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Substance Abuse Treatment Modalities: Literature Review

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Stress Management/Relaxation

Stress management/relaxation training is normally included as a component of multimodal treatment programs for four main purposes: (1) to help people reduce their overall level of physiological arousal; (2) to reduce their craving to drink; (3) to help them sleep more easily; and (4) to help them handle specific environmental factors which result in anxiety (Miller & Hester, 1980). It is believed that many people drink to reduce tension or psychological stress (Rohsenow et al., 1985) and even after treatment, stress is thought to be an antecedent of drinking and relapse ( e.g., Eliany & Rush, 1992).

A recent study (Brown et al., 1990) examined the relationship between stressful life events and drinking outcome among male alcoholics who had completed an alcohol treatment program. Approximately 40% of the pre-treatment stressors were found to be directly or indirectly related to alcohol use. Results showed that men who returned to drinking after treatment experienced more severe or highly threatening stress before their relapse than men who remained abstinent during the follow-up period. The researchers concluded that although less severe stress may not increase risk for relapse, acute severe stressors and highly threatening chronic difficulties appear to be associated with elevated relapse risk.

The current research indicates that stress emanates from a number of different sources in a variety of different ways. Not surprisingly, stress management training can be offered to clients through a number of different approaches. Miller and Hester (1986) reviewed stress management training techniques and found they included such approaches as relaxation training, biofeedback and systematic desensitization (i.e., focusing on environmental factors to reduce anxiety). Miller (1992) also identified aerobic training as a stress management approach. Other approaches have included meditation, muscle relaxation and transcendental meditation (Brochu & Forget, 1990; Rohsenow et al., 1985).

Controlled research has focused on stress management training in alcohol treatment programs only, and no studies to date have examined the impact of such training with drug abusers. Reviews of the alcoholism treatment literature have found that stress management has a positive impact on post-treatment functioning. Miller and Hester (1986) found support through a number of studies which reported improvements in such areas as employment, depression and relaxation after stress management training. A later review by Miller (1992) also found beneficial post treatment impacts from stress management techniques of aerobic exercise and biofeedback training.

Although the reviews did not delineate the actual impact on drinking, evidence exists to suggest that stress management training has a measurable impact on reducing drinking behaviour. Rohsenow et al. (1985) examined the effectiveness of stress management training (SMT) as a drinking reduction program for heavy social drinking college students. The SMT included muscle relaxation and meditation training, cognitive restructuring, and coping skills rehearsal during induced affect. The men in the SMT group showed a significant decrease in daily drinking rates at post treatment and at 2.5-month follow-up, but drinking returned to baseline levels by 5.5 months for the group as a whole. The researchers concluded that stress management training appears to reduce consumption over the short-term post treatment period.

In summary, the rationale for stress management training arises from findings which indicate that stress is related to drinking both before and after treatment. Although some evidence exists questioning the effectiveness of stress management training (e.g., Miller & Taylor, 1980), the majority of research findings have demonstrated positive treatment outcomes in life areas prone to stressful events. In addition, stress management training has been found to impact on drinking behaviour, albeit over a short-term period. Taken together, stress management training can be considered an effective addition to multimodal treatment programs for clients experiencing stressful life events related to substance use.

References for Stress Management/Relaxation:

Brochu, S., & Forget, C. (1990), Survey of literature on substance abuse intervention for inmates. (Unpublished report). Montreal: Universite de Montreal.

Brown, S. A., Vik, P. W., McQuaid, J. R., Patterson, T. L., Irwin, M. R., & Grant, I. (1990), “Severity of psychosocial stress and outcome of alcoholism treatment”, Journal of Abnormal Psychology, 99(4), 344-348.

Eliany, M., & Rush, B. (1992), The effectiveness of prevention and treatment programs for alcohol and other drug problems: A review of evaluation studies, (Unpublished report). Ottawa: Health and Welfare Canada.

Miller, W. R. (1992), “The effectiveness of treatment for substance abuse: Reasons for optimism”, Journal of Substance Abuse Treatment, 9, 93-102.

Miller, W. R., & Hester, R. K. (1980), “Treating the problem drinker: Modern approaches”, In W.R. Miller (Ed.), The addictive behaviours: Treatment of alcoholism, drug abuse, smoking, and obesity, Oxford: Pergamon Press.

Miller, W. R., & Hester, R. K. (1986), “The effectiveness of alcoholism treatment: What research reveals”, In W.R. Miller & N. Heather (Eds.), Treating addictive behaviours: Processes of change. New York: Plenum Press.

Miller, W. R., & Taylor, C. A. (1980), “Relative effectiveness of bibliotherapy, individual and group self-control training in the treatment of problem drinkers”, Addictive Behaviours, 5, 13-24.

Rohsenow, D. J., Smith, R. E., & Johnson, S. (1985), “Stress management training as a prevention program for heavy social drinkers: Cognitions, affect, drinking and individual differences”, Addictive Behaviours, 10, 45-54.