Am J Psychiatry. Author manuscript; available in PMC 2013 Apr 23.

Published in final edited form as:

Am J Psychiatry. 2005 Aug; 162(8): 14521460.

doi: 10.1176/appi.ajp.162.8.1452

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3633201/

24 Maret 2017 5.40

PMCID: PMC3633201

NIHMSID: NIHMS401792

Behavioral Therapies for Drug Abuse

Kathleen M. Carroll, Ph.D. and Lisa S. Onken, Ph.D.

Author information Copyright and License information

The publisher's final edited version of this article is available at Am J Psychiatry

See other articles in PMC that cite the published article.

Abstract
Before the advent of research on treatments derived from operant and classic
behaviorism, there was little indication that any form of psychosocial treatment
was effective for any type of mental disorder (1-3). Research on behavioral
therapies flourished with the adoption of the technology model (4, 5), which
sought to systematize these therapies and the experimental methods through
which they could be evaluated to achieve a level of methodological rigor on a par
with the standards for pharmacological research (6, 7). By the mid to late 1980s,
there were a number of behavioral treatments that had been shown to be
efficacious in the treatment of a variety of mental disorders, including depressive,
panic, and obsessive-compulsive disorders. However, the methodological rigor
and specificity that were characteristic of these studies were not yet apparent in
drug abuse treatment studies, with a few exceptions (8). Although behavioral
approaches were universally available in drug abuse treatment programs by the
late 1980s (9), there was continued pessimism in the field regarding the efficacy
of behavioral therapies for drug use disorders (10, 11).
In the early 1990s, studies in which behavioral therapies, therapist training, study
populations, and objective outcome measures were carefully specified and in
which participants were randomly assigned to experimental and control or
comparison conditions began to appear more frequently in the drug abuse
treatment literature. The technology model facilitated the identification of
effective behavioral treatments for substance use disorders as it enhanced the
internal validity and replicability of research on behavioral therapies. However,
the technology model also had the unanticipated effect of restricting the
development of novel therapies. The stringent methodological requirements
associated with the technology model (e.g., requiring investigators to have fully
developed treatment manuals, therapist training protocols, and fidelity rating
procedures) limited the therapies eligible for efficacy evaluation to those already
developed for drug abuse and to those which could easily be adapted from other
areas (e.g., alcohol and depression treatments). This restriction created
bottlenecks not only in the introduction of new treatments but also in output, as it
limited research on the dissemination of behavioral treatments. That is, once
efficacious treatments were identified, no articulated research strategy was
available to determine how those treatments might best be transferred to and
administered effectively in clinical settings.
Go to:

The Stage Model and Reconceptualization of Behavioral

Therapies Development
In 1992, the National Institute on Drug Abuse (NIDA) began to offer
comprehensive support for a broader range of scientific activity in behavioral
treatment development, spanning from origination and initial testing of novel
behavioral therapies to their dissemination in community settings (12). Three
stages were defined: 1) Stage I, which consists of pilot/feasibility testing for new
and untested treatments, including preparation of treatment manuals,
development of a training program, and development of adherence/competence
measures for new and untested treatments, as well as translation of findings from
basic science to clinical applications; 2) Stage II, which consists principally of
efficacy testing to evaluate treatments that are fully developed and have shown
promise or efficacy in earlier studies; and 3) Stage III, which is aimed principally
at issues of transportability of approaches to community settings (13). By
providing a scientific framework and support not only for efficacy testing at Stage
II but for the development of novel approaches at Stage I and a wide range of
dissemination/diffusion research at Stage III, this program expanded both the
range and the rigor of clinical behavioral science.
Stage I is particularly innovative in that it permits greater creativity by allowing
investigators to develop entirely new therapies or to adapt or improve existing
therapies. Another critical component of Stage I research is the translation of
ideas and concepts from basic or clinical science/neuroscience to treatment
development. Hence, Stage I allows for cross-disciplinary research and also for
the entry of higher-risk/higher-yield projects into the field. Additional goals of
Stage I research include the identification of effective change principles and
strategies through a focus on potential mechanisms of action, even at the earliest
stages of treatment development.
Efficacy testing, including dose-response and dismantling studies, occurs in Stage
II (principles and methods of which have been described in detail elsewhere
[14]). Although research in Stage II can determine if a treatment can be effective,
clarify how and why it works, and identify its essential components, it does not
address whether a treatment will work in clinical practice. Hence, the goal of
Stage III research is to produce all of the necessary knowledge to proceed to and
conduct what is usually considered traditional effectiveness research, that is, an
evaluation of whether an approach is effective when implemented by community-
based clinicians in clinical settings. Stage III research addresses, at the therapy
and therapist level, issues involved in ensuring that a treatment can work in a
community setting. In Stage III research, investigators attempt to produce a
treatment that shows efficacy in a community setting, as well as knowledge about
how to implement the treatment effectively. Thus, in Stage III, research on
questions of transportability, implementation, and acceptability (e.g., What is
needed to train clinicians to learn to use an efficacious treatment?) are encouraged
(15). For example, a Stage III study might include the development of therapist
training procedures, followed by a randomized clinical trial to determine the
effectiveness of those procedures. Alternatively, a Stage III study might simply
determine the effectiveness of a therapy in a community setting or might
compare, in a community setting, the effectiveness of a therapy in an individual
format with the same therapy modified to a group format.
Thus, the stage model provides a conceptual framework and the necessary
structure to produce treatments that are both efficacious and practical while at the
same time fostering continued systematic improvements in those treatments
through scientific advances.
Tahap Model dan rekonseptualisasi Pembangunan Behavioral Therapies
Pada tahun 1992, National Institute on Drug Abuse (NIDA) mulai menawarkan
dukungan komprehensif untuk lebih luas kegiatan ilmiah dalam pengembangan
pengobatan perilaku, mulai dari origination dan pengujian awal dari terapi
perilaku baru untuk penyebaran mereka dalam pengaturan masyarakat (12). Tiga
tahap didefinisikan: 1) Tahap I, yang terdiri dari uji coba / kelayakan untuk
pengobatan baru dan belum teruji, termasuk persiapan manual pengobatan,
pengembangan program pelatihan, dan pengembangan kepatuhan / tindakan
kompetensi untuk pengobatan baru dan belum teruji, serta sebagai terjemahan
dari temuan dari ilmu dasar untuk aplikasi klinis; 2) Tahap II, yang terdiri
terutama dari pengujian khasiat untuk mengevaluasi perawatan yang sepenuhnya
dikembangkan dan menjanjikan atau keberhasilan dalam studi sebelumnya; dan
3) Tahap III, yang ditujukan terutama pada isu-isu transportability pendekatan
untuk pengaturan masyarakat (13). Dengan menyediakan kerangka kerja ilmiah
dan dukungan tidak hanya untuk pengujian khasiat pada Tahap II tetapi untuk
pengembangan pendekatan baru pada Tahap I dan berbagai penelitian
diseminasi / difusi pada Tahap III, program ini diperluas baik jangkauan dan
kekakuan dari klinis perilaku ilmu.
Tahap I sangat inovatif dalam bahwa hal itu memungkinkan kreativitas yang lebih
besar dengan memungkinkan peneliti untuk mengembangkan terapi yang sama
sekali baru atau untuk beradaptasi atau memperbaiki terapi yang ada. komponen
penting lain dari Tahap I penelitian adalah terjemahan dari ide dan konsep dari
dasar atau klinis ilmu / neuroscience untuk pengembangan pengobatan. Oleh
karena itu, Tahap I memungkinkan untuk penelitian lintas disiplin dan juga untuk
masuknya proyek-risiko yang lebih tinggi / lebih tinggi-hasil ke lapangan. gol
tambahan dari Tahap I penelitian meliputi identifikasi prinsip-prinsip perubahan
yang efektif dan strategi melalui fokus pada mekanisme potensial aksi, bahkan
pada tahap awal pengembangan pengobatan.
Go to:

Behavioral Therapies for Drug Abuse and Dependence

The following sections present a brief overview of progress made in the
development of effective behavioral treatments for drug abuse and dependence,
with a primary focus on the broader categories of treatment that have been found
to be effective in Stage II randomized clinical trials (including contingency
management, cognitive behavior approaches, motivational interviewing, and
family/couples approaches) and on the major categories of drug dependence
(opioids, cocaine, and marijuana dependence). Space limitations preclude a more
comprehensive review of this burgeoning literature; hence, a number of important
studies, populations (e.g., adolescents, smokers), and approaches (e.g., combined
therapies, harm reduction) will not be highlighted here.

