Behavioral Intervention Techniques in Drug Abuse Treatment, 46

173 Pages·2000·0.61 MB·English

National
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Drug
Abuse
HHPPAARRGGOONNOOMM SSEEIIRREESS
Behavioral
Intervention
Techniques in
Drug Abuse
Treatment
U. T N.ESMTR AFPOE DHTLAE HDNA NSAEMCUIHVRES Public Health Service Alcohol, Drug Abuse. and Mental Health Administration
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Techniques in Drug Abuse
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Editors:
John Grabowski, Ph.D.
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1984
DEPARTMENT OF HEALTH AND HUMAN SERVICES
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Washington, D.C. 20402
NIDA Research Monographs are prepared by the research divisions of the
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primary objective of the series is to provide critical reviews of research
problem areas and techniques. the content of state-of-the-art confer-
ences, integrative research reviews and significant original research. Its
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Jerome Jaffe, M.D.
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Jack Mendelson, M.D.
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Helen Nowlis, Ph.D.
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William Pollin, M.D.
,ROTCAEDRIIND
Jack Dwell, M.D.
ASSOCIATE DIRECTOR, OFFICE OF SCIENCE, NIDA
FEIHC-NI-ROTIDE
Eleanor W. Waldrop
MANAGING EDITOR
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Behavioral Intervention
Techniques in Drug Abuse
Treatment
ACKNOWLEDGMENT
This monograph is based upon papers and discussion from a technical
review, Behavioral Intervention Techniques in Drug Abuse Treatment,
held July 8 and 9, 1982, in Bethesda, Maryland, sponsored by the
Division of Research, National 'Institute on Drug Abuse.
COPYRIGHT STATUS
The National Institute on Drug Abuse has obtained permission from
the copyright holders to reproduce certain previously published'
material as noted in the text. Further reproduction of this
material is prohibited without specific permission of the copyright
holders. All other material in this volume except quoted passages
from copyrighted sources is in the public domain and may be used or
reproduced without permission from the Institute or the authors.
Citation of the source is appreciated.
Opinions expressed in this volume are those of the authors and do
not necessarily reflect the opinions or official policy of the
National Institute on Drug Abuse or any other part of the U.S.
Department of Health and Human Services.
The U.S. Government does not endorse or favor any specific
commercial product or commodity. Trade or proprietary names
appearing in this publication are used only because they are
considered essential in the context of the studies reported herein.
Library of Congress catalog card number 83-600623
DHHS publication number (ADM)84-1282
Printed 1984
NIDA Research Monographs are indexed in the Index Medicus. They
are selectively included in the coverage of American Statistics
Index, Biosciences Information Service, Chemical Abstracts, Current
Contents, Psychological Abstracts, and Psychopharmacology Abstracts.
iv
Foreword
Knowledge of the behavioral, environmental, and pharmacological
correlates of substance use and abuse is central to the interests
of the National Institute on Drug Abuse. Thus, NIDA has
contributed to the expansion and dissemination of such knowledge
by supporting research and sponsoring major reviews to examine the
mechanisms that determine substance abuse and other habitual
behaviors, with particular emphasis on the common explanatory
elements. The publications that resulted from these reviews have
explored what we know about the specific behavioral
pharmacological processes which underlie the observed effects of
drug use and abuse.
Several volumes in the NIDA Research Monograph series have
embodied the perspective of behavioral pharmacology.* With
varying emphasis, each has examined broad theoretical issues,
sought to expand on and contribute to a sound conceptual
framework, and applied its findings to improving the science and
techniques of treatment--in which basic research ultimately comes
to fruition. Behavioral Intervention Techniques in Drug Abuse
Treatment, the ninth of these monographs, focuses directly on
treatment applications as well as broader issues in the treatment
domain.
Behavioral intervention techniques are based on the premise that
behavior is controlled by its positive and negative consequences
and can be modified by making changes in selected aspects of the
environment so as to reinforce desired behaviors. They encompass
numerous related procedures, variously labeled as behavior
modification, behavior therapy, contingency contracting,
contingency management, or token economy. These interventions are
increasingly being used, integratively with other more traditional
forms of therapy, in treating the diverse disorders associated
with drug dependency. They can enhance the effectiveness of
essentially all available treatment components, including
pharmacological adjuncts, psychotherapy, family therapy, and job
training. Through such a spectrum of uses, behavioral
intervention techniques, thoughtfully planned and applied, promise
increasing levels of success in the treatment of drug abusers.
v
The contributors to this monograph all are actively involved in
various aspects of drug abuse research and treatment in which
behavioral techniques are used. Representing a broad range of
areas of expertise, their presentations will be of interest to
those who are engaged in clinical research, treatment, and
analysis of drug abuse treatment systems.
