Self-Efficacy as a Mechanism of Behavior Change in Addiction Science and Practice

Abstract

Purpose of Review

This review examines self-efficacy and traces the construct from theory and operationalization to clinical practice and intervention design in addiction science.

Recent Findings

Self-efficacy is a construct with a strong theoretical and methodological foundation. While evidence for self-efficacy as a statistical mediator in the context of clinical trials of addictions treatments is mixed, it is most conclusive in within-condition, non-experimental designs. Consistency in empirical support across research methods, populations, and outcomes strengthens support for self-efficacy as a mechanism of alcohol or other substance consumption outcomes.

Summary

The current review provides evidence for self-efficacy as a mechanism worthy of direct attention in clinical care for alcohol or other substance use disorders. It is likely a common mechanism of human behavior change that can be harnessed in a range of treatment modalities and client-identified goals. Future work should target self-efficacy directly in intervention development, implementation, and dissemination.

Introduction

The addictions field is considering future directions for clinical science in the face of non-differential efficacy between evidence-based alcohol or other drug treatments. While not its primary aims, Project MATCH presented foundational evidence for this when a 12-session cognitive behavioral therapy, a four-session motivational enhancement therapy, and a 12-session twelve-step facilitation therapy produced essentially comparable results [1, 2]. Subsequent clinical trials have not produced compelling findings that any one evidence-based treatment is better than others, leaving a range of options available and variable uptake by community providers. Rather than conducting tests of efficacy, mechanisms of behavior change (MOBC) research has focused on examining how behavioral and pharmacological treatments work. If specific MOBC are empirically supported, future implementation science can focus on a smaller, more targeted unit of analysis. This approach may offer advantages over concentrating solely on implementing packaged therapeutic modalities [3]. However, there must be theoretically and empirically credible MOBC for dissemination and/or implementation. In the current review we consider the case of self-efficacy and trace the construct’s credibility from theory and operationalization all the way to clinical practice and intervention design.

Self-Efficacy as a Construct in Addiction Science

Self-efficacy can be defined as the belief in one’s ability to achieve some sort of goal or behavioral outcome. Bandura [4] described self-efficacy expectations in behavioral, cognitive, experiential, and emotional terms as “experiences of mastery arising from effective performance” (4; p. 191), and noted that while “successes raise mastery expectations; repeated failures lower them” and that when “strong efficacy expectations are developed through repeated success, the negative impact of occasional failures is likely to be reduced” (4; p. 195). Importantly, Bandura [4] also noted self-efficacy could be a general mechanism of behavior change across different treatment modalities and accounts for different behaviors displayed among individuals receiving the same treatment [4].

In the intervening years, alcohol researchers have developed self-report measures to assess various forms of self-efficacy, such as abstinence self-efficacy [5], drink refusal self-efficacy [6], and harm reduction self-efficacy [7]. Further, many behavioral treatments have been developed to indirectly target self-efficacy via interventions focused on cognitive reactions and behavioral-coping responses to high-risk situations [8, 9], as well as those directly targeting self-efficacy (e.g., drink refusal self-efficacy; [10]). Overtime, several systematic and narrative reviews have concluded that self-efficacy is an important process variable in behavioral and pharmacological treatment as well as in naturalistic change for alcohol use disorder (AUD; [11–13]).

Consistent with Bandura’s unifying theory, addictions treatment research has indicated that a range of treatments are associated with increases in self-efficacy. Kruger and colleagues [14] conducted a large integrative data analysis of participants in four clinical trials (N = 3720) representing eight different treatment modalities [14]. Results indicated that nearly all treatments were associated with significant increases in self-efficacy, including cognitive-behavioral treatment, a combined behavioral intervention, medication management with pharmacotherapy (i.e., naltrexone, acamprosate, and/or placebo), motivational enhancement treatment, telephone continuing care, twelve-step facilitation, and relapse prevention. Only one of the eight treatments, group treatment that included addiction counseling and twelve-step recovery support, was not associated with significant increases in self-efficacy at follow-up.

Indeed, even treatments that are not designed to target self-efficacy may influence treatment outcomes via increases in self-efficacy. For example, a randomized clinical trial was designed to explicitly target specific MOBC for specific treatments including cognitive behavioral relapse prevention that was hypothesized to impact outcomes via increases in self-efficacy and mindfulness-based relapse prevention that was hypothesized to impactoutcomes via increases in mindful awareness and decreases in reactive responding [15]. Results indicated that mindfulness-based relapse prevention was more effective than cognitive behavioral relapse prevention in reducing substance use post-treatment [15], and secondary analyses indicated that self-efficacy mediated the effects of treatment on substance use outcomes for the mindfulness-based relapse prevention condition and not the cognitive behavioral relapse prevention condition [16].

