ArticleLiterature Review

Cognitive Behavioral Therapy for Substance Use Disorders

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Abstract

Cognitive behavioral therapy (CBT) for substance use disorders has shown efficacy as a monotherapy and as part of combination treatment strategies. This article provides a review of the evidence supporting the use of CBT, clinical elements of its application, novel treatment strategies for improving treatment response, and dissemination efforts. Although CBT for substance abuse is characterized by heterogeneous treatment elements such as operant learning strategies, cognitive and motivational elements, and skills-building interventions, across protocols several core elements emerge that focus on overcoming the powerfully reinforcing effects of psychoactive substances. These elements, and support for their efficacy, are discussed.

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... Cognitive-behavioral strategies assume that in the development of maladaptive behavioral patterns, such as substance abuse, learning processes play a critical role. Much of the techniques (the behavioral) are based on principles of social/sociocognitive learning, modeling, and conditioning classic and operative (McHugh, Hearon, & Otto, 2010;Wu et al., 2016). ...
... Several treatment strategies derived from these two learning models (McHugh et al., 2010). The track exposure approach tries to identify the events that have become most salient for an individual and reduce their impact by extinction, where patients are repeatedly exposed to their most powerful triggers without following them through substance use. ...
... Manage thoughts and desire to use the substance Tolerance of distress Distraction (continued) Therefore, individuals in the cognitive-behavioral approach learn to identify and correct problematic behaviors by applying a range of different skills that can be used to stop drug abuse and address a range of other problems that often co-occur with it (McHugh et al., 2010;Wu et al., 2016). Particularly in the treatment of SUD, social skills training has been identified as a necessary component of treatment, as these individuals often have deficits in specific social skills and benefit from it . ...
Chapter
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A proportion of people who use psychotropic substances can develop patterns of substance abuse that can create and intensify social and health damage. This is a complex problem influenced by several factors, which requires a multidimensional assessment to comprehend the variables involved and plan assertive and effective intervention strategies. In order to assist the evaluation process and contribute to the treatment of these disorders, psychometric instruments such as scales and tests were developed for their detection and survey of complementary information to the interviews. This chapter aims to present and describe the structure and main characteristics of the Addiction Severity Index (ASI); the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST); the Alcohol Use Disorder Identification Test (AUDIT); and the Drug Use Screening Inventory (DUSI) – instruments that are adapted, developed, or validated for the Brazilian population to be used in the process of screening and diagnosis of substance use.
... CBT is another form of structured one-on-one psychotherapy used to treat AUD, which focuses on increasing awareness of the interplay between cognition, emotions, and behaviour [226]. The goal of CBT is to correct the maladaptive thought processes learned over time in order to change subsequent emotions and behaviours. ...
... The goal of CBT is to correct the maladaptive thought processes learned over time in order to change subsequent emotions and behaviours. This can be administered in person with a trained therapist, via self-guided materials, online via Internet or smartphone applications, or in group sessions [224,226]. Multiple meta-analyses and review articles have found the efficacy of CBT in improving perspectives on alcohol and adherence to treatment [224,226,227]. Several group therapy options also exist for the treatment of AUD, including 12-step programs such as AA, a form of treatment centred around camaraderie and spirituality, where people are supported by peers and mentors facing similar challenges [228]. ...
... This can be administered in person with a trained therapist, via self-guided materials, online via Internet or smartphone applications, or in group sessions [224,226]. Multiple meta-analyses and review articles have found the efficacy of CBT in improving perspectives on alcohol and adherence to treatment [224,226,227]. Several group therapy options also exist for the treatment of AUD, including 12-step programs such as AA, a form of treatment centred around camaraderie and spirituality, where people are supported by peers and mentors facing similar challenges [228]. ...
Article
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Alcohol use disorder (AUD) encompasses the dysregulation of multiple brain circuits involved in executive function leading to excessive consumption of alcohol, despite negative health and social consequences and feelings of withdrawal when access to alcohol is prevented. Ethanol exerts its toxicity through changes to multiple neurotransmitter systems, including serotonin, dopamine, gamma-aminobutyric acid, glutamate, acetylcholine, and opioid systems. These neurotransmitter imbalances result in dysregulation of brain circuits responsible for reward, motivation, decision making, affect, and the stress response. Despite serious health and psychosocial consequences, this disorder still remains one of the leading causes of death globally. Treatment options include both psychological and pharmacological interventions, which are aimed at reducing alcohol consumption and/or promoting abstinence while also addressing dysfunctional behaviours and impaired functioning. However, stigma and social barriers to accessing care continue to impact many individuals. AUD treatment should focus not only on restoring the physiological and neurological impairment directly caused by alcohol toxicity but also on addressing psychosocial factors associated with AUD that often prevent access to treatment. This review summarizes the impact of alcohol toxicity on brain neurocircuitry in the context of AUD and discusses pharmacological and non-pharmacological therapies currently available to treat this addiction disorder.
... 36 38 In the context of substance use treatment, a counsellor may use CBT to assist individuals in identifying high-risk situations, as well as developing strategies for coping with these high-risk situations to avoid relapse. 34 36 37 These coping strategies are typically both behavioural (avoid the people/places/things that trigger urges for opioid use) and cognitive (challenging thought patterns to counteract relapse cues). 39 By practising skills during and between sessions, CBT can help a patient strengthen these skills to avoid relapse. ...
... This approach is rooted in operant conditioning, a learning process focused on positive reinforcement of desired behaviours. 34 CM approaches take into consideration the high rates of delayed discounting in people with OUD by providing immediate and tangible reinforcement that is 'contingent' on targeted behaviours (eg, abstinence from illicit drug use). Like 12-step programmes, CM provides praise for meeting short-term abstinence goals, a strategy that may maximise treatment outcomes as people with OUD may experience the immediate rewards as particularly satisfying. ...
... 35 55 Like CBT, the efficacy of CM and MI approaches may also be limited by the cognitive capacity and ability to anticipate future consequences of target behaviours of patients with OUD. 14 56 CM, for example, requires participants to successfully plan and make appropriate decisions while under pressure (ie, executive functioning), which are often demonstrated weaknesses in the cognitive profile of patients with OUD. 16 57 58 As previously described, CM uses immediate and tangible rewards for positive target behaviours 34 to reinforce patients with OUD as they tend to display high rates of delayed discounting. 22 24 31 Owing to cognitive dysfunction, however, relapse may be more likely if the anticipated reward is not perceived as readily accessible. ...
Article
Treatment for opioid use disorder (OUD) is often in the context of biobehavioural interventions, consisting of medication for OUD (for example, methadone and buprenorphine), which is accompanied by psychoeducation and/or behavioural therapies. Patients with OUD often display weaknesses in cognitive function that may impact the efficacy of such behavioural interventions. A review of the literature was conducted to: (1) describe common cognitive dysfunction profiles among patients with OUD, (2) outline intervention approaches for patients with OUD, (3) consider the cognitive demands that interventions place on patients with OUD and (4) identify potential accommodation strategies that may be used to optimise treatment outcomes. Cognitive profiles of patients with OUD often include weaknesses in executive function, attention, memory and information processing. Behavioural interventions require the patients' ability to learn, understand and remember information (placing specific cognitive demands on patients). Accommodation strategies are, therefore, needed for patients with challenges in one or more of these areas. Research on accommodation strategies for patients with OUD is very limited. We applied research from populations with similar cognitive profiles to form a comprehensive collection of potential strategies to compensate for cognitive dysfunction among patients with OUD. The cognitive profiles and accommodation strategies included in this review are intended to inform future intervention research aimed at improving outcomes among patients with OUD.
... Other systematic reviews were more directed towards the effect of third wave and traditional therapies on SUDs co-morbid with depression. 82,83 McHugh et al. 82 conducted a study on a type of second-wave therapy, which included third-wave therapies and is fundamentally different from the treatments in our study. These two types of treatments are completely different in terms of underlying logic and technique. ...
... Other systematic reviews were more directed towards the effect of third wave and traditional therapies on SUDs co-morbid with depression. 82,83 McHugh et al. 82 conducted a study on a type of second-wave therapy, which included third-wave therapies and is fundamentally different from the treatments in our study. These two types of treatments are completely different in terms of underlying logic and technique. ...
Article
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Substance use disorder (SUD) is a prevalent health issue with serious social and personal consequences. SUDs are linked to numerous physical health problems. In the Diagnostic and Statistical Manual of Mental Disorders-5th Edition (DSM-V), the essential characteristic of a SUD is a collection of cognitive, behavioral, and psychological manifestations indicative of the subject's unbaiting substance use despite experiencing significant problems due to continued use. Several alternative interventions have been indicated. Among them, mindfulness-based therapies are receiving growing attention. This article reviews evidence for the use of third-wave cognitive-behavioral therapies (CBTs) in addiction treatment. We have reviewed the literature published from 1990 to 2019. Further research is required to better understand the types of mindfulness-based interventions that work best for specific types of addiction, patients, and situations. Current findings increasingly support third-wave CBTs as a promising complementary therapy for the treatment and prevention of addiction.
... Beck and colleagues (Beck et al., 1993) developed a cognitive behavioural framework to understand substance use problems and treatment of such problems nearly thirty years ago, and this framework has been further developed. Short interventions based on motivational interview (MI) and cognitive behavioural therapy (CBT) are now recommended treatment for alcohol misuse and have proven effective in lowering alcohol consumption (Miller and Wilbourne, 2002;McHugh et al., 2010). However, alcohol misuse is significantly undertreated and is generally associated with shame and guilt (World Health Organization, 2018). ...
... The intervention was a therapist-guided internet-delivered self-help programme developed by the third author of this article and based on principles from MI (Miller and Wilbourne, 2002) and CBT for substance use disorders (McHugh et al., 2010). Principles from MI were implemented at the beginning of the program and among other things, participants were asked to think about the pros and cons of drinking alcohol and why they wanted to change drinking habits. ...
Article
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Background Alcohol is the third leading risk factor for burden of disease in the world, causing significant health damage to the individual as well as costs to the surroundings and society as whole. Internet-delivered psychological interventions may help the individual to address alcohol consumption at an early stage before it develops into more serious problems. There is a need to investigate how participants experience internet-delivered interventions for hazardous and harmful drinking to optimize its usefulness in the target population. Methods The present study was part of an open pre-post pilot trial to evaluate the feasibility and acceptability of a therapist-guided internet-delivered cognitive behavioural intervention for hazardous and harmful alcohol use. The aim was to investigate participants` experiences of the intervention and the ways in which the intervention helped them to address their alcohol consumption. Fifteen participants were selected from the open pre-post trial (n = 32), and semi-structured interviews were conducted immediately after participants had completed the treatment. The interviews were analysed using Thematic Analysis. Results The results indicate that most of the participants found the intervention to be useful. Participants reported that the intervention made them more aware of the consequences of excessive drinking and gave them tools to cope with their alcohol consumption. Among the perceived advantages were the flexibility and anonymity of the intervention and therapist support. Participants called for more individualisation of the treatment to meet individual needs. Conclusions A therapist-guided internet-delivered intervention for hazardous and harmful drinking can help individuals to address their alcohol consumption and give them tools to cope with their drinking. Future studies should examine the feasibility of tailoring modules to individual needs.
... Evidence of CBT in treating substance use disorder is very heterogeneous in terms of protocols; nonetheless, a consolidate literature shows its efficacy in treating addictions (see [47,57] for reviews) and it has proven to be effective as both a single and combined therapy [48] for different substances like alcohol, cocaine (see [48] for a review) and nicotine (see [79] for a review). ...
... Evidence of CBT in treating substance use disorder is very heterogeneous in terms of protocols; nonetheless, a consolidate literature shows its efficacy in treating addictions (see [47,57] for reviews) and it has proven to be effective as both a single and combined therapy [48] for different substances like alcohol, cocaine (see [48] for a review) and nicotine (see [79] for a review). ...
Article
Substance and behavioral addiction is a global health problem related to cognitive functioning and emotional responses like top-down control and craving. The present review discusses the role of non-invasive brain stimulation (NIBS) and cognitive-behavioural therapy (CBT) as evidence-based treatments for addiction disorders. The discussion spans between several evidence for both therapies, also considering the difference and heterogeneity among clinical protocols. Nowadays, literature is consistent in indicating the neurostimulation of the prefrontal cortex as effective for different kinds of addiction, corroborating the evidence that they rely on a common network in the brain. Likewise, within the CBT studies it is possible to observe a wide range of interventions that are overall effective in regulating the executive functions associated with addiction disorders. Nevertheless, the integration of NIBS and CBT in addictions has been scarcely considered in literature so far. For this reason, the present article is meant to foster empirical research in this field by highlighting the findings supporting these evidence-based interventions, both as stand-alone and integrated treatments. To this aim, psychological and neurophysiological mechanisms of NIBS and CBT in addictions are reviewed, and the rationale of their integration discussed. In particular, as evidence suggest these treatments affect top-down and bottom-up processes in different ways, with NIBS reducing craving and CBT boosting motivation and coping, we suggest their combination might better target the different components of addiction to promote abstinence.
