Behavioral and cognitive-behavioral treatments for alcoholism: research opportunities

This status report on behavioral and cognitive-behavioral treatments (CBT) for alcoholism is based on an article commissioned by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) for a review of its treatment research priorities. A number of gaps in knowledge and consequent research opportunities were identified. Additional work on cue exposure is needed to identify the most potent cues for drinking, and strategies for reducing the impact of drinking cues. Regarding contingency management, there is need for further studies with alcoholics, investigation of reinforcement schedules, and exploration of maintenance factors. With respect to the community reinforcement approach (CRA), research should identify its most effective elements and ways to sustain gains following treatment. The mediating role assigned to coping skills in the cognitive-behavioral model needs to be substantiated, and the effectiveness of various coping skills components must be determined. Further studies of relapse prevention (RP) are needed to improve the system for classifying relapse episodes, and to identify the most effective interventions for each type of episode. Studies of behavioral marital therapy should include identifying active ingredients, and testing hypothesized mediators of change. Patient-treatment matching strategies may help to identify clients likely to benefit from these strategies. Finally, given the overlap among these approaches, it is likely that research along the lines suggested will impact several of them and lead to a consolidation of their most effective elements into a common treatment package.