Testing the effectiveness of cognitive-behavioral treatment for substance abuse in a community setting: Within treatment and posttreatment findings.

This study evaluated the short-term effectiveness of cognitive- behavioral treatment (CBT) for substance abuse delivered in a community setting. At entry into outpatient community substance abuse treatment, participants (N=252) were randomly assigned to 3 conditions: high-standardization CBT, low-standardization CBT, and treatment as usual. Treatment consisted of 12 weekly individual therapy sessions. There was a significant decrease in substance use from baseline, with participants reporting being abstinent on 90% of within-treatment days and 85% of days during the 6 months posttreatment. However, there were no significant differences in outcomes across conditions. Findings do not support the hypothesis that disseminating CBT to community settings will improve outcomes and suggest that standard substance abuse counseling may be more effective than previously thought. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Substance abuse assessment and treatment: The current training and practice of APA Division 22 members.

Objective: To determine the preparedness of rehabilitation psychologists to work with people with disabilities with primary or secondary substance-related problems by examining their education, training, and current practice. Design: Mail survey. Participants: 76 (47 men, 29 women) Division 22 members of the American Psychological Association. Results: Although 79% of respondents reported treating individuals with alcohol and other drug issues, over half rated their training in substance abuse treatment as inadequate. Referring to self-help groups and instilling cognitive-behavioral coping skills were common treatments. Participants reported a lack of preparation in substance abuse training in their graduate program coursework, practicum, and internship. Conclusion: Continuing education and changes to curriculum requirements, with linkage to existing certification bodies, should be considered to close the gap between training and practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping strategy use following computerized cognitive-behavioral therapy for substance use disorders.

Coping strategies are emerging as a predictor of treatment outcome for substance users and may be particularly important among computerized and self-change approaches. We used data from a randomized clinical trial of a computer-based version of cognitive–behavioral therapy (CBT4CBT) to: (1) examine the association between observer ratings of coping skills and self-reported coping strategies; (2) evaluate whether participants assigned to the CBT4CBT program reported greater use of coping strategies compared with those not exposed to the program; and (3) examine the differential effect of coping strategies by treatment group on drug-related outcomes. Individuals (N = 77) seeking treatment for substance dependence at a community-based outpatient substance abuse treatment facility were recruited and randomized to receive treatment-as-usual (TAU), or TAU plus CBT4CBT, with the Coping Strategies Scale administered at baseline and posttreatment. Self-reported coping strategy use was strongly correlated with observer ratings on a role-play assessment of coping skills. Although no significant group differences were found across time for coping strategy use, results suggested that as coping strategy use increased, drug use decreased, and this relationship was stronger for participants who received CBT4CBT. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Training for substance abuse treatment among psychologists in a rural state.

Is treating substance abuse generally a part of psychological practice? Do psychologists feel prepared to deliver substance abuse treatment? Licensed psychologists in Idaho were surveyed about their training and provision of substance abuse services. Of 144 respondents (66% return rate), nearly all (89%) had contact with substance abusers, yet most rated their graduate training as inadequate preparation for practice. Rural psychologists reported seeing the highest percentage of substance abusers. Many psychologists limited their treatment to self-help group referral. Continuing education offers the most immediate solution and might be related to certification efforts. Predoctoral training of generalist psychologists, especially in rural areas, is advocated with an emphasis on integrated behavioral health care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognition, commitment language, and behavioral change among cocaine-dependent patients.

Patients' cognitive abilities and verbal expressions of commitment to behavioral change predict different aspects of substance abuse treatment outcome, but these 2 traits have never been examined conjointly. The authors therefore investigated patients' cognitive abilities and verbal expressions of commitment to behavioral change as predictors of retention and drug use outcomes in an outpatient cognitive behavioral treatment (CBT) of adult cocaine-dependent patients. A neuropsychological battery was administered at baseline. Two independent raters used recordings of CBT sessions to code commitment language strength across the temporal segments (e.g., beginning, middle, and end) of 1 session per patient. Better cognitive abilities predicted treatment retention (p     

Review of Treating substance abuse: Theory and technique.

