Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

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22. Cognitive Therapy 483Therapists also draw diagrams of scenarios in which patients take substances(Figure 22.4) to illustrate the cyclical process of substance use and themany opportunities to intervene and avert a relapse.Principle 2: A Strong Therapeutic Alliance Is EssentialSuccessful treatment relies on a caring, collaborative, respectful therapeuticrelationship. Effective therapists explain their therapeutic approach, encouragepatients to express skepticism, help them test the validity of their doubts, provideexplanations for their interventions, share their cognitive formulation tomake sure they have an accurate understanding of the patient, and consistentlyask for feedback.Therapists who are very collaborative typically find that they can establishsound therapeutic relationships with most substance abuse patients. However,even the most skilled therapists, who embody the essential characteristics ofwarmth, empathy, caring, and genuine regard, find it challenging to developgood relationships with occasional patients who are suspicious, manipulative,or avoidant. Therapists are encouraged to examine relationship problems withthe same careful cognitive exploration of session-related behavior as is done forall other behaviors. See Figure 22.5 for a cognitive conceptualization diagram ofmissed sessions and dropout.An effective therapist seeks to avoid activating patients’ core beliefsthrough his or her own behavior in therapy and helps patients test the validityof their ideas about the therapist. For example, Kim’s therapist asked for evidencewhen Kim said she believed the therapist was judging her as “bad” forhaving a substance abuse problem. Of course, effective therapists need to examinetheir own thoughts, feelings, and behaviors periodically to ensure that theyare not viewing their patients in a negative light. When therapists maintaintrue nonjudgmental attitudes, they can sincerely tell patients that they are notnegatively evaluating them. They can further explain that they view patients asusing substances to try to cope with the difficulties inherent in their lives.At times, a persistent problem in the therapeutic relationship arises from aclash of patient and therapist beliefs. Therapists are advised to do conceptualizationdiagrams of patients and of themselves to identify dysfunctional ideasthey may have about interacting with difficult people.For example, one substance abuse patient held the core belief, “If I showany weakness, others will hurt me,” and a related assumption, “If I listen to mytherapist, he’ll see me as weak.” As a result, the patient was very controlling inthe session, kept criticizing the therapist, and would not do any self-help assignmentssuggested by the therapist. The problem persisted, at least in part,because the therapist too had a broad assumption, “If people don’t listen to me,it means they don’t value me, and therefore don’t deserve my best effort.” The
484 V. TREATMENTS FOR ADDICTIONSFIGURE 22.5. Cognitive conceptualization of missed sessions and dropouts.therapist became irritated with the patient, expressing dissatisfaction throughbody language and tone of voice. The patient, already hypervigilant for possibleharm from others, perceived the therapist’s negative attitude and dropped outof therapy prematurely.Liese and Franz (1996) have identified common dysfunctional beliefs oftherapists that interfere with delivering therapy to substance abuse patients.Although many patients may minimize their substance use, confronting themin a harsh manner is likely to result in diminished therapeutic efficacy anddropping out.
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CLINICAL TEXTBOOK OF ADDICTIVE DISO
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© 2005 The Guilford PressA Divisio
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viAbout the EditorsMedical College.
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viiiContributorsStephen L. Dilts, M
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xContributorsRussell K. Portenoy, M
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xiiPrefaceof alcohol in the 2002 su
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xivPrefaceResearch (1) on health sy
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ContentsPART I. FOUNDATIONS OF ADDI
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ContentsxixPART V. TREATMENTS FOR A
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CHAPTER 1The Neurobiologyof Substan
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1. The Neurobiology of Substance De
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2. Historical and Social Context 17
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34 I. FOUNDATIONS OF ADDICTIONThomp
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CHAPTER 3Psychological Evaluationof
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3. Psychological Evaluation 39sever
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3. Psychological Evaluation 41neuro
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3. Psychological Evaluation 43In su
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3. Psychological Evaluation 45subst
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3. Psychological Evaluation 47is im
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3. Psychological Evaluation 49Self-
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3. Psychological Evaluation 51decis
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3. Psychological Evaluation 53Socia
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3. Psychological Evaluation 55Behav
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3. Psychological Evaluation 57socia
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3. Psychological Evaluation 59Lezak
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3. Psychological Evaluation 61Tarte
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CHAPTER 4Laboratory Testingfor Subs
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4. Laboratory Testing 65stance. It
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4. Laboratory Testing 67tive in lab
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4. Laboratory Testing 69Agency (USA
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4. Laboratory Testing 71CONCLUSIOND
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CHAPTER 5AlcoholEDGAR P. NACEAlcoho
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5. Alcohol 77withdrawal symptoms, b
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5. Alcohol 79Drug Abuse-DependenceA
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5. Alcohol 81symptoms as schizophre
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5. Alcohol 83show low incidences of
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5. Alcohol 85the rate of eliminatio
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5. Alcohol 87nisms. The symptoms of
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5. Alcohol 89individual with a hist
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5. Alcohol 91The small intestine sh
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5. Alcohol 93alcohol’s effect of
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5. Alcohol 95Bone marrow recovery w
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5. Alcohol 97Female breast cancer s
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5. Alcohol 99tion and management. P
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5. Alcohol 101nervosa and alcohol u
