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	A Community Reinforcement Approach: Treating Cocaine Addiction

Foreword
Background

Psychosocial Interventions
Supporting Research
- Use With Other Populations
- Concurrent Alcohol Dependence

Program Overview

Lifestyle Changes
Vouchers
Other Drug Abuse
Treatment Parameters
- Schedule
- Components
- Structure

Clinical Approach

Counseling Style
- Flexibility
- Empathy
- Active Involvement
- Directive but Collaborative
- Social Reinforcement
Counseling Techniques
- Behavioral Techniques
- Additional Resources
- Progress Graphs
Counseling Structure
- Preparation
- Session Protocol
- Recent Problems or Crises
Special Issues
- Absences
- Tardiness
- Extra Sessions
- Drug and Alcohol Use
- Concurrent Treatment
- Premature Termination
Documentation of Patient Contact
Clinical Supervision

The Voucher Program

Objective Monitoring
Urinalysis Schedule
Specimen Collection
Laboratory Analysis
Presenting the Results

Intake

Initial Contact
- Screen Applicants
- Schedule Intake
Intake Procedures
- Assessment
- Self-Administered Questionnaires
- Program Description
- Structured Interviews
Initial Treatment Session
- Get to Know the Patient
- Provide Overview and Rationale
- Introduce the Voucher Program
  - Describe Abstinence Contract
  - Explain Urinalysis Monitoring
  - Explain Voucher Program
  - Review Abstinence Contract
  - Priming
- Problem List
- Practical Needs Assessment
- Appointment Book
- Significant Others
- Disulfiram Procedures (if applicable)
- Collect Urine
- Schedule the Next Session

Early Counseling Sessions

Outline a Treatment Plan
Sessions One and Two
- Urinalysis Results
- Complete Intake and Treatment Orientation
- Introduce Functional Analysis and Stimulus Control
- Assist With Practical Needs
- Use the Appointment Book
- Start To Develop the Treatment Plan
  - Discuss Areas for Change
  - Prioritize Problems
  - Set Specific Target Goals
- Follow Through

Drug Avoidance Skills

Functional Analysis
- Components of Functional Analysis
  - Triggers
  - Behavior
  - Positive Consequences
  - Negative Consequences
- Conduct a Functional Analysis
Self-Management Planning
- Rationale
- Initiate Training
- Make the Plan
Drug Refusal Training
- Rationale
- Refusing Cocaine and Other Drugs
- Components of Effective Refusal
Practice Refusal Skills
- Homework

Lifestyle Change Components

Time Management
- Develop Time-Management Skills
- Apply Time Management
Social/Recreational Counseling
- Rationale
- List Activities and People
- Set Goals and Assess Progress
- Facilitate Change
Problemsolving
- Rationale
- Steps for Problemsolving
  - Recognize the Problem
  - Identify the Problem
  - Brainstorm
  - Select Approach
  - Evaluate Effectiveness
  - Practice
Vocational Counseling
- Rationale
- Set Goals
- Treatment Components
Social-Skills Training
- Assertiveness Training
  - Rationale
  - Define Interpersonal Style
  - Assertiveness Skills
  - Practice
  - Set Goals and Assess Progress
HIV/AIDS Prevention
- Rationale
- AIDS Knowledge Pretest
- Video and Discussion
- Pamphlets and Condoms
- AIDS Knowledge Posttest
- HIV Antibody and Hepatitis B Testing
  - Provide Information
  - Discuss Results

Relationship Counseling

Session One
- Introduce Relationship Counseling
- Introduction Exercise
- Relationship Happiness Scale
- Daily Reminder To Be Nice
Session Two
- Perfect Relationship Form
- Positive Requests
Session Three
- Communications Training
Session Four
- Communications Training
Sessions Five - Eight

Other Substance Abuse

General Approach
- Treatment Goals
  - Abstinence
  - Reduced Use
  - No Intervention
Concurrent Alcohol Use
- Abstinence
  - What Is Disulfiram?
  - Medical Oversight
  - Disulfiram Protocol
- Limited Alcohol Use/Safe Drinking
- Patients Who Hesitate or Refuse
- Backup Agreement
Marijuana Use

Other Psychiatric Problems

Depressive Symptomatology
- Evaluate Suicide Risk
- Monitor Symptoms
- Treatment
Anxiety
- Relaxation Protocol
  - Relaxation Exercise and Practice
  - Applications
- Insomnia Protocol
  - Rationale
  - Sleep Diary
  - Sleep-Hygiene Rules
  - Sleep Restriction and Stimulus Control
  - Practice

Clinical Supervision

Weekly Clinical Staff Supervision
- New Cases
Counselor Treatment Team Meetings

References

Therapy Manuals for Drug Abuse:
Manual 2

Authors

Alan J. Budney, Ph.D.
Stephen T. Higgins, Ph.D.

Delinda E. Mercer, Ph.D.
Gloria Carpenter, M.Ed.
University of Vermont

Acknowledgements

Disclaimer

The opinions expressed herein are the views of the author and do not necessarily reflect the official policy or position of the National Institute on Drug Abuse or any other part of the U.S. Department of Health and Human Services.

Public Domain Notice

All material appearing in this report is in the public domain and may be reproduced without permission from the National Institute on Drug Abuse or the author. Citation of the source is appreciated.

National Institute on Drug Abuse
NIH Publication Number 98-4309
Printed April 1998

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Contents

Therapy Manuals for Drug Abuse:Manual 2

Therapy Manuals for Drug Abuse:
Manual 2