Daniel S. Keller

Manual-guided cognitive-behavioral therapy training: A promising method for disseminating empirically supported substance abuse treatments to the practice community

A gap exists between empirically supported substance abuse treatments and those used in community settings. This study examined the feasibility of training substance abuse counselors to deliver cognitive-behavioral treatment (CBT) using treatment manuals. Participants were 29 counselors. Counselors were randomly assigned to receive CBT training or to a control group. Counselor attitudes were assessed pre- and posttraining. In addition, CBT therapy sessions were videotaped and rated for adherence and skillfulness. CBT counselors reported high levels of satisfaction with the training, intention to use CBT interventions, and confidence in their ability to do so. Ratings indicated that 90% of counselors were judged as having attained at least adequate levels of CBT skillfulness. Findings demonstrate the feasibility of using psychotherapy technology tools as a means of disseminating science-based treatments to the substance abuse practice community.

The impact of managed care on substance abuse treatment: a report of the American Society of Addiction Medicine.

Abstract This report examines the impact of managed care (MC) and related developments on substance abuse treatment, and evaluates how it has been associated with a decline in the availability of proper treatment for many addicted patients. A trend toward carve-out and for-profit MC organizations is associated with lower financial incentives for intensive treatment than in earlier staff-model and not-for-profit MC organizations. The value of substance abuse insurance coverage has declined by 75% between 1988 and 1998 for employees of mid-to large-size companies, compared with only an 11.5% decline for general health insurance. The shift towards MC has also been associated with a drastic reduction in frequency and duration of inpatient hospitalization, and there is no clear evidence that this reduction has been offset by a corresponding increase in outpatient support. In a survey of physicians treating addiction, the majority felt that MC had a negative impact on detoxification and rehabilitation, and on their ethical practice of addiction medicine.

Alexithymia in Cocaine Abusers Response to Psychotherapy and Pharmacotherapy

Using the Toronto Alexithymia Scale, the authors evaluated prevalence and significance of alexithymia in 93 ambulatory cocaine abusers treated with psychotherapy (cognitive-behavioral relapse prevention) and pharmacotherapy (desipramine), alone and in combination. Tbirty-nine percent of the sample scored in the alexitbymic range; alexi-tbymic and nonalexitbymic subjects did not differ significantly on demographic variables, severity or pattern of cocaine use, substance-related problems, or treatment history; alexitbymic subjects reported significantly more current distress, but did not differ from nonalexitbymic subjects in rates of Axis I disorders or clinician-rated evaluations; although there was no difference in overall treatment retention or cocaine outcomes, alexitbymic subjects had better outcomes when treated with clinical management over cognitive-behavioral relapse prevention, a finding consistent with tbe theory that suggests alexitbymic patients have difficulty in treatments requiring identifi...

Technology Transfer of Network Therapy to Community-Based Addictions Counselors

This paper describes a technology transfer initiative in which Network Therapy (NT), a substance abuse treatment that utilizes peer and family support, was disseminated to a cohort of addictions counselors located in an outpatient community-based addictions treatment center. Training methods included a didactic seminar, role-playing, use of videotaped illustrations, and clinical supervision, and are described in detail. Counselors then implemented the NT approach with a sample of cocaine-abusing patients (N = 10) who were being treated concurrently with the standard program provided by the treatment setting. NT patients were compared by chart review with a cohort of cocaine abusers who received community treatment--as-usual (TAU) (N = 20). The groups did not differ on demographic variables or the amount of TAU received at the community program. However, NT patients had significantly less positive urinalyses than TAU patients, though they were not significantly different in terms of treatment retention. Implications for technology transfer are discussed.

Current Status of Professional Training in the Addictions

Addictions training curricula within traditional graduate and postgraduate programs of professional disciplines lag behind those devoted to other disorders. After presenting a brief historical overview of addictions training in the United States, this paper focuses on current addictions training practices for each of the major health care professions, highlighting both recent advancements as well as shortcomings, particularly with respect to the ability to disseminate recent empirically tested addiction treatments. New psychosocial and pharmacotherapies for addictive disorders are then discussed which would be better disseminated within training programs with enhanced addictions training components. The paper concludes with a discussion of and recommendations for enhancing substance abuse training and knowledge dissemination.

