Cognitive-Behavioural Therapy in the Treatment of Addiction: A Treatment Planner for Clinicians

194 Pages·2007·1.01 MB·English

by  Christos Kouimtsidis

Cognitive-Behavioural Therapy
in the Treatment of Addiction

Cognitive-Behavioural Therapy
in the Treatment of Addiction
A Treatment Planner for Clinicians
ChristosKouimtsidis
St.George’sUniversityofLondon
MartinaReynolds
BrunelUniversity
ColinDrummond
St.George’sUniversityofLondon
PaulDavis
CamdenandIslingtonMentalHealthandSocialCareTrust
and
NicholasTarrier
UniversityofManchester
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Cognitive-behaviouraltherapyinthetreatmentofaddiction:atreatmentplanner
forclinicians/ChristosKouimtsidis...[etal.].
p.;cm.
Includesbibliographicalreferencesandindex.
ISBN978-0-470-05852-7(pbk.:alk.paper)
1. Substanceabuse–Treatment. 2. Cognitivetherapy. I.Kouimtsidis,Christos.
[DNLM:1.Substance-RelatedDisorders–therapy. 2. CognitiveTherapy.
3.PatientCarePlanning.WM270C67642007]
RC564.C62252007
616.86’06–dc22
2007017037
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ISBN978-0-470-05852-7(pbk)
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Contents
AbouttheAuthors vii
Foreword ix
Preface xi
Acknowledgements xiii
Chapter1 Overview and Use of the Book 1
Chapter2 Introduction to Cognitive-Behaviour Theory
and Research Evidence 7
Chapter3 Cognitive and Behavioural Techniques 35
Chapter4 Agenda Setting and Structure of Sessions 61
Chapter5 Assessment and Case Formulation 69
Chapter6 Core Topics 81
Chapter7 Elective Topics 119
Chapter8 Therapist Training and Supervision 145
AppendixI 155
AppendixII 157
AppendixIII 159
AppendixIV 161
References 163
Index 169
v

