Psychological therapies specific to addiction treatment

Motivational-based approaches

A major shift in the treatment of addiction over the last two decades has been the role that motivation plays in the individual’s ability to engage and benefit from treatment, as well as the role of therapy in building up motivation to change. Prochaska and DiClemente’s cycle of change (see Fig. 7.1) outlines a series of stages of change and identifies reaction tasks that an individual needs to undertake, in order for them to take action and maintain change.

This forms the basis of motivational-type psychological interventions. One way of matching the psychological therapies is based on what stage of change the individual is in the cycle of change. Someone in a pre-contemplation stage would benefit from motivational interviewing to enable them to make changes. Patients in the contemplation stage would benefit from motivational enhancement to harness that motivation further. Whilst in the action determination stage, they may benefit from CBT-type approaches and relapse prevention work.

Motivational-based approaches tend to utilize a number of interventions and strategies which focus on enabling the individual’s engagement and movement through the process of recovery. The most well-known intervention is that of motivational interviewing which focuses primarily on preparing people for change and tackling ambivalence to change. It encompasses a model of patient-therapist interaction characterized by collaboration, evocation of ambivalence, and the promotion of autonomy to enhance decision-making and the resolution of ambivalence. Motivational enhancement therapy is a more formal four-session stage- based manualized treatment which utilizes adaptations of motivational interviewing.

Relapse prevention—cognitive behavioural treatments

(See Cognitive behavioural therapy in Chapter 5, pp. 172-84.)

The stages of change model

Fig. 7.1 The stages of change model.

CBT has been shown to be effective across a wide range of addictive disorders. CBT is utilized in the treatment of specific substances and the management of co-morbid psychiatric conditions, such as depression and anxiety, which occur frequently in the treatment-seeking population. The CBT approach for addiction disorders has an emphasis on understanding drug use with respect to its antecedents and consequences (functional analysis) and on skills training aimed at developing problemsolving and practising the practical application of these skills as part of relapse prevention. A key limitation in the utilization of CBT in the treatment of addiction in the UK is the limited availability of trained clinicians for substance misuse services. However, this may now be changing, as commissioners are specifically commissioning services with psychological interventions.

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