{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T06:00:34Z","timestamp":1785477634207,"version":"3.56.0"},"reference-count":66,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T00:00:00Z","timestamp":1785456000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"\n Background<\/jats:title>\n Problematic substance use is a public health issue that causes significant physical and mental health and societal consequences. Integrated intensive outpatient treatment has shown promise in addressing the multifaceted nature of substance use disorders (SUD). However, the scientific literature on such integrative interventions remains limited.<\/jats:p>\n <\/jats:sec>\n \n Aim<\/jats:title>\n This study aimed to evaluate the outcomes of an integrated, intensive outpatient intervention for clients with SUD in Sweden. Building on previous findings from the same clinic, this study analyzes a new cohort of clients and expands the scope of evaluation to include additional outcome measures, such as craving and affective states, alongside psychological and psychiatric assessments.<\/jats:p>\n <\/jats:sec>\n \n Method<\/jats:title>\n This study constitutes a naturalistic service evaluation, not a clinical trial, as it examines the outcomes of a pre-existing, routinely delivered outpatient program within Swedish municipal social services, without randomization, control conditions, or experimental manipulation of treatment. This is a prospective cohort study with a pre\u2013post, within-subject comparison design. Between 2018 and 2023, 127 clients referred by social services, primarily diagnosed with SUD, participated in a four-month cognitive-behavioral therapy-based integrated intervention. 44% (N\u00a0=\u00a056) of them completed the intervention. Changes in clients\u2019 biological (craving), psychological (hope, hopelessness, self-esteem and affect states) and psychiatric (anxiety and depression) health were assessed using previously validated instruments at intake and at program completion.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Statistically significant, medium-to-large effect size improvements were observed across nearly all outcome domains. Clients who completed the intervention reported increased levels of hope and self-esteem, higher prevalence of positive affect and reduced depression, anxiety, negative affect, and craving (in terms of strength, frequency, and duration). A small, non-significant decrease in hopelessness was also observed, which is discussed in relation to the Bonferroni correction applied and the nature of hopelessness as a deeper cognitive-affective construct.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n This integrated, intensive, outpatient intervention appears to be effective in reducing biological, psychiatric and psychological symptoms while also enhancing protective factors such as hope, self-esteem, and affective resilience in individuals with SUD. These findings highlight the value of holistic, multimodal approaches in community-based addiction treatment.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fpsyt.2026.1805029","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T05:37:56Z","timestamp":1785476276000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Empowering change: a prospective cohort study of an integrated cognitive behavioral therapy-based outpatient intervention for substance use disorder"],"prefix":"10.3389","volume":"17","author":[{"given":"Kourosh","family":"Bador","sequence":"first","affiliation":[{"name":"Centre for Holistic Psychiatry Research (CHoPy)","place":["M\u00f6lndal, Sweden"]},{"name":"AGERA KBT","place":["Gothenburg, Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Pernmyr","sequence":"additional","affiliation":[{"name":"Centre for Holistic Psychiatry Research (CHoPy)","place":["M\u00f6lndal, Sweden"]},{"name":"Department of Health Sciences, University West","place":["Trollh\u00e4ttan, Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Larsson","sequence":"additional","affiliation":[{"name":"Centre for Holistic Psychiatry Research (CHoPy)","place":["M\u00f6lndal, Sweden"]},{"name":"Department of Health Sciences, University West","place":["Trollh\u00e4ttan, Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catrin","family":"Johansson","sequence":"additional","affiliation":[{"name":"Centre for Holistic Psychiatry Research (CHoPy)","place":["M\u00f6lndal, Sweden"]},{"name":"Department of Health Sciences, University West","place":["Trollh\u00e4ttan, Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N\u00f3ra","family":"Kerekes","sequence":"additional","affiliation":[{"name":"Centre for Holistic Psychiatry Research (CHoPy)","place":["M\u00f6lndal, Sweden"]},{"name":"Department of Health Sciences, University West","place":["Trollh\u00e4ttan, Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,31]]},"reference":[{"key":"B1","volume-title":"Diagnostic and Statistical Manual of Mental Disorders","year":"2022"},{"key":"B2","unstructured":"Anv\u00e4ndning Och Beroendeproblem Av Alkohol, Narkotika Och Tobak: En Studie Med Fokus P\u00e5 \u00c5r 2021 I Sverige\n \n 2022"},{"key":"B3","unstructured":"Alkoholens Samh\u00e4llsekonomiska Konsekvenser\n \n 2019"},{"key":"B4","unstructured":"Hofmarcher\n T\n \n \n Ramd\u00e9n\n V\n \n \n Lindgren\n P\n \n \n Samh\u00e4llsekonomiska Kostnader F\u00f6r Narkotikabruk I Sverige\n \n 2022"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1080\/00952990.2020.1712411","article-title":"Dialectical behaviour therapy skills training for the treatment of addictive behaviours among individuals with alcohol use disorder: the effect of emotion regulation and experiential avoidance","volume":"46","author":"Cavicchioli","year":"2020","journal-title":"Am J Drug Alcohol Abuse"},{"key":"B6","unstructured":"Comorbidity of Substance Use and Mental Health Disorders in Europe\n \n 2016"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1080\/02791072.2020.1755478","article-title":"Overcoming heroin addiction without the use of pharmaceuticals: a qualitative interview study","volume":"52","author":"Nehlin","year":"2020","journal-title":"J Psychoact Drugs"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1080\/10826084.2020.1781181","article-title":"Recovery as life transformation: examining the relationships between recovery, hope, and relapse","volume":"55","author":"Gutierrez","year":"2020","journal-title":"Subst Use Misuse"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2019.00388","article-title":"The relationship between self-control and self-efficacy among patients with substance use disorders: resilience and self-esteem as mediators","volume":"10","author":"Yang","year":"2019","journal-title":"Front Psychiatry"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1016\/j.apnu.2016.03.007","article-title":"Social functioning and self-esteem of substance abuse patients","volume":"30","author":"Ers\u00f6\u011f\u00fct\u00e7\u00fc","year":"2016","journal-title":"Arch Psychiatr Nurs"},{"key":"B11","article-title":"Stress and addiction: biological and psychological mechanisms","volume-title":"Negative Affect and Addiction","author":"Kassel","year":"2007"},{"key":"B12","unstructured":"Nationella Riktlinjer F\u00f6r V\u00e5rd Och St\u00f6d Vid Missbruk Och Beroende\n \n 2019"},{"key":"B13","unstructured":"Vi Kan B\u00e4ttre! 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