Evidence-based cognitive-behavioral and behavioral treatments for drug dependence
By: Tara M. Neavins,
Caroline J. Easton, Janet Brotchie and Kathleen M. Carroll
Overview
The purpose of empirical validation of psychological therapies is to identify effective treatments that assist clinicians in delivering appropriate therapies (Chambless et al., 1996; Chambless et al., 1998). In general, this review focuses on interventions classified as ‘empirically validated’ or ‘likely to be efficacious’. To be considered empirically validated, it is necessary that a given treatment demonstrate efficacy in at least two randomized controlled trials (RCTs (McGovern & Carroll, 2003)). Included studies should be methodologically sound and incorporate features such as treatment manuals, random assignment to targeted and appropriate control and treatment conditions, and use validated measures. Moreover, a treatment’s efficacy should be confirmed by at least two independent investigation teams. In contrast, to be considered ‘probably efficacious’, a treatment’s efficacy must be confirmed by at least two positive randomized clinical trials with a waiting list control group, a small series of single case experiments, or one or more experiments meeting criteria for empirical validation but not by independent teams. Although this framework has generated considerable controversy, this model afforded a standard by which to compare treatments (McGovern & Carroll, 2003).Psychological therapies and amphetamine and methamphetamine dependence
Given the relative ease with which amphetamines and methamphetamines can be manufactured and the minimal cost involved in doing so, it is not surprising that amphetamine and methamphetamine dependence are commonplace (World Health Organization, 2001). Despite the prevalence of amphetamine and methamphetamine dependence, no empirically validated pharmacological and only one empirically validated behavioral treatment of methamphetamine dependence currently exists (Rawson et al., 2004; World Health Organization, 2001).
Baker et al.
(2001) conducted a randomized controlled trial of brief psychological
treatments for regular amphetamine users (individuals who used one or more
times per month).
Amphetamine users were assigned to one of three conditions:
(1) four sessions of CBT (including Motivational Interviewing [MI],
relapse-prevention, skills training, coping with cravings) plus a self-help
booklet,
(2) two sessions of CBT (including a motivational interview and skills
training) plus a self-help booklet, or
(3) an assessment and a self-help booklet.
Overall, all participants, irrespective of treatment
assignment, reduced their amphetamine use throughout the course of the
study. Participants in either of the CBT conditions reported more than two times
less daily
amphetamine use than participants in the self-help booklet (control) condition.
In addition, at 6-month follow-up, a significantly greater number of
individuals in the CBT conditions were abstinent from amphetamine use as
compared with the control condition.
Although efficacious behavioral treatments for amphetamine
dependence need considerable investigation, the Matrix Model (a
manualized, intensive, 16-session treatment which broadens CBT by supplementing
it with family education, drug
education, and Alcoholics or Narcotics Anonymous meetings) offers some promise for methamphetamine abuse
and dependence (Huber et al., 1997; Rawson et
al., 2004) after successful use with cocaine addicts (Rawson et
al., 1991, 1995). In the biggest randomized
clinical trial in existence for methamphetamine dependence, Rawson et
al. (2004) randomized 978 methamphetamine users at eight
sites to one of two outpatient treatment conditions:
(1) the Matrix Model or
(2) a control condition (standard treatment).
The superiority of the Matrix Model, as evidenced by a higher percentage
of treatment
sessions attended, longer involvement in treatment, greater number of methamphetamine-negative
urines, and more days of
methamphetamine abstinence, was observed during the treatment phase. However,
patients showed less
drug use and greater functioning in both conditions when the treatment ended and at 6-
month follow-up. That
is, the Matrix Model was not significantly better than standard treatment at
the end of treatment
or at 6-month follow-up.
Low-cost contingency management of amphetamine and methamphetamine dependence Petry
et al. (2005) randomly
assigned 415, outpatient substance abuse treatment, methamphetamine (or
cocaine) users to either standard treatment or contingency management (CM;
based on providing
substance-free urine specimens) and standard treatment. This
study was unique in that it was run across eight community-based agencies.
Participants in the CM plus standard
treatment condition stayed in treatment longer, attended more counseling sessions,
produced more substance-free urine specimens (in terms of alcohol, cocaine, and
methamphetamines), and achieved abstinence for longer periods of the 12-week study.
Surprisingly, the two
groups did not differ in terms of the percentage of urine specimens which were positive for
substances. These
researchers found this treatment to be very cost-effective and noted that the average amount
spent on incentives per
individual was only $203.
Building upon the earlier work of Petry et
al. (2005), Peirce et
al. (2006) conducted a multi-site
investigation at six methadone
maintenance treatment programmes in various community settings. A total of 388
participants, over 80% of whom were
abusing or dependent upon cocaine, methamphetamines, and/or amphetamines (as well as heroin) were
randomized either to CM (based on submitting alcohol-free breathalyzer readings and
urine samples free of cocaine,
methamphetamines, or amphetamines) or a non-CM (standard treatment) condition during the 12-week
study. Among the most significant study findings, Peirce et
al. observed that the CM group was two times more apt
as the standard treatment condition to produce alcohol-free and stimulant-free
(cocaine, methamphetamines, and
amphetamines) urine specimens. Overall, CM participants had 11 times greater
chance of remaining abstinent
from stimulants than standard treatment participants. No differences were found
between the two groups
with regard to remaining in the study or attending sessions. Furthermore, the average
cost per
participant (i.e. $120/day) was approximately 40% less than that found by Petry et
al. (2005).
References
Peter
Tyrer and Kenneth R. Silk, Cambridge Textbook of Effective Treatments in
Psychiatry, Cambridge University Press 2008.
Read Also
An Introduction and Conclusions to Psychological treatments of alcohol use disordersEducational interventions for alcohol use disorders
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Combined pharmacotherapy and psychotherapy for alcohol use disorders
An Introduction to Pharmacotherapy of alcohol misuse, dependence and withdrawal
Treatment of sedative-hypnotic dependence
Treatment of nicotine dependence
Treatment of co-occurring psychiatric and substance use disorders
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