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Overcoming Alcohol Use Problems: A Cognitive-Behavioral Treatment Program Therapist Guide: A Cognitive-behavioural Treatment Program
Problems with alcohol use are common and often occur with other psychological and social problems as well. Left untreated, alcohol use disorder can have significant impact on a person's functioning, health, and relationships. This cognitive-behavioral treatment has been scientifically proven to help individuals achieve and maintain abstinence. The treatment protocol has been developed with the benefit of each author's 25+ years of clinical experience in treating substance abusers; it is user-friendly and easy to deliver in a clinically meaningful way. Rooted in the client's individualized assessment and life context, the program can be tailored to gender-specific issues and personal needs. The 12-session program is comprised of interventions to help the client stop drinking and prevent relapse. The client becomes aware of his or her drinking patterns and triggers through self-recording. Each session involves skill training and anticipating high-risk situations. The client learns how to manage triggers, deal with urges to drink, rearrange behavioral consequences, challenge alcohol-related thoughts and refuse drinks. Additional treatment components include managing anxiety and depression, building social support, assertiveness training, anger management, and problem solving. This therapist guide provides detailed instructions for conducting each session, sample dialogues, and completed examples of forms. Introductory chapters offer important background information, a discussion of clinical issues, and recommendations for assessment and determining the level of care. The corresponding workbook allows the client to follow along with the information prsented in session and includes forms for homework. Overcoming alcohol problems is an attainable goal with this effective and comprehensive program.TreatmentsThatWorkTM represents the gold standard of behavioral healthcare interventions!� All programs have been rigorously tested in clinical trials and are backed by years of research� A prestigious scientific advisory board, led by series Editor-In-Chief David H. Barlow, reviews and evaluates each intervention to ensure that it meets the highest standard of evidence so you can be confident that you are using the most effective treatment available to date� Our books are reliable and effective and make it easy for you to provide your clients with the best care available� Our corresponding workbooks contain psychoeducational information, forms and worksheets, and homework assignments to keep clients engaged and motivated� A companion website (www.oup.com/us/ttw) offers downloadable clinical tools and helpful resources� Continuing Education (CE) Credits are now available on select titles in collaboration with PsychoEducational Resources, Inc. (PER)
258 pages, Kindle Edition
First published January 1, 2009
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September 29, 2020”Interventions over the course of 12 sessions help the client achieve the primary goal of abstinence from drinking. Through self-recording, the client identifies his or her drinking patterns and triggers. With the therapist’s assistance, the client anticipates high-risk situations and plans for dealing with urges to drink. Additional treatment components include coping with anxiety and depression, building social support, assertiveness training, anger management, and problem solving. Extensive relapse prevention helps the client maintain gains and prepares the client for handling slips and relapses.
Other substance use disorders, depression, and anxiety disorders are most common and are found in as many as 60% of males in treatment. The most common Axis II disorder in men with an AUD is antisocial personality disorder, with rates ranging from 15% to 50%. Females are more likely than men to have mood disorders, and one-quarter to a third of women with AUDs have a mood disorder prior to the onset of their alcoholism. The most common Axis II diagnosis among alcohol-dependent women is borderline personality disorder. These individuals may also have problems with their employment, their interpersonal relationships, and the criminal justice system. Cognitive deficits in the areas of abstract reasoning, memory, and problem solving are most common (Bates, Bowden, & Barry, 2002). Interpersonal relationships also may be disrupted. The rates of separation and divorce are elevated, spousal violence is higher in both men and women with AUDs (Drapkin, McCrady, Swingle, & Epstein, 2005), and their spouses and children are more likely to have physical or emotional problems (Moos & Billings, 1982; Moos, Finney, & Gamble, 1982).
Comprehensive reviews of the efficacy of different treatment approaches suggest that there are good efficacy data for brief interventions, social skills training, the community reinforcement approach, behavioral contracting, behavioral couple therapy, case management, opiate antagonists such as naltrexone and nalmefene, and acamprosate (Miller & Wilbourne, 2002). In CBT, we see substance use disorders as multiply determined, complex behaviors (Hesselbrok, Hesselbrock, & Epstein, 1999), but CBT approaches focus primarily on factors maintaining the alcohol-use problems. Specifically, excessive drinking is treated as a habit, an overlearned behavior that can be unlearned. Classic CBT interventions are explicated in this manual and are organized around three major elements: motivational enhancement, functional 8 analysis as a guiding framework for behavior change, and relapse prevention.
