Cited by 694Substance Abuse Treatment and OutcomesPsychotherapy Techniques and ApplicationsAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

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Cognitive-Behavioral Treatment With Adult Alcohol and Illicit Drug Users: A Meta-Analysis of Randomized Controlled Trials

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Magill, Molly, Ray, Lara A.·2009·Journal of Studies on Alcohol and Drugs

DOI 10.15288/jsad.2009.70.516PMC PMC2696292

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Abstract

OBJECTIVE: This meta-analysis examined 53 controlled trials of cognitive-behavioral treatment (CBT) for adults diagnosed with alcohol- or illicit-drug-use disorders. The aims were to provide an overall picture of CBT treatment efficacy and to identify client or treatment factors predictive of CBT effect magnitude. METHOD: The inverse variance weighted effect size (Hedges' g) was calculated for each study and pooled using fixed and random effects methods. Potential study-level moderators were assessed in subgroup analyses by primary drug, type of CBT, and type of comparison condition. In addition, seven client and treatment variables were examined in meta-regression analyses. RESULTS: Across studies, CBT produced a small but statistically significant treatment effect (g = 0.154, p < .005). The pooled effect was somewhat lower at 6-9 months (g = 0.1 15, p < .005) and continued to diminish at 12-month follow-up (g = 0.096, p < .05). The effect of CBT was largest in marijuana studies (g = 0.513, p < .005) and in studies with a no-treatment control as the comparison condition (g = 0.796, p < .005). Meta-regression analyses indicated that the percentage of female participants was positively associated and the number of treatment sessions was negatively associated with effect size. CONCLUSIONS: The findings demonstrate the utility of CBT across a large and diverse sample of studies and under rigorous conditions for establishing efficacy. CBT effects were strongest with marijuana users, when CBT was compared with no treatment, and may be larger with women than with men and when delivered in a brief format.