... Research on cognitive-affective functioning in disinhibitory disorders offers suggestions for effective treatments. For example, there is evidence that contingency management (Table 3) works for ASPD and SUDs [211][212][213][214] , which is consistent with the evidence reviewed above that these individuals tend to be sensitive to rewards and have difficulty tracking rules. Thus, rewarding positive behaviours and explicitly outlining the connection between behaviour and outcome leverages affective preferences and circumvents executive functioning deficits. ...
... Medications are used effectively for acute stabilization, to manage withdrawal symptoms and to reduce harm (for example, naloxone to address an opioid overdose) 226,227 The US Food and Drug Administration has approved a handful of medications, specifically for the treatment of alcohol or opioid use disorders 228 Several psychotherapies have strong, consistent and robust empirical support across a range of substance types 228 Cognitive behavioural therapy emphasizes identifying the antecedents and consequences of substance use, developing skills to recognize and manage situations and states in which substance use is most likely, and implementing coping strategies to manage thoughts and emotions when faced with specific triggers or situations 214 Contingency management involves the use of incentives or rewards (for example, vouchers that can be exchanged for goods or services) for meeting specific behavioural goals (for example, verified abstinence) 213 Motivational interviewing is used to enhance a person's intrinsic motivation for change and is particularly useful for increasing treatment engagement 229 BPD Selective serotonin reuptake inhibitors, atypical antidepressants, anxiolytics, antipsychotics and mood stabilizers are commonly prescribed for individuals with BPD 230 ; however, there is no empirical base to establish the usefulness of these medications for BPD 231 The most common, well-studied and effective treatment for BPD is dialectical behaviour therapy 215 , which involves the development of skills to reduce observable symptoms of BPD through mindfulness (focusing on the present), emotion regulation, distress tolerance and interpersonal effectiveness strategies ...
Article
Disinhibited behaviours such as aggression, criminality and substance misuse are ubiquitous. In the USA, a violent crime occurs every 25 s, a non-violent crime every 4.1 s, an incidence of domestic violence every 3 s and substance misuse every 2.4 s. These behaviours are widespread, but more commonly exhibited by individuals with specific psychological problems, namely disorders characterized by disinhibition. Although individuals with disinhibitory disorders display similar behaviours, the underlying cognitive–affective factors are distinct and must be taken into account when developing scientifically informed interventions. In this Review, we provide a summary of key cognitive–affective factors associated with four disinhibitory disorders: substance use disorders, borderline personality disorder, antisocial personality disorder and psychopathy. We focus on these four disorders given their phenotypic overlap and because individuals with these disorders disproportionately find themselves ensnared in the legal system. We discuss the implications of integrating an understanding of cognitive–affective functioning for more successful interactions between individuals with these disorders and the police, courts and correctional facilities. To protect all members of society, we must consider how psychological science can have a greater role at various stages of legal intervention. Individuals with substance use disorders, borderline personality disorder, antisocial personality disorder and psychopathy are over-represented in the criminal legal system. In this Review, Baskin-Sommers et al. summarize cognitive–affective factors that give rise to these disinhibitory disorders, and discuss implications for legal intervention.
... Hal ini dikarekanakan persepsi setiap diri dapat menyebabkan respon berbeda setiap individu. 7,8,9,10 Respon suatu individu sangat terkait dengan self-management yaitu kemampuan seseorang mengelola diri sendiri. 11,12 Pengetahuan pasien yang dapat mendukung self-management meliputi penyakit yang dialami, dan cara pencegahan/ penanganan perburukan gejala asma, akan mempunyai motivasi baik dalam penanganan penyakitnya. ...
... Unfortunately, the CCHS-MH does not provide any information on what interventions, if any, respondents accessed to support their recovery process. Various systematic reviews have demonstrated the effectiveness of Motivational Interviewing (MI) (Smedslund et al., 2011), Cognitive Behavioral Therapy (CBT) (Magill and Ray 2009;McHugh et al. 2010), Contingency Management (CM) (Davis et al. 2016), and 12-Step programs (Bøg et al. 2017) for reducing drug use when compared with no treatment; however, none has consistently demonstrated superiority to other interventions. A recent Cochrane review examined the effectiveness of various psychosocial interventions for treating psychostimulant misuse and found that while any intervention was superior to no treatment for increasing retention and maintaining abstinence, there was no single intervention significantly advantageous to another (Minozzi et al. 2016). ...
Article
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Research on recovery from drug dependence is largely focused on abstinence without consideration of other aspects of mental health. The present study seeks to identify among Canadians with a lifetime history of illicit drug dependence, the prevalence of, and factors associated with (1) remission, (2) absence of psychiatric disorders (APD), and (3) complete mental health (CMH). A sample of 20,305 respondents from the 2012 Canadian Community Health Survey-Mental Health was selected, including 460 with a history of drug dependence. Chi-square tests and logistic regression analyses were conducted. Among those with a history of drug dependence, 80.6% were in remission. Although 47.9% achieved APD and 37.9% were in CMH, these percentages were significantly lower than those without a history of drug dependence (90.3% and 74.1%, respectively). APD and CMH were more common among older respondents, those with higher levels of social support, and those without a history of depression or anxiety. The present study draws attention to the individuals who may be vulnerable to continued drug dependence, while also illuminating potential modifiable factors to support positive mental health outcomes among those with a history of illicit drug dependence.
... CBT-SUD is brief, structured psychotherapy empirically supported to increase short-term abstinence across SUD populations and treatment settings [33,41,42], including among individuals with comorbid psychopathology [43][44][45] and when administered in web-based formats [46,47]. CBT-SUD aims to facilitate the reduction in substance use via identification of substance use triggers, self-monitoring thoughts and behaviors related to substance use (e.g., functional analysis), planning substance-free activities, and coping skills training to manage withdrawal symptoms and craving [48]. ...
Article
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Purpose of Review To provide an overview of the state of translational substance use disorder (SUD) research by evaluating the extent to which psychosocial interventions target neurobiological processes known to contribute to the maintenance of SUD. Recent Findings A limited number of studies have investigated neurobiological mechanisms of action for commonly utilized SUD treatment approaches. Restrictive samples, post-treatment-only designs, and failure to include substance use outcomes significantly limit the interpretation of these findings. Summary Much work is needed to bridge the translational gap between neuroscience and psychosocial treatment research for SUD. Despite existing gaps, addiction neuroscience is highly relevant to SUD assessment, case conceptualization, and treatment. Implications are discussed in addition to suggestions for future research.
... In such a situation, a trained deep learning algorithm of this study would be helpful in assessing the severity of alcohol-related problems in patients. Patients with alcohol use disorders can receive outpatient medication, intensive behavioral programs, or inpatient treatment depending on their severity (62). Using the deep learning algorithm, the severity of alcohol problems in patients could be analyzed more efficiently, thus facilitating the treatment plan, period and the prediction of prognosis. ...
Article
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Purpose: The number of patients with alcohol-related problems is steadily increasing. A large-scale survey of alcohol-related problems has been conducted. However, studies that predict hazardous drinkers and identify which factors contribute to the prediction are limited. Thus, the purpose of this study was to predict hazardous drinkers and the severity of alcohol-related problems of patients using a deep learning algorithm based on a large-scale survey data. Materials and Methods: Datasets of National Health and Nutrition Examination Survey of South Korea (K-NHANES), a nationally representative survey for the entire South Korean population, were used to train deep learning and conventional machine learning algorithms. Datasets from 69,187 and 45,672 participants were used to predict hazardous drinkers and the severity of alcohol-related problems, respectively. Based on the degree of contribution of each variable to deep learning, it was possible to determine which variable contributed significantly to the prediction of hazardous drinkers. Results: Deep learning showed the higher performance than conventional machine learning algorithms. It predicted hazardous drinkers with an AUC (Area under the receiver operating characteristic curve) of 0.870 (Logistic regression: 0.858, Linear SVM: 0.849, Random forest classifier: 0.810, K-nearest neighbors: 0.740). Among 325 variables for predicting hazardous drinkers, energy intake was a factor showing the greatest contribution to the prediction, followed by carbohydrate intake. Participants were classified into Zone I, Zone II, Zone III, and Zone IV based on the degree of alcohol-related problems, showing AUCs of 0.881, 0.774, 0.853, and 0.879, respectively. Conclusion: Hazardous drinking groups could be effectively predicted and individuals could be classified according to the degree of alcohol-related problems using a deep learning algorithm. This algorithm could be used to screen people who need treatment for alcohol-related problems among the general population or hospital visitors.
... Cognitive behavioral therapy (CBT) is an evidence-based treatment that encompasses a series of empirically validated, structured, present-oriented models that seek to promote lasting cognitive, behavioral, and emotional changes. There is evidence of the effectiveness of CBT protocols for a number of demands and mental disorders, such as major depressive disorder (Driessen & Hollon, 2010), anxiety disorders (Otte, 2011), and substance abuse disorders (McHugh et al., 2010) and a number of other clinical situations (for a review of meta-analyses on the effectiveness status of CBT, cf. Hofmann et al., 2012). ...
Chapter
This chapter will address couple relationships and connectedness in sexual minority emerging adults (SMEA). It is reflected in the development of affective sexual socialization among couples of young lesbian, gay and bissexual (LGB) individuals. With the recent social transformations, from the cultural to the legal field, the sex-loving relationships of this minority group have experienced new formulations and meanings. The establishment of conjugal ties for a long time has been a denied alternative; however, with new legislative configurations around the world, these young people are discovering this experience as a framework for the socialization of sexuality. The chapter’s proposal is divided into three topics: discussing the relationship between emerging adulthood in LGB individuals and conjugality; exploring risk and protective factors of SMEA couple relationships, reflecting on minority stress in a couple level; and pointing out clinical challenges when working with these marital configurations. All these must consider that homophobia is still a reality in several countries and that these emerging adults still live with considerable rates of internalized homophobia and in a community marked by segregation and social hierarchy.
... e. Des stratégies thérapeutiques similaires Enfin, des similitudes au niveau des traitements employés pour traiter ces deux pathologies permettent de rapprocher encore un peu plus les addictions comportementales des addictions aux substances (Grant et al., 2003. D'un point de vue psychothérapeutique, les thérapies cognitives et comportementales visant à prévenir les rechutes ont montré des effets bénéfiques aussi bien dans le cas des addictions aux substances que dans la plupart des TCI (Grant et al., 2010;McHugh et al., 2010;Petry et al., 2006). Concernant les pharmacothérapies, la naltrexone, un antagoniste du système opioïdergique utilisé dans le traitement des addictions à l'alcool et aux opioïdes (et permettant de moduler la transmission dopaminergique au niveau de la voie mésolimbique notamment), a montré par exemple des effets bénéfiques comparés à un placebo lors d'études portant sur la kleptomanie et le jeu pathologique, en diminuant les rechutes et le craving (Anton, 2008;Grant et al., 2009;S. ...
Thesis
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Le concept d’addiction, caractérisé par une incapacité répétée de contrôler la prise d’une substance en dépit des conséquences négatives que cela implique pour la personne ou son entourage, constitue aujourd’hui un problème de santé publique majeure. En effet, ces troubles caractérisés par une perte de contrôle progressive de la personne vis-à-vis de la substance, le développement d’une dépendance ainsi qu’une compulsivité concernent aujourd’hui plusieurs millions de personnes en France. Récemment, ce concept a été étendu aux comportements non liés à la prise de substances, avec la reconnaissance dans les manuels diagnostiques de référence des « addictions comportementales », compte tenu de la similitude des critères diagnostiques utilisés pour les définir avec ceux utilisés pour les addictions aux drogues. Anciennement catégorisés comme étant des troubles du contrôle des impulsions, l’apparition et le développement de ces troubles reste néanmoins encore peu compris, et leur détection ainsi que leur prise en charge encore trop limitée.L’un des principaux facteurs caractérisant ces patients est leur propension à agir de manière impulsive. En effet, une forte intolérance au délai a pu être observée chez les personnes présentant ces addictions, et pourrait constituer un facteur de risque à leur développement. Un autre facteur de vulnérabilité a également été identifié suite à l’observation d’une forte prévalence de ces troubles dans le traitement de diverses pathologies : l’utilisation d’un traitement dopaminergique. Mon projet de thèse a donc consisté à étudier, sur un modèle rongeur, l’influence d’un agoniste dopaminergique (le pramipexole) sur l’impulsivité, et ce en fonction du niveau d’impulsivité initial des rats. En vue d’identifier des biomarqueurs pertinents au développement de ces comportements, et afin de mieux comprendre l’apparition de ces troubles, une évaluation du profil d’expression en micro ARNs a été réalisée au niveau sanguin et tissulaire. En effet ces petits ARNs, impliqués dans le contrôle de nombreuses voies de signalisation de par leur rôle de régulateurs de la transcription, ont été identifiés comme étant dérégulés dans de nombreuses pathologies, y compris dans le cadre de maladies psychiatriques. Leur étude pourrait donc constituer un élément clé dans la compréhension des mécanismes moléculaires sous tendant l’apparition de ces troubles, et améliorer in fine la détection et prise en charge de ces patients.L’impulsivité cognitive des rongeurs a été évaluée à l’aide d’une tâche d’intolérance au délai, durant laquelle l’animal devait choisir entre appuyer sur un levier pour obtenir une petite récompense immédiate, ou bien appuyer sur un autre levier amenant à l’obtention d’une grosse récompense associée à un délai. Les données comportementales obtenues au cours de ma thèse ont indiqué que le pramipexole exerçait un effet pro-impulsif sur les rongeurs, et ce en fonction de leur niveau d’impulsivité initial (effet mis en évidence chez les animaux bassement et moyennement impulsifs). La combinaison des données transcriptomiques obtenues en séquençage à haut-débit et en RT-qPCR a également associé à nos paramètres d’études des dérégulations spécifiques de micro ARNs. L’un d’entre eux, le miR-10a-5p, a ensuite été sélectionné pour valider causalement son implication dans les comportements impulsifs. Malheureusement, la surexpression de son niveau d’expression au niveau du striatum dorsal d’animaux bassement et moyennement impulsifs n’a pas permis d’observer le phénotype impulsif attendu. D’autres études seront donc nécessaires pour valider, ou invalider, définitivement son implication dans les comportements impulsifs.Finalement, ces travaux auront permis d’identifier un profil d’expression en micro ARNs pertinent pour l’étude des comportements impulsifs, et pourraient constituer à terme un élément clé dans la compréhension de l’apparition des addictions comportementales.
