Cognitive behavioral interventions for alcohol and drug use disorders: Through the stage model and back again.

Abstract

Cognitive behavioral therapy (CBT) approaches have among the highest level of empirical support for the treatment of drug and alcohol use disorders. As Psychology of Addictive Behaviors marks its 30th anniversary, we review the evolution of CBT for the addictions through the lens of the Stage Model of Behavioral Therapies Development. The large evidence base from Stage II randomized clinical trials indicates a modest effect size with evidence of relatively durable effects, but limited diffusion in clinical practice, as is the case for most empirically validated approaches for mental health and addictive disorders. Technology may provide a means for CBT interventions to circumvent the ‘implementation cliff’ in Stages 3–5 by offering a flexible, low-cost, standardized means of disseminating CBT in a range of novel settings and populations. Moreover, returning to Stage 1 to reconnect clinical applications of CBT to recent developments in cognitive science and neuroscience holds great promise for accelerating understanding of mechanisms of action. It is critical that CBT not be considered as a static intervention, but rather one that constantly evolves and is refined through the Stage model until the field achieves a maximally powerful intervention that addresses core features of the addictions.

Technology‐Delivered Cognitive‐Behavioral Interventions for Alcohol Use: A Meta‐Analysis

“…Abstract screening occurred by 2 raters in Abstrackr (Wallace et al., ). Finally, a bibliographic search of eligible studies and literature reviews was completed (Carroll and Kiluk, ; Moore et al., ; Riper et al., ; Rooke et al., ; Sugarman et al., ). Figure provides a visual representation of study inclusion, and although all drug use disorders were initially of interest, the majority of studies addressed alcohol use.…”

“…A major obstacle is that most private and publicly funded addiction treatment centers do not have the resources to provide the training, monitoring, and ongoing supervision that will ensure the level of fidelity in CBT treatment delivery that is required in the clinical trials generating the evidence for efficacy (McLellan et al., ; Olmstead et al., ; Rakovshik and McManus, ; Sholomskas et al., ). Using technology to deliver an evidence‐based treatment enhances treatment fidelity by providing a highly standardized delivery of complex activities, while reducing the costs and demands associated with training and supervising healthcare professionals (Carroll and Kiluk, ; Marsch et al., ).…”

The Addictions Neuroclinical Assessment Negative Emotionality Domain Among Treatment‐Seekers with Alcohol Use Disorder: Construct Validity and Measurement Invariance

“…This finding has important implications for clinical research and practice, given that decreases in negative emotionality over time might signify better quality of life (Kirouac et al, ) and lower risk of relapse (Witkiewitz and Villarroel, ). Indeed, regulating negative affect is a target of numerous behavioral treatments for AUD, such as cognitive‐behavioral therapy (Carroll and Kiluk, ) and affect regulation training (Stasiewicz et al, ). Future research should assess if certain treatments are better suited to decrease negative emotionality, and if individuals with AUD and high negative emotionality benefit more from particular treatment modalities.…”

Short and long-term improvements in psychiatric symptomatology to validate clinically meaningful treatment outcomes for cocaine use disorders

“…Finally, the retained and abstinent at the last week of treatment outcome may be especially promising outcome measure for psychosocial interventions that focus on acquisition of specific skills such as Cognitive Behavior Therapy (CBT). Although a generally effective intervention for CUD (Dutra et al, 2008), improvements in CBT tend to be delayed since the effects of this intervention increase as participants acquire specific skills through the completion of pre-determined treatment modules/sessions (Carroll and Kiluk, 2017;Carroll et al, 1994). As a consequence, outcome measures related to continuous abstinence, especially those dependent on the initiation of abstinence at the beginning of treatment, may be less sensitive to CBT and related treatments that may take time to achieve their effects.…”