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Substance Abuse Treatment Modalities: Literature Review

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Problem Solving

In a broad context, problem solving skills can be considered as a general coping skill. Problem solving training involves training participants in a general strategy, or set of rules, for identifying and resolving various life problems. The method is quite straightforward and easily understood by participants, and since it involves application of a set of rules it is flexible and can be applied to a wide variety of situations. Problem solving training was first articulated by D'Zurilla and Goldfried (1971) who described it as involving 5 steps: orientation, definition, generation of alternatives, decision making, and verification. It has been adapted for use by many others, but the basic tasks and their order remains essentially the same. One of the best descriptions of practical problem solving procedures used in treatment for substance abuse can be found in Monti et al. (1989): (1) Problem recognition — determining that a problem exists; (2) Problem Identification — gathering information, being as concrete as possible, checking the accuracy of the information, and defining the exact nature of the problem as well as possible; (3) Considering various approaches — sometimes called “brainstorming,” this involves generating a number of alternatives without regard to how good or bad they are;: (4) Selecting the most promising approach — considering the likely outcomes of the various alternatives and their feasibility, and choosing the approach that maximizes positive consequences while minimizing negative consequences; and (5) Assessing the effectiveness of the selected approach — implementing the chosen alternative and evaluating its results.

Problem solving skills training has most often been incorporated as part of multicomponent treatments (e.g., Chaney et al., 1978; Hawkins et al., 1986; Jones et al., 1982; Monti et al., 1993; Sobell & Sobell, 1973). These programs have generally yielded positive findings, but because problem solving skills training has been used in combination with other procedures (e.g. social skills training) it is impossible to determine how much that particular component contributed to the results. In one of the only tests of problem solving skills training as the central component of treatment, Intagliata (1978, 1979) assigned male veterans in inpatient treatment to either 10 sessions of behavioural group therapy focusing on interpersonal problem solving skills or to a control group. Patients who were in the problem solving group were found to have better problem solving skills at the end of the program, and at 1 month follow–up they reported that they had utilized the training in their everyday lives. While this study supports the use of problem solving training, it clearly has its shortcomings, such as no indication of how the training affected patients' drinking behaviour over follow–up.

In conclusion, problem solving skills training is a popular component of coping skills training treatments for substance abuse problems, but usually has been included as one of several treatment components. Although multicomponent studies have generally yielded positive results, the effect of problem solving skills, per se, is essentially unknown. The evidence supporting problem solving skills training, therefore, should be considered indirect. Nevertheless, the fact that these procedures have been included in several treatment evaluation studies having positive findings suggests they are likely to be of benefit, or at least not to have adverse effects, and justifies their use in favour of procedures totally lacking in evaluation. It should also be mentioned that problem solving procedures have been used and positively evaluated for disorders other than substance abuse (Platt, Prout, & Metzger, 1986).

References for Problem Solving:

Chaney, E. F., O'Leary, M. R., & Marlatt, G. A. (1978), “Skill training with alcoholics”, Journal of Consulting and Clinical Psychology, 46, 1092-1104.

D'Zurilla, T. J., & Goldfried, M. R. (1971), “Problem solving and behavior modification”, Journal of Abnormal Psychology, 78, 107-126.

Hawkins, J. D., Catalano, R. F., Jr., & Wells, E. A. (1986), “Measuring effects of a skills training intervention for drug abusers”, Journal of Consulting and Clinical Psychology, 54, 661-664.

Jones, S. K., Kanfer, R., & Lanyon, R. I. (1982), “Skill training with alcoholics: A clinical extension”, Addictive Behaviors, 7, 285-290.

Monti, P. M., Abrams, D. B., Binkoff, J. A., Zwick, W. R., Liepman, M. R., Nirenberg, T. D., & Rohsenow, D. J. (1993), “Cue exposure with coping skills treatment for male alcoholics: A preliminary investigation”, Journal of Consulting and Clinical Psychology, 61, 1011-1019.

Monti, P. M., Abrams, D. B., Kadden, R. M., & Cooney, N. T. (1989), Treating alcohol dependence, New York: Guilford Press.

Platt, J. J., Prout, M. F., & Metzger, D. S. (1986), “Interpersonal problem–solving therapy.”, In W. Dryden & W. Golden (Eds.), Cognitive behavioral approaches to psychology. London: Harper & Row, pp. 261-289.

Sobell, M. B., & Sobell, L. C. (1973), “Individualized behavior therapy for alcoholics”, Behavior Therapy, 4, 49-72.