Acceptance and Commitment Therapy and Drug Use: A Systematic Review

Maia, Mariana Fonseca Carvalho; Santos, Bruna Ferreira dos; Castro, Lorrainy Costa de; Vieira, Natália São Tiago; Silveira, Pollyanna Santos da

doi:10.1590/1982-4327e3136

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Psychology of Health • Paidéia (Ribeirão Preto) 31 • 2021 • https://doi.org/10.1590/1982-4327e3136 copy

Acceptance and Commitment Therapy and Drug Use: A Systematic Review

Terapia de Aceitação e Compromisso e Uso de Drogas: Uma Revisão Sistemática

Terapia de Aceptación y Compromiso y Uso de Drogas: Una Revisión Sistemática

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The harmful use of psychoactive substances has been considered one of the biggest public health issues. Several approaches are used for the treatment of disorders related to substance use in the face of the challenges imposed. This study aimed to identify the empirical works that used ACT for the treatment of substance use and their respective results regarding acceptance, feasibility, and reduction in the severity of dependence, as well as the results related to comorbidities and other aspects associated with drugs use by a systematic review of the literature on the subject, using the recommendations of the Preferred Report Items for Systematic Reviews and Meta-Analyses (PRISMA) guide and searches in PubMed, APA PsycNET, SciELO, ScienceDirect, Web of Science, VHL, and LILACS. In total, 17 studies were analyzed, allowing the observation of an increase in psychological flexibility, attenuation of treatment dropout rates, and a reduction in substance use in the analyzed interventions.