Reviews the book, Treating substance abuse: Theory and technique edited by Frederick Rotgers, Daniel S. Keller, and Jon Morgenstern (see record 1995-99052-000). The authors initially postulate the question of "why we produced this book": They indicated that it is "a response to forces of change." Their answers are a reflection of "the increasing uneasiness among substance abuse treatment providers, the unstable, and often poor outcomes that result from mainstream treatments." Those who suffer from psychoactive substance use disorders, (PSUD's) constitute a staggering population; and many fail to benefit from treatment over a period of time. The authors organized the book into five major approaches to treatment theory and techniques. (1) 12-step, (2) Psychodynamic, (3) Marital-Family therapy, (4) Behavioral, and (5) Motivational enhancement. This book is essential for the beginning practitioner in the field of substance abuse, but it also serves as a valuable adjunct for those of us who have been in the field for a period of time. The authors were thorough, organized, and clear in their presentations. The text is well written and certainly a valued, up-to-date, adjunct to the field of substance abuse theory and treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized control trial examining the effect of acceptance and commitment training on clinician willingness to use evidence-based pharmacotherapy.

This study evaluated the effectiveness of acceptance and commitment training (ACT) for increasing drug and alcohol counselors' willingness to use evidence-based agonist and antagonist pharmacotherapy. Fifty-nine drug and alcohol counselors were randomly assigned to either a 1-day ACT workshop or a 1-day educational control workshop. Both groups then attended a 2-day workshop on empirically supported treatments for substance abuse. Measures were taken at pre- and posttraining and 3-month follow-up on reported use of pharmacotherapy, willingness to use pharmacotherapy, perceived barriers to implementing new treatments, and general acceptance. As compared with those in the education alone condition, participants in the ACT condition showed significantly higher rates of referrals to pharmacotherapy at follow-up, rated barriers to learning new treatments as less believable at posttraining and follow-up, and showed greater psychological flexibility at posttraining and follow-up. Mediational analyses indicated that reduced believability of barriers and greater psychological flexibility mediated the impact of the intervention. Results support the idea that acceptance-based interventions may be helpful in addressing the psychological factors related to poor adoption of evidence-based treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Enhancing substance abuse treatment engagement in incarcerated adolescents.

The purpose of this study was to determine whether motivational interviewing (MI), compared with an attention control condition (relaxation training [RT]) enhances substance abuse treatment engagement in incarcerated adolescents. At the start of incarceration, adolescents were randomly assigned to individually administered MI or RT. Subsequently, therapists and adolescents (N = 130) rated degree of adolescent participation in the facility's standard care group-based treatments targeting crime and substance use. All adolescents received the facility standard care treatment after their individual MI or RT session. MI statistically significantly mitigated negative substance abuse treatment engagement. Other indicators of treatment engagement were in the expected direction; however, effect sizes were small and nonsignificant. These findings are significant, given concerns regarding the deleterious effects of treating delinquent adolescents in groups and the potential for adolescents to reinforce each other's negative behavior, which in turn may lead to escalated substance use and other delinquent behaviors after release. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Low-cost contingency management in community clinics: Delivering incentives partially in group therapy.

This study examined the feasibility and effectiveness of prize-based contingency management (CM) when incentives for attendance were administered in group therapy and incentives for abstinence were administered in individual meetings. Three community substance abuse treatment programs participated in this two-phase, crossover design study. Outpatients (N = 103) entering treatment who met diagnostic criteria for cocaine, opiate, and alcohol abuse or dependence were recruited. During the standard condition, participants received standard treatment and submitted breath and urine samples that were tested for alcohol, cocaine, and opiates twice weekly during Weeks 1-6 and once weekly during Weeks 7-12. During the CM condition, participants received the same standard treatment and sample and attendance monitoring, plus the opportunity to win prizes for negative samples and treatment attendance. Demographic information and substance abuse history were evaluated at intake, and posttreatment substance use (toxicology results and self-report) was evaluated at Month 6 and Month 9 follow-up interviews. Primary outcomes were weeks retained in treatment and longest duration of sustained abstinence (LDA). LDA was significantly greater in CM-condition participants, but weeks retained did not differ between groups. Rates of substance use were lower in CM participants at Month 9 but not at Month 6. This study suggests that it is feasible to deliver incentives for attendance in group therapy, but that further research is needed to understand the modest effects on attendance. Strengths and limitations of this study are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Distress Tolerance as a Predictor of Early Treatment Dropout in a Residential Substance Abuse Treatment Facility.