The role of therapeutic alliance in network therapy: a family and peer support-based treatment for cocaine abuse.

The therapeutic alliance is a well‐studied construct factor that is important to outcome in many forms of individual therapy. Therapeutic alliance has been rarely studied in group therapy and results in addiction treatment have been mixed. In this paper, we studied the presence of a therapeutic alliance in Network Therapy: an approach that uses peer and family support in addiction treatment. Twenty‐one participants undergoing Network Therapy for cocaine addiction were observed on videotape, and were rated on therapeutic alliance using the Working Alliance Inventory and the Penn Helping Alliance Rating Scale. Results showed a significant positive correlation between therapeutic alliance and outcome as measured by the percentage of cocaine‐free urine toxicology screens and by eight consecutive cocaine‐free urines.

Network Therapy for Addiction: Assessment of the Clinical Outcome of Training

Mental health practitioners in the office setting are often seen as deficient in addiction treatment skills. Relevant training in often quite limited, and trainees are generally not introduced in an effective office-based modality. We studied the feasibility of teaching beginning therapists how to apply Network Therapy, a cognitive-behavioral approach to achieving abstinence and preventing relapse that augments individual therapy with support from family and friends. The therapists were 19 psychiatric residents without experience in substance abuse treatment or outpatient therapy, and the patients were 24 cocaine-dependent patients who received a 24-week course of Network treatment. The patients remained in treatment for an average of 15.4 weeks. Seventy-nine percent of their observed weekly urine toxicologies were negative for cocaine, and 42% of patients produced clean urines in the 3 weeks immediately before termination. The overall outcome compares favorably with that reported in studies on cocaine treatment where experienced therapists were employed. Our results suggest that naive mental health trainees can be taught to apply Network Therapy for effective substance abuse management. This is particularly relevant to technology transfer for general mental health trainees, who are often thought to be perceived to be refractory to learning about the outpatient management of addiction.

Validation of a scale for network therapy : A technique for systematic use of peer and family support in addiction treatment

Substance abuse treatments are increasingly employing standardized formats. This is especially the case for approaches that utilize an individual psychotherapy format but less so for family-based approaches. Network therapy, an approach that involves family members and peers in the patients relapse prevention efforts, is theoretically and clinically differentiated in this paper from family systems therapy for addiction. Based on these conceptual differences, a Network Therapy Rating Scale (NTRS) was developed to measure the integrity and differentiability of network therapy from other family-based approaches to addiction treatment. Seven addictions faculty and 10 third- and fourth-year psychiatry residents recently trained in the network approach used the NTRS to rate excerpts of network and family systems therapy sessions. Data revealed the NTRS had high internal consistency reliability when utilized by both groups of raters. In addition, network and nonnetwork subscales within the NTRS rated congruent therapy excerpts significantly higher than noncongruent therapy excerpts, indicating that the NTRS subscales measure what they are designed to measure. Implications for research and training are discussed.

An intensive program for collegiate substance abusers Progress six months after treatment entry

The New Jersey Collegiate Substance Abuse Program (NJCSAP) provided intensive substances abuse treatment to college students requiring treatment for severe substance use disorders. This study reports the progress of students who received 6 months of treatment of NJCSAP and participated in a research evaluation of the program. Overall, 74.5% of participants who completed the follow-up were abstinent at the 6-month assessment. Including participants who did not complete the follow-up as user yielded a 52.6% rate of abstinence. Students who completed the follow-up experienced decreases in the number of current psychiatric diagnoses met, depressive symptomatology, alcohol and drug problem severity, and family and psychiatric problem severity over the 6 month period. Most students rated the program components as very or moderately helpful and most were attending AA at the 6-month assessment. Result are compared to findings from other programs for adolescents and young adults.