Cognitive Behavioural Therapy for Problem Drinking
This book serves as a concise and practical guide on the application of cognitive behavioural therapy (CBT) to problem drinking. Divided into five chapters it provides:
a detailed account of the cognitive and behavioural processes involved in the development and maintenance of problem drinking
in-depth coverage of assessment and case formulation and their role in planning and sequencing CBT interventions
concise and practical illustrations of the application of CBT interventions in preparing, implementing and maintaining change.
Cognitive Behavioural Therapy for Problem Drinking also includes diaries and worksheets for use with the client making it essential reading for all mental health practitioners in the field of alcohol misuse, as well as a useful resource for those in training.
The appendices of this book contain worksheets that can be downloaded free of charge to purchasers of the print version. Please visit the website www.cbtarena.com/9780415408769 to find out more about this facility.
Marcantonio Spada is Professor of Psychological Therapies at London South Bank University in partnership with North East London NHS Foundation Trust. An expert in cognitive behavioural theory and therapy for problem drinking, he is a practising clinician with extensive experience of working with problem drinkers.
Cognitive Behavioural Therapy for Problem Drinking
A Practitioners Guide
MARCANTONIO SPADA
LONDON AND NEW YORK
First published 2010 by Routledge
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Simultaneously published in the USA and Canada
by Routledge
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Routledge is an imprint of the Taylor & Francis Group, an Informa business
This edition published in the Taylor & Francis e-Library, 2010.
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2010 Marcantonio Spada
Cover design by Andrew Ward
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This publication has been produced with paper manufactured to strict
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British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging-in-Publication Data
Spada, Marcantonio.
Cognitive behavioural therapy for problem drinking: a practitioners
guide/Marcantonio Spada.
p. cm.
Includes bibliographical references and index.
ISBN 978-0-415-40876-9 (pbk.)
1. Alcoholism-Treatment. 2. Cognitive therapy. I. Title.
RC565.S64 2010
616.861dc22
2010008828
ISBN 0-203-84104-2 Master e-book ISBN
ISBN: 978-0-415-40876-9 (pbk only)
In memory of B.
Contents
Figures and tables
Figures
1.1 | The cognitive-behavioural model of the relapse process |
1.2 | The schema model of alcohol abuse |
2.1 | A completed functional analysis and associated identification of therapeutic interventions (key stimulus: being in a pub) |
2.2 | A completed functional analysis and associated identification of therapeutic interventions (key stimulus: being at home alone) |
2.3 | A transposition of a functional analysis (from Figure 2.1) into a model |
2.4 | A diagrammatic representation of a problem formulation |
3.1 | An example of a completed flashcard |
3.2 | Sources of pleasure when drinking is a central activity |
3.3 | Sources of pleasure when drinking alcohol ceases |
5.1 | Interlinking of the functional analyses in a problem formulation |
Tables
2.1 | Drinking diary |
2.2 | A drinking decisional balance sheet |
2.3 | Problems and goals |
2.4 | Advantages of changing, concerns of changing and responses to concerns |
2.5 | Examining specific change concerns |
3.1 | Activating event breakdown |
3.2 | Evidence for and against the uncontrollability of craving |
3.3 | Decision sheet on past slips |
3.4 | Decision sheet on upcoming events |
3.5 | Identifying permissive beliefs |
3.6 | Challenging permissive beliefs |
3.7 | Hierarchy of difficult situations |
3.8 | Drinking postponement experiment |
3.9 | Activity diary |
4.1 | Controlled drinking skills |
4.2 | Controlled drinking programme |
4.3 | Plan for managing high-risk situations |
5.1 | Functional analysis of out-of-control drinking |
5.2 | Functional analysis of low mood linked to thoughts about loneliness |
5.3 | Functional analysis of low mood linked to thoughts about work challenges |
About the author
Marcantonio Spada, PhD, is Professor of Psychological Therapies at London South Bank University in partnership with North East London NHS Foundation Trust. An expert in cognitive-behavioural theory and therapy for problem drinking, he has published extensively in academic journals and authored a self-help guide for problem drinking, Overcoming Problem Drinking, based on cognitive-behavioural therapy principles. As a practitioner, he has extensive experience of working with problem drinkers, both in community mental health organizations and private practice, and has co-led the development of the Community Alcohol and Drugs Service in Brent, London.
Acknowledgements
This book is the culmination of over ten years work in the field of cognitive-behavioural therapy for problem drinking. My doctoral research, undertaken at the University of Manchester, addressed the role of metacognitions in problem drinking and was supervised by Professor Adrian Wells, an important mentor. I have also worked with Professor Michael Bruch and Dr Edward Chesser at University College London, where I received training in cognitive-behavioural therapy. This experience played a crucial role in introducing me to the concepts of functional analysis and case formulation in the treatment of complex cases, as problem drinking cases almost always are. With John Doocey, director of the Community Alcohol and Drugs Service based in Brent, London, we were able to design and establish an alcohol and drugs service based on many of the cognitive-behavioural therapy principles outlined in this book. I am grateful to these people and to the many others I have worked with over the years. A special thank you goes to my wife Ana, who has always supported me, and my children, Yasna and Massimo, who provide an endless source of distraction from my work thanks to their play and affection.
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