An Analysis of Relapse Occurrence for Addictive Substance Behaviors Utilizing an Integrated Cognitive Rehabilitation Curriculum. A Proposed Research Plan Capella University Beth Jones [email protected] 817.689.0442 July 2014. The Current Problem.
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The societal cost of addiction is estimated to be over $300 billion per year and continues to rise each year resulting in one of the most severe health concerns facing America today (SAMHSA, 2008).
A relapse happens when a chemically dependent person begins using a substance again to the point of intoxication after a period of abstinence (Witkiewitz & Marlatt, 2004).
Relapse rates are estimated to be in the range of 70% to 90% following a course of treatment causing many persons continued complications and repeat treatments (Miller, Zweben, & Johnson, 2005).
This addiction counselor has heard the following stated many times by the client after a relapse:
“I know what I need to do, but, in that moment, I make the wrong decision!”
Bechara (2005) states that substance dependence has been shown to impact executive cognitive functioning, specifically decision making, and these deficits influence the potential to relapse after treatment completion.
Neurocognitive deficits related to reduced impulse control and impaired decision making have been shown to predict treatment outcomes and relapse potential in substance users (Passetti, Clark, Mehta, Joyce, & King, 2008).
A study by Tomassini et al. (2012) reinforced findings that decision making impairment in recently abstinent alcoholics shows a tendency to focus on the present and a lack of a future point of view.
The purpose of this study is to compare relapse rates of a group of persons with substance dependence following a standard outpatient curriculum to a group of substance dependent persons following a standard outpatient curriculum that incorporates a cognitive rehabilitation intervention.
To date, only a limited number of studies have examined incorporating cognitive interventions for potential improvements in relapse rates (Verdejo-García, 2011). By incorporating cognitive rehabilitation into a standard outpatient treatment curriculum, the probability that the addicted person will choose to relapse back into use of an addictive substance may be reduced.
The independent variable in this proposed research study is the inclusion of the intervention of cognitive rehabilitation incorporated into a standard treatment curriculum. The control group will receive the standard treatment curriculum and the treatment group will receive the standard treatment curriculum plus the intervention.
The cognitive rehabilitation intervention selected for this proposed study is Problem Solving Therapy. Problem-solving therapy (PST) is a form of cognitive treatment that helps to teach one to effectively manage the negative effects of stressful events (APA, 2006). Problem-solving therapy can provide training in adaptive problem-solving skills as a means of making better decisions and coping with stressful problems.
The dependent variables will be the evidence of a relapse into using an addictive substance by a failed drug screening or self-report and the measure of risky and impulsive decision making as assessed by the Iowa Gambling Task (Bechara & Martin, 2004). The measure will be administered at admission as a pre-test; at discharge of the treatment program as a post-test; and then at 60-days post treatment.
After integrated treatment, the chemically dependent person will likely make more emotionally regulated and reflective decisions when faced with the real world problems of cravings, thoughts, or situations to re-engage in substance abuse activity.
By decreasing impulsivity and by increasing reflection and emotional regulation, the person gathers more information and spends more cognitive cycles in evaluating the information prior to making a decision (Lawrence, Luty, Bogdan, Shahakian, Clark, 2009).
In making more empowered and less risky decisions, the probability to continue addictive behavior is likely to be decreased benefiting the individual, their families, and society.
Exploring a new intervention to potentially improve treatment outcomes
Demonstration of commitment to excellence in treatment by exploring new interventions
Positive exposure for the organization through potential publications
APA Presidential Task Force on Evidence-Based Practice. (2006). Evidence-based practice in psychology. American Psychologist, 61, 271-285.
Bechara, A. (2005). Decision making, impulse control and loss of willpower to resist drugs: A neurocognitive perspective. Nature Neuroscience, 8(11), 1458-1463.
Bechara, A., & Martin, E. M. (2004). Impaired decision- making related to working memory deficits in individuals with substance addictions. Neuropsychology, 18, 152–162
Lawrence, A.J., Luty, J., Bogdan, N.A., Sahakian, B.J., Clark, L. (2009). Impulsivity and response inhibition in alcohol dependence and problem gambling. Psychopharmacology.207(1), 163–172.
Miller, W. R., Zweben, J., & Johnson, W.R. (2005). Evidence-based treatment: Why, what, where, when, and how? Journal of Substance Abuse Treatment, 29 (4), 267–276.
Passetti, F., Clark, L., Mehta, M. A., Joyce, E., King, M. (2008). Neuropsychological predictors of clinical outcome in opiate addiction. Journal of Drug and Alcohol Dependence, 94, 82–91.
Substance Abuse and Mental Health Services Administration. (2008). Projections of National Expenditures for Mental Health Services and Substance Abuse Treatment, 2004-2014.
Tomassini, A., Struglia, F., Spaziani, D., Pacifico, R., Stratta, P., Rossi, A. (2012). Decision making, impulsivity, and personality traits in alcohol‐dependent subjects. The American Journal on Addictions, 21(3), 263-267.
Witkiewitz, K., Marlatt, G. (2004). Relapse Prevention for Alcohol and Drug Problems: That Was Zen, This Is Tao. American Psychologist, 59(4), 224-235.
Verdejo-García, A. (2011). Novel Therapies for Cognitive Dysfunction Secondary to Substance Abuse. Psychiatric Times, 28, 46-48.