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This study presented and tested a model of behavior change in long-term substance use disorder recovery, the acceptance and relationship context (ARC) model. The model specifies that acceptance-based behavior and constructive social relationships lead to recovery, and that treatment programs with supportive, involved relationships facilitate the de...
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... the acceptance and relationship context model The FAP and ACT smoking treatment was based on the acceptance and relationship context model (ARC), a functional model of treatment process (Gifford, Ritsher, McKellar, & Moos, 2006). ARC specifies that supportive, engaging treatment relationships and acceptance of internal states facilitate constructive behavior change (Carrico, Gifford, & Moos, 2007;Gifford et al., 2006). ...
... the acceptance and relationship context model The FAP and ACT smoking treatment was based on the acceptance and relationship context model (ARC), a functional model of treatment process (Gifford, Ritsher, McKellar, & Moos, 2006). ARC specifies that supportive, engaging treatment relationships and acceptance of internal states facilitate constructive behavior change (Carrico, Gifford, & Moos, 2007;Gifford et al., 2006). A number of studies have shown that treatment outcomes may be improved by helping patients learn to accept internal states rather than engaging in maladaptive avoidance (Hayes, Luoma, Bond, Masuda, & Lillis, 2006). ...
... Acceptance appears to play a particularly important role in recovery from addiction. In a prospective longitudinal study of 3,500 patients in substance abuse treatment, the ARC model accounted for a large proportion of the variance in substance use outcomes at 2-year follow-up (41%; Gifford et al., 2006). Another study identified that acceptance contributes to important recovery behaviors such as 12-step involvement after treatment (Carrico et al., 2007). ...
This study evaluated a treatment combining bupropion with a novel acceptance and relationship focused behavioral intervention based on the acceptance and relationship context (ARC) model. Three hundred and three smokers from a community sample were randomly assigned to bupropion, a widely used smoking cessation medication, or bupropion plus functional analytic psychotherapy (FAP) and acceptance and commitment therapy (ACT). Objective measures of smoking outcomes and self-report measures of acceptance and relationship processes were taken at pretreatment, posttreatment, 6-month, and 1-year follow-up. The combined treatment was significantly better than bupropion alone at 1-year follow-up with 7-day point prevalence quit rates of 31.6% in the combined condition versus 17.5% in the medication-alone condition. Acceptance and the therapeutic relationship at posttreatment statistically mediated 12-month outcomes. Bupropion outcomes were enhanced with an acceptance and relationship focused behavioral treatment.
... The article with the highest frequency was the American Psychiatric Association publishing the 5th Diagnostic and Statistical Manual of Mental Disorders in 2013, which means it is an acknowledged diagnostic standard in the field. The highest centrality cited study was written byGifford et al. in 2006 about a model to calculate the influence of relationship networks on patients with SUD(26). ...
Background: This study aimed to identify frontiers for further studies via brief understanding in complementary and alternative medicine (CAM) for substance use disorders (SUDs).
Materials and Methods: Publications on the use of CAM for treating SUDs were retrieved from the Web of Science Core Collection from 2001 to 2020 on July 12, 2020, and visualized by CiteSpace V.
Results: A total of 3,807 publications were obtained. The USA, China, and England were the leading research centers. However, India and Pakistan have recently focused on assessing CAM for the treatment of SUDs. Frederick L Altice was found to be the most productive author. Addiction ranked first among the frequently cited journals, which exceeded 1,000. The most common CAM therapies were acupuncture and CAM psychotherapies, such as mindfulness meditation.
Conclusion: CAM is gaining attention globally for treating SUDs. CAM psychotherapy and acupuncture are hotspots and deserve further study. Researchers should strengthen peer cooperation in this field.
... Psychotherapeutic intervention focusing on interpersonal repertoire would provide access to new sources of positive social reinforcement (e.g., expressing feelings, creating intimacy), physical reinforcement (e.g., meeting groups with interests in games and sports), and escape-avoidance behaviors (e.g., seeking help, dealing with criticism). The antecedent that evoked unwanted responses will now evoke alternative responses that will be progressively consolidated in the client's repertoire, moving him away from drug use (Aranha & Oshiro, 2019;Gifford et al., 2006;Holman et al., 2012;Rachlin, 1997). ...
Motivational interviewing (MI) is a treatment method developed in the field of substance use disorders (SUD), whose use has been shown to be effective both for reducing substance use as well as for reducing risk behaviors and increasing healthy behaviors such as adherence to exercise, diet, and medication. Despite its popularity, its strategies are still poorly disseminated among the behavior analysts’ community. In part, this limited diffusion is due to changes in the organization of principles and methods adopted in MI that have occurred over the years. Furthermore, the fact that the theoretical foundations of MI are not derived from behavioral principles, may make it difficult to integrate MI into the practice of the behavior analyst. This chapter aims to introduce MI to behavior analysts’ community as defined in the third edition of the book “Motivational Interviewing”, published in 2013, as well as to offer an interpretation of its main concepts and strategies from the perspective of Behavior Analysis principles. Translating to behavior analysts’ community the main concepts and strategies of this approach, which basically guides rules for planning verbal contingencies that aim to reinforce the patient’s verbal behavior of commitment to change, may help in the incorporation of this cost-effective practice for the treatment of SUD by these professionals.
