (Published Data Only)

Sacks S, Sacks JY, McKendrick K, et al. Modified TC for MICA offenders: crime outcomes. Behavioral Sciences and the Law. 2004;22:477–501. [PubMed: 15282836]

WEXLER1999 (Published Data Only)

Wexler HK, Melnick G, Lowe L, Peters J. Three-year reincarceration outcomes for Amity In-Prison Therapeutic Community and after care in California. The Prison Journal. 1999;79:321–326.
*. Wexler, H.K., DeLeon, G., Thomas, G., et al. 1999The Amity prison TC evaluation Criminal Justice and Behavior 26147–167.

References of Excluded Studies

CONDELLI2000 (Published Data Only)

Condelli WS, Koch MA, Fletcher B. Treatment refusal/attrition among adults randomly assigned to programs at a drug treatment campus: The New Jersey Substance Abuse Treatment Campus, Seacaucus, NJ. Journal of Substance Abuse Treatment. 2000;18:395–407. [PubMed: 10812314]

MCCUSKER1995 (Published Data Only)

*. McCusker J, Vickers-Lahti M, Stoddard A, et al. The effectiveness of alternative planned durations of residential drug abuse treatment. American Journal of Public Health. 1995;85:1426–1429. [PMC free article: PMC1615635] [PubMed: 7573630]
McCusker J, Vickers-Lahti M, Stoddard A, et al. The effectiveness of alternative planned duration of residential drug abuse treatment. American Journal of Public Health. 1995;85:1426–1429. [PMC free article: PMC1615635] [PubMed: 7573630]

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Bookshelf ID: NBK53223

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National Collaborating Centre for Mental Health (UK). Drug Misuse: Psychosocial Interventions. Leicester (UK): British Psychological Society (UK); 2008. (NICE Clinical Guidelines, No. 51.) APPENDIX 14, CHARACTERISTICS OF REVIEWED STUDIES.
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CHARACTERISTICS OF REVIEWED STUDIES - Drug Misuse
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