Treating Alcohol Dependence, Second Edition: A Coping Skills Training Guide / Edition 2

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Overview

Now in a revised and expanded second edition, this book presents a straightforward, multi-session coping skills training program that has been proven effective in helping alcohol-dependent individuals. The volume provides everything needed to implement the program, including a clear theoretical and empirical rationale, step-by-step session guidelines, helpful clinical pointers, and over 40 reproducible client handouts, assessment instruments, and therapist forms. Sessions focus on developing key interpersonal and intrapersonal skills to help participants learn positive strategies for coping with the everyday demands of life and resisting the urge to drink. Updated throughout to reflect current ideas and research findings on addictive behavior change, the protocols in the second edition have been reorganized and streamlined for greater applicability in today's managed care settings. Two entirely new chapters provide guidelines for conducting cue exposure treatment and addressing dual diagnosis issues, with particular attention to tobacco dependence. Of special value for practitioners, the new 8 ½" x 11" format makes it easier than ever to reproduce and use the practical materials in the book.

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Editorial Reviews

Doody's Review Service
Reviewer: Gary B Kaniuk, Psy.D.(Cermak Health Services)
Description: This is a detailed coping skills training guide for addressing alcohol dependent clients. It includes training to deal with interpersonal skills, intrapersonal skills, and coping with urges. This second edition addresses changes in the field including health maintenance organizations, pharmacological treatments for alcohol dependence, motivation enhancement strategies which prepare clients for change, and dual-diagnosis. The first edition was published in 1989.
Purpose: According to the authors, the book presents a cognitive-social learning perspective on alcohol abuse and dependence. The authors believe that clients who learn a variety of alternative coping techniques to address the demands of everyday living will be better able to resist alcohol. These are worthy objectives because so many people suffer from alcoholism and treatment in 28 day programs is becoming less and less common. The book meets the author's objectives.
Audience: The authors do not specifically say whom the target audience is but it is obvious that it is written for the practitioner who treats alcohol-dependent individuals. I believe that the book is a pragmatic guide for the practitioner in the field. The authors are credible authorities.
Features: This book is a skills training manual for treating alcohol-dependent individuals. The skills are thoroughly described including rationale, modeling, role play, and practice exercise. The book helps the practitioner to teach practical coping skills to the client. It is very readable and covers a wide variety of areas within interpersonal, intrapersonal, and urge coping domains.
Assessment: The book is excellent because it is a step-by-step training guide. It would be of great help for the novice therapist but has enough ideas for even the most seasoned veteran. This second edition does justify replacing the previous edition given that the first one was published over a decade ago and that there are new issues which have arisen. The influence of managed care, reduction of 28-day programs, pharmacological treatment strategies, and dual diagnosis concerns are variables which have influenced the way we do our work.
From the Publisher

"The alcohol treatment landscape has changed dramatically since the first edition of this influential resource for practitioners. Now in an updated second edition, the volume continues to be relevant and useful. The coping skills training approach described here is not only well supported by evidence from clinical trials, but also nicely matches the contingencies of managed care. A relatively brief therapy, it is optimally offered in groups and is entirely compatible with outpatient treatment. The interpersonal life skills are also likely to be useful well beyond coping with addictions, making this an attractive method for working with clients with multiple problems."--William R. Miller, PhD, Department of Psychology, The University of New Mexico

"I highly recommend this book. A state-of-the art guide to scientifically sound behavioral techniques, with added information on psychopharmacology and dual diagnosis, it's both a textbook and a training manual in one volume."--David Lewis, MD, Center for Alcohol and Addiction Studies, Brown University

Drug and Alcohol Review

"Highly recommended to all practitioners in health settings and to clinicians supervising and teaching others."--Drug and Alcohol Review
From the Publisher
"The alcohol treatment landscape has changed dramatically since the first edition of this influential resource for practitioners. Now in an updated second edition, the volume continues to be relevant and useful. The coping skills training approach described here is not only well supported by evidence from clinical trials, but also nicely matches the contingencies of managed care. A relatively brief therapy, it is optimally offered in groups and is entirely compatible with outpatient treatment. The interpersonal life skills are also likely to be useful well beyond coping with addictions, making this an attractive method for working with clients with multiple problems."--William R. Miller, PhD, Department of Psychology, The University of New Mexico

"I highly recommend this book. A state-of-the art guide to scientifically sound behavioral techniques, with added information on psychopharmacology and dual diagnosis, it's both a textbook and a training manual in one volume."--David Lewis, MD, Center for Alcohol and Addiction Studies, Brown University

