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A Cognitive-Behavioral Approach: Treating Cocaine Addiction |
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Topic 6: ProblemsolvingTasks for Topic 6
Session GoalsOver time, many patients' repertoires of coping and problemsolving skills have narrowed such that cocaine or other substance abuse has become their single, overgeneralized means of coping with problems. Many patients are unaware of problems when they arise and ignore them until they become crises. Many others, particularly those who have impulsive cognitive styles or who are unaccustomed to thinking through alternative behaviors and consequences, find this topic particularly useful. Others think they have good problemsolving skills but, when confronted with a problem, are likely to act impulsively, making practice of this skill within sessions particularly important. This session (This section is adapted closely from Monti et al. 1989 as well as Kadden et al. 1992 and D'Zurilla and Goldfried 1971.) provides a basic strategy that can be applied to a range of problems related to cocaine abuse as well as the variety of problems that will invariably arise after patients leave treatment. Despite many patients' fantasies that life will be easier and problem free after stopping cocaine use, often they become aware of problems they have neglected or ignored only after becoming abstinent. The goals of this session are to -
Key InterventionsIntroduce the Basic Steps Therapists should convey that everyone has problems from time to time and that most can be effectively handled. Also, although having a problem may make one anxious, effective problemsolving takes time and concentration, and the impulsive first solution is not necessarily the best. Therapists should review the basic steps in problemsolving summarized below.(Adapted from D'Zurilla and Goldfried 1971 and Monti et al. 1989.)
For impulsive patients, it is important to write down the problem and the selected approach so that the steps are not forgotten when it is time to implement them. Practice Problemsolving Skills Therapists should ask patients to identify two recent problems, one that is closely related to cocaine abuse and one that is less so, and work with them through the problemsolving steps for both. Therapists may have to help patients slow down, because some will have difficulty recognizing current problems. Others will quickly select a solution since they lack practice with brainstorming and considering alternatives. Practice ExerciseTherapists ask patients to practice problemsolving skills outside of the sessions using a reminder sheet for problemsolving (exhibit 10). Remind patients that treatment will end soon, and they will be using these skills on their own.
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