Efficacy of Family-based Interventions in Addressing Substance Use Disorders: A Systematic Review on Randomized Controlled Trials

Abstract

Purpose of the Review:

Substance use disorders (SUDs) persist as a critical public health concern across the globe, affecting individuals, families, and communities across diverse sociocultural contexts. Among various intervention strategies, family-based interventions have emerged as essential components in the holistic management and treatment of SUDs. This study systematically reviews the scientific literature published between 2012 and 2024 to evaluate the efficacy of family-based interventions in mitigating substance use and enhancing family functioning.

Collection and Analysis of Data:

Three databases, PubMed, Scopus, and Web of Science, were searched using a predefined strategy focused on the terms “SUD” and “family-based intervention.” Eligible studies included randomized controlled trials (RCTs) involving individuals with SUDs that implemented family-based interventions aimed at reducing substance use and required the participation of at least one immediate family member. The Cochrane Risk of Bias 2.0 (RoB 2) tool is used to assess the methodological quality.

Results:

A total of 3,864 records were identified, of which 15 trials met the inclusion criteria and were included in the final review. Findings indicate that family engagement in substance use treatment leads to favorable outcomes, including substance use reduction and improvements in family functioning, with 11 studies demonstrating significant positive effects of family-based interventions.

Conclusions:

This review suggests that involving family members in treatment reduces substance use and improves family functioning. However, further high-quality RCTs are necessary to strengthen these conclusions and provide more definitive evidence.

Keywords

Family therapy couple and marital therapy drug addiction alcohol use

Key Messages:

Question: What evidence exists on the effectiveness of family-based interventions for individuals with substance use disorders?

Finding: Family-based interventions demonstrate significant benefits in reducing substance use and enhancing family functioning.

Meaning: The review highlights the critical role of actively involving family members in treatment to support sustained recovery outcomes.

Substance use disorders (SUDs) remain a significant global health challenge, affecting individuals, families, and societies worldwide. These disorders, along with other mental and neurological conditions, contribute substantially toward the global burden of disease, accounting for approximately 10%, and stand out as the leading direct and indirect causes of morbidity and mortality worldwide.¹

According to the World Health Organization’s Global Status Report on Alcohol and Health, nearly 400 million people worldwide are living with alcohol and drug use disorders, including approximately 209 million with alcohol dependence. Combined alcohol and psychoactive drug use contributes to over three million deaths annually, with approximately 2.6 million deaths attributable to alcohol consumption and 0.6 million associated with psychoactive drug use. This highlights the urgent need for enhanced prevention, treatment, and policy interventions worldwide.²

While literature often focuses primarily on individuals with SUDs, the impact on families is both significant and inevitable. Mardani et al. in their systematic review, identified financial, social, cultural, mental, and physical health problems within families attributable to SUDs.³ Families dealing with SUDs frequently experience feelings of shame, anger, and stress related to their responsibilities. They often face exhaustion, encounter difficult-to-resolve problems, suffer injuries, and struggle with a lack of time.⁴ Moreover, families affected by SUDs are prone to dysfunction and a diminished quality of life, which in turn increases the risk of further substance use and relapse.^5,6

In the Indian context, SUDs are frequently conceptualized as a “family illness” reflecting the collectivistic family structure and the central role of family members in initiating treatment, supervising care, and supporting recovery. Indian studies have consistently documented high levels of caregiver burden, marital conflict, stigma, psychological distress among spouses, and adverse emotional and behavioral outcomes among children of individuals with SUDs, underscoring that the consequences of substance use extend beyond the individual and substantially affect the family system.^7–9

Despite the acknowledged importance of family involvement in India, the implementation and systematic evaluation of structured family-based interventions remain limited. Indian literature highlights challenges related to a limited pool of trained personnel, the need to adapt intervention models to local cultures, and resource constraints within treatment settings. Although national clinical guidelines emphasize family involvement and recommend family therapy alongside pharmacological treatment, particularly for alcohol and opioid use disorders, robust randomized evidence evaluating the efficacy of such interventions in routine practice remains sparse.^8,10

Among various intervention strategies, family-based interventions have gained recognition as pivotal elements in the holistic management and treatment of SUDs. Incorporating the family into the treatment regimen has become a crucial aspect of addressing SUDs. Previous literature underscores the importance of family intervention in promoting long-term behavior modification and recovery.^11,12 Furthermore, incorporating family in the substance use treatment has been shown to diminish consumption and enhance family functioning, emphasizing the importance of involving families in interventions for substance use problems.¹³ Guidelines emphasize the active collaboration with the family in treating psychoactive substance use, advocating for family therapy alongside pharmacotherapy, especially in the Indian context.¹⁴

