Behavioral Therapies for Drug Abuse

Abstract

The past three decades have been marked by tremendous progress in behavioral therapies for drug abuse and dependence, as well as advances in the conceptualization of approaches to development of behavioral therapies. Cognitive behavior therapy, contingency management, couples and family therapy, and a variety of other types of behavioral treatment have been shown to be potent interventions for several forms of drug addiction, and scientific progress has also been greatly facilitated by the articulation of a systematic approach to the development, evaluation, and dissemination of behavioral therapies. The authors review recent progress in strategies for the development of behavioral therapies for drug and alcohol abuse and dependence and discuss the range of effective behavioral therapies that are currently available.Before the advent of research on treatments derived from operant and classic behaviorism, there was little indication that any form of psychosocial treatment was effective for any type of mental disorder (1-3). Research on behavioral therapies flourished with the adoption of the technology model (4, 5), which sought to systematize these therapies and the experimental methods through which they could be evaluated to achieve a level of methodological rigor on a par with the standards for pharmacological research (6,7). By the mid to late 1980s, there were a number of behavioral treatments that had been shown to be efficacious in the treatment of a variety of mental disorders, including depressive, panic, and obsessive-compulsive disorders. However, the methodological rigor and specificity that were characteristic of these studies were not yet apparent in drug abuse treatment studies, with a few exceptions (8). Although behavioral approaches were universally available in drug abuse treatment programs by the late 1980s (9), there was continued pessimism in the field regarding the efficacy of behavioral therapies for drug use disorders (10, 11).In the early 1990s, studies in which behavioral therapies, therapist training, study populations, and objective outcome measures were carefully specified and in which participants were randomly assigned to experimental and control or comparison conditions began to appear more frequently in the drug abuse treatment literature. The technology model facilitated the identification of effective behavioral treatments for substance use disorders as it enhanced the internal validity and replicability of research on behavioral therapies. However, the technology model also had the unanticipated effect of restricting the development of novel therapies. The stringent methodological requirements associated with the technology model (e.g., requiring investigators to have fully developed treatment manuals, therapist training protocols, and fidelity rating procedures) limited the therapies eligible for efficacy evaluation to those already developed for drug abuse and to those which could easily be adapted from other areas (e.g., alcohol and depression treatments). This res...

Supply of a Nondrug Substitute Reduces Escalated Heroin Consumption

“…In light of this finding, one can speculate that escalated drug use in drug addicts may persist, not so much because of a loss of efficacy of nondrug substitutes but because of a loss or reduction of their availability. Combining increased drug prices with increased accessibility to nondrug substitutes may therefore provide a powerful approach to reduce drug use in drug-addicted individuals, as already demonstrated by the clinical efficacy of contingency management therapy in the treatment of drug addiction (Higgins et al, 2004;Carroll and Onken, 2005;Stitzer and Petry, 2006).…”

Behavioral Therapies Trials

“…The stage model, however, takes into consideration the fact that behavioral therapies trials do not begin and end with the RCT, the designated goal of Stage II. The model defines an orderly progression of studies from feasibility (Stage I) to efficacy (Stage II) to transportability (Stage III;Carroll & Onken, 2005;Rounsaville & Carroll, 2001; Table 1). Stage I, the focus of this presentation, is the creative first step in the process.…”

“…Stage I, the focus of this presentation, is the creative first step in the process. Stage I studies permit researchers to generate new therapies, or adapt existing ones, often based on clinical observations of behavior change or on principles of neuroscience (Carroll & Onken, 2005). Stage I studies specify the theoretical rationale for the therapy, hypothesizing how the therapy might be expected to influence the change process.…”

“…There is a growing body of literature to support the utility of the stage model in the development of behavioral therapies such as contingency management, cognitive behavioral therapy, couples and family therapy, and motivational interviewing (Carroll & Onken, 2005). Behavioral therapy platforms, used alone or in combination, are required to support pharmacotherapy trials for substance use (Carroll, Kosten, & Rounsaville, 2004).…”

Computer-Assisted Delivery of Cognitive-Behavioral Therapy for Addiction: A Randomized Trial of CBT4CBT

“…Cognitive-behavioral therapy (CBT) has a comparatively strong level of empirical support across a range of psychiatric disorders (1)(2)(3), including substance use disorders (1,4,5). Despite evidence of positive and durable outcome (6,7), CBT remains rarely implemented in the range of settings where individuals with substance use disorders are treated (8).…”