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5. Alcohol 103for alcohol-related p
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CHAPTER 6TobaccoNORMAN HYMOWITZHIST
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6. Tobacco 107geon General’s Advi
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6. Tobacco 109Smokers are wrong abo
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6. Tobacco 111significant substance
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6. Tobacco 113exacerbate existing i
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6. Tobacco 115Substance use, in gen
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6. Tobacco 117cological aids (Fager
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6. Tobacco 119ciently nonirritating
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6. Tobacco 121particular reinforcin
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6. Tobacco 123The results of a smal
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6. Tobacco 125proaches to smoking c
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6. Tobacco 127smoking, and to smoke
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6. Tobacco 129.02) and the 300-mg g
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6. Tobacco 131cholinergic bronchodi
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6. Tobacco 133Green, D.E. (1980). B
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6. Tobacco 135Orleans, C. T. (1993)
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6. Tobacco 137Monograph No. 17, DHE
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7. Opioids 139DEFINITIONSThe opioid
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7. Opioids 141sion of control chara
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TABLE 7.2. Opioid Withdrawal7. Opio
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7. Opioids 145The concept of tolera
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7. Opioids 147der with water, heat
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7. Opioids 149overdose in a pregnan
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7. Opioids 151who may inject from f
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7. Opioids 153more methadone, possi
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7. Opioids 155Bickel, W. K., Stitze
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Marijuana, Hallucinogens,and Club D
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8. Marijuana, Hallucinogens, and Cl
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9. Cocaine and Stimulants 185among
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9. Cocaine and Stimulants 187Cocain
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9. Cocaine and Stimulants 189ited,
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9. Cocaine and Stimulants 191postsy
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9. Cocaine and Stimulants 193herita
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9. Cocaine and Stimulants 195Kleber
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9. Cocaine and Stimulants 197When c
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9. Cocaine and Stimulants 199OBSTET
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9. Cocaine and Stimulants 201guide
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9. Cocaine and Stimulants 203Cognit
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9. Cocaine and Stimulants 205tity i
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9. Cocaine and Stimulants 207purifi
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9. Cocaine and Stimulants 209ence n
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9. Cocaine and Stimulants 211Brady,
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9. Cocaine and Stimulants 213others
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9. Cocaine and Stimulants 215Martin
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9. Cocaine and Stimulants 217DHHS P
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Sedatives/Hypnoticsand Benzodiazepi
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10. Sedatives/Hypnotics and Benzodi
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TABLE 10.1. Pharmacological Charact
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PART IVSPECIAL POPULATIONS
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246 IV. SPECIAL POPULATIONSThis con
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248 IV. SPECIAL POPULATIONSin patie
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250 IV. SPECIAL POPULATIONSdisorder
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252 IV. SPECIAL POPULATIONSsample o
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254 IV. SPECIAL POPULATIONSAntisoci
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256 IV. SPECIAL POPULATIONS(Cloning
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258 IV. SPECIAL POPULATIONSdrug is
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260 IV. SPECIAL POPULATIONSneous us
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262 IV. SPECIAL POPULATIONSamine an
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264 IV. SPECIAL POPULATIONSor bupre
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266 IV. SPECIAL POPULATIONSsonality
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268 IV. SPECIAL POPULATIONS(2001).
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270 IV. SPECIAL POPULATIONSTómasso
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272 IV. SPECIAL POPULATIONSAddition
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274 IV. SPECIAL POPULATIONStreatmen
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276 IV. SPECIAL POPULATIONSOther Th
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278 IV. SPECIAL POPULATIONSDIAGNOSI
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280 IV. SPECIAL POPULATIONStransfer
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282 IV. SPECIAL POPULATIONSSpecific
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284 IV. SPECIAL POPULATIONSattendin
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286 IV. SPECIAL POPULATIONSPHARMACO
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288 IV. SPECIAL POPULATIONSdiagnose
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290 IV. SPECIAL POPULATIONSimproved
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292 IV. SPECIAL POPULATIONSwith nov
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294 IV. SPECIAL POPULATIONSand abus
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296 IV. SPECIAL POPULATIONSpatients
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298 IV. SPECIAL POPULATIONSMahler,
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300 IV. SPECIAL POPULATIONSPowell,
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302 IV. SPECIAL POPULATIONSWeiss, R
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304 IV. SPECIAL POPULATIONSCORE FEA
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306 IV. SPECIAL POPULATIONSThe asso
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308 IV. SPECIAL POPULATIONSefficacy
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TABLE 13.2. Double-Blind, Placebo-C
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312 IV. SPECIAL POPULATIONSreceivin
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314 IV. SPECIAL POPULATIONSLike ind
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316 IV. SPECIAL POPULATIONSmomentar
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318 IV. SPECIAL POPULATIONSChambers
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320 IV. SPECIAL POPULATIONSorders.
