A meta-analysis of cognitive behavioral therapy for substance use disorder: Treatment effects by comparator type and consumption and psychosocial outcomes.

OBJECTIVE

This meta-analysis examines cognitive-behavioral therapy (CBT) for substance use disorders (SUD).

METHOD: A comprehensive literature search was conducted through June of 2025. All available outcomes were extracted and grouped into thirteen categories (e.g., abstinence, quantity of use, cognitive changes, quality of life), and into two broader outcome classes (i.e., consumption; psychosocial). Robust variance estimation accounted for clustering of effect sizes at the study level.

RESULTS

The sample included 52 randomized clinical trials (54 study sites; k = 68 publications; 887 effect sizes; N = 9442 participants). CBT was efficacious based on overall between-group pooled estimates, but sub-group analyses suggested effect variability by comparator type. Specifically, CBT did not outperform other evidence-based treatments but did outperform usual care or minimal treatment for consumption outcomes (g = 0.14: 95% CI = 0.01, 0.26, I2 = 61.8%; k = 28, keffectsize(es) = 182). When CBT was tested as an addition to usual care, it showed significant effects for consumption outcomes (g = 0.44: 95% CI = 0.01, 0.88, p = .048; I2 = 87.6%; k = 16, kes = 55) and psychosocial functioning (g = 0.56: 95% CI = 0.08, 1.03, I2 = 93.8%; k = 14, kes = 69). Within condition (i.e., change from baseline) effects were significant, positive, medium-sized, and heterogeneous.

CONCLUSIONS

CBT for SUD shows clinical benefit primarily for consumption outcomes, and when tested against non-evidence-based comparators. Residual heterogeneity in effect estimates also suggests effect sizes may vary by study design and population factors.