Cognitive behavioral interventions for alcohol and drug use disorders: Through the stage model and back again.

Summary & key facts

Cognitive behavioral therapy (CBT) is one of the most-studied treatments for alcohol and drug problems. Reviews of many trials find a small but real average benefit: a meta-analysis of 53 controlled trials reported an effect size of g = 0.15 and estimated that 58% of people given CBT did better than comparison groups. CBT often shows lasting benefits after treatment ends. Effects are larger when compared to no treatment (g = 0.80) and for marijuana use (g = 0.51), but smaller when compared with other active treatments (about g = 0.13). Researchers note CBT is not widely used in routine care and say technology could help spread it. The exact ways CBT works are still unclear; some studies sugg

Key facts:

• A 2009 meta-analysis of 53 controlled trials reported an average effect size for CBT of g = 0.15 for alcohol and drug use disorders.
• That meta-analysis translated to about 58% of patients receiving CBT faring better than those in comparison conditions.
• CBT showed a large effect versus no treatment (random g = 0.80, p < .005).
• CBT had small effects versus passive or active comparison treatments (random g = 0.15 and g = 0.13, respectively).
• Combining CBT with other psychosocial treatments produced a larger effect (random g = 0.31) than CBT combined with pharmacotherapy (random g = 0.20) or CBT alone (random g = 0.17).
• The largest effects in the meta-analysis were for marijuana use (moderate effect, g = 0.51); smaller effects (g ≈ 0.08–0.13) were found for alcohol, cocaine, stimulants, opiates, and polydrug use.
• CBT often shows durable effects after treatment and sometimes a 'sleeper effect,' meaning some people improve more after treatment ends in follow-up studies.
• Researchers report limited diffusion of CBT into routine clinical practice (an “implementation cliff”) and suggest technology-based delivery could help increase access.
• Evidence about how CBT works is mixed: some studies found that improved coping skills or increased self-efficacy mediated outcomes, but many trials did not find unique mechanisms consistent across studies.
• Contingency management (CM) tends to produce strong immediate reductions in use that weaken after incentives stop, while CBT tends to have more modest early effects but greater durability; some studies found CM+CBT produced higher abstinenc

Abstract

Cognitive-behavioral therapy (CBT) approaches have among the highest level of empirical support for the treatment of drug and alcohol use disorders. As Psychology of Addictive Behaviors marks its 30th anniversary, we review the evolution of CBT for the addictions through the lens of the Stage Model of Behavioral Therapies Development. The large evidence base from Stage II randomized clinical trials indicates a modest effect size with evidence of relatively durable effects, but limited diffusion in clinical practice, as is the case for most empirically validated approaches for mental health and addictive disorders. Technology may provide a means for CBT interventions to circumvent the "implementation cliff" in Stages III-V by offering a flexible, low-cost, standardized means of disseminating CBT in a range of novel settings and populations. Moreover, returning to Stage I to reconnect clinical applications of CBT to recent developments in cognitive science and neuroscience holds great promise for accelerating understanding of mechanisms of action. It is critical that CBT not be considered as a static intervention, but rather 1 that constantly evolves and is refined through the stage model until the field achieves a maximally powerful intervention that addresses core features of the addictions. (PsycINFO Database Record

Topics

Child and Adolescent Psychosocial and Emotional Development Mental Health Research Topics Substance Abuse Treatment and Outcomes

Categories

Epidemiology Health Sciences Medicine

Tags

Alcohol Alcohol use disorder Biochemistry Chemistry Clinical psychology Cognition Cognitive behavioral therapy Cognitive therapy Drug Psychiatry Psychological intervention Psychology Psychotherapist