Substance Abuse, Drug Addiction, CBT & Mindfulness Training

SUBSTANCE ABUSE CBT 1

Substance Abuse, Drug Addiction, CBT & Mindfulness Training

Kelvin Gonzalez

PS504: Advanced Research Methods

December 11, 2018

Prof: Susan Zukowski

Grading Notes:

Content: Great start on your content, you have provided nice background on the topic as well as review of the literature. I provided you some comments and mark-ups to work on making your writing more concise in parts as well as more descriptive in parts. As you work on your literature review for your final draft, work to weave the information together - meaning discuss multiple articles together instead of just one article and then the next under headings. Work to synthesize the literature together, discussing results and how they inform your research.

Nice start discussing your research problem, add more strength to why it is important and more discussion of the proposed research itself, what are you trying to accomplish. You have done a nice job introducing your hypothesis, discuss more about the variables that you will use and why you believe the hypothesis to be true, as well as how the research design relates to the problem statement. You also seem to have two separate studies identified in your hypothesis statements. I have provided you some comments in your paper to review; please let me know if you have questions and need any help in refining your hypothesis.

Style & Mechanics: For your final paper, please remove the headings for the introduction section of your paper. A few opportunities to combine sentences and make your writing more concise, I provided you a couple of examples, but not marked up all areas they could be.

APA Style: Nice job working to incorporate in-text citations into your paper; page numbers only need to be included in a direct quote and then quotation marks must be included as well. Please consult the APA manual, page 177, for citing multiple authors; citations with five authors are all still listed the first time they are used.

Substance Abuse, Drug Addiction, CBT & Mindfulness Training

Drug addiction continues to be an important public health problem, with an estimated 22.6million current illicit drug users in the United States (Sofuoglu, 2013[SZ1], p. 542). While pharmacological treatments are standard practice for some addictions because they block key pathways in the brains, many addictions lack any approved pharmacological intervention (p. 543Sofuoglu, 2013[SZ2]). Among the latter[SZ3], cocaine,methamphetamine, and marijuana addiction, figure in prominently. Accordingly, behavioral treatments are engaged. [SZ4]However, these behavioral treatments can vary widely in scope and practice; and so can their efficacy (Garland et.al[SZ5], 2016, p. 10). For example, certain factors determine whether a candidate is suited for cognitive behavioral therapy (Crawley et.al[SZ6], 2008, p. 378). In such cases, cognitive-behavioral therapy is then selected. Even though it is the method of choice for substance abuse and addictions, it is not a panacea. Nevertheless, discerning which types of substance abuse and addiction cases respond well to cognitive behavioral therapy could inform evidence-based practice. This, in turn, could coauthor clinical guidelines for behavioral therapy selection and promote greater treatment efficacy.

Background

Although cognitive behavioral therapy has been the treatment of choice for substance abuse and addictions, neurocognitive studies have focused on inhibiting factors and cognitive enhancing agents such as galantamine,modafinil, atomoxetine, methylphenidate, and guanfacine. Sofuoglu et.al.[SZ7] (2013) contend these show promising results in preliminary studies (p. 543). Yet, cognitive interventions also offer numerous benefits. After all, substance abuse and addiction are biopsychosocial in nature.

These behaviors [SZ8]do not necessarily arise from purely a biological predisposition, in most cases. Rather, the biological and psychological manifestations interdependently arise and yield life-altering circumstances, cognitive impairments and problems with working memory (Garland et. al, 2016, p. 9). Of course, sSubstance abuse is also correlated with risky behaviors and comorbid addictions or comorbid conditions including but not limited to HIV/AIDS (source). For these reasons, determining which treatment protocols achieve the greatest efficacy would assist clinicians and persons with substance abuse /addiction problems.

Literature Review

To determine which factors and co-occurencesoccurrences are common among persons with substance abuse problems and addictions, it is necessary to evaluate previous research and findings. After all, a common characteristic set paired with outcome can guide evidence-based practice. Even if the pairing proves ineffective, this result is also helpful.

Comorbid Conditions, Risk Factors & CBT

Acknowledging the co-occurrence of psychiatric disorders, traumatic stress and life situations that give rise to such, substance abuse frequently co-occurs. In fact, substance abuse occurs within 24% to 38% of homeless persons in the United States (Fazel, Khosla, Doll, & Geddes, 2008). Given the prevalence of the comorbid conditions among people who abuse substances and/or engage in illicit drug use, Garland et.al. ( (year) asserts more clinical research needs to address these realities. Since cognitive behavioral therapy is preferred for these conditions when they occur independent from one another, Garland et.al. ( (year) examined whether stand –alone CBT rendered efficacy or whether Mindfulness -Oriented Recovery Enhancement better served the needs of affected persons.

