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NEUROSCIENCE OF PSYCHOACTIVE SUBSTANCE USE AND DEPENDENCE

BOX 3.2

Types of psychotherapies/behavioural interventions
Cognitive behavioural therapies
Cognitive behavioural therapies focus on (a) altering the cognitive processes
that lead to maladaptive behaviours of substance users, (b) intervening in the
behavioural chain of events that lead to substance use, (c) helping patients deal
successfully with acute or chronic drug craving, and (d) promoting and reinforcing
the development of social skills and behaviours compatible with remaining drug
free. The foundation of cognitive therapy is the belief that by identifying and
subsequently modifying maladaptive thinking patterns, patients can reduce or
eliminate negative feelings and behaviour (e.g. substance use).
Relapse prevention
An approach to treatment in which cognitive behavioural techniques are used in
an attempt to help patients develop greater self-control in order to avoid relapse.
Specific relapse prevention strategies include discussing ambivalence, identifying
emotional and environmental triggers of craving and substance use, and
developing and reviewing specific coping strategies to deal with internal or external
stressors.
Contingency management
A behavioural treatment based on the use of predetermined positive or negative
consequences to reward abstinence or punish (and thus deter) drug-related
behaviours. Rewards have included vouchers – awarded for producing drug-free
urine samples – that can be exchanged for mutually agreed-upon on items (e.g.
cinema tickets) or ‘community reinforcement,’ in which family members or peers
reinforce behaviours that demonstrate or facilitate abstinence (e.g. participation
in positive activities). Negative consequences for returning to substance use
may include notification of courts, employers or family members.
Motivational enhancement therapy (MET)

This brief treatment modality is characterized by an empathetic approach in which
the therapist helps to motivate the patient by asking about the pros and cons of
specific behaviours, by exploring the patient’s goals and associated ambivalence
about reaching these goals, and by listening reflectively. Motivational enhancement
therapy has demonstrated substantial efficacy in the treatment of substance
dependence.
Source: The American Journal of Psychiatry, 1995.

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