TOPLINE:

Nonpharmacologic interventions — particularly neuromodulation and mind-body therapy (MBT) — are associated with significant improvements in psychiatric symptoms in people with substance use disorder (SUD), a new large meta-analysis showed. However, evidence for short-term improvement in quality of life (QOL) was low.

METHODOLOGY:

• A systematic review and network meta-analysis of 117 randomized controlled trials including 11,177 individuals (mean age, 19-57 years) with SUDs from 25 countries was conducted to compare the relative efficacy of nonpharmacologic interventions for anxiety, depression, and QOL.
• Intervention durations ranged from 5 days to 12 months and 19 nonpharmacologic interventions were analyzed, including neuromodulation, MBT, conventional exercise, cognitive-behavioral therapy (CBT), combined intervention, digital intervention, acupuncture, relapse prevention, and others.
• Primary outcomes were changes in anxiety, depression, and QOL measured at the earliest postintervention timepoint in each study, compared between intervention groups and control groups (usual care, waitlist, placebo, or no intervention).

TAKEAWAY:

• Compared to no intervention, significant reductions in anxiety symptoms were reported in individuals treated with neuromodulation (standardized mean difference [SMD], -0.72; 95% CI, -1.00 to -0.43), combined intervention (SMD, -0.69; 95% CI, -1.15 to -0.24), MBT (SMD, -0.53; 95% CI, -0.78 to -0.27), relapse prevention (SMD, -0.53; 95% CI, -1.00 to -0.06), and acupuncture (SMD, -0.47; 95% CI, -0.90 to -0.03).
• Treatments associated with significant reductions in depression symptoms compared to no intervention included neuromodulation (SMD, -0.34; 95% CI, -0.65 to -0.03), conventional exercise (SMD, -0.62; 95% CI, -1.00 to -0.24), CBT (SMD, -0.41; 95% CI, -0.77 to -0.04), MBT (SMD, -0.90; 95% CI, -1.23 to -0.58), and acupuncture (SMD, -0.88; 95% CI, -1.52 to -0.24).
• None of the interventions significantly improved QOL at the earliest postintervention assessment compared with controls. Neuromodulation was ranked as the potentially most effective option for anxiety and QOL, whereas MBT was ranked as the potentially most effective option for depression.
• The effectiveness of interventions for anxiety, depression, and QOL differed across country development level, intervention duration (short-term, lasting 8 weeks or less vs long-term, lasting more than 8 weeks), and SUD type (alcohol use disorder or opioid use disorder).

IN PRACTICE:

“For patients presenting with high anxiety, (neuromodulation) may be considered where expertise, equipment, and follow-up are available. Where these resources are limited, other structured approaches may be prioritized based on feasibility, acceptability, workforce capacity, and integration with routine care. For patients with prominent depressive symptoms, MBT and other structured psychosocial programs may be reasonable options, particularly when delivery is standardized and adherence can be supported,” the investigators wrote.

“Comparative rankings should be interpreted cautiously given imprecision, heterogeneity, and sparse head-to-head evidence and should be integrated with feasibility, patient preferences, and local service capacity,” they added.

SOURCE:

The study was led by Haoran Luo, Institute of Physical Education, Sports, and Tourism, Peter the Great St Petersburg Polytechnic University, St Petersburg, Russia. It was published online on May 2 in the Journal of Affective Disorders.

LIMITATIONS:

The certainty of evidence was constrained by limited blinding and variability in intervention fidelity and comparator intensity. Substantial clinical and methodologic heterogeneity remained across populations, substances, baseline severity, intervention dose, delivery format, and outcome instruments. Several comparisons were supported by limited direct evidence, potentially lowering the stability of rankings. Prioritizing the earliest postintervention assessment may have favored interventions with faster early effects and underestimated approaches whose gains accumulated more gradually. Cluster-randomized trials were analyzed using reported participant-level summary statistics without cluster adjustment, which may have led to some overly precise estimates.

DISCLOSURES:

The study received no funding. The investigators reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.