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

642 V. TREATMENTS FOR ADDICTIONSalternatives to substance use, as exemplified by the community reinforcementapproach (CRA; Azrin, 1976) or contingency management (Budney & Higgins,1998), which stresses the development of alternate reinforcers for substanceuse.Fostering Affect ManagementAmong the most commonly cited reasons for relapse are powerful negativeaffects, and several clinicians have suggested that failure of affect regulation is acritical dynamic underlying the development of compulsive drug use. Moreover,the difficulty many substance abusers have in recognizing and managingaffect states has been noted in several populations. Thus, an important commontask in substance abuse treatment is to help develop ways of coping withpowerful dysphoric affects, and to learn to recognize and identify the probablecause of these feelings (Rounsaville & Carroll, 1997). Again, whilepsychodynamically oriented treatments such as supportive–expressive therapy(Luborsky, 1984) emphasize the role of affect in the treatment of cocaine abuse,virtually all forms of psychotherapy for substance abuse include a variety oftechniques for coping with strong affects.Improving Interpersonal Functioningand Enhancing Social SupportsA consistent finding in the literature on relapse to substance abuse and dependenceis the protective influence of an adequate network of social supports(Longabaugh, Beattie, Noel, Stout, & Malloy, 1993). Typical issues presentedby drug abusers are loss of or damage to valued relationships occurring whenusing drugs was the principal priority, failure to have achieved satisfactory relationshipseven prior to having initiated drug use, and inability to identifyfriends or intimates who are not themselves drug users (Rounsaville & Carroll,1997). Many forms of treatment, including family/couple therapy (E. E. Epstein& McCrady, 1998; Fals-Stewart, O’Farrell, & Birchler, 1997), 12-step approaches(Nowinski, Baker, & Carroll, 1992), interpersonal therapy (Rounsaville,Gawin, & Kleber, 1985), and network therapy (Galanter, 1993), make buildingand maintaining a network of social supports for abstinence a central focus oftreatment.Fostering Compliance with PharmacotherapyThe difficulties of fostering adequate levels of treatment compliance with substanceusers are well known, so much so that substance abusers are typicallyexcluded from clinical trials of treatments for other disorders. Thus, whenpharmacotherapies are used in the treatment of substance abuse, it is not sur-