Contingency Management Therapies

Contingency management, in which patients receive incentives or rewards for
meeting specific behavioral goals (e.g., verified abstinence), has particularly
strong, consistent, and robust empirical support across a range of types of drug
use. Contingency management approaches are based on principles of behavioral
pharmacology and operant conditioning, in which behavior that is followed by
positive consequences is more likely to be repeated. For example, allowing a
patient the privilege of taking home methadone doses, contingent on the patients
providing drug-free urine specimens, is associated with significant reductions in
illicit drug use, and this strategy can be used address a number of other problems,
such as benzodiazepine use, that are common in methadone maintenance
programs (16, 17). This body of work also supports the view that positive
incentives (e.g., rewards for desired behaviors) are more effective in producing
improved substance use outcomes and in retaining patients in treatment than
negative consequences (such as methadone dose reductions, restriction of clinic
privileges, or termination of treatment) (18-21).
Despite consistent findings of the efficacy of contingent take-home privileges in
methadone maintenance programs, contingency management procedures proved
difficult to implement outside of methadone programs until the early 1990s, when
Budney, Higgins, and their colleagues (22) demonstrated the efficacy of vouchers
redeemable for goods and services, contingent on the patients providing cocaine-
free urine specimens, in reducing targeted drug use and enhancing retention in
treatment. A series of studies by Higgins and his colleagues indicated that the
initiation of abstinence facilitated by contingent vouchers is associated with
durable reductions in drug use (23, 24) and that the addition of the community
reinforcement approach, which encompasses skills training, a job club, disulfiram
therapy, and relationship counseling, can enhance treatment benefits (25).
Voucher-based incentives have been shown to be effective in improving retention
and abstinence in outpatient opioid detoxification (26), in reducing smoking as
well as illicit substance use among opioid addicts in a methadone maintenance
program (27), in reducing the frequency of marijuana use (28), and in improving
medication compliance among opioid-dependent individuals treated with
naltrexone maintenance (29-31). Iguchi et al. (32) expanded voucher-based
contingency management to outcomes other than drug-negative urine specimens,
demonstrating that reinforcement of tasks outlined in an individualized, verifiable
treatment plan was associated with greater reductions in illicit drug use than
reinforcement of drug-free urine specimens. Voucher-based contingency
management has also been shown to reduce cocaine (33, 34) and opioid (35) use
in the context of methadone maintenance, thus extending the availability of
contingency management procedures to methadone programs where the ability to
offer take-home privileges is restricted. Silverman and colleagues (36, 37)
demonstrated the efficacy of a therapeutic workplace for pregnant and postpartum
drug-abusing women in a methadone maintenance program. Access to the
therapeutic workplace, which provided job training and a salary, was linked to
abstinence and was contingent on the participants producing drug-free urine
specimens.
Despite these findings, questions have arisen regarding the applicability and
sustainability of contingency management in clinical practice, especially in
community-based treatment programs where the cost of the vouchers and the
need for frequent urine monitoring can be prohibitive. These issues have been
addressed in part by the work of Petry et al. (38), who developed a lower-cost
contingency management procedure in which vouchers are not given but
participants receive the opportunity to draw prizes of varying value, contingent
on verifiable target behaviors such as provision of drug-free urine specimens.
This approach has been effective in reducing drug use among methadone
maintenance patients (39), as well as cocaine-dependent outpatients (40).
Although the consistent findings of effectiveness in contingency management
interventions are compelling, some limitations have been noted. First, the effects
tend to weaken after the contingencies are terminated. This problem might be
addressed by evaluating combinations of contingency management with
approaches that have more enduring effects, for example, by transferring rewards
from monetary reinforcers to behaviors that are, in and of themselves, reinforcing
or by exploring novel discontinuation strategies, such as lengthening periods
between reinforcement or offering more intermittent reinforcements. Second, the
cost of providing rewards and administering contingency management systems
has been a barrier to the adoption of these approaches by the clinical community
(41). Lower-cost contingency management approaches that use reinforcers
without monetary value and that reinforce behaviors other than provision of drug-
free urine samples are promising strategies, but there are no cost-effectiveness
data that might persuade policy makers and third-party payers to support these
approaches in clinical practice (15). Finally, because a substantial proportion of
substance abusers does not respond to contingency management, there is a need
to understand and address individual differences in response to these approaches.
Terapi perilaku untuk Penyalahgunaan Obat dan Ketergantungan
Bagian berikut menyajikan gambaran singkat dari kemajuan yang dibuat dalam
pengembangan perilaku perawatan yang efektif untuk penyalahgunaan obat dan
ketergantungan, dengan fokus utama pada kategori yang lebih luas dari
pengobatan yang telah ditemukan untuk menjadi efektif dalam Tahap II secara
acak uji klinis (termasuk manajemen kontingensi , pendekatan kognitif perilaku,
wawancara motivasi, dan keluarga / pasangan pendekatan) dan pada kategori
utama dari ketergantungan obat (opioid, kokain, dan ganja ketergantungan).
keterbatasan ruang menghalangi review lebih komprehensif dari literatur yang
berkembang ini; oleh karena itu, sejumlah studi penting, populasi (misalnya,
remaja, perokok), dan pendekatan (misalnya, terapi gabungan, pengurangan
dampak buruk) tidak akan disorot di sini.
Terapi Manajemen kontingensi
manajemen kontingensi, di mana pasien menerima insentif atau imbalan untuk
memenuhi tujuan perilaku tertentu (misalnya, diverifikasi pantang), memiliki
dukungan empiris yang sangat kuat, konsisten, dan kuat di berbagai jenis
penggunaan narkoba. pendekatan manajemen kontingensi didasarkan pada
prinsip-prinsip farmakologi perilaku dan pengkondisian operan, di mana perilaku
yang diikuti oleh konsekuensi positif lebih mungkin untuk diulang. Misalnya,
memungkinkan pasien hak untuk mengambil dosis rumah metadon, bergantung
pada penyediaan spesimen urine bebas narkoba pasien, terkait dengan
pengurangan yang signifikan dalam penggunaan narkoba, dan strategi ini dapat
digunakan alamat sejumlah masalah lain, seperti penggunaan benzodiazepine,
yang umum dalam program rumatan metadon (16, 17). Badan ini bekerja juga
mendukung pandangan bahwa insentif positif (misalnya, hadiah untuk perilaku
yang diinginkan) lebih efektif dalam memproduksi peningkatan hasil penggunaan
narkoba dan dalam mempertahankan pasien dalam pengobatan dibandingkan
konsekuensi negatif (seperti pengurangan dosis metadon, pembatasan hak klinik,
atau penghentian pengobatan) (18-21).
Meskipun temuan konsisten kemanjuran hak dibawa pulang kontingen dalam
program rumatan metadon, prosedur manajemen kontingensi terbukti sulit untuk
menerapkan di luar program metadon sampai awal 1990-an, ketika Budney,
Higgins, dan rekan-rekan mereka (22) menunjukkan kemanjuran voucher
ditukarkan barang dan jasa, bergantung pada penyediaan spesimen urine kokain
bebas pasien, mengurangi penggunaan narkoba yang ditargetkan dan
meningkatkan retensi dalam perawatan. Serangkaian studi oleh Higgins dan
koleganya menunjukkan bahwa inisiasi pantang difasilitasi oleh voucher
kontingen dikaitkan dengan pengurangan tahan lama dalam penggunaan narkoba
(23, 24) dan bahwa penambahan pendekatan penguatan masyarakat, yang
meliputi pelatihan keterampilan, klub pekerjaan , terapi disulfiram, dan konseling
hubungan, dapat meningkatkan manfaat pengobatan (25).
insentif berbasis voucher telah terbukti efektif dalam meningkatkan retensi dan
pantang di rawat jalan opioid detoksifikasi (26), dalam mengurangi merokok serta
penggunaan zat terlarang di kalangan pecandu opioid dalam program rumatan
metadon (27), dalam mengurangi frekuensi ganja menggunakan (28), dan dalam
meningkatkan kepatuhan pengobatan antara individu opioid-dependent diobati
dengan perawatan naltrexone (29-31). Iguchi et al. (32) diperluas berdasarkan
voucher-manajemen kontingensi untuk hasil selain spesimen urine narkoba-
negatif, menunjukkan bahwa penguatan tugas yang digariskan dalam, rencana
perawatan diverifikasi individual dikaitkan dengan penurunan lebih besar dalam
penggunaan narkoba dari penguatan spesimen urine bebas narkoba. manajemen
kontingensi berbasis voucher juga telah terbukti mengurangi kokain (33, 34) dan
opioid (35) digunakan dalam konteks pemeliharaan metadon, sehingga
memperluas ketersediaan prosedur manajemen kontingensi untuk program
metadon di mana kemampuan untuk menawarkan dibawa pulang hak istimewa
dibatasi. Silverman dan rekan (36, 37) menunjukkan kemanjuran dari tempat
kerja terapi untuk wanita hamil dan setelah melahirkan obat-menyalahgunakan
dalam program pemeliharaan metadon. Akses ke tempat kerja terapi, yang
menyediakan pelatihan kerja dan gaji, terkait dengan pantang dan bergantung
pada memproduksi spesimen urine bebas narkoba peserta.
Meskipun temuan ini, pertanyaan muncul mengenai penerapan dan keberlanjutan
pengelolaan kontingensi dalam praktek klinis, terutama dalam program
pengobatan berbasis komunitas di mana biaya voucher dan perlunya pemantauan
urine sering dapat menjadi penghalang. Isu-isu ini telah ditangani sebagian oleh
karya Petry et al. (38), yang mengembangkan lebih rendah-biaya prosedur
manajemen kontingensi di mana voucher tidak diberikan tetapi peserta menerima
kesempatan untuk menarik hadiah dari berbagai nilai, bergantung pada perilaku
sasaran diverifikasi seperti penyediaan spesimen urine bebas narkoba. Pendekatan
ini telah efektif dalam mengurangi penggunaan narkoba di kalangan pasien
rumatan metadon (39), serta kokain tergantung pasien rawat jalan (40).
Walaupun temuan yang konsisten dari efektivitas dalam intervensi manajemen
kontingensi yang menarik, beberapa keterbatasan telah dicatat. Pertama, efek
cenderung melemah setelah kontinjensi dihentikan. Masalah ini dapat diatasi
dengan mengevaluasi kombinasi dari manajemen kontingensi dengan pendekatan
yang memiliki efek yang lebih abadi, misalnya, dengan mentransfer hadiah dari
reinforcers moneter untuk perilaku yang, dalam dan dari diri mereka sendiri,
memperkuat atau dengan mengeksplorasi strategi penghentian baru, seperti
periode pemanjangan antara penguatan atau menawarkan bala bantuan lebih
berselang. Kedua, biaya penyediaan imbalan dan mengelola sistem manajemen
kontingensi telah menjadi penghalang untuk adopsi pendekatan ini oleh
masyarakat klinis (41). pendekatan yang lebih rendah-biaya manajemen
kontingensi yang menggunakan reinforcers tanpa nilai moneter dan yang
memperkuat perilaku selain pemberian sampel urine bebas narkoba adalah
strategi yang menjanjikan, tetapi tidak ada efektivitas biaya data yang mungkin
membujuk para pembuat kebijakan dan pembayar pihak ketiga untuk mendukung
pendekatan dalam praktek klinis (15). Akhirnya, karena sebagian besar
penyalahguna zat tidak menanggapi manajemen kontingensi, ada kebutuhan
untuk memahami dan mengatasi perbedaan individu dalam menanggapi
pendekatan ini.