... A systematic review by Niccols et al. (2012b) also showed positive association between integrated treatment programmes for mothers with substance use problems and the improvements in their child development, physical growth (e.g., length, weight, and head circumference), emotional and behavioural functioning. The provision of comprehensive interventions or targeted services within an integrated treatment programme appears to fulfil the dynamic needs of the mothers (Sword et al., 2009), therefore suggesting that integrated treatment programmes may be more effective for mothers with substance use problems and their children, as compared to single-focus interventions (Lieberman, 1998;McHugh et al., 2010). ...
Article
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Approximately half of mothers receiving substance use treatment are involved with childcare proceedings. This review aims to determine whether integrated treatment programmes for mothers with substance use problems are effective in preventing out-of-home placement (temporally/permanent) and influencing other maternal factors such as patterns of substance use, treatment completion and parenting behaviours. Six trials were identified—two randomised controlled trials and four non-randomised controlled studies. The pooled sample of participants was 1717. The results showed that mothers who participated in integrated treatment programmes were significantly less likely to have the children removed from their care (Odds Ratio (OR) = 0.40, 95% CI = 0.27, 0.61), more likely to complete substance use treatment ( OR = 3.01, 95% CI = 1.79, 5.06), and more likely to reduce their alcohol consumption (Standardised Mean Difference (SMD) = −0.40, 95% Cl = −0.78, −0.01) and drug use ( SMD = −0.30, 95% CI = −0.53, −0.07). However, non-significant reductions were observed for parent–child conflict ( SMD = −0.35, 95% CI = −0.72, 0.03) and child abuse risk ( SMD = −0.03, 95% CI = −0.36, 0.31). While the findings from this review suggest that mothers involved in integrated treatment programmes could potentially be less likely to experience out-of-home child placements and more likely to improve substance use treatment outcomes, little evidence exists for the effectiveness of these interventions. Further research, particularly high-quality RCTs, is required to demonstrate and persuade health and public policy on the far-reaching value of the integrated approaches.
... Drug addiction is a complex disorder manifested by compulsive drug use, which would present various symptoms, such as emotional irritability or depression. Cognitive Behavioral Therapy (CBT) [23] is one of the therapeutic approaches to effectively assist drugaddicted patients in rehabilitation. In CBT for drug addiction, therapists focus on guiding patients to recollect the moments when craving arise, and review the triggering factors, bodily responses, and mental experiences under the circumstances. ...
... For individuals with opioid use disorder who do seek treatment, there is significant variability in quality and utilization of evidence-based therapies across providers [9,10]. Significant training, time, and clinical oversight are required to ensure proper face-to face delivery of behavioral therapy [11]. Digitizing and offering evidence-based therapies on mobile devices can standardize care, ease the burden on clinical staff, and expand access to behavioral treatment. ...
Article
Background: Prescription digital therapeutics are software-based disease treatments that are regulated by the US Food and Drug Administration; the reSET-O prescription digital therapeutic was authorized in 2018 and delivers behavioral treatment for individuals receiving buprenorphine for opioid use disorder. Although reSET-O improves outcomes for individuals with opioid use disorder, most of the therapeutic content is delivered as narrative text. PEAR-008 is an investigational device based on reSET-O that uses an interactive, game-based platform to deliver similar therapeutic content designed to enhance patient engagement, which may further improve treatment outcomes. Objective: We aim to investigate how participants interact with the prescription digital therapeutic's new content delivery format. Secondary objectives include evaluating treatment success, symptoms of co-occurring mental health disorders, recovery capital, and skill development. Methods: Due to the COVID-19 pandemic, this study was redesigned using a decentralized model because it was not possible to conduct medication initiation and study visits in person, as initially intended. A decentralized, randomized controlled trial design will be utilized to compare patient engagement with PEAR-008 and that with reSET-O using both subjective and objective assessments. The study population will consist of approximately 130 individuals with opioid use disorder (based on Diagnostic and Statistical Manual of Mental Disorders 5 criteria) who have recently started buprenorphine treatment for opioid use disorder. Participants will be virtually recruited and randomly assigned to receive either PEAR-008 or reSET-O. All study sessions will be virtual, and the duration of the study is 12 weeks. The primary outcome measure of engagement is operationalized as the number of active sessions per week with either PEAR-008 or reSET-O. (An active session is any session that contains some active participation in the app, such as navigating to a different screen, engaging with a learning module, or responding to a notification.) Subjective dimensions of engagement will be assessed with participant surveys. The hypothesis is that PEAR-008 will have significantly greater participant engagement than reSET-O. Results: As of February 2021, participant enrollment is ongoing. Conclusions: This randomized controlled trial will investigate if changing the delivery format and enhancing the content of a prescription digital therapeutic for opioid use disorder will affect how participants use and interact with the prescription digital therapeutic. The study design may serve as a useful model for conducting decentralized studies in this patient population. Trial registration: ClinicalTrials.gov NCT04542642; https://clinicaltrials.gov/ct2/show/NCT04542642. International registered report identifier (irrid): DERR1-10.2196/32759.
... MHG meetings are a cost-effective method and show very promising results despite the lack of solid evidence (Kelly & Yeterian, 2011). Cognitive behavioral therapy (CBT) for substance use disorders indicates promising results either as part of treatment strategy or as a standalone method (McHugh et al., 2010). According to a meta-analysis published investigating the efficacy of CBT in different substances, they found that the most who will benefit from this method use cannabinoids followed by cocaine, opioids, and, to a lower extent, poly-substance dependence (Magill & Ray, 2009). ...
... Alternatively, political ambivalence towards community violence will continue to reinforce issues of stigma towards PWID across all levels of the MSEM and should be prioritized. At the social network-level, cognitive behavioral interventions combined with family and couple counselling have noted promising results in reducing stigma [42]. Intrapersonal interventions include personalized counseling sessions on "coping" with experienced stigma or changing personal environments, which when well-timed and supported by sufficient resources have been effective [43]. ...
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Background In Kenya, people who inject drugs (PWID) are disproportionately affected by HIV and hepatitis C (HCV) epidemics, including HIV-HCV coinfections; however, few have assessed factors affecting their access to and engagement in care through the lens of community-embedded, peer educators. This qualitative study leverages the personal and professional experiences of peer educators to help identify HIV and HCV barriers and facilitators to care among PWID in Nairobi, including resource recommendations to improve service uptake. Methods We recruited peer educators from two harm reduction facilities in Nairobi, Kenya, using random and purposive sampling techniques. Semi-structured interviews explored circumstances surrounding HIV and HCV service access, prevention education and resource recommendations. A thematic analysis was conducted using the Modified Social Ecological Model (MSEM) as an underlying framework, with illustrative quotes highlighting emergent themes. Results Twenty peer educators participated, including six women, with 2-months to 6-years of harm reduction service. Barriers to HIV and HCV care were organized by (a) individual-level themes including the competing needs of addiction and misinterpreted symptoms; (b) social network-level themes including social isolation and drug dealer interactions; (c) community-level themes including transportation, mental and rural healthcare services, and limited HCV resources; and (d) policy-level themes including nonintegrated health services, clinical administration, and law enforcement. Stigma, an overarching barrier, was highlighted throughout the MSEM. Facilitators to HIV and HCV care were comprised of (a) individual-level themes including concurrent care, personal reflections, and religious beliefs; (b) social network-level themes including community recommendations, navigation services, family commitment, and employer support; (c) community-level themes including quality services, peer support, and outreach; and (d) policy-level themes including integrated health services and medicalized approaches within law enforcement. Participant resource recommendations include (i) additional medical, social and ancillary support services, (ii) national strategies to address stigma and violence and (iii) HCV prevention education. Conclusions Peer educators provided intimate knowledge of PWID barriers and facilitators to HIV and HCV care, described at each level of the MSEM, and should be given careful consideration when developing future initiatives. Recommendations emphasized policy and community-level interventions including educational campaigns and program suggestions to supplement existing HIV and HCV services.
... The transition from addictive to drug-free lifestyle is challenging as it brings tremendous changes in the social and environmental context of an individual (McHugh et al., 2010). For instance, one has to attempt to rebuild his or her life by pursuing employment or study, managing own finance, participating in healthy leisure or reestablishing a "clean" social network but at the same time to avoid drug use, handle craving and tolerate withdrawal (Levy, 2008). ...
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Background Effective lifestyle intervention is essential to promote transition from an addictive life to a drug-free lifestyle. This study retrospectively evaluated the Lifestyle Redesign Program (LRP), a lifestyle intervention featured with motivational enhancement, in promoting drug-free and engaging lifestyle in young drug users in Hong Kong. Methods Retrospective observational design with single-group pre-and-post intervention comparison was adopted. Participants were recruited from two residential detoxification centers. Demographics, abstinence information, engagement status, and outcome measures including self-efficacy on drug avoidance, perceived general health and quality of life were collected. Data were analyzed with descriptive statistics, paired t-test and Spearman’s rank-order correlation. Results A total of 86 participants were recruited. Seventy-two of them (83.7%) maintained abstinence for at least 2 months and 64 of them (74.4%) had meaningful engagement in terms of competitive employment or study after completing the LRP. Statistically significant improvements were found in self-efficacy on drug avoidance (t = 8.3, p < .01, d = 0.90), perceived general health (t = 7.4, p < .01, d = 0.79), and overall quality of life (t = 5.4 to 8.3, p < .01, d = 0.59 to 0.89). Conclusions The findings provide preliminary evidence that LRP is associated with promoting abstinence and achieving healthy lifestyle for young drug users. More controlled studies are recommended to rigorously examine its effectiveness.
... The therapy comprises the use of cognitive (e.g., 'thought records' which are used for keeping track of thought patterns and help to adopt the use of alternative ways of thinking) and behavioural (e.g., task assignments, relaxation) techniques [11] (p. 581). Applied as drug treatment, CBT can be provided as either individual or group intervention, with the use of relapse prevention techniques, such as the identification of contexts that instigate drug use (e.g., the presence of drugtaking peers), and the enhancement of capabilities to cope with the pull factors of drug use (e.g., a thorough understanding of the effects of drug-taking) [29]. For MET, there is a ther-apeutic approach which posits that clients will make most effective changes when they are intrinsically motivated instead of when they are imposed during therapeutic sessions [30]. ...
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In view of the research gap whereby few studies have investigated the inner psychological situations underlying continuous drug use, this study used the Soulmate Scale to investigate the relationship between soulmate experience and drug-taking behaviour. Overall, 276 participants took part in this study. Results showed that soulmate experience was negatively related to drug-taking behaviour, which means that being psychologically attached to drugs and receiving comfort from them encourages dependency and a higher level of difficulty in quitting drugs. In addition, soulmate experience significantly mediated the effect of meaning of life and social isolation on drugs, suggesting that when such psychological bonding and sustenance can be developed in interpersonal relationships instead of drugs, drug users are likely to develop the meaning of life and a lower sense of social isolation, and are more likely to quit drugs. The corresponding implications were discussed.
