National Institute on Drug Abuse
Behavioral Therapies Development Program - Effective Drug Abuse Treatment Approaches
Behavioral Therapy for Adolescents
Behavioral Therapy for Adolescents incorporates the treatment procedures of therapist modeling, behavior rehearsal, specific therapy assignments, self-recording between sessions, review of the self-recordings and assignment records, and extensive praise for progress. The major specific procedures are (1) stimulus control; (2) an urge control procedure for interrupting incipient drug use urges, thoughts, or actions; and (3) social control or behavioral contracting, especially between youth and their parents (Azrin et al., 1994).
The Stimulus Control procedure is designed to eliminate external stimulus situations that are precursors to drug use and to increase situations and activities incompatible with, or not associated with, drug use.
Urge Control is designed to interrupt internal stimuli, (proprioceptive sensations, urges, thoughts or incipient actions) associated with drug use and to then substitute competing internal and external stimuli.
The Social Control procedure is designed to motivate and assist abstinence through the influence of significant-others. A significant other is urged to attend sessions with the patient or to participate through the use of a speakerphone when attendance was not possible. The Social Control procedure consists of assistance with therapy assignments and behavioral contracting. Behavioral contracting consists of providing reinforcement contingent on drug incompatible activities. Behavioral contracts include the following usual features: they (a) are written, (b) are signed and agreed upon by both parties, (c) include only observable actions as responses, (d) employ only controllable reinforcers, (e) employ reinforcers as an extra, or non-assumed events, (f) include short-term (daily) and well as long-term reinforcers, (g) are recorded daily and reviewed on a prepared form, (h) are altered by the consent of both parties, (i) are reviewed at each session and (j) are discontinued after long-term adherence.
In a controlled study on behavioral therapy, the above intervention was compared to supportive drug counseling. The results demonstrate that 37% of subjects in the behavioral condition were drug free at 2 months, 54% at 6 months, and 65% at 12 months versus 20+/- 6% for supportive drug counseling for all twelve months. The behavioral treatment was more effective across sex, age, education level, marital status and type of drug (hard-drugs, cocaine, and marijuana). Greater improvement for this condition was also noted on measures of employment/school attendance, family relationships, depression, institutionalization and alcohol use. A follow-up assessment was taken after a 6-month or more hiatus from treatment (mean 9-month follow-up). At the follow-up month, drugs were used at least once by 71% of the Supportive versus 42% of the Behavioral Subjects. When drug use was measured in terms of the number of days of use per month, Supportive counseled subjects did not decrease drug use either by the end of treatment or at follow-up. Alcohol use, and days worked or in school showed a similar pattern of greater improvement for the behavioral treatment being maintained at the follow-up. These results indicate a substantial treatment specific reduction of drug usage that endures after treatment is discontinued. The present favorable results appear attributable to the inclusion of family significant others in therapy and the use of reinforcement contingent on urinalysis results.
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., Donahue, B., Besalel, V., Lapinski, K.J., Kogan, E., Acierno, R., & Galloway, E. (1994). Behavioral therapy for drug abuse: a controlled treatment outcome study. Behavioral Research & Therapy, 32 (8), 857-866.
Azrin, N.H., Donohue, B., Besalel, V.A., Kogan, E.S., Acierno, R. (1994). Youth drug abuse treatment: A controlled outcome study. Journal of Child & Adolescent Substance Abuse, 3 (3), 1-16.
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