Evidence-Based Treatment for Alcohol and Drug Abuse: A Practititioner's Guide to Theory, Methods, and Practice (Practical Clinical Guidebooks Series)

304 Pages·2006·3.36 MB·English

by  Paul M.G. Emmelkamp

Evidence-Based
Treatment for Alcohol
and Drug Abuse
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Evidence-Based
Treatment for Alcohol
and Drug Abuse
A Practitioner’s Guide to Theory,
Methods, and Practice
Paul M.G. Emmelkamp
Ellen Vedel
New York London
Routledge is an imprint of the
Taylor & Francis Group, an informa business
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Routledge Routledge
Taylor & Francis Group Taylor & Francis Group
270 Madison Avenue 2 Park Square
New York, NY 10016 Milton Park, Abingdon
Oxon OX14 4RN
© 2006 by Taylor and Francis Group, LLC
Routledge is an imprint of Taylor & Francis Group, an Informa business
Printed in the United States of America on acid-free paper
10 9 8 7 6 5 4 3 2 1
International Standard Book Number-10: 0-415-95286-7 (Softcover) 0-415-95285-9 (Hardcover)
International Standard Book Number-13: 978-0-415-95286-6 (Softcover) 978-0-415-95285-9 (Hardcover)
Library of Congress Card Number 2006012723
No part of this book may be reprinted, reproduced, transmitted, or utilized in any form by any elec-
tronic, mechanical, or other means, now known or hereafter invented, including photocopying, micro-
filming, and recording, or in any information storage or retrieval system, without written permission
from the publishers.
Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are
used only for identification and explanation without intent to infringe.
Library of Congress Cataloging-in-Publication Data
Emmelkamp, Paul M. G., 1949-
Evidence-based treatments for alcohol and drug abuse : a practitioner’s guide to
theory, methods, and practice / Paul M.G. Emmelkamp, Ellen Vedel.
p. ; cm. -- (Practical clinical guidebooks series)
ISBN 0-415-95285-9 (hb. : alk. paper) -- ISBN 0-415-95286-7 (pb. : alk. paper)
1. Substance abuse--Treatment. 2. Evidence-based medicine. I. Vedel, Ellen. II.
Title. III. Series.
[DNLM: 1. Substance-Related Disorders--therapy. 2. Behavior Therapy--meth-
ods. 3. Evidence-Based Medicine. WM 270 E54e 2007]
RC564.E46 2007
616.86’06--dc22 2006012723
Visit the Taylor & Francis Web site at
http://www.taylorandfrancis.com
and the Routledge Web site at
http://www.routledge-ny.com
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To Lotte, Esther, and Julie
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Contents
Preface ix
chapter 1: description of substance abuse and
dependence 1
Phenomenology 1
Epidemiology 9
Comorbid Psychiatric Disorders 11
Etiology 21
Course 28
Associated Problems 29
Diagnostic Issues 35
chapter 2: clinical interventions 43
Motivational Interviewing 43
Coping-Skills Training 51
Cue-Exposure 60
Contingency Management and Community
Reinforcement 63
Behavioral Couple Therapy 69
12-Step Approaches 72
Pharmacotherapy 79
chapter 3: research basis of treatments 85
Motivational Enhancement Therapy 85
Coping-Skills Training 89
Cue-Exposure 94
Contingency Management and the Community
Reinforcement Approach 96
Behavioral Couple Therapy 100
12-Step Approaches 104
Controlled Substance Use Versus Abstinence 108
vii
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viii Contents
Pharmacotherapy 110
Treatment Matching 115
chapter 4: clinical cases 119
Detoxification 120
Clinical Assessment and Treatment Planning 120
An Explanation of Craving 126
The Case of Peter 127
The Case of Jan 139
Macroanalysis 140
The Case of Dianne 145
The Case of Gudrun 152
chapter 5: complicating Factors 157
Interpersonal Violence 157
Other Complicating Factors 191
chapter 6: Maintenance and Follow-up strategies 193
Relapse 193
Maintenance Treatment 195
Harm Reduction 202
References 205
Appendix 261
Index 269
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Preface
research in the past decade has shown that substance abuse and sub-
stance dependence are clearly treatable disorders. the field has witnessed
the introduction of evidence-based psychological and specific pharma-
cological treatments. unfortunately, many of these empirical supported
therapies are still not widely applied by practitioners. in fact, many of
the treatment approaches currently used in the addiction field are clearly
not evidence-based.
this volume is intended to give basic information about what one
needs to know when working with patients abusing substances. We
intend to inform substance abuse treatment practitioners, mental health
professionals, and students about the latest developments in the field in
order to provide the clinician with valid and practical guidelines appli-
cable across a variety of treatment settings and patient groups. the opin-
ions expressed herein are the views of the authors and do not necessarily
reflect official guidelines. Further, in every individual case, the practitio-
ner should evaluate whether the interventions proposed here match the
needs of the patient.
the book provides necessary background information on defining
characteristics, classification, and prevalence of substance use disorders.
the latest advances of fundamental research in the addiction field are
discussed in a palatable way for students and clinicians. this means that
substantial selectivity was exercised concerning topics to be included.
in selecting the relevant literature, our primary aim was to provide the
practicing clinician and the student with an up-to-date understanding of
the epidemiology, etiology, and course of substance abuse disorders that
are relevant to clinical practice. in addition to describing phenomenology
and etiology, the book provides a guide to the assessment and treatment
of abuse and dependence of alcohol, stimulants (e.g., cocaine, amphet-
amines), opiates (heroin), hallucinogens (lsd), cannabis/marijuana, and
party drugs (e.g., ecstasy). illustrative case histories were added to fur-
ther clarify phenomenology, assessment, and treatment procedures.
ix
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