The therapist should treat the client with respect and as a person of value. Expressing interest in the client’s emotional experiences and welfare, as well as the details of the client’s daily life, is part of valuing the client. The use of some motivational interviewing strategies (see Miller & Rollnick, 2002 for details) is appropriate, particularly reflective listening, empathy, and “rolling with resistance,” but the therapy is skills-based rather than motivationally based, so these basic therapeutic skills are combined with specific, structured aspects of the therapy.
Highlight the importance of homework implicitly by always remembering to review assigned and completed homework carefully and in a clinically meaningful way so that clients feel reinforced
Be aware that not completing homework may be indicative of a deeper ambivalence toward therapy or stopping drinking. Begin to explore this from a position of concern for the client’s anxiety about giving up drinking, of desiring to understand his experience of the therapy, and of acknowledging that changes often are unsettling to an intimate relationship. Not addressing homework noncompliance can result in therapy attrition.
CBT homework is in fact to help the client “slow down the process of automatic behavior, or habits” so that they become easier to identify and control.
In the CBT model, continued assessment and a feedback loop throughout treatment are important aspects of the treatment. These are accomplished through daily drinking logs completed by clients throughout the program that are reviewed each week at the beginning of the session.
Level of care determination depends on several variables, including need for medically supervised detoxification (see previous information) based on severity of recent alcohol problem, medical history, and history of withdrawal symptoms, psychiatric problems, past treatment experiences, support network, insurance considerations, and client preference (see Kadden & Skerker, 1999). In general, the treatment model in this guide is appropriate (1) as an aftercare program for clients who need a medically supervised detoxification initially to safely eliminate alcohol from their system, or (2) for clients who do not need or refuse a detoxification program but meet criteria for alcohol abuse or dependence or who are considered to be heavy drinkers because they drink more than 14 (for women) and 21 (for men) standard drinks per week (U.S. Department of Health and Human Services, National Institute of 48 Health, 2003), or (3) for clients who do not need inpatient or intensive outpatient treatment.
In all three cases, clients should not have uncontrolled current psychiatric symptoms such as psychosis, mania, or suicidal ideation with intent or plan and should not have recent history of non–alcohol-related domestic violence.
Alcohol-Related Skills:
1. Understanding alcohol in a different way (standard drinks, blood alcohol level, as a toxin that affects you medically, etc.)
2. Self-recording cravings and drinking, linking to triggers
3. Identifying and becoming more aware of triggers
4. Drinking behavior chains: thinking through the drink
5. Self-management planning to cope with triggers, including heavy drinkers in your social network
6. Self-control procedures using your thoughts: thinking about negative consequence of drinking, challenging and replacing positive thoughts about alcohol
7. Positive alternatives to drinking: using your former drinking time to do fun things without the use of alcohol and making sober life fun and satisfying
8. Drink-refusal skills
9. Relapse-prevention strategies: identifying seemingly irrelevant decisions, anticipating and planning for upcoming high-risk situations, identifying and managing warning signs for relapse, coping with slips or relapses
General Coping Skills
1. Understanding and coping with sadness and anxiety
2. Challenging and replacing negative thoughts to better control your emotions
3. Connecting with others
4. Assertiveness
5. Anger management
6. Problem solving”
Other substance use disorders, depression, and anxiety disorders are most common and are found in as many as 60% of males in treatment. The most common Axis II disorder in men with an AUD is antisocial personality disorder, with rates ranging from 15% to 50%. Females are more likely than men to have mood disorders, and one-quarter to a third of women with AUDs have a mood disorder prior to the onset of their alcoholism. The most common Axis II diagnosis among alcohol-dependent women is borderline personality disorder. These individuals may also have problems with their employment, their interpersonal relationships, and the criminal justice system. Cognitive deficits in the areas of abstract reasoning, memory, and problem solving are most common (Bates, Bowden, & Barry, 2002). Interpersonal relationships also may be disrupted. The rates of separation and divorce are elevated, spousal violence is higher in both men and women with AUDs (Drapkin, McCrady, Swingle, & Epstein, 2005), and their spouses and children are more likely to have physical or emotional problems (Moos & Billings, 1982; Moos, Finney, & Gamble, 1982).
