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0	0	Cognitive-Behavioral Therapy	is for	Substance Use Disorders
1	1	Cognitive behavioral therapy (CBT) for substance use disorders	has demonstrated efficacy as	a monotherapy
2	2	Cognitive behavioral therapy (CBT) for substance use disorders	has demonstrated efficacy as part of	combination treatment strategies
3	3	This article	provides a review of	the evidence supporting the use of CBT
4	4	This article	provides a review of	clinical elements of CBT's application
5	5	This article	provides a review of	novel treatment strategies for improving treatment response
6	6	This article	provides a review of	dissemination efforts
7	7	CBT for substance abuse	is characterized by	heterogeneous treatment elements
8	8	Heterogeneous treatment elements	include	operant learning strategies
9	9	Heterogeneous treatment elements	include	cognitive and motivational elements
10	10	Heterogeneous treatment elements	include	skills building interventions
11	11	Core elements of CBT	focus on	overcoming reinforcing effects of psychoactive substances
12	12	Substance use disorders (SUDs)	are	heterogeneous conditions
13	13	Substance use disorders (SUDs)	are characterized by	recurrent maladaptive use of a psychoactive substance
14	14	Recurrent maladaptive use of a psychoactive substance	is associated with	significant distress and disability
15	15	Substance use disorders	are	highly common
16	16	Lifetime rates of substance abuse or dependence	are estimated at	over 30% for alcohol
17	17	Lifetime rates of substance abuse or dependence	are estimated at	over 10% for other drugs
18	18	Past year point prevalence rates	are	8.5% for alcohol
19	19	Past year point prevalence rates	are	2% for other drugs
20	20	Improved understanding of substance use patterns	has led to	greater specificity of psychosocial and pharmacologic treatments
21	21	Psychosocial and pharmacologic treatments	have evidence for	efficacy and cost effectiveness
22	22	This article	provides an overview of	evidence for CBT for substance use disorders
23	23	This article	provides an overview of	clinical application of CBT for substance use disorders
24	24	CBT (in this article)	is defined to include	behavioral interventions
25	25	CBT (in this article)	is defined to include	cognitive behavioral interventions
26	26	This review	will focus on	treatment of alcohol use disorders
27	27	This review	will focus on	treatment of drug use disorders (not including nicotine)
28	28	The term "substance use"	is defined as	taking any illicit psychoactive substance
29	29	The term "substance use"	is defined as	improper use of any prescribed or over the counter medication
30	30	"Substance use disorders" (as used here)	refers to	substance abuse and substance dependence
31	31	Symptoms of substance abuse	reflect	external consequences of problematic use
32	32	External consequences of problematic use	include	failure to fulfill role obligations
33	33	External consequences of problematic use	include	legal problems
34	34	External consequences of problematic use	include	physically hazardous use
35	35	External consequences of problematic use	include	interpersonal difficulty resulting from use
36	36	Symptoms of substance dependence	reflect	internal consequences of use
37	37	Internal consequences of use	include	physical withdrawal upon discontinuation of a substance
38	38	Internal consequences of use	include	difficulty with cutting down or controlling use of a substance
39	39	Large scale trials and quantitative reviews	support	efficacy of CBT for alcohol and drug use disorders
40	40	The authors' group	conducted	a meta-analytic review of CBT for drug abuse and dependence
41	41	The meta-analytic review	included	34 randomized controlled trials
42	42	The meta-analytic review	found	an overall effect size of d = 0.45 for CBT
43	43	Effect sizes for CBT	ranged from	small (d = 0.24) to large
44	44	Effect sizes for CBT	depended on	the substance targeted
45	45	Treatment of cannabis	had	larger effect sizes
46	46	Treatment of poly-substance dependence	had	the smallest effect sizes
47	47	Contingency management approaches	showed	greater effect sizes relative to relapse prevention or other cognitive behavioral treatments
48	48	Treatment advantages	were computed relative to	control conditions
49	49	Control conditions	most frequently were	general drug counseling or treatment-as-usual
