At best, psychotherapeutic methods are only moderately effective in assisting individuals with substance abuse or addiction issues to reduce their dependence, a new study concludes. The research was a meta-review of the literature by a team led by Alexandre Dumais, a professor in the Department of Psychiatry and Addiction at Université de Montréal and a researcher at the Institut universitaire en santé mentale de Montréal.
It is estimated that more than 2% of the global population suffers from a substance use disorder, which equates to approximately 35 million people.
The team evaluated the efficacy of various psychotherapeutic approaches for treating repeated abuse of alcohol, stimulants (cocaine, amphetamines, etc.), cannabis, opioids (morphine, fentanyl, etc.), and anti-anxiety drugs by analyzing 23 meta-analyses of studies with samples ranging from 130 to 33,000 subjects.
Cognitive-behavioral therapy (CBT), motivational interviews, contingency management, voucher-based reinforcement therapy, and motivational enhancement therapy were among the approaches evaluated. The team analyzed studies that measured the efficacy of therapies up to a year after the intervention.
Effects Persistence Mixed
For the treatment of alcohol abuse, researchers discovered that brief psychotherapeutic intervention with adolescents and adults resulted in small reductions in frequency and/or quantity of alcohol consumption in the first few months, but the effect did not persist at 6 or 12 months. CBT alone had no statistically significant influence on drinking frequency or quantity, but when combined with motivational interviews, it had a moderate effect.
Brief psychotherapeutic interventions had no effect on cannabis dependence, whereas CBT combined with motivational approaches reduced cannabis use moderately four months after the intervention.
For stimulant addiction, some studies found that CBT reduced the number of days participants used amphetamines over the course of a month, while contingency management reduced stimulant use during the intervention, but abstinence was not maintained in the subsequent months.
Finally, motivational approaches had no effect on benzodiazepine abuse, whereas CBT combined with a gradual reduction in benzodiazepine doses enabled some subjects to maintain abstinence for as long as three months.
Short-term Change
While the studies reviewed suggest that psychotherapies do not yield major long-term improvement,
“they can produce positive change in the short-term,”
said Dumais.
He noted that the effectiveness of psychotherapeutic approaches can be influenced by the experience, training, and skill of the therapists, which can result in significant variation in the administration of addiction treatments. Dumais observed that, given the average dropout rate of 30% reported in the studies, motivation is a crucial factor in achieving positive outcomes in addiction treatment.
“The results of our meta-review show that while the results are modest, some approaches do work and are worth trying. It is best to approach therapy for addiction with moderate expectations, but the important thing is to get help and be motivated to change one’s behavior,”
he concluded.
Abstract
This meta-review aimed to summarize the current state of knowledge provided by meta-analyzes on the efficacy of psychotherapies for substance use disorders. A systematic search was performed in PubMed, PsycINFO, Web of Science and Google Scholar. Meta-analyzes were included if they quantitatively examined the efficacy of a psychotherapy on substance use. Among the 6866 potential articles that were screened for eligibility, 23 meta-analyzes were eligible (78 effect sizes). Each meta-analysis included 2–156 studies, with samples ranging between approximately 130 to over 33,000 individuals. The quality of evidence was evaluated as being globally of low to moderate quality. Substances were categorized as: alcohol (k = 12), cannabis (k = 7), stimulants (k = 4), opioids (k = 3) and benzodiazepines (k = 1). Interventions comprised brief intervention, cognitive-behavioral therapy, contingency management, voucher-based reinforcement therapy, motivational interview, motivational enhancement therapy, significant other people involved in the treatment, and cue-expose therapy. Concerning solely significant results, small benefits were observed for significant other people involved in treatment, motivational interviewing, and the combination of cognitive-behavioral therapy with motivational interviewing for alcohol use disorder. Likewise, small-to-moderate effects were found for motivational approaches, and cognitive-behavioral therapy as well as the combination of cognitive-behavioral therapy and motivational enhancement therapy in the case of cannabis use disorder. Small effects were observed for contingency management as well as cognitive behavioral-therapy for amphetamine-type use disorder. Small effects were similarly found for contingency management for cocaine use disorder. Concerning opioid use disorder, moderate effects were observed for contingency management and voucher-based reinforcement intervention. For benzodiazepine use disorder, small effects were noted for cognitive-behavioral therapy with taper. Results often displayed small to moderate heterogeneity when reported and were generally compared to inactive controls, such as treatment-as-usual. In all, the psychosocial treatments for substance use disorders included in this meta-review have shown to be at best moderately effective over inactive controls in the short term. Nevertheless, further trials are needed as well as meta-analyzes on interventions not included in this meta-review.
Reference:
- Dellazizzo, Laura et al. Meta-review on the efficacy of psychological therapies for the treatment of substance use disorders. Psychiatry research vol. 326 (2023): 115318. doi:10.1016/j.psychres.2023.115318
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