WEST EDINBURGH WEST EDINBURGH SUPPORT TEAMSUPPORT TEAM

2727thth OCTOBER 2005 OCTOBER 2005

Malcolm LaingMalcolm Laing

Historical BackgroundHistorical Background

The Edinburgh Centre For Cognitive The Edinburgh Centre For Cognitive Therapy and Substance UseTherapy and Substance Use

Satellite project of WEST (1999-2004)Satellite project of WEST (1999-2004) Study: long terms effects of MDMAStudy: long terms effects of MDMA High number of participants displayed High number of participants displayed

symptoms of depression and anxietysymptoms of depression and anxiety Self medicating for the symptoms of an Self medicating for the symptoms of an

underlying affective disorderunderlying affective disorder

Why Cognitive Behavioural Why Cognitive Behavioural Therapy?Therapy?

Widely used treatment for depression, Widely used treatment for depression, anxiety and many other psychological anxiety and many other psychological disorders disorders

Developments underline clinical Developments underline clinical foundations of CBT approach with drug foundations of CBT approach with drug usersusers

Opiate users using from early age -- ?fullOpiate users using from early age -- ?full

cognitive maturation has not occurred cognitive maturation has not occurred

Key ComponentsKey Components

Based on cognitive model of emotional Based on cognitive model of emotional disordersdisorders

Brief and time limitedBrief and time limited Sound therapeutic relationship necessarySound therapeutic relationship necessary Collaborative effort between therapist and Collaborative effort between therapist and

clientclient Socratic method primary toolSocratic method primary tool Structured and directiveStructured and directive

Key Components (2)Key Components (2)

Problem orientatedProblem orientated Based on educational modelBased on educational model Evidence basedEvidence based Homework central featureHomework central feature

Predisposing factorsPredisposing factors(Beck et al.,1993)(Beck et al.,1993)

General exaggerated sensitivity to General exaggerated sensitivity to unpleasant feelingsunpleasant feelings

Deficient motivation to control behaviourDeficient motivation to control behaviour ImpulsivityImpulsivity Excitement seekingExcitement seeking Low tolerance for boredom/frustrationLow tolerance for boredom/frustration Insufficient pre-social alternatives for Insufficient pre-social alternatives for

gaining pleasurable feelings gaining pleasurable feelings

Simple Model of AddictionSimple Model of Addiction

ANXIETY, LOW MOODANXIETY, LOW MOOD

USINGUSING

FINANCIAL,SOCIAL,MEDICAL FINANCIAL,SOCIAL,MEDICAL PROBLEMSPROBLEMS

Three Levels of Thoughts:Three Levels of Thoughts:

Core Beliefs / SCHEMACore Beliefs / SCHEMA

Underlying AssumptionsUnderlying Assumptions

Negative Automatic Negative Automatic Thoughts (NATS)Thoughts (NATS)

Maintenance Maintenance

Thoughts

Physical SymptomsMood

Behaviour

ENVIRONMENT INTERPERSONAL

CBT InterventionsCBT Interventions

Functional Analysis of substance use Functional Analysis of substance use problemproblem

Monitoring use and cravingsMonitoring use and cravings Exploring negative consequences of drug Exploring negative consequences of drug

useuse Discussing adv/dis of abstinence goalDiscussing adv/dis of abstinence goal Distinction between “slip “and relapseDistinction between “slip “and relapse

CBT Interventions (2)CBT Interventions (2)

Coping with cravingCoping with craving Tracking & modifying NATSTracking & modifying NATS Relapse prevention (core belief work)Relapse prevention (core belief work)

SummarySummary

The literature demonstrates that the The literature demonstrates that the cognitive model is an evidence based cognitive model is an evidence based approach to working with a spectrum of approach to working with a spectrum of emotional disorders that include substance emotional disorders that include substance misusemisuse

Our own research and pilot studies Our own research and pilot studies confirm that it is highly effective and confirm that it is highly effective and practicalpractical

SummarySummary

The strength of our work identifies the The strength of our work identifies the principal role of the cognitive model in principal role of the cognitive model in working with a demanding client groupworking with a demanding client group