with other interventions, such as the community
reinforcement approach (CRA).* 268
Behavioral Couples/Family Therapy.
Couples- and family-based treatments aim to
improve communication and support and reduce
conflict between couples and within families
that have a member with addiction.^269 Since
lack of social and family support often is a
barrier to treatment enrollment, the support of
family members is important in helping
individuals with addiction enter and complete
treatment. Studies have found family and
couples therapy to be effective for adolescents
and adults, men and women and racial/ethnic
minorities as well as for individuals for whom
the primary substances of addiction are alcohol,
marijuana, opioids or cocaine.^270
A family approach to treatment generally is
more effective than individual-based programs
and tends to have higher retention rates than
other evidence-based interventions.^271
Combining couples/family therapy with other
forms of individual-based treatments, such as
cognitive behavioral therapy (CBT), tends to
increase treatment effectiveness.^272
Combined Therapies ..................................................................................................
Treatment programs that combine
pharmaceutical and psychosocial treatments
typically are more effective for individuals with
addiction than the use of either form of
intervention alone.^273
- Stronger effects were found when the voucher was
delivered immediately after the patient met the
contingency requirement and when vouchers were of
a higher value.
Combination therapy is successful for multiple
reasons. First, the provision of one treatment
modality tends to enhance compliance with the
other.^276 For example, medication may help
patients better tolerate withdrawal symptoms
that otherwise might have discouraged their
participation in psychosocial therapy and
psychosocial therapy might encourage patients
to initiate and maintain a course of
pharmaceutical therapy.^277 Medications used in
conjunction with psychosocial interventions
have been found to increase patients’ likelihood
of remaining in treatment and maintaining
abstinence.^278 Second, because there is no one
treatment that works perfectly for every patient,
patients who are provided with more than one
treatment approach have an increased chance of
success.^279 Third, each modality may produce
different outcomes, increasing overall success.
For instance, in the case of smoking cessation,
pharmaceutical therapy helps patients face
withdrawal symptoms and maintain abstinence,
while psychosocial treatments improve
behavioral, cognitive and coping skills that are
particularly useful for ensuring compliance with
treatment and preventing relapse.^280Addiction Involving Nicotine. The
combination of nicotine replacement therapy
(NRT) and psychosocial approaches to smoking
cessation increases patients’ chances of quitting
and their chances of achieving long-term
abstinence.^281 A review of combined therapy
studies shows that the inclusion of NRT
produced up to a 15-percentage point increase in
efficacy rates over psychosocial treatment
alone.^282 One explanation for the improved
results of combined therapies for tobacco
cessation is that NRT is the primary mechanism
behind patients’ initial quitting success while the
psychosocial therapies give patients the toolsOur efforts to date have taught us some
humbling lessons about addictive diseases,
namely, that they are complex biopsychosocial
entities which defy simple “either/or”
solutions.^274
--Norman S. Miller, MD
Professor of Medicine and Psychiatry
Michigan State University[Addiction] is a family disease and you cannot
treat an addict without bringing in the family
and children.^275--John Schwarzlose
Chief Executive Officer
Betty Ford Center