The promise of third-wave behavioral therapies in the treatment of substance use disorders

• Positive treatment effects have been found for ACT and DBT with substance abusers.
• Significant emphasis is placed on understanding treatment mechanisms for ACT and DBT.
• Additional research with larger samples and active control groups is needed.

Substance use disorders (SUDs) are common and frequently complex, with overlapping medical, legal, social and psychiatric problems. Innovative treatment models to address the full range of problems in new ways using common principles are needed. Third wave behavior therapies such as Acceptance and Commitment Therapy (ACT) and Dialectical Behavior Therapy (DBT) comprise novel approaches and methods that have great potential to address complex substance abuse cases. These treatment models derive from contextual and behavioral science and have a common emphasis on developing empirical, principle-driven methods for approaching unwanted or distressing psychological and physical experiences common to substance use and other disorders. RCTs targeting substance use with ACT and DBT have been conducted across varying populations, including various target substances (opiates, methamphetamine, polysubstance) and settings (prisons, methadone clinics, residential treatment, and outpatient). Despite methodological heterogeneity, ACT and DBT have compared favorably to passive and active control conditions. Further research is needed, however, with larger samples and active control conditions, along with studies of treatment mechanisms, to inform and shape theoretical models and substance abuse treatment protocols for enhanced efficacy.