Cognitive Behavior and Skills Training Therapies

Cognitive behavior approaches, such as relapse prevention, are grounded in social
learning theories and principles of operant conditioning. The defining features of
these approaches are 1) an emphasis on functional analysis of drug use, i.e.,
understanding drug use within the context of its antecedents and consequences,
and 2) skills training, through which the individual learns to recognize the
situations or states in which he or she is most vulnerable to drug use, avoid those
high-risk situations whenever possible, and use a range of behavioral and
cognitive strategies to cope effectively with those situations if they cannot be
avoided (42, 43). Meta-analyses and extensive reviews of the literature have
established that cognitive behavior approaches have strong empirical support for
use in treatment of alcohol use disorders (44, 45) and several non-substance-
related psychiatric disorders (46) and that these approaches have been
demonstrated to be effective in drug-using populations as well (47). Several
research groups have demonstrated the efficacy of cognitive behavior therapy in
the treatment of cocaine-dependent outpatients, particularly depressed and more
severely dependent cocaine users (48-54), and have shown that cognitive
behavior therapy is compatible and possibly has additive effects when combined
with pharmacotherapies such as disulfiram (55,56).
Furthermore, cognitive behavior therapy is characterized by an emphasis on the
development of skills that can be used initially to foster abstinence but can also
be applied to a range of co-occurring problems. This feature may be a factor in
emerging evidence for the long-term durability of the effects of cognitive
behavior therapy. Several studies have demonstrated that cognitive behavior
therapys effects are durable and that continuing improvement may occur even
after the end of treatment (57, 58). These findings are consistent with evidence
that cognitive behavior therapy may have enduring effects for other disorders,
such as panic disorder and depression (59, 60). Delayed emergence of the effects
of cognitive behavior therapy was highlighted in two studies that directly
compared group cognitive behavior therapy and contingency management among
cocaine-dependent patients in a methadone maintenance program (61, 62).
Although end-oftreatment outcomes favored contingency management over
cognitive behavior therapy, 1-year follow-up indicated significant continuing
improvement for patients assigned to cognitive behavior therapy, in contrast to
weakening effects for contingency management, which resulted in comparable, or
slightly better, outcomes for cognitive behavior therapy at the end of follow-up.
Extending the work on cognitive behavior therapys durability to panic disorder
patients, two studies found that the addition of group cognitive behavior therapy
to slow tapering of alprazolam or clonazepam for patients who were attempting to
discontinue the benzodiazepine resulted in higher rates of successful
discontinuation, compared with the use of slow tapering alone (63, 64).
Cognitive behavior interventions have also been evaluated as a component of
multimodal treatment packages. For example, in a multisite study evaluating
psychosocial treatments for methamphetamine-dependent individuals, the matrix
model (a cognitive behavior approach that included group and individual
treatment) was found to be more effective overall than standard treatment (65).
Another multisite study involving 450 marijuana-dependent individuals
demonstrated that a nine-session individual approach that integrated cognitive
behavior therapy and motivational interviewing (66) was more effective than a
two-session motivational interviewing approach, which was in turn more
effective than a delayed-treatment control condition (67).
Despite the emerging empirical support for use of cognitive behavior therapy in
drug-dependent populations, additional research is needed to address its
limitations. Cognitive behavior therapy is a comparatively complex approach, and
training clinicians to implement this approach effectively can be challenging.
Strategies for addressing these issues include greater emphasis on understanding
the mechanisms of action of cognitive behavior therapy so that ineffective
components can be removed and treatment delivery can be simplified and
shortened and perhaps even accomplished by computer or other automated
means. Strategies for enhancing acceptance and effective implementation of
cognitive behavior therapy by the clinical community are also needed.
Perilaku Kognitif dan Pelatihan Keterampilan Terapi
pendekatan perilaku kognitif, seperti pencegahan kambuh, yang didasarkan pada
teori pembelajaran sosial dan prinsip-prinsip pengkondisian operan. Fitur
mendefinisikan pendekatan ini adalah 1) penekanan pada analisis fungsional
penggunaan narkoba, yaitu, memahami penggunaan narkoba dalam konteks
anteseden dan konsekuensi, dan pelatihan 2) keterampilan, melalui mana individu
belajar untuk mengenali situasi atau negara di yang dia adalah yang paling rentan
terhadap penggunaan narkoba, menghindari situasi berisiko tinggi bila
memungkinkan, dan menggunakan berbagai strategi perilaku dan kognitif untuk
mengatasi secara efektif dengan situasi tersebut jika mereka tidak dapat dihindari
(42, 43). Meta-analisis dan ulasan yang luas dari literatur telah menetapkan
bahwa pendekatan perilaku kognitif memiliki dukungan empiris yang kuat untuk
digunakan dalam pengobatan gangguan penggunaan alkohol (44, 45) dan
beberapa gangguan kejiwaan-non-zat terkait (46) dan bahwa pendekatan ini telah
terbukti efektif dalam populasi pengguna narkoba juga (47). Beberapa kelompok
peneliti telah menunjukkan kemanjuran terapi perilaku kognitif dalam
pengobatan pasien rawat jalan kokain tergantung, pengguna kokain terutama
depresi dan lebih berat tergantung (48-54), dan telah menunjukkan bahwa terapi
perilaku kognitif kompatibel dan mungkin memiliki efek aditif bila
dikombinasikan dengan farmakoterapi seperti disulfiram (55,56).
Selanjutnya, terapi perilaku kognitif ditandai dengan penekanan pada
pengembangan keterampilan yang dapat digunakan pada awalnya untuk
mendorong pantang tetapi juga dapat diterapkan untuk berbagai masalah co-
terjadi. Fitur ini mungkin menjadi faktor dalam muncul bukti untuk daya tahan
jangka panjang efek terapi perilaku kognitif. Beberapa studi telah menunjukkan
bahwa efek perilaku kognitif terapi adalah tahan lama dan yang perbaikan terus
menerus dapat terjadi bahkan setelah akhir pengobatan (57, 58). Temuan ini
konsisten dengan bukti bahwa terapi perilaku kognitif dapat memiliki efek abadi
untuk gangguan lain, seperti gangguan panik dan depresi (59, 60). Tertunda
munculnya efek terapi perilaku kognitif disorot dalam dua studi yang secara
langsung dibandingkan kelompok kognitif terapi perilaku dan manajemen
kontingensi antara pasien kokain tergantung dalam program rumatan metadon
(61, 62). Meskipun hasil akhir oftreatment disukai manajemen kontingensi lebih
terapi perilaku kognitif, 1 tahun follow-up menunjukkan peningkatan terus
signifikan bagi pasien ditugaskan untuk terapi perilaku kognitif, berbeda dengan
efek melemahnya manajemen kontingensi, yang mengakibatkan sebanding, atau
sedikit lebih baik, hasil untuk terapi perilaku kognitif pada akhir tindak lanjut.
Memperluas bekerja pada daya tahan perilaku kognitif terapi untuk panik pasien
gangguan, dua studi menemukan bahwa penambahan kelompok terapi perilaku
kognitif untuk memperlambat meruncing alprazolam atau clonazepam untuk
pasien yang sedang berusaha untuk menghentikan benzodiazepine mengakibatkan
tingkat yang lebih tinggi dari penghentian sukses, dibandingkan dengan
penggunaan lambat meruncing saja (63, 64).
Intervensi perilaku kognitif juga telah dievaluasi sebagai komponen dari paket
pengobatan multimodal. Sebagai contoh, dalam sebuah studi multisite
mengevaluasi perawatan psikososial bagi individu methamphetamine tergantung,
model matriks (pendekatan perilaku kognitif yang termasuk kelompok dan
perawatan individu) ditemukan menjadi lebih efektif secara keseluruhan daripada
pengobatan standar (65). Penelitian multisite lain yang melibatkan 450 individu
ganja tergantung menunjukkan bahwa sembilan sesi pendekatan individu yang
terintegrasi terapi perilaku kognitif dan wawancara motivasi (66) adalah lebih
efektif daripada dua sesi pendekatan motivasi wawancara, yang pada gilirannya
lebih efektif daripada delayed- a kondisi kontrol perlakuan (67).
Meskipun dukungan empiris yang muncul untuk penggunaan terapi perilaku
kognitif pada populasi obat-dependent, penelitian tambahan diperlukan untuk
mengatasi keterbatasan. terapi perilaku kognitif merupakan pendekatan yang
relatif kompleks, dan melatih dokter untuk menerapkan pendekatan ini secara
efektif dapat menantang. Strategi untuk mengatasi masalah ini termasuk
penekanan lebih besar pada pemahaman mekanisme tindakan terapi perilaku
kognitif sehingga komponen tidak efektif dapat dihapus dan pemberian
pengobatan dapat disederhanakan dan dipersingkat dan bahkan mungkin dicapai
dengan komputer atau alat otomatis lain. Strategi untuk meningkatkan
penerimaan dan pelaksanaan yang efektif dari terapi perilaku kognitif oleh
masyarakat klinis juga diperlukan.