... Second, as hypothesized, SUD treatment using the curriculum as delivered to clients by training participants led to significant decreases in frequency of substance use for marijuana, inhalants, alcohol, and cigarettes, with small to medium effect sizes. This matches extensive research demonstrating that approaches used in the curriculum (such as CBT, REBT and 12 Steps) are beneficial in SUD treatment (Arkowitz & Lilienfeld, 2011;Jensen et al., 2011;McHugh et al., 2010;Obi-Nwosu et al., 2019;Omeje et al., 2018). There were no significant changes in the frequency of opiate or cocaine use, possibly because the number of clients using opiates or cocaine was quite low. ...
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Introduction Substance use in Zambia is stigmatized and treatment access is limited. Over 30,000 people are homeless in Lusaka, where one-quarter of homeless youth report use. Zambia's Ministry of Health recently developed policies targeting alcohol, suggesting Chainama, the only mental health hospital, offer treatment. Together, they endorsed training in the curriculum studied in this paper. We hypothesized training Zambian professionals would improve their perceptions of substance users and treatment. We then explored if treatment using the curriculum, as delivered to clients by training participants, would encourage client motivation to change, participation in groups, and reduce substance use frequency. Methods Part 1: One-hundred professionals were trained in a curriculum-based, literacy-free intervention employing cognitive behavioral and rational emotive behavior therapy techniques to explore 12 Steps of addiction recovery through Zambian art forms. Pre/post questionnaires captured perspectives around substance users and treatment. Part 2: Trained organizations delivered the curriculum in their communities. Twenty-five organizations rated feasibility and benefit of the curriculum. Data for 200 clients recorded pre/post motivation to change, open-sharing/participation, and frequency of substance use. Results While training significantly modified professionals’ perspectives regarding the value of offering treatment, their views of substance users did not change. Clients endorsed increases in “motivation to change” and “participation/open-sharing.” Frequency of alcohol, marijuana, inhalant, and cigarette use significantly decreased. Conclusion Training in the curriculum helped address a public health need, playing a role in increased motivational variables and decreased substance use. Research addressing this study’s limitations is encouraged.
... Fourth, substantively extant clinical research suggests that in terms of comparative effectiveness, family therapy, mixed group therapy, and cognitive behavioral therapy are generally more effective in reducing substance abuse dependence in this population group [48,49]. In contrast, cognitive behavioral therapy is effective as monotherapy and as a part of combination therapy in this clinical demographic [50]. ...
Article
Background Substance use disorders are a serious and persistent U.S. public health problem. Although a number of therapy modalities exist, few studies assessed the comparative effectiveness of specific therapies. This study empirically evaluated whether remote intensive counseling (RIC) is more effective than outpatient therapy (OT) in relapse prevention over the period of nine months in patients aged 18-45 years with a history of substance use. Methods The current study utilized a retrospective correlational cross-sectional cohort quantitative research design with multiple between-group comparisons and fixed effects. The sample (n=296) included adults of both sexes, of diverse racial/ethnic backgrounds, and of socioeconomic status (SES) between 18-45 years of age who had been using an illicit addictive substance(s) for at least six months prior and had never participated in any treatment program previously. Individuals with alcohol and/or nicotine co-dependence were excluded. Result and conclusion Remote intensive counseling (RIC) is more effective for patients aged 18-45 years with a history of substance use than outpatient therapy (OT). RIC works better for single or never married females younger than 30-year-old with higher education. The use of RIC for other age and racial/ethnic groups should be guided by whether patients belong to a younger age cohort and/or a specific race/ethnicity.
... MOUD is a comprehensive treatment strategy, often used in conjunction with behavioral interventions to reduce HIV and overdose risks. Common behavioral approaches include cognitive-behavioral therapy (CBT), motivational interviewing (MI), and contingency management CM; (2)(3)(4). Various psychoeducational counseling approaches are also commonly provided in the context of MOUD (5). Such approaches are often used to increase knowledge, motivation, and coping skills related to addiction and health risk reduction (6). ...
Article
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Background Cognitive dysfunction is disproportionately prevalent among persons with opioid use disorder (OUD). Specific domains of cognitive dysfunction (attention, executive functioning, memory, and information processing) may significantly impede treatment outcomes among patients on medication for OUD (MOUD). This limits patient's ability to learn, retain, and apply information conveyed in behavioral intervention sessions. Evidence-based accommodation strategies have been integrated into behavioral interventions for other patient populations with similar cognitive profiles as persons with OUD; however, the feasibility and efficacy of these strategies have not yet been tested among patients on MOUD in a drug treatment setting. Methods We conducted a series of focus groups with 25 key informants (10 drug treatment providers and 15 patients on MOUD) in a drug treatment program in New Haven, CT. Using an inductive approach, we examined how cognitive dysfunction impedes participant's ability to retain, recall, and utilize HIV prevention information in the context of drug treatment. Results Two main themes capture the overall responses of the key informants: (1) cognitive dysfunction issues and (2) accommodation strategy suggestions. Subthemes of accommodation strategies involved suggestions about particular evidence-based strategies that should be integrated into behavioral interventions for persons on MOUD. Specific accommodation strategies included: use of a written agenda, mindfulness meditation, multi-modal presentation of information, hands-on demonstrations, and a formal closure/summary of sessions. Conclusions Accommodation strategies to compensate for cognitive dysfunction were endorsed by both treatment providers and patients on MOUD. These accommodation strategies have the potential to enhance the efficacy of behavioral interventions to reduce HIV transmission among persons on MOUD as well as addiction severity, and overdose.
... It has also been linked to the ability to pursue valued goals, intelligence quotients, sociodemographics, self-control and resilience (Meindl et al., 2019), including the ability to cope with chronic pain (Suso-Ribera et al., 2016). Unsurprisingly, distress and frustration tolerance issues and exercises have become common aspects of treatment programmes for substance use issues, anxiety-related difficulties, and complex disorders such as borderline personality disorder (Clark, 2013;Fassbinder et al., 2016;Leyro et al., 2010;McHugh et al., 2010). Therapist capacity for distress tolerance has also been suggested to be a factor in the skilled delivery of support to suicidal clients, the processing of trauma, and the application of exposure interventions (Waltman et al., 2016;Waltz et al., 1998), while from the SP/SR literature it has been observed that frustration tolerance can help therapists to manage unhelpful expectations of clients (Haarhoff et al., 2011). ...
Article
Application of a self-practice self-reflection (SP/SR) framework to clinical training programmes for those learning cognitive behavioural therapy (CBT) have demonstrated positive outcomes. These programmes have typically resulted in reports of enhanced learning, improved clinical skills, heightened empathy, improved interpersonal skills, increased self-awareness, and self-development for those undertaking such training. However, the utility of specific activities within this framework for enhancing trainees’ learning still requires exploration. This study sought to explore the use of a low frustration tolerance (LFT) exercise to enhance trainee’s learning around issues relating to frustration and discomfort tolerance. It also further explored the possible application of SP/SR as a form of competency-based assessment. The study was based on 41 student trainees that engaged in a self-directed LFT exercise. Written reflections on these exercises were then thematically analysed. From a competency basis, the exercise provided an approach for observing the trainee’s competency with formulation skills, intervention planning, and self-reflective capacity. Participants reported both personal and professional development outcomes from the exercise. These included a ‘deepened’ understanding of cognitive behavioural principles related to their experiences, both in terms of principles relating to maintenance of dysfunction and to creating change. Increased self-awareness and learning outcomes relating to the development of interpersonal skills were also commonly reported by trainees. Key learning aims (1) To understand the usefulness of a behavioural experiment [a low frustration tolerance (LFT) exercise] for training within a SP/SR framework. (2) To examine the potential for using SP/SR as a form of competency-based training. (3) To demonstrate the benefits of experiential learning through SP/SR in training CBT.
... Low average PA was also related to higher proportion of days of use in the present study, consistent with previous work [33]. This finding is in line with principles of psychological treatments which encourage increasing positive affect through identification of alternate reinforcers, including cognitive behavior therapy [34], dialectical behavior therapy [35], and the Community Reinforcement Approach [36]. In contrast, affectivevariability measures (both positive and negative) were not related to opioid use. ...
Article
Affect and craving are dynamic processes that are clinically relevant in opioid use disorder (OUD) treatment, and can be quantified in terms of intra-individual variability and stability. The purpose of the present analysis was to explore associations between opioid use and variability and stability of affect and craving among individuals receiving medication treatment for OUD (MOUD). Adults (N = 224) with OUD in outpatient methadone or buprenorphine treatment completed ecological momentary assessment (EMA) prompts assessing positive affect, negative affect, opioid craving, and opioid use. Dynamic structural equation modeling (DSEM) was used to quantify person-level indices of magnitude and stability of change. Beta regression was used to examine associations between intra-individual variability and stability and proportion of opioid-use days, when controlling for overall intensity of affect and craving. Results suggested that greater magnitude of craving variability was associated with opioid use on a greater proportion of days, particularly among individuals with lower average craving. Low average positive affect was also associated with lower proportion of days of use. Individuals who experience substantial craving variability in the context of lower average craving may be particularly vulnerable to opioid use during treatment. Ongoing assessment of craving may be useful in identifying treatment needs. Examining correlates of intra-individual variability and stability in MOUD treatment remains a relevant direction for future work.
... Historically, corrections-based treatment has primarily focused on treating substance use, sex offenses, and reducing recidivism to increase public safety. The associated research over time altered the recommended treatment procedures from confrontational therapeutic community groups Martin et al., 1999) to cognitive behavioral learning techniques (McHugh et al., 2010) and currently to the focus of intensive treatment for those at the highest risk of recidivism (i.e., the risk-need-responsivity model; Bonta & Andrews, 2016;Wooditch et al., 2014). Yet, many debilitating predictive factors, such as the impact of lifelong trauma, are missing from the analytical models of treatment outcomes studies, impeding the availability of specialized treatment programs designed to address such factors. ...
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This pilot study examined a peer-facilitated trauma-focused intervention among 624 incarcerated men (Exploring Trauma). Pre- and postintervention data were collected on trauma-related mental health symptoms, aggression, and anger. The results demonstrated statistically significant improvement in trauma-related symptoms relative to pretreatment functioning and demonstrated support for the feasibility of peer-facilitation. Effect sizes were small to moderate, with the largest impact on current traumatic distress, depression, and anxiety (Cohen’s d = .54, .48, .46, respectively). The mixed-effects regression results showed the impact of adverse childhood experiences (ACEs) on outcomes was strong and cumulative (i.e., greater exposure to ACEs increased the likelihood of participant program gain on mental health and aggression symptoms, ranging from .15 to .77). The findings showed that trauma can be safely addressed in corrections and provide promising support for peer-facilitation with training and oversight. Rigorous studies are needed on the impact of trauma-informed services and models of program delivery.
Article
Background In the context of the opioid epidemic and growing awareness of addiction as a public health concern, there are efforts to inform the public, patients, families, and policy makers about the factors that contribute to addiction and facilitate recovery. Several theoretical models provide useful frameworks for this discussion, but each of them has limitations. Objectives This paper presents an accessible yet comprehensive theoretical model that integrates empirical evidence about addiction etiology and recovery using the nature-nurture paradigm. Results The model presents substance use along a continuum, and identifies risk and protective factors in multiple domains that have been identified by research. The domains on the nature side of the model include genetic and biological factors, comorbid psychiatric and medical disorders, physiological reinforcement of substance use, and changes to neural mechanisms. The domains on the nurture side of the model include sociocultural factors, environmental factors, personality, emotions, cognitions, psychological reinforcement of substance use, and cognitive and behavioral changes. The progression from increased or decreased substance use to addiction or recovery is mediated by changes in neural mechanisms and cognitive and behavioral changes, which have feedback loops with the physiological and psychological reinforcement. Conclusions/Importance: This model is a useful heuristic, consistent with a public health framework, for discussing addiction and recovery with patients, their families, and the public. This integrated model of nature and nurture factors has the potential to inform clinical practice, consultation, research, prevention programs, educational programs, and public policy.
Article
This presentation is a part of the PEER Liberia Behavioral Health Lecture Series. It provides an overview of cognitive behavioral therapy for physicians, including: What is CBT?; Introduction to basic skills; Evidence for use in primary care/family medicine; CBT for panic and situational anxiety; and CBT for physicians.
