Applied Cognitive and Behavioural Approaches to the Treatment of Addiction: A Practical Treatment Guide

228 Pages·2010·2.234 MB·English

by  Luke Mitcheson, Jenny Maslin, Tim Meynen, Tamara Morrison, Robert Hill, Shamil Wanigaratne(auth.)

Applied Cognitive and
Behavioural Approaches to
the Treatment of Addiction
‘The ways in which we interact with our clients are the essential tools of our
trade. The National Institute for Clinical and Health Excellence has already pub-
lished rigorous analyses of the evidence for various psychological approaches. But,
until now, we have not had an authoritative guide to the relevant cognitive and
behavioural therapeutic techniques. This book fi lls that void. It is easy to read
and draws on the authors’ wealth of experience of working with clients with drug
and alcohol problems. I expect this book rapidly to become a well-thumbed and
widely-borrowed book which will help us all to improve the competence and
quality of the interventions that we deliver.’
Professor John Strang, Director, National Addiction Centre, London
Applied Cognitive and Behavioural Approaches to the Treatment of Addiction: A Practical Treatment Guide
Luke Mitcheson, Jenny Maslin, Tim Meynen, Tamara Morrison, Robert Hill and Shamil Wanigaratne
© 2010 John Wiley & Sons, Ltd. ISBN: 978-0-470-66142-0
Applied Cognitive and
Behavioural Approaches to
the Treatment of Addiction
A Practical Treatment Guide
Luke Mitcheson
Jenny Maslin
Tim Meynen
Tamara Morrison
Robert Hill
Shamil Wanigaratne
A John Wiley & Sons, Ltd., Publication
This edition fi rst published 2010
© 2010 John Wiley & Sons Ltd.
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Library of Congress Cataloging-in-Publication Data
Applied cognitive and behavioural approaches to the treatment of addiction : a practical treatment
guide / Luke Mitcheson ... [et al.].
p. cm.
Includes bibliographical references and index.
ISBN 978-0-470-51062-9 (cloth) – ISBN 978-0-470-51063-6 (pbk.) 1. Substance abuse–
Treatment. 2. Compulsive behavior–Treatment. 3. Cognitive therapy. 4. Behavior
therapy. I. Mitcheson, Luke.
RC564.A65 1010
616.86–dc22
2009053118
A catalogue record for this book is available from the British Library.
Set in 10 on 12 pt Galliard by Toppan Best-set Premedia Limited
Printed in Singapore by Markono Print Media Pte. Ltd.
1 2010
Contents
About the Authors vii
Foreword ix
Preface xiii
List of Abbreviations xv
Acknowledgements xvii
Chapter 1 Introduction to CBT for Substance Use Problems 1
Chapter 2 Cognitive and Motivational Theories of Addiction 21
Chapter 3 Fundamentals of Treatment 41
Chapter 4 Enhancing Motivation to Change 61
Chapter 5 Assessment and Introducing CBT to Clients 75
Chapter 6 Formulation 89
Chapter 7 Introduction to Substance-related Cognitions
and Interventions 99
Chapter 8 A Basic Framework for Working with Substance-related
Beliefs 113
vi Contents
Chapter 9 Additional Techniques to Facilitate Cognitive Change 123
Chapter 10 Behavioural Experiments 141
Chapter 11 Behavioural Interventions 149
Chapter 12 Working with Emotions 177
Chapter 13 CBT and Pathways to Recovery 191
References 211
Index 217
About the Authors
Luke Mitcheson BSc, MSc, D.Clin.Psych. has 15 years’ experience working as a
Clinical Psychologist in substance misuse services. He is a Consultant Clinical
Psychologist and is the lead psychologist in the South London and Maudsley NHS
Foundation Trust, Lambeth addictions services. He is also an accredited psycho-
therapist with the British Association for Behavioural and Cognitive Psychotherapies.
He has developed services for stimulant drug users and has been involved in
research projects looking at applied psychosocial interventions for the treatment
of substance use problems. He is also involved in training and supervision of staff
to develop their psychosocial skills and practice. He is seconded to the National
Treatment Agency as part of the clinical team and holds an honorary lecturership
at the Institute of Psychiatry, Kings College, London.
