What Works

No one group, method, or approach works for everyone. There are, however, a great many studies that have been done concerning what methods and programs actually work in overcoming addictive behavior. If I was starting from scratch, I would have to cite hundreds and hundreds of studies, weight them, and find some format to present the results so that they would make sense to you. Fortunately, I don’t have to do that, as it has already been done for me.

Psychologists at the University of New Mexico, led by Dr. William Miller, tabulated every controlled study of alcoholism treatment they could find. They weighted each study based upon the quality of its research methodology, to arrive at a comprehensive list, which they first published in book form in 1995, and have continually updated since. The book is called Handbook of Alcoholism Treatment Approaches: Effective Alternatives.

Notice that these studies specifically addressed addiction to alcohol, not any other drugs or behaviors. As I have mentioned several times in previous chapters, it is the addictive behaviors we are modifying here, and they are virtually identical across the entire range of habits and substances.

I would also like to note that in Dr. Miller’s list, two of the top ten modalities are drugs themselves. Acamprosate, which reduces urges and cravings, and Naltrexone, which blocks the euphoric effects of alcohol and some narcotics. Acamprosate is still under study for use in the United States, while Naltrexone has been available for quite some time. If you are under a doctor’s care, or involved in a program which uses one of these drugs, follow whatever guidelines you have been given.

Exclusive of the two drugs mentioned above, the top ten modalities are:

  1. Brief interventions
  2. Motivational enhancement
  3. Community Reinforcement (CRA)
  4. Self-change manual (Bibliotherapy)
  5. Behavioral self-control training
  6. Behavior contracting
  7. Social skills training
  8. Marital therapy-Behavioral
  9. Case management
  10. Cognitive therapy

Let’s look at these one at a time:

  1. Brief Intervention — Discussion with trusted medical person, usually a family doctor or other professional. One of our problems as addicts is that we’re rarely honest with medical people when discussing our usage patterns. When we are, it’s usually an indication that we are ready, or nearly ready to make a change. I quit smoking this way, following a heart attack, as a result of a brief discussion with my cardiologist. Research shows that the professional doesn’t always have to come at us with threats of imminent demise to make a difference.
  2. Motivational Enhancement — Also known as Motivational Interviewing, this program consists of a thorough assessment of drug use, risk factors, family history, drug related problems, level of dependence, and motivation. The key in this approach is that it helps you see the good and bad about your drug use to help you resolve any ambivalence you may have about changing your behavior.
  3. Community Reinforcement Approach (CRA) — CRA is a treatment approach that works by eliminating positive reinforcement for using and enhancing positive reinforcement for sobriety. It integrates several treatment components, including building motivation to quit, analyzing using patterns, increasing positive reinforcement, teaching new coping skills, and involving significant others in the recovery process. It shares many components with the Motivational enhancement programs.
  4. Self-change Manuals (Bibliotherapy) — Some of the available self-help manuals address moderation rather than abstinence, and many more address various phases of the 12-step programs. Powerless No Longer falls into this category. A significant number of addicts recover as a result of what they learn from such manuals.
  5. Behavioral Self Control Training — This is a behavioral program that’s based upon the “learning model” of addiction, that I presented in Chapter Three, rather than the “disease model” that many other recovery programs are based upon. Behavioral self-control training can be used by either those who wish to abstain from drugs, or those who wish to moderate. It mainly consists of cognitive behavioral techniques, that can be either self-taught, or used in conjunction with other programs or formal therapy.
  6. Behavior Contracting — Usually used by therapists, it involves the addict making one, or a series, of written contracts concerning their behavior, and their goals. The contract spells out the expectations and the commitments of both the addict, the therapist, and in some cases the family of the addict. It’s primarily used as a positive reinforcement tool.
  7. Social Skills Training — programs which use a cognitive-behavioral approach to change the behavior patterns of addicts, especially in the area of getting along with the rest of the world. Kind of a Kindergarten for recovering addicts.
  8. Behavioral Marital Therapy — Geared to married couples, this method, commonly used by therapists, involves a contract not to use, and a series of behavioral assignments. It’s based upon the assumptions that intimate partners can reward abstinence, and that reducing relationship tension reduces the risk of relapse.
  9. Case Management — Not really a therapy, case management is defined as a set of interventions aiming to facilitate the treatment outcome. Some of the functions are: providing individualized support, helping the addict solve problems, helping with employment issues, etc.. In short, making sure there’s a support system around recovery.
  10. Cognitive Therapy — This is a large, catch-all category that includes Cognitive Behavioral Therapy, Rational Emotive Behavioral Therapy, and several others. Many of the programs and methodologies above use cognitive therapies as part of their procedures, but this category looks at cognitive therapy alone, and not in conjunction with other methodologies.

In Chapter One, I listed four factors that seemed to be common in most successful recoveries. They were: motivation, dealing with urges, problem solving, and balancing short and long term goals. Table 1 below lists the “top ten” recovery modalities, and which of the four points they address.

TABLE ONE

Treatment Modality

Motivation

Urges

Problem Solving

Goals

Brief Intervention

X

Motivational Enhancement

X

CRA

X

X

X

Self-Help

X

X

X

X

Behavioral Self-control

X

X

Behavior Contracting

X

X

Social Skills

X

Marital Therapy

X

X

X

Case Management

X

X

Cognitive Therapy

X

X

As you can see, seven of the modalities address motivation, five address urges, eight address problem solving, and three give some insight to balancing short and long-term goals. Only one of the treatment modalities is shown to address all four of the factors, but that doesn’t mean that every self-help book on the market is that comprehensive. Some are rather narrow in focus, while others, such as this one, offer a broad range of suggestions.

So where are we? The data tells us that to have the best chance of success, any recovery program should include at least some of the modalities and methods indicated above, but how can we go about determining what would work best for ourselves? For some of us who reach this point, the choices can seem quite overwhelming, and we might wonder if there is some sort of guide, or road map we could use to make the choices a little clearer.

Actually, there is, and I have already introduced it in the last chapter. The Stages of Change can serve as our GPS as we navigate through the labyrinth of available recovery choices. There are certain tools suggested by the various stages, and the tools are really independent of the recovery modalities, and can be used across many of them.

In the first chapter, I promised to disclose what actually works for people who have problems with addictive behavior. Well, here they are, and the rest of the book is about putting these methodologies to work on your problem, whatever it might be.

About the Author Pete Soderman

Pete is an author, blogger, and podcaster who makes his home in Ajijic, Jalisco, Mexico. His primary interest is in helping others recover from self-defeating behaviors.

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1 comment
Bill Frayer says March 16, 2013

Hi Pete,

I like this chapter. Seems like you’re really in the meat of the book. Discussion of the methods clear and concise.

Bill

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