Department of Psychiatry, Yale University School of Medicine.
Psychol Addict Behav. 2017 Dec;31(8):847-861. doi: 10.1037/adb0000311. Epub 2017 Aug 31.
Cognitive-behavioral therapy (CBT) approaches have among the highest level of empirical support for the treatment of drug and alcohol use disorders. As marks its 30th anniversary, we review the evolution of CBT for the addictions through the lens of the Stage Model of Behavioral Therapies Development. The large evidence base from Stage II randomized clinical trials indicates a modest effect size with evidence of relatively durable effects, but limited diffusion in clinical practice, as is the case for most empirically validated approaches for mental health and addictive disorders. Technology may provide a means for CBT interventions to circumvent the "implementation cliff" in Stages III-V by offering a flexible, low-cost, standardized means of disseminating CBT in a range of novel settings and populations. Moreover, returning to Stage I to reconnect clinical applications of CBT to recent developments in cognitive science and neuroscience holds great promise for accelerating understanding of mechanisms of action. It is critical that CBT not be considered as a static intervention, but rather 1 that constantly evolves and is refined through the stage model until the field achieves a maximally powerful intervention that addresses core features of the addictions. (PsycINFO Database Record
认知行为疗法 (CBT) 是治疗药物和酒精使用障碍最具实证支持的方法之一。随着 迎来 30 周年，我们通过行为疗法发展阶段模型审视了 CBT 在成瘾领域的发展演变。来自阶段 II 随机临床试验的大量证据基础表明，其具有适度的效果大小，并具有相对持久效果的证据，但在临床实践中的传播有限，就像大多数经过实证验证的心理健康和成瘾障碍方法一样。技术可能为 CBT 干预措施提供一种绕过阶段 III-V 的“实施悬崖”的方法，通过提供灵活、低成本、标准化的方法，在一系列新的环境和人群中传播 CBT。此外，回到阶段 I，将 CBT 的临床应用重新连接到认知科学和神经科学的最新发展，对于加速对作用机制的理解具有巨大的潜力。至关重要的是，不应将 CBT 视为静态干预，而应通过阶段模型不断发展和完善，直到该领域实现一种针对成瘾核心特征的最强大的干预措施。
