0
0

Chapter 24. Cognitive-Behavioral Therapies

Kathleen M. Carroll, Ph.D.
DOI: 10.1176/appi.books.9781585623440.353022

Sections

Excerpt

Cognitive-behavioral treatments are among the most well-defined and rigorously studied psychotherapeutic interventions for substance use disorders. In contrast to the previous edition of this textbook (Galanter and Kleber 2004), behavioral, cognitive-behavioral, and motivational approaches are now covered in separate chapters, reflecting the increasing use of these strategies in clinical practice as well as their accumulating levels of empirical support. Thus, while this chapter will focus almost primarily on cognitive-behavioral approaches, it should be noted that cognitive-behavioral therapy (CBT) shares several features with these other empirically supported behavioral approaches. First, cognitive, behavioral, and motivational therapies are applicable across a broad range of substance use disorders; that is, well-controlled trials have supported their efficacy across alcohol-, stimulant-, marijuana-, and opioid-dependent populations. Second, these approaches were developed from well-founded theoretical traditions with established theories and principles of human behavior. Third, these approaches are highly flexible and can be implemented in a wide range of clinical modalities and settings. Moreover, they are compatible with a variety of pharmacotherapies and, in many cases, foster compliance and enhance the effects of pharmacotherapies, including methadone, naltrexone, and disulfiram treatment. Finally, these approaches are relatively short-term and highly focused approaches that emphasize rapid, targeted change in substance use and related problems. In this manner, they are very compatible in a health care environment that is increasingly influenced by managed care, best clinical practice models, and professional accountability.

Your session has timed out. Please sign back in to continue.
Sign In Your Session has timed out. Please sign back in to continue.
Sign In to Access Full Content
 
Username
Password
Sign in via Athens (What is this?)
Athens is a service for single sign-on which enables access to all of an institution's subscriptions on- or off-site.
Not a subscriber?

Subscribe Now/Learn More

PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing PsychiatryOnline@psych.org or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

FIGURE 24–1. Percentage of clinicians trained to criterion, by training condition.
Table Reference Number

Cognitive-behavioral therapy (CBT) has strong empirical support across a range of different substance use disorders as well as psychiatric syndromes that frequently co-occur with substance use disorders (e.g., depression, anxiety).

CBT is highly compatible with available pharmacotherapies for addiction, and recent evidence suggests it can be delivered in a range of formats and settings.

Key components of virtually all CBT approaches include functional analyses of substance use and individualized skills training with emphasis on cognitive and behavioral coping.

Effects of CBT appear to be comparatively durable, with several studies reporting continuing improvement after patients leave treatment. Emphasis on skills training and practice may underlie this effect.

A variety of manuals, videotapes, and other training materials for CBT may be available. However, specialized coaching and feedback, with structured supervision, may be needed for many clinicians to implement CBT effectively.

References

Addis ME, Jacobson NS: A closer look at the treatment rationale and homework compliance in cognitive-behavioral therapy for depression. Cognit Ther Res 24:313–326, 2000
 
Aharonovich E, Nunes EV, Hasin D: Cognitive impairment, retention and abstinence among cocaine abusers in cognitive-behavioral treatment. Drug Alcohol Depend 71:207–211, 2003
[PubMed]
 
Aigner TG, Balster RL: Choice behavior in rhesus monkeys: cocaine versus food. Science 201:534–535, 1978
[PubMed]
 
Annis HM, Davis CS: Relapse prevention, in Handbook of Alcoholism Treatment Approaches. Edited by Hester RK, Miller WR. New York, Pergamon Press, 1989, pp 170–182
 
Anton RF, Moak DH, Waid LR, et al: Naltrexone and cognitive-behavioral therapy for the treatment of outpatient alcoholics: results of a placebo-controlled trial. Am J Psychiatry 156:1758–1764, 1999
[PubMed]
 
Azrin NH: Improvements in the community-reinforcement approach to alcoholism. Behav Res Ther 14:339–348, 1976
[PubMed]
 