William Pollin. M.D.
Director
National Institute on Drug Abuse
*Behavioral Tolerance: Research and Treatment Implications
(No. 18)
Self-Administration of Abused Substances: Methods for Studv
(No. 20)
Behavioral Analysis and Treatment of Substance Abuse (No. 25)
Behavioral Pharmacology of Human Drug Dependence (No. 37)
Research on Smoking Behavior (No. 17)
Cigarette Smoking as a Dependence Process (No. 23)
The Behavioral Aspects of Smoking (No. 26)
Measurement in the Analysis and Treatment of Smoking Behavior
(No. 48)
vi
Contents
Foreword
William Pollin . . . . . . . . . . . . . . . . . . . . . . . v
Therapeutic Application of Behavioral Techniques: An Overview
John Grabowski, Maxine L. Stitzer, and Jack E. Henningfield. 1
Problems in Methadone Treatment: The Influence of Reference
Groups
Dana E. Hunt, Douglas S. Lipton, Douglas S. Goldsmith,
and David L. Strug . . . . . . . . . . . . . . . . . . . . . 8
Treatment of Behavioral and Psychiatric Problems Associated
With Opiate Dependence
George E. Woody, A. Thomas McLellan, and Charles P. O'Brien. 23
The Role of Behavioral Contingency Management in Drug
Abuse Treatment
George E. Bigelow, Maxine L. Stitzer, and Ira A. Liebson . . 36
Behavioral Treatment of Drug Dependence
Roy W. Pickens and Travis Thompson . . . . . . . . . . . . . 53
Contingency Contracting Treatment of Drug-Abusing Physicians,
Nurses, and Dentists
Thomas J. Crowley . . . . . . . . . . . . . . . . . . . . . 68
Contingency Management of Supplemental Drug Use During
Methadone Maintenance Treatment
Maxine L. Stitzer, George E. Bigelow, Ira A. Liebson,
and Mary E. McCaul . . . . . . . . . . . . . . . . . . . . . 84
A Contingency Analysis of Family Treatment and Drug Abuse
Thomas C. Todd . . . . . . . . . . . . . . . . . . . . . . . 104
vii
The Job Seekers' Workshop: A Skill Training Program for
Drug Treatment Clients
Sharon M. Hall, Peter C. Loeb, and Tim Allen . . . . . . . . . 115
Brokerage Model Rehabilitation System for Opiate Dependence:
A Behavioral Analysis
Travis Thompson, Jon Koerner, and John Grabowski . . . . . . 131
Behavioral Intervention Techniques in Drug Abuse Treatment:
Summary of Discussion
Maxine L. Stitzer, John Grabowski, and Jack E. Henningfield. 147
Contributors . . . . . . . . . . . . . . . . . . . . . . . . 157
List of NIDA Research Monographs . . . . . . . . . . . . . . 158
viii
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Observations on the History of Treatment
History is replete with examples and reports of drug abuse despite
the current popular perspective that drug abuse is a relatively
recent behavioral anomaly. References to maladaptive patterns of
drug use are prevalent in the treatment literature of the past
century, and, on even casual examination, the characteristic
efforts to eliminate the problems are not unfamiliar.
The techniques have ranged from essentially entirely pharmaco-
logical to completely behavioral-psychological. An early example
of treatment in the realm of pharmacological manipulations was
that of Bentley (1880; see Byck 1974, p. 15), who, among others,
treated heroin use by administering cocaine. Later, some
clinicians, researchers, and observers of the discipline did
recognize or acknowledge the importance of environmental factors.
As was noted by Bernfeld (1953), "Neither cocaine nor any other
chemical, in itself, produces addiction. It is a psychological
[behavioral] phenomenon. In the '80s [188Os] the problem of
addiction was approached, if at all, as one of toxicity specific
to certain habit-forming drugs" (see Byck 1974, p. 3473.
Nevertheless, despite a century of documented treatment experi-
ence, intensive research, and repetition of comments paralleling
those of Bernfeld, continued belief in the singular importance of
the substance is frequent, and failure to acknowledge the
importance of behavioral and environmental factors in the
development, maintenance, and elimination of drug use is not
uncommon. Thus, for example, methadone maintenance, when
introduced 20 years ago, constituted a pharmacological inter-
vention which was commonly administered as a primary therapy
rather than as a pharmacological adjunct to other therapy.
Furthermore, this practice is not altogether unusual today.
Early reports of treatment illustrated the general inadequacy of
approaches not explicitly attending to the interactive nature of
drug use. In the United States, "drug addiction," i.e.,
1