The search for mechanisms of behavior change in evidence-based behavioral treatments for alcohol use disorders: overview.
ABSTRACT Over the past three decades, the main question of interest to alcohol treatment researchers has concerned the main effects of a particular behavioral intervention or what works. Increasingly, alcohol treatment researchers are turning their attention to the underlying psychological, social, and even neurophysiologic processes or "active ingredients" that are driving therapeutic change.
The articles contained in this supplement to Alcoholism: Clinical and Experimental Research grew out of invited presentations given at a one-day satellite session immediately preceding the 28th Annual Meeting of the Research Society on Alcoholism (RSA). The conference was a collaborative effort of the Center on Alcoholism, Substance Abuse, and Addiction at the University of New Mexico, the Center on Addiction and Substance Abuse at Columbia University, Brown University, and the National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health.
The conference featured a mix of full-length presentations on conceptual and methodological issues, reports of original research findings, and lively discussion among speakers and conference participants. Understanding mechanisms of behavior change will benefit the field by identifying the key aspects of therapy that must be present for maximum effect, irrespective of the specific technique being applied; provide a new way to approach patient-treatment interactions; and lay the groundwork for understanding how change is affected by social and other extratreatment factors.
Although not a new topic to the field, understanding mechanisms of behavior change has begun to capture the interest of an increasing number of alcohol treatment researchers. Understanding behavior change is an exceedingly complex enterprise and innovative thinking and creative research designs will be required to advance the field.
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ABSTRACT: AIMS.: With the increased need for sanctioning behavioral addiction treatments to guide key stakeholders, focus has shifted to developing and applying criteria for establishing empirically-supported treatments (EST). Among the many criteria offered, demonstration of incremental efficacy over a placebo or comparison in at least two independent randomized clinical trials (RCT) has been the gold standard. While necessary, the present EST criteria are not sufficient. The present work: (1) argues for empirically supported specificity in behavioral addiction treatment, (2) explores the limitations of empirical support for EST efficacy without evidence of specificity, and (3) discusses implications and recommendations for ultimately raising the bar for status as an EST. METHODS.: The authors review relevant literature on ESTs, evidence-based practice, and clinical trial design in the addictions and related disciplines. RESULTS.: We clarify that the additional bar of specificity does not denote uniqueness in causal processes and we argue that specificity should not be inferred only via the nature of the experimental contrast. Rather, a treatment has specificity if its active ingredients are identified and empirically validated as predictors of subsequent treatment-related outcomes. Within this new definition, there are implications for clinical research and other key stakeholders. CONCLUSIONS.: A heightened centrality of empirically-supported addiction treatment ingredients moving forward will advance clinical knowledge and evaluation methodology at a far greater pace.Addiction 10/2012; · 4.58 Impact Factor
- Addiction 05/2013; 108(5):883-4. · 4.58 Impact Factor
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ABSTRACT: In the last decade, there has been an upsurge of interest in understanding the mechanisms of behavior change (MOBC) and effective behavioral interventions as a strategy to improve addiction-treatment efficacy. However, there remains considerable uncertainty about how treatment research should proceed to address the MOBC issue. In this article, we argue that limitations in the underlying models of addiction that inform behavioral treatment pose an obstacle to elucidating MOBC. We consider how advances in the cognitive neuroscience of addiction offer an alternative conceptual and methodological approach to studying the psychological processes that characterize addiction, and how such advances could inform treatment process research. In addition, we review neuroimaging studies that have tested aspects of neurocognitive theories as a strategy to inform addiction therapies and discuss future directions for transdisciplinary collaborations across cognitive neuroscience and MOBC research. (PsycINFO Database Record (c) 2013 APA, all rights reserved).Psychology of Addictive Behaviors 04/2013; · 2.09 Impact Factor