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About the Authors H
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PaulDavishasworkedintheNHSforover30yearsthemajorityofwhichhasbeen
asspecialistclinicianinalcoholanddrugwork.HeisConsultantClinicalPsychol-
ogist and Honorary Senior Lecturer at University College, London and Camden
andIslingtonMentalHealthandSocialCareTrust,London,whereheisalsoHead
ofSubstanceMisusePsychologyServices.Hisclinicalinterestsincludethepractice
anddevelopmentofcognitiveandbehaviouraltherapieswithcomplexcases,andpsy-
chologicalassessmentandmanagementofpatientswithadualdiagnosis.Hismain
areasofresearchhavefocusedonevaluatingtheefficacyandeffectivenessofNHS
interventionsinclinicalsettings,outcomemonitoring,preventionoutcomeevalua-
tion,forensicaspectsofdrugabuseandneuropsychologicalchangesinpeoplewith
drugaddiction.DrDavisisapractitionerandtrainerinCBTandhehaspresented
over 100 invited workshops in CBT and motivational interviewing (MI) applied in
thefieldofsubstancemisuse.HeprovidessupervisionandconsultationinMIand
CBTtohealthprofessionalsfromanumberofNHSTrusts.Hehasco-authoredand
contributedtotreatmentresearchmanualsinthisfieldandhasconductedtreatment
outcometrialsonpsychologicalinterventionswithproblemdrugandalcoholusers.
DrDavishasservedontheBritishPsychologicalSocietyFacultyofAddictionCom-
mitteeforover10yearsandwasChairforseveralyears.HeisaNationalAssessor
forConsultantPsychologypostsintheNHSandhasservedonnumerousnational
committeesonsubstancemisusemostrecentlyonNationalInstituteforHealthand
ClinicalExcellenceGuidanceDevelopmentGroupsinsubstancemisuse.
ColinDrummond, MBChB, MD, FRCPsych, Professor of Addiction Psychiatry and
Consultant Psychiatrist at St George’s Hospital Medical School and South West
LondonandStGeorge’sNHSTrust,wherehehasbeensince1993.HeadofAddic-
tiveBehaviouratStGeorge’s.BeforethathewasLecturerandlaterSeniorLecturer
inAddictionBehaviourattheMedicalResearchCouncilAddictionResearchUnit,
NationalAddictionCentre,InstituteofPsychiatryfrom1987.Hisdoctoratewason
thesubjectofalcoholandpublichealth.HeisPrincipalInvestigatoronseveralre-
search grants including the Department of Health funded national alcohol needs
assessmentprojectandanewnationalresearchprogrammeonscreeningandbrief
alcoholintervention,alsofundedbytheDepartmentofHealth.AssistantEditorof
the journal Addiction. He has published papers on a wide range of topics includ-
ingepidemiology,clinicaltrials,drugandalcoholpolicyandtheoriesofcraving.He
leadsthealcoholtreatmentserviceinSouthWestLondonprovidinginpatientand
community-basedinterventions.Hehasbeencloselyinvolvedinprovidingadviceto
vii
S governmentonalcoholanddrugmisusestrategy.HeisamemberoftheModelsof
R
O Careworkinggroupwhichhasproducedanationalframeworkfordrugandalcohol
H
T servicesinEngland.HeisamemberoftheFacultyofSubstanceMisuseoftheRoyal
U
A CollegeofPsychiatristsandservedastheAcademicSecretary.HeisalsotheDirector
HE oftheSpecialistClinicalAddictionNetworkbasedattheNationalTreatmentAgency.
T
He is a member of the American Psychiatric Association/World Health Organiza-
T
U tionSubstanceUseDisordersWorkingGrouponthefifthrevisionoftheDiagnostic
O
B andStatisticalManual.HeisalsoamemberoftheWHOExpertCommitteeonDrug
A
DependenceandAlcoholProblems.
ChristosKouimtsidis,MBBS,MSc,MRCPsych,isConsultantPsychiatristatNWHerts
Community Drug and Alcohol Team, Hertfordshire Partnership NHS Trust and
HonorarySeniorLectureratSectionofAddictiveBehaviour,StGeorge’s,University
of London since 2003. He was Specialist Registrar and later Clinical Lecturer in
AddictionPsychiatryatStGeorge’sfrom1998.HisMScdissertationin1996wason
CBTinsubstancemisuse.Hisdoctorateisaninvestigationoftheroleofexpectancies
andschemasintreatmentandrelapseofsubstancemisuse.Hehasbeeninvolved
inquantitativeandqualitativeresearchincludingepidemiologyresearchingeneral
hospital,co-morbidityandpsychologicalapproachesinaddiction,staffandservices
users’experiencesoftreatmentprovision.Heistutorforthepostgraduatecourses
atStGeorge’s,andhehasalsoledanumberofseminarsandworkshopsonCBTin
substancemisuse.Hisclinicalteamprovidesservicesfordrugsandalcoholinalarge
geographicalareainHertfordshireconsistingofsmallurbanandruralsettlements.
MartinaReynolds,MA,PhD,isaSeniorLecturerattheSchoolofSocialSciencesof
BrunelUniversity.PriortothisshewasresearchlecturerinAddictionatStGeorge’s,
University of London where she developed her interest in the topic. She obtained
her BA/MA in psychology from the University of Oxford and her PhD from the
UniversityofLondon.Shehasextensiveresearchexperienceandhaspublishedin
thefieldsofsubstanceuse,trauma,post-traumaticstressdisordersanddepression.
She has also convened and taught both undergraduate and postgraduate modules
onaddictionandrelatedareas.
NicholasTarrierisProfessorofClinicalPsychology,HeadoftheDivisionofClinical
Psychology and Research Director of the School of Psychological Sciences, Uni-
versity of Manchester, UK, and Honorary Consultant Clinical Psychologist in the
ManchesterMentalHealthandSocialCareNHSTrust.Hehasheldacademicposts
atuniversitiesinBrazilandAustralia.Hehasalong-standinginterestinthepractice
andevaluationofcognitivebehaviourtherapyanditsapplicationtoawiderangeof
disorders.
viii
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Foreword W
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Cognitive-behavioural therapy (CBT) has emerged as the leading evidence-based
practice in the treatment of psychological disorders, including both interventions
for mental health and addictive behaviour problems. The authors of this book are
tobecommendedforprovidingtherapistswithacomprehensivemanualoutlining
CBTprinciplesandpracticesinthetreatmentofaddiction.Theyhavesuccessfully
integratedinterventionstrategiesderivedfromthetheoreticalmodelsbasedoncog-
nitive psychology, social learning theory, and behaviour change principles. Major
treatmentapproachesbasedonthesetheoreticalapproachesaredescribedindetail
bytheauthors,includingcognitivetherapy,motivationalinterviewing,andrelapse
prevention.Bothexperiencedtherapistsandthoseintrainingwillbenefitfromread-
ingthismostrecentbookonCBTinthetreatmentofaddiction.
Readers are provided with an overview of CBT as it is applied in a structured
treatmentprogramme.Unlikeotherapproachestoaddictiontreatment,CBTadopts
aclient-centeredorientation,basedonmutualcollaborationbetweentherapistand
clientastheyworktogethertohelpresolvethepresentingproblem.Thisisinsharp
distinctiontootherinterventionstrategies,includingthosederivedfromthemoral
model of addiction (clients must be confronted in an authoritative ‘top-down’ ap-
proachinwhichtheyareprescribedspecifictreatmentgoals).CBTisanindividual-
izedtreatmentapproach,inwhicheachclientisconsideredtobeauniquecase,with
differentriskfactorsandcopingskills.Thefocusonmatchingtreatmentstrategies
toeachclient’sindividualneedsisverydifferentfromthetraditionalmedicalmodel
inwhichaddictionisdefinedasadisease,andthattreatmentmustfollowthesame
pharmaceuticalprescriptionsand/orthesameTwelve-StepPathtorecovery.InCBT,
clientslearnthattherearemultiplepathwaysforsuccessfulbehaviourchange,and
thatthetherapistwillhelpthemfindthewaythatworksbestforthem.Theclient’s
goalistomoveforwardinfindingtherightpathtochange,andthetherapististhere
toprovidea‘toolbox’ofclinicaltechniquestohelptheclientarriveattheirchosen
destination. As such, the treatment process over time could be considered more a
journeyofpersonal‘discovery’,notjustonefocusedon‘recovery’.
There are many positive features to this treatment manual. Each clinical tech-
nique is presented in a definitive manner, including a description and overview
of its treatment implications, and a discussion of how to apply the technique, in-
cludingcaseexamples.Awiderangeofbothbehaviouralandcognitivestrategiesis
included.Therapistswillappreciatetheattentiongiventoagendasettingandhowto
structureeachtherapysessionastreatmentproceeds.Clinicalassessment(including