Drug and Alcohol Review
"Highly recommended to all practitioners in health settings and to clinicians supervising and teaching others."--Drug and Alcohol Review
From The Critics
Provides session-by-session instructions for therapists who wish to apply a coping skills training approach to the treatment of alcohol dependence. Skills for coping with specific drinking triggers, communicating effectively, and making general lifestyle modifications are outlined. The second edition adds guidelines for conducting cue exposure treatment and addressing dual diagnosis issues. Annotation c. Book News, Inc., Portland, OR
Booknews
Presents the Brown University/Providence VA treatment program for addictive behaviors. The principles are presented in specific step-by- step detail. Cloth edition ($35.00) not seen. Annotation c. Book News, Inc., Portland, OR (booknews.com)

5 Stars! from Doody
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Product Details

  • ISBN-13: 9781572307933
  • Publisher: Guilford Publications, Inc.
  • Publication date: 8/12/2002
  • Edition description: Second Edition
  • Edition number: 2
  • Pages: 196
  • Sales rank: 814,820
  • Product dimensions: 8.46 (w) x 10.90 (h) x 0.50 (d)

Meet the Author


Peter M. Monti, PhD, is Professor of Medical Science and Director of the Center for Alcohol and Addiction Studies and the Clinical Psychology Internship Consortium at Brown University, Providence, Rhode Island. He is coeditor of Adolescents, Alcohol, and Substance Abuse and coauthor (with David B. Abrams et al.) of a forthcoming book on nicotine dependence.

Ronald M. Kadden, PhD, is currently Professor of Psychology in the Department of Psychiatry at the University of Connecticut School of Medicine. He is an attending psychologist in the Alcohol, Drug Abuse, and Psychiatric Day Hospital Program at the UConn Health Center.

Damaris J. Rohsenow, PhD, is Professor (Research) of Community Health and Research Director at the Addictive Behaviors Lab, Center for Alcohol and Addiction Studies, Brown University. She is also a Research Career Scientist at the Providence VA Medical Center in Providence, Rhode Island.

Ned L. Cooney, PhD, is Associate Professor of Psychiatry at Yale University School of Medicine and Director of Mental Health and Substance Abuse Programs at the Newington Campus of the VA Connecticut Healthcare System.

David B. Abrams, PhD, is Professor of Psychiatry and Human Behavior at Brown Medical School/The Miriam Hospital, where he is also Director of the Centers for Behavioral and Preventive Medicine.

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Read an Excerpt

Treating Alcohol Dependence

A Coping Skills Training Guide
By Peter M. Monti Ronald M. Kadden Damaris J. Rohsenow Ned L. Cooney David B. Abrams

The Guilford Press

Copyright © 2002 The Guilford Press
All right reserved.

ISBN: 1-57230-793-5


Chapter One

SESSION: ANGER MANAGEMENT

Rationale

1. Anger or irritation is a normal human emotion. It occurs when:

a. Things seem out of our control.

b. We think our rights have been stepped on.

c. We are not getting what we want or what we think is right.

Many alcoholics don't like to use the word "anger" for lower levels of anger. Rather than insisting on the term, try "irritation" or another, similar term. Use the term they agree to throughout, instead of "anger."

2. There is a distinction between anger as a feeling (emotion) and some of the behavioral consequences of anger, such as aggression, impulsive actions, passivity, and passive-aggressive behavior. Some of these consequences increase the likelihood of drinking. Anger itself is neither good nor bad. It can be an intense feeling, and the reaction to that feeling may be constructive or destructive.

Destructive effects:

a. Anger causes mental confusion. It leads to impulsive actions and poor decision making, including drinking.

b. Aggressive reactions to anger decrease effective communication, create emotional distance, andtrigger hostility in others. Can you think of some examples in your life of how aggressive behavior has backfired?

c. Passive reactions to anger leave you feeling helpless or depressed, reduce self-esteem, mask real feelings with an appearance of indifference, are a barrier to communication, and build resentments that may spill out at the slightest provocation in a tantrum or drinking.

Constructive effects:

a. Feelings of anger let you know that there is a problematic situation and energize you to resolve it. Use anger as a signal that there is a problem that needs solving.

b. An assertive response to anger increases your personal power over unpleasant situations, helps you communicate your negative feelings and their intensity, can be used to change destructive aspects of a relationship, helps you avoid future misunderstandings, and may strengthen a relationship. An effective response with appropriate assertiveness helps you to increase the constructive effects and decrease the destructive effects of angry feelings.

3. Relationship between anger and problem drinking: Studies of people who relapsed after alcoholism treatment have revealed that many took their first drink when they were angry or upset. Anger seems to make people highly vulnerable to relapse. Therefore, it is particularly important to learn to cope with anger and irritation in a constructive way.

