Therapist techniques used during the cognitive therapy of opiate-dependent patients

A review of current substance abuse literature indicates that although clinicians espouse cognitive and behavioral methods in the treatment of drug-dependent patients, little is known about the process of cognitive-behavioral therapy with these individuals. Our objective is to examine the specific techniques used by manual-guided cognitive-behavioral therapists during the treatment of opiate-dependent patients. Ratings of audiotaped sessions using the Collaborative Study Psychotherapy Rating Scale indicate that the cognitive-behavioral therapists did not rely on behavioral methods early in treatment as predicted by both theory and the clinical literature. Cognitive techniques and techniques oriented toward establishing a collaborative structure predominated and increased from early- to late-in-treatment sessions. We discuss the implications of the results in terms of treatment manual revisions and directions for future research.