Motivational 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. 

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