1. WEST EDINBURGH SUPPORT TEAM 27 th OCTOBER 2005 Malcolm Laing

2. Historical Background  The Edinburgh Centre For Cognitive Therapy and Substance Use  Satellite project of WEST (1999-2004)  Study: long terms effects of MDMA  High number of participants displayed symptoms of depression and anxiety  Self medicating for the symptoms of an underlying affective disorder

3. Why Cognitive Behavioural Therapy?  Widely used treatment for depression, anxiety and many other psychological disorders  Developments underline clinical foundations of CBT approach with drug users  Opiate users using from early age -- ?full cognitive maturation has not occurred cognitive maturation has not occurred

4. Key Components  Based on cognitive model of emotional disorders  Brief and time limited  Sound therapeutic relationship necessary  Collaborative effort between therapist and client  Socratic method primary tool  Structured and directive

5. Key Components (2)  Problem orientated  Based on educational model  Evidence based  Homework central feature

6. Predisposing factors (Beck et al.,1993)  General exaggerated sensitivity to unpleasant feelings  Deficient motivation to control behaviour  Impulsivity  Excitement seeking  Low tolerance for boredom/frustration  Insufficient pre-social alternatives for gaining pleasurable feelings

7. Simple Model of Addiction  ANXIETY, LOW MOOD  USING  FINANCIAL,SOCIAL,MEDICAL PROBLEMS

8. Three Levels of Thoughts: Core Beliefs / SCHEMA Underlying Assumptions Negative Automatic Thoughts (NATS)

9. Maintenance Thoughts Physical Symptoms Mood Behaviour ENVIRONMENT INTERPERSONAL

10. CBT Interventions  Functional Analysis of substance use problem  Monitoring use and cravings  Exploring negative consequences of drug use  Discussing adv/dis of abstinence goal  Distinction between “slip “and relapse

11. CBT Interventions (2)  Coping with craving  Tracking & modifying NATS  Relapse prevention (core belief work)

12. Summary  The literature demonstrates that the cognitive model is an evidence based approach to working with a spectrum of emotional disorders that include substance misuse  Our own research and pilot studies confirm that it is highly effective and practical

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