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Drug
Addiction Treatment Methods
This section presents several examples of
treatment approaches and components that have
been developed and tested through research
supported by the National Institute on Drug
Abuse (NIDA). Each approach is designed to
address certain aspects of drug addiction and
its consequences for the individual, family, and
society.
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Relapse Prevention, a cognitive-behavioral
therapy, was developed for the treatment of
problem drinking and adapted later for cocaine
addicts. Cognitive-behavioral strategies are
based on the theory that learning processes play
a critical role in the development of
maladaptive behavioral patterns. Individuals
learn to identify and correct problematic
behaviors. Relapse prevention encompasses
several cognitive-behavioral strategies that
facilitate abstinence as well as provide help
for people who experience relapse.
The relapse prevention approach to the treatment
of cocaine addiction consists of a collection of
strategies intended to enhance self-control.
Specific techniques 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. A central element of this
treatment is anticipating the problems patients
are likely to meet and helping them develop
effective coping strategies.
Research indicates that the skills individuals
learn through relapse prevention therapy remain
after the completion of treatment. In one study,
most people receiving this cognitive-behavioral
approach maintained the gains they made in
treatment throughout the year following
treatment.
References:
Carroll, K.; Rounsaville, B.; and Keller, D.
Relapse prevention strategies for the treatment
of cocaine abuse. American Journal of Drug and
Alcohol Abuse 17(3): 249-265, 1991.
Carroll, K.; Rounsaville, B.; Nich, C.; Gordon,
L.; Wirtz, P.; and Gawin, F. One-year follow-up
of psychotherapy and pharmacotherapy for cocaine
dependence: delayed emergence of psychotherapy
effects. Archives of General Psychiatry 51:
989-997, 1994.
Marlatt, G. and Gordon, J.R., eds. Relapse
Prevention: Maintenance Strategies in the
Treatment of Addictive Behaviors. New York:
Guilford Press, 1985.
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The Matrix Model provides a framework for
engaging stimulant abusers in treatment and
helping them achieve abstinence. 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 by
urine testing. The program includes education
for family members affected by the addiction.
The therapist functions simultaneously as
teacher and coach, fostering a positive,
encouraging relationship with the patient and
using that relationship to reinforce positive
behavior change. The interaction between the
therapist and the patient is realistic and
direct but not confrontational or parental.
Therapists are trained to conduct treatment
sessions in a way that promotes the patient's
self-esteem, dignity, and self-worth. A positive
relationship between patient and therapist is a
critical element for patient retention.
Treatment materials draw heavily on other tested
treatment approaches. Thus, this approach
includes elements pertaining to the areas of
relapse prevention, family and group therapies,
drug education, and self-help participation.
Detailed treatment manuals contain work sheets
for individual sessions; other components
include family educational groups, early
recovery skills groups, relapse prevention
groups, conjoint sessions, urine tests, 12-step
programs, relapse analysis, and social support
groups.
A number of projects have demonstrated that
participants treated with the Matrix model
demonstrate statistically significant reductions
in drug and alcohol use, improvements in
psychological indicators, and reduced risky
sexual behaviors associated with HIV
transmission. These reports, along with evidence
suggesting comparable treatment response for
methamphetamine users and cocaine users and
demonstrated efficacy in enhancing naltrexone
treatment of opiate addicts, provide a body of
empirical support for the use of the model.
References:
Huber, A.; Ling, W.; Shoptaw, S.; Gulati, V.;
Brethen, P.; and Rawson, R. Integrating
treatments for methamphetamine abuse: A
psychosocial perspective. Journal of Addictive
Diseases 16: 41-50, 1997.
Rawson, R.; Shoptaw, S.; Obert, J.L.; McCann,
M.; Hasson, A.; Marinelli-Casey, P.; Brethen,
P.; and Ling, W. An intensive outpatient
approach for cocaine abuse: The Matrix model.
Journal of Substance Abuse Treatment 12(2):
117-127, 1995.
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Supportive-Expressive Psychotherapy is a
time-limited, focused psychotherapy that has
been adapted for heroin- and cocaine-addicted
individuals. The therapy has two main
components:
Supportive techniques to help patients feel
comfortable in discussing their personal
experiences.
Expressive techniques to help patients identify
and work through interpersonal relationship
issues.
Special attention is paid to the role of drugs
in relation to problem feelings and behaviors,
and how problems may be solved without recourse
to drugs.