Motivational Interviewing
Motivational interviewing is based on principles of motivational psychology and
is intended to enhance the individuals intrinsic motivation for change (66).
Motivational interviewing approaches have strong empirical support for use in
treating alcohol users, with several studies showing significant and durable
effects (68-70). More recently, motivational interviewing has been evaluated as
treatment for drug users. For example, marijuana-dependent adults who received
motivational interviewing had significant reductions in marijuana use, compared
to a delayedtreatment control group (71). A combination of motivational
interviewing with behavioral skills training was found to reduce HIV risk
behaviors among low-income urban women (72, 73).
However, several clinical trials have not supported the efficacy of motivational
interviewing as an engagement strategy for general populations of substance
users. These trials include studies of the effects of motivational interviewing on
drug use outcomes among inpatients and outpatients entering community-based
treatment (74), on attrition among individuals on a waiting list for publicly
funded drug treatment (75), on treatment entry among intravenous drug users
(76), and on engagement in a specialized substance misuse program among
psychiatric inpatients (77). The mixed results of these studies and of smaller pilot
studies in other populations suggest that single- session motivational interviewing
may not greatly enhance engagement or outcome in general populations of illicit
drug users. There is stronger support for motivational interviewing combined
with other evidence-based therapies for drug abusers, although the combination
of treatments precludes attribution of benefit to any single component. More
work is needed to identify the populations that best respond to motivational
interviewing and to determine how motivational interviewing enhances change
among users of illicit drugs.

Couples and Family Treatments

The defining feature of couples and family treatments is that they treat drug-using
individuals in the context of family and social systems in which substance use
may develop or be maintained. The engagement of the individuals social
networks in treatment can be a powerful predictor of change, and thus the
inclusion of family members in treatment may be helpful in reducing attrition
(particularly among adolescents) and addressing multiple problem areas (78, 79).
Meta-analyses have strongly supported the efficacy of these approaches for both
adult (80) and adolescent substance users (81-83). It is important to note that
family-based approaches are quite diverse, and it is unlikely that all are equally
effective. Moreover, many family-based approaches combine a variety of
techniques, including family and individual therapies, skills training, and
communication training (84).
Behavioral couples therapy and behavioral family counseling combine abstinence
contracts and behavioral principles to reinforce abstinence from drugs; these
approaches require the participation of a non-substance-abusing spouse or
cohabitating partner (85). Among men entering methadone maintenance
treatment, behavioral couples therapy was more effective than equally intensive
individual services in reducing the frequency of cocaine- or opioid- positive urine
tests during treatment; behavioral couples therapy was also associated with better
ratings of happiness in the relationship and fewer family and social problems
(86). A study evaluating the addition of behavioral family counseling to
individual treatment for men entering naltrexone treatment found that behavioral
family counseling was associated with better retention and naltrexone
compliance, as well as better substance use outcomes during treatment and
through a 1-year followup (87). Moreover, even though the children of
participants were not directly targeted by the intervention, the children of the
adults who received behavioral couples therapy had meaningful improvements in
psychosocial functioning, relative to the children of parents assigned to the
control condition (88). These findings highlight the possibility that effective
treatment of substance-using parents may ameliorate and conceivably prevent
problems in their children.
Several family therapies have been demonstrated to be effective among drug-
using adolescents. Azrins family behavior therapy, which combines behavioral
contracting with contingency management, was found to be more effective than
supportive counseling in a series of comparisons involving adolescents with
substance use disorders with and without conduct disorder (89). Multisystemic
therapy is a manual-based approach that addresses multiple determinants of drug
use and antisocial behavior and is intended to promote more family involvement
by engaging family members as collaborators in treatment, emphasizing the
strengths of youths and their families, and addressing a broad and comprehensive
array of barriers to attaining treatment goals (90). Henggeler and colleagues
(78, 91-94) have demonstrated the efficacy and durability of multisystemic
therapy in retaining patients and broadly improving outcomes among substance-
using juvenile offenders, compared with similar juvenile offenders who received
the usual community treatment services. Brief strategic family therapy (95) has
also received a substantial level of empirical support. In contrast to the other
family therapies for adolescents reviewed here, brief strategic family therapy is
somewhat less intensive, as it targets fewer systems and can be delivered through
once-a-week office visits. Brief strategic family therapy has been associated with
improved retention (96-98), as well as significant reductions in the frequency of
externalizing behaviors (aggression, delinquency) (99). Multidimensional family
therapy is a multicomponent, staged family therapy that incorporates both
individual and family formats and targets the substance-abusing youth, the family
members, and their interactions (81). Liddle et al. (79) demonstrated that
multidimensional family therapy was more effective than group therapy or
multifamily education among substance-abusing adolescents who were referred
to treatment by the criminal justice system or by schools.
The body of work on family and couples approaches is marked by the consistency
of positive findings regarding the efficacy of these approaches. However, because
most of these approaches include multiple components, it has not yet been
possible to isolate the components that are associated with the treatment effects or
to determine if some components can be eliminated without weakening outcomes
overall. The efficacy of several of these approaches has not yet been replicated by
other investigators, and whether there are meaningful differences in outcome
across the various family approaches is not yet clear. Finally, these approaches
have been evaluated in comparatively small groups of individuals who have
appropriate family members (i.e., family members who are not abusing
substances) who are willing to participate in treatment. Evaluation of the
effectiveness of these approaches in the general population is needed.

motivasi Wawancara
wawancara motivasi didasarkan pada prinsip-prinsip psikologi motivasi dan
dimaksudkan untuk meningkatkan motivasi intrinsik individu untuk perubahan
(66). pendekatan wawancara motivasi memiliki dukungan empiris yang kuat
untuk digunakan dalam mengobati pengguna alkohol, dengan beberapa penelitian
yang menunjukkan efek yang signifikan dan tahan lama (68-70). Baru-baru ini,
wawancara motivasi telah dievaluasi sebagai pengobatan untuk pengguna
narkoba. Misalnya, orang dewasa ganja tergantung yang menerima wawancara
motivasi memiliki pengurangan yang signifikan dalam penggunaan ganja,
dibandingkan dengan kelompok kontrol delayedtreatment (71). Kombinasi
wawancara motivasi dengan pelatihan keterampilan perilaku ditemukan untuk
mengurangi perilaku berisiko HIV di kalangan berpenghasilan rendah wanita
urban (72, 73).
Namun, beberapa uji klinis belum didukung khasiat wawancara motivasi sebagai
strategi keterlibatan untuk populasi umum pengguna narkoba. Percobaan ini
meliputi studi tentang efek dari wawancara motivasi pada hasil penggunaan
narkoba di kalangan pasien rawat inap dan rawat jalan memasuki pengobatan
berbasis komunitas (74), pada gesekan antara individu-individu pada daftar
tunggu untuk terapi obat yang didanai publik (75), pada entri pengobatan antara
obat intravena pengguna (76), dan keterlibatan dalam program penyalahgunaan
zat khusus antara pasien rawat inap psikiatri (77). Hasil campuran studi ini dan
studi percontohan yang lebih kecil pada populasi lain menunjukkan bahwa sesi
single wawancara motivasi mungkin tidak sangat meningkatkan keterlibatan atau
hasil pada populasi umum pengguna narkoba. Ada dukungan kuat untuk
wawancara motivasi dikombinasikan dengan terapi berbasis bukti lain bagi
penyalahguna narkoba, meskipun kombinasi perawatan menghalangi atribusi
manfaat untuk setiap komponen tunggal. Banyak pekerjaan yang diperlukan
untuk mengidentifikasi populasi yang terbaik menanggapi wawancara motivasi
dan untuk menentukan bagaimana motivasi wawancara meningkatkan perubahan
di kalangan pengguna obat-obatan terlarang.
Pasangan dan Perawatan Keluarga
Fitur mendefinisikan pasangan dan perawatan keluarga adalah bahwa mereka
memperlakukan individu obat-menggunakan dalam konteks keluarga dan sistem
sosial di mana penggunaan narkoba dapat mengembangkan atau dipertahankan.
Keterlibatan jaringan sosial individu dalam pengobatan dapat menjadi prediktor
kuat dari perubahan, dan dengan demikian masuknya anggota keluarga dalam
pengobatan mungkin dapat membantu dalam mengurangi gesekan (khususnya di
kalangan remaja) dan menangani beberapa masalah daerah (78, 79). Meta-analisis
telah sangat mendukung keberhasilan pendekatan ini untuk orang dewasa (80)
dan pengguna narkoba remaja (81-83). Penting untuk dicatat bahwa pendekatan
berbasis keluarga yang cukup beragam, dan tidak mungkin bahwa semua sama-
sama efektif. Selain itu, banyak pendekatan berbasis keluarga menggabungkan
berbagai teknik, termasuk keluarga dan terapi individu, pelatihan keterampilan,
dan pelatihan komunikasi (84).
Perilaku pasangan terapi dan konseling keluarga perilaku menggabungkan
kontrak pantang dan prinsip-prinsip perilaku untuk memperkuat pantang dari
obat; pendekatan ini memerlukan partisipasi dari mitra non-zat-menyalahgunakan
pasangan atau hidup bersama (85). Di antara pria yang masuk dalam pengobatan
rumatan metadon, terapi pasangan perilaku lebih efektif dibandingkan layanan
individual sama intensif dalam mengurangi frekuensi tes urine positif kokain atau
opioid- selama pengobatan; terapi pasangan perilaku juga terkait dengan
penilaian yang lebih baik kebahagiaan dalam hubungan dan keluarga yang lebih
sedikit dan masalah sosial (86). Sebuah studi mengevaluasi penambahan
konseling keluarga perilaku untuk perawatan individu untuk pria memasuki
pengobatan naltrexone menemukan bahwa konseling keluarga perilaku dikaitkan
dengan retensi yang lebih baik dan kepatuhan naltrexone, serta sebagai hasil
penggunaan zat lebih baik selama pengobatan dan melalui tindak lanjut 1 tahun
(87) . Selain itu, meskipun anak-anak peserta tidak langsung ditargetkan oleh
intervensi, anak-anak dari orang dewasa yang menerima terapi pasangan perilaku
memiliki perbaikan yang berarti dalam fungsi psikososial, relatif terhadap anak-
anak orang tua ditugaskan untuk kondisi kontrol (88). Temuan ini menyoroti
kemungkinan bahwa pengobatan yang efektif dari orang tua zat-menggunakan
mungkin memperbaiki dan dibayangkan mencegah masalah pada anak-anak
mereka.
Beberapa terapi keluarga telah dibuktikan efektif di kalangan remaja pengguna
narkoba. terapi perilaku keluarga Azrin, yang menggabungkan kontrak perilaku
dengan manajemen kontingensi, ditemukan lebih efektif daripada konseling
mendukung dalam serangkaian perbandingan yang melibatkan remaja dengan
gangguan penggunaan zat dengan dan tanpa gangguan perilaku (89). Terapi
multisistemik adalah pendekatan-pengguna berdasarkan yang membahas
beberapa faktor penentu penggunaan narkoba dan perilaku antisosial dan
dimaksudkan untuk mempromosikan keterlibatan keluarga lainnya terlibat
anggota keluarga sebagai kolaborator dalam pengobatan, menekankan kekuatan
pemuda dan keluarga mereka, dan menangani yang luas dan komprehensif

