Abnormal Psychology

Substance Use Disorders 427

(including cravings) to drug-related cues (see Chapter 4 for a detailed discussion

of extinction). Treatment may also focus on decreasing the frequency or inten-

sity of emotional distress, which can contribute to relapse (Vuchinich &

Tucker, 1996). One way treatment can help patients regulate emo-

tional distress is by helping them develop healthier coping skills,

which will then increase self-control. Thus, many of the CBT methods

used to treat depression and anxiety can be effective here; methods include

self-monitoring, cognitive restructuring, problem solving, and vari-

ous relaxation techniques.

Once (former) users come to understand the antecedents and conse-

quences of their substance use and have developed alternative behaviors,

they might be asked to complete a form that contains items like those in

Table 9.11—which will help consolidate their ability to make healthier

choices and prevent relapse.

Initially, CBT may focus narrowly on the substance use itself—that

is, on how the patient copes when he or she has thoughts about using

the substance. Later, the treatment expands to focus on related problem

areas, such as employment or relationship diffi culties.

Twelve-Step Facilitation (TSF)

Twelve-step facilitation (TSF) is based on the twelve steps or principles that form the

basis of Alcoholics Anonymous (AA) (see Table 9.12). AA views alcohol abuse as a

disease that can never be cured, although alcohol- related behaviors can be modifi ed

by the alcoholic’s recognizing that he or she has lost control and is powerless over

alcohol, turning to a higher power for help, and seeking abstinence. Research sug-

gests that the AA approach can help those who are trying to stop their substance

abuse (Laffaye et al., 2008).

AA’s groups are leaderless, whereas TSF’s groups are led by mental health pro-

fessionals, whose goal is to help group members become ready to follow the twelve

steps of AA. The twelve-step model has been used by those with narcotic abuse

and dependence (Narcotics Anonymous, NA) and in numerous inpatient and out-

patient treatment programs run by mental health professionals (Ries et al., 2008).

Twelve-step facilitation targets motivation to adhere to the steps. In essence, its

9.12 • Abstinence Reinforcement Among

Cocaine Users This graph illustrates the results of a

21-week study with cocaine users on the effects of reinforcing

abstinence with vouchers. When patients’ abstinence was

reinforced with vouchers—compared to patients in a control

group whose abstinence was not reinforced—they were more

likely to stop using the drug. The abstinence reinforcement

group and the control group were signifi cantly different in

their cocaine use in weeks 3–12 of the voucher period and weeks

1 and 4 of the postintervention period.

Source: Silverman et al., 2001. Copyright 2001 by the American Medical

Association. For more information see the Permissions section.

Figure 9.12g9

0

20

40

60

80

100

12345

Baseline

period

Voucher period

Study week

Postintervention

period

Participants abstaining from

cocaine use (percentage)

1234567891011121234

Abstinence reinforcement group

Control group

When making any decision, whether large or small, do the

following:

• Consider all the options you have.


• Think about all the consequences, both positive and nega-
  tive, for each of the options.


• Select one of the options. Pick a safe decision that mini-
  mizes your risk of relapse.


• Watch for “red fl ag” thinking—thoughts like “I have to.. .”
  or “I can handle.. .” or “It really doesn’t matter if... .”
  Practice monitoring decisions that you face in the course
  of a day, both large and small, and consider safe and risky
  alternatives for each.
  Sources: http://www.drugabuse.gov/TXManuals/CBT/CBTX8.html; adapted
  from Monti et al., 1989.

Table 9.11 • Decision Monitoring