Guilford Substance Abuse – serie

The Harvard Cocaine Recovery Project, a National Institute on Drug Abuse-funded randomized clinical trial, was initiated in 1986 to compare different approaches for treating cocaine abusers. Modified Dynamic Group Therapy (MDGT), one of the models used in the study, is a short-term supportive-expressive psychodynamic group approach specifically adapted for cocaine addicts. While many previous studies of substance abuse treatment were compromised by extraordinarily high dropout rates, this approach retained nearly 70% of group members for the entire length of treatment. This book describes MDGT and provides a practical guide to implementation. Based on an understanding of the psychological vulnerabilities of addicts, the MDGT model addresses the modifications in psychodynamic technique that are necessary for addicts' needs. It focuses on four main areas of difficulty involving self-regulation; affect, self-esteem, relationship, and self-care problems. Both supportive and expressive, the approach helps group members identify, process, and modify the characterological traits that mask addict's vulnerabilities. With this approach, a well-led group can heighten self-esteem, improve self-care, combat feelings of isolation and shame, and strengthen the individual's capacity for positive change. Concomitant involvement with an individual therapist/counselor is encouraged as a means to support and facilitate the group therapy, especially early in group treatment, and to maintain a flexible individual and group treatment context for self-exploration and understanding. Bringing the model to life are detailed vignettes and transcripts of groups in different phases of recovery. These cases demonstrate techniques, illustrate technical issues, and illuminate major themes that unfold during treatment.

Based on the author's 18 years of experience supervising group therapists, this quintessentially practical book is designed to help practitioners think through and formulate appropriate strategies in their clinical work. Utilizing many clinical examples, and providing explanations throughout for her interventions, Vannicelli pays special attention to the therapeutic stance -- where the clinician positions him or herself in relation to the patient, and why; and how various strategies and techniques maximize the patient's opportunity for therapeutic growth. A hallmark of Dr. Vannicelli's approach, richly illustrated in this work, is her sensitivity to countertransference and the ways it can be used productively in clinical practice.Alone among books in the substance abuse field, REMOVING THE ROADBLOCKS analyzes the group therapy issues that arise in the three populations most commonly seen in substance abuse clinics -- substance abusers themselves, adult children of alcoholics, and other family members. The author describes characteristics unique to each population and addresses overlap among them in terms of basic procedures, formats, and hurdles that group leaders face.The book also differs from most psychotherapy texts by giving the reader an opportunity to hear the voice of an experienced therapist as she provides examples of various kinds of interventions and demonstrates how they might actually be communicated and implemented. Rather than reading about psychotherapy or about various kinds of problems, one has the sense of experiencing a thorough consultation with a truly seasoned supervisor.A particularly useful feature is the appendix at the end of the volume, which provides examples of assessment and intake questionnaires, history questionnaires, ground rules for treatment, contracts, and other practical materials. Designed for all mental health professionals who work with substance abusers, the book's focus on practical clinical issues also makes it ideal for paraprofessionals. It is an excellent text for courses on substance abuse in social work, psychology, nursing, and other disciplines, as well as for courses in group psychotherapy.

This book is the first complete guide to implementing the Community Reinforcement Approach (CRA), an empirically based, highly effective cognitive-behavioral program for treating alcohol problems. An ideal program for any practitioner trying to reconcile the needs of their clients with mandates of HMOs and insurance providers, this approach has been deemed one of the most cost-effective treatments available by recent research. CRA acknowledges the powerful role of environmental contingencies in encouraging or discouraging drinking, and attempts to rearrange these contingencies so that a non-drinking lifestyle is more rewarding than a drinking one. Unique in its breadth, the approach utilizes social, recreational, familial, and vocational strategies to aid clients in the recovery process. This authoritative manual is a hands-on guide to applying these therapeutic procedures.Opening with an account of the history of CRA and the empirical support for its efficacy, the book addresses the clinical concerns of those treating substance abusing clients. Specific instructions are provided for conducting detailed assessments of the client and interviewing concerned others. Sobriety sampling and disulfiram use within CRA are discussed in chapters of their own.The authors then present a step-by-step guide to each component of the treatment plan, many of which have been shown to be effective forms of treatment in themselves. Topics include * behavioral skills training* social and recreational counseling* marital therapy* motivational enhancement* job counseling* relapse preventionEach chapter provides detailed instructions for conducting a procedure, describes what difficulties to expect, and presents strategies for overcoming them. Sample dialogues between clients and therapists, annotated by the authors, further illuminate the treatment process. The book concludes with a chapter that both addresses the common mistakes made when implementing CRA, and emphasizes the flexibility and benefits of this total treatment plan.An accessible and practical program, CRA can be implemented by all clinicians who treat alcohol abusing clients, regardless of orientation. Providing a cost-effective approach that is highly efficacious, Clinical Guide to Alcohol Treatment is an invaluable resource for the wide range of practitioners working in today's managed-care environment, including psychologists, psychiatrists, substance abuse counselors, and social workers.

Not everyone who experiments with substance use or risky behavior becomes addicted, and many who are addicted have been able to recover. This authoritative book, now revised and updated, has given tens of thousands of professionals and students a state-of-the-art framework for understanding the journey both into and out of addiction. From Carlo C. DiClemente, codeveloper of the transtheoretical model (TTM), the book identifies the stages and processes involved in initiating, modifying, maintaining, or stopping any pattern of behavior. Grounded in extensive research, and illustrated with vivid case examples, the book shows how using the TTM can help overcome obstacles to change and make treatment and prevention more effective.New to This Edition*Incorporates 15 years of research advances, contemporary prevention and treatment approaches, and the ongoing development of the TTM.*Chapter on current developments in intervention research.*Expanded discussions of neuroscience; self-regulation; behavioral economics; self-help, mutual help, and spirituality; motivational issues; "process addictions" (gambling and sex addiction); and more.*Deeper coverage of risk and protective factors across adolescent and young adult development.

Updating and expanding the classic Psychological Theories of Drinking and Alcoholism, this fully revised second edition incorporates state-of-the-art presentations from leaders in the alcoholism field. Contributors review established and emerging approaches that guide research into the psychological processes influencing drinking and alcoholism. The volume's multidisciplinary approach also takes into account biological, pharmacological, and social factors, offering important insights into the development and escalation of drinking problems and the various approaches to treatment. Including significantly expanded coverage of developmental, social learning, and cognitive theories, the book features new chapters on genetics, neurobiology, and emotions.