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Evoking Change Through Acceptance and Awareness: A Sysematic Review of Third-Wave Therapies for Substance Use Disorder.

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Title: Evoking Change Through Acceptance and Awareness: A Sysematic Review of Third-Wave Therapies for Substance Use Disorder.
Authors: Calderone, Andrea (AUTHOR), Latella, Desirèe (AUTHOR), Todaro, Antonino (AUTHOR), De Luca, Rosaria (AUTHOR), Militi, David (AUTHOR), La Fauci, Elvira (AUTHOR), Sergi, Arturo (AUTHOR), Quartarone, Angelo (AUTHOR), Calabrò, Rocco Salvatore (AUTHOR)
Source: Substance Use & Misuse. 2026, Vol. 61 Issue 9, p1376-1397. 22p.
Subjects: Substance abuse treatment, Substance abuse diagnosis, World Wide Web, Medical information storage & retrieval systems, Emotion regulation, Research funding, Mindfulness, Classification of mental disorders, Treatment effectiveness, Descriptive statistics, Psychological well-being, Systematic reviews, MEDLINE, Medical databases, Quality of life, Acceptance & commitment therapy, Online information services, Psychology information storage & retrieval systems
Abstract: Background: Substance use disorders (SUDs) are a major global health burden, and third-wave therapies that target transdiagnostic processes such as psychological flexibility and mindfulness have emerged as promising options. This systematic review synthesized evidence on third-wave interventions for adults with diagnostic and statistical manual of mental disorder (DSM)-defined SUDs. Methods: A comprehensive search of seven databases (2014–2025) identified randomized and non-randomized studies of acceptance and commitment therapy (ACT), related mindfulness-based programs, and dialectical behavioral therapy skills training. Two reviewers screened records, extracted data, assessed risk of bias with Risk of Bias 2 (RoB 2) and risk of bias in non-randomized studies of interventions (ROBINS-I), and synthesized findings using SWiM-consistent narrative methods. The review was prospectively registered in PROSPERO (CRD420251028610). Results: Forty-seven studies (35 randomized, 12 non-randomized) met inclusion criteria. Across modalities, third-wave interventions yielded small-to-moderate benefits on abstinence, craving, and substance use outcomes compared with control conditions, with larger and more consistent gains in psychological flexibility, emotion regulation, and mindfulness. Effect sizes varied and most trials showed some concerns or serious risk of bias, resulting in generally low-to-moderate certainty of evidence. Conclusions: Third-wave interventions may serve as adjunctive or alternative SUD treatments by engaging targeted mechanisms, enhancing psychological functioning, and producing modest but clinically relevant substance-use benefits. More rigorous, adequately powered mechanism-focused trials are needed to clarify comparative efficacy and guide process-based personalization and implementation in routine addiction services. Highlights: The review identifies ACT, MBRP, and DBT skills training as promising interventions for SUDs. ACT improves abstinence and craving outcomes, especially in high-risk groups. MBRP reduces relapse risk and substance use versus treatment as usual. DBT skills training increases days of abstinence and reduces AUD severity. [ABSTRACT FROM AUTHOR]
Copyright of Substance Use & Misuse is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Evoking Change Through Acceptance and Awareness: A Sysematic Review of Third-Wave Therapies for Substance Use Disorder.
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– Name: Abstract
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  Data: Background: Substance use disorders (SUDs) are a major global health burden, and third-wave therapies that target transdiagnostic processes such as psychological flexibility and mindfulness have emerged as promising options. This systematic review synthesized evidence on third-wave interventions for adults with diagnostic and statistical manual of mental disorder (DSM)-defined SUDs. Methods: A comprehensive search of seven databases (2014–2025) identified randomized and non-randomized studies of acceptance and commitment therapy (ACT), related mindfulness-based programs, and dialectical behavioral therapy skills training. Two reviewers screened records, extracted data, assessed risk of bias with Risk of Bias 2 (RoB 2) and risk of bias in non-randomized studies of interventions (ROBINS-I), and synthesized findings using SWiM-consistent narrative methods. The review was prospectively registered in PROSPERO (CRD420251028610). Results: Forty-seven studies (35 randomized, 12 non-randomized) met inclusion criteria. Across modalities, third-wave interventions yielded small-to-moderate benefits on abstinence, craving, and substance use outcomes compared with control conditions, with larger and more consistent gains in psychological flexibility, emotion regulation, and mindfulness. Effect sizes varied and most trials showed some concerns or serious risk of bias, resulting in generally low-to-moderate certainty of evidence. Conclusions: Third-wave interventions may serve as adjunctive or alternative SUD treatments by engaging targeted mechanisms, enhancing psychological functioning, and producing modest but clinically relevant substance-use benefits. More rigorous, adequately powered mechanism-focused trials are needed to clarify comparative efficacy and guide process-based personalization and implementation in routine addiction services. Highlights: The review identifies ACT, MBRP, and DBT skills training as promising interventions for SUDs. ACT improves abstinence and craving outcomes, especially in high-risk groups. MBRP reduces relapse risk and substance use versus treatment as usual. DBT skills training increases days of abstinence and reduces AUD severity. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Substance Use & Misuse is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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        Value: 10.1080/10826084.2025.2606861
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