Drug Counseling
Another major development of the past 10 years has been efforts to rigorously
evaluate approaches similar to those widely used in clinical practice. For
example, researchers have specified the elements of drug counseling approaches
in detailed manuals for therapists and have evaluated these approaches in clinical
trials. A multisite randomized clinical trial of psychotherapeutic treatments for
cocaine dependence (100) provided evidence of the effectiveness of a manual-
guided individual drug counseling approach that combined drug counseling and
relapseprevention techniques (101). Data from this study also indicated that the
reductions in cocaine use were associated with sharp decreases in the frequency
of HIV risk behaviors (102), underscoring the view that effective drug abuse
treatment constitutes effective HIV prevention (103).

HIV Risk Reduction

Behavioral therapies have been demonstrated to be effective in reducing HIV risk
behaviors and promoting health in intravenous drug users enrolled in methadone
maintenance programs. Two randomized clinical trials found that the Holistic
Harm Reduction Program, developed to reduce HIV risk behaviors, illicit drug
use, and transmission of infectious diseases (e.g., HIV, hepatitis B and C),
reduced illicit drug use and risky sexual behavior and, among HIV-positive
participants, improved adherence to antiretroviral treatment (104, 105). Although
these findings are promising, this approach has been evaluated in a fairly narrow
range of populations and requires replication in other settings and other groups of
drug users.
Konseling obat
pengembangan utama lain dari 10 tahun terakhir telah upaya ketat mengevaluasi
pendekatan yang sama dengan yang banyak digunakan dalam praktek klinis.
Misalnya, para peneliti telah ditentukan unsur-unsur pendekatan konseling
narkoba di manual rinci untuk terapis dan telah dievaluasi pendekatan ini dalam
uji klinis. Sebuah uji klinis acak multisite perawatan psikoterapi untuk
ketergantungan kokain (100) memberikan bukti efektivitas manual-dipandu obat
individual pendekatan konseling yang dikombinasikan konseling narkoba dan
relapseprevention teknik (101). Data dari penelitian ini juga menunjukkan bahwa
penurunan penggunaan kokain dikaitkan dengan penurunan tajam dalam
frekuensi perilaku berisiko HIV (102), menggarisbawahi pandangan bahwa
pengobatan penyalahgunaan narkoba yang efektif merupakan pencegahan HIV
yang efektif (103).
Pengurangan Risiko HIV
terapi perilaku telah terbukti efektif dalam mengurangi perilaku berisiko HIV dan
mempromosikan kesehatan pada pengguna narkoba suntikan yang terdaftar dalam
program pemeliharaan metadon. Dua uji klinis acak menemukan bahwa Holistik
Program Harm Reduction, dikembangkan untuk mengurangi perilaku HIV resiko,
penggunaan narkoba, dan transmisi penyakit menular (misalnya, HIV, hepatitis B
dan C), mengurangi penggunaan narkoba dan perilaku seksual berisiko dan, di
antara peserta HIV-positif, meningkatkan kepatuhan terhadap pengobatan
antiretroviral (104, 105). Meskipun temuan ini menjanjikan, pendekatan ini telah
dievaluasi dalam kisaran yang cukup sempit populasi dan membutuhkan replikasi
dalam pengaturan lain dan kelompok lain dari pengguna narkoba.
Go to:

Future Directions
The findings of research on behavioral treatments have been positive, but there is
still a great deal more to be done. Even the most powerful behavioral therapies
are not universally effective, nor do all individuals who benefit from these
treatments improve as quickly or as completely as desired. There are many ways
to improve behavioral therapies at all three stages of treatment development.
Stage I research provides the opportunity for clinical creativity and innovation in
clinical behavioral science. Research at this stage has the potential for a high
yield from evaluation of clinical strategies that have not yet been subject to
empirical evaluation, from the adaptation of effective treatments used for other
disorders, and from translation of concepts from basic science to clinical
applications. Basic neuroscience and basic research on behavioral, cognitive,
affective, and social factors offer rich and relatively untapped sources of
information on behavior and behavior change. With the development of new
technologies of brain imaging, behavioral treatments based on a new
understanding of the brain could be on the horizon.
At Stage II, renewed emphasis is needed on improving understanding of the
mechanisms of action in treatments with established efficacy, not only to enhance
their effectiveness but also to increase the efficiency of treatment delivery.
Currently underutilized strategies for investigating mechanisms of action include
1) evaluating novel combinations of behavioral therapies or
psychotherapy/pharmacotherapy combinations, both to enhance treatment
efficacy and to offset weaknesses of a single approach; 2) investigating individual
differences in treatment response and in treatment moderators by using novel
methods that may in the near future include subtyping and predictor analyses
involving neuroimaging, stress-response paradigms, and genetics; and 3)
developing strategies to investigate sequenced interventions, in which treatments
or treatment components are delivered on the basis of the individual drug users
characteristics, including previous treatment response, neurocognitive
functioning, and family history. Finally, greater emphasis is needed on enhancing
adherence and response to existing behavioral and pharmacological approaches.
At Stage III, promising strategies include evaluation of the means by which
efficacious treatments can be reduced in duration, complexity, and cost. Projects
to make behavioral treatments more community friendly are needed for
treatments that show efficacy but are not deemed feasible for use by treatment
providers or the treatment system. For example, individual treatments could be
transformed into group-based approaches that would have wider acceptability in
clinical practice. Simplified training procedures should be developed for
treatments that are difficult for practitioners to learn. New information
technologies should be considered, both as a means to improve treatment efficacy
and as a way to make treatments more readily available and easier for patients
and practitioners to use.
In summary, the level of progress in the behavioral treatment of drug abuse in
recent years has exceeded what many researchers and practitioners had believed
possible. Efficacious behavioral treatments exist, and conditions for which
efficacious medications exist can be treated with combinations of behavioral and
pharmacological treatments that have even greater potency than either type of
treatment alone. More work can be done to improve effect sizes in research on
behavioral treatments and to develop strategies to help drug users who do not
respond to existing treatments. Work on the mechanisms of action of behavioral
treatments, in addition to translational efforts to link basic science and
neuroscience with treatment development, promises to yield new insights that
will help to make drug abuse not only treatable but treated.
Arah masa depan
Temuan penelitian tentang perilaku perawatan telah positif, namun masih ada
banyak lagi yang bisa dilakukan. Bahkan terapi perilaku yang paling kuat tidak
universal efektif, juga tidak semua individu yang mendapatkan manfaat dari
perawatan ini meningkatkan secepat atau sebagai benar-benar seperti yang
diinginkan. Ada banyak cara untuk meningkatkan terapi perilaku di semua tiga
tahap pembangunan pengobatan.
Tahap I penelitian memberikan kesempatan untuk kreativitas klinis dan inovasi
dalam ilmu perilaku klinis. Penelitian pada tahap ini memiliki potensi hasil yang
tinggi dari evaluasi strategi klinis yang belum pernah dilakukan evaluasi empiris,
dari adaptasi pengobatan yang efektif digunakan untuk gangguan lainnya, dan
dari penjabaran konsep-konsep dari ilmu dasar untuk aplikasi klinis. neuroscience
dasar dan penelitian dasar pada perilaku, kognitif, afektif, dan faktor-faktor sosial
menawarkan sumber yang kaya dan relatif belum dimanfaatkan informasi tentang
perilaku dan perubahan perilaku. Dengan pengembangan teknologi baru dari
pencitraan otak, perilaku perawatan berdasarkan pemahaman baru tentang otak
bisa di cakrawala.
Pada Tahap II, penekanan baru diperlukan untuk meningkatkan pemahaman
tentang mekanisme aksi dalam perawatan dengan khasiat didirikan, tidak hanya
untuk meningkatkan efektivitas mereka tetapi juga untuk meningkatkan efisiensi
pemberian pengobatan. Saat ini kurang dimanfaatkan strategi untuk menyelidiki
mekanisme aksi meliputi 1) mengevaluasi kombinasi baru dari terapi perilaku
atau psikoterapi / kombinasi farmakoterapi, baik untuk meningkatkan efektivitas
pengobatan dan untuk mengimbangi kelemahan dari pendekatan tunggal; 2)
menyelidiki perbedaan individu dalam respon pengobatan dan moderator
pengobatan dengan menggunakan metode baru yang mungkin dalam waktu dekat
termasuk subtyping dan prediksi analisis yang melibatkan neuroimaging,
paradigma stres-respon, dan genetika; dan 3) mengembangkan strategi untuk
menyelidiki intervensi sequencing, di mana perawatan atau perawatan komponen
yang disampaikan atas dasar karakteristik pengguna narkoba individu, termasuk
respon sebelumnya pengobatan, fungsi neurokognitif, dan riwayat keluarga.
Akhirnya, penekanan yang lebih besar diperlukan pada peningkatan kepatuhan
dan respon terhadap pendekatan perilaku dan farmakologis yang ada.
Pada Tahap III, strategi yang menjanjikan mencakup evaluasi sarana yang
perawatan berkhasiat dapat dikurangi dalam durasi, kompleksitas, dan biaya.
Proyek untuk membuat perilaku perawatan lebih "komunitas ramah" diperlukan
untuk perawatan yang menunjukkan efikasi tetapi tidak dianggap layak untuk
digunakan oleh penyedia perawatan atau sistem pengobatan. Misalnya, perawatan
individu dapat diubah menjadi pendekatan berbasis kelompok yang akan
memiliki penerimaan yang lebih luas dalam praktek klinis. prosedur pelatihan
disederhanakan harus dikembangkan untuk perawatan yang sulit bagi praktisi
untuk belajar. teknologi informasi baru harus dipertimbangkan, baik sebagai
sarana untuk meningkatkan efektivitas pengobatan dan sebagai cara untuk
membuat perawatan lebih mudah tersedia dan lebih mudah bagi pasien dan
praktisi untuk menggunakan.
Singkatnya, tingkat kemajuan dalam pengobatan perilaku penyalahgunaan
narkoba dalam beberapa tahun terakhir telah melampaui apa yang banyak peneliti
dan praktisi percaya mungkin. perilaku perawatan berkhasiat ada, dan kondisi
yang obat berkhasiat ada dapat diobati dengan kombinasi dari perilaku perawatan
dan farmakologis yang memiliki potensi lebih besar dari salah satu jenis
pengobatan saja. Lebih banyak pekerjaan yang dapat dilakukan untuk
meningkatkan efek ukuran dalam penelitian tentang perilaku perawatan dan
mengembangkan strategi untuk membantu pengguna narkoba yang tidak
merespon pengobatan yang ada. Bekerja pada mekanisme tindakan perawatan
perilaku, selain upaya translasi untuk menghubungkan ilmu dasar dan ilmu saraf
dengan perkembangan pengobatan, berjanji untuk memberikan pandangan baru
yang akan membantu untuk membuat penyalahgunaan narkoba tidak hanya
diobati tapi diperlakukan.
Go to:

