Chapter 4 Brief Cognitive-Behavioral Therapy Brief Interventions and Brief Therapies for Substance Abuse NCBI Bookshelf

Focusing on individuals with cannabis use disorders, Budney and colleagues developed a computerized approach encompassing MI, CBT and contingency management (Budney et al., 2015). In a randomized controlled trial, 75 adults with marijuana use disorder were randomized to 2 sessions of brief treatment versus a 9-session clinician-delivered MET-CBT approach, or a 9-session version of TES emphasizing MET and CBT. Both MET/CBT conditions included a CM component in which participants could earn up to $435 in gift cards if all urines were negative for cannabis. Significantly more participants in clinician-delivered treatment (44.8%) and TES (46.7%) were abstinent at the end of treatment compared with the 2-session brief treatment (12.5%). Similarly, both the therapist- and computer delivered approaches were significantly more effective in reducing cannabis use compared with brief intervention alone during treatment, but effects weakened during follow-up and were no longer significant at the 6-month follow-up point.

Comorbid psychiatric disorders

In the brief behavioral model designed by Phillipsand Weiner, techniques such as programmed therapy and writing therapy(see Figure 4-6) make whatis typically thought of as “homework” the central concern of the therapysession (Phillips and Weiner,1966). McCrady also included behavioral self-control training as another promisingbut underutilized treatment approach (McCrady, 1991). Hester indicated that there is good empiricalsupport for behavioral self-control training in achieving the goal ofmoderate, nonproblematic drinking (Hester, 1995). In randomized clinical trials, problem drinkersassigned to behavioral self-control with a goal of either moderation orabstinence typically have comparable long-term outcomes. Although behavioralself-control approaches have been used primarily with alcohol problems, theyhave also been used with other substances such as opiates (van Bilsen and Whitehead, 1994). In early review, a robust benefit of combined CBT with other psychosocial therapies such as MI and CM was observed.

Relapse Prevention

MOST designs have been successfully implemented in smoking research to refine multicomponent interventions for smoking (Piper et al., 2016; Schlam et al., 2016). There are some specific cognitive behavioral therapy techniques that are effective at all stages of change in recovery. CBT for substance abuse helps overcome alcoholism and drug addiction by dismissing false beliefs, developing mood-improving skills, and teaching the client effective communication. Overall, behavioral, cognitive, and cognitive-behavioral interventions cbt interventions for substance abuse areeffective, can be used with a wide range of substance abusers, and can beconducted within the timeframe of brief therapies. While reliance on the results of the functional analysis makes skillstraining particularly well suited for individual therapy, theseinterventions can easily be adapted for use in group settings (Monti et al., 1989). Similarly, theycan be used with inpatients or outpatients and can be administered as partof an intensive phase of treatment or as part of less intensive aftercare orcontinuing care.

Integrating Exercise with Therapeutic Approaches

• These reactionsare less likely to occur and to be less pronounced for individuals who aremore firmly committed to the goal of abstinence or moderation and for thosewho have maintained such goals longer.
• 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.
• Attributional processes and emotional responses also play a role in anindividual’s decision to use (Marlatt andGordon, 1985).
• To our knowledge, this is the first targeted meta-analysis of CBT in combination with pharmacotherapy for adults with AUD and other SUDs to summarize the data in a manner relevant to clinical practice guidelines.

By better understanding the difficulties that contribute to substance use, people can then look for ways to better manage difficult thoughts, emotions, or situations. Depending on what stage of treatment you are in and what setting it is held in, your insurance may cover the service at a higher or lower percentage. For example, inpatient coverage may be covered at a higher rate than outpatient, and outpatient may be covered more than aftercare.

CBT Techniques

Interpersonal skills building exercises may target repairing relationship difficulties, increasing the ability to use social support, and effective communication. For patients with strong support from a family member or significant other, the use of this social support in treatment may benefit both goals for abstinence and relationship functioning. In addition, the ability to reject offers for substances can be a limitation and serves a challenge to recovery. Rehearsal in session of socially-acceptable responses to offers for alcohol or drugs provides the patient with a stronger skill set for applying these refusals outside of the session. Where relevant, this rehearsal can be supplemented by imaginal exposure or emotional induction to increase the degree to which the rehearsal is similar to the patient’s high risk situations for drug use. In contrast to many other methods, behavioral approaches to the treatment ofsubstance abuse have substantial research evidence in support of theireffectiveness.

Cognitive Behavioral Therapy Techniques for Addiction

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. Results for the improvement of retention with motivational enhancement in effectiveness studies have been more promising.[53] effectiveness research to better understand the application of CBT outside of controlled research settings. Addicts often try to mask these painful feelings with alcohol or recreational drug use, which over time lead to addiction. Cognitive behavioral therapy involves revisiting painful emotions and learning positive behaviors to replace substance abuse as a coping mechanism. To the extent that the individual is lacking in the coping skills necessaryto deal with the demands of high-risk substance abuse or relapse situations,his sense of self-efficacy decreases.

• The current meta-analysis shows that CBT is more effective than a no treatment, minimal treatment, or non-specific control.
• It also assumes thatover the course of time, substance abusers develop a particular set ofeffect expectancies based on their observations of peers and significantothers abusing substances to try to cope with difficult situations andthrough their own experiences of the positive effects of substances.
• Secondary appraisalrepresents the individual’s evaluation of her ability to meet the challengesand demands specific to the situation.
• A view of Supplemental Table 1 supports this point where non-specific contrasts were quite variable, but often involved addiction information, mutual support, and 12-step program involvement.
• In other words, the approach is well-articulated, but despite this, knowledge on MOBC (ie, how it works) and specific matching factors (ie, for whom it works) is limited.
• An approach that has gained widespread application in the treatment of substanceabuse is cognitive-behavioral therapy (CBT).

As in other areas of health-care, increasing attention is now being focused on providing evidence-based care for persons with substance use disorders and in this context there has been significant progress in the development and standardization of psychosocial treatments for substance use disorders. Psychosocial treatments are now considered essential components to any comprehensive substance use disorder treatment program. CBT in contrast to minimal treatment showed a moderate and significant effect size that was consistent across outcome type and follow-up. When CBT was contrasted with a non-specific therapy or treatment as usual, treatment effect was statistically significant for consumption frequency and quantity at early, but not late, follow-up. CBT effects in contrast to a specific therapy were consistently non-significant across outcomes and follow-up time points. Of ten pooled effect sizes examined, two showed moderate heterogeneity, but multivariate analyses revealed few systematic predictors of between-study variance.

It can be used on its own or combined with other approaches that work together to support a person’s long-term recovery. However, it is not the only option out there, so talk to your healthcare provider about what’s available to decide what approach is best for your needs. As with other treatments for alcoholism and drug abuse, including pharmaceutical treatments, cognitive behavioral therapy works best when combined with other recovery efforts. This includes participation in support groups like Alcoholics Anonymous or Narcotics Anonymous. For example, in a large effectiveness trial https://ecosoberhouse.com/ 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.

Everything You Need to Know About Cognitive Behavioral Therapy for Addiction