half day workshop

COGNITIVE BEHAVIORAL THERAPY IN THE TREATMENT OF COCAINE DEPENDENCE: CHALLENGES AND SOLUTIONS
Jennifer Penberthy, University of Virginia Health System, USA

CCIB Room: 215/16

An important psychosocial treatment with documented utility either alone or in combination with pharmacotherapy in the management of substance abuse disorders is cognitive behavioral therapy (CBT). CBT represents an integrated application of cognitive behavioral and social-learning theory. The overall treatment goal is enablement of clients to achieve and maintain abstinence by increasing their skills for coping in general, and in specific high-risk situations including anticipatory cravings for abused substances.  The primary treatment components include: self-monitoring and functional analysis of situations associated with substance abuse craving and consummatory behavior; training and rehearsal of coping behaviors and general problem-solving skills; development of an abstinence oriented lifestyle, and instructions on how to prevent a lapse from turning into a relapse. The rationale and targets for CBT in cocaine dependence are similar to those for alcoholism, which have been validated in numerous treatment studies.  Higgins, et al. (1993) compared the effectiveness of an intensive CBT program with standard supportive therapy for dependence recovery in cocaine-dependent individuals, and demonstrated efficacy for an intensive cognitive behavioral approach. Rawson and colleagues (2002) have recently shown that CBT is an effective treatment for cocaine dependence and can produce long-lasting improved outcomes.  Thus, treatment outcome research generally supports the clinical utility of CBT using a coping skills training approach to reducing cocaine abuse.   There are, however, significant and specific challenges in utilizing CBT with cocaine dependent individuals. These challenges include limitations in the ability of patients to learn and effectively utilize effective coping strategies due to both external/environmental and internal factors. Since CBT can be conceptualized as a “dose” of treatment, and research in CBT has tentatively demonstrated a correlation between amount of effective coping skills learned and symptom improvement, it is imperative to be able to measure the amount of learning occurring in these patients. We present a review of our 12-session CBT treatment approach and also provide information regarding challenges to this treatment approach specific to this population, as well as solutions to enhance compliance and coping skills learning.

Jennifer Kim Penberthy, Ph.D. is an Assistant Professor and licensed clinical psychologist in the Department of Psychiatry and Neurobehavioral Sciences at the University of Virginia. She is the Head Psychologist and Director of Psychological Training at the Center for Addiction Research and Education (CARE). She conducts research on effective treatment for substance dependence disorders, and also studies how to most effectively train physicians and psychologists to provide CBT. She plans to study a specific form of CBT called Cognitive Behavioral Analysis System of Psychotherapy (CBASP) in combination medication to treat co-occuring substance dependence and chronic depression.

Key References:
Higgins, S.T., Budney, A.J., Bickel, W.K., Hughes, J.R., Foerg, F. and Badger, G. (1993) Achieving cocaine abstinence with a behavioral approach. Am J Psychiatry, 150, 763-769. 
Rawson, R.A., Huber, A., McCann, M., Shoptaw, S., Farabee, D., Reiber, C. and Ling, W. (2002) A comparison of contingency management and cognitive-behavioral approaches during methadone maintenance treatment for cocaine dependence. Arch Gen Psychiatry, 59, 817-824.