National Institute on Drug Abuse
U.S. Department of Health and Human Services, National Institutes of Health
Manual 1:

A Cognitive-Behavioral Approach: Treating Cocaine Addiction

Contents

• Foreword

• Cognitive-Behavioral Therapy: An Overview
  • Why CBT?

  • Components of CBT
    • Functional Analysis
    • Skills Training
    • Critical Tasks

  • Parameters of CBT
    • Format
    • Length
    • Setting
    • Patients
    • Compatibility With Adjunctive Treatments

  • Active Ingredients of CBT
    • Essential and Unique Interventions
    • Recommended But Not Unique Interventions
    • Acceptable Interventions
    • Interventions Not Part of CBT

  • CBT Compared to Other Treatments
    • Similar Approaches
      • Cognitive Therapy
      • Community Reinforcement Approach
      • Motivational Enhancement Therapy
    • Dissimilar Approaches
      • Twelve-Step Facilitation
      • Interpersonal Psychotherapy

• Basic Principles of CBT
  • Learned Behavior
    • Modeling
    • Operant Conditioning
    • Classical Conditioning

  • Functional Analysis
    • Deficiencies and Obstacles
    • Skills and Strengths
    • Determinants of Cocaine Use
    • Relevant Domains
    • Assessment Tools

  • Skills Training
    • Learning Strategies Aimed at Cessation of Cocaine Use
    • Generalizable Skills
    • Basic Skills First
    • Match Material to Patient Needs
    • Use Repetition
    • Practice Mastering Skills
      • Give a Clear Rationale
      • Get a Commitment
      • Anticipate Obstacles
      • Monitor Closely
      • Use the Data
      • Explore Resistance
      • Praise Approximations

• The Structure and Format of Sessions
  • 20/20/20 Rule

  • First Third of Session
    • Assess Patient Status
      • Urine Tests
      • Problem Solving
    • Listen for Current Concerns
    • Discuss the Practice Exercise

  • Second Third of Session
    • Introduce the Topic
    • Relate Topic to Current Concerns
    • Explore Reactions

  • Final Third of Session
    • Assign a Practice Exercise
    • Anticipate High-Risk Situations

  • Topics

• Integrating CBT and Medication

• Session 1: Introduction to Treatment and CBT
  • Session Goals

  • Key Interventions
    • History and Relationship Building
    • Enhance Motivation
    • Negotiate Treatment Goals
    • Present the CBT Model
    • Establish Treatment Ground Rules
    • Introduce Functional Analysis

  • Practice Exercise

• Topic 1: Coping With Craving
  • Session Goals

  • Key Interventions
    • Understanding Craving
    • Describing Craving
    • Identifying Triggers
    • Avoiding Cues
    • Coping With Craving
      • Distraction
      • Talking About Craving
      • Going With the Craving
      • Recalling Negative Consequences
      • Using Self-Talk

  • Practice Exercises

• Topic 2: Shoring Up Motivation and Commitment to Stop
  • Session Goals

  • Key Interventions
    • Clarify Goals
    • Address Ambivalence About Abstinence
    • Identifying and Coping With Thoughts About Cocaine
      • Recognize
      • Avoid
      • Cope

  • Practice Exercises

• Topic 3: Refusal Skills/Assertiveness
  • Session Goals

  • Key Interventions
    • Assess Cocaine Availability
    • Handling Suppliers
    • Cocaine Refusal Skills
      • Within-Session Role-Play
      • Passive, Aggressive, and Assertive Responding
    • Remind Patients of Termination

  • Practice Exercises

• Topic 4: Seemingly Irrelevant Decisions
  • Session Goals

  • Key Interventions
    • Understand Seemingly Irrelevant Decisions
    • Identify Personal Examples
    • Practice Safe Decision-making

  • Practice Exercise

• Topic 5: An All-Purpose Coping Plan
  • Session Goals

  • Key Interventions
    • Anticipate High-Risk Situations
    • Develop a Coping Plan

  • Practice Exercise

• Topic 6: Problemsolving
  • Session Goals

  • Key Interventions
    • Introduce the Basic Steps
    • Practice Problem-solving Skills

  • Practice Exercise

• Topic 7: Case Management
  • Session Goals

  • Key Interventions
    • Problem Identification
    • Goal Setting
    • Resource Identification
    • Specifying a Plan
    • Monitoring Progress

  • Practice Exercise

• Topic 8: HIV Risk Reduction
  • Session Goals

  • Key Interventions
    • Assess Risk
    • Build Motivation to Change
    • Set Goals
    • Problem-solve Barriers
    • Provide Specific Guidelines

  • Practice Exercise

• Significant Other Session
  • Session Goals

  • Key Interventions
    • Plan Ahead
    • Provide Information/Set Goals
    • Identify Strategies

  • Practice Exercise

• Final Session: Termination
  • Session Goals

• Appendix A: Therapist Selection, Training, and Supervision
  • Therapist Training
    • Didactic Seminar
    • Supervised Training Cases
    • Rating of Therapists
      • Therapist Checklist
      • Rating Scale
    • Certification of Therapists

  • Ongoing Supervision
    • Guidelines
    • Common Problems Encountered in Supervision
      • Balance
      • Speeding Through Material
      • Overwhelming the Patient
      • Unclear Strategies
      • No Specific Examples
      • Downplaying Practice Exercises
      • Abandoning the Manual With Difficult Patients

• Appendix B: Clinical Research Supporting CBT
  • CBT and Interpersonal Therapy

  • CBT and Clinical Management
    • CBT and Depressive Symptoms
    • CBT and Alexithymia
    • One-Year Follow-up

  • CBT and Alcoholic Cocaine Abusers

• References

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