It is likely the case that the direction of the association for substance use outcomes is such that decreases in drinking also predict greater self-efficacy, which has been empirically demonstrated in several prior studies [17] and recent work demonstrating reciprocal and feedback effects between substance use and self-efficacy. Specifically, Jenzer and colleagues [18] used random intercept cross-lag modeling to examine bidirectional associations and found at the within subject level that greater alcohol consumption prospectively predicted lower self-efficacy, whereas lower self-efficacy only prospectively predicted greater alcohol consequences and not alcohol consumption [18]. De Visser and Nicholls [19] showed that participation in a temporary abstinence campaign (e.g., Dry January) was associated with greater self-efficacy than not participating, and this effect was even higher among those who were successful in completing the campaign [19].

Novel experimental studies have also demonstrated that self-reports of self-efficacy may be confounded with other measures that are also associated with substance use (i.e., motivation, behavioral intentions, outcome expectances). One study intended to experimentally manipulate self-efficacy by randomizing smokers who were motivated to quit to a high self-efficacy condition or an average self-efficacy condition [20], with the self-efficacy conditions given (false) feedback about likelihood of being successful with quitting as either high or average. Results indicated that individuals who were in the high self-efficacy condition were significantly more likely to quit smoking, but the effects were not mediated by self-reported changes in self-efficacy.

When considering self-efficacy as a construct in addiction science, measurement often specifies an outcome such as abstinence or use reduction. Self-efficacy is broadly applicable across a range of endpoints and in the context of different types of treatments. This is even the case for interventions that do not target self-efficacy, as theory and research suggest that changes in self-efficacy are primarily the result of changes in the behavior itself. Research on self-efficacy as a casual process, a vital step in providing a credible foundation for clinical practice, typically occurs in the context of statistical mediation research. Here, the relationship between treatment and mechanistic processes can be examined.

Self-Efficacy as a Statistical Mediator

Mediators are intervening variables in a causal sequence that statistically account for the relationship between an independent and dependent variable [21]. Figure 1 provides a conceptual overview of two common approaches to testing self-efficacy as a mediator: (1) between-person mediation where the a-path represents the association between treatment condition and self-efficacy and (2) within-condition mediation, which examines a specific treatment ingredient (i.e., drink refusal skills training) in relation to self-efficacy (e.g., drink refusal self-efficacy). For both mediation approaches, the b-path examines the relationship between self-efficacy and a treatment outcome. Establishing evidence for self-efficacy as a mediator of substance use treatment outcomes is an important criterion for building evidence for self-efficacy as a mechanism of change [22, 23].

Fig. 1.

Conceptual overview of self-efficacy as a mediator of a substance use treatment outcome

Reflecting the prominence of self-efficacy in theoretical models of change, several reviews have summarized evidence for self-efficacy as a mediator of substance use treatment outcomes. In their review of college student drinking interventions, Reid and Carey [23] found three of five studies supported self-efficacy as a treatment mediator [24]. Magill et al. [24] found two of six studies examining mediators of cognitive behavioral therapy demonstrated support for between-condition mediation, while two of two found support for within-condition mediation [25]. Most recently, a systematic review of mediators of adolescent substance use treatment found one of three studies that examined self-efficacy as a treatment mediator demonstrated empirical support [25]. Of note, the study supporting mediation tested six unique mediational pathways for self-efficacy, of which, only one was statistically significant [26]. Across these reviews, the authors concluded that there was mixed evidence for self-efficacy as a mediator of substance use treatment outcomes. This conclusion aligns with more recent research on self-efficacy where some studies have found evidence for statistical mediation [16, 27], and others have not [28, 29].

Although counts of significant tests of mediation provide an overview of the evidence to date, examining the specific features of existing tests offers important insights into future directions. Table 1 shows detailed information regarding each study included in the above noted reviews. Of the studies examining between-condition mediation, 61% found support for the a-path. The finding that slightly over one-third of studies failed to find support for the a-path reflects a theoretical complexity of testing between-condition mediation. For example, Kadden and Litt (2011) noted that theoretically, essentially every treatment designed to target substance use should be expected to enhance self-efficacy [17]. If all treatments enhance self-efficacy, any between-condition mediation study examining two active conditions will have difficulty detecting a significant a-path effect. If all substance use treatments target self-efficacy, future research would benefit from isolating the behavior change techniques (i.e., treatment ingredients) that elicit change in self-efficacy. This aligns with recent methodological recommendations for enhancing evidence for mechanisms in substance use disorders treatment research [23]. Identifying these components may facilitate treatment refinement through focusing on the behavior change techniques that enhance self-efficacy and spending less time on those that do not [3].

