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Retrieved from the National Institute on Drug Abuse (NIH/NIDA) at https://www.nida.nih.gov/TXManuals/CBT/CBT1.html. This document includes Chapters #4 to Chapter #19.
Table Of Contents
Tasks For Topic 8
Session Goals
Key Interventions
Assess Risk
Build Motivation To Change
Set Goals
Problemsolve Barriers
Provide Specific Guidelines
Practice Exercise
Generally, few cocaine abusers who do not engage in concurrent opioid use also use injection works (syringe, cotton, water), and thus tend to have low levels of risk for HIV infection from unsafe needle practices. However, most have substantial risk from unsafe sexual practices. Depending upon their level and type of risk for HIV infection, patients may be offered an HIV risk-reduction module in addition to their regular sessions.
The goals of this session are to:
Key Interventions
Assess Risk
Therapists should help patients review their level of risk and their history of HIV testing. This can be done in discussion or by having patients complete a standardized instrument such as the HIV Risk Behaviors Inventory (Metzger et al. 1992). When using a formal test, scores should be presented in writing, with copies for the patients. Therapists should ask for patients’ reactions to their level of risk and reflect and elaborate on their reactions.
Patient: “I guess I didn’t realize how many people I had sex with since I’ve been on this run.”
Therapist: “What do you make of this?”
This strategy can bolster awareness of risk and increase motivation for change.
In assessing and reviewing the level of risk, therapists should use the following motivational strategies. (From Miller et al. 1992.)
If patients are ready to make a change, therapists work with them to set realistic, concrete risk-reduction goals for sexual and/or injection drug behavior risk, as appropriate (e.g., “I want to start using condoms with Jim this week”). Therapists should also encourage patients to identify barriers to risk-reduction goals (e.g., “You’ve come up with good, realistic goals that should lower your risk substantially. Now, what might get in the way of your meeting those goals?”). Barriers can include anticipated problems with negotiating condom use with a sexual partner, continuing to drink and frequent bars before using intravenously, acquiring condoms, and so on.
Therapists should encourage patients to apply some of the skills and problemsolving strategies covered in earlier sessions to the problems they anticipate in meeting risk-reduction goals. This might include, for example, practicing assertiveness in the context of negotiating condom use, using positive self-talk to counter ambivalence about and objections to condom use, or using a problemsolving strategy to clarify the connection between ongoing cocaine abuse and unsafe sexual practices.
As part of this module, therapists should offer specific information and provide handouts on risk reduction. Several areas should be covered, depending on the risk profiles of the patients.
The practice exercise for this session involves the creation of a worksheet to clarify and set patient goals for HIV risk reduction.