SA37 Effectiveness of Psychosocial Interventions for Adults With Substance Use Disorder and Co-Occurring Mental Health Disorder: An Umbrella Review

Objectives
Individuals with substance use disorders (SUDs) frequently have co-occurring mental health conditions. Despite the high prevalence of dual diagnoses, clear guidance on the most effective treatment strategies for these individuals is lacking. This umbrella review aimed to synthesise evidence on the effectiveness of psychosocial interventions in reducing substance use and improving mental health outcomes in people with dual diagnoses.

Methods
Five electronic databases were searched in February 2024 to identify systematic reviews of randomised controlled trials (RCTs) evaluating psychosocial interventions. Eligible studies included adults with SUDs and co-occurring common mental health disorders or borderline personality disorder. Interventions were compared to each other, treatment as usual, or wait-list controls. Study selection, data extraction, and critical appraisal were undertaken by one reviewer and checked by a second reviewer. Methodological quality was assessed using the Joanna Briggs Institute’s critical appraisal checklist, and data were synthesised narratively.

Results
Of the 5,420 citations identified, 30 systematic reviews met the inclusion criteria. The overall methodological quality of the reviews was generally good. Most focused on co-occurring depression, anxiety, or post-traumatic stress disorder. Across reviews, various psychosocial interventions, along with many active comparators, were associated with improvements in both mental health symptoms and substance use outcomes. Integrated treatment approaches were generally more effective than uncoordinated parallel interventions. However, given the heterogeneity of the reviews and RCTs within reviews, high drop-outs, short follow-up, and the positive effects observed across various psychosocial interventions, including active comparators, no single intervention could be recommended over others. An interactive evidence map is available via https://tinyurl.com/35pmhve2.

Conclusions
The findings suggest an advantage for coordinated, integrated psychosocial services for individuals with dual diagnoses. Future research should prioritise direct comparisons of integrated versus parallel or sequential approaches, incorporate longer follow-up, and examine reasons for high drop-outs.