Aside from individual and group counseling, behavioral therapies are the most commonly used treatments for drug addiction in the United States. By focusing on a patient’s behavior, practitioners can help engage the patient in treatment, provide incentives to remain sober, change harmful attitudes and behaviors associated with drug abuse, and increase a patient’s ability to handle difficult situations or environmental triggers that create cravings for drugs and threaten sobriety.
Cognitive-behavioral therapy (CBT) has proven to be most effective at combating addiction to alcohol, nicotine, methamphetamine, cocaine and marijuana and is geared toward anticipating problems and developing effective coping mechanisms. It was initially created as a way to prevent relapse in people who drink to avoid dealing with problems, and was later modified to help those who were abusing cocaine. The methods associated with cognitive behavioral therapy are based on the concept that learning plays a vital part in developing negative behaviors. CBT teaches patients how to identify and fix negative behaviors by using different skills to stop drug abuse and deal with co-occurring issues.
CBT typically consists of a series of mechanisms intended to bolster self-control, including considering the pros and cons of continued abuse, learning to recognize cravings early, and learning to identify potentially high-risk situations and developing strategies to cope with them without falling back into bad habits.
Studies show that CBT skills stay with a person in recovery long after initial treatment is over, perhaps even a year or longer. More research needs to be conducted to determine how to create stronger effects by combining CBT, other behavior-based therapies, and anti-abuse medications.
When treating alcoholics and cocaine addicts, some addiction professionals combine the community reinforcement approach (CRA) with vouchers to encourage continued sobriety. CRA is typically administered as an intensive, six-month outpatient program and seeks to help maintain sobriety long enough for the patient to learn new skills and reduce alcohol consumption, especially in those who drink during cocaine use.
Patients in CRA must participate in at least one weekly individual counseling session, where the focus is mainly on improving family interactions, learning new skills to help lessen drug use, obtaining career counseling, and discovering new hobbies and social communities that do not involved drugs. For those who abuse both cocaine and alcohol, Antabuse will be prescribed and monitored in the clinical setting. In order to ensure that participants remain sober, they will be required to submit to thrice-weekly urine tests; those testing negative for cocaine will be issued vouchers, the value of which will increase with each successive clean test. The vouchers can be traded in for items that coincide with a drug-free lifestyle.
CRA helps patients take a more proactive approach to their own recovery and assists them in accumulating longer periods of sobriety. CRA has been evaluated in both inner cities and rural areas and effectively treats adults addicted to opioids and methadone patients who abuse cocaine intravenously.
Contingency Management Interventions/Motivational Incentives
For people who abuse alcohol, stimulants, opioids, marijuana and nicotine, contingency management and motivational incentives can be effective drug treatments. These methods typically involve offering patients low-cost rewards for negative drug tests. Common incentives include actual prizes or vouchers that can be exchanged for food, movie tickets and other personal items.
Some addiction professionals, however, question the wisdom of using a gambling-based game in the drug treatment setting, especially since gambling and substance abuse can co-occur. To date, research has yet to show an increase in gambling addiction between those participating in incentive-based treatment and those participating in more traditional, CBT-type programs.
Some individuals who are addicted to alcohol, marijuana or cigarettes are actually quite ambivalent about whether they wish to get treatment for their problem. Motivational Enhancement Therapy (MET) is patient-centered counseling that assists patients in resolving the ambivalence. Instead of guiding patients, step-by-step, through drug addiction recovery, techniques used in MET evoke rapid and internally motivated changes. MET begins with an initial assessment followed by several individual sessions with a therapist trained in MET. During the first treatment session, feedback is given on the initial assessment, which often leads to a discussion about the patient’s own drug abuse; the patient will likely begin making his own motivating statements. The role of the therapist is to interview the patient in such a way as to solidify his own motivation and develop a plan for achieving his goals. As with many behavioral therapies, mechanisms for dealing with high-risk situations must be explored and developed. As the course of treatment progresses, the therapist will keep track of the patient’s progress, review effectiveness of core strategies and encourage adherence to the sobriety plan. In this type of therapy, patients may be encouraged to bring a spouse or partner.
