Background: Addiction treatment has evolved dramatically over the past two decades, with mounting evidence supporting integrated approaches across both substance use disorders and process addictions. This comprehensive review synthesizes current evidence to guide clinical decision-making across the full spectrum of addictive disorders. Methods: A systematic literature review was conducted examining evidence-based treatments for substance use disorders and process addictions. Sources included systematic reviews, meta-analyses, randomized controlled trials, and clinical guidelines from major databases and professional organizations. The review encompasses pharmacological interventions, behavioral therapies, and integrated treatment approaches. Results: Combined cognitive behavioral therapy and pharmacotherapy demonstrated superior effectiveness compared to usual care and pharmacotherapy alone across multiple substance types 1. Medication-assisted treatment represents the gold standard for opioid use disorders, with methadone showing four-fold increased treatment retention and reduced heroin use compared to placebo 2. Process addictions, including food addiction (2.8% lifetime prevalence) 3, sex addiction (3-6% prevalence) 4,5, and gambling disorder (up to 6% global prevalence) 6, respond to adapted evidence-based interventions developed for substance use disorders. Twelvestep facilitation interventions showed 42% continuous abstinence at one year compared to 35% for other treatments including CBT 7,8. Acceptance and commitment therapy demonstrated higher abstinence rates than CBT at end of treatment 9. Implementation gaps persist, with only a small percentage of services providing evidence-based treatments despite robust efficacy data 10. Conclusions: The evidence overwhelmingly supports integrated, multi-modal approaches combining pharmacotherapy with behavioral interventions when appropriate. Treatment selection should be individualized based on addiction type, severity, co-occurring conditions, and patient preferences while maintaining fidelity to evidence-based protocols. Process addictions require similar comprehensive approaches with adaptations for behavioral patterns. Addressing implementation gaps through workforce development, policy changes, and systemlevel improvements remains critical for translating evidence into practice.
Julian Ungar-Sargon (Thu,) studied this question.