Motivation is a well-established predictor of recovery for addictive behaviors. Treatments aimed at changing substance use and gambling frequently employ motivational enhancing strategies, based in the principles of Motivational Interviewing (MI). Evidence for these approaches across addictive behaviors does not always paint a clear picture. The purpose of this review was to examine existing reviews of motivational-based interventions for various substances of abuse and gambling in the last decade to gain a deeper understanding of the current evidence and implications for future research and clinical practice. Literature searches were conducted to identify review articles from January 1, 2007 to January 30, 2017 for motivational enhancing interventions for alcohol, tobacco, drugs, marijuana, cocaine, opioids, methamphetamines, and gambling. Of the 144 articles assessed we included a total of 34 review articles in our review, including 6 Cochrane reviews. This review supports use of motivationally enhancing interventions across addictive behaviors with strongest evidence supporting use in alcohol and tobacco, with brief interventions showing strong efficacy. There is strong support for MI with marijuana and some support for gambling. Insufficient evidence is available for methamphetamine or opiate use. There are important caveats. In most cases, MI is more effective than no treatment and as effective (but not necessarily more effective) than other active treatments. Findings for effectiveness of more intensive motivational interventions or combinations are mixed. Treatment fidelity assessments, limited subpopulation analyses, and differences in dose, outcomes, and protocol specification continue to pose significant problems for reviews. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Síntesis amplia/ Revisión panorámica de revisiones sistemáticas
ANTECEDENTES: El consumo de tabaco es la principal causa de muerte prevenible en los Estados Unidos.
OBJETIVO: Revisar la eficacia y seguridad del tratamiento farmacológico y las intervenciones conductuales para el abandono del tabaco.
FUENTE DE DATOS: 5 bases de datos y 8 sitios web de la organización se buscaron hasta el 1 de agosto de 2014 para las revisiones sistemáticas, y se realizaron búsquedas en PubMed al 1 de marzo de 2015 para los ensayos en los sistemas electrónicos de administración de nicotina.
Selección de estudios Dos revisores examinaron 114 artículos para identificar los comentarios en idioma Inglés que informaron sobre la salud, el cese o resultados adversos.
EXTRACCIÓN DE DATOS: Un revisor de datos resumidos de los comentarios calidad justa y bueno-, y una segunda verificado su exactitud.
SÍNTESIS: Cincuenta y cuatro comentarios fueron incluidos. Las intervenciones conductuales se incrementaron para dejar de fumar a los 6 meses o más (el consejo del médico tenía un ratio combinado del riesgo [RR] 1,76 [IC del 95%, 1,58 a la 1,96]). terapia de reemplazo de nicotina (RR, 1,60 [IC, 1,53-1,68]), bupropión (RR, 1,62 [IC, 1,49-1,76]), y la vareniclina (RR, 2,27 [IC, 2,02-2,55]) también fueron efectivos para dejar de fumar . intervenciones conductuales y farmacoterapia combinadas se incrementaron en un 82% el cese en comparación con una intervención mínima o la atención habitual (RR, 1,82 [IC, 1,66 a la 2.00]). Ninguno de los fármacos se asocia con los principales eventos adversos cardiovasculares. Sólo 2 ensayos abordaron la eficacia de los cigarrillos electrónicos para dejar de fumar y no encontraron beneficios. Entre las mujeres embarazadas, las intervenciones conductuales se beneficiaron cesación y la salud perinatal; efectos de la terapia de reemplazo de nicotina no fueron significativas.
LIMITACIONES: La evidencia publicada después de la fecha de la última búsqueda de cada revisión no se incluyó.
Conclusión: Las intervenciones conductuales y farmacoterapia mejorar las tasas de abandono del tabaquismo entre la población adulta en general, solo o en combinación. Los datos sobre la eficacia y la seguridad de los sistemas de suministro de nicotina electrónicos son limitados.
PRIMARIA FUENTE DE FINANCIACIÓN: Agencia para la Investigación y Calidad.
Motivation is a well-established predictor of recovery for addictive behaviors. Treatments aimed at changing substance use and gambling frequently employ motivational enhancing strategies, based in the principles of Motivational Interviewing (MI). Evidence for these approaches across addictive behaviors does not always paint a clear picture. The purpose of this review was to examine existing reviews of motivational-based interventions for various substances of abuse and gambling in the last decade to gain a deeper understanding of the current evidence and implications for future research and clinical practice. Literature searches were conducted to identify review articles from January 1, 2007 to January 30, 2017 for motivational enhancing interventions for alcohol, tobacco, drugs, marijuana, cocaine, opioids, methamphetamines, and gambling. Of the 144 articles assessed we included a total of 34 review articles in our review, including 6 Cochrane reviews. This review supports use of motivationally enhancing interventions across addictive behaviors with strongest evidence supporting use in alcohol and tobacco, with brief interventions showing strong efficacy. There is strong support for MI with marijuana and some support for gambling. Insufficient evidence is available for methamphetamine or opiate use. There are important caveats. In most cases, MI is more effective than no treatment and as effective (but not necessarily more effective) than other active treatments. Findings for effectiveness of more intensive motivational interventions or combinations are mixed. Treatment fidelity assessments, limited subpopulation analyses, and differences in dose, outcomes, and protocol specification continue to pose significant problems for reviews. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