Whereas both cognitive behavioral therapy and mindfulness oriented training aim to alleviate stressors, give the person a sense of greater control over oneself and circumstances, both hold the potential to desensitize persons to life stressors. For persons challenged by traumatic disorders, unstable life circumstances and substance abuse problems, substance abuse often serves as a means to “control” one’s perception of stress and reality, if only temporarily. For these reasonsreasons, Garland et. al. (2016) opted to examine whether these therapies reduced cravings, alleviated traumatic stress symptoms and anxiety and granted participants greater self-efficacy (p. 13).

Ultimately, the mindfulness therapy, daily meditation and reaffirmation reduced cravings and traumatic stress manifestations slightly more than cognitive behavioral therapy did Garland et.al, 2016, p.2016 18). Even though the study did not utilize biochemical markers, Garland et.al. (2016) contended that a larger randomized trial might yield evidence-based practice guidelines.

Computer-Based CBT

Still other research examines the utility and efficacy of computer-based cognitive behavioral therapy. Carroll et.al. (2014) hypothesized that this method used in complementary fashion with methadone for persons previously addicted to cocaine would yield better outcomes. Since cocaine addiction is not usually managed well with methadone maintenance, Carroll et.al. (2014) hypothesized this methodology could yield numerous benefits. After eight weeks, the group given the additional computer-based cognitive behavioral therapy had abstained from cocaine use for three weeks as opposed to one week in the methadone-alone maintained group. Moreover, adherence to therapy among the computer based cognitive behavioral therapy group was also increased by 50%.

Follow-up results six-months after the study concluded also demonstrated greater abstinence among the CBT group. Therefore, this inclusion should be considered for persons challenged by substance abuse not well controlled through other methods.

Substance Abuse: Long-term Cognitive Effects

Sofuoglu, Devito, Walters & Carroll (2012) examined the cognitive effects of long-term substance abuse and its role in treatment efficacy and substance abuse program completion.

Sofuoglu et.al. (2012) contended that Despite the strong association of cognitive deficits in substance dependentpopulations, clinical implications of these findings have been largely omitted or dismissed. Because of this, cognitive deficits produced by substance abuse may be partially reversible through therapy. Given the improvements in cognitive performance after one-month’s abstinence from some substances such as cannabis and methamphetamines, this finding merits more attentions. After all, cognitive behavioral therapy may play a role in reversing some of the damage.

Given these findings, cognitive behavioral therapy delivered via therapy or via computer, and mindfulness training could yield significant benefits. Since many persons challenged by illicit drug use, comorbid conditions such as psychiatric disorders or traumatic stress disorders often find abstinence from substances difficult, providing therapy that treats the manifestations of the comorbid conditions could grant persons greater self-efficacy long-term. As demonstrated by the Carroll et.al. (2014) study of cocaine users, treatment efficacy is possible.

Proposed Research

To examine the efficacy of computer-based cognitive behavioral therapy and mindfulness training with regard to abstinence, program compliance, program completion and anxiety manifestations, this study will recruit persons with substance abuse problems currently seeking group treatment or methadone maintenance. A questionnaire with characteristics, risk factors such as homelessness, previous or current, previous trauma will be given to participants(Crawley et.al, 2008, p. 379[SZ9]). Responses will be recorded and coded. Participants will be randomized into either treatment group. Assessments will occur at the 4-week and 5-week mark. Abstinence, program compliance, and anxiety symptoms will be assessed. By examining the treatments in this context, clinicians might gain better insight into which types of persons with substance abuse problems would gain the most benefit from either treatment.

Hypotheses:

Computer-Based Cognitive Behavioral Therapy will prove more effective for persons with cocaine abuse problems and higher cognitive deficits.

Among persons with substance abuse problems and psychiatric disorders, previous trauma or history of homelessness, Mindfulness Training will offer optimum benefit.

[SZ10]Conclusion

Based on the multiple measures paired with the individual characteristics recorded at intake, this will serve as an exploratory study. It will direct more focused studies and inform clinical frameworks for practice. Given the number of persons in the U.S. challenged by substance abuse, addiction and other risk factors or comorbid conditions, this research will examine treatment protocols and efficacy in a clinical, evidence-based setting.

