Cognitive behavioural interventions in addictive disorders PMC
There is typically a phase of personalized assessment characterized by techniques such as functional analysis. Then, there is a phase of action, or coping skills training, that emphasizes enactment of specific behaviors to re-shape reward contingencies, put numerous biopsychosocial resources into place, and facilitate ongoing relapse prevention given this can be part of the normal course of AOD. Data demonstrating very low fidelity in CBT among clinicians in community settings comes from a project exploring what constitutes ‘treatment as usual’ as part of two large multisite clinical trials evaluating Motivational Interviewing (MI) (Miller & Rollnick, 1991, 2002) and Motivational Enhancement Therapy (MET) for individuals seeking treatment for substance use disorders.
As a means of developing a fidelity rating system to evaluate implementation of MET/MI versus TAU in those trials, the 66 volunteer clinicians from the 11 participating sites were surveyed as to their usual theoretical orientation and techniques when working with clients at that site. Multiple orientations were endorsed, including 12-Step/disease concept, reality therapy, MI/MET, client centered, psychodynamic, and experiential; however, the most commonly endorsed orientation was relapse prevention/CBT (Ball et al., 2002). Nevertheless, review of taped TAU sessions by independent raters blind to treatment assignment indicated CBT techniques and strategies were among the most infrequently used in practice. Specifically, any clinician mention of cognitions or thoughts about substance use was identified in 14 of the 379 sessions rated and mention of skills training was detected only 13 times (Santa Ana et al., 2008). That these basic CBT components were detectable in less than 6% of all sessions rated suggests very limited success in disseminating CBT to the clinical community, at least in the settings included in those studies. Skills building can be broadly conceptualized as targeting interpersonal, emotion regulation, and organizational/problem-solving deficits.
Behavioural interventions
It can be used on its own or combined with other approaches that work together to support a person’s long-term recovery. However, it is not the only option out there, so talk to your healthcare provider about what’s available to decide what approach is best for your needs. As with other treatments for alcoholism and drug abuse, including pharmaceutical treatments, cognitive behavioral therapy works best when combined with other recovery efforts. This includes participation in support groups like Alcoholics Anonymous or Narcotics Anonymous. One outcome of the Blending Initiative was the inception of the Clinical Trials Network (CTN), a 17 site regional research and training center which collaborates with many community treatment programs to study the effectiveness of specific interventions in diverse community settings and patient populations.
What Does CBT Treat?
Additionally, this model acknowledges the contributions of social cognitive constructs to the maintenance of substance use or addictive behaviour and relapse1. Through the use of problem-solving exercises and the development of a repertoire for emotion regulation, the patient can begin to both determine and utilize non-drug use alternatives to distress. Strategies for coping with negative affect, such as using social supports, engaging in pleasurable activities, and exercise can be introduced and rehearsed in the session.
Technology may provide a means for CBT interventions to circumvent the ‘implementation cliff’ in Stages 3–5 by offering a flexible, low-cost, standardized means of disseminating CBT in a range of novel settings and populations. Moreover, returning to Stage 1 to reconnect clinical applications of CBT to recent developments in cognitive science and neuroscience holds great promise for accelerating understanding of mechanisms of action. It is critical that CBT not be considered as a static intervention, but rather one that constantly evolves and is refined through the Stage model until the field achieves a maximally powerful intervention that addresses core features of the addictions. Cognitive behaviour therapy is a structured, time limited, psychological intervention that has is empirically supported across a wide variety of psychological disorders. CBT for addictive behaviours can be traced back to the application of learning theories in understanding addiction and subsequently to social cognitive theories. The focus of CBT is manifold and the focus is on targeting maintaining factors of addictive behaviours and preventing relapse.
Efficacy of CBT for SUDs
Relapse prevention programmes are based on social cognitive and cognitive behavioural principles. More recent developments in the area of managing addictions include third wave behaviour therapies. Third wave behaviour therapies are focused on improving building awareness, and distress tolerance skills using mindfulness practices. These approaches have shown promise, and more recently the neurobiological underpinnings of mindfulness strategies have been studied. The article provides an overview of cognitive behavioural approaches to managing addictions. Within the CBT for AOD literature, alcohol has been the most studied drug although efficacy for other substances such as cocaine, opioids, and cannabis has been demonstrated in individual trials.1 In the meta-analytic literature, studies with minimal treatment controls (eg, a waitlist, a pamphlet, a very brief intervention) are quite rare and thus effect sizes for CBT are often small.
The four key elements of PST are problem identification, generating alternatives, decision making, implementing solutions, reviewing outcomes and revising steps where needed. Problem orientation must also be addressed in addition to these steps, and the efficacy of PST increases when problem orientation is addressed in addition to the other steps25,26. Training in assertiveness involves two steps, a minimal effective response and escalation. When the minimal effective response (such as informing friends that “I do not drink”) is not sufficient to bring about change, the individual is instructed to escalate to a stronger response, such as warning, threat, involving others’ support.
Write down the negative thoughts you might have between therapy sessions and how you replaced them with more positive ones. As you start healthier thoughts and behaviors, you start associating them with healthier emotions, and this can start to become second nature the more you do it. “You have to challenge your mary jane meaning drug beliefs about what is a healthier strategy with your money, for your family, for yourself,” she adds.
His wife brought him for treatment and he was not keen on taking help He did not believe it was a problem (stage of change). He believed that drinking helped him across many domains of life (positive outcome expectancies regarding alcohol use and its effects, stage of change). Cognitive behavioral treatments are one of the most frequently evaluated psychosocial approaches to treating substance use disorders. 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 stages of sobriety alcohol the timing of interventions. Matching interventions to the stage of change at which an individual is, can maximize outcome.
- A patient with co-occurring panic disorder and alcohol dependence may be experiencing cycles of withdrawal, alcohol use, and panic symptoms that serve as a barrier to both reduction of alcohol consumption and amelioration of panic symptoms.
- His wife brought him for treatment and he was not keen on taking help He did not believe it was a problem (stage of change).
- Listen to Greenhouse Treatment Center‘s Gary Malone, MD discuss the role of therapy in addiction treatment.
- For CBT for AOD, the MOBC of interest are the specific indicators that are, based in theory, expected to transmit the effects of the intervention on its targeted outcomes.
In addition, the ability to reject offers for substances can be a limitation and serves a challenge to recovery. Rehearsal in session of socially-acceptable responses to offers for alcohol or drugs provides the patient with a stronger skill set for applying these refusals outside of the session. Where relevant, this rehearsal can be supplemented by imaginal exposure or emotional induction to increase the degree to which the rehearsal is similar to the patient’s high risk situations for drug use. CBT for AOD has a rich theoretical foundation, including general cognitive and behavioral theories, specific models of CBT for AOD (eg, Marlatt and Gordon’s Relapse Prevention Model), and numerous manuals to facilitate training and delivery with fidelity. In other words, the approach is well-articulated, but despite this, knowledge on MOBC (ie, how it works) and specific matching factors (ie, for whom it works) is limited. The limitations are not in study quality per se, but certainly in study quantity (ie, too few mediation studies to build a cohesive narrative of CBT MOBC) and heterogeneity (ie, do alcoholics get red noses varied assessment of potential mediators).