Recent systematic reviews and evidence synthesis consistently report that family- and couple-based interventions are associated with reductions in substance use and improvements in relational and family outcomes. A landmark systematic review of systematic reviews synthesized evidence available up to 2012 and concluded that family-based interventions demonstrate effectiveness for certain substance-related and relational outcomes, particularly for adult alcohol use and adolescent substance use. However, the authors highlighted substantial heterogeneity and gaps in the evidence base, which limited the ability to draw definitive conclusions.¹⁵ Subsequent reviews have reinforced these findings, reporting favorable outcomes for specific models while noting that the evidence remains more consistent for adolescents than for adults.^11,13 In particular, recent systematic reviews indicate that evidence is more robust for adolescent-focused models than for adult populations, for whom randomized controlled trials (RCTs) remain comparatively fewer and more heterogeneous in both intervention content and outcome measurement.

Despite the growing body of literature, several important research gaps persist. The family intervention literature has been characterized as broad and fragmented, with existing reviews variably focusing on treatment engagement, joint participation in treatment, or interventions targeting family members independently, thereby complicating the translation of evidence into clear, efficacy-focused conclusions for clinical practice and policy.¹⁶ In addition, RCTs involving adult populations remain limited and methodologically heterogeneous compared with adolescent-focused studies.¹³ These gaps underscore the need for a focused and methodologically rigorous synthesis of contemporary randomized evidence.

Accordingly, the present review seeks to consolidate existing evidence on the impact of family-centered interventions on both substance use outcomes and family functioning. The review was registered with PROSPERO in 2022. It was designed as a decadal review, focusing on studies published from 2012 onward to provide an updated synthesis of contemporary evidence on family-based interventions for SUDs. To achieve this objective, the present study systematically reviews RCTs published from 2012 to 2024 that examined family-focused interventions for SUDs.

Methods

This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines.¹⁷ The review protocol for this study was registered with the PROSPERO systematic review registry.

Selection Criteria

The inclusion criteria required studies to be RCTs involving individuals diagnosed with SUDs using standardized methods such as Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD) criteria. Participants could be adolescents or adults, but at least one immediate family member—such as a spouse, parent, sibling, or child—had to participate in the intervention actively. Eligible interventions were family-based approaches aimed at reducing substance use. Comparator conditions included usual care (routine clinical management without structured family involvement); individually focused psychosocial treatments; and minimal-intervention controls, such as psychoeducation, waitlist, or delayed-treatment comparators. Studies are needed to report primary outcomes related to substance use reduction using validated methods. Only full-text articles published in English were considered.

Studies were excluded if they focused on prevention rather than treatment, employed fully digital or online interventions without therapist-guided family involvement, or compared multiple family-based interventions without including a non–family-based comparator.

Population: Persons with SUDs.

Intervention: Family-based interventions involving the active participation of at least one immediate family member.

Comparator: Usual care, individually focused psychosocial treatments, or minimal-intervention comparators.

Outcome: Primary outcomes included reduction in substance use; secondary outcomes included improvements in family functioning.

Search Strategy and Screening

A systematic search of three major databases—PubMed, Scopus, and Web of Science—was conducted to identify relevant studies published from 2012 to 2024. The first author developed the search strategy and conducted the database searches. The detailed list of search strategies used for each database is included in Supplementary File 1. A secondary search of gray literature was not undertaken, as the review was intentionally restricted to peer-reviewed RCTs to ensure methodological rigor. The studies retrieved from various databases were imported into the “Rayyan” software to facilitate the review process, remove duplicates, and conduct preliminary title and abstract screening.¹⁸ Title and abstract screening were done by the first and second authors. Subsequently, the screened articles were accessed in full-text and examined to determine eligibility for further analysis based on the predefined inclusion and exclusion criteria set by the first and second authors. Any discrepancies concerning the inclusion of studies were settled through discussion and consensus with the sixth author.

