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

Abstract

This paper describes four related theories that specify common social processes that protect individuals from developing substance use disorders and may underlie effective psychosocial treatments for these disorders: social control theory, behavioral economics and behavioral choice theory, social learning theory, and stress and coping theory. It then provides an overview of the rationale and evidence for four effective psychosocial treatments for substance use disorders: motivational interviewing and motivational enhancement therapy, 12-step facilitation treatment, cognitive-behavioral treatment and behavioral family counseling, and contingency management and community reinforcement approaches. The presumed active ingredients of these treatments are described in terms of how they exemplify the social processes highlighted by the four theories. The identified common components of effective treatment include support, goal direction, and structure; an emphasis on rewards that compete with substance use, a focus on abstinence-oriented norms and models, and attempts to develop self-efficacy and coping skills. Several issues that need to be addressed to enhance our understanding of the active ingredients involved in effective treatment are discussed, including how to develop measures of these ingredients, how well the ingredients predict outcomes and influence conceptually comparable aspects of clients' life contexts, and how much their influence varies depending upon clients' demographic and personal characteristics.

Overcoming alcohol and other drug addiction as a process of social identity transition: the social identity model of recovery (SIMOR)

“…As Best and colleagues (2008) The foregoing analysis is consistent with the work of Moos (2007), who has argued that one of the effective elements of mutual aid groups like AA is the availability of opportunities for social learning provided by the observation of group members who are further into their recovery journeys. Moos goes further to argue that it is not just role models that AA offers but also an implicit expectation that new members will learn and conform to the group's norms to achieve and maintain membership, a process he refers to as 'social control'.…”

“…Frequency of contact with a recovery-oriented social network is important because it determines exposure to both recovery values and processes (Longabaugh et al, 2010;Moos, 2007), and the creation of a social environment in which an emerging sense of self as 'nonusing' or 'in recovery' can be nurtured and shaped by the norms, values and expectations of the group (Best et al, 2008;. Furthermore, the benefits of social support for recovery (which may take the form of information or practical assistance, emotional support and a sense of belonging) appear to be dependent on the degree to which those providing support are perceived to be relevant, similar, and connected to the self.…”

“…These changes are sustained and supported through group processes of social influence, through the transmission of new recovery-oriented norms and values, and through the social control that comes from internalising these norms and values (Moos, 2007). The social processes embedded in Alcoholics Anonymous, an enduring and successful peer-based mutual aid group, provide an effective and tangible case study through which to examine the role of group-based social influence on social identity change in recovery.…”

Influence of Religiosity on 12-Step Participation and Treatment Response Among Substance-Dependent Adolescents

“…Empirical evidence indicates that religious/spiritual behaviors are also linked to reduced risk of relapse and improved posttreatment outcomes (Avants et al, 2001;Booth and Martin, 2001;Carter, 1998;Flynn et al, 2003;Moos, 2007;Pardini et al, 2000;Polcin and Zemore, 2004;Zemore and Kaskutas, 2004). Religious/spiritual behaviors have been examined as a treatment matching variable in Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity; e.g., randomization to 12-step-facilitated treatment).…”

Driving While Intoxicated Among Individuals Initially Untreated for Alcohol Use Disorders: One- and Sixteen-Year Follow-Ups

“…Because participation in AA may be associated with a decline in impulsivity (Blonigen et al, 2009) and because mutual-help groups encourage lifestyle changes encompassing greater structure, organization, and planning in daily routines (Moos, 2007(Moos, , 2008Morgenstern et al, 1997), such mechanisms of action may reduce individuals' impulsivity and thereby lead to a decline in impulsive behaviors such as DWI. Decreases in drinking-related problems and drinking to reduce tension explained part of the association between more extended participation in AA and reduced DWI at 1 year.…”