Psychotherapy for Addictive Disorders Comprehensive Nursing Essay Example

Psychotherapy for Addictive Disorders Comprehensive Nursing Essay Example

Inevitable human experiences present life stressors that require adequate coping skills. For instance, chronic pain, illness, neglect, or trauma are life stressors that can influence an individual’s spiritual, emotional, interpersonal, physiological, and cognitive regulation. Consequently, people tend to resort to the use of mood-altering behaviors and substances in an attempt to cope with life stressors. However, the legal and sociocultural context frames the extent of acceptance of these behaviors and substance use. Some substances considered addictive, including caffeine, alcohol, and nicotine, are socially and legally accepted.(Psychotherapy for Addictive Disorders Comprehensive Nursing Essay Example)

Nevertheless, excessive consumption, misuse, dependence, and the inability to manage the urge to use these substances are considered problematic (Wheeler, 2020). Addiction is assessed when an individual experiences the compulsive need for one or more of these substances, tolerance, and consequent withdrawal without use. Consequently, individuals are diagnosed with specific or comorbid substance use disorders. The Diagnostic Statistics Manual of Mental Disorder (DSM-5) outlines the diagnostic criterion for addictive disorders and other mental health illnesses. Mental health care practitioners primarily use it to make a definitive diagnosis and initiate treatment interventions (American Psychiatric Association [APA], 2022). The paper evaluates an article on nicotine addiction and psychotherapeutic intervention to provide an overview of the article, findings, limitations, and implications for mental health practices.(Psychotherapy for Addictive Disorders Comprehensive Nursing Essay Example)

The Overview

Cooney et al.’s (2017) article, “A randomized trial of contingency management for smoking cessation during intensive outpatient alcohol treatment,” was selected for evaluation.  This trial was designed to evaluate the effectiveness of contingency management (CM) as a therapy modality for smoking cessation delivered alongside outpatient alcohol therapy. Moreover, the study assessed the indirect influence of smoking cessation and alcohol dependence and abuse management.  (Psychotherapy for Addictive Disorders Comprehensive Nursing Essay Example)

The target population was primarily smokers with comorbid alcohol dependence or abuse. The participants were United States veterans admitted to outpatient treatment for substance addiction. Smoking among veterans is a public health concern since at least one in every five veterans reports smoking, and an estimated 14% enrolled for care are cigarette smokers (Coughlin et al., 2019). Those smoking ten or more cigarettes daily were recruited for the screening exercise to evaluate their eligibility for the study. The eligibility involved not having mental instability, unstable residence, smoking less than ten cigarettes a day, not nicotine and alcohol dependent, having opiate dependence/use in the past year, and taking excluded drugs or dedications.(Psychotherapy for Addictive Disorders Comprehensive Nursing Essay Example)

The primary intervention for the study was contingency management. However, the intervention was reinforced with pharmacological and evidence-based behavioral therapies for smoking cessation. The pharmacological and evidence-based behavioral treatments were based on the present context of the outpatient intervention for comorbid alcohol-dependent smokers. Like other psychotherapy interventions, CM is often used as a reinforcement intervention with medication and CBT (Wheeler, 2020). The alcohol dependant smokers were randomized into two study groups. The first group was subjected to cognitive behavioral therapy, nicotine replacement therapy, and contingency management (CBT+NRT+CM), while the second group was subject to cognitive behavioral therapy and nicotine replacement therapy (CBT+NRT). These interventions are not new and have been tested with significant addictive disorders. However, the reinforcement had not been tested for alcohol use-dependent smokers.(Psychotherapy for Addictive Disorders Comprehensive Nursing Essay Example)

The intensive outpatient intervention involved five-hour sessions five days a week for three weeks. The participants were treated in groups for substance use using CBT coping skills, twelve-step support, and motivation enhancement therapy. The participants were prescribed nicotine patch therapy for eight weeks, beginning with a 21mg dosage for the first four weeks. The dosage was titrated to 14mg for the following two weeks and 7mg for the last two weeks. The cognitive behavioral therapy sessions for the two groups amounted to 120 minutes (40 minutes per session for the CBT+NRT group and 10 minutes for the CBT+NRT+CM groups), varying in session length and frequency. The treatment combinations prepared the participants to cease smoking, cope with associated withdrawal, and prevent relapse. The procedures for the tobacco treatment interventions were based on proven clinical practice guidelines, while the cognitive behavioral therapy and contingency management were based on evidence-based smoking cessation protocols.(Psychotherapy for Addictive Disorders Comprehensive Nursing Essay Example)

The CM for this study was based on escalating financial incentives for individuals with lower biochemical confirmed smoking abstinence based on the target quit date. Most CM interventions are based on monetary incentives (Wheeler, 2020). Individuals with decreasing carbon monoxide (CO) readings of less than 5ppm following the quit date received a progressive monetary incentive, beginning at $5.5 on day one, $and up to $12.5 on the last day. The financial incentive was reset following relapse. CO levels were measured at baseline and the end of treatment.(Psychotherapy for Addictive Disorders Comprehensive Nursing Essay Example)