Keywords:
drugs; cognitive therapy; psychological intervention

Articles	Population (n)	Objectives	Instruments
Luoma, Kohlenberg, Hayes and Fletcher (2011Luoma, J. B., Kohlenberg, B. S., Hayes, S. C., & Fletcher, L. (2011). Slow and steady wins the race: A randomized clinical trial of acceptance and commitment therapy targeting shame in substance use disorders. Journal of Consulting and Clinical Psychology, 80(1), 43-53. doi:10.1037/a0026070 https://doi.org/10.1037/a0026070... )	Program participants (n = 133)	Assess ACT for reducing shame in substance users	ISS; TSR; TLFB; The General Health Questinnaire- 12; The Quality of Life Scale; The Multidimentional Scale of Perceveid Social Support.
Litvin, Kovacs, Hayes and Brandon (2012Litvin, E. B., Kovacs, M. A., Hayes, P. L., & Brandon, T. H. (2012). Responding to tobacco craving: Experimental test of acceptance versus suppression. Psychology of Addictive Behaviors, 26(4), 830-837. doi:10.1037/a0030351 https://doi.org/10.1037/a0030351... )	Adult smokers (n = 162)	Compare ACT to suppression technique	FTND; QSU-4; Single item urgency scale; Magnitude estimate of desire.
Villagrá Lanza & Gonzáles-Menéndez (2013Villagrá Lanza P., & González-Menéndez, A. (2013). Acceptance and commitment therapy for drug abuse in incarcerated women. Psicothema, 25(3), 307-312. doi:10.7334/psicothema2012.292 https://doi.org/10.7334/psicothema2012.2... )	Incarcerated women (n = 31)	Test the effectiveness of ACT in the treatment of substance use disorders	Interview ad hac; MINI International Neuropsychiatric Interview; ASI-6; Anxiety sensitivity index; AAQ-II; AU; Auto save.
Villagrá Lanza, Fernández García, Rodríguez Lamelas and González-Menéndez (2014Villagrá Lanza, P., Fernández García, P., Rodríguez Lamelas, F., & González-Menéndez, A. (2014). Acceptance and commitment therapy versus cognitive behavioral therapy in the treatment of substance use disorder with incarcerated women: Drug abuse treatments to incarcerated women. Journal of Clinical Psychology, 70(7), 644-657. doi:10.1002/jclp.22060 https://doi.org/10.1002/jclp.22060... )	Incarcerated women (n = 50)	Determine the differential efficacy of ACT and CBT in substance use disorders	ASI-6; MINI Internacional Neuropsychiatric Interview; ASI; AAQ-II; UA; Auto save.
Kelly et al. (2015Kelly, M. M., Sido, H., Forsyth, J. P., Ziedonis, D. M., Kalman, D., & Cooney, J. L. (2015). Acceptance and commitment therapy smoking cessation treatment for veterans with posttraumatic stress disorder: A pilot study. Journal of Dual Diagnosis , 11(1), 50-55. doi:10.1080/15504263.2014.992201 https://doi.org/10.1080/15504263.2014.99... )	Smokers undergoing drug treatment for bipolar disorder and smoking (n = 19)	Evaluation of the viability and acceptance of ACT-TP combined with nicotine patches	Structured clinical interview for the non-patient version of the DSM-IV; FTND; The scale of contemplation; CSQ-8; QSU-Brief; Self report.
Marín Romero (2015Marín Romero, B. (2015). Tratamiento mediante ACT en un caso de conductas adictivas con sintomatología prefrontal [Treatment by ACT in a case of addictive behaviors with prefrontal symptoms]. Apuntes de Psicología, 33(3), 117-126. Retrieved from https://idus.us.es/bitstream/handle/11441/85145/568-1288-1-SM.pdf?sequence=1&isAllowed=y https://idus.us.es/bitstream/handle/1144... )	Adult multi-drug user (n = 1)	ACT-based intervention in conjunction with neuropsychological rehabilitation to reduce substance use	AAQ-II; ISP; SCL-90-R Symptoms Inventory; MoCA; VinciDrog.
Thekiso et al. (2015Thekiso, T. B., Murphy, P., Milnes, J., Lambe, K., Curtin, A., & Farren, C. K. (2015). Acceptance and commitment therapy in the treatment of alcohol use disorder and comorbid affective disorder: A pilot matched control trial. Behavior Therapy , 46(6), 717-728. doi:10.1016/j.beth.2015.05.005 https://doi.org/10.1016/j.beth.2015.05.0... )	Hospital patients with comorbid affective disorder (n = 52)	Examine the effectiveness of ACT added to the usual treatment	TLFB; BDI; BAI; YMRS
Mak, Lee e Loke (2015Mak, Y. W., Lee, P. H., & Loke, A. Y. (2015). Predictors of participation in a telephone-based acceptance and commitment therapy for smoking cessation study. BMC Public Health, 15(1), 1288. doi:10.1186/s12889-015-2650-0 https://doi.org/10.1186/s12889-015-2650-... )	Smoking patients in Primary Care Centers (n = 420)	Explore factors related to participation in an ACT-based program	SF-12; FTND; ERQ
Heffner, McClure, Mull, Anthenelli e Bricker (2015Heffner, J. L., McClure, J. B., Mull, K. E., Anthenelli, R. M., & Bricker, J. B. (2015). Acceptance and commitment therapy and nicotine patch for smokers with bipolar disorder: Preliminary evaluation of in-person and telephone-delivered treatment. Bipolar Disorders, 17(5), 560-566. doi:10.1111/bdi.12300 https://doi.org/10.1111/bdi.12300... )	Group Health members daily smokers with bipolar disorder (n = 16)	Develop and test new smoking cessation intervention by combining ACT with the use of nicotine patches	Semi-structured assessment protocol for the genetics of alcoholism; YMRS; MADRS; MINI International Neuropsychiatric Interview; PHQ-9; ASRM
Jones et al. (2015Jones, H. A., Heffner, J. L., Mercer, L., Wyszynski, C. M., Vilardaga, R., & Bricker, J. B. (2015). Web-based acceptance and commitment therapy smoking cessation treatment for smokers with depressive symptoms. Journal of Dual Diagnosis, 11(1), 56-62. doi:10.1080/15504263.2014.992588 https://doi.org/10.1080/15504263.2014.99... )	General population of smokers (n = 94)	Compare the receptivity of treatment with ACT with a government program via web	Anxiety and Depression Detector; AIS-27; Satisfaction questionnaire.
Zeng et al. (2016Zeng, E. Y., Heffner, J. L., Copeland, W. K., Mull, K. E., & Bricker, J. B. (2016). Get with the program: Adherence to a smartphone app for smoking cessation. Addictive Behaviors, 63, 120-124. doi:10.1016/j.addbeh.2016.07.007 https://doi.org/10.1016/j.addbeh.2016.07... )	General population of smokers (n = 84)	Examine a smoking cessation app based in the ACT	AIS-27
Smallwood, Potter e Robin (2016Smallwood, R. F., Potter, J. S., & Robin, D. A. (2016). Neurophysiological mechanisms in acceptance and commitment therapy in opioid-addicted patients with chronic pain. Psychiatry Research: Neuroimaging, 250, 12-14. doi:10.1016/j.pscychresns.2016.03.001 https://doi.org/10.1016/j.pscychresns.20... )	Patients with chronic low back pain (n = 12)	Assess ACT in relation to pain and opioid dependence	AAQ-II; MAAS; RMDQ; Ten Point (0-9); SPM8.
Thurstone, Hull, Timmerman and Emrick (2017Thurstone, C., Hull, M., Timmerman, J., & Emrick, C. (2017). Development of a motivational interviewing/acceptance and commitment therapy model for adolescent substance use treatment. Journal of Contextual Behavioral Science, 6(4), 375-379. doi:10.1016/j.jcbs.2017.08.005 https://doi.org/10.1016/j.jcbs.2017.08.0... )	Adolescents in substance use treatment program (n = 41)	Intervention with Motivational Interview/ACT for the treatment of substance use, evaluating its viability	ORS; TLFB; SRS
Shorey et al. (2017Shorey, R. C., Elmquist, J., Gawrysiak, M. J., Strauss, C., Haynes, E., Anderson, S., & Stuart, G. L. (2017). A randomized controlled trial of a mindfulness and acceptance group therapy for residential substance use patients. Substance Use & Misuse, 52(11), 1400-1410. doi:10.1080/10826084.2017.1284232 https://doi.org/10.1080/10826084.2017.12... )	Residential substance use treatment program (n = 117)	Verify the effectiveness of Mindfulness and ACT-based interventions in relation to the usual treatment	PACS; FFMQ; AAQ-AS

