Moderators of Effects of Motivational Enhancements to Cognitive Behavioral Therapy

Abstract

Patient treatment matching hypotheses were tested for substance users randomly assigned to a group cognitive behavioral therapy (CBT; n= 114) or a group motivational intervention (GMI; n= 116). Treatment was scheduled twice weekly for 10 weeks. Using a patient attribute by treatment interaction design with a 15-week follow-up, the study predicted that alexithymia, antisocial personality disorder (ASPD), and network support for alcohol and drug use would be associated with less substance use for CBT subjects and that hostility and lower treatment motivation would be associated with less substance use for GMI subjects. Three of the hypothesized moderators were empirically supported: alexithymia, network support for alcohol, and ASPD. Results indicate the use of assessing specific patient attributes to better inform treatment recommendations.

The Level of Alexithymia in Alcohol-Dependent Patients Does Not Influence Outcomes after Inpatient Treatment

“…However, sometimes alexithymia does not interfere with the outcome results; in three studies alexithymia was associated with some positive results (12,14). Our current results confirm that inpatient alexithymic patients with AUD, as we already found for a mixed drug and alcohol inpatient SUD population (13), can benefit from a CBT-oriented treatment.…”

Alexithymia and Addiction: A Review and Preliminary Data Suggesting Neurobiological Links to Reward/Loss Processing

“…However, alexithymia did not change over an 8-week course of treatment using computerized cognitive-behavioral therapy (CBT) [44•]. Similarly, other treatment comparison studies in populations with cocaine-use disorder [45] and polysubstance-use disorders [46] also revealed no change in alexithymia scores over time, regardless of the type of treatment delivered. Alexithymia also remained stable over a 6-week course of treatment in individuals with polysubstance-use disorders [47•].…”

Theory-based active ingredients of effective treatments for substance use disorders

“…For example, more impaired patients appear to need more goal direction and structure in treatment, whereas patients who are functioning relatively well may respond better to a more flexible approach (Beutler et al, 2002;Rosenblum et al, 2005). Similarly, when therapists are more direct and rely more on setting the agenda of treatment, reactant clients (those high in need for control) tend to experience worse alcohol-related outcomes.…”