Literature Review Diana Carter University Of South Carolina ✓ Solved

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1 Literature Review Diana Carter University of South Carolina

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, has replaced the terms “substance abuse” and “substance dependence” with the term “substance use disorders.” The DSM V describes substance use disorders as patterns of symptoms resulting from the use of a substance, which the individual continues to take despite experiencing problems as a result. According to Harvard Health publications, most research on substance abuse and dependence focused on men until the early 1900s. When U.S. agencies began requiring federally funded studies to enroll more women, the focus on men changed. Researchers have since learned that gender differences are present in some types of addiction; 11.5% of males ages 12 and older had a substance abuse or dependency problem in 2008, compared to 6.4% of females.

Women tend to progress more rapidly from using to dependency with an addictive substance. As stated by the US National Survey on Drug Use and Health, women develop medical and social consequences of addiction more rapidly, finding it harder to stop using addictive substances, and are more vulnerable to relapse. According to Greenfield, the most common drug abused by women in the United States is alcohol. Compared to 20% of men, 7% to 12% of women abuse alcohol; researchers state that since the early 1970s, this gender gap has narrowed because drinking by women has become more socially acceptable. Women are less likely to seek treatment due to numerous barriers such as childcare responsibilities, transportation, financial status, and social stigma.

Programs should consider offering childcare and other services specific for women to inspire them to seek treatment. Despite the fact that substance abuse treatment frequently happens in an individual or group position, the disorder itself has solid binds to the patient's social condition. According to the National Association of Cognitive Behavioral Therapists, cognitive behavioral therapy (CBT) has been proven an effective model in combating substance use disorder (SUD). CBT is based on the idea that our thoughts cause our feelings and behaviors, not external things like people, situations, or events. According to the model, an individual can change the way he or she thinks, which, in turn, changes what one feels or how one behaves.

CBT is used to treat addictions, depression, anxiety, and other disorders. Patients may not be able to control every aspect of the world around them; therefore, cognitive behavioral therapy teaches them to deal with and take control of how they interpret things in their environment. Cognitive behavioral therapy focuses on changing negative thoughts to positive thoughts to affect change in one’s feelings and behaviors. For example, a person addicted to drugs has come out of inpatient treatment and has gone to see a therapist as part of their outpatient treatment. The client states, “I want to get high because it makes me feel better.” The therapist replies, “Can you talk about how getting high makes you feel better?” The client remarks, “It takes my mind off the problems I have, like being separated from my kids.” The therapist could respond, “Tell me something else that makes you feel better.” The client goes on to disclose that she feels better when she talks to her children or draws them together in their home.

The therapist continues by asking the client if that happens often, to which the client replies, “I spoke with my children every day, and I would draw us together at least twice a week when I was in treatment.” The therapist reminds the client she is home now and can talk with her children or draw whenever she has free time. The client responds, “Thanks! I didn’t think of that and I feel better. Wow!” The therapist suggests to the client to keep a log of how often she and the children have family talks and how often she draws her family in her spare time, and to bring the drawings to her next appointment. Cognitive behavioral therapy, together with group therapy, indicates promise in working with women challenged with substance use disorder.

By placing more emphasis on the interests of a community, therapy can be a resourceful and suitable approach in providing a supportive recovery society as well as acting as a cushion for stressors that are linked with recovery. According to Baker, et al. (2010), between 1950 and 2006 only 12 studies have been conducted concerning CBT among women with substance use disorder. Subsequently, reports indicate that research specifies there is proof that CBT turns out to be a suitable approach among women clients suffering from SUD. In one study, 284 participants gave written, informed consent to take part in the 18-week assessment. All participants were offered a single-session after completing treatment.

Using CBT and medication, nine study sessions focused on depression and alcohol among groups of women. The results of this study show evidence that treatment integrated with CBT may be superior to a single-focused treatment when coexisting depression and alcohol problems are present. The next study consists of 221 first-year undergraduate women from two universities in eastern Canada, who participated in a brief CBT intervention. Most participants were Caucasian and from families of origin whose average yearly salary range was over $60,000. Questionnaires were given to participants in all experimental conditions at pre- and post-intervention, as well as for a 10-week follow-up. Only drinking measures collected immediately pre-intervention and at the 10-week follow-up were examined to provide an adequate time for capturing change in drinking behavior. For the specifics of intervention, evidence found CBT to affect participants, showing a significant reduction in drinking behavior from pre-intervention to follow-up.

Another study evaluated the effectiveness of the “Seeking Safety” treatment as an aid in an uncontrolled pilot study of incarcerated women with SUD and PTSD. Seeking Safety therapy is an integrative, cognitive behavioral treatment of SUD and PTSD. It is a manual-based treatment, which pulls upon the tradition of CBT. Of the seventeen incarcerated women with SUD and PTSD receiving Seeking Safety treatment, results show that sixteen women met the criteria for PTSD, which was maintained at the 3-month follow-up. Based on the urinalyses, only six women used illegal drugs after a 3-month follow-up. The overall data suggests that the Seeking Safety treatment appears to fascinate incarcerated women with SUD and PTSD, and that the treatment is beneficial. Zlotnick, et al. (2003), argue that CBT, supported by a nonjudgmental and collaborative therapeutic relationship, may give women a chance for empowerment.