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Self-citation
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Boness, C. L., Votaw, V. R., Schwebel, F. J., Moniz-Lewis, D. I. K., McHugh, R. K., & Witkiewitz, K. A. (2023) · Clinical Psychology Science and Practice · doi:10.1037/cps0000131 · Cited by 42
Applying methods for personalized medicine to the treatment of alcohol use disorder.
Kuhlemeier, A., Desai, Y., Tonigan, A. T., Witkiewitz, K. A., Jaki, T., Hsiao, Y., Chang, C., & Horn, M. L. V. (2021) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000634 · Cited by 31
“Treatments for AUD have been shown to be modestly effective, with effect sizes for behavioral treatments versus control conditions and for pharmacotherapies versus placebo conditions in the small to medium range (Magill & Ray, 2009; Ray et al., 2020).”
Background
Extended-Release Naltrexone and Harm Reduction Counseling for Chronically Homeless People with Alcohol Dependence
Collins, S. E., Duncan, M. H., Smart, B. F., Saxon, A. J., Malone, D. K., Jackson, T. R., & Ries, R. K. (2014) · Substance Abuse · doi:10.1080/08897077.2014.904838 · Cited by 33
Treatment of Adolescent Substance Use Disorders and Co-Occurring Internalizing Disorders: A Critical Review and Proposed Model
A. Hulvershorn, L., D. Quinn, P., & L. Scott, E. (2015) · Current Drug Abuse Reviews · doi:10.2174/1874473708666150514102745 · Cited by 30
Regulate yourself: Emotion regulation and protective behavioral strategies in substance use behaviors
Blanchard, B. E., Stevens, A. K., Cann, A. T., & Littlefield, A. K. (2018) · Addictive Behaviors · doi:10.1016/j.addbeh.2018.12.020 · Cited by 31
Dissemination of Cognitive Behavioral Therapy for Substance Use Disorders in the Department of Veterans Affairs Health Care System: Description and Evaluation of Veteran Outcomes
DeMarce, J. M., Gnys, M., Raffa, S. D., Kumpula, M. J., & Karlin, B. E. (2019) · Substance Abuse · doi:10.1080/08897077.2019.1674238 · Cited by 30
eHealth Interventions to Treat Substance Use in Pregnancy: A Systematic Review and Meta-Analysis
Silang, K., Sanguino, H., Sohal, P. R., Rioux, C., Kim, H. S. A., & Tomfohr‐Madsen, L. M. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18199952 · Cited by 32
The Clinical and Theoretical Basis for Integrated Cognitive Behavioral Treatment of Comorbid Social Anxiety and Alcohol Use Disorders
Stapinski, L. A., Rapee, R. M., Sannibale, C., Teesson, M., Haber, P., & Baillie, A. (2014) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2014.05.004 · Cited by 29
Problem solving styles among people who use alcohol and other drugs in South Africa
Sorsdahl, K. R., Stein, D. J., Carrara, H., & MYERS, B. J. (2013) · Addictive Behaviors · doi:10.1016/j.addbeh.2013.09.011 · Cited by 36
Effect of computerized cognitive behavioral therapy on acquisition of coping skills among cocaine-dependent individuals enrolled in methadone maintenance
Kiluk, B. D., DeVito, E. E., Buck, M. B., Hunkele, K. A., Nich, C., & Carroll, K. M. (2017) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2017.09.011 · Cited by 29
“However, despite ample evidence regarding the efficacy of CBT at reducing substance use (Dutra et al., 2008; Magill & Ray, 2009), the evidence supporting the role of coping skills as a mediator of outcomes and a unique mechanism of change has been mixed (Litt, Kadden, Cooney, & Kabela, 2003; Litt,…”
Background
Achieving a Spiritual Therapy Standard for Drug Dependency in Malaysia, from an Islamic Perspective: Brief Review Article.
Seghatoleslam, T., Habil, H., Hatim, A., Rashid, R. B. A., Ardakan, A., & Motlaq, F. E. (2015) · PubMed Central · Cited by 28
Patient-centred care for addiction treatment: a scoping review protocol
Marchand, K., Beaumont, S., Westfall, J., MacDonald, S., Harrison, S., Marsh, D. C., Schechter, M. T., & Oviedo-Joekes, E. (2018) · BMJ Open · doi:10.1136/bmjopen-2018-024588 · Cited by 28
Using peers to increase veterans’ engagement in a smartphone application for unhealthy alcohol use: A pilot study of acceptability and utility.
Blonigen, D. M., Harris-Olenak, B., Kuhn, E. R., Timko, C., Humphreys, K. N., Smith, J. S., & Dulin, P. L. (2020) · Psychology of Addictive Behaviors · doi:10.1037/adb0000598 · Cited by 27
Future Directions for Interventions Targeting PTSD in HIV-infected Adults
Applebaum, A. J., Bedoya, A. C., Hendriksen, E., Wilkinson, J. L., Safren, S. A., & O’Cleirigh, C. M. (2014) · Journal of the Association of Nurses in AIDS Care · doi:10.1016/j.jana.2014.11.001 · Cited by 27
“CBT has also demonstrated particular efficacy in the treatment of substance use disorders (Magill & Ray, 2009; McHugh, Hearon, & Otto, 2010), and concurrent treatment of substance abuse within PTSD may decrease the risk of relapse (e.g., Antoni et al., 2000).”
Background
Alcohol and other drug (AOD) staffing and their workplace: examining the relationship between clinician and organisational workforce characteristics and treatment outcomes in the AOD field