Barrowclough C, Haddock G, Tarrier N, et al: Randomized controlled trial of motivational interviewing, cognitive behavior therapy and family intervention for patients with comorbid schizophrenia and substance use disorders. Am J Psychiatry 158:1706–1713, 2001
[PubMed]
 
Beck AT, Rush AJ, Shaw BF, et al: Cognitive Therapy of Depression. New York, Guilford, 1979
 
Bigelow GE, Stitzer ML, Liebson IA: The role of behavioral contingency management in drug abuse treatment. NIDA Res Monogr 46:36–52, 1984
[PubMed]
 
Blagys MD, Hilsenroth MJ: Distinctive activities of cognitive behavioral therapy: a review of the comparative psychotherapy process literature. Clin Psychol Rev 22:671–706, 2002
[PubMed]
 
Budney AJ, Higgins ST: A Community Reinforcement Plus Vouchers Approach: Treating Cocaine Addiction. Rockville, MD, National Institute on Drug Abuse, 1998
 
Budney AJ, Higgins ST, Radonovich KJ, et al: Adding voucher-based incentives to coping skills and motivational enhancement improves outcomes during treatment for marijuana dependence. J Consult Clin Psychol 68:1051–1061, 2000
[PubMed]
 
Burns DD, Spangler DL: Does psychotherapy homework lead to improvements in depression in cognitive-behavioral therapy or does improvement lead to increased homework compliance? J Consult Clin Psychol 68:46–56, 2000
[PubMed]
 
Carroll KM: Relapse prevention as a psychosocial treatment approach: a review of controlled clinical trials. Exp Clin Psychopharmacol 4:46–54, 1996
 
Carroll KM: A Cognitive-Behavioral Approach: Treating Cocaine Addiction. Rockville, MD, National Institute on Drug Abuse, 1998
 
Carroll KM: Behavioral and cognitive behavioral treatments, in Addictions: A Comprehensive Guidebook. Edited by McCrady BS, Epstein EE. New York, Oxford University Press, 1999, pp 250–267
 
Carroll KM, Rounsaville BJ: A vision of the next generation of behavioural therapies in the addictions. Addiction 102:850–862, 2007
[PubMed]
 
Carroll KM, Rounsaville BJ, Gawin FH: A comparative trial of psychotherapies for ambulatory cocaine abusers: relapse prevention and interpersonal psychotherapy. Am J Drug Alcohol Abuse 17:229–247, 1991
[PubMed]
 
Carroll KM, Rounsaville BJ, Gordon LT, et al: Psychotherapy and pharmacotherapy for ambulatory cocaine abusers. Arch Gen Psychiatry 51:177–197, 1994a
 
Carroll KM, Rounsaville BJ, Nich C, et al: One year follow-up of psychotherapy and pharmacotherapy for cocaine dependence: delayed emergence of psychotherapy effects. Arch Gen Psychiatry 51:989–997, 1994b
 
Carroll KM, Nich C, Ball SA, et al: Treatment of cocaine and alcohol dependence with psychotherapy and disulfiram. Addiction 93:713–728, 1998
[PubMed]
 
Carroll KM, Nich C, Frankforter TL, et al: Do patients change in the way we intend? Treatment-specific skill acquisition in cocaine-dependent patients using the Cocaine Risk Response Test. Psychol Assess 11:77–85, 1999
 
Carroll KM, Nich C, Ball SA, et al: One year follow-up of disulfiram and psychotherapy for cocaine-alcohol abusers: sustained effects of treatment. Addiction 95:1335–1349, 2000a
 
Carroll KM, Nich C, Sifry R, et al: A general system for evaluating therapist adherence and competence in psychotherapy research in the addictions. Drug Alcohol Depend 57:225–238, 2000b
 
Carroll KM, Fenton LR, Ball SA, et al: Efficacy of disulfiram and cognitive-behavioral therapy in cocaine-dependent outpatients: a randomized placebo controlled trial. Arch Gen Psychiatry 64:264–272, 2004
 
