The Effectiveness of Alcoholism Treatment

Miller, William R.; Hester, Reid K.

doi:10.1007/978-1-4613-2191-0_7

Cited by 250 publications

(149 citation statements)

References 182 publications

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“…Such a person's goal striving and the nonchemical incentives produced by that striving do not provide emotional satisfaction that competes successfully with the emotional satisfaction attainable by drinking alcohol. There are various reasons why this is so (Klinger, 1977;Pervin, 1983) Baker, Cooney, & Pomerleau, 1987;Miller & Hester, 1986). Conditioning methods, however, have succeeded in reducing drinking behavior temporarily (L. H. Baker, Cooney, & Pomerleau, 1987), but this is a goal that should be regarded as merely the first step in treating alcohol problems (Miller & Hester, 1986).…”

Section: Implications For Treatmentmentioning

confidence: 99%

A motivational model of alcohol use.

Cox¹,

Klinger²

1988

Journal of Abnormal Psychology

1,193

1,096

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The final, common pathway to alcohol use is motivational. A person decides consciously or unconsciously to consume or not to consume any particular drink of alcohol according to whether or not he or she expects that the positive affective consequences of drinking will outweigh those of not drinking. Various factors (e.g., past experiences with drinking, current life situation) help to form expectations of affective change from drinking, these factors always modulated by a person's neurochemical reactivity to alcohol. Such major influences include the person's current nonchemical incentives and the prospect of acquiring new positive incentives and removing current negative incentives. Our motivational counseling technique uses nonchemical goals and incentives to help the alcoholic develop a satisfying life without the necessity of alcohol. The technique first assesses the alcoholic's motivational structure and then seeks to modify it through a multicomponent counseling procedure. The counseling technique is one example of the heuristic value of the motivational model. This article presents a motivational formulation of alcohol use. The formulation is intended to incorporate advances made in understanding the inheritable constitutional factors (e.g., Goodwin, in press; Schuckit, Li, Cloninger, & Deitrich, 1985) and the appetitive systems (T. B. Baker, Morse, & Sherman, 1987) in alcohol-related behavior, and also the array of other motivational factors that are increasingly recognized to play decisive roles in understanding and treating addictive behavior patterns (e.g., Klinger, 1977;Marlatt & Gordon, 1985;Miller, 1985). The particular benefit of this formulation is to place alcoholic behavior in the context of contemporary theory of motivation and emotion, as they relate both to alcohol use in the narrow sense and to the life context in which the alcoholic continually makes choices between drinking and alternative actions. The formulation thereby suggests additional contributory factors, treatment strategies, and conceptual approaches.Despite the fact that there are multiple factors that influence drinking, the final common pathway to alcohol use is, in our view, motivational. The net motivation to drink, moreover, is closely tied to people's incentives in other life areas and to the affective changes that they derive from their incentives. We begin, therefore, by defining incentive motivation and affective change and showing how these two concepts are related to people's use of alcohol. Incentive MotivationThe term incentive motivation was introduced by Clark L.Hull (1951, 1952) as a theoretical construct to account for the vigor and intensity of behavior. Previously, Hull (1943) had assumed that organisms can perform a learned response to the Correspondence concerning this article should be addressed to W. Miles Cox, Psychology Service (116B), VA Medical Center, 1481 West 10th Street, Indianapolis, Indiana 46202. extent that they have acquired habit strength (the learned association between a stimulus and the ...

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Section: Implications For Treatmentmentioning

confidence: 99%

A motivational model of alcohol use.

Cox¹,

Klinger²

1988

Journal of Abnormal Psychology

1,193

1,096

View full text Add to dashboard Cite

show abstract

“…Both animal (Bickel et al, 1990;Balster, 1991;Carroll et al, 1991) and human studies (Hursh, 1991;Bickel et al, 1992Bickel et al, , 1995 amply demonstrate the responsiveness of drug-taking behavior to reinforcement contingencies. Therapeutic strategies derived from an operant model have already shown promise in treating drug problems (Stitzer et al, 1979;Miller and Hester, 1986;Higgins et al, 1991;Stitzer and Kirby, 1991;Bickel et al, 1995), and more generally as family therapy interventions Patterson, 1982). The Community Reinforcement Approach (CRA) was explicitly developed as an application of operant theory to the treatment of alcoholism (Hunt and Azrin, 1973;Azrin et al, 1982;Sisson and Azrin, 1986).…”

Section: Introductionmentioning

confidence: 99%

Community reinforcement and family training (CRAFT): engaging unmotivated drug users in treatment

Meyers

Miller

Hill

et al. 1998

Journal of Substance Abuse

213

146

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Although motivation for drug abuse treatment is a substantial problem, unilateral intervention through concerned significant others (CSOs) represents a promising method for engaging unmotivated individuals. The Community Reinforcement and Family Training (CRAFT) program, based on principles of reinforcement, was developed for this specific purpose. In Phase I, CSOs received the CRAFT intervention, whereby they were taught skills for modifying a loved one's drug-using behavior and for enhancing treatment engagement. CSOs were evaluated at 3 and 6 months. In Phase II, engaged drug users received treatment using the Community Reinforcement Approach (CRA). A total of 62 CSOs participated in this evaluation of the effectiveness of CRAFT. CSOs completed, on average, 87% of offered treatment sessions. During the 6-month study period, 74% succeeded in engaging their resistant loved one in treatment. Reported abstinence both from illicit drugs and alcohol increased significantly for drug users engaged in treatment, but not for unengaged cases. All CSOs showed significant reductions in depression, anxiety, anger, and physical symptoms, with average scores dropping into the normal range on all measures. CRAFT provides a promising alternative to confrontational and detachment approaches in counseling CSOs to help their loved ones.

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“…There is a long history of literature, which supports person-centred care for SUDs and matching care approaches to individual needs and preferences, and not diagnoses [46][47][48][49]. Yet, despite the support in the literature, and grounding in Rogerian theory, person-centred approaches appear to be lacking in the field of SUD care.…”

Section: Person-centred Carementioning

confidence: 99%

User-involvement/oriented Care Models and Substance Use Disorder Care: Review of the Literature

Arnett¹

2016

J Addict Res Ther

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A review of the most current substance use disorder (SUD) treatment/care literature best practices, suggests implementation of user-involvement/oriented models of care results in successful care outcomes. User-involvement models of care are (1) person-centred, (2) demonstrate a patient/person participation approach, (3) apply shared decision-making, and (4) include a recovery model approach to care and client-provider interaction. Current studies that have examined the implementation of user-involvement models of care in SUD treatment are limited, and furthermore, represent a great degree of overlap without identifying care outcomes that are specific to each model. There appears to be no empirical study that examines SUD care outcomes based on a synthesis of the four models and this may be an indication of further research.

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The Effectiveness of Alcoholism Treatment

Cited by 250 publications

References 182 publications

A motivational model of alcohol use.

A motivational model of alcohol use.

Community reinforcement and family training (CRAFT): engaging unmotivated drug users in treatment

User-involvement/oriented Care Models and Substance Use Disorder Care: Review of the Literature

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