Cognitive Behavioural Therapy and Dual Diagnosis: A Systematic Review Exploring Its Effectiveness and Implications for Nursing Practice.
Dominic Nessbach, Alan Simpson
PMID 41108580WHAT IT FOUND
Cognitive behavioural therapy helps people with dual diagnosis reduce substance use and mental health symptoms, but it is often no more effective than standard addiction treatments alone.
Integrated approaches work, yet they do not clearly beat single-disorder care, so therapy choice should depend on patient tolerance and access.
Key findings
01Integrated CBT interventions reduced both PTSD and substance use symptoms, but the benefits were often only marginally better than treatments targeting substance use alone.
02For people with co-occurring psychosis and substance use, integrated CBT showed no advantage over standard care in improving mental health or substance use outcomes.
03Treatment dropout was high across integrated CBT studies, with only 31.8% of participants meeting completion criteria in one trial and average attendance at 50% of sessions in another.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study selection and data extraction were performed by a single author, which increases the risk of bias and errors in screening. The review did not include a meta-analysis due to the high variability in study designs and patient populations, limiting the ability to draw firm statistical conclusions. The review excluded studies on neurodevelopmental conditions like ADHD, so findings do not apply to patients with those comorbidities. Most included studies focused on PTSD and substance use, with very few addressing psychosis, depression, or anxiety, meaning the evidence is uneven across different dual diagnosis presentations. The review did not account for cultural factors or equality, diversity, and inclusion, which may affect how well these interventions work in different populations.
Declared interests
The authors declared no conflicts of interest. The study was conducted as part of a university degree dissertation and was not pre-registered.
The easy way to misread this
Do not conclude that integrated CBT is the gold standard for all dual diagnosis patients. The review found that integrated CBT was often no more effective than standard addiction treatments, and it showed no benefit for patients with co-occurring psychosis. Additionally, high dropout rates suggest that intensive integrated therapies may not be feasible for many patients without significant support for retention.