50	50	Magill and Ray	reported	similar results for alcohol and illicit drugs in a meta-analytic review of CBT trials
51	51	Evidence	supports	durability of treatment effects over time
52	52	Rawson and colleagues	reported that	60% of patients in the CBT condition provided clean toxicology screens at 52-week follow-up
53	53	CBT for substance use disorders	includes	several distinct interventions
54	54	Distinct interventions in CBT for SUDs	can be	combined or used in isolation
55	55	Distinct interventions in CBT for SUDs	can be administered in	individual formats
56	56	Distinct interventions in CBT for SUDs	can be administered in	group formats
57	57	Evaluation of CBT for SUDs in special populations	is beyond the scope of	the current review
58	58	Special populations	include	those with other Axis I disorders (dual diagnosis)
59	59	Special populations	include	pregnant women
60	60	Special populations	include	incarcerated individuals
61	61	CBT for SUDs	encompasses	a variety of interventions that emphasize different targets
62	62	This article	reviews	individual and group treatments
63	63	Individual and group treatments	include	motivational interventions
64	64	Individual and group treatments	include	contingency management strategies
65	65	Individual and group treatments	include	Relapse Prevention and related interventions
66	66	Relapse Prevention and related interventions	focus on	functional analysis
67	67	Motivational enhancement techniques	have been created and tested to address	motivational barriers to change
68	68	Motivational Interviewing (MI)	is	an approach based on targeting ambivalence toward behavior change
69	69	MI	targets ambivalence toward behavior change relative to	drug and alcohol use
70	70	MI	has subsequent application to	motivation and adherence to other disorders and behaviors
71	71	Treatments based on the MI model	are utilized as	stand-alone interventions for SUDs
72	72	Treatments based on the MI model	are utilized in combination with	other treatment strategies for SUDs
73	73	A meta-analytic review of MI interventions	found	small to moderate effect sizes for alcohol use (compared to placebo/no-treatment)
74	74	A meta-analytic review of MI interventions	found	moderate effect sizes for drug use (compared to placebo/no-treatment)
75	75	MI interventions	showed	similar efficacy to active treatment comparisons
76	76	MI	is typically offered in	an individual format
77	77	MI	can also be utilized in	group formats
78	78	MI treatment	often consists of	a relatively brief treatment episode
79	79	Greater efficacy of MI	may be achieved with	a higher dose of treatment
80	80	Contingency management (CM) approaches	are grounded in	operant learning theory
81	81	CM approaches	involve	administration of a non-drug reinforcer following abstinence
82	82	Non-drug reinforcers	include	vouchers for goods
83	83	Clinical trials	have supported	efficacy of CM for alcohol
84	84	Clinical trials	have supported	efficacy of CM for cocaine
85	85	Clinical trials	have supported	efficacy of CM for opioids
86	86	Meta-analytic reviews	indicate	moderate effect sizes for CM efficacy
87	87	CM efficacy	is greater for	opioids and cocaine (relative to tobacco, polydrug use)
88	88	Researchers	have investigated	lottery-type strategies for distributing reinforcers (to improve cost efficacy of CM)
89	89	The punchbowl method	rewards	negative screens for drug use with a prize drawing opportunity
90	90	Inclusion of rarer large prizes	saves	money
91	91	Inclusion of rarer large prizes	offers	a successful inducement for abstinence
92	92	CM procedures	may use	stable reinforcement schedules
93	93	CM procedures	may use	escalating reinforcement schedules
94	94	Reinforcer value	increases as	duration of abstinence increases in escalating schedules
95	95	CM approaches	have successfully modified	adaptive behaviors (e.g., attendance at prenatal visits, medication adherence)
96	96	Availability of funds for reinforcers in clinical settings	is	a limitation of CM
97	97	Job-based reinforcements	have been introduced as	alternatives to aid CM clinical adoption
98	98	Contingency management strategies	have been incorporated into	couple's interactions to aid reduction of drug use
99	99	Relapse Prevention (RP)	is	a well-researched cognitive-behavioral approach to drug abuse

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