individual sessions with a primary counselor to group
sessions with peers and counselors. In addition to inpa-
tient and outpatient services, treatment centers generally
provide aftercare to provide ongoing support to clients
who have completed treatment.SSuuppppoorrtt GGrroouuppss
Treatment providers generally encourage support
group participation as an adjunct to therapy. Support
groups vary in terms of philosophies. Twelve-step
groups operate under the assumption that substance use
disorders are chronic incurable diseases that require a
lifetime of working the 12 steps to facilitate abstinence.
Other groups such as Rational Recovery understand
substance use disorders as a problem of disordered
thinking and behavior that can be changed permanently
with aid of the group and the Rational Recovery
Program (based on the work of Albert Ellis).
Moderation Management is an example of a support
group that works with individuals who do not necessar-
ily have abstinence as a goal but, instead, want to reduce
substance use. Each program seems to be successful for
participants when program philosophies closely match
the values and worldview of the participants.Evidence-Based Treatment
Researchers have developed and tested a great variety
of therapies that have proved effective as interventions
in substance use disorders. To provide quality and
consistent care for psychological disorders, including
substance use, the therapy used has to have two char-
acteristics. The first is demonstration that the treat-
ment has worked better than nothing at all by
comparing outcomes in a particular therapy with a no-
therapy or care-as-usual control group. The second
important characteristic is conducting therapy using a
manual. Manualized therapy promotes adherence to
the scientifically validated treatment protocol to pre-
vent drift. The following sections review therapies
that have been tested under controlled conditions or
have manuals or guidelines available for use by physi-
cians/therapists to provide best practices to clients.BBiiooppssyycchhoossoocciiaall MMooddeell
Research supports a biopsychosocial model for
addictive behaviors. Successful models of treatment
incorporate biological (physiological), psychological,and social (environmental) interventions to modify
biopsychosocial processes associated with substance
misuse. For example, physiological (biological) treat-
ment methods typically involve pharmacological
means. There is evidence that certain medications may
be helpful to promote treatment success among clients
with alcohol use disorders. Disulfiram (Antabuse) has
been used as a disincentive to alcohol use among people
at high risk for relapse but with mixed results.
Disulfiram blocks metabolism of alcohol and causes
clients to become violently ill when they drink, which
sometimes persuades clients to remain abstinent when
they are tempted to drink. However, clients have been
known to drink when on disulfiram, and client compli-
ance for taking the medication is a problem. Naltrexone
and acamprosate have been shown in some studies to
help reduce cravings and improve treatment outcomes.
Methadone has been used as a safe substitute for heroin.
For clients with co-occurring mental disorders, such as
depression, bipolar disorders, and schizophrenia, psy-
chiatric medications can help reduce substance use.
Many clients believe that substance use helps with psy-
chiatric symptoms. When prescribed medications func-
tion to control psychiatric symptoms, it may reduce the
desire to self-medicate with illicit substances.PPssyycchhoollooggiiccaall TThheerraappiieess
Several types of psychological therapies have been
found to be efficacious for the treatment of substance
use disorders. Twelve Step Facilitation Therapy has
been found to be efficacious in treating substance use
disorders. This is a 12-session therapy that includes a
manual to promote consistency in the delivery of the
treatment. The therapy incorporates principles from
12-step programs (such as Alcoholics Anonymous and
Narcotics Anonymous). Although Twelve Step
Facilitation Therapy has been found to be an effective
treatment under controlled conditions, many treat-
ment centers across the country do not use this ther-
apy, even though the manual is readily available from
the National Institute of Alcohol Abuse and
Alcoholism. Use of this therapy manual would likely
increase quality and consistency of care in treatment
centers dedicated to the 12-step model.
Cognitive-behavioral therapy, which involves the
use of scientifically developed and tested cognitive and
behavioral modification methods to change behavior,
has been found to be an effective means to intervene in
substance use disorders. Many psychologists use776 ———Substance Abuse TreatmentS-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 776