van de Ven, K., Ritter, A. J., & ROCHE, A. M. (2019) · Drugs Education Prevention and Policy · doi:10.1080/09687637.2019.1622649 · Cited by 27
“…2006; Rawson et al., 2000; Ross et al., 2005), the type of treatment provided and its associated efficacy and effectiveness (Amato et al., 2005; Magill & Ray, 2009; Weisner, Matzger, & Kaskutas, 2003), the quality of the therapeutic relationship (Connors, Carroll, DiClemente, Longabaugh, &…”
Background
A Mobile Phone App Featuring Cue Exposure Therapy As Aftercare for Alcohol Use Disorders: An Investigator-Blinded Randomized Controlled Trial
Mellentin, A. I., Nielsen, B., Nielsen, A. S., Yu, F., Mejldal, A., Nielsen, D. G., & Stenager, E. N. (2019) · JMIR mhealth and uhealth · doi:10.2196/13793 · Cited by 26
“This is expected because cognitive behavioral therapy is one of the most effective evidence-based psychological interventions for AUD [9-12].”
Cognitive-behavioral therapy and buprenorphine for opioid use disorder: A systematic review and meta-analysis of randomized controlled trials
Gregory, V. L., & Ellis, R. J. B. (2020) · The American Journal of Drug and Alcohol Abuse · doi:10.1080/00952990.2020.1780602 · Cited by 26
“Cognitive-behavioral therapies (CBT) are one of the most researched psychosocial interventions for substance use disorders (11).”
Background
Reducing Juvenile Recidivism With Cognitive Training and a Cell Phone Follow-Up
Burraston, B. O., Cherrington, D. J., & Bahr, S. J. (2010) · International Journal of Offender Therapy and Comparative Criminology · doi:10.1177/0306624x10388635 · Cited by 28
“Although some uncertainty remains about the longterm impacts of cognitive–behavioral programs, recent research confirms that they are useful interventions that tend to reduce drug use and recidivism (Dutra et al., 2008; Magill & Ray, 2009; Milkman & Wanberg, 2007).”
Background
Duration of therapy – Does it matter?
Schmidt, L. K., Bojesen, A. B., Nielsen, A. S., & Andersen, K. (2017) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2017.11.002 · Cited by 31
Memory-Focused Cognitive Therapy for Cocaine Use Disorder: Theory, Procedures and Preliminary Evidence From an External Pilot Randomised Controlled Trial
Marsden, J., Goetz, C., Meynen, T., Mitcheson, L., Stillwell, G., Eastwood, B., Strang, J., & Grey, N. (2018) · EBioMedicine · doi:10.1016/j.ebiom.2018.01.039 · Cited by 26
“This is the estimate of effectiveness for CBT on reduced cocaine use from meta-analysis (Magill & Ray, 2009).”
MethodInfluential
Computerized Cognitive Behavioral Therapy for Substance Use Disorders: A Summary of the Evidence and Potential Mechanisms of Behavior Change
Kiluk, B. D. (2019) · Perspectives on Behavior Science · doi:10.1007/s40614-019-00205-2 · Cited by 25
Integrated Cognitive-Behavioral Therapy for Social Anxiety and HIV/STI Prevention for Gay and Bisexual Men: A Pilot Intervention Trial
Hart, T. A., Noor, S. W. B., Vernon, J. R. G., Antony, M. M., Gardner, S. L., & O’Cleirigh, C. M. (2019) · Behavior Therapy · doi:10.1016/j.beth.2019.09.001 · Cited by 26
How to increase the role of social workers in suicide preventive interventions
Levine, J., & Sher, L. (2020) · Acta Neuropsychiatrica · doi:10.1017/neu.2020.11 · Cited by 29
Understanding eHealth Cognitive Behavioral Therapy Targeting Substance Use: Realist Review
Shams, F., Wong, J. S. H., Nikoo, M., Outadi, A., Zadeh, E. M., Kamel, M. M., Song, M. J., Jang, K. L., & Krausz, M. R. (2020) · Journal of Medical Internet Research · doi:10.2196/20557 · Cited by 25
“These eHealth interventions have been used to target a range of substance use problems and have demonstrated effectiveness in previous meta-analyses [7-15].”
Method
Clinical Effectiveness of an Intensive Outpatient Program for Integrated Treatment of Comorbid Substance Abuse and Mental Health Disorders
Watkins, L. E., Patton, S. C., Drexler, K. P. G., Rauch, S. A. M., & ROTHBAUM, B. O. (2022) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2022.05.005 · Cited by 29
“Counselor in Your Pocket”: Youth and Provider Perspectives on a Mobile Motivational Intervention for Marijuana Use
Shrier, L. A., Rhoads, A. M., Fredette, M. E., & Burke, P. J. (2013) · Substance Use & Misuse · doi:10.3109/10826084.2013.824470 · Cited by 23
“Cognitive behavioral therapy (CBT), which emphasizes self-monitoring, has been shown to be an efficacious treatment for substance use disorders and may be particularly useful for cannabis misuse (Magill & Ray, 2009).”
Background
Alcohol consumption, alcohol dependence, and related mortality in Italy in 2004: effects of treatment-based interventions on alcohol dependence
Shield, K. D., Rehm, J. T., Gmel, G. E., Rehm, M. X., & Allamani, A. (2013) · Substance Abuse Treatment Prevention and Policy · doi:10.1186/1747-597x-8-21 · Cited by 25
