A Meta-Analysis of Cognitive-Behavioral Therapy for Alcohol or Other Drug Use Disorders: Treatment Efficacy by Contrast Condition

• Published in: Journal of consulting and clinical psychology 2019-12, Vol.87 (12), p.1093-1105
• Main Authors: Magill, Molly, Ray, Lara, Kiluk, Brian, Hoadley, Ariel, Bernstein, Michael, Tonigan, J. Scott, Carroll, Kathleen
• Format: Article
• Language: English
• Subjects: Alcohol; Alcohol Treatment; Alcohol use; Alcoholism - therapy; Analysis; Behavior modification; Bias; Clinical trials; Cognitive Behavior Therapy; Cognitive behavioral therapy; Cognitive Behavioral Therapy - statistics & numerical data; Cognitive therapy; Cognitive-behavioral factors; Drug abuse; Drug efficacy; Drug use; Efficacy; Female; Human; Humans; Male; Meta-analysis; Moderators; Outcome Assessment, Health Care - statistics & numerical data; Random effects; Relapse Prevention; Substance Use Disorder; Substance Use Treatment; Substance-Related Disorders - therapy; Systematic review; Treatment Effectiveness Evaluation; Treatment Outcomes
• ISSN: 0022-006X; 1939-2117
• DOI: 10.1037/ccp0000447

Objective: This meta-analysis examined 30 randomized controlled trials (32 study sites; 35 study arms) that tested the efficacy of cognitive-behavioral therapy (CBT) for alcohol or other drug use disorders. The study aim was to provide estimates of efficacy against three levels of experimental contrast (i.e., minimal [k = 5]; nonspecific therapy [k = 11]; specific therapy [k = 19]) for consumption frequency and quantity outcomes at early (1 to 6 months [kes = 41]) and late (8+ months [kes = 26]) follow-up time points. When pooled effect sizes were statistically heterogeneous, study-level moderators were examined. Method: The inverse-variance weighted effect size was calculated for each study and pooled under random effects assumptions. Sensitivity analyses included tests of heterogeneity, study influence, and publication bias. Results: CBT in contrast to minimal treatment showed a moderate and significant effect size that was consistent across outcome type and follow-up. When CBT was contrasted with a nonspecific therapy or treatment as usual, treatment effect was statistically significant for consumption frequency and quantity at early, but not late, follow-up. CBT effects in contrast to a specific therapy were consistently nonsignificant across outcomes and follow-up time points. Of 10 pooled effect sizes examined, two showed moderate heterogeneity, but multivariate analyses revealed few systematic predictors of between-study variance. Conclusions: The current meta-analysis shows that CBT is more effective than a no treatment, minimal treatment, or nonspecific control. Consistent with findings on other evidence-based therapies, CBT did not show superior efficacy in contrast to another specific modality. What is the public health significance of this article? This meta-analysis provides an up-to-date summary of treatment efficacy in cognitive-behavioral therapy (CBT) for alcohol or other drug use disorders. CBT is effective for these conditions with outcomes roughly 15% to 26% better than average outcomes in untreated, or minimally treated, controls.