Substance Use & Addictions
Substance-Related and Addictive Disorders (DSM-5-TR)
Compulsive use despite consequences, tolerance, withdrawal, and functional impairment. Includes alcohol, opioids, stimulants, cannabis, and behavioral addictions. MI, CBT, contingency management, and 12-step facilitation have strong evidence.
Prevalence: ~17% for any SUD in past year (US)
29 Therapeutic Approaches
Sorted by evidence tier: guideline-recommended first, then RCT-supported, then emerging/limited evidence.
Guideline-Recommended (6)
Integrative
12-Step Facilitation
Nowinski / Baker / Carroll · 1992
Project MATCH: equivalent to CBT and MET
Family Systems
Brief Strategic Family Therapy
Jose Szapocznik · 1978
NIDA recommended; SAMHSA NREPP listed; WHO mhGAP references family interventions
Cognitive-Behavioral
Community Reinforcement Approach
George Hunt / Nathan Azrin · 1973
SAMHSA: evidence-based; included in NIDA principles; strong VA/DoD evidence base for SUD
Behavioral
Contingency Management
Higgins / Petry · 1991
SAMHSA: endorsed and funded (2023). NICE: recommended
Humanistic
Motivational Enhancement Therapy
William Miller (Project MATCH) · 1993
NICE: referenced for alcohol use. VA/DoD: referenced within MI recommendations
Humanistic
Motivational Interviewing
Miller / Rollnick · 1983
Effect: d = 0.28
~25-35% improvement over control
NICE: recommended for substance use. SAMHSA: listed
RCT-Supported (17)
Cognitive-Behavioral
ACT
Steven Hayes · 1999
Cognitive-Behavioral
Behavioral Couples Therapy
Neil Jacobson / Andrew Christensen · 1979
Cognitive-Behavioral
CBT
Aaron Beck · 1964
Cognitive-Behavioral
CBT-I
Spielman / Perlis · 1987
Family Systems
FFT
Alexander / Parsons · 1973
Cognitive-Behavioral
iCBT
Various (Andersson / Titov) · 2000
Cognitive-Behavioral
Imagery Rehearsal Therapy
Barry Krakow · 1995
Psychedelic
KAP
Various (Wolfson, Bennett) · 2010
Contemplative
Mindfulness-Based Relapse Prevention
Sarah Bowen / Neha Chawla / G. Alan Marlatt · 2010
Effect: d = 0.42
~31% fewer heavy drinking days vs TAU
Family Systems
MST
Scott Henggeler · 1998
Psychedelic
Psilocybin-Assisted Therapy
Griffiths / Carhart-Harris · 2016
Cognitive-Behavioral
REBT
Albert Ellis · 1955
Cognitive-Behavioral
Seeking Safety
Lisa Najavits · 2002
Effect: d = 0.35 for PTSD + SUD
~30-40% improvement in both
Postmodern
SFBT
de Shazer / Insoo Kim Berg · 1985
Family Systems
Strategic Family Therapy
Jay Haley / Cloe Madanes · 1973
Psychedelic
EMBARK
Brennan / Belser · 2022
Somatic
Neurofeedback
Barry Sterman / Joel Lubar · 1968
Emerging / Limited Evidence (6)
Contemplative
Buddhist Psychology / Contemplative Psychotherapy
Chögyam Trungpa / Jack Kornfield / Mark Epstein · 1974
Psychedelic
Holotropic Breathwork
Stanislav Grof / Christina Grof · 1976
Eastern-Influenced
Naikan Therapy
Ishin Yoshimoto · 1940
Psychedelic
Psychedelic Harm Reduction & Integration (PHRI)
Various (Gorman, Nielson, Gael) · 2015
Cognitive-Behavioral
Reality Therapy / Choice Theory
William Glasser · 1965
Existential
Transpersonal Psychology
Abraham Maslow / Stanislav Grof · 1969
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