428 CHAPTER 9
goals are like those of motivational enhancement therapy but the enhanced mo-
tivation focuses on sticking with a specifi c type of treatment.Matching Treatment to Patient
Research sponsored by the National Institute on Alcohol Abuse and Alcoholism
studied whether some types of treatments for alcohol abuse and dependence are
more effective for certain types of people. That is, the research sought to match
treatment types and patients. Investigators compared TSF, CBT, and motivational
enhancement across variables such as gender, readiness to change, severity of
abuse, degree of cognitive impairment, and additional psychiatric problems (Proj-
ect MATCH Research Group, 1997, 1998). This large study found that patients
generally tended to improve regardless of the type of treatment; all three treatments
reduced the amount and frequency of drinking as well as of use of other drugs.
Patients who were depressed found that treatment improved their mood, and the
improved mood lasted for up to a year afterward. No matches were found between
types of patients and types of treatments. Studies of treatments for abuse of cocaine
have produced similar fi ndings regarding matching (Beck, 1999).
Although studies have not shown a neat match between specifi c types of pa-
tients and specifi c treatments, two general fi ndings have emerged: (1) For patients
who abuse more than one substance, a single treatment program that focuses on
polysubstance abuse tends to be more effective than a series of programs that
focus on one substance at a time. (2) Patients who have substance abuse or de-
pendence and another psychiatric disorder (which is true of many abusers) fared
better when the other disorder was also treated.Targeting Social Factors
Treatments that target social factors aim to change interpersonal and community
antecedents and consequences of substance abstinence and use. Antecedents might
be addressed by decreasing family tensions, increasing summer employment among
teens, and decreasing community violence. Consequences might be addressed by
increasing community support for abstinence and providing improved housing or
employment opportunities for reduced use or for abstinence.Residential Treatment
Some people who seek treatment for substance abuse may need more intensive
help, such as the assistance that can be found in residential treatment, which pro-
vides a round-the-clock therapeutic environment (such as the Betty Ford Center in
California). Because it is so intensive, residential treatment can help an individual
more rapidly change how he or she thinks, feels, and behaves; some residential
treatment programs have a spiritual component. Depending on the philosophy of
the program, various combinations of methods—targeting neurological, psycho-
logical, and social factors—may be available.Community-Based Treatment
Treatments that target social factors are usually provided in groups. One approach
focuses on providing group therapy, which typically take place in residential pro-
grams, day-treatment programs (to which patients come during the day to attend
groups and receive individual therapy but do not stay overnight), methadone clin-
ics, and drug counseling centers. In addition, there are a number of self-help groups
for people with substance abuse.Group Therapy
CBT may be used in a group format to help those with substance abuse. The group
provides peer pressure and support for abstinence (Crits-Christoph et al., 1999).
Moreover, members may use role-playing to try out new skills, such as saying “no”
to friends who offer drugs. Other types of groups include social-skills training
groups, where members learn ways to communicate their feelings and desires more(1) We admitted we were powerless over alcohol—
that our lives had become unmanageable.
(2) Came to believe that a Power greater than our-
selves could restore us to sanity.
(3) Made a decision to turn our will and our lives
over to the care of God as we understood Him.
(4) Made a searching and fearless moral inventory
of ourselves.
(5) Admitted to God, to ourselves and to another
human being the exact nature of our wrongs.
(6) Were entirely ready to have God remove all
these defects of character.
(7) Humbly asked Him to remove our shortcomings.
(8) Made a list of all persons we had harmed, and
became willing to make amends to them all.
(9) Made direct amends to such people wherever
possible, except when to do so would injure
them or others.
(10) Continued to take personal inventory and when
we were wrong promptly admitted it.
(11) Sought through prayer and meditation to im-
prove our conscious contact with God as we
understood Him, praying only for knowledge of
His will for us and the power to carry that out.
(12) Having had a spiritual awakening as the result
of these steps, we tried to carry this message to
alcoholics, and to practice these principles in all
our affairs.
Source: http://www.aa.org/en_pdfs/smf-121_en.pdf.Table 9.12 • Twelve Steps of
Alcoholics Anonymous