Behavioural Therapies

Behavioural approaches help engage people in drug abuse treatment, provide incentives for them to remain abstinent, modify their attitudes and behaviours related to drug abuse, and increase their life skills to handle stressful circumstances and environmental cues that may trigger intensive craving for drugs and prompt another cycle of compulsive abuse

Motivational Interviewing

Motivational Interviewing (MI) is a clinical style designed to facilitate behaviour change. This is done through a collaborative process between Mark and the client, aimed at resolving an individual’s ambivalence regarding change and strengthening their level of internal motivation. MI was originally developed for use with clients with problems relating to alcohol misuse and later applied to substance use more broadly.

Four Processes in Motivational Interviewing

Engaging: Engaging is the process of building a helpful and collaborative therapeutic relationship

Focusing: Focusing involves the development of a shared understanding of the clients goals and using this to provide direction for conversations about change

Evoking: This process involves eliciting a clients personal motivation for change through identification of their reasons for change and how change may be carried out.

Planning: Planning involves strengthening a participants commitment to change while developing a plan of cation

Family Behaviour Therapy

Family Behavior Therapy (FBT), which has demonstrated positive results in both adults and adolescents, is aimed at addressing not only substance use problems but other co-occurring problems as well, such as conduct disorders, child mistreatment, depression, family conflict, and unemployment. FBT combines behavioral contracting with contingency management.

FBT involves the participant along with at least one significant other such as a cohabiting partner or a parent (in the case of adolescents). Mark seeks to engage families in applying the behavioral strategies taught in sessions and in acquiring new skills to improve the home environment. Participants are encouraged to develop behavioral goals for preventing substance use and HIV infection, which are anchored to a contingency management system. Substance-abusing parents are prompted to set goals related to effective parenting behaviors. During each session, the behavioral goals are reviewed, with rewards provided by significant others when goals are accomplished. Participants participate in treatment planning, choosing specific interventions from a menu of evidence-base treatment options. In a series of comparisons involving adolescents with and without conduct disorder, FBT was found to be more effective than supportive counselling

Cognitive Behavioural Therapy. (Alcohol, Marijuana, Cocaine, Methamphetamine, Nicotine)

Cognitive Behavioural Therapy (CBT) is a psychological treatment approach that examines the link between an individual’s environment, thoughts, feelings and their behaviour. Based on the principles of operant conditioning, classical conditioning and social learning theory, CBT views substance misuse as a learned maladaptive pattern of behaviour. CBT is based on the rationale that an individual’s thinking patterns and interpretation of events influence the way they feel and behave. These thinking patterns may be inaccurate or unhelpful and as a result, may lead to negative mood states or problematic behaviour. Thinking patterns that may contribute to substance use include beliefs about the positive effects of substance use, beliefs supporting substance misuse as a strategy to manage uncomfortable emotions or experiences and permissive beliefs that justify substance misuse

A central element of CBT is anticipating likely problems and enhancing participants’ self-control by helping them develop effective coping strategies. Specific techniques include exploring the positive and negative consequences of continued drug use, self-monitoring to recognize cravings early and identify situations that might put one at risk for use, and developing strategies for coping with cravings and avoiding those high-risk situations.

Contingency Management Interventions/Motivational Incentives (Alcohol, Stimulants, Opioids, Marijuana, Nicotine

Research has demonstrated the effectiveness of treatment approaches using contingency management (CM) principles, which involve giving participants tangible rewards to reinforce positive behaviors such as abstinence. Studies conducted in both methadone programs and psychosocial counseling treatment programs demonstrate that incentive-based interventions are highly effective in increasing treatment retention and promoting abstinence from drugs.

Multisystemic Therapy

Multisystemic Therapy (MST) addresses the factors associated with serious antisocial behavior in children and adolescents who abuse alcohol and other drugs. These factors include characteristics of the child or adolescent (e.g., favorable attitudes toward drug use), the family (poor discipline, family conflict, parental drug abuse), peers (positive attitudes toward drug use), school (dropout, poor performance), and neighborhood (criminal subculture). By participating in intensive treatment in natural environments (homes, schools, and neighborhood settings), most youths and families complete a full course of treatment. MST significantly reduces adolescent drug use during treatment and for at least 6 months after treatment. Fewer incarcerations and out-of-home juvenile placements offset the cost of providing this intensive service and maintaining the clinicians’ low caseloads

Motivational Enhancement Therapy (Alcohol, Marijuana, Nicotine)

Motivational Enhancement Therapy (MET) is a counselling approach that helps individuals resolve their ambivalence about engaging in treatment and stopping their drug use. This approach aims to evoke rapid and internally motivated change, rather than guide the patient step wise through the recovery process. This therapy consists of an initial assessment battery session, followed by two to four individual treatment sessions with Mark. In the first treatment session, Mark provides feedback to the initial assessment, stimulating discussion about personal substance use and eliciting self-motivational statements. Motivational interviewing principles are used to strengthen motivation and build a plan for change. Coping strategies for high-risk situations are suggested and discussed with the participant. In subsequent sessions, the therapist monitors change, reviews cessation strategies being used, and continues to encourage commitment to change or sustained abstinence.

Research on MET suggests that its effects depend on the type of drug used by participants and on the goal of the intervention. This approach has been used successfully with people addicted to alcohol to both improve their engagement in treatment and reduce their problem drinking. MET has also been used successfully with marijuana-dependent adults when combined with cognitive behavioral therapy, constituting a more comprehensive treatment approach. The results of MET are mixed for people abusing other drugs (e.g., heroin, cocaine, nicotine) and for adolescents who tend to use multiple drugs. In general, MET seems to be more effective for engaging drug abusers in treatment than for producing changes in drug use.

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