Addiction Research and Theory,February 2005; 13(1): pp. 95–96

BOOK REVIEW

Getting the C-bit between your teeth

Cognitive-behavioural Integrated Treatment (C-BIT): A treatment manualfor Substance Misuse in those with Severe Mental Health Problems.Hermine L. Graham et al. Chichester: John Wiley. (2004) 294 pp. £17.99 (pbk)

This book by Hermine Graham and no less than 10 colleagues is truly a manualfor practitioners. It introduces theory in small doses on a need-to-know basis andfocuses on giving practical ideas, tools and skills for working with clients.

It describes the unfortunately named C-BIT (Cognitive-behavioural integratedtreatment) approach in four sections:

1. An overview of the approach including a discussion of the issues involved in tryingto help those who have severe mental health problems as well as substance misusedifficulties.

2. C-BIT core components.3. Additional treatment components I–skills building.4. Additional treatment components II–family and social network members.

It has a fourth section on implementation issues.

The appendices section, which follows, is likely to be the most thumbed in anyeditions of the book found on shelves in a few years time. It is packed with worksheetsthat can be copied as handouts for clients (although you’d want to enlarge them toA4 size to enable clients to actually write in the spaces).

C-BIT is rooted firmly in cognitive counselling but also includes behavioural,motivational and social strategies for helping people. They describe it as ‘structuredin the sense that it provides a systematic method for clinicians to address their clients’ alco-hol/drug use’ and yet ‘flexible, as it allows clinicians to deliver snippets of the treatment inthe time available’ (p. 21) and this seems a fair assessment. Unlike some other manualson CBT, it takes for granted that clients will dip between engagement and resistanceand discusses how to manage this. Practical tasks, like helping clients’ budget,are included as part of the whole package of building rapport and engaging clients.It may be worth pointing out though that it is a pretty intensive approach, intendedfor clinicians with ongoing relationships with their clients; it does not lend itselfto the brief encounters this client group often have with workers in, for example,arrest referral schemes.

As an integrated approach, it incorporates a lot of counselling methods that willbe familiar to experienced workers in this field. My interest in C-BIT was stimulatednot so much by the novelty of any of the ingredients but by the coherent way it is all

ISSN 1606-6359 print: ISSN 1476-7392 online � 2005 Taylor & Francis Group LtdDOI: 10.1080/16066350412331331309

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brought together. It shows how clients, who show constantly varying levels of ambiva-lence, can be engaged to use a range of strategies, with the support of their social net-works, towards goals of either abstinence or harm reduction. I found the structureof the chapters helpful, each starting with a clearly expressed aim and a list of‘helpful references’, punctuated by little ‘So, remember . . . . . .’ boxed summaries.Each was full of transcripts of examples.

My favourite chapters were the one on relapse prevention and the one on workingwith social and network members which, while acknowledging that loved ones some-times act in ways that make things worse for clients, was compassionate and offeredpractical ways to help them be truly supportive.

The activity diary exercise (p.156) did divert me for a while. You list a day’sactivities rating each on a pleasure scale of 1–10 with a view to restoring balance inyour life. I had to have a go for myself:

7am alarm goes off 1/107.10 snooze alarm goes off 1/107.15 clean teeth 2/107.18 try to make hair lie flat 1/107.25 milk curdles in coffee 1/10

By this stage I started to feel like Bridget Jones and gave it a miss! The re-evaluatedthought diary (assertiveness) exercise also looked very useful (p. 181) but I resistedthe temptation.

All in all, I recommend this book to anyone working in a structured way with thisclient group. It is well written, practical and clearly based on years of experience.

Pip Mason RGN BSc (Econ) MSocSc

Pip Mason Consultancy LtdBirmingham UK

96 Book review

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