TreaTing addicTion Treating addiction A Guide for Professionals William R. Miller Alyssa A. Forcehimes Allen Zweben Postscript by A. Thomas McLellan THe gUiLFord PreSS New York London © 2011 The Guilford Press A Division of Guilford Publications, Inc. 72 Spring Street, New York, NY 10012 www.guilford.com All rights reserved Except as indicated, no part of this book may be reproduced, translated, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, microflming, recording, or otherwise, without written permission from the publisher. Printed in the United States of America This book is printed on acid-free paper. Last digit is print number: 9 8 7 6 5 4 3 2 1 LIMITED PHOTOCOPY LICENSE These materials are intended for use only by qualifed professionals. With the exception of some materials that are in the public domain, the publisher grants to individual purchasers of this book nonassignable permission to reproduce all materi- als for which photocopying permission is specifcally granted in a footnote. This license is limited to you, the individual purchaser, for personal use or use with individual cli- ents. This license does not grant the right to reproduce these materials for resale, redis- tribution, electronic display, or any other purposes (including but not limited to books, pamphlets, articles, video- or audiotapes, blogs, fle-s haring sites, Internet or intranet sites, and handouts or slides for lectures, workshops, or webinars, whether or not a fee is charged). Permission to reproduce these materials for these and any other purposes must be obtained in writing from the Permissions Department of Guilford Publications. The authors have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards of practice that are accepted at the time of publication. However, in view of the possibility of human error or changes in behavioral, mental health, or medical sciences, neither the authors, nor the editor and publisher, nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they are not responsible for any errors or omissions or the results obtained from the use of such information. Readers are encouraged to confrm the information con- tained in this book with other sources. Library of Congress Cataloging-in-P ublication Data Miller, William R. (William Richard) Treating addiction: a guide for professionals / by William R. Miller, Alyssa Forcehimes, and Allen Zweben p. cm. Includes bibliographical references and index. ISBN 978-1-60918-638-8 (hardback) 1. Substance abuse—Treatment. 2. Drug abuse—Treatment. I. Forcehimes, Alyssa. II. Zweben, Allen, 1940– III. Title. RC564.M546 2011 362.29—dc23 2011017582 To Robert G. Hall, PhD, who in 1973 persuaded me that I ought to learn something about addiction treatment W. R. M. To my sister, who showed me that lasting change from addiction can and does occur A. A. F. To my wife, Aviva, who has always been there for me A. Z. About the Authors William R. Miller, PhD, is Emeritus Distinguished Professor of Psychology and Psychiatry at the University of New Mexico in Albuquerque. Through- out his career he has developed and evaluated various methods for addic- tion treatment, including motivational interviewing, behavior therapies, and pharmacotherapies. More generally interested in the psychology of change, Dr. Miller has also focused on the interface of spirituality and psychotherapy. Having authored more than 40 books and 400 professional and scientifc articles and chapters, Dr. Miller is listed by the Institute for Scientifc Information as one of the world’s most cited scientists. Alyssa A. Forcehimes, PhD, is a clinical psychologist on the faculty of Psychiatry at the University of New Mexico Health Sciences Center. She coordinates the Southwest Node of the National Institute on Drug Abuse Clinical Trials Network, which is located at the University’s Center on Alcoholism, Substance Abuse, and Addictions. Dr. Forcehimes’s research focuses on processes of motivation for change and on effective methods for disseminating and teaching evidence-based behavioral treatments for addiction to mental health, substance abuse, and health care providers. Allen Zweben, PhD, is Professor and Associate Dean for Research and Aca- demic Affairs at the Columbia University School of Social Work in New York. Dr. Zweben has been a principal investigator on numerous feder- ally and privately funded behavioral and medication trials, including two landmark studies funded by the National Institute on Alcohol Abuse and Alcoholism: Project MATCH, a patient–t reatment matching study, and the COMBINE study, a project examining the effcacy of combining pharma- cotherapy and psychotherapy interventions for alcohol problems. vii Acknowledgments or me, this book represents a retrospective of what I have learned during F 37 years of work in addiction treatment and research. There is no way to adequately thank the hundreds of colleagues, students, research staff, and clients who have helped me to learn along the way, but I do want to name just a few. First of all, there is Robert G. Hall, named in the dedication. He invited a totally green summer intern into the world of addiction treat- ment and set me on a path that would fascinate me throughout my career. I have had the privilege of sharing the hard work of conducting many clini- cal research projects and discussing their implications with several long- s tanding colleagues, among them Drs. Reid Hester, Dick Longabaugh, Bob Meyers, Terri Moyers, Steve Rollnick, Scott Tonigan, Paula Wilbourne, and Carolina Yahne. I owe so much to two of the fnest administrative assis- tants anyone could have, Dee Ann Quintana and Delilah Yao, who looked after me through two lively and impossibly busy decades. The last two decades of my academic career were continuously and generously funded by grants from the National Institute on Alcohol Abuse and Alcoholism and the National Institute on Drug Abuse. I spent my entire professional career at the University of New Mexico (UNM), and I can’t imagine a bet- ter place to have worked. The amazing staff of UNM’s Center on Alcohol- ism, Substance Abuse, and Addictions (CASAA) were a fne community of friends and colleagues without whom I could not have undertaken half of what I’ve managed to squeeze into these years. After working with 20 publishing companies throughout my career, I have settled into a happy relationship with The Guilford Press, appreciating the unusual quality of ix