2. Effective therapies for drug and alcohol addiction
(National Institute on Drug Abuse- NIDA)
CBT (Alcohol, Marijuana, Cocaine, Methamphetamine,
Nicotine)
Community Reinforcement approach plus vouchers
(alcohol, cocaine)
Contingency Management Interventions/Motivational
Incentives (Alcohol, Stimulants, Opioids, Marijuana,
Nicotine)
Motivational Enhancement Therapy (Alcohol, Marijuana,
Nicotine)
The Matrix Model (Stimulants)
12 Step Therapy (Alcohol, Stimulants, Opiates)
Behavioral Couples Therapy
3. CBT
CBT strategies are used to help addicted individuals learn to
identify and correct problematic behaviors by applying a
range of different skills that can be used to stop drug abuse
and to address a range of other problems that often co-occur
with it.
The CBT strategies are used to strengthen self-control in the
individual.
Other strategies include exploring the positive and negative
consequences of continued use, self-monitoring to recognize
drug cravings early on and to identify high risk situations for
use, and developing strategies for coping with and avoiding
high-risk situations and the desire to use.
It is critical in CBT to explore possible problems and
helppatients develop effective coping strategies.
4. Community Reinforcement Approach plus
Vouchers (CRA)
CRA consists of an intensive 24-week outpatient therapy for treatment of
cocaine and alcohol addiction.
There are 2 treatment goals:1. To maintain abstinence long enough for
patients to learn new life skills to help sustain it, and 2. To reduce alcohol
consumption for patients whose drinking is associated with cocaine use
Patients attend one or two individual counseling sessions every week. The
focus is on improving family functioning, learning a variety of skills to
minimize drug use, receiving vocational counseling, and developing new
recreational activities and social networks.
Patients who abuse alcohol also receive Antabuse therapy.
Patients provide urine samples two or three times each week and receive
vouchers when they test negative for cocaine. The value of the vouchers
increases with consecutive clean samples. Patients may exchange vouchers
for retail goods that are consistent with a cocaine-free lifestyle.
This therapy helps patients engage in treatment and assists them in going
long periods of time without cocaine use.
5. Contingency Management/Motivational
Incentives
Studies have shown that Contingency Management/Motivational
incentives is an effective treatment for Alcohol, Stimulants, Opioids,
Marijuana, Nicotine use.
This treatment approach uses contingency management principles,
which involve giving patients in drug treatment the chance to earn
low-cost incentives in exchange for drug-free urine samples.
Incentives can include prizes given immediately or vouchers
exchangeable for food items, movie passes, and other personal
goods.
This treatment approach has been effective in increasing treatment
retention and promoting abstinence from drugs.
There have been concerns that this treatment can promote
gambling. However, when investigated the contingency
management therapy did not promote gambling behavior.
6. Motivational Enhancement Therapy (Alcohol,
Marijuana, Nicotine)
MET is a patient centered counseling approach for initiating
behavior change by helping individuals resolve ambivalence about
engaging in treatment and stopping drug use.
MET seeks to increase internal motivation to change in a short
amount of time.
MET includes an initial assessment battery session, followed by 2-4
individual treatment sessions with a therapist.
In the first treatment session, the therapist provides feedback about
the initial assessment battery. Substance use is discussed and the
therapist tries to elicit self-motivational statements. Motivational
interviewing principles are used to strengthen motivation and build
a plan for change. Coping strategies for high-risk situations are
suggested and discussed with the patient.
In sessions 2-4 the therapist monitors change, reviews strategies
being used, and continues to encourage commitment to change or
sustained abstinence.
7. MET has been used successfully with alcoholics to
improve both treatment engagement and treatment
outcomes (e.g., reductions in problem drinking).
MET has also been used successfully with adult
marijuana-dependent individuals in combination
with cognitive-behavioral therapy, comprising a
more comprehensive treatment approach.
MET tends to be more effective for engaging patients
in therapy than for changing actual drug use.
8. The Matrix Model (Stimulants)
The Matrix Model is used to engage stimulant (e.g.,
methamphetamine and cocaine) abusers in treatment and
help stop abusing.
Patients learn about issues critical to addiction and relapse,
receive direction and support from a trained therapist,
become familiar with self-help programs, and are monitored
for drug use through urine testing.
The therapist acts as both a teacher and a coach, and uses this
positive relationship with the patient to promote behavior
change. Therapists should not be confrontational or behave
like a parent. The treatment sessions are conducted with the
purpose of increasing the patient's self-esteem, dignity, and
self-worth.
