National Institute on Drug Abuse
U.S. Department of Health and Human Services, National Institutes of Health   Manual 2:
  A Community Reinforcement Approach: Treating Cocaine Addiction
  

Authors

Alan J. Budney, Ph.D.
Stephen T. Higgins, Ph.D.
University of Vermont

Contents

• Foreword
  

• Background
  

  • Psychosocial Interventions
  • Supporting Research
    
    • Use With Other Populations
    • Concurrent Alcohol Dependence
      

• Program Overview
  

• Lifestyle Changes
  

• Vouchers
  

• Other Drug Abuse
  

• Treatment Parameters

  • Schedule
  • Components
  • Structure
    

• Clinical Approach
  

  • Counseling Style
    • Flexibility
    • Empathy
    • Active Involvement
    • Directive but Collaborative
    • Social Reinforcement
      
  • Counseling Techniques
    • Behavioral Techniques
    • Additional Resources
    • Progress Graphs
      
  • Counseling Structure
    • Preparation
    • Session Protocol
    • Recent Problems or Crises
      
  • Special Issues
    • Absences
    • Tardiness
    • Extra Sessions
    • Drug and Alcohol Use
    • Concurrent Treatment
    • Premature Termination
      
  • Documentation of Patient Contact
    
  • Clinical Supervision

• The Voucher Program
  • Objective Monitoring

  • Urinalysis Schedule

  • Specimen Collection

  • Laboratory Analysis

  • Presenting the Results

• Intake
  • Initial Contact
    • Screen Applicants
    • Schedule Intake

  • Intake Procedures
    • Assessment
    • Self-Administered Questionnaires
    • Program Description
    • Structured Interviews

  • Initial Treatment Session
    • Get to Know the Patient
    • Provide Overview and Rationale
    • Introduce the Voucher Program
      • Describe Abstinence Contract
      • Explain Urinalysis Monitoring
      • Explain Voucher Program
      • Review Abstinence Contract
      • Priming
    • Problem List
    • Practical Needs Assessment
    • Appointment Book
    • Significant Others
    • Disulfiram Procedures (if applicable)
    • Collect Urine
    • Schedule the Next Session

• Early Counseling Sessions
  • Outline a Treatment Plan

  • Sessions One and Two
    • Urinalysis Results
    • Complete Intake and Treatment Orientation
    • Introduce Functional Analysis and Stimulus Control
    • Assist With Practical Needs
    • Use the Appointment Book
    • Start To Develop the Treatment Plan
      • Discuss Areas for Change
      • Prioritize Problems
      • Set Specific Target Goals
    • Follow Through

• Drug Avoidance Skills
  • Functional Analysis
    • Components of Functional Analysis
      • Triggers
      • Behavior
      • Positive Consequences
      • Negative Consequences
    • Conduct a Functional Analysis

  • Self-Management Planning
    • Rationale
    • Initiate Training
    • Make the Plan

  • Drug Refusal Training
    • Rationale
    • Refusing Cocaine and Other Drugs
    • Components of Effective Refusal

  • Practice Refusal Skills
    • Homework

• Lifestyle Change Components
  • Time Management
    • Develop Time-Management Skills
    • Apply Time Management

  • Social/Recreational Counseling
    • Rationale
    • List Activities and People
    • Set Goals and Assess Progress
    • Facilitate Change

  • Problemsolving
    • Rationale
    • Steps for Problemsolving
      • Recognize the Problem
      • Identify the Problem
      • Brainstorm
      • Select Approach
      • Evaluate Effectiveness
      • Practice

  • Vocational Counseling
    • Rationale
    • Set Goals
    • Treatment Components

  • Social-Skills Training
    • Assertiveness Training
      • Rationale
      • Define Interpersonal Style
      • Assertiveness Skills
      • Practice
      • Set Goals and Assess Progress

  • HIV/AIDS Prevention
    • Rationale
    • AIDS Knowledge Pretest
    • Video and Discussion
    • Pamphlets and Condoms
    • AIDS Knowledge Posttest
    • HIV Antibody and Hepatitis B Testing
      • Provide Information
      • Discuss Results

• Relationship Counseling
  • Session One
    • Introduce Relationship Counseling
    • Introduction Exercise
    • Relationship Happiness Scale
    • Daily Reminder To Be Nice

  • Session Two
    • Perfect Relationship Form
    • Positive Requests

  • Session Three
    • Communications Training

  • Session Four
    • Communications Training

  • Sessions Five - Eight

• Other Substance Abuse
  • General Approach
    • Treatment Goals
      • Abstinence
      • Reduced Use
      • No Intervention

  • Concurrent Alcohol Use
    • Abstinence
      • What Is Disulfiram?
      • Medical Oversight
      • Disulfiram Protocol
    • Limited Alcohol Use/Safe Drinking
    • Patients Who Hesitate or Refuse
    • Backup Agreement

  • Marijuana Use

• Other Psychiatric Problems
  • Depressive Symptomatology
    • Evaluate Suicide Risk
    • Monitor Symptoms
    • Treatment

  • Anxiety
    • Relaxation Protocol
      • Relaxation Exercise and Practice
      • Applications
    • Insomnia Protocol
      • Rationale
      • Sleep Diary
      • Sleep-Hygiene Rules
      • Sleep Restriction and Stimulus Control
      • Practice

• Clinical Supervision
  • Weekly Clinical Staff Supervision
    • New Cases
    • Active Cases

  • Counselor Treatment Team Meetings

• References