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322 IV. SPECIAL POPULATIONSican wom
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324 IV. SPECIAL POPULATIONSamounts
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326 IV. SPECIAL POPULATIONSLiteratu
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328 IV. SPECIAL POPULATIONStrol and
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330 IV. SPECIAL POPULATIONS& Fein,
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332 IV. SPECIAL POPULATIONSAsian pr
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334 IV. SPECIAL POPULATIONSBaker, F
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336 IV. SPECIAL POPULATIONSGraves,
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338 IV. SPECIAL POPULATIONSDifferen
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CHAPTER 15Addictions in the Workpla
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342 IV. SPECIAL POPULATIONSOrganiza
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344 IV. SPECIAL POPULATIONSStimulan
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346 IV. SPECIAL POPULATIONSemployer
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348 IV. SPECIAL POPULATIONSshould b
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350 IV. SPECIAL POPULATIONSstances,
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352 IV. SPECIAL POPULATIONSbe halte
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CHAPTER 16Addiction and the LawAVRA
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356 IV. SPECIAL POPULATIONSobjected
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358 IV. SPECIAL POPULATIONSOver tim
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360 IV. SPECIAL POPULATIONSDisabili
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362 IV. SPECIAL POPULATIONSdrawal f
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364 IV. SPECIAL POPULATIONSStates h
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366 IV. SPECIAL POPULATIONSMcClella
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368 IV. SPECIAL POPULATIONSThe expa
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370 IV. SPECIAL POPULATIONSThere co
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372 IV. SPECIAL POPULATIONSTABLE 17
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374 IV. SPECIAL POPULATIONScommon m
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376 IV. SPECIAL POPULATIONSstand th
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378 IV. SPECIAL POPULATIONSapproach
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380 IV. SPECIAL POPULATIONS1. What
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TABLE 17.5. Opioid AsnalgesicsEquia
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384 IV. SPECIAL POPULATIONSadminist
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386 IV. SPECIAL POPULATIONSas methy
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392 IV. SPECIAL POPULATIONSArner, S
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394 IV. SPECIAL POPULATIONSPassik,
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CHAPTER 18Alcoholism and Substance
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398 IV. SPECIAL POPULATIONSdrug eff
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400 IV. SPECIAL POPULATIONSI (Zimbe
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402 IV. SPECIAL POPULATIONSAlcohol-
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404 IV. SPECIAL POPULATIONSStaffing
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406 IV. SPECIAL POPULATIONSLocation
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408 IV. SPECIAL POPULATIONSREFERENC
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410 IV. SPECIAL POPULATIONSSurock,
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412 IV. SPECIAL POPULATIONSfueling
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414 IV. SPECIAL POPULATIONSLipton &
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416 IV. SPECIAL POPULATIONSCo-abuse
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418 IV. SPECIAL POPULATIONSsion. We
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420 IV. SPECIAL POPULATIONSand the
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422 IV. SPECIAL POPULATIONSthe immu
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424 IV. SPECIAL POPULATIONSothers w
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426 IV. SPECIAL POPULATIONSfuture p
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428 IV. SPECIAL POPULATIONSand sex-
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430 IV. SPECIAL POPULATIONSCole, S.
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Page 476: PART VTREATMENTS FOR ADDICTIONS
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538 V. TREATMENTS FOR ADDICTIONSfir
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540 V. TREATMENTS FOR ADDICTIONSles
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542 V. TREATMENTS FOR ADDICTIONSove
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544 V. TREATMENTS FOR ADDICTIONS1.
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548 V. TREATMENTS FOR ADDICTIONSvs.
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554 V. TREATMENTS FOR ADDICTIONSBeh
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584 V. TREATMENTS FOR ADDICTIONSLew
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586 V. TREATMENTS FOR ADDICTIONSRob
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CHAPTER 26Psychopharmacological Tre
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590 V. TREATMENTS FOR ADDICTIONSmen
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592 V. TREATMENTS FOR ADDICTIONS(1,
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600 V. TREATMENTS FOR ADDICTIONSSuc
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602 V. TREATMENTS FOR ADDICTIONSuse
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604 V. TREATMENTS FOR ADDICTIONSTAB
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624 V. TREATMENTS FOR ADDICTIONSsta
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646 V. TREATMENTS FOR ADDICTIONS(Vo
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660 V. TREATMENTS FOR ADDICTIONSMoy
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662 V. TREATMENTS FOR ADDICTIONStie
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664 IndexAfrican Americansadolescen
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666 IndexAsian Americans (cont.)rel
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668 IndexCocaine use and abuse (con
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670 IndexDepressionin adolescents,
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672 IndexFetal alcohol syndrome, 97
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674 IndexImpulse control disorders
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676 IndexMethamphetamine (cont.)neu
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678 IndexPPain managementadjuvant a
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680 IndexPsychological assessment (
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682 IndexSexual behaviorHIV infecti
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684 IndexWWernicke-Korsakoff syndro
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