Aspect	Result
Method	Number of Publications / (%)
Type of design
Quantitative	12 / (85.71)
Qualitative/Quantitative	02 / (14.29)
Target Audience:
Population:
Teens of both sexes	01 / (7.14%)
Adults of both sexes	09 / (64.29%)
Women	02 / (14.29%)
Men	01 / (7.14%)
Elderly Men	01 / (7.14%)
Drugs evidenced
Alcohol	01 / (7.14%)
Tobacco	06 / (42,86%)
Opiates	01 / (7.14%)
Drugs in general	06 / (42,86%)
Comorbidities
Neuropsychological comorbidities	01 / (7.14%)
Depression	02 / (14.29%)
Bipolar Affective Disorder (BAD)	02 / (14.29%)
Posttraumatic Stress Disorder (PTSD)	01 / (7.14%)
Mental disorders in general	01 / (7.14%)
No disorder identified	07 / (50.00%)
Procedures
Individual	07 / (50.00%)
Grupal	07 / (50.00%)
Face-to-face mode	09 / (64.29%)
Distance mode	05 / (35.71%)
Via phone	03 / (21.42%)
Via web	01 / (7.14%)
Via smartphone app	01 / (7.14%)
Random distribution	09 / (64.29%)
Control group	08 / (57,12%)
Pre-test	12 / (85.71%)
Post-test	09 / (64.29%)
Main Results
Effectiveness of ACT in relation to the reduction of drug use	09 / (64.29%)
Increased acceptance and psychological flexibility	05 / (35.71%)
Effectiveness in reducing the desire to use substances and greater adherence to treatment	05 / (35.71%)
Increased confidence, motivation and reduction of comorbidities related to substance use	05 / (35.71%)
Reduction of comorbid symptoms	06 / (42,86%)
High receptivity, increased probability of adherence and the levels of acceptance based on the benefits of treatment	04 / (28.58%)

Universidade de São Paulo, Faculdade de Filosofia Ciências e Letras de Ribeirão Preto, Programa de Pós-Graduação em Psicologia Av.Bandeirantes 3900 - Monte Alegre, 14040-901 Ribeirão Preto - São Paulo - Brasil, Tel.: (55 16) 3315-3829 - Ribeirão Preto - SP - Brazil
E-mail: paideia@usp.br

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[1] Correspondence adress: Pollyanna Santos da Silveira. Universidade Católica de Petrópolis. Rua Benjamin Constant, 213 - Centro, Petrópolis-RJ, Brazil. CEP 25.610-130. E-mail: pollyanna.silveira@ucp.br