4.2.1.2. Cognitive behavioral therapy (CBT)

Bellack and DiClemente [footnote] outline a treatment protocol acknowledging that behavioral change is a longitudinal process consisting of several stages. "Escalating symptoms and other warning signs must be recognized, cravings coped with, coming up with healthy alternative activities developed, drug addiction lapses normalized, lapse or relapse plans developed, and cognitive restructuring counteracting positive beliefs about substance use devised." Barriers to significant personal changes include lack of motivation, impaired cognition, and social skill limitations. Low motivation, energy levels, and mood, common within this group, may arise from medication, illness, or constrained life circumstances. They provide obvious challenges for engagement, goal setting, and therapy continuance. Deficits in attention, concentration, and abstract thinking, as well as thought blocking, may impede information processing, problem-solving, and realistic planning. Underdeveloped social interaction skills required to meet people and maintain relationships may result in the absence of a healthy social support system to sustain persons through change processes, as well as in difficulties resisting pressure from substance-using peers (Table 1).

Many studies of cognitive behavioral therapy (CBT) and motivational interviewing (MI) with contingency management or standard care, comprising 6 months of supportive group therapy, revealed positive outcomes [15].

situations (such as carrying money and proximity to easy drug access locations and people) and to participate in role play to develop personalized ways of avoiding or extricating themselves from those situations. "Realistic relapse-prevention approaches have to be tai-

Nursing Care for Persons with Drug Addiction http://dx.doi.org/10.5772/intechopen.73334 55

Self-help groups often play important and meaningful roles for persons with dual diagnoses, offering essential social support from others who understand the difficulties of remaining sober. They provide a structure for daily living and commitment to stopping drug abuse. Research reveals that PDDs who consistently attend self-help groups for at least 1 year achieve

ACT is a structured health-care service approach to working with dual-diagnosis PDDs, particularly by adapting a conventional model of case management to the needs of the PDD cohort [4]. Usual case manager responsibilities include developing a working alliance with PDDs, linking them to relevant other services, and functioning as an advocate for these

Case managers are central to PDD engagement, treatment, and retention. A study of standard outpatient case management found that case management is effective in preventing hospitali-

From research published over the past decade, Drake et al. [23] outlined ten principles essential for effective treatment of PDD, including engagement strategies, motivational counseling, stage-wise interventions, active treatment, long-term program retention, integrated mental illness and drug addiction treatments, and relapse-prevention strategies. Further comprehensive services such as peer support, family education and interventions, liaison with the criminal justice system, housing, and vocational rehabilitation should also be available, along with specialized programs for those with more complex disorders, cognitive impairment, and treatment resistance, as well as for minority groups [23]. In addition, services need to be flexible in order to cater to actual consumer needs, given their real-life circumstances. Hence, there is likely to be a "window of opportunity" for effective prevention or reduction of drug

Sequential, parallel, and integrated service models are applied for persons with drug addiction and dual diagnoses. Firstly, they are treated for one condition by sequential treatment. Secondly, person with dual diagnoses was treated by the parallel model at the same time [23].

lored to each participant's abilities and style" [23].

reduced drug addiction outcomes [4, 22].

4.2.2.3. Assertive community treatment (ACT)

services with health professionals [22].

zation and drug abuse relapse [24, 25].

use shortly after a first psychotic episode.

4.4. Potential treatment models

4.2.2.4. Case management

4.3. Treatment principles

4.2.2.2. Self-help groups

## 4.2.1.3. Family support

Family support may enhance individual and group treatment with case management or assertive community with enhanced substance use treatment services to reduce or eliminate drug addiction [21].