Carroll KM, Nich C, Ball SA: Practice makes progress? Homework assignments and outcome in treatment of cocaine dependence. J Consult Clin Psychol 73:749–755, 2005
[PubMed]
 
Carroll KM, Easton CJ, Nich C, et al: The use of contingency management and motivational/skills-building therapy to treat young adults with marijuana dependence. J Consult Clin Psychol 74:955–966, 2006
[PubMed]
 
Chaney EF, O'Leary MR, Marlatt GA: Skill training with problem drinkers. J Consult Clin Psychol 46:1092–1104, 1978
[PubMed]
 
Childress AR, Mozley PD, McElgin W, et al: Limbic activation during cue-induced cocaine craving. Am J Psychiatry 156:11–18, 1999
[PubMed]
 
Cooney NL, Kadden RM, Litt MD, et al: Matching alcoholics to coping skills or interactional therapies: two-year follow-up results. J Consult Clin Psychol 59:598–601, 1991
[PubMed]
 
Craighead WE, Craighead LW, Ilardi SS: Behavioral therapies in historical perspective, in Comprehensive Textbook of Psychotherapy: Theory and Practice. Edited by Bongar BM, Beutler LE. New York, Oxford University Press, 1995, pp 64–83
 
Crits-Christoph P, Siqueland L, Chitlams J, et al: Training in cognitive, supportive-expressive, and drug counseling therapies. J Consult Clin Psychol 66:484–492, 1998
[PubMed]
 
DeRubeis RJ, Crits-Christoph P: Empirically supported individual and group psychological treatments for adult mental disorders. J Consult Clin Psychol 66:37–52, 1998
[PubMed]
 
Edelman RE, Chambliss DL: Adherence during sessions and homework in cognitive-behavioral group treatment of social phobia. Behav Res Ther 33:573–577, 1995
[PubMed]
 
Epstein DE, Hawkins WE, Covi L, et al: Cognitive behavioral therapy plus contingency management for cocaine use: findings during treatment and across 12-month follow-up. Psychol Addict Behav 17:73–82, 2003
[PubMed]
 
Farabee D, Rawson RA, McCann MJ: Adoption of drug avoidance strategies among patients in contingency management and cognitive-behavioral treatments. J Subst Abuse Treat 23:343–350, 2002
[PubMed]
 
Fiore MC, Smith SS, Jorenby DE, et al: The effectiveness of the nicotine patch for smoking cessation. A meta-analysis. JAMA 271:1940–1947, 1994
[PubMed]
 
Galanter M, Kleber HD: The American Psychiatric Publishing Textbook of Substance Abuse Treatment, 3rd Edition. Washington, DC, American Psychiatric Publishing, 2004
 
Gonzalez VM, Schmitz JM, DeLaume KA: The role of homework in cognitive behavioral therapy for cocaine dependence. J Consult Clin Psychol 74:633–637, 2006
[PubMed]
 
Hall SM, Reus VI, Munoz RF, et al: Nortriptyline and cognitive-behavioral therapy in the treatment of cigarette smoking. Arch Gen Psychiatry 55:683–690, 1998
[PubMed]
 
Higgins ST, Delany DD, Budney AJ, et al: A behavioral approach to achieving initial cocaine abstinence. Am J Psychiatry 148:1218–1224, 1991
[PubMed]
 
Higgins ST, Budney AJ, Bickel WK, et al: Incentives improve outcome in outpatient behavioral treatment of cocaine dependence. Arch Gen Psychiatry 51:568–576, 1994
[PubMed]
 
Higgins ST, Wong CJ, Badger GJ, et al: Contingent reinforcement increases cocaine abstinence during outpatient treatment and one year follow-up. J Consult Clin Psychol 68:64–72, 2000
[PubMed]
 
Higgins ST, Sigmon SC, Wong CJ, et al: Community reinforcement therapy for cocaine-dependent outpatients. Arch Gen Psychiatry 60:1043–1052, 2003
[PubMed]
 
