2 - (OP2) Active Ingredients of Psychological Interventions for Substance Use Disorders: A Trans-theoretical Taxonomy

Importance: Psychological interventions are a mainstay of treatment for substance use disorders (SUDs), but their active ingredients remain unknown.

Objective: Identify active ingredients of evidence-based psychological interventions for SUDs and develop a trans-theoretical taxonomy.
Data Sources: The National Library of Medicine via Pubmed, searched on 11/01/2023 (update 04/01/2025) for network meta-analyses (NMAs) published since 11/01/2018, using keywords related to substance types, psychotherapy and network meta-analysis.
Study selection: Evidence-based psychological interventions were identified from randomized controlled trials (RCTs) included in a large, recent NMA of stand-alone interventions targeting a SUD. The selected NMA comprised 50 RCTs comparing any structured psychosocial intervention to active control or treatment as usual for cocaine and/or amphetamine use disorder in adults. A search update identified 10 additional RCTs meeting the index NMA’s eligibility criteria. From the 60 RCTs, two independent researchers identified all psychological intervention arms, defined as manualized and containing structured psychosocial components.
Data Extraction and Synthesis: PRISMA 2020 reporting guidelines were followed. For each psychological intervention, two researchers retrieved complete descriptions, like treatment protocols or manuals. Subsequently, they independently and iteratively extracted components, with multiple consensus meetings held for groups of 3-5 RCTs to standardize the extraction and coding decisions. Components were organized into higher-order categories with shared functional characteristics and unified definitions (active ingredients).
Main Outcome(s) and Measure(s): Active ingredients of psychological interventions, and unique intervention profiles, defined as distinct combinations of these.

Results: 109 psychological intervention arms yielded 1494 components, subsequently consolidated into a taxonomy of 25 distinct active ingredients. Four (therapeutic alliance, psycho-education, case formulation, relapse prevention) are elements common across therapeutic approaches. Based on the taxonomy, the 109 psychological arms were condensed in 38 unique profiles. Most frequently employed specific active ingredients included skill generalization (26/38 profiles), behavioral activation/lifestyle change (25/38), functional analysis (24/38), stress management & emotional regulation (23/38), motivation enhancement/addressing ambivalence (22/38), relationship/family counseling (20/38), and coping with craving (19/38). Least frequent components included mindfulness/meditation (3/38), specific sub-populations issues (4/38), decision-making skills (5/38), establishing a social support system (7/38), relaxation techniques (7/38), addressing spirituality and meaning (7/38), and comorbidities management (7/38).
Conclusions and Relevance: Recasting psychological interventions as unique combinations of active ingredients instead of trademarked protocols could accelerate treatment optimization and personalization by evaluating component contribution to overall efficacy and individualized response to components.