Cognitive Behavioral Approach – Treating Cocaine Addiction

by Kathleen M. Carroll, PhD
Yale University

CONTENTS

Foreword

Cognitive-Behavioral Therapy: An Overview

  • Why CBT?
  • Components of CBT
    • Functional Analysis
    • Skills Training
    • Critical Tasks
  • Parameters of CBT
    • Format
    • Length
    • Setting
    • Patients
    • Compatibility With Adjunctive Treatments
  • Active Ingredients of CBT
    • Essential and Unique Interventions
    • Recommended But Not Unique Interventions
    • Acceptable Interventions
    • Interventions Not Part of CBT
  • CBT Compared to Other Treatments
    • Similar Approaches
      • Cognitive Therapy
      • Community Reinforcement Approach
      • Motivational Enhancement Therapy
    • Dissimilar Approaches
      • Twelve-Step Facilitation
      • Interpersonal Psychotherapy

Basic Principles of CBT

  • Learned Behavior
    • Modeling
    • Operant Conditioning
    • Classical Conditioning
  • Functional Analysis
    • Deficiencies and Obstacles
    • Skills and Strengths
    • Determinants of Cocaine Use
    • Relevant Domains
    • Assessment Tools
  • Skills Training
    • Learning Strategies Aimed at Cessation of Cocaine Use
    • Generalizable Skills
    • Basic Skills First
    • Match Material to Patient Needs
    • Use Repetition
    • Practice Mastering Skills
      • Give a Clear Rationale
      • Get a Commitment
      • Anticipate Obstacles
      • Monitor Closely
      • Use the Data
      • Explore Resistance
      • Praise Approximations

The Structure and Format of Sessions

  • 20/20/20 Rule
  • First Third of Session
    • Assess Patient Status
      • Urine Tests
      • Problem Solving
    • Listen for Current Concerns
    • Discuss the Practice Exercise
  • Second Third of Session
    • Introduce the Topic
    • Relate Topic to Current Concerns
    • Explore Reactions
  • Final Third of Session
    • Assign a Practice Exercise
    • Anticipate High-Risk Situations
  • Topics

Integrating CBT and Medication

Session 1: Introduction to Treatment and CBT

  • Session Goals
  • Key Interventions
    • History and Relationship Building
    • Enhance Motivation
    • Negotiate Treatment Goals
    • Present the CBT Model
    • Establish Treatment Ground Rules
    • Introduce Functional Analysis
  • Practice Exercise

Topic 1: Coping With Craving

  • Session Goals
  • Key Interventions
    • Understanding Craving
    • Describing Craving
    • Identifying Triggers
    • Avoiding Cues
    • Coping With Craving
      • Distraction
      • Talking About Craving
      • Going With the Craving
      • Recalling Negative Consequences
      • Using Self-Talk
  • Practice Exercises

Topic 2: Shoring Up Motivation and Commitment to Stop

  • Session Goals
  • Key Interventions
    • Clarify Goals
    • Address Ambivalence About Abstinence
    • Identifying and Coping With Thoughts About Cocaine
      • Recognize
      • Avoid
      • Cope
  • Practice Exercises

Topic 3: Refusal Skills/Assertiveness

  • Session Goals
  • Key Interventions
    • Assess Cocaine Availability
    • Handling Suppliers
    • Cocaine Refusal Skills
      • Within-Session Role-Play
      • Passive, Aggressive, and Assertive Responding
    • Remind Patients of Termination
  • Practice Exercises

Topic 4: Seemingly Irrelevant Decisions

  • Session Goals
  • Key Interventions
    • Understand Seemingly Irrelevant Decisions
    • Identify Personal Examples
    • Practice Safe Decision-making
  • Practice Exercise

Topic 5: An All-Purpose Coping Plan

  • Session Goals
  • Key Interventions
    • Anticipate High-Risk Situations
    • Develop a Coping Plan
  • Practice Exercise

Topic 6: Problemsolving

  • Session Goals
  • Key Interventions
    • Introduce the Basic Steps
    • Practice Problem-solving Skills
  • Practice Exercise

Topic 7: Case Management

  • Session Goals
  • Key Interventions
    • Problem Identification
    • Goal Setting
    • Resource Identification
    • Specifying a Plan
    • Monitoring Progress
  • Practice Exercise

Topic 8: HIV Risk Reduction

  • Session Goals
  • Key Interventions
    • Assess Risk
    • Build Motivation to Change
    • Set Goals
    • Problem-solve Barriers
    • Provide Specific Guidelines
  • Practice Exercise

Significant Other Session

  • Session Goals
  • Key Interventions
    • Plan Ahead
    • Provide Information/Set Goals
    • Identify Strategies
  • Practice Exercise

Final Session: Termination

  • Session Goals

Appendix A: Therapist Selection, Training, and Supervision

  • Therapist Training
    • Didactic Seminar
    • Supervised Training Cases
    • Rating of Therapists
      • Therapist Checklist
      • Rating Scale
    • Certification of Therapists
  • Ongoing Supervision
    • Guidelines
    • Common Problems Encountered in Supervision
      • Balance
      • Speeding Through Material
      • Overwhelming the Patient
      • Unclear Strategies
      • No Specific Examples
      • Downplaying Practice Exercises
      • Abandoning the Manual With Difficult Patients

Appendix B: Clinical Research Supporting CBT

  • CBT and Interpersonal Therapy
  • CBT and Clinical Management
    • CBT and Depressive Symptoms
    • CBT and Alexithymia
    • One-Year Follow-up
  • CBT and Alcoholic Cocaine Abusers

References

Acknowledgements


Disclaimer
The opinions expressed herein are the views of the author and do not necessarily reflect the official policy or position of the National Institute on Drug Abuse or any other part of the U.S. Department of Health and Human Services.

Public Domain Notice
All material appearing in this report except the forms (Exhibit 9, Exhibit 13 and Exhibit 14) is in the public domain and may be reproduced without permission from the National Institute on Drug Abuse or the author. Citation of the source is appreciated.

National Institute on Drug Abuse
NIH Publication Number 98-4308
Printed April 1998

Page last modified or reviewed by athealth on February 1, 2014