Cognitive-behavioural therapy (CBT) examines the interplay between thoughts, feelings, the behaviour and the environment. In CBT the etiology and persistence of problematic drug use is regarded as a maladaptive way of coping with problems, which can be changed through the application of combined cognitive and behavioural interventions. Interventions typically focus on enhancing client motivation, providing new knowledge about drug use and its consequences, and challenging problematic beliefs about drug use and more general beliefs and cognitions.

Acceptance and Commitment Therapy (ACT) is one of a group of approaches referred to as mindfulness behavioural therapy. It has proven effective with a diverse range of clinical conditions including depression, obsessive compulsive disorder, stress, anxiety and substance use disorders. The goal of ACT is to create a rich and meaningful life, while accepting the pain that inevitably goes with it. It is about taking effective action guided by our values and teaches mindfulness skills (or conscious awareness) to handle unpleasant and unwanted thoughts, images, feelings, urges and memories.

More information: Embracing Your Demons: an Overview of Acceptance and Commitment Therapy

Motivational interviewing (MI) is a method to work with ambivalence and help patients explore their reasons to change drug use. The basic elements include:

• Express empathy
• Develop discrepancy
• Avoid argumentation
• Roll with resistance
• Support self-efficacy

The main aim of MI is to enhance the motivation of the client to change.

Contingency management (CM) rewards specific behaviours using a structured, transparent approach that increases learning of desired behaviours. Most programs focus on contingencies with positive reinforcement for the desired behaviour. The elements of a contingency management program are:

• clear definitions of the desirable behaviour (e.g., abstinence from drug use)
• regular monitoring for the presence or absence of the desired behaviour (e.g., urine tests)
• specified rewards for the desired behaviour (e.g., money, vouchers, privileges)
• positive personal feedback from staff for the desired behaviour

Contingency management can be administered by staff with relatively little training.

The Community Reinforcement Approach (CRA) uses social, recreational, familial and vocational reinforcers to aid clients in the recovery process. CRA integrates several treatment components, including building motivation to quit, helping cessation of drug use, analysing drug use pattern, increasing positive reinforcement, learning new coping behaviours, and involving significant others in the recovery process.

Elements of CRA include motivational induction, monitoring pharmacotherapy, functional analysis, skills training, job finding, marital counselling, and social-recreational counselling. CRA has also been integrated with unilateral family therapy into an approach called the Community Reinforcement Approach and Family Training (CRAFT).

Social Behaviour and Network Therapy (SBNT) was developed in the United Kingdom, originally for treatment of alcohol dependence, but with adaptation to drug users. The basic principle is to encourage a change of social network, from one that is supportive of drug use to one that is supportive of abstinence.

The 12-step approach is best known as the basis of Alcoholics Anonymous and Narcotics Anonymous. These are free, voluntarily-attended gatherings characterised by working together on a common problem, self-directed leadership, and the sharing of experiences. AA and NA espouse a disease concept of drug and alcohol dependence with the potential for recovery, but not cure, for those who adhere to it. The concept is that by working through the 12 steps of AA and NA, addicts will experience personal growth, and be ‘in recovery’, an ongoing lifelong process of increasing insight and commitment to change. The 12 steps emphasise the importance of reconstructing relationships with other people including confession, restitution and an injunction to help other addicts. They contain an implication that a decision to change is within the power of the individual, even if the power to effect the change is not.