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Cognitive-Behavioral Treatment With Adult Alcohol and Illicit Drug Users: A Meta-Analysis of Randomized Controlled Trials
Open accessAbstract
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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“However, some patients are resistant to CBTs and its effectiveness decreases in the long term.4”
From 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 (2019) · cites this paper as [4]
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“Magill and Ray [41] found that CBT was most effective for individuals with marijuana use disorders.”
From Relapse prevention for addictive behaviors (2011) · cites this paper as [41]
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“the authors concluded that 58% of individuals who received CBT had better outcomes than those in comparison conditions.”
From Relapse prevention for addictive behaviors (2011) · cites this paper as [41]
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“It is widely known as being effective for a range of conditions, including cessation of smoking [57] and other drugs [58], managing pain [59], and relieving symptoms of mental ill-health across a range of psychological disorders [56].”
From Apps with maps-anxiety and depression mobile apps with evidence-based frameworks: Systematic search of major app stores (2020) · cites this paper as [58]
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“There is evidence supporting the efficacy of CBTs in the treatment of addictions.4”
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“Even though several psychosocial interventions have shown their efficacy for treating drug, alcohol (Dutra et al., 2008; Magill and Ray, 2009), and gambling disorders (Pallesen et al., 2005; Gooding and Tarrier, 2009), help-seeking rates are low.”
From Online and Mobile Interventions for Problem Gambling, Alcohol, and Drugs: A Systematic Review (2017) · cites this paper as Magill and Ray, 2009
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“Traditional outpatient CBT programs have typically demonstrated modest to moderate improvements in psychological well-being and reductions in substance use (37, 38), but often lack the integrative components employed in the present study — such as yoga, acupuncture, and structured mindfulness.”
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“14 Contrast-ingly, in a recent meta-analysis of CBT for SUD, sex was not a signi fi cant moderator of effect size; however, only one-third of the sample were women, possibly limiting the ability to detect a statistically signi fi cant relationship.”
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Myles, L. A. M. (2026) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x26100890
“Narrative and meta-analytic reviews of randomised controlled trials (RCTs) suggest that CBT produces small, but reliable, improvements in both alcohol and illicit SUDs (Mehta et al ., 2021; Zamboni et al ., 2021), with sustained effects 12 months after treatment (Magill and Ray, 2009).”
Clinical features of mental imagery in substance use disorders: A mixed‐methods analysis
Scott, G., Meynen, T., Small, F., Mitcheson, L., Appiah‐Kusi, E., Barber, W. H., Hirsch, C. R., & Marsden, J. (2026) · Addiction · doi:10.1111/add.70685
Reis, A. C., Hayward, P., Kearns, A., Whitton, G., Peel, N., & Fatema, K. (2026) · The Arts in Psychotherapy · doi:10.1016/j.aip.2026.102563
(2014) · Työväentutkimus Vuosikirja · Cited by 1
Metadata
- Authors
- Magill, M., & Ray, L. A.
- Affiliations
- Brown University (US)
- 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
- 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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