In addition to primary care settings, recent studies have found that brief MI sessions may have a place in acute settings such as the emergency room 35. In acute settings, MI interventions are feasible, and may be more effective in younger adolescents under the age of 16 years 36, as well as with adolescent girls more so than boys 37. Trying alcohol and drugs for the first time is common among adolescents, and approximately 5% will develop problematic patterns of use that meet criteria for a substance use disorder (SUD) 1. Over 90% of adults with a SUD began using alcohol or drugs during adolescence 2, and earlier initiation of substance use corresponds to a greater lifetime risk of adverse effects including increased mental health burden, school-related problems, physical health concerns, and neurocognitive impairments 3–7. Pharmacotherapy https://ecosoberhouse.com/ and psychotherapy have distinct modes of action, time to effect, target symptoms, durability, and applicability.
Disorders
For example, in a large effectiveness trial of motivational enhancement therapy for Spanish-speaking patients seeking treatment for substance use, Carroll et al 50 found small advantages for this treatment relative to TAU only among those in the sample seeking treatment for alcohol problems. This finding of an advantage for motivational enhancement in alcohol and not drug using samples was consistent with prior investigations.51 Similarly, a study conducted by Gray, McCambridge, and Strang 52 examined the effects of single-session MI delivered by youth workers for alcohol, nicotine, and cannabis use among young people. Upon 3-month follow-up those who received MI reported significantly fewer days of alcohol use than those who did not receive MI; however, significant differences were not found for cigarette or cannabis use indicating that the extent of benefit of MI is more modest than that identified by efficacy research studies.
Treatment Methods & Evidence-Based Practices
Of course, there are some patients who are remanded for treatment who otherwise would not seek treatment on their own. They may deny that they have a problem with alcohol and other drugs, and not truly engage in the therapy process at all. The therapist’s understanding of the patient’s stage of change will be vital in helping them know just how directive to be, without going too far for a particular patient to tolerate at a given time in treatment.
CBI effect on mental health symptoms: overall and by subgroup
Outcomes were alcohol or other drug use and mental health symptoms at post-treatment through follow-up. CBT is one of the most researched forms of treatments, so there is an abundance of evidence and support for its use with a variety of mental conditions, including alcohol and substance use disorders. More than 53 randomized controlled trials on alcohol and drug abuse were examined to assess the outcomes of CBT treatment.
A number of published treatment manuals are available to guide skillstraining with substance users (Carroll,1998; Kadden et al.,1992; Monti et al., 1989).These manuals provide a session-by-session overview of the intervention. The skills to be taught are either specific to substanceabuse (e.g., coping with craving, refusing an offer of alcohol or drugs) orapply to more general interpersonal and emotional areas (e.g., communicationskills, coping with anger or depression). Some might be viewed as essential and would beexpected to be used for all clients, while others would be viewed as moreelective in nature and would be selected for a particular individual basedon the functional analysis. The ability to individually tailor the skillstraining to the client’s needs represents one of the strengths of CBT. Attributional styles play a major role in the cognitive-behavioral theory ofsubstance abuse disorders (Davies,1992; Marlatt and Gordon,1985). The nature of substance abusers’ attributional styles isthought to have considerable bearing on their perception of their substanceabuse problem and their approach to recovery.
- Behavioral, cognitive, and cognitive-behavioral treatments all rely heavilyon an awareness of the antecedents and consequences of substance abuse.
- This curriculum is a structured curriculum intended for individuals who are moderate to high need in the area of sexual offending and related behaviors.
- Through CBI, patients learn to examine their thoughts, recognize when negative thoughts are increasing, and then apply a number of strategies to alter those negative thoughts and emotions.
In comparison to cognitive behavioral interventions for substance abuse cognitive therapy, CBTplaces less emphasis on identifying, understanding, and changing underlyingbeliefs about the self and the self in relationship to substance abuse. Itfocuses instead on learning and practicing a variety of coping skills, only someof which are cognitive. A greater emphasis is also placed on using behavioralcoping strategies, especially early in therapy. More recently, there has been an increased interest in the expectations ofnegative outcomes that individuals hold about substances. Negativeexpectancies about alcohol include cognitive and behavioral impairment, riskand aggression, and negative self-perception (Fromme et al., 1993). Negative consequences expectedfrom cocaine include global negative effects, anxiety, depression, andparanoia (Jaffe and Kilbey, 1994;Schafer and Brown, 1991).
These are the basis of the self-help philosophy of Narcotics Anonymous and Alcoholics Anonymous (AA). This approach regards addiction as a relapsing illness with complete abstinence as the only treatment goal and is based on behavioral, spiritual and cognitive principles. As part of the process toward recovery, individuals must acknowledge to themselves (and another people) the harm substance use has caused to themselves and others, admit that they are powerless over drug use and surrender to a higher power for recovery. Social learning theory, developed by Albert Bandura, posits that people learn new behavior by watching others’ behavior and imitating it.
How people in recovery are using movies to heal from addiction
Whereas the internal, global, andstable attribution for the use of alcohol is likely to lead to feelings ofhopelessness and a return to drinking, the external, specific, unstableattribution is likely to lead to greater efforts to cope with similarsituations in the future. When distorted or unproductive ways of thinking about daily lifeevents lead to negative emotional states that then promote substance use,cognitive therapy can be used to alter the sequence by targeting and modifyingthe client’s thoughts. When clients limit their options for coping with stressby rigid or all-or-nothing thinking (e.g., “nothing will help me deal with thisproblem but a drink”), cognitive therapy can help them explore alternativebehaviors and attitudes that do not involve the use of substances. In addition,cognitive therapy can help the client develop healthier ways of viewing both hishistory of substance abuse and the meaning of a recent “slip” or relapse so thatit does not inevitably lead to more substance abuse. Based on a review of the information collected through self-monitoring,subsequent sessions involve negotiation about treatment goals.
- Historically, most treatment programs for individuals with substance use disorders have been designed and validated with homogenous, predominantly white youth 91.
- The following section presents a brief overview of some of the major approaches to managing addictive behaviours.
- The participants learn various strategies to help achieve and maintain sobriety over the course of this 42-session long program.
- Modifying social and environmental antecedents and consequences another approach to working with addictive behaviours18.
The authors did not report group differences in A-CRA versus individualized CBT for initial non-responders; however, the study was likely underpowered to detect treatment effects. Using an instrument designed to measure patient what is alcoholism problems and severity on multiple dimensions (the Addiction Severity Index), McLellan et al 103–105 found that when services are matched to problem areas, both naturalistically and prospectively, outcomes on these dimensions improve. This is consistent with the mental health services research of Drake et al 106, who have demonstrated the importance of integrating services for people with co-occurring substance use disorders and severe mental illness, although this practice has not been explored fully in addiction treatment settings and research.