Data Extraction and Synthesis

Following screening of titles and abstracts, full-text articles meeting the eligibility criteria were reviewed. Data extracted and tabulated by the first reviewer, and the obtained data were cross-checked independently by a second reviewer to ensure accuracy in data extraction. The data were extracted on: (a) Basic study characteristics (author’s name, publication year); (b) study population characteristics; (c) treatment characteristics; and (d) outcome. All data were meticulously recorded, organized in a Microsoft Excel spreadsheet, and systematically synthesized. A systematic review methodology was employed to ensure a transparent and reproducible synthesis of evidence on family-based interventions for SUDs. Owing to substantial clinical and methodological heterogeneity across the included studies, a meta-analysis was not undertaken. Instead, findings were synthesized narratively to facilitate structured comparison and interpretation across studies.

Risk of Bias Assessment

Two independent reviewers evaluated potential sources of bias in the included studies using the Cochrane Risk of Bias 2.0 (RoB 2) tool.¹⁹ The bias assessment encompassed five domains: Randomization process, deviations from intended interventions, missing outcome data, measurement of outcomes, and selection of reported results. Each domain was rated as “low risk,” “some concerns,” or “high risk” using the RoB 2.0 algorithm. Subsequently, the overall RoB was graded as “high risk,” “some concern,” or “low risk” according to the RoB 2.0 criteria. In the event of any disagreement between reviewers regarding the RoB assessment, a third reviewer was consulted to resolve it. The final quality of the literature was categorized into “low risk,” “some concern,” and “high risk” levels. Visualizations were generated using the “Robvis tool” based on the Cochrane RoB 2.0 framework.²⁰

Results

Study Selection

The initial search yielded 3,864 records, which were imported into “Rayyan.”¹⁸ After removing 708 duplicate records, 3,156 unique studies remained for title and abstract screening. Of these, 2,913 records were excluded, and 243 full-text articles were assessed against the predefined inclusion and exclusion criteria. Twenty-nine full-text articles could not be retrieved, leaving 214 articles for eligibility assessment. Following full-text evaluation, 15 studies met the inclusion criteria and were included in the review.

Figure 1 shows a flowchart of the systematic selection of articles in accordance with the PRISMA 2020 guidelines.¹⁷

Figure 1.

PRISMA Flowchart Illustrating the Systematic Selection of Literature.

Characteristics of the Included Studies

A total of 15 RCTs met the inclusion criteria, including both adult and adolescent populations meeting standardized diagnostic thresholds for SUD. Diagnostic confirmation was based on instruments such as the DSM-IV or DSM-5 criteria, the Structured Clinical Interview for DSM, the Michigan Alcohol Screening Test, or the Alcohol Use Disorders Identification Test. The adult-focused trials primarily involved individuals with alcohol or drug dependence, including women with SUDs, and treatment-resistant drinkers. In contrast, the adolescent-focused studies recruited youth aged approximately 12–19 years, meeting criteria for cannabis, alcohol, or polysubstance use disorders, often accompanied by co-occurring emotional or behavioral problems. The detailed characteristics of the included studies are presented in Table 1.

Table 1.

Characteristics of the Study.

Author	Age of the Participants	Sample Size and Family Member Involved	Study Design	Region	Treatment Group	Control Group
Rigter et al., 2013	13–18	N = 450 parent	Multicentre randomized controlled effectiveness trial	Europe	MDFT	IP
Slesnick et al., 2013	12–17	N = 179 parent	RCT	USA	EBFT	C1: CRA; C2: MI
Valdez et al., 2013	12–17	N = 200 parent	RCT	USA	BSFT	PE
Schumm et al., 2014	18–65	N = 105 male partners	RCT	USA	BCT + IBT	IBT
Horigian et al., 2015	12–17	N = 480 parents	Multisite RCT	USA	BSFT	TAU
Stanger et al., 2015	12–18	N = 153 parent/guardian	Three-arm RCT	USA	MET/CBT + CM + PT	C1: MET/CBT + CM; C2: MET/CBT
Santisteban et al., 2015	14–17	N = 40 parents	RCT	USA	I-BAFT	IDC
Slesnick et al., 2016	Children: 8–16 yrs, Mothers: (M = 33.9)	N = 183 mother and child	RCT	USA	EBFT	WHE
Farrell et al., 2017	Mean age - 38.7	N = 61 male partners	RCT	USA	BCT + IBT	IBT
Spirito et al., 2017	12–19	N = 107 parents	RCT	USA	FCU	PE
Liddle et al., 2018	13–18	N = 113 parent	RCT	USA	MDFT	RT
Ager et al., 2020	Mean age - 47	N = 69 spouse	RCT	USA	UFT	Delayed-treatment
Sheidow et al., 2021	10–17	N = 134 parents/adult caregiver	RCT	USA	OPT-A	TAU
Lee et al., 2022	Mean age - 45	N = 96 partner	RCT	Canada	CCT	TAU
McCrady et al., 2023	Mean age - 42	N = 35 concerned significant other	Randomized controlled pilot trial	USA	B-FIT	TAU

