Cognitive-Behavioral and Schema-Based Models for the Treatment of Substance Use Disorders.

Abstract

This chapter summarizes four cognitive-behavioral theoretical and therapeutic models for substance use disorders: relapse-prevention coping skills, rational-emotive behavior therapy, cognitive therapy, and dual-focus schema therapy. All models view faulty cognition as a core component of addictive behavior. Although genetic vulnerability, biochemical processes, cultural factors, past events, unconscious processes, and environmental contingencies may be important factors, an individual's core beliefs, attitudes, and assumptions are viewed as important factors contributing to emotionalThe author acknowledges the support of the National Institute on Drug Abuse (R01 DA10012-01; R01 14967). Portions of this paper have been appeared in other publications including Ball (1998), Ball and Cecero (2001), Ball and Young (2000), and Ball (2003 and are reprinted with permission from the Association for the Advancement of Behavior Therapy, Guilford Press, and Wiley.

The early maladaptive schemas of an opioid-dependent sample of treatment seeking young adults: A descriptive investigation

“…Because it is theorized that early maladaptive schemas may underlie and maintain substance use and other Axis-I and Axis-II disorders (Young et al, 2003), it may be important for treatment providers to assess for early maladaptive schemas and determine whether they are contributing to substance use. Because there is mounting evidence that early maladaptive schemas are prevalent in substance using populations (Ball, 2007; Shorey et al, in press), and even more prevalent than in non-substance using populations (Brotchie et al, 2004; Roper et al, 2010), it is likely that schemas are contributing to substance use. Assessment of these schemas, and the coping responses individuals use to help cope with their schemas (e.g., avoidance in the form of substance use), could aid in the case conceptualization of individual patients and in treatment planning.…”

“…Recently, researchers have begun to examine the early maladaptive schemas of substance use patients, as it is theorized that schemas may underlie the development and maintenance of substance use (Ball, 1998, Young, 1994). Early maladaptive schemas, which can be defined as “enduring and pervasive themes about oneself, others, and the world” (Ball, 2007, p. 307), are cognitive and behavioral ways of viewing and interacting with the world that are resistant to change (Young, Klosko, & Weishaar, 2003). Early maladaptive schemas are believed to develop during childhood through traumatic and toxic experiences with close individuals (i.e., parents, caretakers).…”

“…In response to the negative emotional, behavioral, and cognitive aspects associated with each of the 18 schemas, coping responses are believed to develop in an attempt to alleviate the distress associated with these schemas (Young et al, 2003). Unfortunately, the coping responses often used to manage early maladaptive schemas produce a high level of avoidance behavior and can result in substance use as a key coping mechanism (Ball, 1998; 2007). …”

“…Knowing which early maladaptive schemas are most prevalent among young adult opioid users and whether males and females differ on their schemas could provide important information for the treatment of opioid dependence. For instance, Ball (1998, 2007) developed Dual-Focused Schema Therapy (DFST) for the concurrent treatment of substance use and early maladaptive schemas. DFST attempts to modify early maladaptive schemas to a manageable level and increase adaptive coping with schemas through a combination of techniques outlined in schema therapy, such as cognitive restructuring, behavioral skills training, experiential exercises (e.g., imagery), and the therapeutic relationship (Young et al, 2003), as well as incorporating Marlatt and Gordon’s (1985) relapse prevention model.…”

“…Because it is unlikely that early maladaptive schemas can be completely removed (Ball, 1998; Young et al, 2003), the goal of DFST is to reduce belief in schemas, leading to a reduction in the influence that they have over one’s life while also increasing adaptive coping responses. Initial results suggest that this approach is beneficial; DFST resulted in faster decreases in substance use than 12-step facilitation therapy (based on Project MATCH’s manual-guided 12-step facilitation therapy, which emphasized the disease concept of addiction and complete abstinence form substances) for adult opioid dependent patients (Ball, 2007). If research shows that early maladaptive schemas are prevalent among young adult opioid users, treatment programs could consider targeting the dysfunctional beliefs and behaviors associated with early maladaptive schemas, which could result in improved outcomes.…”