Clinician Administered Treatment Resources

General Treatment Recommendations and Resources

The goal of most treatment programs is abstinence, whereby any substance use (even in moderation) is considered a treatment failure. However, moderation can also be a goal, which allows for more flexibility in treatment. If the patient lapses it provides an opportunity for him or her to learn, without the guilt associated with failure to meet an abstinence treatment goal. Harm reduction goals are based on each individual's unique substance-related consequences, severity of substance abuse or dependence, self-efficacy, and beliefs about substance use. For example, the goal may be to stop drinking while under the influence. If this goal is achieved then treatment may target reducing substance use. (source Marlatt, G.A., & Witkiewitz, K. (in press). Substance Use Disorders. In J. E. Fisher & W. T. O'Donohue (Eds.), Practice Guidelines for Evidence Based Psychotherapy. New York: Springer Publishing Company). Research has shown that a harm reduction approach is effective for helping young adults reduce problematic drinking. More

Harm Reduction Therapy
Harm Reduction Therapy Center Approaches substance abuse from a belief that addiction develops in each individual from a unique interaction of biological, psychological, and social factors.

NIDA's Clinical Toolbox National Institute on Drug Abuse
Science-based materials for drug abuse treatment.

Good Things & Not So Good Things About Recovery
Created with support from the National Institute on Drug Abuse
Information for therapists who lead groups in substance dependence recovery.

Seeking Safety: A Treatment Manual for PTSD and Substance Abuse L.M. Najavits A manual for teaching trauma-related coping skills, including comorbid PTSD and substance abuse.

Motivational Interviewing: Preparing People for Change
W.R. Miller & S. Rollnick
A useful resource to help patients reduce ambivalence and increase their readiness to change.

Relapse Prevention, 2nd Ed: Maintenance Strategies in the Treatment of Addictive Behaviors
G. A. Marlatt and D. M. Donovan (Editors)
This is a useful resource for preventing relapse to a variety of substances.

Primary Care Strategies to Foster Male Health Care Seeking
Courage to Care Fact Sheet for Providers

Treatment for Alcohol Use Disorders

The American Psychological Associations, Division 12, Society of Clinical Psychology, notes that the following treatments have been shown to be effective for serious alcohol problems:

Community Reinforcement Approach
Developed for the Behavioral Health Recovery Management project, this comprehensive behavioral program for treating substance-abuse problems has been developed as an introduction to clinicians caring for patients who present for drug and/or alcohol treatment.

Cue Exposure Treatment (CET)
Exposes a patient to alcohol-related cues and allows the patient to practice responses to these cues in real-life situations. CET also teaches a variety of coping skills for dealing with urges.

Behavioral Couples Therapy for Alcoholism and Drug Abuse The purpose of Behavioral Couples Therapy (BCT) is to build support for abstinence and to improve relationship functioning among married or cohabiting individuals seeking treatment for alcoholism or drug abuse.

Social skills training
Social skills training is a common component of substance abuse treatment programs and is intended to assist drug/alcohol users to function more effectively in social situations. Miller (1992) defined social skills training as focusing on teaching more effective communication skills to improve interpersonal relationships.

Treatment for Illicit Drug Use Disorders

The American Psychological Associations, Division 12, Society of Clinical Psychology, notes that cognitive behavioral treatments have been shown to be effective for illicit drug related disorders. Cognitive-behavioral treatments often focus on identifying maladaptive behavioral patterns related to drug use and implement self-monitoring, psychoeducation, cognitive-restructuring, coping skills training, and relapse prevention (source Marlatt, G.A., & Witkiewitz, K. (in press). Substance Use Disorders. In J. E. Fisher & W. T. O'Donohue (Eds.), Practice Guidelines for Evidence Based Psychotherapy. New York: Springer Publishing Company). Make this a link to reference b/c it's not cited in the APA Division 12 publication.

A Cognitive-Behavioral Approach: Treating Cocaine Addiction Attempts to help patients recognize the situations in which they are most likely to use cocaine, avoid these situations when appropriate, and cope more effectively with a range of problems and behaviors associated with substance abuse.

Professional Journal Resources for Subscribers

Behavior therapy for cocaine abuse
Higgins, S.T., Budney, A.J., Bickel, W.K., Hughes, J.R., Foeg, F., & Badger, G. (1993).
Achieving cocaine abstinence with a behavioral approach. American Journal of Psychiatry, 150, 763-769.