A large percentage of individuals who enter residential substance abuse treatment drop out before completing treatment. Given that early treatment dropout places individuals at an increased risk for relapse, identifying the mechanisms underlying treatment dropout would have several important theoretical and clinical implications. In the current study, the authors examined levels of psychological and physical distress tolerance as a predictor of early treatment dropout in a residential substance abuse treatment facility. In a sample of 122 individuals entering a residential substance abuse treatment facility, level of psychological distress tolerance was predictive of early treatment dropout above and beyond relevant self-report variables. There was no relationship between physical distress tolerance and early treatment dropout. Implications for future studies and treatment development or modification are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of childhood abuse on relapse in a recently homeless substance-dependent veteran population.

The impact of childhood abuse, both childhood sexual abuse (CSA) and childhood physical abuse (CPA), is well documented. Both CSA and CPA have been associated with a number of mental health difficulties, including substance dependence. Though the association between abuse and mental health problems is well documented, what has received little attention is the impact that abuse histories may have on the ability to complete treatment for these problems. This study evaluates the association between abuse and failure to complete treatment due to substance relapse in 70 substance-dependent homeless men served by a Veterans Affairs Domiciliary Residential Rehabilitation and Treatment Program. Demographic and mental health variables were compared with incident rates of sexual and physical abuse as well as with rates of relapse prior to program completion. Contrary to predictions, results found that physical abuse, not sexual abuse, was associated with higher relapse rates. Limitations, implications, and future directions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Early therapeutic alliance and treatment outcome in individual and family therapy for adolescent behavior problems.

The impact of early therapeutic alliance was examined in 100 clients receiving either individual cognitive- behavioral therapy (CBT) or family therapy for adolescent substance abuse. Observational ratings of adolescent alliance in CBT and adolescent and parent alliance in family therapy were used to predict treatment retention (in CBT only) and outcome (drug use, externalizing, and internalizing symptoms in both conditions) at post and 6-month follow-up. There were no alliance effects in CBT. In family therapy, stronger parent alliance predicted declines in drug use and externalizing. Adolescents with weak early alliances that subsequently improved by midtreatment showed significantly greater reductions in externalizing than adolescents whose alliances declined. Results underscore the need for ongoing developmental calibration of intervention theory and practice for adolescent clinical populations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Clinical management of substance abuse programs.

Reviews the book, Clinical management of substance abuse programs by Robert J. Craig (see record 1987-97819-000). Clinical management of substance abuse programs is a significant contribution to substance abuse program management. The author provides the program director with specific information about increasing program effectiveness. His thesis is that broad program activities have greater impact on total patient care than does any individual activity with a particular patient. The book is divided into three parts. Part I is devoted to the following sections: (a) an introduction and review of the book's contents, (b) diagnostic interviewing, and (c) psychological testing. The three chapters in Part II review general models of treatment, including multimodal, combined alcohol and drug, and treatment matching. Part III, which contains four chapters, details clinical program management activities. In this section the author offers the nuts and bolts for designing a substance abuse program based on effective evaluation and quality control. The author is successful in providing a basic text to assist clinician/managers in designing more effective treatment programs for substance abusers. I recommend this book to any professional responsible for program development in substance abuse treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of The substance abuse problems: New issues for the 1980’s (vol. 2).

Reviews the book, The substance abuse problems: New issues for the 1980’s (vol. 2) by Sidney Cohen (1984). In this second volume of writings on substance abuse problems, Sidney Cohen offers the reader a glimpse into the many substance abuse issues facing society, treatment personnel, and the individual. The 54 chapters in this book, divided almost equally among the sections, offer brief and insightful vignettes on a variety of substance abuse issues. Overall, this book provides information and intellectual stimulation on a broad range of topics. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Dual diagnosis: Counseling the mentally ill substance abuser.