Acknowledgments
Supported by National Institute on Drug Abuse grants R01 DA-10679, K05 DA-
00457, and P50 DA-09241.
Go to:

References
1. Sargent S. The treatment of depressive states. Int J Neurol. 1967;6:53
64. [PubMed]
2. Agras WS, Chapin HN, Oliveau DC. The natural history of phobia. Arch Gen
Psychiatry. 1972;26:315317. [PubMed]
3. Marks IM. New approaches to the treatment of obsessive-compulsive
disorders. J Nerv Ment Dis.1973;156:420426. [PubMed]
4. Waskow IE. Specification of the technique variable in the NIMH Treatment of
Depression Collaborative Research Program. In: Williams JBW, Spitzer RL,
editors. Psychotherapy Research: Where Are We and Where Should We Go? New
York: Guilford; 1984. pp. 150159.
5. Docherty JP. Implications of the technological model of
psychotherapy. Ibid. :139149.
6. Elkin I, Pilkonis PA, Docherty JP, Sotsky SM. Conceptual and methodologic
issues in comparative studies of psychotherapy and pharmacotherapy, I: active
ingredients and mechanisms of change. Am J Psychiatry.1988;145:909
917. [PubMed]
7. Elkin I, Pilkonis PA, Docherty JP, Sotsky SM. Conceptual and methodological
issues in comparative studies of psychotherapy and pharmacotherapy, II: nature
and timing of treatment effects. Am J Psychiatry.1988;145:10701076. [PubMed]
8. Woody GE, Luborsky L, McLellan AT, OBrien CP, Beck AT, Blaine JD,
Herman L, Hole A. Psychotherapy for opiate addicts: does it help? Arch Gen
Psychiatry. 1983;40:639645. [PubMed]
9. Onken LS, Blaine JD. Psychotherapy and counseling research in drug abuse
treatment: questions, problems, and solutions. NIDA Research
Monogr. 1990;104:18. [PubMed]
10. Kang SY, Kleinman PH, Woody GE, Millman RB, Todd TC, Kemp J, Lipton
DS. Outcomes for cocaine abusers after once-a-week psychosocial therapy. Am J
Psychiatry. 1991;148:630635. [PubMed]
11. Kleber HD, Gawin FH. Cocaine abuse: a review of current and experimental
treatments. In: Grabowski J, editor. Cocaine: Pharmacology, Effects and
Treatment of Abuse. DHHS Publication (ADM) 84-1326.Rockville, Md: National
Institute on Drug Abuse; 1984. pp. 111129. [PubMed]
12. Onken LS, Blaine JD, Battjes R. Behavioral therapy research: a
conceptualization of a process. In: Henggeler SW, Santos AB, editors. Innovative
Approaches for Difficult-to-Treat Populations. Washington, DC: American
Psychiatric Press; 1996. pp. 477485.
13. Rounsaville BJ, Carroll KM, Onken LS. A stage model of behavioral
therapies research: getting started and moving on from Stage I. Clin Psychol Sci
Pract. 2001;8:133142.
14. Kazdin AE. Comparative outcome studies in psychotherapy: methodological
issues and strategies. J Consult Clin Psychol. 1986;54:95105. [PubMed]
15. Carroll KM, Rounsaville BJ. Bridging the gap between research and practice
in substance abuse treatment: a hybrid model linking efficacy and effectiveness
research. Psychiatr Serv. 2003;54:333339.[PMC free article] [PubMed]
16. Stitzer ML, Bickel WK, Bigelow GE, Liebson IA. Effect of methadone dose
contingencies on urinalysis test results of polydrug abusing methadone
maintenance patients. Drug Alcohol Depend. 1986;18:341348.[PubMed]
17. Stitzer ML, Iguchi MY, Felch LJ. Contingent take-home incentives: effects on
drug use of methadone maintenance patients. J Consult Clin
Psychol. 1992;60:927934. [PubMed]
18. Dolan MP, Black JL, Penk WE, Rabinowitz R, DeFord HA. Contracting for
treatment termination to reduce illicit drug use among methadone maintenance
treatment failures. J Consult Clin Psychol.1985;53:549551. [PubMed]
19. Kidorf M, Stitzer ML. Contingent use of take-homes and splitdosing to
reduce illicit drug use of methadone patients. Behav Ther. 1996;27:4151.
20. Iguchi MY, Stitzer ML, Bigelow GE, Liebson IA. Contingency management
in methadone maintenance: effects of reinforcing and aversive consequences on
illicit polydrug use. Drug Alcohol Depend. 1988;22:17.[PubMed]
21. Stitzer ML, Iguchi MY, Kidorf M, Bigelow GE. Contingency management in
methadone treatment: the case for positive incentives. In: Onken LS, Blaine JD,
Boren JJ, editors. Behavioral Treatments for Drug Abuse and
Dependence. Rockville, Md: National Institute on Drug Abuse; 1993. pp. 19
36. [PubMed]
22. Budney AJ, Higgins ST, Mercer DE, Carpenter G. NIH Publication 98-
4309. Rockville, Md: National Institute on Drug Abuse; 1998. A Community
Reinforcement Plus Vouchers Approach: Treating Cocaine Addiction.
23. Higgins ST, Wong CJ, Badger GJ, Ogden DE, Dantona RL. Contingent
reinforcement increases cocaine abstinence during outpatient treatment and 1 year
of follow-up. J Consult Clin Psychol. 2000;68:6472.[PubMed]
24. Higgins ST, Badger GJ, Budney AJ. Initial abstinence and success in
achieving longer term cocaine abstinence. Exp Clin
Psychopharmacol. 2000;8:377386. [PubMed]
25. Higgins ST, Sigmon SC, Wong CJ, Heil SH, Badger GJ, Donham R, Dantona
RL, Anthony S. Community reinforcement therapy for cocaine-dependent
outpatients. Arch Gen Psychiatry. 2003;60:10431052. [PubMed]
26. Bickel WK, Amass L, Higgins ST, Badger GJ, Esch RA. Effects of adding
behavioral treatment to opioid detoxification with buprenorphine. J Consult Clin
Psychol. 1997;65:803810. [PubMed]
27. Shoptaw S, Rotheram-Fuller E, Yang X, Frosch D, Nahom D, Jarvik ME,
Rawson RA, Ling W. Smoking cessation in methadone
maintenance. Addiction. 2002;97:13171328. [PubMed]
28. Budney AJ, Higgins ST, Radonovich KJ, Novy PL. Adding voucher-based
incentives to coping skills and motivational enhancement improves outcomes
during treatment for marijuana dependence. J Consult Clin
Psychol. 2000;68:10511061. [PubMed]
29. Preston KL, Silverman K, Umbricht A, DeJesus A, Montoya ID, Schuster CR.
Improvement in naltrexone treatment compliance with contingency
management. Drug Alcohol Depend. 1999;54:127135.[PubMed]
30. Carroll KM, Ball SA, Nich C, OConnor PG, Eagan D, Frankforter TL,
Triffleman EG, Shi J, Rounsaville BJ. Targeting behavioral therapies to enhance
naltrexone treatment of opioid dependence: efficacy of contingency management
and significant other involvement. Arch Gen Psychiatry. 2001;58:755761. [PMC
free article] [PubMed]
31. Carroll KM, Sinha R, Nich C, Babuscio T, Rounsaville BJ. Contingency
management to enhance naltrexone treatment of opioid dependence: a
randomized clinical trial of reinforcement magnitude. Exp Clin
Psychopharmacol. 2002;10:5463. [PubMed]
32. Iguchi MY, Belding MA, Morral AR, Lamb RJ, Husband SD. Reinforcing
operants other than abstinence in drug abuse treatment: an effective alternative
for reducing drug use. J Consult Clin Psychol.1997;65:421428. [PubMed]
33. Silverman K, Higgins ST, Brooner RK, Montoya ID, Cone EJ, Schuster CR,
Preston KL. Sustained cocaine abstinence in methadone maintenance patients
through voucher-based reinforcement therapy. Arch Gen
Psychiatry. 1996;53:409415. [PubMed]
34. Silverman K, Wong CJ, Umbricht-Schneiter A, Montoya ID, Schuster CR,
Preston KL. Broad beneficial effects of cocaine abstinence reinforcement among
methadone patients. J Consult Clin Psychol.1998;66:811824. [PubMed]
35. Silverman K, Wong CJ, Higgins ST, Brooner RK, Montoya ID, Contoreggi C,
Umbricht-Schneiter A, Schuster CR, Preston KL. Increasing opiate abstinence
through voucher-based reinforcement therapy. Drug Alcohol
Depend. 1996;41:157165. [PubMed]
36. Silverman K, Svikis DS, Robles E, Stitzer ML, Bigelow GE. A