“For these simulations, we examined the effects of increasing the AD treatment coverage for five different treatments: Acamprosate and opioid antagonists therapy (referred to in this paper as pharmacological treatment) [23,24], Motivational Interviewing/ Cognitive Behavioral Therapy (MI/CBT) [25,26], MI/ CBT assuming t…”
Method
Relapse prevention: From radical idea to common practice
Donovan, D. M., & Witkiewitz, K. A. (2012) · Addiction Research & Theory · doi:10.3109/16066359.2011.647133 · Cited by 25
“In a recent meta-analysis by Magill and Ray (2009), who evaluated 53 controlled trials of CBT for substance use disorders, the authors noted that the CBT studies evaluated in their review were based on the RP model.”
Method
Feasibility, acceptability and preliminary outcomes of a mindfulness-based relapse prevention program in a naturalistic setting among treatment-seeking patients with alcohol use disorder: A prospective observational study
von Hammerstein, C., Khazaal, Y., Dupuis, M., Aubin, H.-J., Benyamina, A., Luquiens, A., & Romo, L. (2019) · BMJ Open · doi:10.1136/bmjopen-2018-026839 · Cited by 24
“There is evidence supporting the efficacy of CBTs in the treatment of addictions.(4) However,”
Background
Therapeutic Potential of Embodied Cognition for Clinical Psychotherapies: From Theory to Practice
Fugate, J. M. B., Macrine, S. L., & Hernandez-Cuevas, E. M. (2024) · Cognitive Therapy and Research · doi:10.1007/s10608-024-10468-y · Cited by 29
ADHD and Substance Use Disorders in Young People: Considerations for Evaluation, Diagnosis, and Pharmacotherapy.
Taubin, D., Wilson, J. C., & Wilens, T. (2022) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2022.01.005 · Cited by 15
Cultural Adaptation of 2 Evidence-Based Alcohol Interventions for Antiretroviral Treatment Clinic Patients in Vietnam
Hutton, H. E., Lancaster, K. E., Zuskov, D., Mai, N. V. T., Quynh, B. X., Chander, G., Latkin, C. A., Vu, P. T., Sripaipan, T., Hà, T. V., et al. (2019) · Journal of the International Association of Providers of AIDS Care (JIAPAC) · doi:10.1177/2325958219854368 · Cited by 24
Chapter 23. Cognitive-Behavioral Therapy
Carroll, K. M., & Kiluk, B. D. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615373970.kb23 · Cited by 23
Cultural adaptations of cognitive behavioural therapy for Latin American patients: unexpected findings from a systematic review
Hernández, M. E. H., Waller, G., & Hardy, G. E. (2020) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x20000574 · Cited by 24
“It has proven to be helpful in treating anxiety and depression (e.g. Twomey et al., 2015), substance abuse (Magill and Ray, 2009), post-traumatic stress disorder (Karatzias et al., 2019) and insomnia (Mitchell et al., 2012).”
Background
Treatment of alcohol use disorder in patients with liver disease
Nielsen, A. S., Askgaard, G., & Thiele, M. S. (2022) · Current Opinion in Pharmacology · doi:10.1016/j.coph.2021.11.012 · Cited by 23
Offenders with mental health problems and problematic substance use: Affective psychopathic personality traits as potential barriers to participation in substance abuse interventions
Durbeej, N., Palmstierna, T., Berman, A. H., Kristiansson, M., & Gumpert, C. H. (2014) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2014.01.002 · Cited by 23
An exploratory evaluation of Take Control : A novel computer-delivered behavioral platform for placebo-controlled pharmacotherapy trials for alcohol use disorder
Devine, E. G., Ryan, M. L., Falk, D. E., Fertig, J. B., & Litten, R. Z. (2016) · Contemporary Clinical Trials · doi:10.1016/j.cct.2016.08.006 · Cited by 23
“Although the effect sizes generally are small to moderate [25], any variability in the therapy between treatment groups may mask detection of a medication's actual effect.”
Alcohol Consumption and Inpatient Health Service Utilization in a Cohort of Patients With Alcohol Dependence After 20 Years of Follow-up
Miquel, L., Gual, A., Vela, E., Lligoña, A., Bustins, M., Colom, J., & Rehm, J. T. (2016) · Alcohol and Alcoholism · doi:10.1093/alcalc/agw075 · Cited by 23
“Interventions that had success in reducing drinking levels including, but not limited to, alcohol dependence treatment have been associated with reduced morbidity and mortality (Magill and Ray, 2009; Rosner et al., 2010a, 2010b; McQueen et al., 2011) and a reduction of health utilization costs.”
Background
“Tougher than ever”: An exploration of relapse prevention strategies among patients recovering from poly-substance use disorders in Ghana
Appiah, R., Boakye, K. E., Ndaa, P. O., & Aziato, L. (2017) · Drugs Education Prevention and Policy · doi:10.1080/09687637.2017.1337080 · Cited by 26
“Previous studies (Greenfield et al., 2000; Irvin et al., 1999) and more recent ones (Hendershot et al., 2011; Magill & Ray, 2009) have also demonstrated the efficacy of psychosocial interventions in relapse prevention.”
Result

