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The lack of supervision and monitoring of clinician implementation of evidence-based treatments in clinical practice suggests that CBT and other EBPs, in practice, may bear little resemblance to the more closely monitored versions of those treatments as implemented in randomized clinical trials demonstrating their efficacy (Martino et al., 2016). As such, the cognitive behavioral therapist needs to consider how abstinence is to be rewarded as part of treatment. In addition to consideration of traditional CM rewards—monetary prizes, vouchers for goods, or treatment “privileges” (e.g., take-home doses of methadone)—the cognitive behavioral interventions for substance abuse arrangement of social contingencies, such as is evident in BCT approaches, should be considered. The question to be addressed in treatment is how contingencies can be arranged to encourage initial experiences of abstinence and entry into non-drug activities. When this goal is achieved, treatment becomes concerned with identification of more naturally-occurring rewards for abstinence (e.g., greater employment, relationship, and social success). As such, problem solving strategies and programming and rehearsal of steps to broader goal attainment may need to be provided, depending on the skills available to the patient.

The evaluation of CBT for SUDs in special populations such as those diagnosed with other Axis I disorders (i.e., dual diagnosis), pregnant women, and incarcerated individuals is beyond the scope of the current review, and thus the descriptions provided below focus on SUD treatment specifically. The COMBINE study[51] was designed to evaluate the efficacy or pharmacotherapy, behavioral therapy and their combinations for treatment of alcohol dependence and to evaluate placebo effect on the overall outcome. This large RCT involved 1383 patients with the diagnosis of alcohol dependence, recently abstinent from alcohol. No combination was more effective than naltrexone or combined behavioral intervention (CBI) in the presence of medical management.

What Is Cognitive Behavioral Therapy?

The therapist and patient collaboratively review the advantages/disadvantages of engaging in substance use or addictive behaviour. A relative limitation of CM is the availability of funds for providing the reinforcers in clinical settings. The establishment of job-based reinforcements have been introduced as alternatives to aid the clinical adoption of these methods.[21, 22]Also, contingency management strategies have also been incorporated into couple’s interactions (utilizing the reinforcers available to the couple) to aid the reduction of drug use (see below). The standardized mean difference was used to measure efficacy outcomes in this meta-analysis.1 Hedges’ g includes a correction, f, for a slight upward bias in the estimated population effect (Hedges, 1994). This study was a non-randomized trial with pretest/posttest evaluation on patients divided into an intervention and a control group. The following case study involves a young male cocaine user who has sought
outpatient treatment.

  • A particular barrier to effective dissemination of CBT is the lack of a system for training, supervision, and feedback to clinicians.
  • A 12-session CBT for cocaine addicts suggested that this
    length of treatment is sufficient to achieve and stabilize abstinence from
    cocaine (Carroll, 1998).
  • To conclude, the use of therapeutic communities for treatment of substance use disorders does not have a strong evidence base.
  • Negative consequences expected
    from cocaine include global negative effects, anxiety, depression, and
    paranoia (Jaffe and Kilbey, 1994;
    Schafer and Brown, 1991).
  • A literature review was undertaken using the several electronic databases (PubMed, Cochrane Database of systemic reviews and specific journals, which pertain to psychosocial issues in addictive disorders and guidelines on this topic).
  • Thus, it is not clear whether the large number of dependent cases is related to the higher availability of substances or the openness of this group in expressing their dependency compared to those with high education levels.

Issues of privacy and confidentiality are particularly important to consider when dealing with individuals who are users of illicit drugs, particularly in the era of electronic medical records (Ramsey et al., 2016). Finally, while validated technology based interventions are generally less expensive than traditional clinician-delivered interventions, the lack of a reimbursement structure for these interventions constrains their availability to date. Guiding patients in setting treatment goals can serve as a first practice of this skill building. Also assisting patients in setting smaller goals in the service of longer term goals is an important exercise.

Group Interventions

It reflects interactions early in the course of the
session and is meant to depict some of the questions the therapist could ask
to gain information about the antecedents, consequences, and cognitive
mediators involved in his use. Marlatt and Gordon posit that one source of possible
relapse risk has to do with the degree of stress or daily hassles that the
client experiences (Marlatt and Gordon,
1985). They suggest that when the demands and obligations a
client feels («shoulds») outweigh the pleasures the individual can engage in
(«wants»), then his life is out of balance.

Decisions about the length of treatment are made on the
basis of these assessments, rather than according to a formula or theoretical
assumption about how long therapy should take. Each individual is approached as
a unique case, albeit one to which broad principles can be applied. English language articles describing randomized clinical trials examining CBT in combination with pharmacotherapy for AUD and SUD were included. We provide an overview of Cognitive Behavioral Therapy (CBT) efficacy for adult alcohol or other drug use disorders (AOD) and consider some key variations in application as well as contextual (ie, moderators) or mechanistic (ie, mediators) factors related to intervention outcomes.

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