Table 6 Summary of evidence-based mixed sud group treatment for adults

Downey et al., 2000 [82]

14 buprenophrine maintained poly-drug users (cocaine plus heroin). (SCID). Mean age 40 years, 39% female, 35% Caucasian.

18 weeks:

1. Individual CBT (6 sessions) plus 12 session (weekly) group therapy (CBT; relapse prevention)

2. CBT based plus vouchers (VBRT)

1. Yes

2. Yes

RAAT; post-test at end of 18-week tx; 37% tx completion/ f/u rate in CBT; 65% tx completion/f/u VBRT.

No significant differences on treatment outcome. Among the subsample that produced one or more poly-drug free urine results, VBRT participants had significantly increased cocaine abstinence.

Greenfield et al., 2007 [52]

13 (for pilot) and 31 (in trial) recruited patients with SUD (other than nicotine; SCID), substance use within 60 days of baseline, and no need for medical detoxification, mandate to treatment, psychosis, PTSD, concurrent self-help group treatment. Mean age 58 years for GDC and 45 for WRG, 100% female, predominantly Caucasian.

12 weeks, 90-min sessions, 1x per week:

1. Group Drug Counseling (GDC; mixed gender; 12 weeks)

2. Women’s Recovery Group (WRG; author)

1. Yes

2. Yes

RAWC; 6-month f/u. 87% f/u rate, 78% tx completion.

Pilot testing of WRG evidenced significantly greater reductions in average drinks/drinking day than GDC at 6-month f/u. WRG was equally effective as mixed-gender GDC in reducing substance use during the 12-week in-treatment phase, but demonstrated significantly greater improvement in reductions in drug and alcohol use over the f/u compared with GDC. Women were significantly more satisfied with WRG than GDC

Margolin et al., 2003 [83]

90 HIV-seropositive, methadone-maintained injection drug users with opioid dependence, and abuse or dependence on cocaine (screened at intake, utilizing Addiction Severity Index). Mean age 41 years, 30% female, 48.9% African American, 15.6% Hispanic.

6-months of methadone maintenance plus:

1. HIV Harm Reduction Program (HHRP; twice weekly, 2-h groups)

2. Active control that included harm reduction components recommended by the National AIDS Demonstration Research Project (six sessions).

1. Yes

2. Yes

RAWC; 6- and 9-month f/u. 71% 6-month f/u rate, 70% 9-month f/u rate. 64.4% tx completion.

Both groups showed reductions in risk behaviors. HHRP evidenced less use of illicit opiates and more adherence to antiretroviral medications; at follow-up, they had lower addiction severity scores and were less likely to have engaged in high risk behavior compared to control.

Marques & Formigioni (2001) [84]

155 recruited alcohol and/or drug dependent patients (standardized assessment interview). Mean age of drug dependent patients 25 years Mean age of AD patients 41 years, 8% female. No ethnicity data reported.

17 sessions over 8 months (1 session per week during Month 1–2, 1 session every 2 weeks in Month 3–5, 1 session per month during Month 6–8.

1. Individual CBT (IT; structured)

2. Group CBT (GT; structured)

1. Yes

2. Yes

RAAT; 15-month f/u. 66% f/u rate in IT, 70% f/u rate in GT. IT attended average of 7 sessions, GT attended average of 8 sessions.

At follow- up the two formats presented similar outcomes, higher compliance in GT (66.7%)

McKay et al., 2005 [85]

359 referred patients with AD or CD (SCID). Mean age 42 years, 17% female, 77% African American.

12-week continuing care interventions:

1. weekly telephone monitoring and counseling combined with a support group in the first 4 weeks (TEL);

2. twice-weekly individualized relapse

prevention (RP)

3. twice-weekly standard group counseling (STND; 12 step).

1. Yes

2. Yes

3. Yes

RAAT; 3, 6, 9- and 12-months f/u. 90% f/u rates. The average number of sessions was 14.12 in STND, 14.41 in RP and 10.94 in TEL.

Days of abstinence were higher in STND than TEL. Higher scores on a composite risk indicator indicated higher abstinence rates in STND than TEL and lower composite risk scores indicated higher abstinence rates in TEL than STND.

Nemes et al., 1999 [86]

412 patients in a therapeutic community with multiple drug/alcohol use dependencies/abuse (SCID. Mean age “mid-thirties”, 23% SC females, 33% AP females, primarily African American.

12-month program (inpatient and outpatient):

1. Standard Care (SC, 10 months inpatient, 2 months outpatient)

2. Abbreviated program (AP, 6 months inpatient, 6 months outpatient)

1. No

2. No

RAWC; 6-month f/u. 93% f/u rate. SC completed average of 8.2 months of program; AP completed average of 8.6 months of program.

Both groups had reductions in arrests and drug use. No significant differences between groups.

Rawson et al., 2006 [87]

171 recruited individuals with CD or methamphetamine abuse (SCID), and no AD or benzodiazepine dependence, or court mandated to treatment. Mean age 36 years, 24% female, 32% African American.

16-weeks:

1. Contingency Management (CM; vouchers for stimulant-free urine samples; three urine samples per week and meet briefly with the CM technician)

2. CBT group (CBT; three 90-min group sessions each week, for 16 weeks).

3. CM plus CBT groups (CM-CBT; separate sessions)

1. Yes

2. Yes

3. Yes

RAAT; Baseline and weeks 17, 26 and 52 f/u. 81% f/u rate. 60% CM completed tx, 59% CM-CBT completed tx, and 40% CBT completed tx.

CM produced better retention and lower rates of stimulant use during the study. Stimulant use was reduced from baseline levels at all f/u points for all groups and urinalysis data did not differ between groups at f/u. CM produced evidence of efficacy during treatment application, but CBT produced comparable longer-term outcomes. There was no evidence of an additive effect in CM-CBT.

Schottenfeld et al., 2000 [88]

117 patients with opioid dependence and CD or cocaine abuse (SCID) without psychosis and not suicidal or pregnant. Mean age 34 years, 49% female, 64% Caucasian.

In addition to maintenance medications- 24 weeks of:

1. Group Drug Counseling (GDC; weekly, 1-h

group DC sessions).

2. Community Reinforcement Approach (CRA; met in individual sessions with a CRA therapist twice weekly during the first 12 weeks and then weekly during the following 12 weeks).

1. Yes

2. Yes

RAAT; 9-week ff/u. No f/u rate reported. Tx completion for GDC was 59.6 and 61.7% for the CRA.

There were no significant differences in retention or drug use. The total number of hours and average hours per week engaged in nondrug-related activities was higher for CRA patients who achieved abstinence from opioids, cocaine, or both combined.

Smith et al., 1999 [89]

383 inpatient veterans, meeting AD, CD or amphetamine dependence (Semi-structured interview). Mean age 40–50 years, 0% female, 11–46% of participants in each group were African American.

Between 21 and 28 days of treatment:

1. Standard treatment program (STP; daily group counseling, family outreach, 12-step program introduction, four 2-h. sessions for family)

2. Enhanced treatment program (ETP; 10 h. per week, twice weekly groups on relapse prevention and interpersonal counseling)

1. No

2. Yes

1st cohort completed STP; 2nd cohort completed ETP; 3- and 12-month f/u. 92% f/u rate at 3-month and 83% f/u at 12-month. 80% tx completion.

ETP evidenced enhanced abstinence rates at 3-month and 12-month follow-up compared to STP, regardless of type of drug use.