An evaluation of cognitive behavioral therapy for substance use disorders: A systematic review and application of the society of clinical psychology criteria for empirically supported treatments.

Abstract

Cognitive behavioral therapy (CBT) is a commonly used treatment for substance use disorders (SUDs) but has not been evaluated using the American Psychological Association’s “Tolin Criteria” for determining the empirical basis of psychological treatments. The current systematic review evaluated five meta-analyses of CBT for SUD. One meta-analysis had sufficient quality to be considered in the evaluation of effect sizes. CBT produced small to moderate effects on substance use when compared with inactive treatment and was most effective at early follow-up (1–6 months posttreatment) compared with late follow-up (8+ months posttreatment). Sensitivity analyses including all five meta-analyses found similar results. A “strong recommendation” was provided for CBT as an empirically supported treatment for SUD, based on effects on substance use, quality of the evidence, and consideration of contextual factors (e.g., efficacy in diverse populations).

It is time to broaden community dissemination of cognitive-behavioral therapy for substance use disorders: Charting pathways to ascend the remaining mountainside.

“…As of this writing, NIH-funded work akin to each of the generic methodological pathways described is ongoing—with focal strategies that tailor CBT for SUDs to special client populations, examine mobile health and computerized CBT applications for persons with SUD, or work to influence leadership and organizational change in community treatment settings. In these and other efforts to follow, there is an opportunity to heed a call to arms to “delineate the effects of CBT for SUD among underserved and understudied populations” (Boness et al, 2023). Indeed, this is a salient and overdue focus for future work examining CBT for SUDs, including that which intends to address its community translation.…”

“…Fortunately, and as with other foundational therapies in the addiction field (e.g., motivational interviewing [MI], contingency management), the past half-century provided ample evidence for the efficacy of cognitive-behavioral therapy (CBT). The systematic review by Boness et al (2023), in its application of Tolin criteria advocated by the American Psychological Association Division 12 to meta-analyses and a “strong recommendation of CBT for SUD,” marks a salient point of transition for this behavior therapy. If as the authors assert the weight of that collective evidence satisfies Tolin’s criteria that CBT produces clinically meaningful impacts on both the symptoms and functional outcomes of SUD , this should inform future dissemination efforts to be undertaken by researchers, purveyors, and clinicians.…”

“…The further ascent up the mountainside may require looking back over what is already been climbed. The search strategy of Boness et al (2023) identified five meta-analyses of CBT for SUDs, a reflection of the scientific attention bestowed on this topic to date, but other conceptual and scientific milestones have been attained along a historical pathway for CBT in the addictions field. Any chronology must acknowledge the pioneering efforts of Aaron Beck (and others) that first applied CBT to mood and anxiety disorders.…”

“…Fellow health service dissemination and implementation (D/I) researchers advocate that increased treatment-seeking by persons with SUD will be spurred if empirically supported therapies are routinely availed in community treatment settings. As Boness et al (2023) have asserted a strong recommendation for CBT for SUDs, the time seems to have come for broadening its dissemination to the treatment community. To that end, a discussion of relevant scientific methods, purveyor resources, and conceptual issues is offered that may guide such efforts.…”

“…These are all likely to remain moving targets, and suggest that efforts to broaden community dissemination of CBT for SUDs be persistent and dynamic. Another intriguing topic is the impact of CBT for SUDs on client outcomes beyond substance use, among which Boness et al (2023) allude to the broader concept of recovery. This is a timely issue, as expanding conceptualizations of recovery continue to emerge and do so in a sociopolitical environment that now more than ever is embracing harm reduction principles and practices.…”