The efficacy of individual supportive-expressive
psychotherapy has been tested with patients in
methadone maintenance treatment who had
psychiatric problems. In a comparison with
patients receiving only drug counseling, both
groups fared similarly with regard to opiate
use, but the supportive-expressive psychotherapy
group had lower cocaine use and required less
methadone. Also, the patients who received
supportive-expressive psychotherapy main-tained
many of the gains they had made. In an earlier
study, supportive-expressive psychotherapy, when
added to drug counseling, improved outcomes for
opiate addicts in metha-done treatment with
moderately severe psychiatric problems.
References:
Luborsky, L. Principles of Psychoanalytic
Psychotherapy: A Manual for
Supportive-Expressive (SE) Treatment. New York:
Basic Books, 1984.
Woody, G.E.; McLellan, A.T.; Luborsky, L.; and
O'Brien, C.P. Psychotherapy in community
methadone programs: a validation study. American
Journal of Psychiatry 152(9): 1302-1308, 1995.
Woody, G.E.; McLellan, A.T.; Luborsky, L.; and
O'Brien, C.P. Twelve month follow-up of
psychotherapy for opiate dependence. American
Journal of Psychiatry 144: 590-596, 1987.
Individualized Drug Counseling focuses directly
on reducing or stopping the addict's illicit
drug use. It also addresses related areas of
impaired functioningÑsuch as employment status,
illegal activity, family/social relationsÑas
well as the content and structure of the
patient's recovery program. Through its emphasis
on short-term behavioral goals, individualized
drug counseling helps the patient develop coping
strategies and tools for abstaining from drug
use and then maintaining abstinence. The
addiction counselor encourages 12-step
participation and makes referrals for needed
supplemental medical, psychiatric, employment,
and other services. Individuals are encouraged
to attend sessions one or two times per week.
In a study that compared opiate addicts
receiving only methadone to those receiving
methadone coupled with counseling, individuals
who received only methadone showed minimal
improvement in reducing opiate use. The addition
of counseling produced significantly more
improvement. The addition of onsite
medical/psychiatric, employment, and family
services further improved outcomes.
In another study with cocaine addicts,
individualized drug counseling, together with
group drug counseling, was quite effective in
reducing cocaine use. Thus, it appears that this
approach has great utility with both heroin and
cocaine addicts in outpatient treatment.
References:
McLellan, A.T.; Arndt, I.; Metzger, D.S.; Woody,
G.E.; and O'Brien, C.P. The effects of
psychosocial services in substance abuse
treatment. Journal of the American Medical
Association 269(15): 1953-1959, 1993.
McLellan, A.T.; Woody, G.E.; Luborsky, L.; and
O'Brien, C.P. Is the counselor an 'active
ingredient' in substance abuse treatment?
Journal of Nervous and Mental Disease 176:
423-430, 1988.
Woody, G.E.; Luborsky, L.; McLellan, A.T.;
O'Brien, C.P.; Beck, A.T.; Blaine, J.; Herman,
I.; and Hole, A. Psychotherapy for opiate
addicts: Does it help? Archives of General
Psychiatry 40: 639-645, 1983.
Crits-Cristoph, P.; Siqueland, L.; Blaine, J.;
Frank, A.; Luborsky, L.; Onken, L.S.; Muenz, L.;
Thase, M.E.; Weiss, R.D.; Gastfriend, D.R.;
Woody, G.; Barber, J.P.; Butler, S.F.; Daley,
D.; Bishop, S.; Najavits, L.M.; Lis, J.; Mercer,
D.; Griffin, M.L.; Moras, K.; and Beck, A.
Psychosocial treatments for cocaine dependence:
Results of the NIDA Cocaine Collaborative Study.
Archives of General Psychiatry (in press).
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Motivational Enhancement Therapy is a
client-centered counseling approach for
initiating behavior change by helping clients to
resolve ambivalence about engaging in treatment
and stopping drug use. This approach employs
strategies to evoke rapid and internally
motivated change in the client, rather than
guiding the client stepwise through the recovery
process. This therapy consists of an initial
assessment battery session, followed by two to
four individual treatment sessions with a
therapist. The first treatment session focuses
on providing feedback generated from the initial
assessment battery to stimulate discussion
regarding personal substance use and 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 client. In
subsequent sessions, the therapist monitors
change, reviews cessation strategies being used,
and continues to encourage commitment to change
or sustained abstinence. Clients are sometimes
encouraged to bring a significant other to
sessions. This approach has been used
successfully with alcoholics and with
marijuana-dependent individuals.
