Lecture 3: Cognitive Behavioral Treatment Of Substance Abuse

Question 1

What are 3 evidence-based treatments of addiction

Answer 1

• CBT
• Motivational Interviewing = technique used to elicit motivation in the client to change a specific negative behavior
• Contingency Management = specific desired behaviors are reinforced or rewarded

Question 2

What does CBT assume is substance abuse a result of and what are 3 versions of this

Answer 2

Learning:
- social learning; observing and imitating
- operant conditioning; substance use is rewarded
- classical conditioning; substance use is maintained through associations

Question 3

How can a session be structured according to the 20/20/20 rule

Answer 3

• discussing homework
• introducing new theme
• giving new homework (related to new theme)

Question 4

How can a session be structured according to the 4-part structure (Mitcheson)

Answer 4

1. Setting agenda and previous session recap
2. Specific agenda items (focus)
3. Planning for next session
4. Session review

Question 5

Guided discovery

Answer 5

= primary tool to support self-reflection; asking questions to promote thinking/reflection, requires collaboration/curiosity, assumes the client has the (means to find) answer(s)

Question 6

What are 8 interventions of the content of CBT

Answer 6

1. Preparing for change: motivational interviewing, making cost/benefit balance, provoke change language
2. Goal setting: should be important and feasible for the client and counselor, abstinence or controlled use
3. Self-control measures: preventing use: stimulus control (avoidance), stimulus-response prevention (alternative behavior), response consequences (reward; negative consequences)
4. Functional analysis: common thread of the treatment, determining function of use
5. Emergency measures: interrupting use during a slipup or relapse
6. Dealing with craving: learn skills to deal with craving, alternative thoughts, seeking social support, mindsurfing (pos consequences of not using, neg cons of use)
7. Change your thoughts: formulating helpful thoughts
8. Refusal of offered resources: learning how to do it

Question 7

What are SMART goals

Answer 7

S = specific; what do you want
M = measurable; how will you know when you’ve reached it
A = achievable; is it in your power to accomplish it
R = realistic; can you realistically achieve it
T = timely; when exactly do you want to accomplish it

Question 8

Abstinence violation effect

Answer 8

Negative emotional and cognitive response to relapsing after a period of abstinence; guilt, shame, self-doubt —> may increase the risk of further relapses and hinder recovery process

Question 9

What are 4 kinds of CB therapies

Answer 9

1. Relapse prevention: develop skills to identify/prepare for high-risk situations that lead to relapse
2. Cognitive therapy: focus on cognitive, behavioral, emotional and physiological variables that are immediate triggers and distal background factors that provide vulnerabilities and may act as maintaining factors
3. Coping skills therapy: relapse prevention training, social/communication skills training, training to cope with urges/cravings, mood management
4. Mindfulness-based cognitive behavioral approaches

Question 10

What are 3 possible variations in CBT

Answer 10

• Brief CBTs: primarily based on relapse prevention and coping skills therapy —> best for people not ready for intensive treatment
• Low-intensity CBTs: low intensity for practitioner and sometimes for client, can be face-to-face but mostly done using remote/self-oriented technologies
• Digital CBTs: computer delivered intervention: increased number of people who can access treatment, lower barrier and assist with delivering treatments of greater consistency/fidelity

Question 11

What are the 6 factors of the general model of CBT

Answer 11

• Early experience
• Beliefs
• Thoughts and beliefs
• Feelings
• Behaviors

Question 12

What are the 3 categories of thoughts and beliefs in the model

Answer 12

• Analyzing: identifying thoughts and their relation to feelings/behavior and considering their (un)helpfulness
• Challenging: analyzing them and utilizing strategies such as asking for evidence for beliefs and looking for exceptions/contradictions
• Accepting: noticing/accepting thoughts and beliefs without judgement or necessary further action

Question 13

What are 4 special issues and challenges in motivational interviewing

Answer 13

1. Engaging: facilitating change and increase likelihood that client comes back, developing collaborative alliance
2. Focusing: establishing common goals, working on intermediate goals (eg. reducing use), work on changes people are willing to make (= harm reduction)
3. Evoking: eliciting clients own reasons for change
4. Planning: once there is sufficient motivation, move ahead with planning —> plan should always change depending on the situation and should consider possible obstacles

Question 14

What are 4 ways to respond to change talk

Answer 14

• asking more
• reflecting
• affirming
• summarizing

Question 15

Explain ‘surfing the urge’

Answer 15

Phase 1: the craving presents itself
Phase 2: the craving gets bigger and bigger as long as you don’t do anything about it and don’t give in to what you normally do
Phase 3: eventually the craving diminishes

Question 16

What are 5 solutions for how to deal with craving

Answer 16

• seek distraction
• surfing the urge
• alternative thoughts
• Mind surfing; thinking about positive consequences of not using and negative consequences of using
• seek social support

Question 17

Acceptance and Commitment Therapy

Answer 17

= guiding people to accept the urges and symptoms associated with substance abuse and use psychological flexibility and value-based interventions to reduce those urges and symptoms

Question 18

Phases in CBT

Answer 18

• taxation
• interventions
• relapse prevention
• conclusions

—> working with an agenda and homework

Question 19

What are 4 kinds of medication used for treating substance abuse and their specific medications

Answer 19

detoxification; patient stops using drugs
- benzodiazepines = leads to reduced withdrawal symptoms

aversive drugs
- disulfiram = prevents the alcohol/drugs from breaking down and therefore causes nausea etc, leads people to not want to take the substance anymore

anti-craving medication;
- naltrexone = reduces the rewarding effects of the drug, and therefore reduces craving -> relatively ineffective for chronic addicts
- acamprosate = has an inhibitory effect on the glutamatergic system and reduces craving for alcohol after abstinence
- nalmefene = similar to naltrexone, is fast-acting and can even be taken preventatively on days where patient feels increased relapse risk

preservation treatment = drugs that have the same chemical properties as the drug -> lead to no craving or withdrawal
- methadone
- buprenorphine/naloxone (suboxone)