A Cochrane review [Abstract] 3 included 22 studies with a total of 2274 participants. Heroin, cocaine, and alcohol were the most commonly reported substances used. Psychosocial interventions were more effective at reducing the frequency of parental alcohol misuse than comparison conditions at 6-month (mean difference (MD) −0.32, 95% CI −0.51 to −0.13; 6 studies, n=475) and 12-month follow-up (SMD −0.25, 95% CI −0.47 to −0.03; 4 studies, n=366). Parents receiving integrated interventions which combined both parenting- and substance use-targeted component reduced alcohol misuse with a small effect size (6 months: SMD −0.56, 95% CI −0.96 to −0.16 and 12 months: SMD −0.42, 95% CI −0.82 to −0.03; 2 studies, n=113) and drug use (6 months: SMD −0.39, 95% CI −0.75 to −0.03 and 12 months: SMD −0.43, 95% CI −0.80 to −0.07; 2 studies, n=131). Psychosocial interventions in which the child was present in the sessions were not effective in reducing the frequency of parental alcohol or drug use, whilst interventions that did not involve children in any of the sessions were found to reduce frequency of alcohol misuse.
Another Cochrane review [Abstract] 2 included 7 studies with a total of 825 pregnant women with concurrent problem alcohol and illicit drug use. There were no significant difference between one intervention compared with another intervention or usual care.
Cognitive-behavioural coping skills training vs twelve-step programme (1 trial, n=41): No significant difference between groups for alcohol abstinence assessed with Substance Abuse Calendar and breathalyser at one year (RR 2.38,95% CI 0.10 to 55.06); and retention in treatment at end of treatment (RR 0.89, 95% CI 0.62 to 1.29).
Brief intervention vs treatment as usual (3 trials, n=197): No significant difference between groups for alcohol use, measured as scores on AUDIT or Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) at 3 months (standardised mean difference [SMD] 0.07, 95% CI -0.24 to 0.37); and retention in treatment at 3 months (RR 0.94, 95% CI 0.78 to 1.13).
Motivational interviewing vs treatment as usual or educational intervention only (3 trials, n=462): No significant difference between groups for alcohol use, measured as scores on the AUDIT or ASSIST at 3 months (SMD 0.04, 95% CI -0.29 to 0.37); and retention in treatment at 3 months (RR 0.93, 95% CI 0.60 to 1.43).
Motivational interviewing (intensive) vs motivational interviewing (1 trial, n=163): No significant difference between groups for alcohol use, measured using the Addiction Severity Index-alcohol score (ASI) at 2 months (MD 0.03, 95% CI 0.02 to 0.08); and retention in treatment at end of treatment (RR 17.63, 95% CI 1.03 to 300.48).
Comment: The quality of evidence is downgraded by several shortcomings in study quality, by inconsistency (heterogeneity in interventions and outcomes), and by imprecise results (limited study size for each comparison).
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