Cognitive-behavioral

Since biological systems can reasonably cope with some of these problems, the intuition behind neural nets is that computing systems based on the architecture of the brain can better emulate human cognitive behavior than systems based on symbol manipulation. Unfortunately, the processing characteristics of the brain are as yet incompletely understood. Consequendy, computational systems based on brain architecture are highly simplified models of thek biological analogues. To make this distinction clear, neural nets are often referred to as artificial neural networks. 

Anton RF, Moak DH, Latham PK, et al Posttreatment results of combining naltrexone and cognitive-behavior therapy for the treatment of alcoholism. J Clin Psycho-pharmacol 21 72—77, 2000... 

Kranzler HR, Del Boca F, Korner P, et ah Adverse effects limit the usefulness of flu-voxamine for the treatment of alcoholism.] Subst Abuse Treat 10 283-287, 1993 Kranzler HR, Burleson JA, Del Boca FK, et ah Buspirone treatment of anxious alcoholics a placebo-controlled trial. Arch Gen Psychiatry 31 720—731, 1994 Kranzler HR, Burleson JA, Korner P, et ah Placebo-controlled trial of fluoxetine as an adjunct to relapse prevention in alcoholics. Am] Psychiatry 152 391-397, 1995 Kranzler HR, Burleson JA, Brown J, et al Fluoxetine treatment seems to reduce the beneficial effects of cognitive-behavioral therapy in type B alcoholics. Alcohol Clin Exp Res 20 1534-1341, 1996... 

In two studies in which benzodia2epines were gradually tapered, concurrent cognitive-behavioral therapy (CBT) did not increase the proportion of patients who were able to successfully discontinue their use of these agents (Oude Voshaar et al. 2003 Vorma et al. 2003). On the other hand, other studies of patients with panic disorder found that CBT facilitated the discontinuation of benzodiazepine use (Otto et al. 1993). Similarly, CBT may be superior to supportive medical management in preventing the reoccurrence of panic attacks in panic disorder patients in whom alprazolam has been tapered (Bruce etal. 1999). 

Bruce TJ, Spiegel DA, Hegel MT Cognitive-behavioral therapy helps prevent relapse and recurrence of panic disorder following alprazolam discontinuation a longterm follow-up of the Peoria and Dartmouth studies. J Consult Clin Psychol 67 151-156, 1999... 

Otto MW, Pollack MH, Sachs GS, et al Discontinuation of benzodiazepine treatment efficacy of cognitive-behavioral therapy for patients with panic disorder. Am J... 

Evins AE, Mays VK, Rigotti NA, et al A pilot trial of bupropion added to cognitive behavioral therapy for smoking cessation in schizophrenia. Nicotine Tob Res 3 397-M03, 2001... 

Hall SM, Reus VI, Munoz RF, et al Nortriptyline and cognitive-behavioral therapy in the treatment of cigarette smoking. Arch Gen Psychiatry 55 683-690, 1998 Hall SM, Humfleet GL, Reus VI, et al Psychological intervention and antidepressant treatment in smoking cessation. Arch Gen Psychiatry 59 930-936, 2002 Hayford KE, Patten CA, Rummans TA, et al Efficacy of bupropion for smoking cessation in smokers with a former history of major depression or alcoholism. Br J Psychiatry 174 173-178, 1999... 

A number of psychosocial treatments for alcohol and other substance use disorders exist and are widely used. In this chapter, we discuss six of these psychotherapies as they are applied to alcohol, cocaine, and opioid dependence brief interventions, motivational enhancement therapy, cognitive-behavioral therapy, behavioral treatments (including contingency management and community reinforcement approaches), behavioral marital therapy, and 12-step facilitation. We also describe studies that examined the efficacy of a medication in combination with one or more of the six psychotherapies. In the second section of the chapter, we highlight research that directly studied the interaction between psychosocial and pharmacological treatments. 

Cognitive-behavioral therapy (CBT) is based on the theoretical assumption that alcohol and other substance use problems are related to maladaptive so-... 

