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Title and link for copying Comment/query to editor Drug Matrix Alcohol Matrix

S Seminal studiesK Key studiesR ReviewsG Guidancemore Search for more studies

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Drug Matrix cell A4: Interventions; Psychosocial therapies

K Match counselling style to the client (2003). US trial shows that structure and directiveness are key dimensions on which therapies can be matched to client characteristics.

K Visual aids enhance counselling (2009). Node-link maps are flow charts of a patient’s aims and plans which facilitate patient-counsellor communication; in this study they helped methadone patients reduce illegal opiate use and probably also cocaine use.

K Couples therapy improves the lives of both partners (2003). Proven most firmly for alcoholics, this study showed that the benefits of systematically involving a patient’s wife/partner in their treatment extends to the use of an opiate-blocking medication to sustain abstinence from heroin and allied drugs; relative to non-family alternative therapies, there were also improvements in family functioning and other social and legal domains. Similar story for methadone patients (2001).

R Common relationship factors (American Psychological Association, 2011). Introduces reviews based on the understanding that treatment methods are not simply technical interventions, but ways client and therapist relate, so cannot be divorced from the relationship between client and therapist. From here you can find the component reviews and the overall conclusions (2011) reached by the association’s task force.

R Directiveness is a key difference between therapies (2006). The interpersonal style (eg, directive v. patient-led) associated with different therapies is why some work better with some clients than others.

R Reviews of trials of motivational interviewing (Cochrane review, 2011) and cognitive-behavioural therapy (2009) suggest any structured approach grounded in an coherent theory is as good as any other. We have, it was argued, been looking in the wrong direction for therapy’s active ingredients.

R Motivational starts to treatment (2005). Findings review discovers that manualised motivational interviewing is not always better than more directive approaches as a way of engaging clients with treatment.

R Mindfulness meditation takes its place among addiction therapies (2009). Increasingly popular, variants of mindfulness meditation are among the ‘third wave’ of behavioural therapies allying Western and Eastern traditions. This first review of their application to addiction finds them equivalent to other structured therapies, but an important later study (2014) suggests otherwise. See also this more recent review (2014).

R Peer-based addiction recovery (2009). Includes a chapter on the evidence for NA, AA and allied mutual support networks and treatments based on the same principles and networks. See also this review (2004) of how treatment services can promote mutual aid and this synthesis of studies (1999) of approaches based on AA/NA’s 12-steps versus alternative treatments.

R Therapeutic communities certainly work while residents stay (2012). Shortcomings in the original studies prevented a firm conclusion on the lasting benefits of residential communities of patients exerting mutually therapeutic influences, but it was clear that while residents stayed, substance use was significantly reduced.

R Reserve therapeutic communities for most vulnerable patients (2013). Review specific to users of illegal drugs argues therapeutic communities should be reserved for drug addicts with multiple and severe problems who do not do well in outpatient treatment due to the lack of structure and supports, or the fact that they live in high drug use areas.

R Some patients get worse (2005). Reminder that after psychosocial therapy up to 15% of clients end up worse than before; some of the reasons are to do with poor therapy including a weak relationship, failing to assess how clients are doing, being confrontational or critical, low or inappropriate expectations, and lack of challenge.

R Rewards and sanctions for not using drugs (2013). Findings hot topic asks whether we can dispense with counselling and therapy and just punish people or deprive them of rewards when they use substances in ways they and/or we would rather they didn’t, and reward them when they behave as we and/or they would wish? Formalised in to set schedules, these approaches are known as ‘contingency management’.

G NICE-recommended psychosocial interventions ([UK] National Institute for Health and Care Excellence [NICE], 2007). UK’s official health advisory body recommends contingency management and behavioural couples therapy.

G Implementing NICE-recommended psychosocial interventions ([English] National Treatment Agency for Substance Misuse, 2010). Report commissioned by England’s national addiction treatment agency from the British Psychological Society; includes protocols for conducting the main psychosocial therapies.

G Expert US consensus on group therapy ([US] Substance Abuse and Mental Health Services Administration, 2005). Consensus guidance on the different types of groups, how to organise and lead them, desirable staff attributes, and staff training and supervision.

G No magic bullet, but treatment based on sound principles (2006). Based on reviews commissioned by the American Psychological Association; reviews evidence and offers in-principle guidance on how to relate to clients and the content of sessions. Argues that these principles “provide a more research-informed and potentially effective approach to treatment than either the application of a one-size-fits-all standard treatment protocol or the use of idiosyncratically selected interventions”. Free source available at time of writing

more This search retrieves all relevant analyses.
For subtopics go to the subject search page or hot topics on contingency management, residential rehabilitation, motivational interviewing, 12-step mutual aid and counselling in methadone treatment.

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