References:
Budney, A.J.; Kandel, D.B.; Cherek, D.R.;
Martin, B.R.; Stephens, R.S.; and Roffman, R.
College on problems of drug dependence meeting,
Puerto Rico (June 1996). Marijuana use and
dependence. Drug and Alcohol Dependence 45:
1-11, 1997.
Miller, W.R. Motivational interviewing:
research, practice and puzzles. Addictive
Behaviors 61(6): 835-842, 1996.
Stephens, R.S.; Roffman, R.A.; and Simpson, E.E.
Treating adult marijuana dependence: a test of
the relapse prevention model. Journal of
Consulting & Clinical Psychology, 62: 92-99,
1994.
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Behavioral Therapy for Adolescents incorporates
the principle that unwanted behavior can be
changed by clear demonstration of the desired
behavior and consistent reward of incremental
steps toward achieving it. Therapeutic
activities include fulfilling specific
assignments, rehearsing desired behaviors, and
recording and reviewing progress, with praise
and privileges given for meeting assigned goals.
Urine samples are collected regularly to monitor
drug use. The therapy aims to equip the patient
to gain three types of control:
Stimulus Control helps patients avoid situations
associated with drug use and learn to spend more
time in activities incompatible with drug use.
Urge Control helps patients recognize and change
thoughts, feelings, and plans that lead to drug
use.
Social Control involves family members and other
people important in helping patients avoid
drugs. A parent or significant other attends
treatment sessions when possible and assists
with therapy assignments and reinforcing desired
behavior.
According to research studies, this therapy
helps adolescents become drug free and increases
their ability to remain drug free after
treatment ends. Adolescents also show
improvement in several other areasÑemployment/school
attendance, family relationships, depression,
institutionalization, and alcohol use. Such
favorable results are attributed largely to
including family members in therapy and
rewarding drug abstinence as verified by
urinalysis.
References:
Azrin, N.H.; Acierno, R.; Kogan, E.; Donahue,
B.; Besalel, V.; and McMahon, P.T. Follow-up
results of supportive versus behavioral therapy
for illicit drug abuse. Behavioral Research &
Therapy 34(1): 41-46, 1996.
Azrin, N.H.; McMahon, P.T.; Donahue, B.; Besalel,
V.; Lapinski, K.J.; Kogan, E.; Acierno, R.; and
Galloway, E. Behavioral therapy for drug abuse:
a controlled treatment outcome study. Behavioral
Research & Therapy 32(8): 857-866, 1994.
Azrin, N.H.; Donohue, B.; Besalel, V.A.; Kogan,
E.S.; and Acierno, R. Youth drug abuse
treatment: A controlled outcome study. Journal
of Child & Adolescent Substance Abuse 3(3):
1-16, 1994.
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Multidimensional Family Therapy (MDFT) for
Adolescents is an outpatient family-based drug
abuse treatment for teenagers. MDFT views
adolescent drug use in terms of a network of
influences (that is, individual, family, peer,
community) and suggests that reducing unwanted
behavior and increasing desirable behavior occur
in multiple ways in different settings.
Treatment includes individual and family
sessions held in the clinic, in the home, or
with family members at the family court, school,
or other community locations.
During individual sessions, the therapist and
adolescent work on important developmental
tasks, such as developing decisionmaking,
negotiation, and problem-solving skills.
Teenagers acquire skills in communicating their
thoughts and feelings to deal better with life
stressors, and vocational skills. Parallel
sessions are held with family members. Parents
examine their particular parenting style,
learning to distinguish influence from control
and to have a positive and developmentally
appropriate influence on their child.
References:
Diamond, G.S., and Liddle, H.A. Resolving a
therapeutic impasse between parents and
adolescents in Multi-dimensional Family Therapy.
Journal of Consulting and Clinical Psychology
64(3): 481-488, 1996.
Schmidt, S.E.; Liddle, H.A.; and Dakof, G.A.
Effects of multidimensional family therapy:
Relationship of changes in parenting practices
to symptom reduction in adolescent substance
abuse. Journal of Family Psychology 10(1): 1-16,
1996.
This section is not a complete list of
efficacious, scientifically based treatment
approaches. Additional approaches are under
development as part of NIDA's continuing support
of treatment research. |
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