Irvin JE, Bowers CA, Dunn ME, et al: Efficacy of relapse prevention: a meta-analytic review. J Consult Clin Psychol 67:563–570, 1999
[PubMed]
 
Kadden RM, Cooney NL, Getter H, et al: Matching alcoholics to coping skills or interactional therapies: posttreatment results. J Consult Clin Psychol 57:698–704, 1989
[PubMed]
 
Kadden RM, Carroll KM, Donovan D, et al: Cognitive-Behavioral Coping Skills Therapy Manual: A Clinical Research Guide for Therapists Treating Individuals With Alcohol Abuse and Dependence. Rockville, MD, National Institute on Alcohol Abuse and Alcoholism, 1992
 
Kraemer HC, Wilson GT, Fairburn CG, et al: Mediators and moderators of treatment effects in randomized clinical trials. Arch Gen Psychiatry 59:877–883, 2002
[PubMed]
 
Longabaugh R, Donovan DM, Karno MP, et al: Active ingredients: how and why evidence-based alcohol behavioral treatment interventions work. Alcohol Clin Exp Res 29:235–247, 2005
[PubMed]
 
Marlatt GA, Donovan D: Relapse Prevention: Maintenance Strategies in the Treatment of Addictions, 2nd Edition. New York, Guilford, 2005
 
Marlatt GA, Gordon JR: Relapse Prevention: Maintenance Strategies in the Treatment of Addictive Behaviors. New York, Guilford, 1985
 
Marques AC, Formigoni ML: Comparison of individual and group cognitive-behavioral therapy for alcohol and/or drug-dependent patients. Addiction 96:835–846, 2001
[PubMed]
 
Maude-Griffin PM, Hohenstein JM, Humfleet GL, et al: Superior efficacy of cognitive-behavioral therapy for crack cocaine abusers: main and matching effects. J Consult Clin Psychol 66:832–837, 1998
[PubMed]
 
McKay JR, Alterman AI, Cacciola JS, et al: Group counseling versus individualized relapse prevention aftercare following intensive outpatient treatment for cocaine dependence: initial results. J Consult Clin Psychol 65:778–788, 1997
[PubMed]
 
McKay JR, Alterman AI, Cacciola JS, et al: Continuing care for cocaine dependence: comprehensive 2-year outcomes. J Consult Clin Psychol 63:70–78, 1999
 
Meichenbaum DH: Cognitive-behavioral therapy in historical perspective, in Comprehensive Textbook of Psychotherapy: Theory and Practice. Edited by Bongar BM, Beutler LE. New York, Oxford University Press, 1995, pp 140–158
 
Miller WR, Wilbourne PL: Mesa Grande: a methodological analysis of clinical trials of treatments for alcohol use disorders. Addiction 97:265–277, 2002
[PubMed]
 
Miller WR, Brown JM, Simpson TL, et al: What works? a methodological analysis of the alcohol treatment literature, in Handbook of Alcoholism Treatment Approaches: Effective Alternatives. Edited by Hester RK, Miller WR. Boston, MA, Allyn & Bacon, 1995, pp 12–44
 
Monti PM, Rohsenow DJ, Abrams DB, et al: Treating Alcohol Dependence: A Coping Skills Training Guide in the Treatment of Alcoholism. New York, Guilford, 1989
 
Monti PM, Rohsenow DJ, Rubonis AV, et al: Cue exposure with coping skills treatment for male alcoholics: a preliminary investigation. J Consult Clin Psychol 61:1011–1019, 1993
[PubMed]
 
Monti PM, Rohsenow DJ, Michalec E, et al: Brief coping skills treatment for cocaine abuse: substance abuse outcomes at three months. Addiction 92:1717–1728, 1997
[PubMed]
 
Morgenstern J, Longabaugh R: Cognitive-behavioral treatment for alcohol dependence: a review of the evidence for its hypothesized mechanisms of action. Addiction 95:1475–1490, 2000
[PubMed]
 