reinforcement-based therapeutic workplace for the treatment of drug abuse: six-
month abstinence outcomes. Exp Clin Psychopharmacol.2001;9:14
23. [PubMed]
37. Silverman K, Svikis DS, Wong CJ, Hampton J, Stitzer ML, Bigelow GE. A
reinforcement-based therapeutic workplace for the treatment of drug abuse: three-
year abstinence outcomes. Exp Clin Psychopharmacol. 2002;10:228
240. [PubMed]
38. Petry NM, Martin B, Cooney JL, Kranzler HR. Give them prizes and they
will come: contingency management treatment of alcohol dependence. J Consult
Clin Psychol. 2000;68:250257. [PubMed]
39. Petry NM, Martin B. Low-cost contingency management for treating cocaine-
and opioid-abusing methadone patients. J Consult Clin Psychol. 2002;70:398
405. [PubMed]
40. Petry NM, Tedford J, Austin M, Nich C, Carroll KM, Rounsaville BJ. Prize
reinforcement contingency management for treating cocaine abusers: how low
can we go, and with whom? Addiction. 2004;99:349360. [PMC free
article] [PubMed]
41. Crowley TJ. Research on contingency management treatment of drug
dependence: clinical implications and future directions. In: Higgins ST,
Silverman K, editors. Motivating Behavior Change Among Illicit Drug
Abusers. Washington, DC: American Psychological Association; 1999. pp. 345
370.
42. Carroll KM. NIH Publication 98-4308. Rockville, Md: National Institute on
Drug Abuse; 1998. A Cognitive-Behavioral Approach: Treating Cocaine
Addiction.
43. Marlatt GA, Gordon JR. Relapse Prevention: Maintenance Strategies in the
Treatment of Addictive Behaviors. New York: Guilford; 1985.
44. Miller WR, Wilbourne PL. Mesa Grande: a methodological analysis of
clinical trials of treatments for alcohol use disorders. Addiction. 2002;97:265
277. [PubMed]
45. Miller WR, Brown JM, Simpson TL, Handmaker NS, Bien TH, Luckie LF,
Montgomery HA, Hester RK, Tonigan JS. What works? a methodological
analysis of the alcohol treatment literature. In: Hester RK, Miller WR,
editors. Handbook of Alcoholism Treatment Approaches: Effective
Alternatives. Boston: Allyn & Bacon; 1995. pp. 1244.
46. DeRubeis RJ, Crits-Christoph P. Empirically supported individual and group
psychological treatments for adult mental disorders. J Consult Clin
Psychol. 1998;66:3752. [PubMed]
47. Irvin JE, Bowers CA, Dunn ME, Wong MC. Efficacy of relapse prevention: a
meta-analytic review. J Consult Clin Psychol. 1999;67:563570. [PubMed]
48. Maude-Griffin PM, Hohenstein JM, Humfleet GL, Reilly PM, Tusel DJ, Hall
SM. Superior efficacy of cognitive-behavioral therapy for crack cocaine abusers:
main and matching effects. J Consult Clin Psychol.1998;66:832837. [PubMed]
49. Rohsenow DJ, Monti PM, Martin RA, Michalec E, Abrams DB. Brief coping
skills treatment for cocaine abuse: 12-month substance use outcomes. J Consult
Clin Psychol. 2000;68:515520. [PubMed]
50. Monti PM, Rohsenow DJ, Michalec E, Martin RA, Abrams DB. Brief coping
skills treatment for cocaine abuse: substance abuse outcomes at three
months. Addiction. 1997;92:17171728. [PubMed]
51. McKay JR, Alterman AI, Cacciola JS, Rutherford MJ, OBrien CP,
Koppenhaver J. Group counseling versus individualized relapse prevention
aftercare following intensive outpatient treatment for cocaine dependence. J
Consult Clin Psychol. 1997;65:778788. [PubMed]
52. Carroll KM, Rounsaville BJ, Gordon LT, Nich C, Jatlow PM, Bisighini RM,
Gawin FH. Psychotherapy and pharmacotherapy for ambulatory cocaine
abusers. Arch Gen Psychiatry. 1994;51:177197. [PubMed]
53. Carroll KM, Rounsaville BJ, Gawin FH. A comparative trial of
psychotherapies for ambulatory cocaine abusers: relapse prevention and
interpersonal psychotherapy. Am J Drug Alcohol Abuse. 1991;17:229
247. [PubMed]
54. Rosenblum A, Magura S, Palij M, Foote J, Handlesman L, Stimmel B.
Enhanced treatment outcomes for cocaine-using methadone patients. Drug
Alcohol Depend. 1999;54:207218. [PubMed]
55. Carroll KM, Nich C, Ball SA, McCance-Katz E, Rounsaville BJ. Treatment
of cocaine and alcohol dependence with psychotherapy and
disulfiram. Addiction. 1998;93:713728. [PubMed]
56. Carroll KM, Fenton LR, Ball SA, Nich C, Frankforter TL, Shi J, Rounsaville
BJ. Efficacy of disulfiram and cognitive-behavioral therapy in cocaine-dependent
outpatients: a randomized placebo controlled trial.Arch Gen
Psychiatry. 2004;64:264272. [PMC free article] [PubMed]
57. Carroll KM, Rounsaville BJ, Nich C, Gordon LT, Wirtz PW, Gawin FH. One
year follow-up of psychotherapy and pharmacotherapy for cocaine dependence:
delayed emergence of psychotherapy effects.Arch Gen Psychiatry. 1994;51:989
997. [PubMed]
58. Carroll KM, Nich C, Ball SA, McCance-Katz EF, Frankforter TF, Rounsaville
BJ. One-year follow-up of disulfiram and psychotherapy for cocaine-alcohol
abusers: sustained effects of treatment. Addiction.2000;95:13351349. [PubMed]
59. Barlow DH. Cognitive behavioral therapy for panic disorder: current status. J
Clin Psychiatry.1997;58(suppl 2):3236. [PubMed]
60. Hollon SD, Shelton RC, Davis DD. Cognitive therapy for depression:
conceptual issues and clinical efficacy. J Consult Clin Psychol. 1993;61:270
275. [PubMed]
61. Rawson RA, Huber A, McCann MJ, Shoptaw S, Farabee D, Reiber C, Ling
W. A comparison of contingency management and cognitive- behavioral
approaches during methadone maintenance for cocaine dependence. Arch Gen
Psychiatry. 2002;59:817824. [PubMed]
62. Epstein DE, Hawkins WE, Covi L, Umbricht A, Preston KL. Cognitive
behavioral therapy plus contingency management for cocaine use: findings during
treatment and across 12-month follow-up. Psychol Addict Behav. 2003;17:73
82. [PMC free article] [PubMed]
63. Otto MW, Pollack MH, Sachs GS, Reiter SR, Maltzer-Brody S, Rosenbaum
JF. Discontinuation of benzodiazepine treatment: efficacy of cognitive-behavioral
therapy for patients with panic disorder. Am J Psychiatry. 1993;150:1485
1490. [PubMed]
64. Spiegel DA, Bruce TJ, Gregg SF, Nuzzarello A. Does cognitive behavior
therapy assist slow-taper alprazolam discontinuation in panic disorder? Am J
Psychiatry. 1994;151:876881. [PubMed]
65. Rawson RA, Marinelli Casey PJ, Anglin MD, Dickow A, Frazier Y, Gallagher
C, Galloway GP, Herrell J, Huber A, McCann MJ, Obert J, Pennell S, Reiber C,
Vandersloot D, Zweben J. Methamphetamine Treatment Project Corporate
Authors. A multi-site comparison of psychosocial approaches for the treatment of
methamphetamine dependence. Addiction. 2004;99:708717. [PubMed]
66. Miller WR, Rollnick S. Motivational Interviewing: Preparing People for
Change. 2. New York: Guilford; 2002.
67. MTP Research Group. Brief treatments for cannabis dependence: findings
from a randomized multisite trial. J Consult Clin Psychol. 2004;72:455
466. [PubMed]
68. Dunn C, Deroo I, Rivara FP. The use of brief interventions adapted from
motivational interviewing across behavioral domains: a systematic
review. Addiction. 2001;96:17251742. [PubMed]
69. Burke BL, Arkowitz H, Menchola M. The efficacy of motivational
interviewing: a meta-analysis of controlled clinical trials. J Consult Clin
Psychol. 2003;71:843861. [PubMed]
70. Project MATCH Research Group. Matching alcohol treatments to client
heterogeneity: Project MATCH posttreatment drinking outcomes. J Stud
Alcohol. 1997;58:729. [PubMed]
71. Stephens R, Roffman RA, Curtin L. Comparison of extended versus brief