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Resilience, or the process of adapting to adversity, may protect against the harmful effects of minority-related stressors on the cardiovascular health of sexual minority women (SMW). An online survey was conducted in a sample of cisgender, non-heterosexual women to evaluate resilience as a moderator of the association between discrimination experiences and key cardiovascular disease (CVD) risk factors: stress, tobacco-smoking, hazardous alcohol consumption, poor diet quality, physical inactivity, and sedentary behaviors. Overall, 191 women (mean age = 29.34, SD = 6.92; 84.5% White) completed the survey and met eligibility to be included in the data analysis. White race (b = − 6.71, SE = 2.49) and education (b = − 3.36, SE = 0.56) were each independently associated with fewer discrimination experiences. Latinx ethnicity was associated with more discrimination experiences (b = 9.34, SE = 2.61). Education was associated with greater resilience (b = 4.57, SE = 0.83). Multivariable regression models were adjusted for race, ethnicity, and education. Discrimination was associated with a higher likelihood of smoking in the past month (b = 0.04, SE = 0.02) and drinking at hazardous levels (b = 0.09, SE = 0.02). Resilience was associated with less stress (b = − 0.15, SE = 0.02), a lower likelihood of hazardous alcohol consumption (b = − 0.02, SE = 0.01) and less time spent engaging in sedentary behaviors (b = − 0.02, SE = 0.01). One moderation emerged, such that discrimination was negatively associated with stress for those low in resilience (b = − 1.75, SE = 0.58), and not associated with stress for those high in resilience. These findings may inform the development of CVD-risk reduction interventions for SMW, which could include both strategies to mitigate the effects of discrimination on substance use and coping skills to promote resilience.
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ÖZGÜL ÖĞRENME GÜÇLÜĞÜ, KAYGI, BİREYSEL DANIŞMANLIK, BİLİŞSEL DAVRANIŞÇI TERAPİ
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Questo lavoro si propone di presentare l'attuale stato dell'arte sul tema della dipendenza affettiva, una forma di amore ossessivo ed esasperato nei confronti del proprio partner, che nuoce al benessere della persona. Nella prima parte ven-gono trattate la definizione, la fenomenologia e la prevalenza di questa condizio-ne. Vengono inoltre esposte le principali teorie riguardanti l'inquadramento noso-grafico del problema e le considerazioni diagnostiche per differenziarlo da patolo-gie simili. La seconda parte dell'articolo riporta invece le varie ipotesi sull'eziologia della dipendenza affettiva, le principali misure per il suo assessment e i trattamenti che ad oggi sono stati proposti. Nel complesso si evidenzia che, sebbene si discuta da tempo di dipendenza affettiva, tuttora la letteratura a riguardo risulta fram-mentaria e poco chiara, il che è da considerarsi, a detta degli autori, come il princi-pale limite da superare per poter aiutare efficacemente chi soffre di tale condizio-ne.
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Background Substance use disorder (SUD) is a leading contributor to the global burden of disease. In Indonesia, the availability of formal treatment for SUD falls short of the targeted coverage. A standardised therapeutic option for SUD with potential for widespread implementation is required, yet evidence-based data in the country are scarce. In this study, we developed a cognitive behavioural therapy (CBT)-based group telemedicine model and will investigate effectiveness and implementability in a multicentre randomised controlled trial. Methods A total of 220 participants will be recruited from the social networks of eight sites in Indonesia: three hospitals, two primary healthcare centres and three rehabilitation centres. The intervention arm will participate in a relapse prevention programme called the Indonesia Drug Addiction Relapse Prevention Programme (Indo-DARPP), a newly developed 12-week module based on CBT and motivational interviewing constructed in the Indonesian context. The programme will be delivered by a healthcare provider and a peer counsellor in a group therapy setting via video-conferencing, as a supplement to participants’ usual treatments. The control arm will continue treatment as usual. The primary outcome will be the percentage increase in days of abstinence from the primarily used substance in the past 28 days. Secondary outcomes will include addiction severity, quality of life, motivation to change, psychiatric symptoms, cognitive function, coping, and internalised stigma. Assessments will be performed at baseline (week 0), post-treatment (week 13), and 3 and 12 months post-treatment completion (weeks 24 and 60). Retention, participant satisfaction, and cost-effectiveness will be assessed as the implementation outcomes. Ethics and dissemination The study protocol was reviewed and approved by the Ethics Committees of Universitas Indonesia and Kyoto University. The results will be disseminated via academic journals and international conferences. Depending on trial outcomes, the treatment programme will be advocated for adoption as a formal healthcare-based approach for SUD. Trial registration number UMIN000042186.
Chapter
Substance use including alcohol, tobacco, prescription drugs, inhalants, and many others in sub-Saharan Africa and around the world has deleterious consequences on the health, economy, and social aspects of society. There is no single approach to dealing with substance use as intervention depends on aetiology, personality traits of the users, and the different rehabilitation services available. Thus, several strategies and multi-disciplinary approaches should be used for effective intervention. The primary focus of this chapter is to explore and review prevention and effective interventions for harm reduction in substance use. Interventions for addressing problems that could not be prevented are discussed. The following interventions are discussed: cognitive-based therapies, confrontational models of intervention, crisis intervention, and systemic family models of persuasive intervention.
Article
Background The overlap between justice system involvement and drug use is well-documented. Justice-involved people who misuse opioids are at high risk for relapse and criminal recidivism. Criminal justice policymakers consider opioid-specific medication-assisted therapies (MATs) one approach for improving outcomes for this population. More research is needed that explores the impacts of opioid-specific MATs for justice-involved people. Objectives This study sought to assess the effects of opioid-specific MAT for reducing the frequency and likelihood of criminal justice and overdose outcomes for current or formerly justice-involved individuals. Search Methods Records were searched between May 7, 2021 and June 23, 2021. We searched a total of sixteen proprietary and open access databases that included access to gray literature and conference proceedings. The bibliographies of included studies and relevant reviews were also searched. Selection Criteria Studies were eligible for inclusion in the review if they: (a) assessed the effects of opioid-specific MATs on individual-level criminal justice or overdose outcomes; included (b) a current or formerly justice-involved sample; and (c) a randomized or strong quasi-experimental design; and c) were published in English between January 1, 1960 and October 31, 2020. Data Collection and Analysis We used the standard methodological procedures as expected by The Campbell Collaboration. Main Results Twenty studies were included, representing 30,119 participants. The overall risk of bias for the experimental studies ranged from “some” to “high” and for quasi-experimental studies ranged from “moderate” to “serious.” As such, findings must be interpreted against the backdrop of less-than-ideal methodological contexts. Of the 20 included studies, 16 included outcomes that were meta-analyzed using mean log odds ratios (which were reported as mean odds ratios). Mean effects were nonsignificant for reincarceration (odds ratio [OR] = 0.93 [0.68, 1.26], SE = .16), rearrest (OR = 1.47 [0.70, 3.07], SE = 0.38), and fatal overdose (OR = 0.82 [0.56, 1.21], SE = 0.20). For nonfatal overdose, the average effect was significant (OR = 0.41 [0.18, 0.91], SE = 0.41, p < 0.05), suggesting that those receiving MAT had nearly 60% reduced odds of a nonfatal overdose. Implications for Policy, Practice, and Research The current review supports some utility for adopting MAT for the treatment of justice-involved people with opioid addiction, however, more studies that employ rigorous methodologies are needed. Researchers should work with agencies to improve adherence to medication regimens, study design, and collect more detailed information on participants, their criminal and substance use histories, onset, and severity. This would help clarify whether treatment and control groups are indeed comparable and provide better insight into the potential reasons for participant dropout, treatment failure, and the occurrence of recidivism or overdose. Outcomes should be assessed in multiple ways, if possible (e.g., self-report and official record), as reliance on official data alone may undercount participants' degree of criminal involvement.
Article
Introduction Despite cognitive behavioral therapy (CBT)'s effectiveness for treating substance use disorder, dissemination to clinical practice has been limited due to a range of barriers (e.g., time, cost). Computer-based training for cognitive behavioral therapy (CBT4CBT) offers a feasible and cost-effective opportunity to improve the quality and reach of SUD treatment. Research to date has supported the effectiveness of CBT4CBT in outpatient settings; however, research has not yet tested it in residential treatment. Methods The current study evaluated the feasibility of CBT4CBT as an adjunct to residential treatment in a sample of women with SUDs using a two-arm pilot RCT comparing women randomized to either standard residential treatment plus access to the CBT4CBT program (N = 34) or residential treatment alone (TAU; N = 29). Assessments occurred at baseline, discharge from residential care, and at 4- and 12-weeks post-discharge. The study compared the two groups over the 12-week follow-up period on relapse to any substance (Y/N), relapse to primary substance (Y/N), and days of use using chi-square for categorical and t-tests for continuous measures. The study team also performed a Kaplan-Meier analysis to compare the two groups on time to relapse. Results Demographically, the sample was predominantly African American (79.4%), with a mean age of 41.2 years (SD = 12.1). Although the current study was not powered for statistical significance, findings were in the predicted direction, with women in the CBT4CBT group reporting lower likelihood of relapse, longer time to relapse, and fewer days of substance use in the follow-up period compared to women in TAU. Conclusions This study expands the current literature. While a fully powered trial should confirm our findings, the current study provides benchmark data on the use of CBT4CBT in residential treatment for women with SUDs.
Article
Despite growing availability of several evidence-based approaches in the treatment of substance use disorders, existing pharmacotherapy and psychosocial interventions continue to have significant limitations, such as low treatment retention rates and high rates of relapse. There is a need to develop new strategies and models to address these limitations and target underlying psychosocial drivers of addiction, such as motivation to change – a crucial factor in achieving positive addiction treatment outcomes. Re-emerging clinical evidence and literature signal the promise of psychedelic-assisted psychotherapies as being novel, adjunctive treatments for a range of mental health and substance use disorders, encouraging further research. However, there remains a lack of formally validated metrics to evaluate recovery capital and motivation, limiting interpretation of the growing psychedelic literature. This commentary describes the current state of this line of investigation and potential impact of psychedelic-assisted psychotherapy on enhancing motivation to change in addiction treatment, and the need for validated metrics to evaluate recovery motivation and capital to assess the potential for psychedelic-assisted psychotherapies to elicit positive, lasting changes in substance use behaviors among those seeking treatment.
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Both major depression and alcohol use are highly prevalent in the Canadian population. They are the major contributors to disability and decreased quality of life and, as they are often comorbid with each other, the diagnosis and treatment of concurrent depression and alcohol use disorder represent a challenging task with multiple clinical questions requiring evidence-based recommendations. Thus, the goal of this article is to review the optimal strategies to treat concurrent alcohol use and major depressive disorders in the context of current research findings and clinical practice. Narrative review, knowledge synthesis, and secondary data analysis. Based on the review of the relevant literature and secondary data analyses of our own clinical data, we devised a set of pragmatic clinical recommendations and guidance on differential diagnosis between alcohol-induced mood disorder and independent major depressive disorder concurrent with alcohol use disorder, the choice and timing of pharmacological agents, organization of care, selection of best-evidence psychotherapeutic approaches and their integration into clinical practice, management of patients’ and team expectations in terms of clinical outcomes, as well as the implementation of measurement-based approaches to optimize care delivery and achieve better clinical outcomes. Seven clinically relevant problems were reviewed and the evidence-based ready-to-implement clinical approaches were offered. La dépression majeure et la consommation d’alcool sont très répandues dans la population canadienne. Ils sont les principaux contributeurs à l’invalidité et à la diminution de la qualité de vie et, comme ils sont souvent comorbides les uns avec les autres, le diagnostic et le traitement de la dépression concomitante et des troubles liés à la consommation d’alcool représentent une tâche difficile avec de multiples questions cliniques nécessitant des recommandations fondées sur des preuves. Ainsi, le but de cet article est d’examiner les stratégies optimales pour traiter la consommation concomitante d’alcool et les troubles dépressifs majeurs dans le contexte des résultats de recherche actuels et de la pratique clinique. Revue narrative, synthèse des connaissances, analyse des données secondaires. Sur la base de la revue de la littérature pertinente et des analyses de données secondaires de nos propres données cliniques, nous avons conçu un ensemble de recommandations cliniques pragmatiques et de conseils sur le diagnostic différentiel entre les troubles de l’humeur induits par l’alcool et les troubles dépressifs majeurs indépendants concomitants avec les troubles liés à la consommation d’alcool, le choix et le timing des agents pharmacologiques, l’organisation des soins, la sélection des approches psychothérapeutiques les plus probantes et leur intégration dans la pratique clinique, la gestion des attentes des patients et des équipes en terme de résultats cliniques ainsi que la mise en œuvre d’approches basées sur la mesure afin d’optimiser la prestation des soins et obtenir de meilleurs résultats cliniques. Sept problèmes cliniquement pertinents ont été examinés et des approches cliniques fondées sur des preuves prêtes à être mises en œuvre ont été proposées.