Morgenstern J, Morgan TJ, McCrady BS, et al: Manual-guided cognitive behavioral therapy training: a promising method for disseminating empirically supported substance abuse treatments to the practice community. Psychol Addict Behav 15:83–88, 2001
[PubMed]
 
Marijuana Treatment Project Research Group: Brief treatments for cannabis dependence: findings from a randomized multisite trial. J Consult Clin Psychol 72:455–466, 2004
 
Nowinski J, Baker S, Carroll KM: Twelve-Step Facilitation Therapy Manual: A Clinical Research Guide for Therapists Treating Individuals With Alcohol Abuse and Dependence. Rockville, MD, National Institute on Alcohol Abuse and Alcoholism, 1992
 
O'Malley SS, Jaffe AJ, Chang G, et al: Naltrexone and coping skills therapy for alcohol dependence: a controlled study. Arch Gen Psychiatry 49:881–887, 1992
[PubMed]
 
O'Malley SS, Jaffe AJ, Chang G, et al: Six month follow-up of naltrexone and psychotherapy for alcohol dependence. Arch Gen Psychiatry 53:217–224, 1996
[PubMed]
 
Patten CA, Martin JE, Myers MG, et al: Effectiveness of cognitive-behavioral therapy for smokers with histories of alcohol dependence and depression. J Stud Alcohol 59:327–335, 1998
[PubMed]
 
Petry NM, Martin B: Low-cost contingency management for treating cocaine- and opioid-abusing methadone patients. J Consult Clin Psychol 70:398–405, 2002
[PubMed]
 
Primakoff L, Epstein N, Covi L: Homework compliance: an uncontrolled variable in cognitive therapy outcome research. Behav Ther 17:433–446, 1986
 
Project MATCH Research Group: Project MATCH (Matching Alcoholism Treatment to Client Heterogeneity): rationale and methods for a multisite clinical trial matching patients to alcoholism treatment. Alcohol Clin Exp Res 17:1130–1145, 1993
 
Project MATCH Research Group: Matching alcoholism treatments to client heterogeneity: Project MATCH three-year drinking outcomes. Alcohol Clin Exp Res 22:1300–1311, 1998a
 
Project MATCH Research Group: Matching alcoholism treatments to client heterogeneity: treatment main effects and matching effects on drinking during treatment. J Stud Alcohol 59:631–639, 1998b
 
Rawson RA, Huber A, McCann MJ, et al: A comparison of contingency management and cognitive-behavioral approaches during methadone maintenance for cocaine dependence. Arch Gen Psychiatry 59:817–824, 2002
[PubMed]
 
Rawson RA, McCann MJ, Flammino F, et al: A comparison of contingency management and cognitive-behavioral approaches for stimulant-dependent individuals. Addiction 101:267–274, 2006
[PubMed]
 
Rohsenow DJ, Monti PM, Martin RA, et al: Brief coping skills treatment for cocaine abuse: 12-month substance use outcomes. J Consult Clin Psychol 68:515–520, 2000
[PubMed]
 
Rotgers F: Behavioral theory of substance abuse treatment: bringing science to bear on practice, in Treating Substance Abusers: Theory and Technique. Edited by Rotgers F, Keller DS, Morgenstern J. New York, Guilford, 1996, pp 174–201
 
Roth A, Fonagy P: What Works for Whom? A Critical Review of the Psychotherapy Literature, 2nd Edition. New York, Guilfsord, 2005
 
Rounsaville BJ, Gawin FH, Kleber HD: Interpersonal psychotherapy adapted for ambulatory cocaine abusers. Am J Drug Alcohol Abuse 11:171–191, 1985
[PubMed]
 
Schmidt NB, Woolaway-Bickel K: The effects of treatment compliance on outcome in cognitive-behavioral therapy for panic disorder: quality versus quantity. J Consult Clin Psychol 68:13–18, 2000
[PubMed]
 