Table 1.

Overview of studies included in Magill et al. [24], Meisel et al. [22], and Reid & Carey [23]

Study	Treatment	Mediator	Outcome	a-path significant	b-path significant	a- and b-path time lags
Between-Condition Studies
Black et al. [30]	BI for socially anxious drinkers vs. psychoeducation Relapse prevention vs. 12-Step Facilitation		Alcohol Use	Yes	Yes	a-path: 1 month b-path: 3 months
		Drinking refusal self-efficacy	Alcohol Problems	Yes	Yes
			Heavy Drinking Days	Yes	Yes
Brown et al. [31]		Self-efficacy confidence in high-risk situations	Alcohol use severity	Yes	No	a-path: 10 weeks b-path: 3.5 months1
			Drug use severity	Yes	Yes
			Drug use days	Yes	Yes
			Days to lapse	Yes	No
			Days to relapse	Yes	No
		Self-efficacy temptation in high-risk situations	Alcohol use severity	Yes	Yes
			Drug use severity	Yes	Yes
			Drug use days	Yes	Yes
			Days to lapse	Yes	No
			Days to relapse	Yes	No
Burleson and Kaminer [32]	CBT vs. Psychoeducation	Self-efficacy for negative affect situations	Substance use abstinence	No	No	a-path: 8 weeks b-path: 3 months and 9 months
		Self-efficacy for positive affect situations	Substance use abstinence	No	No
		Self-efficacy for urges and testing	Substance use abstinence	No	No
Feldstein Ewing et al. [33]	MI vs. Psychoeducation		Alcohol use	Yes	No	a-path: 2 weeks months b-path: 5.5 months
		Drinking refusal self-efficacy	Alcohol dependence	Yes	No
			Alcohol problems	Yes	Yes
			Cannabis use	No	Yes
		Cannabis refusal self-efficacy	Cannabis dependence	No	Yes
			Cannabis problems	No	No
Glasner-Edwards et al. [34]	Integrated CBT vs. 12-Step Facilitation	Self-efficacy in high-risk situations	Abstinence	No	Yes	a-path: 24 weeks b-path: cross-sectional2
Johnson et al. [35]	Cognitive behavioral program vs. 12-step program	Self-efficacy in high-risk situations	Abstinence	No	No	a-path: 1 year b-path: cross-sectional
			Substance-related problems	No	No
Kulesza et al. [36]	50-minute BI vs. 10 min BI vs. attention-control3	Abstinence self-efficacy	Alcohol consumption	No	No	a-path: 1 month b-path: cross-sectional
LaChance et al. [37]	Group MET vs. alcohol information only group Alcohol concerns vs. alcohol information only group	Drinking refusal self-efficacy	Problem drinking	No	Yes	a-path: 2 weeks b-path: 3 months
	Group MET vs. focus on alcohol concerns group	Drinking refusal self-efficacy	Problem drinking	Yes	Yes
Johnson et al. [35] Lozano and Stephens [38]	Packaged CBT vs. case management	Abstinence self-efficacy	Abstinence	No	Yes	a-path: 3 months b-path: 2 years
	Participatory goal setting vs. assigned goal	Self-efficacy for drinking goal	Drinks per dinking day	Yes	No4	a-path: 1 week
			Drinking days per week	Yes	No5	b-path: 1 week
Maisto et al. [39]	MET vs. 12-Step Facilitation	Self-efficacy in high-risk situations	Drinking days	No	Yes	a-path: 3 months b-path: cross-sectional6
			Drinks per drinking day	No	Yes
			Drinking consequences	No	Yes
	CBT vs. MET		Drinking days	Yes	Yes
			Drinks per drinking day	Yes	Yes
			Drinking consequences	Yes	Yes
Murgraff et al. [40]	Action planning vs. nointervention control	Action-specific self-efficacy	Risky drinking	Yes	Yes	a-path: 8 weeks b-path: 8 weeks
		Self-efficacy for drinking reduction	Risky Drinking	Yes	No
Sandhal et al. [41]	CBT vs. psychodynamic group	Self-efficacy for high-risk situations	Days abstinent	No	Yes	a-path: 15 weeks b-path: 15 months
Wit-kiewitz et al. [10]	Drink refusal training module vs. did not receive drink refusal module	Abstinence self-efficacy	Drinking frequency	Yes	Yes	a-path: 26 weeks b-path: 26 weeks7
Study	Treatment Ingredient	Mediator	Outcome	a-path significant	b-path significant	a- and b- path time lags
Within-Condition Studies
Kelly et al. [42]	12-step attendance	Self-efficacy to refrain from substance use	Substance use abstinence	No	Yes	a-path: cross-sectional b-path: 3 months
Hartzler et al. [43]	Therapeutic bond (combined behavioral intervention group)	Abstinence self-efficacy	Drinking frequency	Yes	Yes	a-path: 16 weeks b-path: 1 year
			Drinking consequences	Yes	Yes
			Global symptom severity	Yes	Yes
	Therapeutic bond (medication and medication management group)		Drinking frequency	No	Yes
			Drinking consequences	No	Yes
			Global symptom severity	No	Yes
	Therapeutic bond (combined behavioral intervention + medication and medication management)		Drinking frequency	No	Yes
			Drinking consequences	No	Yes
			Global symptom severity	No	Yes

