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EMPIRICALLY-SUPPORTED TREATMENTS FOR STIMULANT DEPENDENCE

EMPIRICALLY-SUPPORTED TREATMENTS FOR STIMULANT DEPENDENCE. RICHARD A. RAWSON, Ph.D. UCLA INTEGRATED SUBSTANCE ABUSE PROGRAMS (ISAP) October 9, 2004. Behavioral/Cognitive Behavioral Treatments. Cognitive/Behavioral Therapy-CBT Motivational Interviewing-MI Contingency Management-CM

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EMPIRICALLY-SUPPORTED TREATMENTS FOR STIMULANT DEPENDENCE

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  1. EMPIRICALLY-SUPPORTED TREATMENTS FOR STIMULANT DEPENDENCE RICHARD A. RAWSON, Ph.D. UCLA INTEGRATED SUBSTANCE ABUSE PROGRAMS (ISAP) October 9, 2004

  2. Behavioral/Cognitive Behavioral Treatments • Cognitive/Behavioral Therapy-CBT • Motivational Interviewing-MI • Contingency Management-CM • Community Reinforcement Approach-CRA • Matrix Model of Outpatient Treatment

  3. Cognitive Behavioral Therapy • Based upon Social Learning Theory (Bandura and others) • Also referred to as Relapse Prevention Therapy • Applied to treatment of alcoholism, cocaine dependence, nicotine dependence and marijuana abuse.

  4. Cognitive Behavioral Therapy • Key Concepts • Encouraging and reinforcing behavior change • Recognizing and avoiding high risk settings • Behavioral planning (scheduling) • Coping skills • Conditioned “triggers” • Understanding and dealing with craving • Abstinence violation effect • Understanding basic psychopharmacology principles • Self-efficacy

  5. Cognitive Behavioral Therapy • Resources • Marlatt and Gordon 1985 • NIDA CB Manual • NIAAA Project Match CB Manual • Gorski Publications • Washton Publications

  6. Motivational Interviewing • Based upon Prochaska and DiClemente Stages of Change Theoretical Model • Also referred to as Motivational Enhancement Therapy • Applied with many substances, data primarily with alcoholics • Major Publications/Studies: Miller and Rollnick, 1991; Project MATCH

  7. Motivational Interviewing • Basic Assumptions • People change their thinking and behavior according to a series of stages • Individuals may enter treatment at different “stages of change” • It is possible to influence the natural change process with MI techniques • MI can be used to engage individuals in longer term treatment and to promote specific behavior changes • Confrontation of “denial” can be counterproductive and or harmful to some individuals

  8. Motivational Interviewing • Key Concepts • Empathy and therapeutic alliance • Give feedback and reframe • Create dissonance • Focus of discrepancy of expected and actual • Reinforce change • Roll with resistance

  9. Motivational Interviewing • Resources • Miller and Rollnick 1991 • NIAAA Project MATCH manual • CSAT TIP on Motivational Techniques • NIDA Tool Box

  10. Community Reinforcement Approach • Basic assumptions • Drug and alcohol use are positively reinforced behaviors. They can be reduced/eliminated by proper application of behavioral techniques. • To successfully build an effective intervention, some techniques should focus on reducing drug and alcohol use and others should focus on acquisition of new incompatible behaviors.

  11. Community Reinforcement Approach • Key concepts • Behavioral analysis and teach conditioning information • Positive reinforcement with vouchers for drug free urine samples • Behavioral marriage counseling • Shape and reinforce new behavioral repertoire • Coping skill/Drug refusal skill training • Vocational Counseling • Frequent urine testing

  12. Community Reinforcement Approach • Resources • Meyers and Smith 1995 • NIDA CRA Manual • Higgins and Silverman 2000

  13. Contingency Management • Basic Assumptions • Drug and alcohol use behavior can be controlled using operant reinforcement procedures • Vouchers can be used as proxy’s for money or goods • Vouchers should be redeemed for items incompatible with drug use • Escalating the value of the voucher for consecutive weeks of abstinence promotes better performance • Counseling/therapy may or may not be required in conjunction with CM procedure

  14. Contingency Management • Key concepts • Behavior to be modified must be objectively measured • Behavior to be modified (e.g. urine test results) must be monitored frequently • Reinforcement must be immediate • Penalties for unsuccessful behavior (e.g. positive UA) can reduce voucher amount • Vouchers may be applied to a wide range of pro-social alternative behaviors

  15. Matrix ModelAn Integrated, Empirically-based, Manualized Treatment Program

  16. Matrix Model of Outpatient Treatment Organizing Principles of Matrix Treatment • Create explicit structure and expectations • Establish positive, collaborative relationship with patient • Teach information and cognitive-behavioral concepts • Positively reinforce positive behavior change

  17. Matrix Model of Outpatient Treatment Organizing Principles of Matrix Treatment (cont.) • Provide corrective feedback when necessary • Educate family regarding stimulant abuse recovery • Introduce and encourage self-help participation • Use urinalysis to monitor drug use

  18. Elements of the Matrix Model • Engagement/Retention • Structure • Information • Relapse Prevention • Family Involvement • Self Help Involvement • Urinalysis/Breath Testing

  19. The Matrix Model • Urine or breath alcohol tests once per week, weeks 1-16

  20. Matrix Model: Resources • Matrix Treatment Manual (Matrix Institute, www.matrixinstitute.org • CSAT TIP 33 • CSAT TAP Matrix Manual

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