The Addiction Treatment Planner. Группа авторов
those psychological treatments with the best available supporting evidence, added Objectives and Interventions consistent with them in the pertinent chapters, and identified these with this symbol:
The sources we used to identify the evidence-based treatments integrated into this Planner are multiple and, we believe, high quality. They include rigorous meta-analyses, current critical, expert reviews, as well as EBP guideline recommendations. Examples of specific sources include the Cochrane Collaboration reviews; the work of the Society of Clinical Psychology identifying research-supported psychological treatments; evidence-based treatment reviews (e.g. David, Lynn, & Montgomery, 2018; Nathan & Gorman, 2015), as well as critical analyses of the process through which EBP is defined (e.g. Dimidjian, 2019; Norcross, Hogan, Koocher, & Maggio, 2017). EBP guidelines informing the selection process include those from the APA, American Psychiatric Association, the National Institute for Health and Clinical Excellence (NICE) in the United Kingdom, and the National Institute on Drug Abuse (NIDA) to name a few.
Although sources may vary slightly in the criteria they use for judging levels of empirical support, we favored those that use more rigorous criteria, typically requiring demonstration of efficacy through randomized controlled trials or clinical replication series, good experimental methodology, and independent replication. Our approach was to evaluate these various sources and include those treatments supported by the highest level of evidence and for which there was consensus across most of these sources. For any chapter in which EBP is indicated, references to the sources used to identify them can be found online at www.wiley.com/go/jongsma/addictiontp6e. In addition to these references to empirical support, we have also included a Professional Reference appendix listing references to Clinical Resources. Clinical Resources are books, manuals, and other resources for clinicians that describe the details of the application, or the “how to,” of the treatment approaches described in a chapter.
We recognize that there is debate regarding EBP among mental health professionals, who are not always in agreement regarding the best treatment, what factors contribute to good outcomes, or even what constitutes “evidence.” We also recognize that some practitioners are skeptical about changing their practice based on psychotherapy research. Our intent in this book is to accommodate these differences by providing a range of treatment plan options, including those consistent with the “best available research” (APA, 2006), those reflecting common clinical practices of experienced clinicians (that may have not been subjected to study), and some that reflect promising emerging approaches. Our intent is to allow users of this planner an array of options so that they can construct what they believe to be the best plan for their particular client.
More recently, psychotherapy research is moving toward trying to identify evidence-based principles of psychotherapeutic change that cut across the various individual psychotherapies that have largely been the focus of outcome research. An example of this call in seen in Goldfried (2019), in which he advances the following principles:
Promoting client expectation and motivation that therapy can help,
Establishing an optimal therapeutic alliance,
Facilitating client awareness of the factors associated with his or her difficulties,
Encouraging the client to engage in corrective experiences, and
Emphasizing ongoing reality testing in the client's life.
Although many endorse this effort, at the time of this writing it is still in progress. Consequently, our approach to identifying objectives and interventions consistent with EBPs reflects what has been done from the “principles” approach as well as the research demonstrating the efficacy and effectiveness of individual models. Perhaps the field will advance enough by the next edition of this planner to include only evidence-based principles of psychotherapeutic change. Until then, we believe that the approach we have taken reflects the current state of the science.
We would also like to note that for those selecting EBT objectives and interventions in their treatment, fidelity to the EBT as it was delivered in the studies demonstrating its efficacy or effectiveness offers the best chance for reproducing its results for your client. A demonstration of this point was witnessed in a recently published meta-analysis examining 12-Step Facilitation Therapy (TSF; Kelly, Humphreys, & Kelly, 2020). The review found that TSF manualized interventions intended to increase Alcoholics Anonymous (AA) participation during and following alcohol use disorder (AUD) treatment lead to enhanced abstinence outcomes compared to other well-established treatments over the next few months and for up to three years. Of note was that fidelity to the TSF treatment model was critical to this outcome as conveyed in this statement by the authors:
…when different types of TSF interventions were tested against each other, the more intensive TSF interventions (e.g. those that include actively prescribing AA participation and ongoing monitoring of AA attendance and related experiences; personal linkages to existing AA members) often worked better at improving drinking-related outcomes than the ‘“treatment as usual (TAU) TSF”’ intervention. This suggests that although many treatment professionals may believe that they “‘already do 12-step’” (i.e. implement TSF strategies) because they hand out 12-step literature or mention 12-step groups to patients, this alone may not be sufficient to achieve a superior benefit (Kelly, Humphreys, & Yeterian, 2013). The types of TSF strategies used do matter, and the more intensive strategies, such as those evaluated herein, enhance participation rates and outcomes compared to the more routine 12-step-oriented TAU. Some of these strategies could be clinical linkage to existing members (e.g. Manning, et al. 2012; Timko, Debenedetti, & Billow, 2006), or active prescription of attendance versus leaving it to people to decide for themselves whether they want to attend AA (e.g. Walitzer, Dermen, & Barrick, 2009) (p. 33).
Throughout this Planner we cite references and include an appendix of clinical resources, including treatment manuals and books, which describe the how-to of delivering the EBT with high fidelity, and we recommend them for those who share the value of delivering treatment with the intent to maximize the client's outcome.
At the beginning of each chapter, as we launch into the process of offering ideas for treatment interventions for the presenting problem, we have listed one Client Objective along with two associated Therapeutic Interventions that emphasize the critical nature of a therapeutic relationship. These options were derived from the research on empirically supported relationship factors (e.g. Norcross, 2002) and disseminated most recently in Norcross & Lambert (2018) and Norcoross & Wampold (2018). The relationship factors cited are as follows: collaboration with the client regarding the treatment process, agreement on the clear goals and expectations of therapy, demonstration of consistent empathy toward the client's feelings and struggles, verbalization of positive regard toward and affirmation of the client, and the collection and delivery of client feedback based on the client's appraisal of his/her progress in therapy (Norcross & Lambert, 2018; Norcross & Wampold, 2018). The body of research on relationship factors supports the conclusion that establishing a strong therapeutic relationship is necessary to optimize the treatment outcome. Accordingly, any of the other objectives and interventions that are selected to be included in a client's treatment plan should be integrated into and supported by an effective, foundational therapeutic relationship, and speaks to including this Client Objective and two associated Therapeutic Interventions in every