For most medical conditions, financial concerns are shown to the biggest barrier in the effective delivery of treatment. However, for those with substance use disorders, therapy is barred by more complex, complicating factors. The patient must convince himself that his body needs the outside help.
In a 2011 paper, Tracy Stecker, a professor of Community and Family Medicine at the Geisel School of Medicine, explored the use of cognitive-behavioral intervention (CBT) in affecting the rate of treatment initiation among alcoholics. The results indicated that the participants who received CBT were three times more likely than the control group to attend treatment sessions within a three-month period.
The percentage of patients with substance use disorders that receive treatment is only 38%. Patients cite person-related barriers—doubts related to the effectiveness of treatment—more often than cost issues as the reason for their hesitation in undergoing treatment. All patients were Cognitive-behavioral therapy operates on the theory that cognitions, feelings, and behaviors all interact with one another, and thus seeks to influence patients’ outlook towards treatment by changing beliefs related to the care.
In this study, 198 individuals, ranging from 19 to 81 years, who scored 16 or above on the Alcohol Use Disorders Identification Test (scores of 8 and above indicate hazardous alcohol use) were selected. Patients were divided randomly into a control or intervention group.
CBT was conducted via telephone in a 45-60 minute one-on-one session. The patient was asked to identify which beliefs most greatly influenced their treatment-seeking behavior. They were to then asked of the certainty of their beliefs, and what factors could possibly influence their opinion. The process was repeated with up to three beliefs.
Meanwhile, the control group was read a pamphlet about the dangers of alcohol use.
Telephone follow-up interviews three months later indicated that CBT was effective in changing the beliefs of patients. Although only 88% and 81% of the control and the intervention group, respectively, could be contacted for the interview, the majority of respondents in both groups indicated that they were in the “action” phase of readiness to change (72% and 66%, respectively). The slight difference in this response (6%) could be considered an experimental error.
In the control group, only 11 respondents (12%) sought medical treatment and an additional 13 attended AA meetings. In the group that had undergone CBT, 25 respondents (30%) received treatment while 17 went to AA meetings. An odds ratio of 3.14 was recorded, indicating a clear increase in treatment-seeking behavior from patients that underwent CBT.
This success suggests CBT as an effective option for alcoholics who need additional encouragement in seeking therapy. Stecker states that for further applications, similar studies could be conducted with other substances abuse disorders and conditions related to psychological disorders. Different populations could be used to discover the effects that CBT has on different socioeconomic classes and even populations who are mandated the therapy.
The real power of CBT is in the ease with which it can be applied in relation to its effectiveness. While PhD-level CBT-trained psychologists administered the therapy in this particular study, CBT has also been shown to be effective in other formats. Computer and telephone formats of CBT have been explored, as well as therapy cases administered by individuals who are not especially trained professionals. The expansion of CBT application in influencing treatment-seeking behavior could provide for a gradual dip in the number of substance abuse patients without care.