Schmitz JM, Oswald LM, Jacks SD, et al: Relapse prevention treatment for cocaine dependence: group vs. individual format. Addict Behav 22:405–418, 1997
[PubMed]
 
Sholomskas D, Syracuse G, Ball SA, et al: We don't train in vain: a dissemination trial of three strategies for training clinicians in cognitive behavioral therapy. J Consult Clin Psychol 73:106–115, 2005
[PubMed]
 
Silverman K, Higgins ST, Brooner RK, et al: Sustained cocaine abstinence in methadone maintenance patients through voucher-based reinforcement therapy. Arch Gen Psychiatry 53:409–415, 1996
[PubMed]
 
Stephens RS, Roffman RA, Simpson EE: Treating adult marijuana dependence: a test of the relapse prevention model. J Consult Clin Psychol 62:92–99, 1994
[PubMed]
 
Stephens RS, Roffman RA, Curtin L: Comparison of extended versus brief treatments for marijuana use. J Consult Clin Psychol 68:898–908, 2000
[PubMed]
 
Stephens RS, Babor TF, Kadden R, et al: The Marijuana Treatment Project: rationale, design, and participant characteristics. Addiction 97:109–124, 2002
[PubMed]
 
Stitzer ML, Iguchi MY, Kidorf M, et al: Contingency management in methadone treatment: the case for positive incentives, in Behavioral Treatments for Drug Abuse and Dependence. Edited by Onken LS, Blaine JD, Boren JJ. Rockville, MD, National Institute on Drug Abuse, 1993, pp 19–36
 
Thompson T, Pickens RW: Stimulus Properties of Drugs. New York, Appleton-Century-Crofts, 1971
 
Weissman MM, Verdeli H, Gameroff MJ, et al: National survey of psychotherapy training in psychiatry, psychology, and social work. Arch Gen Psychiatry 63:925–934, 2006
[PubMed]
 
Weisz JR, Hawley KM, Pilkonis PA, et al: Stressing the (other) three Rs in the search for empirically supported treatments: review procedures, research quality, relevance to practice and the public interest. Clinical Psychology: Science and Practice 7:243–258, 2000
 
Wikler A: Dynamics of drug dependence: implications of a conditioning theory for research and treatment. Arch Gen Psychiatry 28:611–616, 1973
[PubMed]
 
Wilson GT, Fairburn CG, Agras WS, et al: Cognitive-behavioral therapy for bulimia nervosa: time course and mechanisms of change. J Consult Clin Psychol 70:267–274, 2002
[PubMed]
 
+

CME Activity

Add a subscription to complete this activity and earn CME credit.
Sample questions:
1.
Cognitive-behavioral therapy (CBT), behavioral therapy, and motivational therapy share a number of features. Which of the following is not one of these features?
2.
CBT has been shown to be effective in treating all of the following substance use disorders except
3.
Cognitive-behavioral approaches involve a range of skills necessary to foster or maintain abstinence. One such skill is known as the decisional balance technique. Which of the following describes this technique?
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Related Content
Articles
Books
Gabbard's Treatments of Psychiatric Disorders, 4th Edition > Chapter 18.  >
Gabbard's Treatments of Psychiatric Disorders, 4th Edition > Chapter 24.  >
Gabbard's Treatments of Psychiatric Disorders, 4th Edition > Chapter 29.  >
The American Psychiatric Publishing Textbook of Psychiatry, 5th Edition > Chapter 31.  >
Gabbard's Treatments of Psychiatric Disorders, 4th Edition > Chapter 15.  >
Topic Collections
Psychiatric News
PubMed Articles
[Cocaine addiction: current data for the clinician]. Presse Med 2014;43(1):9-17.doi:10.1016/j.lpm.2013.01.069.
Individual mindfulness-based psychotherapy for cannabis or cocaine dependence: a pilot feasibility trial. Am J Addict 2013 Nov-Dec;22(6):521-6.doi:10.1111/j.1521-0391.2013.12036.x.
 
  • Print
  • PDF
  • E-mail
  • Chapter Alerts
  • Get Citation