Theory-Based Active Ingredients of Effective Treatments for Substance Use Disorders PMC

Behavioral economics or behavioral choice theory, which is closely related to the social control perspective, focuses specifically on involvement in protective activities. In behavioral choice theory the key element of the social context is the alternative rewards provided by activities other than substance use. These rewards can protect individuals from exposure to substances and opportunities to use them, as well as from escalating and maintaining substance use. The theory posits that the choice of one rewarding behavior, such as substance use, depends in part on lack of effective access to alternative rewards through involvement in school and work pursuits, religious engagement, and participation in physical activity. For example, physical activity and substance use may both elevate mood and decrease anxiety, which may make them functionally similar and substitutable (Bickel and Vuchinich 2000). After describing these theories, I focus on the rationale underlying each of the four sets of proven psychosocial treatments for substance use disorders and briefly note evidence of their effectiveness.

Developmental Stages of the Family

• Actively link family members to community-based family recovery supports (e.g., Al-Anon) and additional behavioral health or social services, when appropriate.
• However, in contrast to drug treatment, less evidence isavailable concerning the effectiveness of such contingency managementapproaches in the treatment of alcohol problems (Higgins et al., 1998).
• A review of controlled outcome studies found that it provided significant positive benefits to adults with mental disorders and showed promise for improving family functioning, particularly for families under stress of having a family member with a mental disorder (Gingerich & Peterson, 2013).
• This change in perspective will help reduce the client’s sense ofhelplessness and loss of control.

However, it can be useful in getting a general picture of the common dynamics in families dealing with addiction. Like anything else, please take the aspects of these family roles that apply to you and your family and leave the rest. You may have played more than one role at different times in your life or you may identify with a combination of these traits and coping strategies. The four treatment orientations differ in how much they emphasize rewards during treatment for remaining substance-free versus planning for a generally more rewarding life style.

• The key ideas are to make a sober lifestyle more rewarding than substance use and to use social, familial, recreational, and vocational rewards to assist in the recovery process (Meyers and Squires, 1998).
• The primary audience for this TIP is SUD treatment counselors— many, but not all, of whom possess certification in addiction counseling or related professional licensing.
• Integrate specific family counseling models, techniques, and concepts into SUD treatment to enhance effective family coping and healthy communication patterns—paving the road toward recovery for everyone in the family.
• In this scenario, it may be best to limit or postpone family-based interventions until stabilization.
• Counseling and therapy for addiction often involvecounseling for family members in addition to the person in recovery.

Later Sessions

In doing so, the counselor can develop strategies the couple can use as a team to learn from the experience and prevent another return to use. Behavioral, cognitive, and cognitive-behavioral treatments all rely heavilyon an awareness of the antecedents substance abuse counseling and consequences of substance abuse. Inall of these therapeutic approaches, the client and therapist typicallybegin therapy by conducting a thorough functional analysis of substanceabuse behavior (Carroll, 1998;Monti et al., 1994; Rotgers, 1996).

Behavioral Couples and Family Counseling

In the absence of these skills, such problems areviewed as threatening, stressful, and potentially unsolvable. Based onthe individual’s observation of both family members’ and peers’responses to similar situations and from their own initial experimentaluse of alcohol or drugs, the individual uses substances as a means oftrying to deal with these problems and the emotional reactions theycreate. From this perspective, substance abuse is viewed as a learnedbehavior having functional utility for the individual–the individualuses substances in response to problematic situations as an attempt tocope in the absence of more appropriate behavioral, cognitive, andemotional coping skills. Cognitive therapy can be useful in the treatment of substance abuse disorders inseveral ways.

Music Therapy

If the client agrees to family involvement in treatment, get signed privacy/confidentiality releases and then schedule an initial family interview. Many families or family members may be hesitant to participate in treatment at first. Counselors can tailor SUD treatment to meet family needs through developmental tasks.

The information gained in the session will assist the counselor indetermining the antecedents that prompt substance abuse and thereinforcers that appear to maintain it. McCrady also included behavioral self-control training as another promisingbut underutilized treatment approach (McCrady, 1991). Hester indicated that there is good empiricalsupport for behavioral self-control training in achieving the goal ofmoderate, nonproblematic drinking (Hester, 1995). In randomized clinical trials, problem drinkersassigned to behavioral self-control with a goal of either moderation orabstinence typically have comparable long-term outcomes. Although behavioralself-control approaches have been used primarily with alcohol problems, theyhave also been used with other substances such as opiates (van Bilsen and Whitehead, 1994).

When To Use Cognitive-Behavioral

• Key concepts in both theories are feedback, homeostasis and boundaries that are defined and operationalized in this section.
• You should become familiar with family peer recovery support services in your community so that you can actively link family members to a peer recovery support specialist who can help family members follow through on their own recovery goals in concert with the family’s treatment plan.
• When family counseling and SUD treatment occur at the same time, communication between providers is vital.
• MDFT is a flexible, family-based counseling approach that combines individual counseling and multisystem methods to treating adolescent substance misuse and conduct-related behaviors (Horigian, Anderson, & Szapocznik, 2016).

Other Ways Families Can Help and Stay Connected