Note. BI = brief intervention, CBT = cognitive behavioral therapy, MET = motivational enhancement therapy.

¹Brown et al. (2002) examined their b-path in two ways: the first was as a change score from pre-treatment to end of treatment and the second was from pre-treatment through the 6-month follow-up. Results for the b-paths reported in the table are for the second method of examining the b path. Change from pretreatment to end of treatment only demonstrated a significant association for self-efficacy confidence predicting drug use severity.

²The mediator and outcome were assessed at the same time point. Johnson et al. (2006) modeled percent days abstinent using growth mixture modeling. Classes were a function of percent days abstinent from prior to the treatment through a 27-month follow-up.

³Kulesza et al. (2013) compared the 50-minute intervention to control as well as the 10-minute intervention condition to control in their tests of the a and b paths. This study used the Baron and Kenny approach to mediation and did not provide a formal test of the b path because the a path was not significant.

⁴Lozano-Stephens (2010) only found 2 out of 4 associations with drinks per drinking day were significant. Given this limited evidence, the b-path was labeled “no.”

⁵In the same study, only 1 out of 4 associations with drinking days per week were significant. Given this limited evidence, the b path was labeled no.

⁶Maisto et al. (2015) examined the relationship between self-efficacy and drinking outcomes using bivariate growth curves. Growth in self-efficacy was significantly associated with growth in drinking outcomes, however, in tests of mediation, only a b-path from the intercept of self-efficacy to the intercept of drinking was significant.

⁷Witkiewitz et al. [10] modeled their mediation pathway using bivariate latent growth curve modeling. Growth in self-efficacy was modeled from the beginning of treatment through 10 weeks following treatment. Percent drinking days were measured from weeks 4–16 during treatment and then 10–52 weeks following treatment

An additional consideration warranting increased attention in mediational tests of self-efficacy is timescale [23, 44]. As seen in Table 1, there was considerable variability across timescales in both a- and b-paths. The mixed evidence for statistical mediation for self-efficacy may stem from the variability in timescales used across studies. Recent work has found relationships across the same variables to differ depending on the selected timescale [45, 46]. The exact time-lag between the intervention or behavior change technique and self-efficacy (a-path), as well as between self-efficacy and substance use outcomes (b-path) should be guided by theory [44]. As suggested by Meisel et al. [22], studies may wish to employ methods that allow for refined assessments of time (e.g., ecological momentary assessment) and compare mediational pathways operationalized across multiple timescales [26]. This approach aligns with recent work demonstrating day-to-day and session-to-session changes in self-efficacy during substance use treatment [46, 47]. Therefore, future mediation studies can consider these methodological refinements, but transitioning the construct of self-efficacy from mediator to mechanism also requires a convergence of evidence across multiple study designs, treatments settings, and with differing populations.

