Title : Culturally adapted cognitive behavioral therapy for substance use disorder in Pakistan: A feasibility and public health perspective
Abstract:
Substance use disorder (SUD) continues to represent a significant public health challenge in low- and middle-income countries, including Pakistan, where access to culturally responsive psychological interventions remains limited. While Cognitive Behavioral Therapy (CBT) is widely recognized as an effective treatment modality, its standard forms are not always readily transferable to contexts shaped by distinct cultural and social dynamics. This study sought to examine the feasibility and preliminary impact of a culturally adapted CBT intervention for individuals with SUD in Pakistan. The intervention was developed through a structured process that combined evidence-based literature with stakeholder input, incorporating perspectives from patients, caregivers, and practicing therapists. A pilot randomized controlled framework was adopted, with participants allocated to CBT alongside treatment-as-usual (TAU) or TAU alone. Outcomes included substance use frequency, psychological well-being, treatment engagement, and retention. To illustrate the analytical approach in a teaching-oriented context, a simulated dataset reflecting typical pilot trial characteristics was utilized. The simulated analysis (N = 60) suggested a consistent directional benefit associated with the intervention. Participants receiving CBT demonstrated a notable reduction in substance use frequency, declining from a mean of 5.8 days per week at baseline to 2.9 post-intervention, whereas the TAU group showed a more modest reduction (5.6 to 4.8 days). Within-group improvement in the CBT arm was statistically significant (t(29) = 8.12, p < .001), and between-group differences at follow-up favored CBT (t(58) = 4.76, p < .001), with effect sizes in the large range. Improvements in psychological well-being followed a similar pattern. Retention rates exceeding 80% further indicated strong feasibility and acceptability. These findings support the potential value of culturally adapted CBT in addressing substance use disorder in resource-constrained settings. Although presented within a simulated instructional framework, the results align with broader evidence suggesting that culturally sensitive adaptations can enhance engagement and therapeutic outcomes. Further large-scale empirical research is warranted to confirm effectiveness and inform public health integration.