Skill Guidelines

Most emotions are best understood by using a behavior chain. Anger does not just happen. People often think that situations or events make them angry, but actually it is their thoughts or beliefs about the trigger situations or events that result in anger. Let's show what we mean by putting a behavior chain on the board to show how alternative thoughts affect feelings.

Trigger [arrow] Thoughts/beliefs [arrow] Feelings [arrow] Behavior Driver cuts in front "That S.O.B. How dare Fury Dangerous driving of you he!" Driver cuts in front "He must be in a hurry, Calm Safe driving of you maybe late to work."

The first step to managing your anger is to become more aware of your personal triggers and thoughts about those triggers. Increased awareness can help you to identify angry feelings early, before they grow and get out of hand, to change the thoughts that aggravate anger, and to change your behavior in response to the anger.

1. Become more aware of situations that trigger anger.

a. Direct triggers: a direct attack on you, whether verbal (e.g., insult) or nonverbal (e.g., physical attack, obscene gesture), or frustration resulting from inability to reach a goal (e.g., your ex-wife won't let you see the kids).

b. Indirect triggers: observing an attack on someone else, or your appraisal of a situation (e.g., feeling that you are being blamed, thinking that someone is disapproving of you, or feeling that too many demands are being made of you).

2. Become more aware of your automatic thoughts associated with anger.

This is the hardest step at first. Often, these thoughts occur so automatically and quickly that we are not aware of them. Sometimes you may notice the words that are running through your head, such as "That crazy loon, I'm not going to let him get away with that!" Other times, you can figure out what thoughts or beliefs you must be having in order to produce the emotion. For example, you say "Hi" to a friend and he just grunts and walks on:

Thoughts Feelings

"Uh oh, he must be annoyed with me about something. What Fear did I do to make him mad?" Guilt

"How dare he! After all I've done for him!" Irritation Anger "Poor guy. His boss must be ragging on him again." Sympathy Calm 3. Change your thoughts about the trigger.

a. The first thing to do is calm down. As long as you keep cool, you will be in control of the situation. Here are some phrases to help you cool off in a crisis:

"Slow down." "Chill out." "Take it easy." "Easy does it." "Take a deep breath." "Relax." "Cool it." "Count to 10." Decide on one or two phrases like these that you can say to yourself to help you cool your anger while in the situation.

b. After you've slowed yourself down, think about the situation: "What's getting me angry?" Question your interpretation of the situation. Think about whether your reaction was realistic: "Is it really that bad?", "Am I overreacting?", "Is it really worth getting stressed out over this little thing?"

c. Think about whether there might be another interpretation of the situation: "Maybe she's not trying to control me, she's just trying to help," "Maybe my son's not mad at me. He's scared that I might start drinking again," or "Is this really an attack or insult?"

d. Think about the negative consequences of getting angry: "If I blow up, I risk my sobriety," "If I yell, I'll just make things worse," or "If I stay cool, I'll handle this better."

e. Replace the negative thoughts with more positive thoughts: "There are a lot of jerks in the world but so what? I don't have to let them bother me," "Life's too short to sweat the small stuff," "This will be over soon. I can handle it," or "He's not trying to put me down, he's just upset about something I did that was wrong. Let me fix this."

4. Change what you do in response to the trigger.

a. Think about your options: "What is in my best interests here? My anger should be a signal that it's time to do some problem solving," or "What can I do? What is the best thing for me to do?" (Communications skills, or other coping skills might be used in this situation.)

b. Choose possible behaviors that will make you calmer or will solve the problem:

Leave the situation (useful with strangers, impersonal events).

Take time out to cool.

Use assertiveness to request a change.

Analyze how to solve or cope with the problem.

Talk to the person about it in a calm, rational way.

c. After trying to resolve the problem, you may find that you cannot resolve the conflict, and you still feel angry. Remember that you can't fix everything. Thinking about it over and over again only makes you more upset. Try to shake it off-it may not be so serious. Don't let it interfere with your life. Some actions you can take include the following:

Call a sober friend to help you calm down. Plan something fun to counteract the lousy feelings.

Modeling (Optional)

The therapists present the clients with the following scenario:

Your spouse (or friend, or teenage child) is helping you to wash and wax your car. In the middle of the job, he/she suddenly walks away, goes inside, and turns on the TV. You find yourself increasingly angry as you look at the work that remains and the mess that has to be cleaned up. You decide to confront your work partner.

The therapists should demonstrate an appropriate response to this situation, articulating their self-statements for anger management aloud:

Cool-down phrases ("OK, chill down and think a minute."). Thoughts about the situation ("What's getting me angry? Is this a personal attack? Am I expecting too much?"). Thoughts about options ("What is in my best interest here? What can I do?").