References

Carroll, K. M., Kiluk, B. D., Nich, C., Gordon, M. A., Portnoy, G. A., Marino, D. R., & Ball, S. A. (2014). Computer-assisted delivery of cognitive-behavioral therapy: efficacy and durability of CBT4CBT among cocaine-dependent individuals maintained on methadone. American journal of Psychiatry, 171(4), 436-444. Retrieved from

Crawley, S. A., Beidas, R. S., Benjamin, C. L., Martin, E., & Kendall, P. C. (2008). Treating socially phobic youth with CBT: Differential outcomes and treatment considerations. Behavioural and Cognitive Psychotherapy, 36(04), 379-389. Retrieved November 1, 2016 from

Treating_Socially_Phobic_Youth_with_CBT_Differential_Outcomes_and_Treatment_Considerations/ links/0a85e52d7fdaceb548000000.pdf

Fazel, S., Khosla, V., Doll, H., & Geddes, J. (2008). The prevalence of mental disorders among the homeless in western countries: systematic review and meta-regression analysis. PLoS Med, 5(12), e225.

Garland, E. L., Roberts-Lewis, A., Tronnier, C. D., Graves, R., & Kelley, K. (2016). Mindfulness-Oriented Recovery Enhancement versus CBT for co-occurring substance dependence, traumatic stress, and psychiatric disorders: Proximal outcomes from a pragmatic randomized trial. Behaviour research and therapy, 77, 7-16. Retrieved from
Oriented_Recovery_Enhancement_Versus_CBT_for_Co-Occurring_Substance_Dependence_Traumatic_Stress_and_Psychiatric_Disorders_Proximal_Outcomes_from_a _Pragmatic_Randomized_Trial/links/56fabccf08aef6d10d904df7/Mindfulness-Oriented- Recovery-Enhancement-Versus-CBT-for-Co-Occurring-Substance-Dependence- Traumatic-Stress-and-Psychiatric-Disorders-Proximal-Outcomes-from-a-Pragmatic- Randomized-Trial.pdf

Marsch, L. A., Guarino, H., Acosta, M., Aponte-Melendez, Y., Cleland, C., Grabinski, M., ... Edwards, J. (2014). Web-based behavioral treatment for substance use disorders as a partial replacement of standard methadone maintenance treatment. Journal of Substance Abuse Treatment, 46(1), 43-51. Retrieved from

Santos, V. A., Freire, R., Zugliani, M., Cirillo, P., Santos, H. H., Nardi, A. E., & King, A. L. (2016). Treatment of Internet Addiction with Anxiety Disorders: Treatment Protocol and Preliminary Before-After Results Involving Pharmacotherapy and Modified Cognitive Behavioral Therapy. JMIR research protocols, 5(1). Retrieved from

Sofuoglu, M., DeVito, E. E., Waters, A. J., & Carroll, K. M. (2013). Cognitive enhancement as a treatment for drug addictions. Neuropharmacology, 64, 452-463.

Stevens, L., Verdejo-García, A., Goudriaan, A. E., Roeyers, H., Dom, G., & Vanderplasschen, W. (2014). Impulsivity as a vulnerability factor for poor addiction treatment outcomes: a review of neurocognitive findings among individuals with substance use disorders. Journal of Substance Abuse Treatment, 47(1), 58-72. Retrieved from

[SZ1]Page numbers only need to be included if you are using a direct quote, is this a direct quote? Same question applies to all of the sentences in your paper. If you are using a direct quote, you need to include the passage in quotation marks

[SZ2]The author and year need to be included each time they are used

[SZ3]Be precise in your language, you could state something like “Addictions without pharmacological interventions include cocaine, methamphetamine…”

[SZ4]I’m not sure what this means, how is this connecting to the types of addictions? I think you want to add on to the end of the last sentence stating “Addictions without pharmacological interventions such as cocaine, methamphetamine, and marijuana tend to use a behavioral treatment approach”.

[SZ5]First use needs to include all authors

[SZ6]First use needs to include all authors

[SZ7]First use needs to include all authors

[SZ8]What behaviors?

[SZ9]I’m not sure why you are using the source here; you are now describing your own research, not what someone else did.

[SZ10]You seem to be trying to test two completely different things in your study; I would highly recommend you focus on only one of these. If the Mindfulness Training is the computer-based cognitive behavioral therapy than call that out specifically. For your second hypothesis, are you looking at all types of substance abuse and psychiatric disorders? This would truly be two different studies. If you are looking for mindfulness training only perhaps focus on cocaine abuse problems only or select all drug abuse not substance and psychiatric disorders.