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 cannabis dependence
Although it is the most commonly used illicit substance, treatment of cannabis dependence is a comparatively understudied area to date, in part, because relatively few individuals present for treatment with a primary complaint of cannabis dependence. No effective pharmacotherapies for cannabis dependence exist, and only a few controlled trials of psychosocial approaches have been completed for adults (Budney et al., 1997; Stephens et al., m1994). In their innovative study using vouchers, Budney et al. (2000) randomly assigned outpatients to one of three interventions:
(1) Motivational enhancement (MET),
(2) MET plus behavioral coping skills therapy (MBT), or
(3) a combination of the first two approaches plus voucher-based incentives (MBTV).
(2) MET plus behavioral coping skills therapy (MBT), or
(3) a combination of the first two approaches plus voucher-based incentives (MBTV).
Overall, the MBTV intervention was the most successful
approach as noted by greater marijuana abstinence both during and after
treatment. There were no significant differences in patient outcomes between
the MET and MBT conditions. Stephens et al.
(2000) compared a delayed treatment control, a two-session motivational approach, and a
more intensive
(14-session) relapse prevention approach. These investigators found better
cannabis outcomes for the two active treatments compared with the delayed-treatment
control group but no
significant differences between the brief and the more intensive treatment. More recently,
a replication
and extension of the Stephens study (Stephens et
al., 2000) involving a multisite trial of 450
adult cannabis-dependent patients, compared three approaches:
(1) a delayed treatment control,
(2) a 2-session motivational approach, and
(3) a 9-session combined motivational/coping skills (case
management)/CBT approach (The Marijuana Treatment Research Project Group, 2004).
There were four assessment periods: baseline, 4-month, 9-month, and 15-months.
Results suggested that both active treatments were
associated with significantly greater reductions in marijuana use than the delayed treatment control through the
15-month follow-up. In addition, the 9-session intervention was significantly more
effective than the 2-session
intervention. Moreover, this effect also was sustained through the 15-month follow-up.
Psychotherapy approaches and cannabis dependence amongst Young adults (ages 18–25 years old)
Drug dependence amongst young adults has begun to receive greater attention in recent years with the vast majority of clinical trials aimed at addressing marijuana use. Sinha et al. (2003), for example, compared a three session motivational enhancement therapy (MET only) with a three-session MET and contingency management therapy (MET/CM). In the CM condition, individuals were given vouchers as a reward for attending treatment. Sixty five, primarily cannabis-dependent, probation-referred patients, between the ages of 18 to 25 years, were randomly assigned to one of the two conditions. These investigators found that treatment completion was significantly higher in the MET/CM condition than in the MET only condition. Participants in both conditions had significantly less cannabis usage and fewer legal problems than they did before this brief treatment.
Carroll et al.
(2006) recently studied 136 marijuana dependent 18- to 25-year-olds who were
all referred by the Office of Adult
Probation. Individuals were randomly assigned to one of four treatment modalities:
(1) Motivational enhancement therapy/cognitive-behavioral
therapy (MET/CBT) in addition to
voucher-based contingency management (CM) based either on attending therapy
sessions or providing urine samples free of marijuana,
(2)
MET/CBT alone,
(3)
Individual drug counseling (DC) in addition to CM, and
(4)
DC alone. Four primary findings emerged.
First,
individuals assigned to CM stayed in the study longer and were more apt to
provide cannabis-free urine samples than were individuals who were not assigned
to CM. Second, the MET/CBT plus CM condition was superior to all other study
treatment modalities in terms of promoting greater study session attendance,
consecutive urine samples free of cannabis, and likelihood of having at least
one cannabis-free urine sample during the study. Third, these same outcome
measures were significantly worse for individuals in the DC alone condition.
Finally, individuals in either MET/CBT condition were able to maintain their
treatment gains by continuing to use
cannabis less frequently at 6- month follow-up than they did pre-treatment
References
Peter
Tyrer and Kenneth R. Silk, Cambridge Textbook of Effective Treatments in
Psychiatry, Cambridge University Press 2008.
Read Also
Psychological therapies and amphetamine and methamphetamine dependenceAn Introduction and Conclusions to Psychological treatments of alcohol use disorders
Educational interventions for alcohol use disorders
Complex interventions for alcohol use disorders
Alcoholics Anonymous
The Minnesota model of care for alcohol use disorders
Therapeutic communities for alcohol use disorders
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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