Alcoholics Anonymous (AA) is a self-help organization for people whose common goal is recovery from alcoholism, and it is the most widely accessed resource for individuals with alcohol problems (McCrady and Miller 1993). The philosophy is based on the concept of alcoholism as a chronic disease that cannot be cured, but one that can be halted by means of complete abstinence. AA has described 12 principles or steps to guide those in recovery. Twelve-step facilitation, a manual-based psychotherapy to promote AA participation (Nowinski et al. 1992), was equally efficacious, compared with cognitive-behavioral and motivational enhancement therapies, in a large study of treatments for alcohol dependence (Project Match Research Group, 1997). 

In other substance use disorders, the use of 12-step interventions is also popular, and participation in 12-step groups is correlated with better outcomes in cocaine abusers (e.g., McKay et al. 1994). However, a smdy of 128 cocaine abusers found that cognitive-behavioral therapy was more efficacious than 12-step facilitation in engendering cocaine abstinence (Maude-Griffm et al. 1998). Thus, the relative efficacy of 12-step approaches for drug use disorders requires further investigation. No known studies have systematically evaluated the efficacy of 12-step treatments in opioid-dependent patients, either alone or in conjunction with pharmacotherapies. 

O Malley et al. (1992) conducted a double-blind study combining naltrexone and CBT for alcohohsm. Patients were randomly assigned to participate in cognitive-behavioral coping skills treatment or supportive therapy and to receive 50 mg/day of naltrexone or placebo. Naltrexone-treated patients who received supportive therapy had more continuous abstinence than the other treatment groups. However, naltrexone-treated patients who received CBT had a lower level of craving and lower risk of relapse than the other three groups. This interaction would not have been observed in a study that manipulated only psychosocial treatment or only medication. 

Anton RF, Moak DH, Waid LR, et al Naltrexone and cognitive behavioral therapy for the treatment of outpatient alcoholics results of a placebo-controlled trial. Am J Psychiatry 156 1758—1764, 1999... 

Carroll KM, Sinha R, Nich C, er al Conringency management to enhance naltrexone treatment of opioid dependence a randomized clinical trial of reinforcement magnitude. Exp Clin Psychopharmacol 10 5d—63, 2002 Carroll KM, Fenron LR, Ball SA, er al Efficacy of disulfiram and cognitive behavior rherapy in cocaine-dependenr ourparienrs. Arch Gen Psychiatry 61 264—272, 2004... 

Rawson RA, Huber A, McCann M, et al A comparison of contingency management and cognitive-behavioral approaches during methadone maintenance treatment for cocaine dependence. Arch Gen Psychiatry 59 817—824, 2002 Rohsenow DJ, Monti PM, Martin RA, et al Motivational enhancement and coping skills training for cocaine abusers effect on substance use outcomes. Addiction... 

Psychotherapy focused on reducing the influence of the CNS on the gut has been studied. Cognitive behavioral therapy (CBT), dynamic psychotherapy, relaxation therapy, and hypnotherapy have been reported to be effective in some patients. However, CBT and relaxation therapy do not appear to be better than standard approaches.18 Biofeedback may provide relief in cases of severe constipation, but definitive evidence is lacking.16 Psychotherapy interventions provide relief from pain and diarrhea but not constipation.19... 

Boyce PM, Talley NJ, Balaam B, et al. A randomized controlled trial of cognitive behavior therapy, relaxation training, and routine clinical care for the irritable bowel syndrome. Am J Gastroenterol 2003 98 2209-2218. 

While pharmacologic agents may help prevent relapse, psychotherapy should be the core therapeutic intervention. Motivational enhancement therapy (MET), cognitive-behavioral therapy (CBT), 12-step facilitation (TSF), behavioral couples therapy (BCT), community reinforcement approaches, and contingency management are the best-studied forms of psychotherapy in this group of patients. 

Cognitive-behavioral therapy (CBT) has the specific goal of learning relapse prevention techniques such as having a ready toolbox to deal with cravings and avoidance of triggers that have led to relapses in the past. 

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