... Psychotherapeutic intervention focusing on interpersonal repertoire would provide access to new sources of positive social reinforcement (e.g., expressing feelings, creating intimacy), physical reinforcement (e.g., meeting groups with interests in games and sports), and escape-avoidance behaviors (e.g., seeking help, dealing with criticism). The antecedent that evoked unwanted responses will now evoke alternative responses that will be progressively consolidated in the client's repertoire, moving him away from drug use (Aranha & Oshiro, 2019;Gifford et al., 2006;Holman et al., 2012;Rachlin, 1997). ...
Behaviors that characterize substance use and dependence are ordered and multidetermined, that is, of a complex and multifactorial nature, as defended by the theoretical model of behavior analysis, a science based on the philosophical assumptions of radical behaviorism. The variables influencing the acquisition and maintenance of these behavioral patterns can be described, predicted, and managed; and the functional analysis, being an important assessment tool for the identification and understanding of these various factors involved in these behavioral patterns, describes which circumstances increase the likelihood of recurrence and which consequences control and maintain substance use. The purpose of this chapter is to present the functional analysis in order to equip professionals for a contextualized assessment of behavior, enabling the planning of interventions at the most effective level of prevention and treatment, thus promoting changes in the actions of individuals and, therefore, better indicators of health and quality of life.
... An investigation of the change mechanisms that underlie LTR could enhance the understanding of how and why recovery processes work. As Gifford et al. (2006) noted, "while evidence about overall treatment efficacy continues to mount, our understanding of the curative processes initiated by SUD treatment remains limited" (p. 1167). ...
... 2004). In another study conducted with 2,549 patients in 15 residential SUDs treatment programs, Gifford et al. (2006) tested the acceptance and relationship context (ARC) model of behavior change in long-term recovery from SUDs. The results indicate that better long-term outcomes were related to treatment programs that provided a supportive environment, in which patients learned to accept and respond appropriately to internal states linked to SU and enter into meaningful relationships. ...
Long-term recovery (LTR) from substance use disorders (SUDs) has been described as a complex process. It has been proposed that psychological mechanisms can influence the resolution of problematic substance using behaviors and may explain how and why a recovery process works. The aims of this narrative review were to (a) examine acceptance and change as an underlying mechanism in LTR from SUDs; (b) examine the practice of acceptance and change in the Narcotics Anonymous (NA) and Alcoholics Anonymous (AA) programs; and (c) present a conceptual model of self-acceptance and change in LTR from SUDs. Based on dialectical behavioral philosophy and mindfulness-based intervention, I posited that self-acceptance is an underlying mechanism that addresses the cyclical nature of shame, guilt, and SUDs; improves emotion dysregulation; psychological well-being; and activates a change process of recovery from SUDs. This article contributes to the field by presenting the opposing forces of acceptance versus change and their synthesis in promoting LTR from SUDs, and by discussing the practice of acceptance and change in the AA and NA programs. ARTICLE HISTORY
... 50). These implicit elements of mindfulness meditation can be incorporated into other "third-wave" CBT approaches, such as mindfulness-based relapse prevention and Acceptance and Commitment Therapy (Bowen et al., 2010;Chiesa & Serretti, 2014;Gifford et al., 2006;Stotts & Northrup, 2015;Witkiewitz et al., 2005). In fact, an approach such as Acceptance and Commitment Therapy (ACT) may be especially compatible with 12-Step approaches, largely due to its spiritual underpinnings (Wilson & DuFrene, 2012). ...
Background: Cognitive-behavioral therapy is an umbrella term which encompasses a wide range of distinct, yet related interventions, several of which have been shown to be efficacious in the treatment of substance use disorders. However, 12-Step programs (including Alcoholics Anonymous and Narcotics Anonymous) are traditionally the most widely known and commonly used approaches to managing alcohol and substance abuse. Objectives: Therefore, this paper attempts to offer a summary of the compatibility of CBT-based approaches and 12-Step philosophy, in order to assist clinicians who work with patients with a strong adherence to 12-Step ideology. Results: Specific passages from AA's Big Book, NA's Basic Text, and ancillary 12-Step literature will be highlighted where appropriate. Moreover, common roadblocks to synthesis (e.g. belief in a "higher power;" acceptance of one's "powerlessness") will also be addressed. Conclusions: Clinicians who are committed to evidence-based, CBT-related practices are ultimately advised to adopt flexibility when working with patients who identify with the cultural values of 12-Step programs.
