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

Background: Research on dialectical behaviour therapy (DBT) or 12-step programmes has shown inconclusive results; no systematic review has directly compared the two. Objectives: The 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). Methods: We 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). Results: No 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. Conclusions: Despite 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.