Enhancement Therapy

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. 

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). 

Miller WR, Zweben A, DiClemente CC, et al Motivational Enhancement Therapy Manual A Clinical Research Guide for Therapists Treating Individuals With Alcohol Abuse and Dependence. Project MATCH Monograph Series, Vol 2 (NIH Publ No 94—3723). Rockville, MD, National Institute on Alcohol Abuse and Alcoholism, 1995b... 

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. 

Motivational enhancement therapy begins with the assumption that the capacity for change lies within the patient. The therapist and patient then work together to design a plan to implement treatment goals. The findings suggest that this may be... 

Miller, W. R., Zweben, A., DiClemente, C. C., Rychtarik, R. G. (1999). Motivational enhancement therapy manual A clinical research guide for therapists treating individuals with alcohol abuse and dependence. In M. E. Mattson (Ed.), Project MATCH Monograph Series, 2. Rockville, MD National Institute on Alcohol Abuse and Alcoholism. 

Rapid and broad access to the ever-expanding results of genomic research will undoubtedly result in new and improved therapies for a wide range of disease states. The issue of patents covering genomic inventions and access to these inventions for research purposes is the subject of intense debate both in the US and Europe. Strong patent laws encourage the innovation necessary for the development of new and enhanced therapies. 

Pametti, L., Senin, U., Mecocci P. Cognitive Enhancement Therapy for Alzheimer s Disease. The Way Forward, Drugs Future 1997, 53, 752-768. 

Different auxiliary methods of administration can be used in conjunction with nebulizers to deliver aerosol to the patient [144]. A mouthpiece may be inserted in the mouth or a face mask may be attached tightly to the face. A large-bore inlet adapter attaches tubing from the nebulizer outlet to the mouthpiece or mask. It is possible to compensate for exhaled aerosol without increasing resistance to prevent condensation. A face tent fits more loosely around the patient s mouth, allowing speech. The latter arrangement is frequently used with ultrasonic nebulizers. A tracheostomy mask may be fitted to the patient s tracheostomy tube directly and requires a T-shaped adapter. Environmental chambers are used to enhance therapy and include incubators, pediatric croup tents, and hoods. 

In conclusion, the role of enhanced serotonergic transmission in alleviating OCD symptoms is fairly well established. However, the relatively moderate response to serotonergic enhancement therapies and the fact that as many as 20-60% of OCD patients remain with at least some residual symptoms following pharmacotherapy suggest that other, more complex, interactions are involved in OCD. 

Molineux G (2002). Pegylation Engineering improved pharmaceutical for enhanced therapy. Cancer Treat. Rev. 28(suppl A) 13-16. 

Tabas, I. Phagocyte enhancement therapy for atherosclerosis. U.S. Pat. Appl. Publ. US 2008267909,2008 Chem. Abstr. 2008,149,506154. 

With the recognition that certain antibodies can protect tumor cells against the host s immune response thereby resulting in tumor enhancement, therapy with unblocking antibodies has been attempted. Bansal and Sjogren96 studied a rat polyoma tumor system and found unblocking activity... 

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