Date of Award

Summer 8-2020

Document Type


Degree Name

Doctor of Philosophy (PhD)


Counseling & Human Services



Committee Director

Nina G. Brown

Committee Member

Corrin Richels

Committee Member

Narketta Sparkman-Key


The purpose of this systematic review and meta-analysis was to compare group treatment effectiveness for substance use disorders within the U.S. across treatment philosophies as it relates to the primary research question, Is there a significant difference of group treatment effectiveness between Abstinence and Harm Reduction treatment philosophies? It was hypothesized that group treatment will remain an effective intervention to treat substance use disorders between treatment philosophies and that no significant differences exist between-group comparisons. The aim of this study is to provide evidence of treatment effectiveness that will ultimately improve treatment outcomes for substance use disorders, provide guidance for broader implementation of evidence-based treatment approaches within the U.S., and to provide current information for evidence-based decision-making.

Targeted studies included randomized and non-randomized controlled trials published in scholarly, peer-reviewed journals within the past 15 years, i.e. 2004-2020. Targeted participants were individuals diagnosed with one or more substance use disorders and/or co-occurring disorders. Treatment outcomes must be measured in quantitative methods with group treatment as the independent variable and substance use disorder outcomes as the dependent variables. The selected studies must indicate treatment philosophy used and provide a direct comparison of Abstinence and Harm Reduction. Random-effects model meta-analysis was used to compute effect sizes for treatment outcomes to compare treatment philosophies.

Five studies met eligibility criteria (Miotto et al., 2012; Nyamathi et al., 2011; Rosenblum et al., 2005; Weiss et al., 2007; Weiss et al., 2009). In four of the five included studies, the Harm Reduction condition outperformed the Abstinence condition. However, the meta-analysis indicated that there was not a statistically significant difference between outcomes of substance use by treatment philosophy (Z = 1.29) and (P = 0.20). However, there may be a clinically significant difference due to the aggregate standardized mean difference (-0.15, CI [-0.38, 0.08]) which favors Harm Reduction over Abstinence in the reduction of substance use. Future research focused on clearly identified group treatment philosophy is imperative to provide up-to-date and a more accurate reflection on the effectiveness for treating substance use disorders.


In Copyright. URI: This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s).