Studies on the effectiveness of MET show that it may depend on the particular drug the patient is addicted to or the person’s individual treatment goals. MET has been shown effective in treating alcoholics. Adults with marijuana addiction also benefit from MET, especially in conjunction with cognitive-behavioral therapy. Ultimately, however, MET has been shown to be most effective at getting people to engage in the treatment process rather than causing positive changes in drug use. More talk, less action.
For people addicted to stimulants such as cocaine or methamphetamine, the Matrix Model helps engage the patient in treatment and achieve sobriety. While participating in the Matrix Model, participants learn important concepts in addiction and relapse, get direction and support from a trained addiction professional, are introduced to self-help and 12-step programs, and must submit to drug tests.
A therapist engaged in the Matrix Model will be both coach and teacher, creating a positive, inviting relationship with the patient, which will be used to reinforce positive behavioral changes. Without this bond, a successful outcome is unlikely. Unlike in some other treatment models, however, the relationship between student and teacher will remain non-confrontational. During treatment sessions, therapists trained in the Matrix Model know how to foster the patient’s self-esteem, dignity and self-worth.
The Matrix Model borrows from other treatment methods and includes parts of relapse prevention, family and group therapy, drug education and12-step participation. Sessions are more structured than in other modalities and utilize worksheets. Other techniques used in the Matrix Model include groups for family education, early recovery skills, relapse prevention and analysis, and social support. Studies show that patients treated under the Matrix Model reduce drug and alcohol use, improve psychological stability and reduce risky sexual behaviors.
12-step self-help groups are instrumental in a person’s recovery and after-care, often meaning the difference between relapse and sobriety. Many residential and outpatient treatment facilities recognize the importance of 12-step participation and often encourage attendance at meetings even prior to discharge from the facility. Although some facilities maintain meetings on-campus, therapists often consider the introduction into the community’s recovery community to be an important benefit of structured treatment programs and will, thus, make it possible for patients to attend meetings off-site.
12-step facilitation therapy is intended to increase the chance that a drug addict will join a self-help group after treatment and continue to be actively involved in 12-step programs long after sobriety has been attained. This type of therapy focuses on three main issues – acceptance, the realization and acceptance that drug addiction is a chronic condition that cannot be controlled, that life with drugs is not manageable, that willpower is not enough to overcome addiction, and that abstinence is the only alternative; surrender, giving oneself over to a higher power, accepting support from others in recovery, and following the steps, and active participation in 12-step meetings.
12-steps meetings have been shown to be effective in helping people abstain from alcohol use. However, more search needs to be done on whether 12-step programs are as effective in the drug addict population.
Drug abusers do not just hurt themselves. They harm everyone around them, especially loved ones. Drug addiction treatment is a time to not only heal the patient, but also begin to heal the relationships that have been damaged by the drug abuse. Behavioral Couples Therapy (BCT) is often used for drug addicts who are involved in romantic relationships. The significant other is invited to the sessions. During therapy, the participants develop a sobriety and abstinence contract, in addition to identifying particular behaviors they believe will reinforce abstinence and developing ways to encourage such behavior.
Patients who participate in BCT often also participate in individual and group counseling. BCT is typically conducted over 12 weeks, one hour per week. BCT has been shown to help alcoholic men and their spouses and, to a lesser degree, alcoholic women and their spouses. When compared to individual “talk” therapy, BCT has higher therapy attendance rates, better compliance with naltrexone protocols, and higher abstinence rates. Those who participated in BCT have often experienced fewer legal and family problems at the one-year mark. As many patients do not stay in residential treatment for a full 12 weeks, addiction professionals are exploring ways to reduce the length of BCT treatment so that the program can successfully end at patient discharge.
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