Table 4.

Additional contextual factors considered in increasing or decreasing the GRADE recommendation for CBT for SUD

Positive	Negative
□ Treatment appears superior to other established and effective treatment(s)	□ There are other psychological treatments that have well-documented and much larger effects
✓ The treatment generates an effect that is similar to other well-studied treatments and has strong evidence for flexibility via technology-delivered CBT	□ The treatment generates an effect that is similar to other well-studied treatments, but requires a very large number of sessions or length of time to generate the same effect at a much higher cost
✓ Evidence supports the purported mechanism or active ingredient(s) of treatment	□ Evidence fails to support the purported mechanism or active ingredient(s) of treatment
□ Treatment has demonstrated good effects with marginalized groups	□ Treatment has demonstrated weak effects with marginalized groups
□ Treatment has been studied by a wide array of researchers without strong allegiance to the treatment	□ Treatment has been studied by a narrow array of researchers with strong allegiance to the treatment
✓ Other: Demonstrated efficacy across several patient populations	□ Other:

Note. This table identifies additional positive contextual factors to consider in the overall GRADE treatment recommendation that are supported by the CBT for SUD literature and was adapted from Tolin et al., 2015. Lack of identification of a positive or negative assessment of a contextual factor indicates that there is not enough data to make a firm conclusion in this category for CBT for SUD.