Interview with Evelyn Beneke (Camps Bay Psychotherapy)

Evelyn Beneke has been a clinical psychologist at Camps Bay Psychotherapy since 2010. She is passionate about helping South Africans get the help they need to maximise their potential and overcome anxiety and depression.

In 2014, she began an extensive research project looking into cocaine as part of a PhD at the University of Amsterdam under the supervision of Professor Reinout Wiers. This innovative research project was called IQuit Cocaine, an online cognitive behaviour modification (CBM) intervention. The research is a randomised double blind clinical study registered in the Netherlands.

Through her research, she discovered that the treatment of substance abuse is incomplete without targeting implicit as opposed to explicit dimensions. Her goal is to make it available to all South Africans in as many languages as possible. We spoke to Evelyn to find out more.

What did your research tell you about substance abuse to late adolescents and adults in South Africa?

Substance abuse is a process which over time, is automatic, involuntary, and outside of conscious awareness. Recognition of the importance of this factor has led to the development of strategies that address the implicit dimension of dependence on a substance. Fundamental to such a treatment strategy are the concepts of attentional bias and approach bias.

For example, if one were to see two pictures, one of a spider and one of a butterfly, the chances are that an arachnophobic’s attention would be drawn to the spider rather than to the butterfly. Such a person has an attentional bias (sensitivity) to spiders. Similarly, a person dependent on alcohol would be drawn to a picture of a glass of wine rather than to a soft drink. Research has shown that this response bias is a basic human reaction. My research into cocaine use has shown that such a response bias is also found among late adolescents and adults in South Africa.

What measures can be taken to help eliminate or minimise risks of substance abuse?

In addition to attentional bias, approach bias is common – individuals who use a substance are automatically drawn to a picture that shows the substance. When given the option, they tend to immediately pull the picture of the substance towards them. In order to desensitise people to the power of paying attention and being drawn to images of the substance, one uses cognitive bias modification (CBM) treatment.

CBM involves training people for an hour a day to respond to these images by pressing a key on their computer. They are instructed to press a key when they see the pictures and also instructed to either push away or pull the picture towards them. In so doing, their response time is recorded. A quicker response time indicates a greater bias to towards the image. Response time is recorded in milliseconds. In my research with cocaine users, CBM training reduced the amount of cocaine used over a six-week period. Then, without regular therapy, the participants relapsed at three month follow up. This suggests that CBM cannot be successful without treatment as usual.

Can you talk us through the treatment programme offered by the Camps Bay Psychotherapy?

To date, the CBM programme has only been available to cocaine users who present for treatment. As soon as they start working on the CBM at home on their computer, they are treated in therapy sessions in which they are provided with practical coping strategies to address craving, withdrawal symptoms and other factors that are known to play a role in relapse.

Coping strategies are essential because they are linked to why people use a substance in the first place. People use substances to numb negative emotions, and to enhance positive feelings of confidence, euphoria and control. However, the underlying coping mechanism is usually linked to avoidance, a learned pattern of surrendering (e.g. people pleasing) or overcompensation (e.g. grandiosity). When shown how their conditioned coping strategies led to substance use, most people are able to rely on healthier more adaptive ways of coping. Individuals who receive CBM for purposes of research are not charged for the therapy or for access to the CBM programme.

Whilst coping skills are essential in relapse prevention, they do need to be offered in conjunction with some human contact by a therapist. Because this was an online programme, the coping skills were offered online. These cocaine specific coping skills were obtained from Professor Damaris Rosenhow at Brown University in the United States.

How can treatment be adapted to overcome the various different types of substance abuse?

It is easy to adapt an online treatment programme utilising CBM to any other substance. It is a matter of modifying an existing computer programme. In modifying attentional and approach biases, images are preferred because the role of language is eliminated. This was a decisive factor in my own research because the aim was to reach all South Africans, not only first-language English speakers. However, it is possible to use words, as research has indicated that words that are related to a substance also elicit quicker response times than neutral words.

It would be possible to tailor a program so that specific geographical areas could be targeted. For example, if one were addressing nyope (a combination of heroin and other substances) use, the research participant could select their language of choice and nyope-related and neutral words would appear in their mother tongue. They would be trained over time to respond quicker to the neutral word, and to push away the nyope-related word. Again, the CBM would be supplemented with in or outpatient treatment.

Where is the treatment currently being offered?

As far as I know treatment that uses CBM is not used anywhere in South Africa at the moment. There are many publicly or privately run facilities that offer outstanding treatment for substance use disorders. However, CBM is unique because it desensitises the individual to triggers that lead to substance use. It would be appropriate to supplement conventional treatment programmes in both in- and out-patient facilities with CBM. This is currently the preferred mode of treatment in Europe.

Is there anything else you would like to add?

I am honoured to have my research into cocaine use recognised by this award from CorporateLiveWire. There is no doubt that cognitive bias modification is an effective treatment in dealing with substance use disorders. I hope to continue researching and devising online strategies that can be implemented especially during the COVID-19 pandemic. As it is online, it is an ideal treatment at this time.

Worldwide, there are many people who use alcohol to cope. It is not a sustainable strategy because at the very least, in people who are heavy drinkers over a long period of time, it leads to cognitive impairment and even vascular dementia.

Camps Bay Psychotherapy has been awarded Most Innovative in Multicultural Substance Abuse Research by South Africa Prestige. The judges were particularly impressed with the innovative methods and results achieved as a result of Evelyn Beneke’s research into cocaine use. They also praised the accessibility of the programmes she plans to develop which can be conducted online, in a variety of languages, whilst also having the potential to be adapted to treat other forms of substance abuse. For more information, please visit: www.campsbaypsychotherapy.co.za