Research continues to state that CBT based on skills along with support systems can easily be adapted to fit a strength-based method instead of an insufficient approach. As for relevance, with CBT, researchers should appreciate and stress the significance of family and community support as a necessary measure of recovery. Even though the total substance abuse admissions among African American women have consistently been decreasing since the 1990s, TEDS reports that in 2006, 21% of admissions to substance abuse treatment facilities were African American women, in contrast to 12% of non-Hispanic women populations. The main source of referral to treatment among women with SUD was through self-referral or by family and friends.

Alcohol contributes to 20% of substance abuse treatment admissions among African-American women. However, other researchers indicate a margin of variation in alcohol consumption patterns among men and African American women, as well as between other diverse groups of women. Participants in the next study were enrolled in seven community-based substance abuse treatment programs across the United States, had at least one traumatic event in their lifetime, and met criteria set forth in the Diagnostic and Statistical Manual of Mental Disorders. The study used randomized, controlled, and repeated measures designed to assess the effectiveness of CBT. With the Post Traumatic Stress Scale-Self Report (PPS-SR), Seeking Safety (SS) groups, and the Women’s Health Education (WHE) group, cognitive behavioral therapy shows to be effective after a 12-month follow-up with 54% less usage of drugs or alcohol.

According to Hien, et al. (2009), back in the 1990s, many studies were conducted on women challenged with substance use disorder focusing on low-income and urban areas. Even though some studies consist of a limited amount of treatment techniques and methods, researchers are beginning to develop promising practices of CBT for women with SUD. Research on the effectiveness of drug treatment programs for women prisoners, parolees, and probationers that were classified as Level 3 or higher on the Maryland Scale was reviewed and published after the year 2000. Participants in therapeutic CBT communities and drug courts had lower rates of drug use and crime than comparable individuals who did not receive such treatment.

Several different types of pharmacological treatments were associated with a reduced frequency of drug use. Those who received contingency management tended to use drugs less frequently, particularly if they also received cognitive behavioral therapy. Conclusively, researchers reported that drug use and crime were lower among individuals undergoing cognitive behavioral therapy followed by an aftercare program focusing on high-risk offenders and providing encouragement in treatment. In regards to the achievement of CBT as an effective tool for combating substance use disorder, PTSD, and depression, much work must still be done to enhance rates of treatment reaction. One new approach has been the use of computer-aided treatment delivery.

A current review conducted by Lanza and partners thought about the expansion of every other week computer-based CBT from standard, medication-advising treatment. Outcomes showed that the individuals receiving the computer-based treatment had essentially higher quantities of medication-free urine tests and longer patience with benefits proceeding through a 6-month change. It is common for individuals struggling with substance use disorder to have destructive, negative thinking. Not recognizing these thought patterns are harmful; they seek treatment for depression or other external influences. Because what we think affects our wellbeing, changing harmful thought patterns is necessary.

Cognitive behavioral therapy addresses harmful thought patterns, helping clients recognize their ability to practice different ways of thinking and control over distressing emotions and harmful behavior. CBT is an active therapeutic model, problem-focused and goal-directed; however, one must be skilled to administer it. There are many benefits from using CBT; it discovers the client’s patterns of behavior, which may lead to negative actions and beliefs that direct their thoughts. It also allows for the therapist and client to work together in a therapeutic relationship to identify harmful thought patterns and actively seek alternate thinking. CBT can be provided in individual as well as group therapy.

Using CBT, therapists offer clients valuable viewpoints, helping to improve their quality of life and manage stress better than simply “problem-solving” tough situations on their own. Evolving into my professional career as a social worker, cognitive behavioral therapy will become one of my favored models of therapy to practice with those challenged with substance use disorder.

References

• Bahr, S. J., Masters, A. L., & Taylor, B. M. (2012). What works in substance abuse treatment programs for offenders? The Prison Journal, 92(2).
• Baker, A. L., Kavanagh, D. J., Kay-Lambkin, F. J., Hunt, S. A., Lewin, T. J., Carr, V. J., & Connolly, J. (2010). Randomized controlled trial of cognitive–behavioral therapy for coexisting depression and alcohol problems: short-term outcome. Addiction, 105, 87–99.
• Diagnostic and Statistical Manual of Mental Disorders: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association, 2013.
• Greenfield, S. F., Back, S. E., Lawson, K., & Brady, K. T. (2010). Substance Abuse in Women. The Psychiatric Clinics of North America, 33(2), 339–355.
• Hien, D. A., Wells, E. A., Jiang, H., Suarez-Morales, L., Campbell, A. N., Cohen, L. R., ... & Hansen, C. (2009). Multisite randomized trial of behavioral interventions for women with co-occurring PTSD and substance use disorders. Journal of consulting and clinical psychology, 77(4), 607.
• Lanza, P. V., Garcia, P. F., Lamelas, F. R., & González-Ménendez, A. (2014). Acceptance and commitment therapy versus cognitive behavioral therapy in the treatment of substance use disorder with incarcerated women. Journal of clinical psychology, 70(7).
• U.S. Substance Abuse and Mental Health Services Administration Office of Applied Studies. (2008). Results from the 2008 National Survey on Drug Use and Health: National Findings.
• Watt, M., Stewart, S., Birch, C., & Bernier, D. (2006). Brief CBT for high anxiety sensitivity decreases drinking problems, relief alcohol outcome expectancies, and conformity drinking motives: Evidence from a randomized controlled trial. Journal of Mental Health, 15(6).
• Zlotnick, C., Najavits, L. M., Rohsenow, D. J., & Johnson, D. M. (2003). A cognitive-behavioral treatment for incarcerated women with substance abuse disorder and posttraumatic stress disorder: Findings from a pilot study. Journal of Substance Abuse Treatment, 25(2), 99-105.

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