Article
Background: Risky drinking is prevalent among women of childbearing age. Although many women reduce their drinking during pregnancy, more than half return to prepregnancy levels during the early postpartum period. Risky drinking in new mothers may be associated with negative child and maternal health outcomes; however, new mothers are unlikely to seek treatment for risky drinking because of stigma and fear of child protective service involvement. SMS text messaging is a promising approach for reaching non-treatment-seeking new mothers at risk because of risky drinking. SMS text messaging interventions (TMIs) are empirically supported for alcohol use, but a tailored intervention for new mothers does not exist. This study aims to fill this gap by developing a just-in-time adaptive TMI for postpartum risky drinking. Objective: The objectives of this paper are to present a preliminary conceptual model of postpartum risky drinking and describe the protocol for conducting an ecological momentary assessment (EMA) study with new mothers to inform the refinement of the conceptual model and development of the TMI. Methods: This paper presents a preliminary conceptual model of postpartum risky drinking based on the motivational model of alcohol use, social cognitive theory, and temporal self-regulation theory. The model proposes three primary intervention targets: motivation, self-efficacy, and self-regulation. Theoretical and empirical literature in support of the conceptual model is described. The paper also describes procedures for a study that will collect EMA data from 30 participants recruited via social media and the perinatal Central Intake system of New Jersey. Following the baseline assessment, EMA surveys will be sent 5 times per day for 14 days. The assessment instruments and data analysis procedures are described. Results: Recruitment is scheduled to begin in January 2022 and is anticipated to conclude in March 2022. Study results are estimated to be published in July 2022. Conclusions: The study findings will enhance our understanding of daily and momentary fluctuations in risk and protective factors for risky drinking during the early postpartum period. The findings will be used to refine the conceptual model and inform the development of the TMI. The next steps for this work include the development of intervention components via an iterative participatory design process and testing of the resulting intervention in a pilot microrandomized trial. International registered report identifier (irrid): PRR1-10.2196/36849.
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Post-traumatic stress disorder (PTSD) and substance use disorder (SUD) occur frequently as comorbid diagnoses among adolescents. Historically, these conditions have been treated using a sequential model; however, emerging evidence suggests that an integrated treatment model may be most effective. This article presents two de-identified clinical case studies from an ongoing randomised controlled trial examining the efficacy of an integrated, exposure-based, cognitive-behavioral psychotherapy (CBT) for PTSD and SUD among adolescents (COPE-A), relative to a supportive counselling control condition (person-centred therapy). In both case studies, participants were randomised to receive the COPE-A integrated treatment, which incorporates prolonged exposure (PE) including imaginal and in vivo exposure as a core treatment component alongside CBT for PTSD and SUD. The clinical profile and treatment response of each participant is discussed. Promising results were found in both cases, with substantially reduced traumatic stress symptoms and decreased or stable levels of substance use by the end of treatment. Clinical implications of these early findings are discussed.
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Cocaine use continues to be a significant public health problem with limited treatment options and no approved pharmacotherapies. Cognitive-behavioral therapy (CBT) remains the mainstay treatment for preventing relapse, however, people with chronic cocaine use display cognitive impairments that are associated with poor response to CBT. Emerging evidence in animal and human studies suggests that the peroxisome proliferator-activated receptor-gamma (PPAR- γ) agonist, pioglitazone, improves white matter integrity that is essential for cognitive function. This project will determine whether adjunctive use of pioglitazone enhances the effect of CBT in preventing relapse during the early phase of recovery from cocaine use disorder. This paper describes the design of a mechanism-focused phase 2 randomized clinical trial that aims first to evaluate the effects of pioglitazone on targeted mechanisms related to white matter integrity, cognitive function, and cocaine craving; and second, to evaluate the extent to which improvements on target mechanisms predict CBT response. Positive results will support pioglitazone as a potential cognitive enhancing agent to advance to later stage medication development research.
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This article uses participatory photography to explore the relationships animating efforts towards recovery from opioid use disorder (OUD) in the Dayton, Ohio area, an epicenter of illicit opioid use and overdose death. A photo-elicitation project was conducted with thirteen people who met the DSM-5 criteria for OUD. Photographs were used as prompts during qualitative interviews, which were thematically analyzed. Analysis of both visual and textual data demonstrated the ways in which recovery became an unfolding process of calculation as participants made strategic choices to navigate relations and encounters with things, people, and places. Relationships across each of these domains could, under some circumstances , serve as supports or motivators in the recovery process, but, in alternate settings, be experienced as ''triggers'' prompting a resumption of problematic drug use or, at the very least, a reckoning with the feelings and emotions associated with painful or problematic aspects of personal histories and drug use experiences. Findings highlight the importance of understanding recovery as a calibration of the ambiguous relations animating experiences of everyday life. We argue for continued emphasis on recovery as an active performance and ongoing practice of & Sydney M. Silverstein calculation-of risks and benefits, of supports and triggers, of gratification and heartbreak-rather than a goal or static state.
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Background Despite evidence that standard substance use disorder (SUD) treatment may be less effective in people with intellectual disability (ID), there is an absence of appropriate clinical tools with which to support them. Objectives: This study examined the clinical utility of an alcohol and other drug refusal skills intervention designed to be cognitively accessible to adults with ID. Methods: Thirty individuals at high risk for or in recovery from a SUD in developmental disability services (DDS) community residential and day habilitation settings participated in the 2-week refusal skills group. Measures included pretest versus posttest improvement in refusal skill competency and baseline performance on a standardized verbal learning test. Results: There was a strong effect for refusal skill acquisition (p <.001); and the magnitude of skill acquisition was predicted by group attendance (p < .001) and not by individual differences in verbal learning ability (p = .074) or efficiency (p =.35). Conclusions: The Refusal Skills Group is developmentally appropriate for people with borderline-to-mild ID in that: (1) they can learn and demonstrate refusal skills and (2) their skill acquisition is predicted more strongly by exposure to the intervention than by individual differences in learning characteristics. Delivering refusal skills in DDS settings familiar to clients increased their access to services and minimized disruption to their usual routines and schedules.
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The purpose of this chapter is to address the impact addiction has throughout the United States among various aspects of society. This specifically includes a focus on individuals incarcerated because of the role addiction has had in their life and the role incarceration has on addiction. This chapter will also dive into the research behind who is more likely to end up with an addiction, how children and adolescents are affected by addiction, the effects of parental incarceration on children and adolescents, various treatment methods for addiction, and how addiction is portrayed in the media.
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A 4-factor measure of drinking motives based on a conceptual model by M. Cox and E. Klinger (see PA, Vol 75:32975; see also 1990) is presented. Using data from a representative household sample of 1,243 Black and White adolescents, confirmatory factor analyses showed that the hypothesized model provided an excellent fit to the data and that the factor pattern was invariant across gender, race, and age. Each drinking motive was related to a distinct pattern of contextual antecedents and drinking-related outcomes, and these relationships did not generally vary across demographic subgroups. Results support both the conceptual validity of Cox and Klinger's model and the utility of this measure for clinical and research purposes across a diverse range of adolescent populations. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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The authors studied the efficacy of the community reinforcement approach (CRA) as compared to standard counseling in opiate-dependent patients on methadone maintenance. One hundred eighty subjects were randomized to three treatment conditions: standard, CRA, and CRA with relapse prevention (CRA/RP). Of these, 151 subjects were followed up 6 months after intake. Since few of the RP sessions had been concluded at the 6-month follow-up, the two CRA groups were combined for analyses. Weekly urinalysis drug screens and Addiction Severity Index (ASI) scores at intake and 6 months were compared. The combined CRA groups did significantly better than the standard group in the following areas: consecutive opiate-negative urinalysis (3 weeks), and the 6-month ASI drug composite score. These results support the benefit of adding CRA strategies to the treatment of patients who are opiate dependent and on methadone maintenance. Because of insufficient treatment exposure to RP at the 6-month follow-up, the additive effect of RP could not be adequately evaluated; further follow-up will be required.
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Augmentation of cue exposure (extinction) therapy with cognitive-enhancing pharmacotherapy may offer an effective strategy to combat cocaine relapse. To investigate this possibility at the preclinical level, rats and squirrel monkeys were trained to self-administer cocaine paired with a brief visual cue. Lever pressing was subsequently extinguished by withholding cocaine injections while maintaining response-contingent presentations of the cue. The glycine partial agonist D-cycloserine (DCS; 15 and 30 mg/kg in rats, 3 and 10 mg/kg in monkeys) was evaluated for its effects on the rate of extinction and subsequent reacquisition of cocaine self-administration. Compared with vehicle, pretreatment with 30 mg/kg DCS 0.5 h before extinction training reduced the number of responses and latency to reach the extinction criterion in rats, but neither dose of DCS altered these measures in monkeys. In both species, pretreatment with the higher dose of DCS before extinction training significantly attenuated reacquisition of cocaine self-administration compared with either extinction training in the absence of DCS or DCS in the absence of explicit extinction. Furthermore, treatment with 30 mg/kg DCS accompanied by brief handling (a stress induction) immediately after but not 6 h after extinction training attenuated reacquisition of cocaine self-administration in rats. No adverse effects of 10 mg/kg DCS were evident in quantitative observational studies in monkeys. The results suggest that DCS augmented consolidation of extinction learning to deter reacquisition of cocaine self-administration in rats and monkeys. The results suggest that DCS combined with exposure therapy may constitute a rational strategy for the clinical management of cocaine relapse.
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Lack of motivation may negatively impact cognitive behavioral therapy (CBT) response for pediatric patients with obsessive-compulsive disorder (OCD). Motivational interviewing is a method for interacting with patients in order to decrease their ambivalence and support their self-efficacy in their efforts at behavior change. The authors present a preliminary randomized trial (N = 16) to evaluate the effectiveness of adding motivational interviewing (MI) as an adjunct to CBT. Patients aged 6 to 17 years who were participating in intensive family-based CBT for OCD were randomized to receive either CBT plus MI or CBT plus extra psychoeducation (PE) sessions. After four sessions, the mean Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) score for the CBT plus MI group was significantly lower than for the CBT plus psychoeducation group, t(14) = 2.51, p < .03, Cohen's d = 1.34. In addition, the degree of reduction in CY-BOCS scores was significantly greater, t(14) = 2.14, p = .05, Cohen's d = 1.02, for the CBT plus MI group (mean Delta = 16.75, SD = 9.66) than for the CBT plus psychoeducation group (mean Delta = 8.13, SD = 6.01). This effect decreased over time, and scores at posttreatment were not significantly different. However, participants in the MI group completed treatment on average three sessions earlier than those in the psychoeducation group, providing support for the utility of MI in facilitating rapid improvement and minimizing the burden of treatment for families.
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Individuals with different drinking motives show distinctive patterns of alcohol use and problems. Drinking to cope, or endorsing strong coping motives for alcohol use, has been shown to be particularly hazardous. It is important to determine the unique triggers associated with coping drinking. One limitation of past research has been the failure to contend with the complexities inherent in coping motives. Using the Modified Drinking Motives Questionnaire-Revised (Grant, Stewart, O'Connor, Blackwell, & Conrod, 2007), which separates coping-anxiety and coping-depression motives, we investigated whether these motives moderated relationships between daily mood and subsequent drinking (statistically controlling for sex, baseline anxious and depressive symptomatology, initial alcohol problems, and additional drinking motives). College students (N=146) provided daily reports of mood and alcohol consumption online for 3 weeks. Multilevel modeling analyses revealed that, as hypothesized, stronger initial coping-depression motives predicted higher daily depressed mood-alcohol consumption slopes. Also consistent with expectation, stronger initial coping-anxiety motives predicted higher anxious mood-alcohol consumption slopes. We discuss how this identification of the unique mood triggers associated with each type of coping drinking motive can provide the basis for targeted interventions.
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This meta-analysis examined 53 controlled trials of cognitive-behavioral treatment (CBT) for adults diagnosed with alcohol- or illicit-drug-use disorders. The aims were to provide an overall picture of CBT treatment efficacy and to identify client or treatment factors predictive of CBT effect magnitude. The inverse variance weighted effect size (Hedges' g) was calculated for each study and pooled using fixed and random effects methods. Potential study-level moderators were assessed in subgroup analyses by primary drug, type of CBT, and type of comparison condition. In addition, seven client and treatment variables were examined in meta-regression analyses. Across studies, CBT produced a small but statistically significant treatment effect (g = 0.154, p < .005). The pooled effect was somewhat lower at 6-9 months (g = 0.1 15, p < .005) and continued to diminish at 12-month follow-up (g = 0.096, p < .05). The effect of CBT was largest in marijuana studies (g = 0.513, p < .005) and in studies with a no-treatment control as the comparison condition (g = 0.796, p < .005). Meta-regression analyses indicated that the percentage of female participants was positively associated and the number of treatment sessions was negatively associated with effect size. The findings demonstrate the utility of CBT across a large and diverse sample of studies and under rigorous conditions for establishing efficacy. CBT effects were strongest with marijuana users, when CBT was compared with no treatment, and may be larger with women than with men and when delivered in a brief format.
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Although relapse prevention (RP) has become a widely adopted cognitive-behavioral treatment intervention for alcohol, smoking, and other substance use, outcome studies have yielded an inconsistent picture of the efficacy of this approach or conditions for maximal effectiveness. A meta-analysis was performed to evaluate the overall effectiveness of RP and the extent to which certain variables may relate to treatment outcome. Twenty-six published and unpublished studies with 70 hypothesis tests representing a sample of 9,504 participants were included in the analysis. Results indicated that RP was generally effective, particularly for alcohol problems. Additionally, outcome was moderated by several variables. Specifically, RP was most effective when applied to alcohol or polysubstance use disorders, combined with the adjunctive use of medication, and when evaluated immediately following treatment using uncontrolled pre-post tests.
