Over the last thirty years, hundreds of well-constructed treatment studies have generated a mountain of evidence about successful approaches for helping people with substance use problems. These include motivational strategies, cognitive-behavioral therapies, positive reinforcement strategies for families, and medications, as well as other approaches. The good news: these approaches are starting to filter into mainstream mental health treatment with an increase in public knowledge about their effectiveness. Increasingly as well, clients are educated about treatment differences, have increasingly come to understand that “one size doesn’t fit all”, and are asking questions about treatment effectiveness.
The bad news: the field of substance abuse treatment in the United States has been using the same traditional methods for approximately sixty years. These methods have included a strong focus on the “twelve steps” of the Anonymous programs (very helpful for some, but not all), the idea of addiction as a “disease,” lack of collaboration with clients as equal partners, and ignoring advances in the use of effective medications. Strikingly, treatments backed by evidence have found very little foothold in traditional treatment centers; we consider this to be a quality of care tragedy.
CMC was founded with the central idea of providing exactly those treatments with the greatest degree of evidence and support for their effectiveness. Providing evidence based treatments is more than a phrase however; it also includes ongoing training and supervision for our staff in these approaches, as well as ongoing client by client tracking of effectiveness to answer the question: are we helping? All of this is part of providing truly evidence based treatment, and this remains central to our mission.
You can read more about Motivational Interviewing here.
The motivational and cognitive-behavioral bases of CRA together serve as the basis for all treatment at CMC. In this way, CRA is not a separate track at CMC, rather a part of all the work that we do.
Community Reinforcement and Family Training (CRAFT) teaches family and friends effective strategies for helping their loved one to change and for feeling better themselves. CRAFT works to affect the loved one’s behavior by changing the way the family interacts with him or her. It is designed to accomplish three goals:
- When a loved one is abusing substances and refusing to get help, CRAFT helps families move their loved one toward treatment.
- On its own, CRAFT helps reduce the loved one’s alcohol and drug use, whether or not the loved one has engaged in treatment yet.
- CRAFT improves the lives of the concerned family and friends.
CRAFT is a skills-based program that impacts families in multiple areas of their lives, including self-care, pleasurable activities, problem solving, and goal setting. At the same time, CRAFT addresses their loved one’s resistance to change. CRAFT teaches families behavioral and motivational strategies for interacting with their loved one. Participants learn, for example, the power of positive reinforcement for positive behavior (and of withdrawing it for unwanted behavior), and how to use positive communication skills to improve interactions and maximize their influence.
Specifically, CRAFT teaches several skills, including:
- Understanding a loved one’s triggers to use substances
- Positive communication strategies
- Positive reinforcement strategies – rewarding non-using behavior
- Domestic violence precautions
- Getting a loved one to accept help
In multiple studies, across a range of substances and settings, CRAFT engaged on average 7 out of 10 reluctant loved ones into treatment.
DBT skills training encompasses four areas: distress tolerance, emotion regulation, interpersonal effectiveness, and mindfulness.
- In vivo exposure will help you to gain experience confronting situations and memories you have previously worked to avoid, outside of sessions. You can learn that you can actually tolerate the situations and the feelings you experience, and nothing bad actually happens to you. In fact, the more you confront these situations, your anxiety will decrease, a process called habituation. Further, you will gain a new sense of competence and confidence in your life and experience new learning and a shift in perspective related to situations which were previously considered unsafe due to trauma reminders.
- Through imaginal exposure, (repeatedly revisiting the traumatic memory) in session, you will come to realize that your trauma was a specific event occurring in a specific time and place. This realization will help change any beliefs that you have that the entire world is a dangerous place and that you are incompetent to deal with it. In addition, you will learn that you can tolerate the anxiety you experience when remembering the traumatic memory and that this anxiety, with repetition, will decrease. You will also gain new perspective on the memory and learn that although the memories can be very scary, the memories are not dangerous.
STAIR is a two part treatment, each phase consisting of approximately 8 sessions. The first phase of treatment focuses on learning skills for handling negative feelings and managing distress and developing emotional awareness. Phase 1 also prepares you to work effectively in the more emotionally intense Phase II, which involves discussion and analysis of painful memories of childhood trauma.
The goal of Phase II, or Narrative Story Telling (NST), is to organize your memories of trauma and resolve your feelings about them, so that you control the memories rather than the memories’ controlling you. In addition, the process of describing your past is a means by which you will be able to identify beliefs about yourself and patterns of relating that might have been adaptive in abuse circumstances, but no longer are adaptive and need to be changed.
The skills training from Phase I will help you leave behind old patterns of functioning and develop interpersonal behaviors and emotion management strategies that are consistent with your current life goals. We offer both group and individual STAIR services.
The most common treatment for insomnia is sleep medication, such as Ambien and Lunesta. These medications do help to initiate sleep and often result in people sleeping through the night, but can have side effects such as feeling “hung over” in the morning, sleep walking, sleep driving, and sleep eating. Furthermore, sleep medications are often abused and are therefore not appropriate for patients with a substance abuse history.
CBT-I is an empirically supported, sleep-medication-free treatment. It has repeatedly proven to be the most effective treatment for chronic insomnia, equal to sleep medications in the short term and more effective in the long term. Combining the techniques of sleep restriction, stimulus control, cognitive corrections, and relaxation training, CBT-I’s six-to-twelve-week protocol works to change sleep habits and correct common misconceptions about sleep that help to maintain the insomnia.
- Sleep restriction is a technique for matching up sleep ability with sleep opportunity. Clients collect sleep data and, with their CBT-I therapist, determine a bedtime, wake-time, and rules around sleep that increase the pressure to sleep and decrease time spent awake in bed.
- Stimulus control is used to change sleep-destructing behaviors that have developed from insomnia, behaviors like watching TV in bed, using a computer in bed, and otherwise creating a whole world in the bedroom, naturally, since spending so much time awake in bed. Stimulus control means to break those habits and make the bedroom a place that stimulates sleep.
- There are many unhelpful myths about sleep. For example, a person who believes he must get eight hours of sleep each night may worry about getting less, which worrying makes it harder for him to sleep. Correcting such cognitive distortions and replacing them with facts (many people function very well on less than eight hours of sleep) reduces anxiety and stress that prevent sleep.
- Relaxation training helps to quiet the body and mind. It is particularly helpful for people who have a lower threshold for anxiety and worry and find themselves unable to stop racing thoughts at night. Relaxation training includes progressive muscle relaxation and breathing and mindfulness techniques.
- Are there other emotional/psychiatric issues (such as depression, anxiety, mood swings, ADHD) that could be well-managed with medication?
- Are there “addiction” medications (those developed specifically for help with certain substances of abuse) that could be useful, such as disulfiram (Antabuse) or naltrexone for alcohol issues, or buprenorphine (Suboxone) for opiate use issues?
It is not helpful to ignore these adjuncts to treatment. It can, in fact, be harmful. When appropriate, CMC refers clients to outside psychiatrists who specialize in addiction issues for evaluation.