Psychosocial interventions for people with comorbid substance use disorders in people with severe mental health conditions in low- and middle-income countries: scoping review.

Abstract

Background: The high comorbidity of substance use disorders (SUDs) among people with severe mental health conditions (MHCs) poses major challenges to providing effective care, particularly in low- and middle-income countries (LMICs), where treatment options are limited.

Aims: The aim of this scoping review was to produce an overview of the current evidence on psychosocial interventions for people with comorbid MHCs and SUDs in LMICs.

Method: The following databases were searched from their inception to 23 July 2024: PubMed/Medline, Global Health, Embase, PsycINFO and Global Index Medicus. We also searched for grey literature, using Google Scholar, ProQuest and Clinicaltrials.gov. Reporting was according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist. Studies were eligible if they focused on any psychosocial intervention targeting substance use in people with severe MHCs from LMICs. Of the 6304 records screened by titles and abstracts, 138 full-text articles were assessed and included for data extraction.

Results: Of the 6304 records screened by titles and abstracts, 138 full-text articles were assessed and 13 articles were included for data extraction. Many of the studies (n = 9) had a quasi-experimental design, and were from Latin America and South Asia. Four studies were randomised controlled trials. The primary outcomes examined were substance use abstinence, treatment engagement and retention, reduction in psychiatric symptoms, functioning and suicidal behaviours. Despite some heterogeneity in study designs, target populations and evaluated outcomes, interventions including various tobacco cessation programmes, screening and brief intervention with family support, and community-based programmes, have demonstrated positive outcomes in reducing tobacco, alcohol and khat use, respectively.

Conclusions: The review shows that there have been few initiatives to design and test psychosocial interventions for individuals with comorbid severe MHCs and SUDs in LMICs. There is a clear need to design and test feasible, acceptable, and effective interventions to address both severe MHCs and substance use when they co-occur.