... Alternatively, Roberts, Luo, et al. (2017) also found that personality change was robust across different forms of therapy, suggesting an influence of crosstherapeutic processes on personality change. In the context of a residential treatment milieu, program alliance and relationship quality with other residents are general processes, which in the SUD literature have been shown to predict patients' treatment outcomes (Gifford, Ritsher, McKellar, & Moos, 2006). Motivation for behavioral change has also been highlighted in the SUD treatment literature as a strong predictor of treatment engagement and long-term recovery from substance use problems (Gaume, Bertholet, & Daeppen, 2017). ...
Prior research suggests that personality traits change during substance use disorder (SUD) treatment. However, the extent to which changes in traits during SUD treatment are associated with subsequent improvements in treatment outcomes remains untested. Among U.S. military veterans (n = 200) enrolled in SUD residential treatment, we examined whether changes in the personality factors of positive emotionality (PEM), negative emotionality (NEM), and constraint (CON) during treatment were associated with subsequent changes in abstinence self-efficacy and SUD symptoms. We analyzed data at treatment entry, discharge, and 12-months post-discharge via univariate and bivariate latent change score models. During treatment, PEM, CON, and abstinence self-efficacy increased, while NEM decreased, on average. Changes in NEM and CON were largely sustained, whereas PEM and abstinence self-efficacy significantly decreased post-treatment. SUD symptoms decreased from pre- to post-treatment. In bivariate models, higher levels of NEM at baseline were associated with less improvement in both abstinence self-efficacy during treatment and SUD symptoms pre- to post-treatment. Higher levels of CON at baseline were associated with greater improvement in SUD symptoms pre- to post-treatment, and increases in CON during treatment were associated with greater retention of treatment gains in abstinence self-efficacy post-treatment. Greater improvements in CON during treatment were also associated with greater improvements in SUD symptoms pre- to post-treatment in unadjusted (p = 0.041) but not adjusted models (p = 0.089). Our findings suggest that personality changes marked by improvements in impulse control over the course of SUD treatment may be linked to subsequent improvements in treatment outcomes and may have value as a proximal treatment target among SUD patients during residential care.
... Poor social support, including lack of peer support for quitting alcohol and drugs, is an established predictor of SUD treatment outcomes in veterans (Moos, 2007) and has been shown to predict past-year aggression among Iraq/Afghanistan returnees (Elbogen et al., 2012b). In terms of treatment processes, lower relationship quality with other SUD patients, lower satisfaction with treatment, and poor treatment retention are all associated with substance use relapse in veterans (e.g., Gifford, Ritsher, McKellar, & Moos, 2006;Harris, McKellar, Moos, Schaefer, & Cronkite, 2006;Hser, Evans, Huang, & Anglin, 2004) and have been found to predict criminal CRIMINAL RECIDIVISM AMONG JUSTICE-INVOLVED VETERANS 6 recidivism after discharge among probationers in SUD treatment (Broome, Knight, Hiller, & Simpson, 1996;Broome, Knight, Knight, Hiller, & Simpson, 1997;Hiller, Knight, & Simpson, 1999). ...
Veterans in treatment for substance use disorders (SUD) often report past criminal offending. However, the rate of criminal recidivism in this population is unknown. Further, prior research in veterans has not examined personality factors as predictors of recidivism, despite the prominence of such factors in leading models of recidivism risk management. We examined these issues in a secondary data analysis of 197 military veterans with a history of criminal offending who were enrolled in an SUD residential treatment program. Participants were interviewed using several measurement instruments at treatment entry, one month into treatment, treatment discharge, and 12 months post-discharge. Most veterans (94%) had a history of multiple charges, and 53% had recent involvement in the criminal justice system at the time of treatment entry. In the 12 months post-discharge, 22% reported reoffending. In addition, 30% of patients who had been recently involved in the criminal justice system at treatment entry reoffended during follow-up. Higher friend relationship quality (OR = 2.32, 95% CI [1.03, 5.21]) at treatment entry and higher staff ratings of patients' relationship quality with other residents during treatment (OR = 2.76, 95% CI [1.40, 5.41]) predicted lower odds of recidivism post-discharge. After accounting for these factors, smaller reductions during treatment in the personality trait of Negative Emotionality predicted an increased risk for criminal recidivism post-discharge (OR = 1.13, 95% CI [1.01, 1.26]). Results support augmenting the curriculum of SUD programs for veterans with services aimed at reducing risk for criminal recidivism, with a focus on interventions that directly target patients' social support networks and tendencies towards negative emotionality.
