from the book: Shadow Dancing on the Grave of Hope:
Application of the Community Reinforcement Procedures to Users of Illegal Drugs
Users of illegal drugs have unique problems. The drugs are less available than alcohol, possession is illegal and maintaining a steady supply of the drug is costly and usually difficult. Azrin and his colleagues, using the community reinforcement approach for alcoholism as a guide, produced a program for drug users with many of the same components. This program shares many of the characteristics of other successful programs and concentrates on changing what the client does. The program group was abstinent 65% of the time after 12 months with the non-program group abstinent 25% of the time. Additional follow-up showed that the control group did not change drug use during treatment or follow-up while the drug use of the treatment group decreased by 63% at the end of treatment and 73% at the end of the 9 months of the follow-up period.
The Stimulus Control procedure ensured that the client would avoid those situations which made drug use more likely. Daily logs were kept and the counsellor reinforced engaging in drug free behavior and avoiding situations where the probability of drug use was high. Urge Control was designed to control the internal stimuli arising from the desire to take drugs. Behavioral Contracting required behavior incompatible with drug use in return for agreed upon reinforcers such as increased allowance, social activities and sexual activities. The required behavior had to be measurable. Attendance at school or work were two of the main measurable objectives. An Annoyance Review outlined the major consequences for drug use. The client requested reinforcers from others using a Positive Request Procedure. The Annoyance/Anger Prevention procedure was used to reduce anger towards others who were significant in the social world of the client. The Problem Solving procedure was used when the client was having difficulty in choosing drug-incompatible courses of action. The Relationship Enhancement procedure demonstrated how to give non-contingent reinforcers such as compliments, express appreciation, offer help, etc. The Job Club was essentially that used in the procedure for alcoholics.
Treatment integrity was monitored by audio-taping the sessions, having non-participating observers sit in on some sessions and using a session checklist which listed the components of the program which had to be covered. Integrity assurance procedures, absent in most programs, ensure that the program is being carried out in the same way as it is described.
Azrin, N.H., Acierno, R., Kogan, E., Donahue, B., Besalel, V., & McMahon, P.T., (1996). Follow-up results of supportive versus behavioral therapy for illicit drug abuse. Behavioral Research & Therapy, 34 (1), 41-46.
Azrin, N. H., McMahon, P. T., Donohue, B., Besallel, V. A., Lapinski, K. J., Cogan, E. S., Acierno, R.E., & Galloway, E. (1994). Behavior therapy for drug abuse: A controlled treatment outcome study. Behavior Research and Therapy, 32, 857-866.
Cheerio and ttfn,
Grant Coulson
