Dialectical behaviour therapy and 12‐step programmes for substance use disorder: A systematic review and meta‐analysis

Abstract

AbstractBackgroundResearch on dialectical behaviour therapy (DBT) or 12‐step programmes has shown inconclusive results; no systematic review has directly compared the two.ObjectivesThe goals of this meta‐analytic review were to assess if DBT is more effective than treatment as usual (TAU) and if DBT is more effective than 12‐step programmes (including twelve‐step facilitation [TSF] and self‐help groups like Alcoholics Anonymous) for substance use disorder (SUD).MethodsWe searched for randomised controlled trials (RCTs) and extracted data on the following outcomes: reduction in substance use, retention in treatment, severity of substance dependence/abuse and severity of mental health symptoms. Studies involved adult (>18 years) women with SUD, according to DSM‐5 or the equivalent diagnoses in DSM‐IV. Three RCTs met the inclusion criteria and contained appropriate data for meta‐analysis (75 participants).ResultsNo significant effects of DBT have been found compared to 12‐step programmes. Comparing DBT with TAU, we found a beneficial short‐term (1 RCT, n = 12, SMD = −0.84; 95% CI [−1.64, −0.04]) and long‐term (2 RCTs, n = 29, SMD = −1.26; 95% CI [−2.13, −0.40]) effect of DBT on severity of substance use.ConclusionsDespite the limited evidence of the present review, contextual evidence supports DBT and 12‐step programmes. RCTs with larger sample sizes are needed to better elucidate the impact of both treatments on SUD and facilitate the comparison between DBT and 12 steps programmes.