Behavior Rehearsal Role Plays

Have clients each list a trigger situation and the thoughts or beliefs they each had in the situation that led to anger. Guide the group in generating positive, alternative thoughts and behaviors in each situation. Then, have clients discuss what they think the consequences of these alternatives would be.

Introducing the Practice Exercise

This assignment asks clients to practice using these skills in an anger-provoking situation. Clients describe the situation, calming phrases, anger-increasing thoughts, alternative anger-reducing thoughts, and behaviors to solve the problem or to calm themselves.

Therapist Tip Sheet: Anger Management

POINTS FOR RATIONALE

1. Anger is a normal emotion when we feel out of control, rights violated, don't get what we want. 2. Distinction between feeling (emotion) and some behavioral consequences:

Anger or irritation as a feeling is neither good nor bad.

Behavioral reaction can be constructive or destructive.

3. Some consequences (aggression, impulsive actions, passivity, passive-aggression) increase likelihood of drinking.

4. Destructive effects:

Anger causes mental confusion, can lead to poor decisions, impulsive acts, drinking.

Aggressive reactions: poor communication, emotional distance, hostile response.

Passive reactions: feeling helpless, lower self-esteem, poor communication, resentments. Constructive effects:

Anger is a signal that there is a problem that needs solving.

Anger provides energy to act. Assertive response: more power, better communication, improve relationships, resolve problem, avoid future misunderstandings.

POINTS FOR BLACKBOARD (IN CAPITALS)

BEHAVIOR CHAIN to show how thoughts/beliefs about triggers result in anger.

TRIGGER [arrow] THOUGHTS/BELIEFS [arrow] FEELINGS [arrow] BEHAVIOR

SKILL GUIDELINES

1. BECOME AWARE OF TRIGGERS-situations that trigger anger:

DIRECT TRIGGERS: attack, insult, stopped from reaching goal.

INDIRECT TRIGGERS: observation, appraisal, thoughts.

2. BECOME AWARE OF AUTOMATIC THOUGHTS associated with anger.

3. CHANGE YOUR THOUGHTS ABOUT THE TRIGGER: CALM DOWN before reacting.

THINK ABOUT SITUATION. QUESTION YOUR REACTION.

ANOTHER INTERPRETATION?

THINK ABOUT NEGATIVE CONSEQUENCES of acting angry.

REPLACE NEGATIVE THOUGHTS WITH POSITIVE THOUGHTS.

4. CHANGE WHAT YOU DO:

THINK ABOUT OPTIONS.

CHOOSE EFFECTIVE BEHAVIOR: makes you calmer or solves problem.

AFTERWARDS, LET GO OF THOUGHTS.

PLAN ACTIVITY TO COUNTERACT BAD FEELINGS:

Call a sober friend to calm down or ask advice about a problem.

Do something fun.

Reminder Sheet: Anger Management

Anger often results from the way we think about things: Trigger Events [arrow] Thoughts [arrow] Anger [arrow] Behavior

Become more aware of the events and thoughts that trigger your anger.

Use phrases like these first, to help you calm down in a crisis:

Slow down. Chill out. Take it easy. Easy does it. Take a deep breath. Relax. Cool it. Count to 10.

Next, think about what's getting you so angry: What's getting me angry? What event? What thoughts?

Is there another way to interpret the situation? Is this really a personal attack or insult? Am I overreacting? Is it really that bad?

Think about the negative consequences of getting angry and the positive consequences of staying cool.

Replace the negative thoughts with more positive thoughts: I don't have to let jerks bother me. Life's too short to sweat the small stuff. It's not worth risking my sobriety.

Think about your options: What can I do? What is in my best interests here? Anger should be a signal to start problem solving.

Do something to make yourself calmer or to solve the problem: Leave the situation or take time out. Make an assertive request for change. Analyze how to deal with the problem. Talk to the person in a calm, rational way.

If the problem won't go away or if you still feel angry: Remember that you can't fix everything. Try to shake it off. Don't let it interfere with your sobriety. Plan something fun to make yourself feel better. Call a sober friend to help you calm down.

PRACTICE EXERCISE

Until the next session, pay attention to your response to anger-provoking situations. Try to identify and change your thoughts in those situations.

Continues...


Excerpted from Treating Alcohol Dependence by Peter M. Monti Ronald M. Kadden Damaris J. Rohsenow Ned L. Cooney David B. Abrams Copyright © 2002 by The Guilford Press. Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

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Table of Contents


1. Introduction, Theoretical Rationale, and Evidence Base
2. General Treatment Considerations: Setting the Stage and Treatment Setting
3. Coping Skills Training, Part I: Interpersonal Skills
4. Coping Skills Training, Part II: Intrapersonal Skills
5. Cue Exposure Treatment with Urge Coping Training
6. Dual Diagnosis Issues
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