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

654 V. TREATMENTS FOR ADDICTIONSto help patients accept that they have the illness, or disease, of addiction) andsurrender (e.g., to help patients acknowledge that there is hope for sobrietythrough accepting help from others and from a “Higher Power”)(Nowinski etal., 1992). In addition to abstinence from all psychoactive substances, a majorgoal of the treatment is to foster active participation in self-help groups, andpatients are actively encouraged to attend AA or CA meetings and becomeinvolved in traditional fellowship activities. In a comparison of TSF, CBT, andclinical management (a supportive approach in which patients receive comparableempathy, support and other “common elements” of psychotherapy butnone of the unique “active ingredients” of TSF or CBT) for alcoholic cocainedependentindividuals, TSF was significantly more effective than clinical managementand was comparable to CBT in reducing cocaine use (Carroll, Nich,Ball, McCance-Katz, & Rounsaville, 1998).The National Institute on Drug Abuse (NIDA) Collaborative CocaineTreatment Study (CCTS), a multisite, randomized trial of psychotherapeutictreatments for cocaine dependence (Crits-Christoph et al., 1999), also offeredstrong evidence of the effectiveness of a similar approach, individual drug counseling(Mercer & Woody, 1999). In this study, 487 cocaine-dependent patientswere randomized to one of four manual-guided treatment conditions: (1) cognitivetherapy plus group drug counseling; (2) SE, a short-term psychodynamicallyoriented approach, plus group drug counseling; (3) individual drugcounseling plus group drug counseling; or (4) group drug counseling alone. Outcomeson the whole were good, with all groups significantly reducing cocaineuse from baseline; however, the best cocaine outcomes were seen for subjectswho received individual drug counseling. Considered together with the recentfindings of the Project MATCH Research Group (1997), where TSF was foundto be comparable to CBT and motivational enhancement therapy in reducingalcohol use among 1,726 alcohol-dependent individuals, the findings fromthese studies offer compelling support for the efficacy of manual-guided diseasemodel approaches. This has important clinical implications, because theseapproaches are similar to the dominant model applied in most communitytreatment programs and may thus be more easily mastered by “real-world” cliniciansthan approaches such as contingency management or CBT, treatmentswhose theoretical underpinnings may not be seen as highly compatible withdisease model approaches.TREATMENT OF MARIJUANA DEPENDENCEAlthough marijuana is the most commonly used illicit drug in the UnitedStates, treatment of marijuana abuse and dependence is a comparatively understudiedarea to date, in part because comparatively few individuals present for