MDFT = Multidimensional Family Therapy, IP = Individual psychotherapy, EBFT = Ecologically Based Family Therapy, CRA = Community Reinforcement Approach, MI = Motivational Interviewing, BSFT = Brief Strategic Family Therapy, PE = Psychoeducation, IBT = Individually-based treatment, TAU = Treatment-as-usual, MET/CBT + CM + PT = Motivational Enhancement Therapy/Cognitive Behavioral Therapy + Contingency Management + Parent Training, I-BAFT = Integrative Borderline Personality Disorder–Oriented Adolescent Family Therapy, IDC = Individual drug counseling, WHE = Women’s Health Education, FCU = Family Check-Up, RT = Residential treatment, UFT = Unilateral Family Therapy, OPT-A = Outpatient Treatment for Adolescents, CCT = Congruence Couple Therapy, B-FIT = Brief family-involved treatment.

A broad range of family-based interventions was evaluated across these trials. Multidimensional Family Therapy (MDFT) was used in two studies, focusing on multiple dimensions of family functioning and individual behavior change.^21,22 Ecologically Based Family Therapy (EBFT), employed in two studies, emphasized environmental and systemic influences on substance use within the family unit.^23,24 Behavioral Couples Therapy (BCT) and Brief Strategic Family Therapy (BSFT) were each tested in two studies.^25–28 Outpatient Treatment for Adolescents (OPT-A) was examined in one study, tailored for non-residential adolescent treatment.²⁹ Unilateral Family Therapy (UFT) and the Family Check-Up (FCU) were each explored in one study, targeting family relationships and substance use mitigation.^30,31 Additionally, Integrative Borderline Personality Disorder–Oriented Adolescent Family Therapy (I-BAFT), Brief Family-Involved Treatment (B-FIT), Parent Training (PT), combined with Motivational Enhancement Therapy/Cognitive Behavioral Therapy plus Contingency Management (MET/CBT + CM), and Congruence Couple Therapy (CCT) were each investigated in the remaining studies.^32–35 Collectively, these interventions reflect a diverse spectrum of family-centered approaches designed to address both substance use reduction and improvements in family functioning across varied clinical and demographic contexts.

Effect on Adolescent Population

Nine randomized trials assessed the impact of family-based interventions on adolescents experiencing SUDs.

MDFT showed superior efficacy relative to individual psychotherapy in reducing cannabis dependence and associated symptoms, particularly among adolescents with heavier baseline use. MDFT also achieved higher treatment engagement and completion rates.²¹ In comparison with residential treatment (RT), both MDFT and RT resulted in significant reductions in substance use problems; however, no between-group difference was observed in the frequency of use over 30 days. Importantly, MDFT demonstrated better maintenance of a bstinence during follow-up periods ranging from 2 to 18 months post-baseline.²²

In gang-affiliated Mexican American adolescents, an adapted BSFT intervention significantly reduced alcohol use at six months compared with control referrals and psychoeducation, though effects on marijuana or other illicit drug use were not significant. No measurable improvements were observed in family functioning.²⁷ In another trial, BSFT was compared against treatment-as-usual (TAU). Parents in the BSFT group showed a significant decline in alcohol use from baseline through 12 months, whereas no comparable improvement was noted in the TAU group. Although differences in parental drug use were not statistically significant, adolescents with drug-using parents showed a markedly slower progression in substance use over time when their families received BSFT compared to TAU. Furthermore, family functioning, assessed using composites from the Parenting Practices Questionnaire and the Family Environment Scale, improved significantly more in BSFT than in TAU.²⁸

An integrated, family-based outpatient model, OPT-A, demonstrated higher abstinence rates than TAU at three months. However, between-group differences were no longer significant at six and 12 months. By 18 months, both groups showed relapse; the OPT-A group showed a comparatively smaller increase in substance use, suggesting more sustained gains. Short-term improvements were observed in parenting practices (monitoring and rules), but these were not consistently sustained over time; other parenting domains showed no between-group differences.²⁹

A family-oriented, dialectical behavior therapy–integrated model (I-BAFT) yielded greater reductions in substance use and enhanced family involvement compared to individual drug counseling among adolescents with comorbid depression. For those without depression, both treatments improved borderline personality–related behaviors, but neither showed clear superiority in reducing substance use. Family functioning was not directly measured as a separate quantitative variable in this study.³²

