title: Effectiveness of secondary prevention and treatment interventions for crack-cocaine abuse: a comprehensive narrative overview of English-language studies.
abstract: There are an estimated several million crack-cocaine users globally; use is highest in the Americas. Most crack users are socio-economically marginalized (e.g., homeless), and feature elevated risks for morbidity (e.g., blood-borne viruses), mortality and crime/violence involvement, resulting in extensive burdens. No comprehensive reviews of evidence-based prevention and/or treatment interventions specifically for crack use exist. We conducted a comprehensive narrative overview of English-language studies on the efficacy of secondary prevention and treatment interventions for crack (cocaine) abuse/dependence. Literature searches (1990-2014) using pertinent keywords were conducted in main scientific databases. Titles/abstracts were reviewed for relevance, and full studies were included in the review if involving a primary prevention/treatment intervention study comprising a substantive crack user sample. Intervention outcomes considered included drug use, health risks/status (e.g., HIV or sexual risks) and select social outcome indicators. Targeted (e.g., behavioral/community-based) prevention measures show mixed and short-term effects on crack use/HIV risk outcomes. Material (e.g., safer crack use kit distribution) interventions also document modest efficacy in risk reduction; empirical assessments of environmental (e.g., drug consumption facilities) for crack smokers are not available. Diverse psycho-social treatment (including contingency management) interventions for crack abuse/dependence show some positive but also limited/short-term efficacy, yet likely constitute best currently available treatment options. Ancillary treatments show little effects but are understudied. Despite ample studies, pharmaco-therapeutic/immunotherapy treatment agents have not produced convincing evidence; select agents may hold potential combined with personalized approaches and/or psycho-social strategies. No comprehensively effective 'gold-standard' prevention/treatment interventions for crack abuse exist; concerted research towards improved interventions is urgently needed.
authors: Social & Epidemiological Research Department, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Canada M5S 2S1; Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, 2400, 515 West Hastings Street, Vancouver, Canada V6B 5K3; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Canada M5T 1R8. Electronic address: bfischer@sfu.ca.
authors: Benedikt
authors: B
authors: Fischer
authors: Parnassia Addiction Research Centre, PO Box 53002, The Hague 2505 AA, The Netherlands.
authors: Peter
authors: P
authors: Blanken
authors: Department of Psychiatry, Federal University of São Paulo, Rua Florida 320, São Paulo 04565-000, Brazil.
authors: Dartiu
authors: D
authors: Da Silveira
authors: Faculty of Ceilandia, Federal University of Brasilia, 72220-900 Brasília, DF, Brazil.
authors: Andrea
authors: A
authors: Gallassi
authors: Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, 2400, 515 West Hastings Street, Vancouver, Canada V6B 5K3.
authors: Elliot M
authors: EM
authors: Goldner
authors: Social & Epidemiological Research Department, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Canada M5S 2S1; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Canada M5T 1R8; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Canada M5T 3M7.
authors: Jürgen
authors: J
authors: Rehm
authors: British Columbia Centre for Disease Control, 655 West 12th Ave, Vancouver, BC, Canada V5Z 4R4; Department of Medicine, University of British Columbia, 2775 Laurel St., Vancouver, Canada V5Z 1M9.
authors: Mark
authors: M
authors: Tyndall
authors: Department of Medicine, University of British Columbia, 2775 Laurel St., Vancouver, Canada V5Z 1M9; Urban Health Research Initiative, BC Centre for Excellence in HIV/AIDS, 608, 1081 Burrard Street, Vancouver, Canada V6Z 1Y6.
authors: Evan
authors: E
authors: Wood
mesh_terms: D016739:Behavior, Addictive; D000697:Central Nervous System Stimulants / Q000009:adverse effects*; D019970:Cocaine-Related Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D016578:Crack Cocaine / Q000009:adverse effects*; D055030:Drug Users / Q000523:psychology; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D012008:Recurrence; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods*; D016320:Substance Abuse Treatment Centers; D016896:Treatment Outcome
chemical_list: D000697:Central Nervous System Stimulants; D016578:Crack Cocaine
keywords: Crack-cocaine; Dependence; Intervention; Prevention; Review; Treatment