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
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.
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.
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.
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.
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.
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 patients self-esteem, dignity, and self-worth. This relationship is very important in ensuring the patients retention in therapy.
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.
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.
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.
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.
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.
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.
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 adolescents 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).