Mike: Hello, I'm Mike Clarke, podcast editor for the Cochrane Library. In February 2024, we published the first update of the Cochrane Drugs and Alcohol review of psychosocial treatments for people with stimulant use disorder. Here's lead author, Silvia Minozzi from the Lazio Regional Health Service in Rome Italy to tell us about the latest findings.

Silvia: Stimulant use disorder is a mental condition characterized by a strong urge to use psychostimulants and inability to control their use. These drugs include cocaine, amphetamines, crack, and MDMA, and they are the second-most commonly used illicit drug worldwide, after cannabis. Stimulant use disorder is associated with serious medical consequences, including delusions and hallucinations, cardiovascular diseases, viral hepatitis, and sexually transmitted infections. People with stimulant use disorder are also at high risk of being involved in car accidents, crime, sexual abuse, and interpersonal violence.
It's important, therefore, to try to identify effective therapies for stimulant use disorder and currently, no medications are approved for its treatment. Instead, psychosocial interventions are regarded as suitable alternatives. Many types of such therapy are available, which act on people's memory and learning, with the aim of helping them develop skills to deal with their condition.
In 2016, when we published the first version of the Cochrane Review, we found that the interventions could have some benefits but we only had moderate to low confidence in the results because so many participants were lost to follow up and many studies reported conflicting results. We've updated the review to see whether more recent studies could change the findings or strengthen our confidence in the results, and our confidence in the results has moved to high for several outcomes, although it remains moderate or low for others because of small sample size and conflicting results.
We were now able to include 64 studies, involving more than 8200 people with stimulant use disorder. Three quarters of the studies were from the United States, with the others from Australia, Brazil, Iran, the Netherlands South Africa, Spain, Switzerland the UK. Overall, the studies offered treatment for an average of four months, but the study programs varied from a single session to a 12-months program.
Turning to the results, compared to no treatment, we found that psychosocial treatments reduce the number of people who leave the study prematurely, reduce the frequency of drug intake and increase the length of time people abstain from stimulants. They probably also increase the number of people with continuous abstinence during treatment but may make little to no difference to continuous abstinence in the long term. 
Compared to usual care, psychosocial treatments also reduce the number of people who leave treatment prematurely but they may have little to no effect on helping people stay continuously abstinent during treatment or on the duration of abstinence. They also probably have little to no effect on the frequency of drug intake.
In summary, therefore, we can conclude that the current evidence suggests that although psychosocial treatments are effective when compared to no treatment, they don't seem to do much better than usual care.

Mike: If you would like to look in more depth at this current evidence, the review can be found online. If you go to Cochrane Library dot com and search 'Psychosocial interventions for stimulant use disorder' you'll see the link to it.