Psychosocial Interventions for Substance Use Disorder: A Systematic Review of Therapeutic Approaches and Their Clinical Effectiveness

INTRODUCTION: Psychosocial interventions are a core component of substance use disorder (SUD) treatment, yet recent evidence remains fragmented across substances, delivery formats and clinical contexts. The objective was to identify the most effective psychosocial intervention strategies for the treatment of SUD, considering different substances and delivery formats (face-to-face/digital/hybrid). METHOD: A PRISMA-guided systematic review was conducted and registered in PROSPERO (CRD42024600203). Searches were performed in Web of Science, PubMed/MEDLINE and Scopus (19 November-18 December 2025), including peer-reviewed RCTs published in English or Spanish (2021-2025) and excluding samples < 18 years. Methodological quality was assessed using the PEDro scale. RESULTS: From 843,112 articles, 64 randomized controlled trials were included. Cognitive behavioural therapy (CBT) and multicomponent approaches showed the most consistent support, particularly for alcohol and tobacco, while contingency management emerged as especially effective for engagement/retention and short-term abstinence, notably in cannabis and stimulants. Third-wave approaches (e.g., mindfulness) showed benefits for specific outcomes (e.g., craving, emotion regulation, stress tolerance), but with heterogeneous effects that depend on clinical and implementation factors. Accordingly, their use requires screening, monitoring and tailoring, and may not be advisable or potentially contraindicated for certain clinical profiles or in high-complexity contexts. Technology-assisted interventions appeared promising for expanding access and continuity, though impact depended on adherence and clinical integration. CONCLUSIONS: Evidence supports psychosocial interventions as essential for SUD care, with effectiveness varying by substance, format and context. When indicated, combined psychosocial and pharmacological care improves stabilization and maintenance.