... As a result, the CIPI intervention includes a cognitivebehavioural AC group following the CCT phase to provide skills for effectively managing triggers for ATS use. Drawing on prior research highlighting common change processes that predict better substance abuse treatment outcomes, [35][36][37][38] the overarching goals of the cognitive-behavioural AC programme are to: build social networks that are supportive of abstinence from ATS use, improve cognitive-behavioural coping skills, and bolster self-efficacy for managing triggers for ATS use. The CIPI CCT+AC intervention aims to assist individuals with achieving clinically meaningful reductions in their ATS use that will result in lower HIV risk. ...
Introduction HIV risk among female entertainment and sex workers (FESW) remains high and use of amphetamine-type stimulants (ATS) significantly increases this risk. We designed a cluster randomised stepped wedge trial (The Cambodia Integrated HIV and Drug Prevention Implementation (CIPI) study) to test sequentially delivered behavioural interventions targeting ATS use.
Methods and analysis The trial combines a 12-week Conditional Cash Transfer (CCT) intervention with 4 weeks of cognitive-behavioural group aftercare (AC) among FESW who use ATS. The primary goal is to reduce ATS use and unprotected sex among FESW. The CCT+AC intervention is being implemented in 10 provinces where order of delivery was randomised. Outcome assessments (OEs) including biomarkers and self-reported measures of recent sexual and drug use behaviours are conducted prior to implementation, and at three 6-month intervals after completion. Consultation with multiple groups and stakeholders on implementation factors facilitated acceptance and operationalisation of the trial. Statistical power and sample size calculations were based on expected changes in ATS use and unprotected sex at the population level as well as within subjects.
Ethics and dissemination Ethical approvals were granted by the Cambodia National Ethics Committee; University of New Mexico; University of California, San Francisco; and FHI360. The trial is registered with ClinicalTrials.gov. Dissemination of process indicators during the multiyear trial is carried out through annual in-country Stakeholder Meetings. Provincial ‘Close-Out’ forums are held at the conclusion of data collection in each province. When analysis is completed, dissemination meetings will be held in Cambodia with stakeholders, including community-based discussion sessions, policy briefs and results published and presented in the HIV prevention scientific journals and conferences.
Conclusions CIPI is the first trial of an intervention to reduce ATS use and HIV risk among FESW in Cambodia.
Results Will inform both CCT+AC implementation in low and middle-income countries and programmes designed to reach FESW.
Trial registration number NCT01835574; Pre-results.
... Another limitation of the literature is that few studies have included longitudinal analyses to determine whether the subtypes of these multidimensional typologies can predict variation in not only functioning at treatment entry, but also key treatment processes and outcomes. For example, indicators of functioning such as (a) psychiatric distress, (b) social support, (c) coping styles, and (d) abstinence self-efficacy are robust predictors of treatment engagement and posttreatment outcomes (Boden et al., 2014;Ilgen, McKellar, & Tiet, 2005;Long, Williams, Midgley, & Hollin, 2000;Moggi, Ouimette, Moos, & Finney, 1999), as are treatment processes such as (a) quality of relations with other residents in treatment, and (b) program alliance (e.g., perceived support and involvement of program staff and patients; treatment satisfaction) (Gifford, Ritsher, McKellar, & Moos, 2006;Harris, McKellar, Moos, Schaefer, & Cronkite, 2006;Hser, Evans, Huang, & Anglin, 2004;Long et al., 2000;Lowmaster, Morey, Baker, & Hopwood, 2010;Moos & King, 1997). Few studies of SUD subtypes have examined differences on these key treatment-related variables; thus, the clinical utility of these typologies is unclear. ...
... A program alliance composite was constructed separately at the 1-month and discharge assessments from a principal component analysis of scores on COPES-Involvement, COPES-Support, and the CSQ-total scores (Gifford et al., 2006). These analyses yielded one large component at both time points that accounted for 78% and 74% of the variance across these indicators at the 1-month and discharge assessments, respectively. ...
There is a long history of using personality to subtype patients in treatment for substance use disorders (SUD). However, no one has validated a typology of SUD patients using a structural model of normal-range personality, particularly indicating whether subtypes differ on treatment processes and outcomes. We developed a personality-based typology among 196 military veterans enrolled in residential SUD treatment at a Veterans Affairs medical center. Patients were assessed at treatment entry, 1 month into treatment, and at discharge from treatment. Personality was assessed using the Multidimensional Personality Questionnaire-Brief Form at treatment entry. Latent profile analyses identified a 3-group solution consisting of low pathology, internalizing, and externalizing groups. The internalizing group scored lowest on measures of functioning at treatment entry, whereas the externalizing group scored more poorly on treatment processes and outcomes over the course of their residential stay (e.g., more stressful relationships with other residents, lower program alliance). These findings support a clinically meaningful typology of SUD patients based on a 3-factor model of personality and can serve as a guide for future efforts aimed at developing targeted interventions that can address the individual differences of patients in this population.
