communities

Interventions to reduce stigma about substance abuse aim to establish contact with vulnerable groups to avoid social isolation, protest and take action against prejudice, and foster education to replace myths with factual knowledge. A systematic review (Gür & Yilmaz, 2023, 10 studies) to assess the effectiveness of interventions reducing substance-related stigma found that:

• interventions did not have a significant impact on reducing stigma (Hedges’ g = 0.301, 95% CI =-0.154 to 0.755, p = 0.195) nor social stigma (g=-0.198, 95% CI=-1.271 to 0.876).
• interventions had a small significant impact on reducing structural stigma [0.360 (95% CI= 0.156-0.564), p = 0.00].

In a narrative systematic review (Kerman et al., 2021, studies = 35) harm reduction outcomes and practices in Housing First were examined in four domains: substance-related harms, viral health, sexual health, and harm reduction service use. Overall the review found that harm reduction outcomes in Housing First remain underexamined and any conclusions of the intervention's impacts in this domain would be premature. Effective harm reduction practices in Housing First require strong working relationships between staff and tenants.

Specific results of the analysis found that:

• harm reduction outcome studies focused mostly on nonspecific substance use problems, with Housing First being found to have minimal effects in this domain.
• More severe harms, such as delirium tremens and substance use-related deaths, have been minimally explored, though preliminary evidence is promising.
• Viral health, sexual health, and harm reduction service use outcomes were the focus of few studies. 

Primary care-based models for opioid substitution treatment were analysed in a systematic review (Legisetty et al., 2017, 35 studies) to identify models' structures and processes associated
with improved patient outcomes. While some models, namely multidisciplinary and coordinated care delivery models were common to most studies and showed positive association with some outcomes, overall the review could not find a significant correlation between models and/or components in:

• improving patients' treatment outcomes

Community-based interventions showed some impact in a systematic review (Stockings et al, 2018, 24 trials, n=249 125, samples subject to high-risk bias) in:

• reducing risky drinking (AUDIT ˃8, 3 trials, RR 0.78, 95% CI 0.62 to 0.99).

Community-based interventions showed no significant impact in a systematic review (Stockings et al, 2018, 24 trials, n=249 125, samples subject to high-risk bias) in:

• reducing binge-drinking (5 trials, RR 0.97, 95% CI 0.98 to 1.06); and
• reducing 12 month marijuana use (2 trials, RR 0.98, 95% CI 0.86 to 1.11).

Police interventions in licensed premises, with uniformed police officers visiting pubs two to three times a week was found in a narrative review (Calafat, Juan and Duch, 2009) to lead to:

• a 20 % reduction in recorded public disorders offences in the intervention area, compared with no reduction in the control area.

Police intervention in high-risk premises was found in a systematic review (Jones et al 2010) and in a narrative review (EMCDDA, 2012) to be a more effective strategy than ‘low level’ policing in:

• reducing alcohol-related incidents (narrative results only).

Police interventions aimed at reducing the movement of clients between bars, the overall alcohol consumption of clients and contain that consumption within safer settings was found to be effective in a systematic review (Ker and Chinnock, 2008) in:

• reducing assault rates: pre-intervention serious assault rate in the experimental area was 52 % higher than the rate in the control area. After intervention, the serious assault rate in the experimental area was 37 % lower than in the control area.

Mentoring (intended as a supportive relationship in which one person offers support, guidance and concrete assistance to a partner) is based on the sharing of experience and expertise without expectation of personal gain by the mentor - Center for Substance Abuse Prevention 2000) was found in a systematic review (Thomas et al., 2011) more effective than no interventions in:

• preventing alcohol use (3 RCTs) (RR 0.71, 95% CI  0.57 to 0.90, p = 0.005).

Family-based prevention programs (including development of parenting skills, parental support, nurturing behaviours, establishing clear boundaries or rules, parental monitoring, social and peer resistance skills, development of behavioural norms and positive peer affiliations) have shown to be effective in a systematic review (Foxcroft et al., 2011, 12 RCTs) in:

• reducing alcohol misuse in adolescents, with persistence of effects over the medium and longer-term (in 9 of the 12 RCTs analysed)

Behavioural interventions (face-to-face or group counselling, print materials, interactive computer-based tools designed for patient use, and clinician training and quality improvement programs) implemented in primary care settings and targeting youth not seeking or identified as needing special treatment were found in a systematic review with meta-analysis (O'Connor E. et al., 2020, 29 studies, N=18 353) to have no significant effect in:

• preventing or reducing illicit drug use (SMD= - 0.08, 95% CI = -0.16, p<0.001, 24 studies, N=12 801).

The majority of intervention showed no clear evidence of benefit, and 2 reported increased illicit drug use in youth participating in the interventions for at least 1 drug-related outcome.
However a few showed a benefit for some outcomes in some subgroups, especially  the combination of a clinician interview and an electronic-based intervention  (e.g. computer-based interventions targeting young female adolescents or the computer-based version of the Familias Unidas intervention).