Cognitive-behavior therapy for benzodiazepine withdrawal in panic disorder patients Otto, M.W., Pollack, M.H., Sachs, G.S., Reiter, S.R., Meltzer-Brody, S., Rosenbaum, J.F. (1993)
Discontinuation of benzodiazepine treatment: Efficacy of cognitive behavioral therapy for patients with panic disorder. American Journal of Psychiatry, 150, 1485-1490; Spiegel, D.A., Bruce, T.J., Gregg, S.F., & Nuzzarello, A. (1994). Does cognitive behavior therapy assist slow-taper alprazolam discontinuation in panic disorder? American Journal of Psychiatry, 151, 876-881.

Cognitive-behavior therapy for benzodiazepine withdrawal in panic disorder patients Otto, M.W., Pollack, M.H., Sachs, G.S., Reiter, S.R., Meltzer-Brody, S., Rosenbaum, J.F. (1993)
Discontinuation of benzodiazepine treatment: Efficacy of cognitive behavioral therapy for patients with panic disorder. American Journal of Psychiatry, 150, 1485-1490; Spiegel, D.A., Bruce, T.J., Gregg, S.F., & Nuzzarello, A. (1994). Does cognitive behavior therapy assist slow-taper alprazolam discontinuation in panic disorder? American Journal of Psychiatry, 151, 876-881.

Treatment for Tobacco Use Disorders

The American Psychological Associations, Division 12, Society of Clinical Psychology, notes that several treatments have been shown to be effective for smoking cessation:

Multi-Component Cognitive-Behavior Therapy With Relapse Prevention for Smoking Cessation
Cognitive-behavioral treatments often focus on identifying maladaptive behavioral patterns related to drug use and implement self-monitoring, psychoeducation, cognitive-restructuring, coping skills training, and relapse prevention (source Marlatt, G.A., & Witkiewitz, K. (in press). Substance Use Disorders. In J. E. Fisher & W. T. O'Donohue (Eds.), Practice Guidelines for Evidence Based Psychotherapy. New York: Springer Publishing Company).

References:

Cinciripini, P.M., Lapitsky, L.G., Seay, S., Wallfisch, A., Kitchens, K., & van Vunakis, H. (1995). The effects of smoking schedules on cessation outcome: Can we improve on common methods of gradual and abrupt nicotine withdrawal? Journal of Consulting and Clinical Psychology, 63, 388-399.
Cinciripini, P.M., Lapitsky, L.G., Wallfisch, A., Mace, R., Nezami, E., & van Vunakis, H. (1994). An evaluation of a multicomponent treatment program involving scheduled smoking and relapse prevention procedures: Initial findings. Addictive Behaviors, 19, 13-22.

Scheduled, Reduced Smoking Adjunctive to Multi-Component Behavior Therapy for Smoking Cessation& Scheduled, reduced smoking involves gradually decreasing cigarette use on a fixed schedule.

References:

Hill, R.D., Rigdon, M., & Johnson, S. (1993). Behavioral smoking cessation treatment for older chronic smokers. Behavior Therapy, 24, 321-329.
Stevens, V.J., & Hollis, J.F. (1989). Preventing smoking relapse, using an individually tailored skills-training technique. Journal of Consulting and Clinical Psychology, 57 , 420-424.)

Pharmacological Treatments

There are a number of pharmacological treatments for substance use disorders. The Veterans Health Administration and Department of Defense Clinical Practice Guideline for Substance Use Disorders summarizes pharmacotherapy for alcohol and opioid dependence on page 9 (source VHA/DoD clinical practice guideline for the management of substance use disorders) Nicotine replacement therapy and bupropion SR are considered first line treatments for nicotine dependence. (Source VA/DoD clinical practice guideline for the management of tobacco use.)

Web Sites

Patient Feedback: A Performance Improvement Resource
The University of Pennsylvania, Treatment Research Center
Offers a variety of resources for clinicians related the assessment and treatment of Substance Use Disorders.

National Institute on Drug Abuse
Provides a number of clinician resources. For information related to substance use and clinical practice. For Principles of Drug Addiction Treatment: A Research Based Guide

Substance Abuse and Mental Health Service Administration (SAMHSA)
Provides a variety of information related to substance use problems.

U.S. Department of Health and Human Services and SAMHSA's National Clearinghouse for Alcohol and Drug Related Information
Request publications, find facts and statistics, order videos and other multimedia, and access additional drug resources. Search by drug, consumer, and media type, to access the specific information needed quickly.

National Institute on Alcohol Abuse and Alcoholism
National Institutes of Health
Resources for alcohol-related problems.

Motivational Interviewing
Mid-Atlantic Addiction Technology Transfer Center
Provides details about the approach, as well as links, training resources, and information about reprints and research on motivational interviewing.