Reviews the book, Dual diagnosis: Counseling the mentally ill substance abuser by Katie Evans and J. Michael Sullivan (1991). This book is intended to be a practical guide for counseling a particularly difficult group of clients. The authors hope that it will be read by a wide audience, including psychologists, psychiatrists, social workers, chemical dependency counselors, family and marital therapists, child protective service workers, court examiners, school counselors, and others. The 10 chapters cover a variety of topics, touching on several aspects of working with "dual diagnosis" clients (i.e., people who present for treatment with both substance use and major psychiatric disorders). The authors have attempted to cover a complicated and extensive set of problems and a variety of issues and approaches in this short book. Many readers will appreciate the practical and straightforward suggestions for assessing and treating the dual diagnosis client. However, along with the straightforward approach comes simplification of some difficult problems. For example, the chapter on identifying chemical dependency includes no discussion of assessing patterns of drug or alcohol use or the antecedents or consequences that may be peculiar to people with a particular disorder. Dual diagnosis clients seem to use mental health and substance abuse services at a disproportionately high rate, yet they also seem the most likely to "fall through the cracks." Use of some of the treatment suggestions discussed in this book may help remedy the situation and could be useful for someone not yet familiar with dual diagnosis clients. However, in the end, one wishes that the book was more focused and detailed. Instead, probably because of the large scope of intended readers and clients, it becomes more of an outline and loses some of its practical significance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Case Management for Traumatic Brain Injury Survivors With Alcohol Problems.

Objective: To evaluate a community-based approach to substance abuse using comprehensive case management for persons with traumatic brain injury (TBI). Setting: Two programs that provide case management services (n=217): a comparison group was recruited that did not receive case management (n=102). Intervention: Comprehensive case management. Main Outcome Measures: Self-reported substance use, community integration, employment status, health-related quality of life. Results: For those receiving case management, employment at recruitment and early referral were associated with employment 9 months later. Community integration and physical well-being increased for both groups. Earlier program referral was associated with larger gains in physical well-being, employment, and community integration. Conclusions: Case management appears to have beneficial effects for adults with TBI and substance abuse problems in terms of life and family satisfaction as well as to have potential cost savings. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Victimization and substance abuse among women: Contributing factors, interventions, and implications.

Although the literature indicates that there is an association of victimization with substance abuse, there has been limited research focused on understanding and synthesizing the factors that have been identified as contributing to victimization and substance abuse and on interventions designed to address these contributing factors. The purposes of this article are to (a) review the literature on factors related to victimization and substance abuse, (b) review interventions and outcomes, and (c) discuss clinical implications for interventions and research. Results suggest that there is a high rate of co-occurrence of victimization and substance abuse among women, that the factors contributing to victimization and substance abuse are complex, and that there is a lack of treatment models addressing victimization and substance abuse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Obituary: Herbert J. Freudenberger (1926-1999).

Memorializes Herbert J. Freudenberger, known for his treatment of substance abusers and supervised drug abuse training programs. His work in the free clinics and therapeutic communities led to his original development of the clinical concept of burnout. Burnout has since become a construct applied throughout psychology and incorporated into the public vocabulary. Beyond private practice and his work on addiction, he made professional contributions to the understanding of anxiety and executive stress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A prospective test of the negative affect model of substance abuse: Moderating effects of social support.

The authors tested whether dimensions of negative affect--specifically, trait levels of negative emotionality and state levels of depressive symptoms--increased risk for substance abuse onset and whether perceived social support moderated this relation using data from a 5-year prospective study of 496 school-recruited adolescent girls. Initial negative emotionality, but not depressive symptoms, and deficits in parental, but not peer, support predicted future substance abuse onset in a multivariate hazard model. Tests of the interaction between negative affect dimensions and social support suggested that support did not moderate the relation of negative affect to risk for substance abuse onset. Results provide prospective support for the etiological role in the onset of substance abuse of trait-linked negative affect and of parental support. (PsycINFO Database Record (c) 2010 APA, all rights reserved)