This relationship is very important in ensuring the patients
retention in therapy.
9. The Matrix Model also incorporates strategies from
relapse prevention, family and group therapy, drug
education, and self-help groups.
The treatment manuals contain worksheets for individual
sessions; other components include family education
groups, early recovery skills groups, relapse prevention
groups, combined sessions, urine tests, 12-step
programs, relapse analysis, and social support groups.
Several studies have shown that patients treated using
the Matrix Model show statistically significant reductions
in drug and alcohol use, improvements in psychological
indicators, and reduced risky sexual behaviors associated
with HIV transmission.
10. 12-Step Facilitation Therapy (Alcohol,
Stimulants, Opiates)
Twelve-step facilitation seeks to improve the chances of a drug addict
becoming actively involved in a 12-step self-help group which promotes
abstinence.
When the patient joins the group it is necessary for them to accept that: 1.
drug addiction is a chronic, progressive disease over which one has no
control, 2. life has become unmanageable because of drugs, 3. willpower
alone cannot overcome the problem, and 4. abstinence is the only
alternative.
The 12-step philosophy states that the individual has to surrender to a
higher power, accept the support structure of other addicts in recovery and
follow the recovery activities laid out by the 12-step program.
The individual must become actively involved in 12-step meetings and
related activities.
The efficacy of 12-step programs (and 12-step facilitation) has only been
demonstrated for alcohol dependence. Currently, research on other drugs is
being conducted.
11. Behavioral Couples Therapy
Behavioral Couples Therapy (BCT) is a therapy for drug
abusers and their significant others.
BCT uses an abstinence contract and behavioral principles to
promote abstinence from drugs and alcohol. It is used as an
add-on to individual and group therapy.
BCT includes 12 weekly couple sessions, lasting approximately
60 minutes each.
Research has shown that BCT works for alcoholic men and
their spouses and with drug-abusing men and women and
their significant others. BCT also has been shown to produce
higher treatment attendance, naltrexone adherence, and rates
of abstinence than individual treatment, along with fewer
drug-related, legal, and family problems at 1-year follow-up.
12. Behavioral Treatments for Adolescents
Therapies created for adults need to be modified so
that they work better for adolescents. Involvement of
the adolescent’s family is critical for adolescent
interventions.
Multisystemic Therapy (MST), Multidimensional
Family Therapy (MDFT) and Brief Strategic Family
Therapy (BSFT) are two family therapies that have
shown promise with adolescents who have substance
abuse addiction.
13. Multisystemic Therapy (MST)
MST targets antisocial behavior in children and adolescents
who abuse alcohol and other drugs.
Some of these behaviors/attitudes are characteristics of the
child or adolescent (e.g., favorable attitudes toward drug use),
the family (poor discipline, family conflict, parental drug
abuse), peers (positive attitudes toward drug use), school
(dropout, poor performance), and neighborhood (criminal
subculture).
MST is an intensive treatment that is conducted in the
environment(home, school, and neighborhood) of the youth.
Because of this most youths and families complete a full
course of treatment.
MST reduces adolescent drug use during treatment and for at
least 6 months after treatment.
14. Multidimensional Family Therapy (MDFT)
MDFT is an outpatient family- based alcohol and drug abuse
treatment for adolescents. Treatment includes individual and
family sessions held in a clinic, in the home, or with family
members at the family court, school, or other community
locations.
MDFT views adolescent drug use in terms of a network of
influences (individual, family, peer, community) and behavior
change must occur in each of those areas.
During individual sessions, the focus is on decision making,
negotiation, and problem solving skills. Sessions with family
members focus on parenting styles, using their influence
productively and in a developmentally appropriate manner.
15. Brief Strategic Family Therapy (BSFT)
BSFT seeks to alter family interactions that maintain or
exacerbate adolescent drug abuse and other co-occurring
problem behaviors. Such problem behaviors include conduct
problems at home and at school, oppositional behavior,
delinquency, associating with antisocial peers, aggressive and
violent behavior, and risky sexual behavior.
BSFT is based on a family systems approach to treatment.
This approach posits that the symptoms of any one member
are a reflection of what else is going on in the family system.
The BSFT counselor must identify the patterns of family
interaction that are associated with the adolescent's behavior
problems and to assist in changing family patterns.
BSFT is flexible and can be adapted to different family
situations in different settings (i.e. mental health clinics, drug
abuse treatment programs, and families' homes).