Comprehensive reviews of the efficacy of different treatment approaches suggest that there are good efficacy data for brief interventions, social skills training, the community reinforcement approach, behavioral contracting, behavioral couple therapy, case management, opiate antagonists such as naltrexone and nalmefene, and acamprosate (Miller & Wilbourne, 2002). In CBT, we see substance use disorders as multiply determined, complex behaviors (Hesselbrok, Hesselbrock, & Epstein, 1999), but CBT approaches focus primarily on factors maintaining the alcohol-use problems. Specifically, excessive drinking is treated as a habit, an overlearned behavior that can be unlearned. Classic CBT interventions are explicated in this manual and are organized around three major elements: motivational enhancement, functional 8 analysis as a guiding framework for behavior change, and relapse prevention.
The therapist should treat the client with respect and as a person of value. Expressing interest in the client’s emotional experiences and welfare, as well as the details of the client’s daily life, is part of valuing the client. The use of some motivational interviewing strategies (see Miller & Rollnick, 2002 for details) is appropriate, particularly reflective listening, empathy, and “rolling with resistance,” but the therapy is skills-based rather than motivationally based, so these basic therapeutic skills are combined with specific, structured aspects of the therapy.
Highlight the importance of homework implicitly by always remembering to review assigned and completed homework carefully and in a clinically meaningful way so that clients feel reinforced
Be aware that not completing homework may be indicative of a deeper ambivalence toward therapy or stopping drinking. Begin to explore this from a position of concern for the client’s anxiety about giving up drinking, of desiring to understand his experience of the therapy, and of acknowledging that changes often are unsettling to an intimate relationship. Not addressing homework noncompliance can result in therapy attrition.
CBT homework is in fact to help the client “slow down the process of automatic behavior, or habits” so that they become easier to identify and control.
In the CBT model, continued assessment and a feedback loop throughout treatment are important aspects of the treatment. These are accomplished through daily drinking logs completed by clients throughout the program that are reviewed each week at the beginning of the session.
Level of care determination depends on several variables, including need for medically supervised detoxification (see previous information) based on severity of recent alcohol problem, medical history, and history of withdrawal symptoms, psychiatric problems, past treatment experiences, support network, insurance considerations, and client preference (see Kadden & Skerker, 1999). In general, the treatment model in this guide is appropriate (1) as an aftercare program for clients who need a medically supervised detoxification initially to safely eliminate alcohol from their system, or (2) for clients who do not need or refuse a detoxification program but meet criteria for alcohol abuse or dependence or who are considered to be heavy drinkers because they drink more than 14 (for women) and 21 (for men) standard drinks per week (U.S. Department of Health and Human Services, National Institute of 48 Health, 2003), or (3) for clients who do not need inpatient or intensive outpatient treatment.
In all three cases, clients should not have uncontrolled current psychiatric symptoms such as psychosis, mania, or suicidal ideation with intent or plan and should not have recent history of non–alcohol-related domestic violence.
Alcohol-Related Skills:
1. Understanding alcohol in a different way (standard drinks, blood alcohol level, as a toxin that affects you medically, etc.)
2. Self-recording cravings and drinking, linking to triggers
3. Identifying and becoming more aware of triggers
4. Drinking behavior chains: thinking through the drink
5. Self-management planning to cope with triggers, including heavy drinkers in your social network
6. Self-control procedures using your thoughts: thinking about negative consequence of drinking, challenging and replacing positive thoughts about alcohol
7. Positive alternatives to drinking: using your former drinking time to do fun things without the use of alcohol and making sober life fun and satisfying
8. Drink-refusal skills
9. Relapse-prevention strategies: identifying seemingly irrelevant decisions, anticipating and planning for upcoming high-risk situations, identifying and managing warning signs for relapse, coping with slips or relapses
General Coping Skills
1. Understanding and coping with sadness and anxiety
2. Challenging and replacing negative thoughts to better control your emotions
3. Connecting with others
4. Assertiveness
5. Anger management
6. Problem solving”
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