Three studies did not find a significant superiority of family-based interventions. In a trial among adolescents recruited from a runaway shelter, EBFT, the Community Reinforcement Approach, and Motivational Interviewing all led to substantial decreases in substance use over 24 months, but without significant differences between modalities.²⁴ Adding a clinic-based and home-based CM session to MET or CBT increased abstinence during treatment compared with MET/CBT alone; the addition of PT did not further improve cannabis or family outcomes.³⁴ A brief, parent-oriented motivational program (FCU) targeting adolescents engaged in substance use and their siblings showed no significant reductions in substance use for either group compared with a psychoeducation control at three, six, and 12-month follow-ups. Likewise, there were no meaningful improvements in parental monitoring or family interaction patterns.³¹

Overall, these interventions reduced substance use among adolescents compared with individual or standard care, although the strength and consistency of the effects varied across studies.

Effect on Adult Population

A total of six RCTs evaluated family-based interventions among adults with SUDs.

In a trial comparing EBFT with Women’s Health Education, EBFT produced a more rapid decline in alcohol, marijuana, and cocaine use. At the same time, opioid outcomes and family interaction trajectories improved over time in both conditions without significant group differences.²³

BCT demonstrated superior substance-related outcomes compared to individually-based treatment (IBT) for women with alcohol use disorder, with higher percentages of days abstinent maintained across the 12-month follow-up. Regarding family functioning outcomes, male partners reported greater relationship happiness, and women showed improved relationship adjustment in the BCT condition. Intimate partner violence decreased in both groups, with no significant between-group differences.²⁵ In a separate study among women with SUDs, both treatment conditions—BCT + IBT and IBT—showed significant, large within-group improvements in abstinence and reductions in drug use over 12 months, although no between-group differences were observed. Regarding relationship satisfaction measured using the Dyadic Adjustment Scale, male partners of women receiving BCT in addition to IBT demonstrated significant improvement from baseline, whereas no such change was noted in the IBT-only group.²⁶

UFT, which engages non–substance-using spouses to motivate treatment entry among resistant partners, was effective for treatment-resistant alcohol users. At six months, 39% of participants in the immediate-treatment group entered treatment compared to 11% in the delayed group, accompanied by significant reductions in alcohol consumption and moderate effect sizes for decreased drinking frequency and quantity. The intervention also improved marital satisfaction, reduced family distress, and enhanced the spouse’s psychological well-being. These effects were sustained for up to one-year post-intervention.³⁰

A B-FIT, adapted from Alcohol BCT, showed preliminary evidence of efficacy for alcohol use disorder, with large effect sizes favoring the intervention for increased abstinent days and reduced heavy drinking. However, differences were not statistically significant due to the small sample size. However, family functioning outcomes did not improve and tended to favor standard care.³³

Final, CCT—a systemic, emotion-focused intervention integrating relational and transgenerational components—produced significant reductions in alcohol and gambling behaviors, along with notable improvements in couple adjustment and emotional regulation, compared with individual-based treatment, thereby demonstrating dual benefits for both substance use and family functioning.³⁵

Overall, the evidence indicates that family-based interventions consistently enhance substance use outcomes, with several models also demonstrating meaningful improvements in family functioning.

Risk of Bias Assessment

Overall, the methodological rigor of the included RCTs was generally moderate, with most studies exhibiting some concerns in at least one domain of the Cochrane RoB 2 tool. Bias due to randomization (D1) and deviations from intended interventions (D2) were predominantly rated as low risk or of some concern, indicating reasonably adequate allocation procedures and satisfactory intervention fidelity. However, several studies raised concerns about missing outcome data (D3), largely due to participant attrition and incomplete follow-up. Measurement bias (D4) and selective reporting bias (D5) were generally rated as low to some concerns, suggesting acceptable outcome assessment and reporting practices across most trials. Figure 2 depicts the reviewers’ overall judgments for each RoB domain, expressed as percentages across all included studies. In contrast, Figure 3 presents the domain-specific RoB evaluations for each study. Both visualizations were generated using the “Robvis tool” based on the Cochrane RoB 2.0 framework.²⁰

Figure 2.

Weighted Bar Plot—The Distribution of Risk-of-bias Judgment Across Domains.

Figure 3.

Traffic Light Plot—Domain-level Risk-of-bias Judgments for Included Studies.

Discussion

The present systematic review showed that family-based interventions for persons with substance use improved both substance use outcomes and family functioning compared to other individual-based treatments.