Cooney et al. (2017) put forth several claims to support the robustness of the research. First, the authors posited that CM would lead to higher smoking abstinence, indirectly impacting alcohol use. The claim was based on supporting the indirect influence of smoking cessation on alcohol dependence. Secondly, the authors claimed that CM, based on financial incentives given upon authentication of accomplishment of set behavioral goals, would effectively manage substance use disorders.(Psychotherapy for Addictive Disorders Comprehensive Nursing Essay Example) Thirdly, the authors argued that CM for smoking cessation should be evaluated using evidence-based behavioural and medication with augmented treatment. The claim is founded on the fact that individuals with comorbid smoking and substance use addiction are difficult to treat, and the existing guidelines endorse combined pharmacological and behavioral interventions. The authors further claimed that outpatient treatment of addiction disorders provides a promising context for smoking cessation using CM due to the inherent ability to monitor addicts frequently, verify abstinence, and reinforce intervention.(Psychotherapy for Addictive Disorders Comprehensive Nursing Essay Example)

Findings/Outcomes

The findings support the hypothesis that smoking rates are reduced with contingency management. However, the impact of CM reinforcement of evidence-based pharmacotherapy and CBT on smoking rates was significant during the initial period. The initial smoking abstinence rates were double compared to CBT and NRT intervention and concurrent with other substance addiction trials using CM. These findings suggest that individuals with tobacco addiction administered with CM are more likely to experience the indirect effect of smoking cessation on alcohol abstinence in the short term (McKelvey et al., 2017). I would use CM as part of pharmacotherapy and behavioral intervention for individuals with specific or comorbid addiction disorders.(Psychotherapy for Addictive Disorders Comprehensive Nursing Essay Example)

However, CM is sometimes considered a kickback or inducement when they exceed the nominal monetary values. The Centers for Medicare and Medicaid services cap annual incentives at $75, and different states have different laws limiting CM intended to prevent fraud and abuse, and through the CM intervention cap, penalize providers for inducing patients into accessing their services or specific treatment (Glass et al., 2020)(Psychotherapy for Addictive Disorders Comprehensive Nursing Essay Example). Given the controversial nature of CM, its application should be cautionary, and providers should uphold the ethical practice. Considering the devastation of substance use disorders, CM should be regarded as a frontline treatment intervention, not an inducement. However, CM should be used as reinforcement with evidence-based medication and behavioral therapy for effective patient outcomes.(Psychotherapy for Addictive Disorders Comprehensive Nursing Essay Example)

Limitations

The study has various limitations that would impact practice. First, the authors did not manipulate CM parameters. As such, the authors acknowledge the possible impact of reward frequency, e.g., three times a week, in higher tobacco abstinence rates. Therefore, the article does not provide evidence-based knowledge on how frequent monetary interventions should be applied for effective patient outcomes. Besides, the small sample size limits the detection of small effects of treatment intervention.(Psychotherapy for Addictive Disorders Comprehensive Nursing Essay Example)

Furthermore, the authors did not find monetary incentive significant after a one-month follow-up, suggesting the duration inefficiency of CM effects. The use of a non-conventional design involving 12 brief CBT sessions rather than three CBT sessions made it impossible to disassociate the impact of CBT from CM interventions on smoking cessation. These findings suggest that augmenting CM with other behavioral and pharmacological interventions is crucial in achieving higher tobacco cessation rates. Together, these limitations could limit the exclusive use of CM as a primary intervention for smoking cessation.(Psychotherapy for Addictive Disorders Comprehensive Nursing Essay Example)

Conclusion

The article provides primary evidence on the efficacy of CM intervention for tobacco use disorder. However, the existing barriers, including federal and state legislation against kickbacks and inducements, limit the exclusive adoption of CM as a frontline intervention for tobacco use disorder. While these concerns are crucial, I believe the concerned authorities, including the Centres for Medicare and Medicaid Services (CMS)(Psychotherapy for Addictive Disorders Comprehensive Nursing Essay Example) and states, should regulate CM for effective adoption and use by psychiatrists for treating addictions disorders. Besides, mental health providers ought not to use CM to direct patients to certain forms of treatment or induce patients to access care for personal gains. Further studies are also crucial to determine the association between the frequencies and amount of monetary incentive on tobacco abstinence rates and abstinences of comorbid alcohol use. Lastly, future studies should evaluate the long-term efficiency of CM tobacco use disorder.(Psychotherapy for Addictive Disorders Comprehensive Nursing Essay Example)

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url=https://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425787

Cooney, J. L., Cooper, S., Grant, C., Sevarino, K., Krishnan-Sarin, S., Gutierrez, I. A., & Cooney, N. L. (2017). A randomized trial of contingency management for smoking cessation during intensive outpatient alcohol treatment. Journal of Substance Abuse Treatment, 72, 89-96. https://doi.org/10.1016/j.jsat.2016.07.002

Coughlin, L. N., Wilson, S. M., Erwin, M. C., Beckham, J. C., Workgroup, V. M. A. M., & Calhoun, P. S. (2019). Cigarette smoking rates among veterans: Association with rurality and psychiatric disorders. Addictive Behaviors, 90, 119-123. https://doi.org/10.1016%2Fj.addbeh.2018.10.034

Glass, J. E., Nunes, E. V., & Bradley, K. A. (2020). Contingency management: a highly effective treatment for substance use disorders and the legal barriers that stand in its way. Health Affairs Blog. Published March 11. https://www.healthaffairs.org/do/10.1377/forefront.20200305.965186

McKelvey, K., Thrul, J., & Ramo, D. (2017). Impact of quitting smoking and smoking cessation treatment on substance use outcomes: An updated and narrative review. Addictive Behaviors, 65, 161-170. https://doi.org/10.1016%2Fj.addbeh.2016.10.012  

Wheeler, K. (Ed.). (2020). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (3rd ed.). Springer Publishing.(Psychotherapy for Addictive Disorders Comprehensive Nursing Essay Example)