Psychosocial Therapies ..............................................................................................
Psychosocial treatments for substance addiction
aim to alter patients’ attitudes and behaviors
with regards to the use of tobacco, alcohol and
other drugs. These therapies enhance patients’
skills in coping with life challenges, navigating
high-risk situations, avoiding substance use
triggers, controlling cravings and coping with
lapses.^238 Some therapies focus on enhancing
patients’ motivations to change their substance-
related behaviors. Other therapies focus on
helping patients alter their environments in order
to reduce pressures and cues to use, or provide
positive or negative reinforcements to help
patients change their attitudes and behavior.^239
Psychosocial therapies are critical components
of almost every treatment regimen, regardless of
a patient’s primary substance of addiction; when
combined with pharmaceutical treatments they
enhance treatment efficacy.^240
As is true of treatments for most other health
conditions, successful treatment for patients with
addiction takes into account patients’ social and
financial circumstances as well as their physical
well-being. And, as is the case for other health
conditions, not all approaches work equally well
for all patients; the effectiveness of a particular
approach depends on patient circumstances such
as the severity of the addiction, the primary
substance involved in the addiction, the extent of
social support and the presence of co-occurring
disorders; the venue in which the treatment is
provided; and the nature and dynamics of the
provider-patient relationship.^241
The following are brief descriptions of the
primary psychosocial therapies for addiction
treatment:
Motivational Interviewing (MI) and
Motivational-Enhancement Therapy (MET).
Motivational techniques capitalize on patients’
readiness to stop using addictive substances and
enter treatment by bolstering their motivation to
change their substance use behaviors.^242 In
acute care, motivational therapies are employed
early in the treatment process. They also may be
used in conjunction with other psychosocial and
pharmaceutical approaches.^243Motivational Interviewing (MI), which can
occur in inpatient or outpatient settings, is rooted
in the idea that individuals with addiction often
feel ambivalent about their substance use and the
need to change their behaviors.^244 MI
techniques help patients deal with this
ambivalence and strengthen their commitment to
engage in behavior change.^245 Motivational
Enhancement Therapy (MET) is an adaptation
of MI* that restricts the intervention to four
sessions.† 246Both MI and MET have proven efficacy in
addressing adolescent and adult addiction and
are cost-effective approaches to treating
addiction involving nicotine, alcohol and other
drugs.^247 Two main benefits of MI/MET are
increased treatment retention and program
completion,^248 which are associated with
improved treatment outcomes.^249 A study of
tobacco cessation among patients who had
previously had a heart attack found that those
receiving MI were more likely to achieve
abstinence after a year than patients who only
received brief advice about quitting (65.5
percent vs. 37.0 percent).‡ 250 An evaluation of
MET across five treatment sites found that it
was associated with greater reductions in alcohol
and other drug use over a 12-week period than
standard individual counseling.§ 251* Both modalities are based on the Transtheoretical
Model of Behavior Change.
† MET was developed for Project MATCH (1997), a
large study of treatment efficacy that compared the
effectiveness of three treatment modalities: 12
sessions of cognitive behavioral therapy (CBT), 12
sessions of Twelve-Step Facilitation Therapy or four
sessions of MET. All three groups showed
significant and comparable declines in alcohol use up
to three years later.
‡ These rates are based on at least one week of
abstinence corroborated by a family member.
§ More than 450 individuals with addiction were
randomly assigned to receive three sessions either of
MET or standard individual counseling during a one-
month period.