Cognitive Therapy of Substance Abuse PDF
Preview Cognitive Therapy of Substance Abuse
C O G N I T I VE T H E R A PY OF S U B S T A N CE A B U SE -•^ .^'^ySi:'yf^'^''->->*' 'r... ^'i-'Mt .#''a^K"'-M>' • M^ i€ • ^^. M'^::.':^: A A R ON T. B E CK •^•rf- F R ED D. W R I G HT C O RY F. N E W H AN B R U CE S. L I E SE COGNITIVE THERAPY OF SUBSTANCE ABUSE C o g n i t i ve T h e r a py of S u b s t a n ce A b u se Aaron T. Beck, M.D. Fred D. Wright, Ed.D. Cory F. Newman, Ph.D. Bruce S. Liese, Ph.D. THE GUILFORD PRESS New York London ©1993 The Guilford Press A Division of Guilford PubHcations, Inc. 72 Spring Street, New York, NY 10012 www.guilford.com All rights reserved No part of this book may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher. Printed in the United States of America. This book is printed on acid-free paper. Last digit is print number: 9 Library of Congress Cataloging-in-Publication Data Cognitive therapy of substance abuse / Aaron T. Beck . . [et al.]. p. cm. Includes bibliographical references and index. ISBN 0-89862-115-1 (he.) ISBN 1-57230-659-9 (pbk.) 1. Substance Abuse—Treatment. 2. Cognitive therapy. I. Beck, Aaron T. [DNLM: 1. Cognitive therapy—methods. 2. Substance Abuse— therapy. WM 270 C6765 1993] RC564.C623 1993 616.86'0651—dc20 DNLM/DLC for Library of Congress 93-5208 CIP To Phyllis, Gwen, Jane, and Ziana P r e f a ce s L-#ubstance abuse is widely recognized as a serious social and legal problem. In fact, the use of illegal drugs may be responsible for more than 25% of property crimes and 15% of violent crimes. Financial losses related to these crimes have been estimated at $1.7 billion per year. Homicides are also strongly linked to drug dealing. Approximately 14% of homicides per year are causally related to drugs. The costs for criminal justice activities directed against drug trafficking on the federal level were approximately $2.5 billion in 1988, compared to $1.76 billion spent in 1986. There are also many health problems caused by these drugs. Alcohol can damage almost every body organ, including the heart, brain, liver, and stomach. Illegal drugs such as cocaine can have a serious effect on the neurological, cardiovascular, and respiratory systems. Cigarettes can cause cancer, heart disease, and more. The most widely used and abused drug in the world is alcohol. In the United States, two-thirds of the population drink alcohol. About ten out of a hundred people have problems with alcohol so serious that they can be considered "alcoholic" or "alcohol-dependent." (Interestingly, this 10% of Americans buys and drinks more than half of the alcoholic beverages!) At least 14 million Americans take illegal drugs every month. Dur ing "peak months" this number climbs to more than 25 million users. Some experts have estimated that approximately 2.3% of Americans over 12 years of age have a problem with illegal drugs serious enough to warrant drug treatment. To a large degree, we have tried to put a halt to drug abuse by making drugs illegal. For example, heroin and cocaine are presently illegal in the United States. Cigarette smoking is becoming increas ingly proscribed. At one time we tried to stop alcoholism by legal Vll via Preface mechanisms (i.e., prohibition). Obviously, these methods will never make substances completely unavailable. Not all people who use drugs become addicted to them, although many people have asked themselves, "Am I [or is someone else] an alcoholic [or a substance abuser]?" The American Psychiatric Associ ation has defined the addictions very specifically. In fact, the official term for an addiction is "substance dependence." There are some specific signs of substance dependence, including (1) heavy use of the substance, (2) continued use even though it may cause problems to the person, (3) tolerance, and (4) withdrawal symptoms. Cultural and historical factors are implicated in substance use and abuse. The patterns and consequences of drug use have been influ enced by historical developments, which have had positive and neg ative effects. Two centuries ago, the extraction of pure chemicals from plant materials created more powerful medicinal agents. The inven tion of the hypodermic needle in the middle of the nineteenth cen tury was also a medical boon, which, on the other hand, allowed drug users to circumvent the body's natural biological controls consisting of bitter taste and slow absorption through the digestive tract. Many synthetic drugs developed in the twentieth century had medical appli cation but created further opportunities for abuse and addiction. In short, any activity that affects the reward mechanisms of the brain may lead to compulsive, self-defeating behavior. Social, environmental, and personality factors have affected sub stance use and abuse in ways that go far beyond the simple pharma cological properties of these agents. Alcoholism, for example, is preva lent among certain ethnic groups and practically absent among others, such as the Mormons, who require abstinence for group acceptance. On the other hand, other social subgroups may condition group accep tance on using or drinking. The social milieu may influence using. Soldiers used illegal drugs extensively in Vietnam but, for the most part, relinquished heavy drug use after returning home. Impoverished environments have been shown in both animal experiments and human studies to lead to addiction. As pointed out by Peele, the com mon denominator is the lack of other opportunities for satisfaction. Finally, our clinical experiences have indicated that addicted indi viduals have certain clusters of addictive attitudes that make them abusers rather than users. Successful treatment depends on clinicians' effectiveness in deal ing with these addictive potentials. And what form will this care take? As pointed out by Marc Galanter, president of the American Academy of Psychiatrists in Alcoholism and Addiction, the long-term efficacy of new pharmacological treatments is open to question. "Tricyclics,
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