The first concerns fidelity and other sources of variability in what comprised the sample of CBT interventions. As noted, we sought homogeneity in how CBT was defined via inclusion of face-to-face CBT not combined with another intervention, whether psychosocial or pharmacological. However, reporting of therapist training (44%), supervision frequency and/or methods (70%), and fidelity (7%) was variable in the sample of studies. Second, study results should be considered in the context of the ongoing debate about what constitutes an optimal outcome in randomized clinical trials with substance use disorders. We selected consumption measures, and favored biological assay variables, but equally meaningful are use consequences and improvements in overall functioning (Kiluk, Fitzmaurice, Strain, & Weiss, 2019).
- Some might be viewed as essential and would be
expected to be used for all clients, while others would be viewed as more
elective in nature and would be selected for a particular individual based
on the functional analysis. - A review of
the alcohol treatment outcome literature identifies CRA among those
interventions having the greatest empirical support (Miller et al., 1995). - Finally, we will examine moderating and mediating factors that have been observed in studies of intervention efficacy.
A model
of relapse that is based on the role of self-efficacy and coping is depicted
in Figure 4-15. In a brief version of this therapy, there is less time to understand and
restructure all of the cognitions that may be influencing substance abuse. The therapist must use the early sessions to determine the most productive
focus of the therapy, given the short timeframe. If the client used
substances primarily to cope with negative mood states, then therapy may
focus on understanding how the client’s interpretation of events led to the
negative moods.
Combination Treatment Strategies
The community reinforcement approach (CRA) was developed as a treatment for
alcohol abuse disorders (Azrin,
1976; Hunt and Azrin,
1973). After a period during which it appears to have been little
used, it has received increased interest as a behavioral approach to
substance abuse (Higgins et al.,
1998; Meyers and Smith,
1995; Smith and Meyers,
1995). CRA is a broad-spectrum approach based on the principles of
operant learning, the goal of which is to increase the likelihood of
continued abstinence from alcohol or drugs by reorganizing the client’s
environment. Most often, behavioral contracts and contingency management procedures are
embedded in a more comprehensive treatment program. The effectiveness of such contracts also appears to
be linked to the severity of the consequences that might result from a
broken contract (Magura et al.,
1987).
When non-specific therapies or usual care were the contrast, the pooled effect size was small to non-significant. Modest relative efficacy in contrast to these conditions underscores how little we know about the specificity of CBT ingredients when delivered to populations with alcohol or other drug use disorders. A view of Supplemental Table 1 supports this point where non-specific contrasts were quite variable, but often involved addiction information, mutual support, and 12-step program involvement. These are established elements of community-based care and confer benefit in their own right (SAMHSA, 2017). Cognitive behavioral therapy (CBT) for substance use disorders has demonstrated efficacy as both a monotherapy and as part of combination treatment strategies. This article provides a review of the evidence supporting the use of CBT, clinical elements of its application, novel treatment strategies for improving treatment response, and dissemination efforts.
Primary Study Inclusion
For example, among individuals with low levels of literacy, the use of written homework forms may need to be replaced by alternative means of monitoring home practice (e.g., using simplified forms or having the patient call to leave a phone message regarding completion of an assignment). As noted, a variety of CM procedures have shown success in helping patients reduce drug use. As such, the cognitive behavioral therapist needs to consider how abstinence is to be rewarded as part of treatment. In addition to consideration of traditional CM rewards—monetary prizes, vouchers for goods, or treatment “privileges” (e.g., take-home doses of methadone)—the arrangement of social contingencies, such as is evident in BCT approaches, should be considered.
After discussing the issues
involved in the session, the therapist models the effective coping skill for
the particular topic. The therapist then asks the client to participate in cbt interventions for substance abuse a
role-playing scenario in which he can rehearse the new coping behaviors. The
therapist provides feedback and guidance while the client continues in the
behavioral rehearsal.
Cognitive behavioural interventions in addictive disorders
First, there appears to be a
considerable degree of situational specificity in the coping process. That is, different types of substance-related situations seem to require
different types of coping responses rather than a general coping
strategy’s being equally effective across situations. Second, strategies
used to cope with nonspecific stress appear to be somewhat different
from those used to cope with temptation.
Research suggests that the skills obtained through CBT are enduring and can also be applied in other areas of an individual’s life as well. Approximately 60% of people who are treated with cognitive behavioral therapy for a substance use problem are able to maintain their recovery for a year. When MBIs were compared to a distraction strategy or passive control or suppression condition (54, 65), there were no overall differences between groups. It seems that dispositional anxiety sensitivity did not have an impact on the outcomes but, state symptom-focused anxiety immediately after the cue induction procedure was a significant predictor of self-efficacy at follow-up. Specifically, and contrary to previous research, individuals who are anxiety sensitive do equally well, or better, when coping with cravings using a suppression-based approach as they do when using a mindfulness strategy, at least in the short term. Depending on your plan, you may have a co-pay due at the time of service, you may have to meet a certain deductible before your coverage kicks in, or you may have other out-of-pocket costs.
Benefits of CBT for Alcoholism and Addiction
An individual progresses through various stages of changes and the movement is influenced by several factors. Stages imply a readiness to change and therefore the TTM has been particularly relevant in the timing of interventions. Matching interventions to the stage of change at which an individual is, can maximize outcome.