Among the adolescent population, both trials of MDFT included in this review demonstrated reductions in adolescent substance use, particularly at follow-up assessments; however, no data were reported on changes in family functioning. These findings align with prior research identifying MDFT as one of the most effective and promising interventions for adolescent SUDs, showing superior outcomes compared to individual or group-based therapies and maintaining treatment gains over extended follow-up periods.^13,36

BSFT has also shown a reduction in alcohol outcomes and better outcomes in family functioning. Improving family functioning serves as a mediating factor in reducing substance use. Similar reports, quoted in a recent systematic review, indicate that in the BSFT trial, parental consumption decreased more in the intervention arm, and that these effects were closely linked to changes in family functioning indices.¹³

The short-term superiority of OPT-A over TAU in achieving abstinence, followed by convergence of outcomes by 6–12 months and partial relapse by 18 months, is consistent with broader evidence that family-based outpatient treatments often show their strongest effects in the early post-treatment period, with attenuation over time in the absence of ongoing support or booster sessions.^37,38

Among the women population, all three trials focusing on women favored substance use outcomes. When comparing BCT with IBT, improvements in family functioning were also observed. These findings align with previous research demonstrating that couples therapy may be particularly beneficial for women experiencing both SUDs and relationship distress.^39,40 Specifically, McCrady et al. (2009) found that women with greater relationship distress at baseline showed the greatest improvements in abstinence and relationship satisfaction following Alcohol BCT compared to individual therapy.³⁹ The convergence of evidence across these RCTs indicates that couples-focused intervention addresses dual treatment targets—substance use reduction and relationship enhancement. This dual-benefit mechanism distinguishes family-based approaches from individual treatment modalities. It supports couples therapy as a better intervention for women seeking to address both substance use and relational impairment.

The strengths of this study include prospective registration of the protocol, adherence to PRISMA guidelines, and a rigorous RoB assessment using the Cochrane RoB 2 tool.

This systematic review also has notable limitations that merit consideration for a balanced interpretation of the findings. Although the review was restricted to RCTs to enhance methodological rigor, many included studies exhibited a moderate RoB. In addition, substantial heterogeneity across intervention models, participant populations, and outcome measurement approaches precluded quantitative synthesis and limited the ability to derive pooled estimates of intervention efficacy. Finally, the predominance of studies conducted in high-income settings restricts the generalizability of the findings. The exclusion of gray literature may have led to the omission of unpublished studies and introduced the possibility of publication bias. Further research is warranted to refine family-based interventions, expand their evaluation across diverse sociocultural contexts, and strengthen the evidence base; where feasible, future meta-analytic synthesis may provide more precise estimates of intervention effects.

Conclusion

This systematic review indicates that family-centered interventions are broadly effective in reducing substance use levels and enhancing family relationships among adolescent and adult populations affected by SUDs. Although the present review focuses on family-based interventions and their effectiveness in treating SUDs, the bidirectional relationship between substance use and family functioning suggests that integrating elements from individual-based approaches remains essential. The findings highlight the importance of involving families as active agents in treatment to enhance engagement, sustain abstinence, and promote relational well-being. Future research should prioritize long-term follow-ups, culturally adapted intervention models, and meta-analytic synthesis to better quantify effect sizes and inform clinical practice.

Supplemental Material

Supplemental material for this article is available online.

Supplemental Material

Supplemental material for this article is available online.

Supplemental Material

Supplemental material for this article is available online.

Supplemental Material

Supplemental material for this article is available online.

Footnotes

Acknowledgements

NA.

Appropriate Permissions from the Concerned Authorities

NA.

Data Sharing Statements

NA.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, or publication of this article.

Declaration Regarding the Use of Generative AI

No part of this article was written or generated by a generative AI tool. The authors take full responsibility for the accuracy, integrity, and originality of the published article.

Ethical Approval

Ethical approval was not required, as it utilized secondary data without any direct involvement of human participants. Name of the Institutional Ethics Committee/Independent Review Board: NA. Approval Ref. No.: NA Date: NA

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Informed Consent/Assent

NA.

Prior Presentations

The findings from this study have not been presented previously.

PROSPERO/CTRI Details

CRD42022335965.

Registration

NA.

Trial registry name: NA

URL: NA

Registration number: NA

Simultaneous Submission to Another Journal or Resource

This manuscript is not under consideration by any other journal.

Status of Your Study (for Study Protocol)

Completed.

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