Cognitive-Behavioral Interventions Targeting Alcohol or Other Drug Use and Co-Occurring Mental Health Disorders: A Meta-Analysis

Considering the importance of anger management and aggression control, anger management education performed by nurses and other healthcare members is highly crucial. Therefore, it is essential to encourage nurses to establish permanent educational programs, especially in psychiatric wards, for controlling patients’ anger through anger management using group education. Attributional processes and emotional responses also play a role in an
individual’s decision to use (Marlatt and
Gordon, 1985). Should the client attribute her substance abuse to
internal, stable, and global characteristics (e.g., “I’m nothing but an
addict; there’s nothing that I can do to stop using”), then it is likely
that she will feel angry, depressed, hopeless, and helpless. These reactions
are less likely to occur and to be less pronounced for individuals who are
more firmly committed to the goal of abstinence or moderation and for those
who have maintained such goals longer. If the individual does not have the necessary
restorative coping skills to deal with them and to counteract the impact of
a negative attributional style, it is more likely that an initial slip will
continue on as a full-blown relapse (Stephens et al., 1994).

CBT is commonly used to treat depression, anxiety disorders, phobias, and other mental disorders, but it has also been shown to be valuable in treating alcoholism and drug addiction. Mindfulness based interventions or third wave therapies have shown promise in addressing specific aspects of addictive behaviours such as craving, negative affect, impulsivity, distress tolerance. The greatest strength of cognitive behavioural programmes is that they are individualized, and have a wide applicability. Several studies have developed web-based interventions for individuals with stimulant use disorders (amphetamines or cocaine). In a study conducted fully online in Australia, 160 individuals with self-reported amphetamine use problems were randomly assigned to a three-session computerized intervention based on MI with some components of CBT or a wait list control (Tait et al., 2014).

How Effective is CBT for Alcohol Addiction?

While aversive conditioning procedures have most often been used in the
treatment of alcohol dependence, they have also been applied to the
treatment of marijuana and cocaine use (Frawley and Smith, 1990; Smith et al., 1988). It should be noted that these aversive
conditioning techniques, as well as cue exposure approaches, are best viewed
as components of a more comprehensive treatment program rather than as
independent, free-standing treatments (O’Brien, et al., 1990; Smith
and Frawley, 1993). In this context, Smith and colleagues
reported positive outcomes for dependent users of both alcohol and cocaine
who received chemical aversion procedures https://ecosoberhouse.com/ as part of their treatment in
comparison to those who did not receive similar treatment (Frawley and Smith, 1990; Smith et al., 1997). Rimmele and
colleagues also recommended covert sensitization as a highly effective and
portable treatment component which, unlike chemical or electric aversion
therapies, can be used at any time and in any setting as a self-control
strategy (Rimmele et al., 1995). Empirical evidence indicates that cognitive therapy has the potential to be an efficacious treatment for alcohol and other substance use disorders, especially with adult patients who present with comorbid mood disorders, and with adolescents.

• In particular, those contingencies that are found
  through a functional analysis (see Figure
  4-4
  ) to prompt as well as reinforce substance abuse
  are weakened by associating evidence of substance use (e.g., a drug-positive
  urine screen) with some form of negative consequence or punishment.
• Relapse prevention approaches rely heavily on functional
  analyses, identification of high-risk relapse situations, and coping skills
  training, but also incorporate additional features.

Candidate variables were entered in participant (i.e., age, sex, race, primary drug, substance use severity), implementation, (i.e., treatment length, treatment delivery), and methodological (i.e., study risk-of-bias) blocks. Analyses were conducted with Wilson’s (2005) METAREG for Maximum Likelihood regression (ML; SPSS Version 24), and variables with significant regression coefficients were placed into a final predictive model along with residual variance estimates. Missing variable codes for regression covariates were mean imputed, and a predictor was removed from the analysis if imputed values reached 20% of total cases (Pigott, 1994). We conducted sensitivity analyses throughout data analysis and considered heterogeneity and moderator analyses as two primary methods for examining effect size validity. Trimmed estimates with influential studies removed (Baujat, Mahé, Pignon, & Hill, 2002) were also provided.3 Finally, to test for potential publication bias, the relationship between error and effect size was assessed using rank correlation (Begg & Mazumdar, 1994) and graphical methods (Egger, Smith, Schneider, & Minder, 1997). Here, small sample/small effect studies are assumed to characterize unpublished research, resulting in a significant and negative relationship, thus an asymmetrical funnel plot, when publication bias is present.

Using CBT for Alcohol Treatment

Early behavioral theories of substance abuse were nonmediational in nature (Donovan and Marlatt, 1993). They focused
almost exclusively on overt, observable behaviors, and it was believed that
understanding the antecedents and reinforcement contingencies was sufficient to
explain behavior cognitive behavioral interventions for substance abuse and to modify it. Over time, however, these behavioral theories
began to incorporate cognitive factors into their conceptualizations of
substance abuse disorders. This expanded, mediational model has been described as cognitive
social learning or cognitive-behavioral theory.

• Anton, R. F., Moak, D. H., Latham, P. K., Waid, R., Malcolm, R. J., Dias, J. K., & Roberts, J. S.
• As seen in Rajiv’s case illustration, internal (social anxiety, craving) and external cues (drinking partner, a favourite brand of drink) were identified as triggers for his craving.
• Clearly,
  different clients will have different responses to these qualitatively different
  approaches to modifying their thoughts and beliefs.