Authors: Magill, M., & Ray, L. A.
Affiliations: Brown University (US)
ORCID: Magill, Molly
Ray, Lara A.
Venue: Journal of Studies on Alcohol and Drugs
Publisher: Alcohol Research Documentation, Inc.
Published: 2009-07
Volume: 70
Issue: 4
Pages: 516-527
ISSN: 1937-1888 (ISSN-L)
1938-4114
DOI: 10.15288/jsad.2009.70.516
PMC: PMC2696292
OpenAlex: W2035068440
Cited by: 694
References: 111
Citations by year: 2026: 21 · 2025: 32 · 2024: 47 · 2023: 45 · 2022: 37 · 2021: 55 · 2020: 128 · 2019: 45 · 2018: 55 · 2017: 39 · 2016: 34 · 2015: 40 · 2014: 45 · 2013: 32 · 2012: 22
FWCI: 1.55
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Journal of Studies on Alcohol and Drugs (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Funders: Boston College
National Institute on Alcohol Abuse and Alcoholism (T32 AA07459-22, AA07459, T32AA007459)
Topics: Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords: cognitive behavioral therapy, alcoholism, treatment efficacy, cannabis use, short-term treatment, gender differences
MeSH terms: Adult, Alcoholism, Female, Humans, Male, Sex Characteristics, Time Factors, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Treatment Outcome, Substance-Related Disorders

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Cognitive-Behavioral Treatment With Adult Alcohol and Illicit Drug Users: A Meta-Analysis of Randomized Controlled Trials

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