Contingency Management for the Treatment of Substance Use Disorders

In conjunction with chapters 16 and 17, which described non-pharmacological approaches to pain management, this chapter reviews the available non-pharmacological approaches to substance use disorders (SUD). Specific subtopics include 12-Step programs and facilitation, motivational enhancement therapy, cognitive behavioral therapy, individual and group psychotherapies, contingency management, community reinforcement, family therapy, relapse management, and the terminal consideration of all therapies, termination (what is the duration of treatment)? Each subtopic is addressed in abstract rather than in comprehensive format, to allow the primary care provider to identify her level of interest and present level of understanding, and to inform further reading. The chapter concludes with a text box providing additional resources.

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Psychosocial Treatment Approaches for Substance Use

10.1093/med/9780190275334.003.0013 ◽

2018 ◽

Author(s):

Lynn McFarr ◽

Julie Snyder ◽

Lisa Benson ◽

Rachel Higier

Keyword(s):

Substance Use ◽

Substance Use Disorders ◽

Meta Analysis ◽

Contingency Management ◽

Psychosocial Interventions ◽

Psychosocial Treatment ◽

Community Based ◽

Theoretical Orientations ◽

Psychosocial Treatments ◽

Community Based Programs

Multiple psychosocial treatments for substance-use disorders have been studied for efficacy. A recent meta-analysis indicates that psychosocial interventions are effective across multiple types of substances used. In the case of opiates, psychosocial interventions combined with medication appear to be the most effective. Many studies further agree that psychosocial interventions are an integral and necessary part of treating substance-use disorders. Although theoretical orientations may differ across psychosocial treatments, they have several principles and practices in common. All involve talk therapy or talk in communities as a way to clarify triggers, build commitment, and improve accountability. Many also target addiction behaviors and work to develop alternative contingencies to reduce or eliminate use. Finally, targeting repeated performance (or building “chains of committed behavior”) decreases the likelihood of relapse. This chapter discusses the most frequently studied and employed psychosocial treatments for substance use including CBT, motivational interviewing, contingency management, mindfulness, and community-based programs.

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Psychosocial Treatments for Substance Use Disorders

10.1093/med:psych/9780199342211.003.0023 ◽

2015 ◽

Cited By ~ 2

Author(s):

Daniel M. Blonigen ◽

John W. Finney ◽

Paula L. Wilbourne ◽

Rudolf H. Moos

Keyword(s):

Substance Use ◽

Alcohol Use ◽

Substance Use Disorders ◽

Behavioral Interventions ◽

Contingency Management ◽

Limited Evidence ◽

Motivational Enhancement ◽

Differential Effectiveness ◽

Cognitive Behavioral Interventions ◽

Use Behavior

The most effective psychosocial modalities for treating substance use disorders are cognitive-behavioral interventions, motivational interviewing and motivational enhancement, contingency management, community reinforcement, behavioral couples and family therapies, and 12-step facilitation approaches. The foci of these interventions include substance use behavior, patients’ life contexts, and their social and personal resources. Limited evidence is available for these interventions’ differential effectiveness. Brief interventions are highly effective in the treatment of alcohol use disorders. However, as stand-alone treatments, they are best suited for individuals with mild to moderate alcohol use problems. Therapists who are interpersonally skilled, empathic, and nonconfrontational, and who develop a strong therapeutic alliance, are more effective at helping patients achieve better outcomes.

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