Jenny Maslin is a Clinical Psychologist who has worked in Substance Misuse
Services for South London and Maudsley NHS Foundation Trust, Lambeth for
the last fi ve years. She works with clients at varying stages of their substance use
career, who use a variety of substances and experience a range of psychological
problems. She also provides training, along with her co- facilitators, in the use of
cognitive and behavioural therapy for clients with substance use and co - morbid
diffi culties.
Tim Meynen is a Chartered Clinical Psychologist who has worked in Community
and Criminal Justice Substance Misuse Services for South London and Maudsley
NHS Foundation Trust, Lambeth for the last six years. He provides cognitive and
behavioural therapy training and supervision to both addictions and adult mental
health staff for clients with substance use and co- morbid diffi culties.
Tamara Morrison BSc Hons, D.Clin.Psych has worked in clinical and research
posts in a number of South London mental health services since completing a
viii About the Authors
degree in Human Psychology at Aston University in 1999. She qualifi ed as a
Clinical Psychologist in 2005 from University College, London, and has since
been working as a Clinical Psychologist in Lambeth Community Drug and Alcohol
Team. She has worked with both statutory and non- statutory drug services. Since
2009, Tamara has also been working in the Islington Psychology Assessment and
Treatment Service, which became a site for Improving Access to Psychological
Therapies in September 2009.
Robert Hill BSc, MSc, MA, PhD, Psych.D has worked in the fi eld of mental
health since 1983. Since 1999 he has worked as lead Clinical Psychologist for
inpatient addictions at the South London and Maudsley NHS Foundation Trust,
Lambeth. He has also worked as a Senior Lecturer at Middlesex University, jointly
managing a three- year European project focusing on the reduction of patient
violence, stress and burnout among community and inpatient mental health per-
sonnel in Denmark, Finland, Norway, Poland and the UK. He has a particular
interest in philosophy and holds an MA in Modern European Philosophy.
Shamil Wanigaratne BSc, D.Clin.Psych, C.Psychol, AFBPsS is Consultant Clinical
Psychologist and Head of Clinical Psychology of the Addictions Division at the
South London and Maudsley NHS Foundation Trust, Lambeth. He is also
Honorary Senior Lecturer at the Institute of Psychiatry, Kings College, London.
Throughout his career he has worked to combine clinical practice with academic
research. He is currently involved in a number of research collaborations. His
clinical and research interests include cognitive and neuropsychological aspects of
addictions, initiation and maintenance of behaviour change, outcome measure-
ment, culture and substance misuse, psychological impact of trauma and the
association between trauma and addictive behaviours.
He has acted as a consultant to various UK government bodies. He has also
acted as an international consultant in a number of countries and was one of the
founding members of the British Psychological Society’ s Special Interest Group
in Addictions, which is now the Faculty of Addiction.
He co- founded the UK− Sri Lanka Trauma Group in 1996 and was the fi rst
chair. He was also involved in setting up the fi rst clinical psychology training course
in Sri Lanka, at the University of Colombo.
Foreword
Traditionally there has been a divide between health care professionals who do
and those who do not specialise in the treatment of addictions. Addiction speciali-
sation certainly has its advantages for those dedicated to working full - time with
these issues. These diffi culties occur on a continuum; people who experience severe
addictions often need specialised medical, psychological and psychosocial help.
Clients struggling with addiction also often need help with a myriad of other issues
such as depression, anxiety, relationship diffi culties and even psychosis. Some
addiction specialists are not trained to treat these problems and it would be benefi -
cial for their clients if they were more knowledgeable about effective treatments
for common co- occurring conditions.
