Alcoholism Treatment Directory Approaches
Relapse Prevention
Relapse Prevention is 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.
The Matrix Model
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.
Supportive-Expressive Psychotherapy
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.
Individualized Drug Counseling
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.
Motivational Enhancement Therapy
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.
Behavioral Therapy for Adolescents
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.
Multidimensional Family Therapy (MDFT) for Adolescents
Multidimensional Family Therapy (MDFT) for
Adolescentsis 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. |
