Elsevier

Drug and Alcohol Dependence

Volume 91, Issue 1, 2 November 2007, Pages 97-101
Drug and Alcohol Dependence

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Enhancing brief cognitive-behavioral therapy with motivational enhancement techniques in cocaine users

https://doi.org/10.1016/j.drugalcdep.2007.05.006Get rights and content

Abstract

Background

We investigated the impact of enhancing brief cognitive-behavioral therapy with motivational interviewing techniques for cocaine abuse or dependence, using a focused intervention paradigm.

Methods

Participants (n = 74) who met current criteria for cocaine abuse or dependence were randomized to three-session cognitive-behavioral therapy (CBT) or three-session enhanced CBT (MET + CBT), which included an initial session of motivational enhancement therapy (MET). Outcome measures included treatment retention, process measures (e.g., commitment to abstinence, satisfaction with treatment), and cocaine use.

Results

Participants who received the MET + CBT intervention attended more drug treatment sessions following the study interventions, reported significantly greater desire for abstinence and expectation of success, and they expected greater difficulty in maintaining abstinence compared to the CBT condition. There were no differences across treatment conditions on cocaine use.

Conclusions

These findings offer mixed support for the addition of MET as an adjunctive approach to CBT for cocaine users. In addition, the study provides evidence for the feasibility of using short-term studies to test the effects of specific treatment components or refinements on measures of therapy process and outcome.

Introduction

The effectiveness of CBT for improving treatment outcomes among cocaine-using populations has been documented (Carroll et al., 2000, Carroll et al., 2004, Rawson et al., 2002, Rohsenow et al., 2000). Although CBT's effects are comparatively durable, a relative weakness of CBT is that its effects on early retention are mixed and it does not strongly address the individual's motivation and engagement, aspects more specifically targeted in motivational enhancement therapy (Miller and Rollnick, 2002). MET has demonstrated efficacy comparable to other standard substance abuse treatments (Burke et al., 2003, Project MATCH Research Group, 1998, Stephens et al., 2000) and has been conceptualized as an adjunctive or preparatory treatment, particularly for more severe drug use disorders (Miller et al., 2003, Rohsenow et al., 2004).

An emerging treatment strategy is to combine empirically supported therapies (or their components) to address their relative strengths and weaknesses. Although some studies have found support for the effectiveness of CBT–MET combinations (MTP Research Group, 2004), few empirical evaluations have examined whether standard approaches such as CBT are improved by combining components from other approaches and whether such combinations work in the manner hypothesized (Kazdin, 1986, Kazdin, 2004, Kazdin and Nock, 2003). The standard evaluative strategy is to conduct full-scale randomized clinical trials (Jacobson et al., 1996), which is costly and time-consuming. An alternate, and potentially more efficient strategy is to conduct smaller highly focused trials evaluating the effect of specific components on treatment outcome (Kazdin, 1986, Kazdin, 2004, Kazdin and Nock, 2003).

Using a short-term intervention paradigm, participants were randomized to two treatment entry interventions prior to standard substance abuse treatment: CBT only, and MET + CBT to evaluate whether the addition of MET to CBT improves treatment outcomes. Changes in treatment motivation, treatment satisfaction, and retention were evaluated as primary outcomes, with cocaine use a secondary outcome given the brief nature of the protocol interventions and the anticipated effect of MET on process measures.

Section snippets

Sample

Participants were recruited through an outpatient substance abuse clinic. Seventy-four eligible individuals who met current criteria for cocaine abuse (11%) or dependence (89%) were randomly assigned to one of two treatment conditions; MET + CBT (n = 38) or CBT (n = 36). Exclusion criteria included current opiate abuse or dependence, a lifetime diagnosis of bipolar disorder or schizophrenia, current suicidal or homicidal plans and intent, or a pending legal case.

Intervention conditions

Both brief introductory interventions

Sample description

There were no significant differences in demographic characteristics or pre-treatment motivation across therapy conditions (Table 1). Assessment of past 30-day drug use indicated greater frequency [F(1, 66) = 6.93, p < .05] and quantity [F(1, 66) = .51, p < .10] of cannabis use in the CBT condition.

Treatment retention

Mean sessions completed (CBT = 2.19, S.D. = 1.14; MET + CBT = 2.39, S.D. = 1.00) and percentage of participants completing all three sessions (CBT = 61%, MET + CBT = 68%), were comparable across conditions (p > .05). There

Discussion

This study examined whether enhancing CBT with MET would primarily increase client participation, engagement, and commitment to abstinence, and secondarily decrease cocaine use during the initial phase of substance abuse treatment. While there were no differences in completion rates for the three therapy sessions, participants who received MET + CBT attended more treatment sessions during the follow-up period. This finding is consistent with a number of emerging studies suggesting that

Conflict of interest

Drs. O’Malley and Carroll are members of Applied Behavioral Research, LLC, which develops and evaluates clinician-training strategies for a range of empirically supported therapies.

Acknowledgements

Authors O’Malley, Carroll, and Sinha designed the study. Author Robinson was the project director and supervised study therapists. Author Cavallo coordinated the study. Authors Nich and McKee undertook the statistical analysis. Author McKee wrote the first draft of the manuscript. All authors contributed to and approved the final manuscript.

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    Funding for this study was provided by National Institute on Health grants P50DA09241, K02AA00171, K05DA00457, and K05AA014715; the NIH had no further role in the study design, in the collection, analysis and interpretation of data; in the writing of the report or in the decision to submit the paper for publication.

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