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This study assessed whether contingent incentives can be used to reinforce cocaine abstinence in dependent outpatients. Seventy cocaine-dependent outpatients were randomized into 2 conditions. All participants received 24 weeks of treatment and 1 year of follow-up. The treatment provided to all participants combined counseling based on the community reinforcement approach with incentives in the form of vouchers exchangeable for retail items. In 1 condition, incentives were delivered contingent on cocaine-free urinalysis results, whereas in the other condition incentives were delivered independent of urinalysis results. Abstinence-contingent incentives significantly increased cocaine abstinence during treatment and 1 year of follow-up compared with noncontingent incentives.
Article
In a particular success for translational research agendas, characterization of the neuronal circuits underlying fear extinction, and basic research in animal extinction paradigms, has led to intervention studies examining the use of D-cycloserine (DCS) to enhance therapeutic learning from exposure-based cognitive-behavioral therapy (CBT). In this article, we review these intervention studies, and discuss DCS augmentation of CBT relative to more traditional combination-treatment strategies in the treatment of anxiety disorders. We offer an accounting, based on evidence for internal context effects, of current limitations in the combination of antidepressant or benzodiazepine medications with CBT and discuss the advantages of isolated-dosing strategies with DCS relative to these limitations. This strategy is contrasted with the chronic-dosing applications of DCS for schizophrenia and Alzheimer's disease, and future directions for isolated-dosing strategies are discussed.
Article
This study reports 3-year outcomes for clients who had been treated in the five outpatient sites of Project MATCH, a multisite clinical trial designed to test a priori client treatment matching hypotheses. The main purpose of this study was to characterize the status of the matching hypotheses at the 3-year follow-up. This entailed investigating which matching findings were sustained or even strengthened across the 3-year study period, and whether any hypotheses that were not supported earlier eventually emerged at 3 years, or conversely, whether matching findings discerned earlier dissipated at this later time. This research also examines the prognostic effects of the client matching attributes, characterizes the overall outcomes at 37 to 39 months, and explores differential effects of the three treatments at extended follow-up. With regard to the matching effects, client anger demonstrated the most consistent interaction in the trial, with significant matching effects evident at both the 1-year and 3-year follow- ups. As predicted, clients high in anger fared better in Motivational Enhancement Therapy (MET) than in the other two MATCH treatments: Cognitive- Behavioral Therapy (CBT) and Twelve-Step Facilitation (TSF). Among subjects in the highest third of the anger variable, clients treated in MET had on average 76.4% abstinent days, whereas their counterparts in the other two treatments (CBT and TSF) had on average 66% abstinent days. Conversely, clients low in anger performed better after treatment in CBT and TSF than in MET. Significant matching effects for the support for drinking variable emerged in the 3-year outcome analysis, such that clients whose social networks were more supportive of drinking derived greater benefit from TSF treatment than from MET. Among subjects in the highest third of the support for drinking variable, TSF participants were abstinent 16.1% more days than MET participants. At the lower end of this variable, difference in percent days abstinent between MET and TSF was 3%, with MET clients having more abstinent days. A significant matching effect for psychiatric severity that appeared in the first year posttreatment was not observed after 3 years. Of the 21 client attributes used in testing the matching hypotheses, 11 had prognostic value at 3 years. Among these, readiness-to-change and self- efficacy emerged as the strongest predictors of long-term drinking outcome. With regard to the overall outcomes, the reductions in drinking that were observed in the first year after treatment were sustained over the 3-year follow-up period: almost 30% of the subjects were totally abstinent in months 37 to 39, whereas those who did report drinking nevertheless remained abstinent an average of two-thirds of the time. As in the 1-year follow-up, there were few differences among the three treatments, although TSF continued to show a possible slight advantage.
Article
Aims. Cue exposure treatment (CET) has shown promise in preliminary studies with alcoholics, and Communication Skills Training (CST) has been found beneficial, especially in intensive treatment programs. The aim of the present study was to investigate the effects of CET and CST in a larger controlled study when both were added to intensive treatment programs. Design and interventions. A 2 x 2 design investigated the effects of CET with urge coping skills training compared to a meditation-relaxation control, and CST compared to an education control when all were added to intensive treatment programs for alcoholics. Setting. The sites were the inpatient or partial hospital substance abuse treatment programs at a private psychiatric hospital, a state-funded residential facility and a VA medical center. Participants. Patients diagnosed with alcohol dependence without active psychosis were eligible. Measurements. Participants were assessed for quantity and frequency of drinking, alcohol cue-reactivity, responses to high risk simulations and urge specific coping skills. Findings. Of 100 treated patients, 86% provided 6-month and 84% provided 12-month follow-up data. Patients who received either CET or CST had fewer heavy drinking days in the first 6 months than control patients. In the second 6 months, CET continued to result in fewer heavy drinking days among lapsers and interacted with CST to decrease quantity of alcohol consumed. CST resulted in fewer alcohol-related problems reported at 12 months. CET resulted in greater reductions in urge to drink in a measure of simulated high-risk situations. CET also resulted in greater reports of use of coping strategies during the follow-up, and many of the urge-specific strategies taught in CET were associated with reduced drinking. Conclusions. Both CET and CST continue to show promise as elements of comprehensive alcohol treatment programs. Limitations and directions for future research are discussed.
Article
Objective: To assess the benefits of matching alcohol dependent clients to three different treatments with reference to a variety of client attributes. Method: Two parallel but independent randomized clinical trials were conducted, one with alcohol dependent clients receiving outpatient therapy (N = 952; 72% male) and one with clients receiving aftercare therapy following inpatient or day hospital treatment (N = 774; 80% male). Clients were randomly assigned to one of three 12-week, manual guided, individually delivered treatments: Cognitive Behavioral Coping Skills Therapy, Motivational Enhancement Therapy or Twelve-Step Facilitation Therapy. Clients were then monitored over a 1-year posttreatment period. Individual differences in response to treatment were modeled as a latent growth process and evaluated for 10 primary matching variables and 16 contrasts specified a priori. The primary outcome measures were percent days abstinent and drinks per drinking day during the 1-year posttreatment period Results: Clients attended on average two-thirds of treatment sessions offered, indicating that substantial amounts of treatment were delivered, and research follow up rates exceeded 90% of living subjects interviewed at the 1-year posttreatment assessment. Significant and sustained improvements in drinking outcomes were achieved from baseline to 1-year posttreatment by the clients assigned to each of these well-defined and individually delivered psychosocial treatments. There was little difference in outcomes by type of treatment. Only one attribute, psychiatric severity, demonstrated a significant attribute by treatment interaction: In the outpatient study, clients low in psychiatric severity had more abstinent days after 12 step facilitation treatment than after cognitive behavioral therapy. Neither treatment was clearly superior for clients with higher levels of psychiatric severity. Two other attributes showed time-dependent matching effects: motivation among outpatients and meaning-seeking among aftercare clients. Client attributes of motivational readiness, network support for drinking, alcohol involvement, gender, psychiatric severity and sociopathy were prognostic of drinking outcomes over time. Conclusions: The findings suggest that psychiatric severity should be considered when assigning clients to outpatient therapies. The lack of other robust matching effects suggests that, aside from psychiatric severity, providers need not take these client characteristics into account when triaging clients to one or the other of these three individually delivered treatment approaches, despite their different treatment philosophies.
Article
This article describes outcomes observed during the year after treatment entry from two controlled trials in which cocaine-dependent outpatients were randomly assigned to either a multicomponent behavioral treatment or to one of two control treatments. The behavioral treatment integrated the community reinforcement approach (CRA) with an incentive program in which cocaine abstinence was reinforced with vouchers exchangeable for retail items. The two control treatments were drug abuse counseling and CRA without the incentive program. All treatment groups improved significantly compared to intake, and those changes were maintained through the follow-up period. When efficacy differences were observed during treatment and follow-up, they supported CRA with vouchers over control treatments. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
The current report presents the underlying rationale and components of an interoceptive exposure-based smoking cessation treatment for anxiety-sensitive smokers. The intervention was pilot-tested on three (female) daily smokers with moderate to high levels of nicotine dependence and high levels of anxiety sensitivity. Results indicated meaningful therapeutic gains in smoking outcome and theoretically expected changes in anxiety sensitivity, distress tolerance, and negative as well as positive affective states. Overall, the present case series highlights a potentially promising way to integrate interoceptive exposure-based treatment with standard smoking cessation treatment for smokers high in anxiety sensitivity. From a treatment development perspective, these case-series data suggest that future study of this intervention in a large-scale (controlled) clinical trial is indicated.
Article
[using a metaanalytic approach, summarizes the alcohol] treatment outcome literature while taking into account the methodological quality of studies / [argue that] the better-designed studies would be more likely to detect treatment differences / provide . . . detailed information on the evidence for 11 groups of specific alcohol treatment approaches / they are presented roughly in the order of strength of evidence for efficacy (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
For much of the last century, there has been a longstanding and largely unchallenged position held by providers in the substance abuse treatment community, as well as by the public more generally, that alcoholism and drug abuse are fundamentally problems of the individual and are thus most appropriately addressed on an individual basis. However, of the various family-based intervention approaches that have been developed and used by providers to treat substance abuse by adults, partner-involved therapies have received the most attention. Indeed, among the various psychosocial interventions presently available to treat alcoholism and substance abuse, it could be reasonably argued that partner-involved treatments are the most broadly efficacious. There is not only substantial empirical support for the use of couple-based treatments in terms of improvements in primary targeted outcomes such as substance use and relationship adjustment, but also in other areas that are of clear public health significance, including intimate partner violence, children's adjustment, and cost-benefit and cost-effectiveness. Behavioral couples therapy (BCT) currently has the strongest empirical support for its effectiveness. In this chapter, we will (a) provide a conceptual rationale as to why couples therapy for substance-abusing patients may be particularly appealing compared to more traditional individual-based approaches; (b) describe theoretical and practical considerations when implementing couples therapy with these patients; (c) examine available evidence as to the efficacy of couples therapy with alcoholic and drug-abusing patients; and (d) discuss future directions with respect to partner-involved therapies with these patients. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Client ambivalence is a key stumbling block to therapeutic efforts toward constructive change. Motivational interviewing—a nonauthoritative approach to helping people to free up their own motivations and resources—is a powerful technique for overcoming ambivalence and helping clients to get "unstuck." The first full presentation of this powerful technique for practitioners, this volume is written by the psychologists who introduced and have been developing motivational interviewing since the early 1980s. In Part I, the authors review the conceptual and research background from which motivational interviewing was derived. The concept of ambivalence, or dilemma of change, is examined and the critical conditions necessary for change are delineated. Other features include concise summaries of research on successful strategies for motivating change and on the impact of brief but well-executed interventions for addictive behaviors. Part II constitutes a practical introduction to the what, why, and how of motivational interviewing. . . . Chapters define the guiding principles of motivational interviewing and examine specific strategies for building motivation and strengthening commitment for change. Rounding out the volume, Part III brings together contributions from international experts describing their work with motivational interviewing in a broad range of populations from general medical patients, couples, and young people, to heroin addicts, alcoholics, sex offenders, and people at risk for HIV [human immunodeficiency virus] infection. Their programs span the spectrum from community prevention to the treatment of chronic dependence. All professionals whose work involves therapeutic engagement with such individuals—psychologists, addictions counselors, social workers, probations officers, physicians, and nurses—will find both enlightenment and proven strategies for effecting therapeutic change. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Background: Promising treatments for alcoholics include naltrexone (NTX), cue exposure combined with urge-specific coping skills training (CET), and communication skills training (CST). This study investigated the effects of combining these elements as treatment adjuncts.Methods: A 2 × 2 design investigated the effects of CET combined with CST, as compared with an education and relaxation control treatment, during a 2-week partial hospital program (n= 165) followed by 12 weeks of NTX (50 mg/day) or placebo during aftercare (n= 128). Drinking outcomes were assessed at 3, 6, and 12 months after discharge from the partial hospital. Process measures included urge, self-efficacy (confidence about staying abstinent in risky situations), and self-reported coping skills. Medically eligible alcohol-dependent patients were recruited.Results: Among those compliant with medication on at least 70% of days, those who received NTX had significantly fewer heavy drinking days and fewer drinks on days that they drank than those receiving placebo during the medication phase but not during the subsequent 9 months. CET/CST-condition patients were significantly less likely to report a relapse day and reported fewer heavy drinking days at the 6- and 12-month follow-ups than patients in the control treatment. Interactions of medication with behavioral treatments were not significant. Process measures showed that NTX resulted in lower weekly urge ratings, and those in CET/CST used more of the prescribed coping skills after treatment, reported fewer cue-elicited urges, and reported more self-efficacy in a posttest role-play test. Drinking reductions at 3, 6, and 12 months correlated with more use of coping skills, lower urge, and higher self-efficacy.Conclusions: The results suggest the probable value of keeping alcoholics on NTX for longer periods of time and the importance of increasing compliance with NTX. They also support the earlier promising effects of CET and CST as adjuncts to treatment programs for alcoholics by maintaining treatment gains over at least a year. The value of the urge-specific and general coping skills and of self-efficacy and urge constructs was demonstrated in their association with drinking outcomes.
