Combined behavioral intervention

Ciraulo DA, Jaffe JH Tricyclic antidepressants in the treatment of depression associated with alcoholism. Clin Psychopharmacol 1 146—150, 1981 Ciraulo DA, Nace E Benzodiazepine treatment of anxiety or insomnia in substance abuse patients. Am J Addict 9 276—284, 2000 Ciraulo DA, Barnhill JG, Jaffe JH, et al Intravenous pharmacokinetics of 2-hydroxy-imipramine in alcoholics and normal controls. J StudAlcohol 51 366-372, 1990 Ciraulo DA, Knapp CM, LoCastro J, et al A benzodiazepine mood effect scale reliability and validity determined for alcohol-dependent subjects and adults with a parental history of alcoholism. Am J Drug Alcohol Abuse 27 339—347, 2001 Collins MA Tetrahydropapaveroline in Parkinson s disease and alcoholism a look back in honor of Merton Sandler. Neurotoxicology 25 117-120, 2004 COMBINE Study Research Group Testing combined pharmacotherapies and behavioral interventions in alcohol dependence rationale and methods. Alcohol Clin Exp Res 27 1107-1122, 2003a... 

COMBINE Smdy Research Group Testing combined pharmacotherapies and behavioral interventions in alcohol dependence rationale and methods. Alcohol Clin Exp Res 27 1107-1122, 2003a... 

Behavioral therapy can be used to treat patients with ADHD however, it is generally not recommended as first-line monotherapy.8 Several studies have demonstrated that treatment with medication alone is superior to behavioral intervention alone in improving attention.12 However, behavioral therapy in combination with stimulant therapy was better at improving oppositional and aggressive behaviors.12 Behavioral modification involves training parents, teachers, and caregivers to change the physical and social environment and establishment... 

The obvions qnestion is whether combining naltrexone, acamprosate, and/or disnlfiram is better than either medication alone. To our knowledge, this has not been systematically studied, but it may be a viable alternative in particularly severe cases when other treatment options have failed. The cornerstone of success in the treatment of alcoholism is clearly the behavioral intervention including Alcoholics Anonymons. 

Rowan-Szal GA, Bartholomew NG, Chatham LR Simpson DD (2005). A combined cognitive and behavioral intervention for cocaineusing methadone clients. Journal of Psychoactive Drugs, 37, 75-84... 

Anton RF et al Combined pharmacotherapies and behavioral interventions for alcohol dependence The COMBINE study A randomized controlled trial. JAMA 2006 295 2003. [PMID 16670409]... 

Perhaps the role of cognitive-behavioral treatments ought to be tested, as both depression and chronic pain tend to be responsive to cognitive and behavioral interventions. To our knowledge, very few, if any, treatments have studied the combined effects of pharmacotherapy and behavioral or physical therapies. Given the complex nature of FM, a multifactorial approach may be the most effective (40) and an important area to explore with more scientific rigor. 

In general, experience and research agree that, in the long run, an approach that combines the behavioral interventions described above with medication is more effective in treating ADHD symptoms than medication alone. 

Anton, R. F., et al. (2006). Combined pharmacotherapies and behavioral interventions for alcohol dependence. Journal of the American Medical Association, 295, 2003-2017. 

Anton RF, Oroszi G, O Malley S, Couper D, Swift R, Pettinati H, Goldman D (2008) An evaluation of mu-opioid receptor (OPRM1) as a predictor of naltrexone response in the treatment of alcohol dependence results from the Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence (COMBINE) study. Arch Gen Psychiatry 65 135-144... 

Organizations with unique occupations and a culture that lacks employee involvement require clever and creative behavioral interventions in order to succeed. Such was the case with a large power and light company that employs numerous linemen. These employees perform hazardous work on electrical lines, often in remote locations and always in teams of three. The behavioral safety process created for these employees involved a combination of self- and peer-sampled observations. 

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. 

On the other hand, identifying problem areas allows for interventions to be devised to reduce or remove roadblocks to recovery. In a well-designed treatment plan, a problem area and its specific links with the drug use are identified and described. After the descriptive portion of the problem area, the treatment plan prescribes specific courses of action on the part of the client, with therapist or counselor support, to change the problem behavior. Problems areas may be biological, environmental, behavioral, cognitive, or emotional domains, or in some cases may represent complex combinations in more than one of these areas. 

More recent studies have examined combinations of medical and nonmedical treatments for ADHD, usually in an effort to determine whether one form of treatment is superior to, or enhances the effectiveness of, another. The largest-scale study examining the relative and combined effectiveness of medical and nonmedical interventions for ADHD is the recently completed MTA study (MTA Cooperative Group, 1999). In this 5-year, six-site project, 579 elementary school-age children with ADHD were randomly assigned to one of four 14-month treatment conditions behavioral treat-... 

For mild to moderate anxiety, we recommend the conservative approach of beginning with CBT and including medication if CBT is ineffective or only partially effective. However, severe anxiety that involves duress, prominent avoidance behavior, physiological symptoms, or marked impairment, requires a combination of CBT and medication as an initial intervention. Furthermore, children and families with low motivation (i.e., those unlikely to participate in CBT assignments) or having a poor subjective sense of anxiety may require medication treatment as one of the initial interventions. 

---