On the other hand, health care providers who are not addiction specialists often
fail to recognise substance use problems or behavioural addictions and therefore
may not include these in treatment planning. Given the widespread use of alcohol,
prescription medications and other drugs it is unlikely there are many health care
workers, therapists or counsellors who do not have clients who might benefi cially
work on issues related to substance use. However, when therapists lack specialisa-
tion in addictions yet have expertise in treating mood disorders, relationship dif-
fi culties and other common therapy issues, it is understandable that these latter
issues are identifi ed for focus in treatment rather than substance use. A therapist
may conjecture, My client ’ s overuse of alcohol, prescription medication, or street drugs
is simply self - medication for anxiety and it will go away as the anxiety improves .
Sometimes it does and sometimes it doesn’ t.
The historical division between addiction specialists and non- specialists artifi -
cially divides clients into categories of addicts and non - addicts when the human
reality is not this clear- cut at all. There is no way to know how many serious
addictions might have been prevented if health care workers had more eagerly
helped clients manage the early stages of substance misuse. Similarly, we do not
know how many ‘ treatment failures’ in psychotherapy are, at least in part, due to
x Foreword
missed opportunities to explore a reliance on addictive behaviours or chemical use.
Nor do we know how many people ‘fail’ in treatment of their addiction because
other psychological diffi culties are not effectively treated.
In my experience as a CBT instructor and consultant, I have learned that health
care providers rarely neglect treatment areas in which they are knowledgeable and
confi dent in their abilities. We all want to help our clients in the best ways pos-
sible. Thus, one important antidote to all these missed opportunities is to build a
knowledge bridge so addiction specialists and non - specialist therapists can all
become better educated about effective treatment approaches for addictions and
their co- existing psychological problems.
Applied Cognitive and Behavioural Approaches to the Treatment of Addiction: A
Practical Treatment Guide elegantly constructs this bridge. Readers who are addic-
tion specialists and yet relatively unfamiliar with cognitive behavioural therapy
(CBT) will appreciate the simple and practical explanations of CBT ’ s principles
and methods. The authors clearly illustrate how CBT can be integrated with other
treatment approaches that may be more familiar to addiction specialists such as
motivational interviewing, relapse prevention and pharmacologically assisted
recovery. At the same time, therapists and counsellors without a speciality in addic-
tions will learn to artfully apply the therapy methods they already understand to
addiction problems. In addition, therapists without addiction expertise learn to
integrate CBT with key methods from motivational interviewing and other addic-
tion therapies to help many client problems, not only addictions.
Chapter by chapter, readers learn good questions to ask that help provide
therapeutic focus to the assessment and treatment of addictions. Detailed examples
show how to tailor CBT homework and behavioural experiments to help these
problems. In addition, the authors educate readers how to implement a non-
judgemental, compassionate treatment framework that emphasises and enhances
client optimism, resilience, social integration and choice.
As a CBT - specialist who is not an addictions specialist, I appreciate the person-
able non- academic writing style adopted by these authors. The lives of clients with
substance use problems can sometimes seem messy and chaotic. It is reassuring to
read a therapy guide for helping these clients that is clear, organised and empathic
to both therapists and clients. The authors are highly experienced in treatment of
addictions and their expertise is refl ected in the calm guidance they offer on how
to foster personal development in clients no matter where their struggles fi t along
the addiction continuum. At the same time, the authors acknowledge a deep
understanding of the pressures and challenges therapists face, especially those of
us without addiction expertise. They address common therapist fears and beliefs
as well as social and moral values that can impact the treatment choices we make.
The shadows these concerns can cast on treatment are slowly dispelled by the
practical and, at times, inspirational guidance offered.
In the end, this book captures how rewarding it can be to help clients engaged
in this very human struggle. The authors not only destigmatise addiction, they
show how therapists in all practice settings can approach and help clients manage
these issues. As each chapter unfolds, readers are likely to notice their own opti-
mism, resilience and choices increase as they begin to practise the methods
described and integrate these with current knowledge and skills.
Foreword xi
Now it is time for you to dip into this inviting book or take a deep plunge,
whichever approach suits your current learning needs. Whether you are an addic-
tions specialist already, a therapist wary of addictions, or someone in between,
your clients will benefi t from the time you spend with this practical treatment
guide.
Christine A. Padesky, Ph.D.
www.padesky.com
Co - author, M ind Over Mood