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Substance Abuse Treatment Modalities: Literature Review

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Social Skills Training

Social skills training is a common component of substance abuse treatment programs and is intended to assist drug/alcohol users to function more effectively in social situations. Miller (1992) defined social skills training as focusing on teaching more effective communication skills to improve interpersonal relationships. Others have proposed that inappropriate social functioning generally is the result of skill deficiencies, and teaching individuals through social skills training to improve upon or otherwise overcome their deficiencies should lead to more adaptive behaviours (e.g., Elder et al., 1979; Freedman et al., 1978).

It is generally agreed that social skills training serves as a rubric treatment approach involving a variety of interventions. Miller and Hester (1986) reviewed the alcoholism treatment literature and suggested that optimal elements of social skills training include assertiveness training, group training with practice, branching programmed instruction (if written materials are used) and attention to cognitive inhibitions. Corrigan (1991), in a meta-analysis of social skills training, reported a broadening of techniques from a narrow focus on conversational behaviour to include assertiveness and problem solving skills. Moreover, the components of skill training - instructions, modelling, rehearsal, feedback, and homework - have been evaluated alone and in varying combinations to apportion their relative influence on outcome.

Despite the subtle differences in definitions and social skills training approaches, the general intent of these programs is to teach the kind of generic skills for coping with life that will have a relatively broad application. It is argued, however, that social skills training programs should emphasize the applications of these skills to situations directly related to substance abuse (Botvin, 1990). Given the common knowledge (e.g., Eliany & Rush, 1992; Miller & Hester, 1986) that substance abusers are often deficient in social skills, the utility of such training is evidenced in studies which have demonstrated positive treatment outcomes.

In their review, Miller and Hester (1986) identified a number of controlled studies that examined the value of adding social skills training to alcoholism treatment programs. Results across the different studies showed clear support for social skills training as an integral component to alcoholism treatment. In a more recent review on the effectiveness of substance abuse treatment, Miller (1992) identified additional studies that supported the efficacy of social skills training. He reported that programs with social skills training have been found to be superior to supportive counselling, brief interventions or controls, or to yield significantly improved outcomes when added to traditional treatment.

A few remaining studies not included in Miller's review have demonstrated the utility of social skills training with substance abusers. Eriksen, Bjornstad, and Gotestam (1986) randomly assigned 24 DSM-III diagnosis alcoholics to two identical traditional treatment programs. The manipulation involved one program that offered social skills training in addition to the regular treatment curriculum. A one-year follow-up showed that the social skills training group drank significantly less amounts of alcohol and had twice as many sober days and working days compared to the control group clients. Moreover, the abstinence period after discharge was over 6 times longer compared to the controls.

Corrigan (1991) conducted a meta-analysis on 73 studies of social skills training in four adult psychiatric populations: developmentally disabled, psychotic, nonpsychotic, and legal offenders. Of particular interest is that almost all (11 out of 15) of the studies on the offender sample consisted of drug and alcohol abusing individuals. Results presented a moderate effect size indicating that, for all the offender studies, social skills training enhanced acquisition of skills that were maintained for several months after treatment. Interestingly though, offenders demonstrated relatively large skill acquisition but did not retain the skills as well as the other populations. In addition, the large increase in the offenders' repertoire had less an effect on symptoms and social adjustment measures. Corrigan (1991) suggested these results may be related to the fact that offenders are often coerced into treatment.

In summary, social skills training has been found to be an effective component of substance abuse treatment programs. Results from a number of studies have reported positive impacts on substance-abusing behaviour evidenced after treatment discharge and at longer follow-up intervals. The available research suggests that social skills training, as a single component program or as part of a more comprehensive treatment approach, should be offered to substance abusers with the intent of reducing or diminishing maladaptive drug/alcohol-using behaviour.

References for Social Skills Training:

Botvin, G. J. (1990), “Substance abuse prevention: Theory, practice, and effectiveness”, In M. Tonry & J.Q. Wilson (Eds.), Drugs and crime. Chicago: The University of Chicago Press.

Corrigan, P. W. (1991), “Social skills training in adult psychiatric populations: A meta-analysis”,. Journal of Behaviour Therapy and Experimental Psychiatry, 22(3), 203-210.

Elder, J., Edelstein, B., & Narick, M. (1979), “Adolescent psychiatric patients: Modifying aggressive behaviour with social skills training”, Behaviour Modification, 3, 161-178.

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.

Eriksen, L., Bjornstad, S., & Gotestam, K. G. (1986), “Social skills training in groups for alcoholics: One-year treatment outcome for groups and individuals”, Addictive Behaviour, 11, 309-329.

Freedman, B., Donahue, C., Rosenthal, D., Schlundt, D., & McFall, R. (1978), “A social-behavioural analysis of skill deficits in delinquent and nondelinquent adolescent boys”, Journal of Consulting and Clinical Psychology, 46, 1448-1462.

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. (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.