Global practices in adapting cognitive behavioral therapy for ethnoracial populations with substance use disorders: a scoping review of adaptation strategies, treatment outcomes, and geographic gaps.

Abstract

Background: Cognitive behavioral therapy (CBT) is an evidence-based treatment for substance use disorders (SUDs), yet standard protocols may have limited cultural relevance for ethnoracially diverse populations. Cultural adaptation may enhance the fit and relevance of interventions; however, the scope, characteristics, and outcomes of ethnoracial adaptations of CBT for SUD remain underexamined. This scoping review mapped the global evidence on ethnoracially adapted CBT for SUDs, including strategies, implementation characteristics, and treatment outcomes.

Methods: Following PRISMA-ScR guidelines, we systematically searched nine databases for peer-reviewed empirical studies evaluating ethnoracially adapted CBT interventions for SUDs. Studies were included if they explicitly described an ethnoracial adaptation to CBT. Extracted data included study design, population characteristics, strategies, comparator conditions, implementation indicators, and substance use outcomes.

Results: Of 671 records identified, 12 studies met the inclusion criteria, representing populations in the United States and Kenya. Most studies focused on Latino/Hispanic populations living in the United States, with comparatively limited representation of other ethnoracial groups and low- and middle-income country contexts. Adaptations included both surface-structure modifications (e.g., language translation, culturally relevant examples, and tailored delivery formats) and deep-structure modifications that incorporated culturally relevant values, belief systems, and lived experiences into core CBT content and delivery. Most studies reported favorable substance use outcomes following participation in ethnoracially adapted CBT interventions. Several studies also identified culturally salient factors, including ethnic identity, familismo, and religiosity, as moderators or correlates of treatment response. However, implementation outcomes such as feasibility, fidelity, and acceptability were inconsistently reported, long-term follow-up data were limited, and only a small number of studies directly compared ethnoracially adapted CBT with standard CBT.

Conclusions: The current literature suggests that ethnoracially adapted CBT is a promising approach for addressing SUDs among diverse populations. However, limitations in implementation reporting, long-term outcome assessment, geographic representation, and direct comparisons with standard CBT constrain conclusions regarding the specific contribution of cultural adaptation to treatment outcomes. Future research should expand representation across ethnoracial groups and geographic regions and clarify how cultural adaptations influence treatment engagement, implementation, and substance use outcomes.