Article
A theoretically driven approach to the cognitive-behavioral treatment of panic disorder and smoking is articulated. For persons with panic disorder who smoke, it is suggested that it may be useful to directly integrate smoking cessation within cognitive-behavioral treatment for panic disorder. To illustrate the potential viability of this type of treatment approach, the nature of the panic and smoking co-occurrence is first discussed. Then, a treatment model that integrates an interoceptive exposure-based program of smoking cessation into cognitive-behavioral therapy for panic disorder is presented. Finally, a case example is used to illustrate this approach, followed by a discussion of the potential implications of this therapeutic model.
Article
Studies suggest a complex relationship between cognitive-behavior therapy (CBT) and pharmacotherapy for the combined treatment of mood disorders and anxiety disorders. Combined treatment for depression may have beneficial effects when applied to patients with chronic depression and in cases to prevent relapse. In bipolar disorder there is evidence for a strong effect of psychosocial treatment on the course of the disorder. In the anxiety disorders, there are some benefits in the short term, but combined treatment may limit the maintenance of treatment gains offered by CBT alone. Combined treatment should not be considered the default treatment for mood and anxiety disorders, with the possible exception of bipolar disorder. Instead, decisions whether combined treatment is worth the added cost and effort should be made in relation to the disorder under treatment, the level of severity or chronicity, and the stage of treatment (e.g., acute vs. relapse prevention).
Article
The American Psychiatric Association has published a practice guideline for treatment of patients with substance use disorders. This review focuses on scientific and clinical strengths and limitations of the guideline, and the relevance of the guideline to behavior therapy. The guideline incorporated a thorough review of the scientific literature, presented substance use disorders as complex and multifaceted problems, recommended pharmacological and psychosocial interventions where appropriate, and noted the limits of scientific knowledge. The guideline focuses on the strong empirical support for a number of major behavioral and cognitive-behavioral interventions. Expansion of the guideline to consider less severe cases, expanded information about specific population subgroups, more careful attention to assessment and diagnosis, and more objective criteria for classifying studies that are applied more systematically would strengthen future editions.
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Hispanic individuals are underrepresented in clinical and research populations and are often excluded from clinical trials in the United States. Hence, there are few data on the effectiveness of most empirically validated therapies for Hispanic substance users. The authors conducted a multisite randomized trial comparing the effectiveness of 3 individual sessions of motivational enhancement therapy with that of 3 individual sessions of counseling as usual on treatment retention and frequency of substance use; all assessment and treatment sessions were conducted in Spanish among 405 individuals seeking treatment for any type of current substance use. Treatment exposure was good, with 66% of participants completing all 3 protocol sessions. Although both interventions resulted in reductions in substance use during the 4-week therapy phase, there were no significant Treatment Condition x Time interactions nor Site x Treatment Condition interactions. Results suggest that the individual treatments delivered in Spanish were both attractive to and effective with this heterogeneous group of Hispanic adults, but the differential effectiveness of motivational enhancement therapy may be limited to those whose primary substance use problem is alcohol and may be fairly modest in magnitude.
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Cues paired with drug administration trigger relapse to drug seeking by inducing conditioned drug craving and withdrawal. Because drug cues hinder abstinence in addicts, therapies that reduce responsiveness to drug cues might facilitate rehabilitation. Extinction is a means of reducing conditioned responses and involves exposure to the conditioned stimulus in the absence of the unconditioned stimulus with which it was paired previously. We examined conditioned withdrawal extinction using naloxone-induced conditioned place aversion (CPA) in morphine-dependent rats. Morphine-dependent rats were trained to associate an environment with naloxone-precipitated withdrawal. Subsequently, they received extinction training in which they were confined in the previously naloxone-paired environment in the absence of acute withdrawal. In some rats, the N-methyl-D-aspartate (NMDA) receptor partial agonist D-cycloserine (DCS) was administered before extinction training. Morphine withdrawal-induced CPA persists in the absence of extinction training. Administration of DCS before extinction training facilitates extinction. D-cycloserine facilitates extinction of morphine withdrawal-associated place aversion. This effect is qualitatively similar to the effect of DCS on extinction of conditioned fear, raising the possibility of common neural mechanisms. This work extends our understanding of drug cue responsivity and provides a rationale for the development of extinction-based treatments for addiction.
Article
Due to the chronic nature of cocaine dependence, long-term maintenance treatments may be required to sustain abstinence. Abstinence reinforcement is among the most effective means of initiating cocaine abstinence. Practical and effective means of maintaining abstinence reinforcement programs over time are needed. To determine whether employment-based abstinence reinforcement can be an effective long-term maintenance intervention for cocaine dependence. Participants (n = 128) were enrolled in a 6-month job skills training and abstinence initiation program. Participants who initiated abstinence, attended regularly and developed needed job skills during the first 6 months were hired as operators in a data entry business and assigned randomly to an employment-only (control, n = 24) or abstinence-contingent employment (n = 27) group. A non-profit data entry business. Participants Unemployed welfare recipients who used cocaine persistently while enrolled in methadone treatment in Baltimore. Abstinence-contingent employment participants received 1 year of employment-based contingency management, in which access to employment was contingent upon provision of drug-free urine samples under routine and then random drug testing. If a participant provided drug-positive urine or failed to provide a mandatory sample, then that participant received a temporary reduction in pay and could not work until urinalysis confirmed recent abstinence. Cocaine-negative urine samples at monthly assessments across 1 year of employment. During the 1 year of employment, abstinence-contingent employment participants provided significantly more cocaine-negative urine samples than employment-only participants [79.3% and 50.7%, respectively; P = 0.004, odds ratio (OR) = 3.73, 95% confidence interval (CI) = 1.60-8.69]. Conclusions Employment-based abstinence reinforcement that includes random drug testing is effective as a long-term maintenance intervention, and is among the most promising treatments for drug dependence. Work-places could serve as therapeutic agents in the treatment of drug dependence by arranging long-term employment-based contingency management programs.
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Seventy-six individuals with a principal diagnosis of generalized anxiety disorder (GAD) were randomly assigned to receive either an MI pretreatment or no pretreatment (NPT), prior to receiving CBT. Significant group differences favoring the MI-CBT group were observed on the hallmark GAD symptom of worry and on therapist-rated homework compliance, which mediated the impact of treatment group on worry reduction. Adding MI pretreatment to CBT was specifically and substantively beneficial for individuals with high worry severity at baseline. There was evidence of relapse at 6-month follow-up for high severity individuals who received MI-CBT, but significant moderator effects favoring the high severity MI-CBT group were again apparent at 12-months post-treatment. Pending replication in a more controlled test, these findings suggest that MI may be a promising adjunct to CBT for GAD for those of high severity, a group which has been less responsive to CBT in past research.
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To present nationally representative findings on the prevalence, correlates, and comorbidity of and disability associated with DSM-IV schizotypal personality disorder (SPD). This study used the 2004-2005 Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions, which targeted a nationally representative sample of the adult civilian population of the United States aged 18 years and older and residing in households and group quarters. In Wave 2, attempts were made to conduct face-to-face reinterviews with all respondents to the Wave 1 interview. Lifetime prevalence of SPD was 3.9%, with significantly greater rates among men (4.2%) than women (3.7%) (p < .01). Odds for SPD were significantly greater among black women, individuals with lower incomes, and those who were separated, divorced, or widowed; odds were significantly lower among Asian men (all p < .01). Schizotypal personality disorder was associated with substantial mental disability in both sexes. Co-occurrence rates of Axis I and other Axis II disorders among respondents with SPD were much higher than rates of co-occurrence of SPD among respondents with other disorders. After adjustment for sociodemographic characteristics and additional comorbidity, associations remained significant in both sexes between SPD and 12-month and lifetime bipolar I disorder, social and specific phobias, and posttraumatic stress disorder, as well as 12-month bipolar II disorder, lifetime generalized anxiety disorder, and borderline and narcissistic personality disorders (all p < .01). Common and unique factors may underlie associations of SPD with narcissistic and borderline personality disorders, whereas much of the comorbidity between SPD and most mood and anxiety disorders appears to reflect factors common to these disorders. Some of the associations with SPD were sex specific. Schizotypal personality disorder and dependent, avoidant, and borderline personality disorders were associated with the occurrence of schizophrenia or psychotic episode. Schizotypal personality disorder is a prevalent, fairly stable, highly disabling disorder in the general population. Sex differences in associations of SPD with other specific Axis I and II disorders can inform more focused, hypothesis-driven investigations of factors underlying the comorbid relationships. Schizotypal as well as borderline, dependent, and avoidant personality disorders may be components of the schizophrenia spectrum.
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The purpose of this study was to evaluate the comparative cost of treating alcohol dependence with either cognitive behavioral therapy (CBT) alone or CBT combined with naltrexone (CBT+naltrexone). Two hundred ninety-eight outpatients dependent on alcohol who were consecutively treated for alcohol dependence participated in this study. One hundred seven (36%) patients received adjunctive pharmacotherapy (CBT+naltrexone). The Drug Abuse Treatment Cost Analysis Program was used to estimate treatment costs. Adjunctive pharmacotherapy (CBT+naltrexone) introduced an additional treatment cost and was 54% more expensive than CBT alone. When treatment abstinence rates (36.1% CBT; 62.6% CBT+naltrexone) were applied to cost effectiveness ratios, CBT+naltrexone demonstrated an advantage over CBT alone. There were no differences between groups on a preference-based health measure (SF-6D). In this treatment center, to achieve 100 abstainers over a 12-week program, 280 patients require CBT compared with 160 CBT+naltrexone. The dominant choice was CBT+naltrexone based on modest economic advantages and significant efficiencies in the numbers needed to treat.
Article
D-cycloserine (DCS), a partial N-methyl-D-aspartate receptor agonist, has been shown to enhance the extinction of both cocaine and amphetamine-induced conditioned place preference (CPP). However, there have been no reports of the effects of DCS on the extinction of ethanol-conditioned behaviors in mice. Thus, the current experiments examined the effects of DCS on the extinction and subsequent reconditioning of ethanol-induced CPP in mice. Male DBA/2J mice received either 2 or 4 pairings of ethanol (2 g/kg) with a conditioned stimulus (CS+) floor cue (and an equal number of saline pairings with a CS- floor cue on alternate days) resulting in either a weak or strong ethanol CPP, respectively. Following conditioning of a strong ethanol CPP mice received saline or 30 mg/kg DCS prior to each of the twelve 30-minute choice extinction trials administered at 48-hour intervals. Mice that had received conditioning of a weak ethanol CPP received saline, 30 or 60 mg/kg DCS immediately before each of the six 30-minute choice extinction trials. Following successful ethanol CPP extinction, mice received reconditioning trials similar to the initial conditioning trials. A final experiment examined the effects 12 DCS pre-exposures (15, 30, and 60 mg/kg) on initial conditioning of ethanol CPP. First, we showed that 2 doses of DCS (30 and 60 mg/kg) did not have aversive properties that could confound the effects on extinction of CPP (Experiment 1). Second, we showed that DCS (30 and 60 mg/kg) had no effect on the rate of extinction of either strong (Experiment 2) or weak (Experiment 3) ethanol-induced CPP. Interestingly, DCS administered during extinction interfered with reconditioning of ethanol-induced CPP--an effect specific to reconditioning, as DCS pre-exposure did not influence initial ethanol CPP conditioning (Experiment 4). These experiments show that although DCS showed no effect on extinction behavior, when given during extinction it interfered with subsequent reconditioning of ethanol CPP. The mechanisms of this effect were not, however, due to nonspecific interference with learning because repeated DCS pre-exposures did not impair initial conditioning of ethanol CPP.
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A growing problem of major proportions had been confronting biomedical scientists for many decades. Until solved, this long-neglected problem, the abject failure of the American health care system, presents a gigantic obstacle to the application of the discoveries flowing from neuropsychopharmacological research into deliverable medications utilized by medical practitioners. Although it is recognized that such advances could benefit all of society, both in the United States and globally, progress toward this important goal has not happened. As I noted 5 years ago, 'Unless steps are taken soon to undertake a comprehensive restoration of our system, the profound advances in bio-medical research so rapidly accruing today may never be effectively transformed into meaningful advances in health care for society.' I remain perplexed and frustrated by the reluctance of scientific research societies such as our ACNP to engage their energies and intellect into this most serious issue.