Cognitive-behavioral coping-skills therapy for alcohol dependence. Current status and future directions

Abstract

Cognitive-behavioral coping-skills training (CBST) is an alcoholism treatment approach aimed at improving the patients' cognitive and behavioral skills for changing their drinking behavior. CBST encompasses a variety of approaches that despite their core similarities differ in duration, modality, content, and treatment setting. Numerous studies and reviews have ranked CBST among the most effective approaches for treating alcoholic patients. Nevertheless, a recent analysis of nine studies failed to identify specific CBST components that could account for the treatment's effectiveness. Furthermore, a similar analysis of 26 studies suggested that CBST's superior effectiveness was limited to specific treatment contexts (i.e., when delivered as part of a comprehensive treatment program) and to specific patient subgroups (e.g., patients with less severe alcohol dependence). Several measures may help broaden CBST's focus and effectiveness, such as incorporating components of other treatment approaches.

An example of a decision tree for assessing a patient’s social network. The therapist first assesses how highly invested the patient is in his or her social network (i.e., How many people are in the patient’s social network? How much time does the patient spend with them? Does the patient regard the members of his or her social network as important?). Next, the therapist evaluates whether the network supports the patient’s drinking or abstinence. Network members who support drinking frequently drink themselves, drink a lot per drinking occasion, and encourage or accept the patient’s drinking. Finally, the therapist determines the patient’s treatment based on the assessment of this information. *AA = Alcoholics Anonymous.