Transitioning Self-Efficacy from Evidence for Mediation to Evidence for a Mechanism of Behavior Change

Identifying MOBC underlying addictions treatment effects on consumption and related outcomes and implementing that knowledge into clinical practice are two essential steps for enhancing the quality of care provided to individuals impacted by substance use. Recently, a review examined whether three important addictions constructs could be considered MOBC, and self-efficacy was among them [48]. The method consisted of two stages. Stage 1 was a review of reviews published between 2008 and 2023. Eligibility for inclusion was: (1) a systematic or non-systematic review publication, (2) a focus on one or more addictions treatment modalities, (3) referenced findings from empirical tests of statistical mediation effects, and (4) findings targeting adult samples. The results showed that there is little evidence to support the hypothesis that there are treatment-specific treatment mediators, and that self-efficacy was one of the hypothesized mediators receiving the most frequent empirical support.

In Stage 2, a systematic review of individual studies published between 1990 and 2023 was conducted. This review followed PRISMA guidelines, and articles were included if they met the following criteria: (1) an empirical study, (2) targeting an adult sample, (3) with participants attending/enrolled in a specified alcohol or drug use treatment, (4) self-efficacy was empirically examined as a potential treatment mediator or mechanism, and (5) the treatment outcome examined was substance use related. Next, the identified studies were analyzed according to the Kazdin and Nock (2003) causal criteria to determine the likelihood that self-efficacy is an MOBC of alcohol or drug consumption effects [49]. The criteria are Association, Specificity, Gradient, Experiment, Temporal Relation, Plausibility and Coherence, and Consistency.

The results showed that a total of 21 of the 25 self-efficacy studies (84%) met the Kazdin and Nock (2003) criterion of Association, where relationships at the a- and/or b-paths were observed [50]. In addition, 23 (92%) studies met the Specificity criterion, which refers to providing evidence for mediation after considering possible confounding variables. All the studies met the Gradient criterion. In general, the gradient criterion was met if greater changes in the proposed mechanism resulted in greater changes in the outcome. The data also showed that 16 (64%) of the studies met the Experiment criterion for at least one path in the casual chain. Although 20 of the 25 studies were in the context of clinical trials, several studies were secondary analyses that were conducted within the experimental treatment condition. Moreover, none of the 25 self-efficacy studies involved the direct, targeted manipulation of an indicator of self-efficacy to test its relation to outcome. A total of 60% of the self-efficacy studies included no overlap in time between measurement of the purported mediator and outcome and thus represented Temporal Relation. Finally, only 6 (24%) of the self-efficacy studies mentioned theory and thus met the criterion of Plausibility and Coherence.

The criterion of Consistency relates to the triangulation of findings across different research methodologies and contexts. The determination of the degree to which this criterion was met was a subjective process of considering the direction of the association, features of research design and data analysis (when relevant), treatment approaches tested and their delivery contexts, outcomes, sample characteristics, measures, and use of theory. For self-efficacy, 21 of 25 (84%) studies described findings consistent with the hypothesis that self-efficacy was an intervening process between the predictor and a substance use outcome. That result alone is important, but it could reflect publication bias, as studies with significant findings in the predicted direction tend to have a higher likelihood of publication than those that do not [51]. Still, the high percentage of positive results across a heterogeneous sample of studies provides support for Consistency. For example, the research participants were engaged in a variety of behavioral and pharmacological treatments that were delivered in a range of settings. The treatment targets also varied, including alcohol, cannabis, and cocaine use. The samples of participants spanned the adult age range, and several different standardized measures of self-efficacy were used. The study concluded that self-efficacy met the Consistency criterion at a medium level, based on mostly positive findings across a wide range of research designs, populations and treatments, and that the evidence from this research suggests that self-efficacy is a likely an addictions treatment MOBC.

Leveraging Self-Efficacy as a MOBC in Direct Patient Care

The ultimate purpose of research on MOBC is to improve the effectiveness, efficiency, and quality of evidence-based treatments for psychosocial ailments like addictive disorders [52, 53]. Across treatments, self-efficacy has been supported as a core process underlying adaptive behavior change [17, 39]. Yet, there remains a nascent direction on how the empirical findings on self-efficacy can be extended to the many unique individuals that addictions treatments seek to benefit. Bridging this gap between the research evidence for self-efficacy as a common treatment mechanism and concrete actions providers can take in clinical practice is a vital next step for self-efficacy research.

When considering the ways in which self-efficacy can be targeted in clinical practice, it is fruitful to begin by first considering the directionality in the relationship between self-efficacy as an MOBC and clinically salient treatment outcomes. As mentioned previously, research supporting self-efficacy suggests that the relationship between self-efficacy and outcome is bidirectional [17, 20, 39, 53]. On one hand, increases in self-efficacy can be an important antecedent to the behavior change targeted in treatment. Conversely, as one moves closer towards the achievement of one’s goals, one’s self-efficacy may consequently increase.

