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Evidence-Based Modalities Used in Clinical Substance Use Treatments

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Evidence-based treatment refers to treatment modalities that have been proven effective in scientific research and can be implemented in various treatment settings. Just because a treatment option is evidence-based doesn’t mean it will work for everyone. But it does mean it has shown to be significantly effective. When clinicians implement an evidence-based modality, they can reasonably assume it’s likely to lead to progress or insight for their clients or patients. 

Treatment options that aren’t based on scientific evidence may include alternative therapies that have helped some individuals or been helpful in specific clinics. However, many alternative therapies haven’t been adequately studied or shown to be significantly effective in studies. While they still may help some people as supplemental therapies, treatment plans should be grounded in evidence-based approaches. 

Pharmacotherapies

There are many pharmacological options in addiction treatment, from nicotine patches to the use of opioids in medication-assisted treatments. Drugs can be used to taper patients off addictive substances during detox. In some cases, drugs are used to replace more harmful substances, while clients go through an addiction treatment program. Medication-assisted treatment, known as MAT, is often better reserved for clients who have tried traditional treatment but relapsed several times.

Behavioral Therapies

Behavioral therapy refers to a category of treatment options that focus on your thoughts and how they influence your behaviors and motivations. Behavioral therapies often deal with things like motivation, modifying your attitude, and learning skills to deal with stressful situations. Behavioral therapies are used for a wide variety of issues, including mental health disorders like depression and anxiety. They are especially useful in substance use treatment because behavioral therapies can address substance use disorders and underlying mental health issues. 

Several different types of behavioral therapy options are used in addiction treatment. It’s possible that you might go through more than one during your time in a treatment program. Here are a few of the most common.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is one of the most common behavioral therapies, not only in addiction treatment but in mental health treatment as a whole. The idea behind cognitive behavioral therapy is that people often develop behavioral issues through maladaptive learned responses. In other words, you might respond to stress with ineffective coping mechanisms that lead to unhelpful behavior. For instance, drinking may become your go-to coping response to stress in your life. CBT can help you identify stressors and high-risk situations that may trigger a craving for an addictive substance. You’ll also develop skills to better cope with stressful situations or drug cravings. 

Motivational Enhancement Therapy

Motivational enhancement therapy (MET) is designed to help people increase their motivation about treatment and make positive changes in their lives. Not everyone who enters an addiction treatment program is ready to change. Some are there to appease their loved ones; others are fulfilling court orders. MET is designed to strengthen a person’s resolve to engage in treatment and develop a plan to make a change. 

Contingency Management Interventions

Contingency management interventions, or motivational incentives, involve rewarding treatment milestones with tangible prizes. Incentives are designed to increase motivation and treatment retention by providing a real, tangible reward for behaviors like abstinence. 

In some cases, the rewards are small but represent the hard work that went into achieving them. For instance, a classic example of contingency management principles is the chip rewards of Alcoholics Anonymous. Participants receive colored chips when they reach specific abstinence benchmarks in the program. Other incentives may be monetary rewards or vouchers that are often used in community-based treatment options. 

Sources

American Psychiatric Association. (2017, January). What Is Addiction? from https://www.psychiatry.org/patients-families/addiction/what-is-addiction

National Institute on Drug Abuse. (2018, July). Treatment and Recovery. from https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery

National Institute on Drug Abuse. (2020, June 01). Pharmacotherapies. from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/evidence-based-approaches-to-drug-addiction-treatment/pharmacotherapies

National Institute on Drug Abuse. (2020, June 01). Cognitive-Behavioral Therapy (Alcohol, Marijuana, Cocaine, Methamphetamine, Nicotine). from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/evidence-based-approaches-to-drug-addiction-treatment/behavioral-therapies/cognitive-behavioral-therapy

National Institute on Drug Abuse. (2020, June 01). Contingency Management Interventions/Motivational Incentives (Alcohol, Stimulants, Opioids, Marijuana, Nicotine). from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/evidence-based-approaches-to-drug-addiction-treatment/behavioral-therapies/contingency-management-interventions-motivational-incentives

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