treatments for marijuana use. J Consult Clin Psychol. 2000;68:898
908. [PubMed]
72. Carey MP, Maisto SA, Kalichman SC, Forsythe AD, Wright EM, Johnson BT.
Enhancing motivation to reduce the risk of HIV infection for economically
disadvantaged urban women. J Consult Clin Psychol.1997;65:531541. [PMC
free article] [PubMed]
73. Carey MP, Braaten LS, Maisto SA, Gleason JR, Forsythe AD, Durant LE,
Jaworski BC. Using information, motivational enhancement, and skills training to
reduce the risk of HIV infection for low-income urban women: a second
randomized clinical trial. Health Psychol. 2000;19:311. [PubMed]
74. Miller WR, Yahne CE, Tonigan JS. Motivational interviewing in drug abuse
services: a randomized trial.J Consult Clin Psychol. 2003;71:754763. [PubMed]
75. Donovan DM, Rosengren DB, Downey L, Cox GC, Sloan KL. Attrition
prevention with individuals awaiting publicly funded drug
treatment. Addiction. 2001;96:11491160. [PubMed]
76. Booth RE, Kwiatkowski C, Iguchi MY, Pinto F, John D. Facilitating treatment
entry among out-of-treatment injection drug users. Public Health
Rep. 1998;113(suppl 1):116128. [PMC free article] [PubMed]
77. Baker A, Lewin T, Reichler H, Clancy R, Carr V, Garret R, Sly K, Devir H,
Terry M. Motivational interviewing among psychiatric inpatients with substance
use disorders. Acta Psychiatr Scand.2002;106:233240. [PubMed]
78. Henggeler SW, Pickrel SG, Brondino MJ, Crouch JL. Eliminating (almost)
treatment dropout of substance abusing or dependent delinquents through home-
based multisystemic therapy. Am J Psychiatry.1996;153:427428. [PubMed]
79. Liddle HA, Dakof GA, Parker K, Diamond GS, Barrett K, Tejeda M.
Multidimensional family therapy for adolescent drug abuse: results of a
randomized clinical trial. Am J Drug Alcohol Abuse. 2001;27:651
688. [PubMed]
80. Stanton MD, Shadish WR. Outcome, attrition, and family-couples treatment
for drug abuse: a meta-analysis and review of the controlled, comparative
studies. Psychol Bull. 1997;122:170191. [PubMed]
81. Liddle HA, Dakof G. Efficacy of family therapy for drug abuse: promising
but not definitive. J Marital Fam Ther. 1995;21:511543.
82. Waldron HB. Adolescent substance abuse and family therapy outcome: a
review of randomized trials.Adv Clin Child Psychol. 1997;19:199234.
83. Deas D, Thomas SE. An overview of controlled studies of adolescent
substance abuse treatment. Am J Addict. 2001;10:178189. [PubMed]
84. Waldron HB, Slesnick N, Brody JL, Turner CW, Peterson TR. Treatment
outcomes for adolescent substance abuse at 4- and 7-month assessments. J
Consult Clin Psychol. 2001;69:802813. [PubMed]
85. Fals-Stewart W, OFarrell TJ, Birchler GR. Behavioral couples therapy for
male substance-abusing patients: a cost outcomes analysis. J Consult Clin
Psychol. 1997;65:789802. [PubMed]
86. Fals-Stewart W, OFarrell TJ, Birchler GR. Behavioral couples therapy for
male methadone patients: effects on drug-using behavior and relationship
adjustment. Behav Ther. 2001;32:391411.
87. Fals-Stewart W, OFarrell TJ. Behavioral family counseling and naltrexone
for male opioid-dependent patients. J Consult Clin Psychol. 2003;71:432
442. [PubMed]
88. Kelley ML, Fals-Stewart W. Couples- versus individual-based therapy for
alcohol and drug abuse: effects on childrens psychosocial functioning. J Consult
Clin Psychol. 2002;70:417427. [PubMed]
89. Azrin NH, Donohue B, Besalel VA, Kogan ES, Acierno R. Youth drug abuse
treatment: a controlled outcome study. J Child Adolesc Subst Abuse. 1994;3:1
16.
90. Henggeler SW, Borduin CM. Family Therapy and Beyond: A Multisystemic
Approach to Treating the Behavior Problems of Children and Adolescents. Pacific
Grove, Calif: Brooks/Cole; 1990.
91. Henggeler SW, Melton GB, Smith LA. Family preservation using
multisystemic therapy: an effective alternative to incarcerating serious juvenile
offenders. J Consult Clin Psychol. 1992;60:953961. [PubMed]
92. Borduin CM, Mann BJ, Cone LT, Henggeler SW, Fucci BR, Blaske DM,
Williams RA. Multisystemic treatment of serious juvenile offenders: long-term
prevention of criminality and violence. J Consult Clin Psychol. 1995;63:569
578. [PubMed]
93. Huey SJ, Henggeler SW, Brondino MJ, Pickrel SG. Mechanisms of change in
multisystemic therapy: reducing delinquent behavior through therapist adherence
and improved family and peer functioning. J Consult Clin Psychol. 2000;68:451
467. [PubMed]
94. Henggeler SW, Clingempeel WG, Brondino MJ, Pickrel SG. Four-year
follow-up of multisystemic therapy with substance-abusing and substance-
dependent juvenile offenders. J Am Acad Child Adolesc
Psychiatry. 2002;41:868874. [PubMed]
95. Szapocznik J, Hervis O, Schwartz S. NIH Publication 03-4751. Bethesda,
Md: National Institute on Drug Abuse; 2003. Brief Strategic Family Therapy for
Adolescent Drug Abuse.
96. Szapocznik J, Perez-Vidal A, Brickman AL, Foote FH, Santisteban DA,
Hervis O, Kurtines WM. Engaging adolescent drug abusers and their families in
treatment: a strategic structural systems approach. J Consult Clin
Psychol. 1988;56:552557. [PubMed]
97. Santisteban DA, Coatsworth JD, Perez-Vidal A, Mitrani V, Jean-Gilles M,
Szapocznik J. Engaging behavior problem/drug abusing youth and their families
in treatment: a replication and further exploration of the factors that contribute to
differential effectiveness. J Fam Psychol. 1996;10:3544.
98. Coatsworth JD, Santisteban DA, McBride CK, Szapocznik J. Brief strategic
family therapy versus community control: engagement, retention, and an
exploration of the moderating role of adolescent severity.Fam
Process. 2001;40:313332. [PubMed]
99. Szapocznik J, Kurtines WM, Foote FH, Perez-Vidal A, Hervis O. Conjoint
versus one-person family therapy: some evidence for the effectiveness of
conducting family therapy through one person. J Consult Clin
Psychol. 1986;54:395397. [PubMed]
100. Crits-Christoph P, Siqueland L, Blaine JD, Frank A, Luborsky L, Onken LS,
Muenz L, Thase ME, Weiss RD, Gastfriend DR, Woody G, Barber JP, Butler S,
Dale D, Salloum I, Bishop S, Najavits L, Lis J. Psychosocial treatments for
cocaine dependence: results of the National Institute on Drug Abuse
Collaborative Cocaine Study. Arch Gen Psychiatry. 1999;56:495502. [PubMed]
101. Mercer DE, Woody GE. NIH Publication 99-4380. Rockville, Md: National
Institute on Drug Abuse; 1999. An Individual Drug Counseling Approach to Treat
Cocaine Addiction: The Collaborative Cocaine Treatment Study Model.
102. Woody GE, Gallop R, Luborsky L, Blaine JD, Frank A, Salloum IM,
Gastfriend DR, Crits-Christoph P. Cocaine Psychotherapy Study Group. HIV risk
reduction in the National Institute on Drug Abuse Cocaine Collaborative
Treatment Study. J Acquir Immune Defic Syndr. 2003;33:8287. [PubMed]
103. Sorensen JL, Copeland AL. Drug abuse treatment as an HIV prevention
strategy: a review. Drug Alcohol Depend. 2000;59:1731. [PubMed]
104. Margolin A, Avants SK, Warburton LA, Hawkins KA, Shi J. A randomized
clinical trial of a manual-guided risk reduction intervention for HIV-positive
injection drug users. Health Psychol. 2003;22:223228.[PubMed]
105. Avants SK, Margolin A, Usubiaga MH, Doebrick C. Targeting HIV-related
outcomes with intravenous drug users maintained on methadone: a randomized
clinical trial of harm reduction group therapy. J Subst Abuse Treat. 2004;26:67
78. [PubMed]