A reciprocal dynamic offers a two-fold opportunity for clinicians seeking to leverage self-efficacy in addictions treatment. First, by recognizing self-efficacy as an antecedent to behavior change, clinicians can actively work to cultivate a patient’s beliefs in his/her/their ability to succeed. This can be done using evidence-supported practices such as motivational interviewing, collaborative goal setting, and in session role-plays whereby clients can gain confidence with new skills before seeking to use them in daily life [54]. Second, as patients make progress towards their goals, the natural increase in self-efficacy presents an additional opportunity for clinicians to reinforce progress. Clinicians can leverage evidence-based practices like affirmations and functional analysis focusing on the positive consequences of behavior change to highlight the benefits of treatment. In doing so, treatment providers can support the naturally rewarding effects of movement towards one’s recovery goals.

Irrespective of the approach a clinician is using, the focus for intervention must remain on the client. As has been argued and supported since the genesis of research on therapist “common factors”, the relationship between the client and provider is as important as any treatment or treatment component [55]. Therefore, specific treatment components can target client self-efficacy, but we must leverage this mechanism from a patient-centered orientation. This requires openness to multiple pathways that exist for individuals seeking recovery from alcohol and other substance use. A limitation of the empirical literature on self-efficacy as an MOBC is the lack of attention paid to non-abstinent recovery pathways. While many studies on the role of self-efficacy in treatment have been conducted, the vast majority have centered on abstinence self-efficacy [7, 56]. This proves useful for those seeking to serve clients who hold abstinence goals, but it marginalizes a significant portion of individuals seeking equally valid pathways of harm reduction [57, 58].

Changes in client self-efficacy may also reflect self-efficacy as a generalized expectancy. In this regard, the predominance of empirical studies on self-efficacy in addictions treatment have concerned self-efficacy that is specific to abstiencne and substance use reduction. This follows from Bandura’s [4] original idea that self-efficacy is behavior- and context-specific. However, Bandura also allowed for the possibility that some of the experiences that an individual has may create more generalized efficacy expectations. There have been recent, albeit descriptive studies using the General Self-Efficacy Scale [59] to investigate self-efficacy as a generalized construct in substance using clinical populations [60–61]. As a result, when targeting self-efficacy as an antecedent, a behavior-specific conceptualization may be warranted, but when self-efficacy is a consequence, the clinical impact could become more general.

The utility of self-efficacy in recovery aptly applies across treatment goals, and from a person-centered orientation, seeking to leverage self-efficacy requires an awareness and integration of existing client strengths and autonomy. Thus, while the empirical literature provides a foundation, translating this knowledge into direct clinical practice requires additional research. In the meantime, an individualized approach that extends beyond any single treatment modality offers promise. By understanding the reciprocal relationship between self-efficacy and recovery outcomes and fostering a strong therapeutic alliance, clinicians can effectively leverage self-efficacy to enhance addictions treatment outcomes and support individuals in actualizing lives of greater wellbeing.

Conclusions

The goal of this review was to take one important MOBC and consider it from theory and operationalization, through empirical testing in the context of treatment, to consideration of the MOBC and its role in clinical practice. While we emphasized the context of treatment, it is important to note that the original conceptualization was based in natural human behavior and behavior change [4]. Findings suggest that self-efficacy is a general and common MOBC that is part of the human experience and that can be harnessed in the context of a range of treatment modalities. Because this expectancy is behavior specific, it can also be used to facilitate the full range of goals that clients may desire as well as recovery outside of a formal treatment context. When success is experienced, those efficacy expectations may additionally generalize. In the future, addiction clinical science could benefit from formal approaches to self-efficacy dissemination and implementation. For example, there is widespread availability of training methods that target interventions such as cognitive behavioral therapy, but training or supervision frameworks that target self-efficacy specifically are rare. It may be that modular training methods could be developed for these purposes, and these may present fewer implementation barriers because the goal is to incorporate an evidence-based principle into a provider’s pre-existing approach [62]. Further, and with the exception of drug craving, little work in the addictions has considered what intervention design would look like when a single mechanistic target is the focus [36]. Self-efficacy is an important construct in naturalistic and treatment-facilitated behavior change that is broadly incorporated in a range of evidence-based treatments. Yet, data support the importance of self-efficacy in its own right to the extent that concerted intervention development, dissemination and implementation are needed.

Data Availability

No datasets were generated or analysed during the current study.