Cognitive-Behavioral Interventions Targeting Alcohol or Other Drug Use and Co-Occurring Mental Health Disorders: A Meta-Analysis

Aims: This meta-analysis reviewed 15 clinical trials (18 study sites/arms), examining the efficacy of an integrated cognitive-behavioral intervention (CBI) delivered to individuals with an alcohol or other drug use disorder and a co-occurring mental health disorder (AOD/MHD). Outcomes were alcohol or other drug use and mental health symptoms at post-treatment through follow-up. Methods: The inverse-variance weighted effect size was calculated for each study and pooled under random effects assumptions. Results: Integrated CBI showed a small effect size for AOD (g = 0.188, P = 0.061; I-2 = 86%, tau(2) = 0.126, k = 18) and MHD (g = 0.169, P = 0.024; I-2 = 58%, tau(2) = 0.052, k = 18) outcomes, although only MHD outcomes were statistically significant. Analysis by subgroup suggested that effect magnitude varied by type of contrast condition (integrated CBI + usual care vs. usual care only; integrated CBI vs. a single-disorder intervention), follow-up time point (post-treatment vs. 3-6 months) and primary AOD/MHD diagnosis, although these sub-groups often contained significant residual heterogeneity. In a series of mixed effects, meta-regression models, demographic factors were non-significant predictors of between-study heterogeneity. For AOD outcomes, greater effects were observed in higher quality studies, but study quality was not related to effect size variability for MHD outcomes. Conclusions: The current meta-analysis shows a small and variable effect for integrated CBI with the most promising effect sizes observed for integrated CBI compared with a single disorder intervention (typically an AOD-only intervention) for follow-up outcomes, and for interventions targeting alcohol use and/or post-traumatic stress disorder. Given the clinical and methodological variability within the sample, results should be considered a preliminary, but important step forward in our understanding of treatment for co-occurring AOD/MHD.

Automated summary

The integrated cognitive-behavioral intervention (CBI) for individuals with co-occurring alcohol or other drug use disorder and mental health disorder showed small effect sizes varied by different factors, with most promising results observed in comparison with single disorder interventions. Further research is needed to understand the treatment for co-occurring AOD/MHD disorders due to the clinical and methodological variability observed in the current meta-analysis.