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Psychotherapy for Opiate Addicts: Does It Help?

Psychotherapy for Opiate Addicts: Does It Help? Abstract • Opiate addicts beginning a new treatment episode on a methadone maintenance program were offered random assignment to drug counseling alone or to counseling plus six months of either supportive-expressive psychotherapy or cognitive-behavioral psychotherapy. Sixty percent of patients meeting the study criteria expressed an interest and 60% of these actually became engaged. One hundred ten subjects completed the study intake procedure and kept three or more appointments within the first six weeks of the project. Measures including standardized psychological tests, independent observer ratings, and continuous records of licit and illicit drug use were done at baseline and seven-month follow-up. All three treatment groups showed significant improvement, but patients receiving the additional psychotherapies showed improvement in more areas and to a greater degree than those who received counseling alone, and with less use of medication. More than a third of opiate addicts in our treatment program thus both were interested in professional psychotherapy and apparently benefitted from it. Certain administrative procedures appear necessary to maximize the chances that psychotherapy can be used effectively with drug-addicted patients. (Arch Gen Psychiatry 1983;40:639-645) References 1. Khantzian EJ, Mack JE, Schatzberg AF: Heroin use as an attempt to cope: Clinical observations . Am J Psychiatry 1974;131:160-164. 2. Wurmser L: The Hidden Dimension: Psychopathology of Compulsive Drug Use . New York, Jason Aronson Inc, 1979. 3. Rounsaville BJ, Weissman MM, Wilber CH, et al: The heterogeneity of psychiatric diagnosis in treated opiate addicts . Arch Gen Psychiatry 1982;39:161-166.Crossref 4. Bourne PG: Methadone: Benefits and Shortcomings . Washington, DC, Drug Abuse Council Inc, publication MS-12, 1975, pp 11-12. 5. Karkus HD: Methadone vs. psychotherapy in the treatment of addiction . Int J Addict 1973;8:427-434. 6. Nyswander M, Winick C, Bernstein A, et al: The treatment of drug addicts as voluntary outpatients: A progress report . Am J Orthopsychiatry 1958;28:714-729.Crossref 7. Willett EA: Group therapy in a methadone treatment program: An evaluation of changes in interpersonal behavior . Int J Addict 1973;8:33-39. 8. Abrams J: A cognitive behavioral versus nondirective group treatment program for opioid addicted persons: An adjunct to methadone maintenance . Int J Addict 1979;14:503-511. 9. Stanton MD, Todd T, et al (eds): The Family Therapy of Drug Abuse and Addiction . New York, Guilford Press, 1982. 10. LaRosa JC, Lipsius JH, LaRosa JH: Experiences with a combination of group therapy and methadone maintenance in the treatment of heroin addiction . Int J Addict 1974;9:605-617. 11. Connett G: Comparison of progress of patients with professional and paraprofessional counselors in a methadone maintenance program . Int J Addict 1980;15:585-589. 12. Resnick RB, Washton AM, Stone-Washton N, et al: Psychotherapy and naltrexone in opioid dependence , in Harris LS (ed): Problems of Drug Dependence, 1980 , NIDA research monograph 34, DHHS publication (ADM) 81-1058. US Dept of Health and Human Services, National Institute on Drug Abuse, 1981, pp 109-115. 13. Rounsaville BJ, Glazer W, Wilber CH, et al: Short-term interpersonal Psychotherapy in methadone-maintained opiate addicts. Arch Gen Psychiatry, in press. 14. Luborsky L, Singer B, Luborsky L: Comparative studies of psychotherapies: Is it true that 'everybody has won and all must have prizes'? Arch Gen Psychiatry 1975;32:995-1008.Crossref 15. Smith M, Glass G, Miller T: The Benefits of Psychotherapy . Baltimore, Johns Hopkins University Press, 1980. 16. Andrews G, Harvey R: Does psychotherapy benefit neurotic patients? Arch Gen Psychiatry 1981;38:1203-1212.Crossref 17. McLellan AT, Luborsky L, O'Brien CP, et al: Is treatment for substance abuse effective? JAMA 1982;247:1423-1428.Crossref 18. Woody GE, Carr EK, Stanton ME, et al: Program flexibility and support , in Stanton MD, Todd TG, et al (eds): The Family Therapy of Drug Abuse and Addiction . New York, Guilford Press, 1982, pp 393-402. 19. Malan D: A Study of Brief Psychotherapy . Philadelphia, JB Lippincott Co, 1963. 20. Sifneos P: Short-term Psychotherapy and Emotional Crisis . Cambridge, Mass, Harvard University Press, 1972. 21. Wallerstein R, Robbins L, Sargent H, et al: The psychotherapy research project of the Menninger Foundation . Bull Menninger Clin 1956;20:221-280. 22. Orne M, Wender P: Anticipatory socialization for psychotherapy: Method and rationale . Am J Psychiatry 1968;124:88-98. 23. Beck AT, Beck AW: Screening depressed patients in family practice . Postgrad Med 1972;52:81-85. 24. Eysenck HJ: The Manual of the Maudsley Personality Inventory . London, University of London Press, 1959. 25. Derogatis L, Lipman R, Rickels K: The Hopkins symptom checklist (HSCL): A self-report symptom inventory . Behav Sci 1974;19:1-16.Crossref 26. Nunnally J: Psychometric Theory . New York, McGraw-Hill Book Co, 1967. 27. Endicott J, Spitzer RL: A diagnostic interview: The schedule for affective disorders and schizophrenia . Arch Gen Psychiatry 1978;37: 837-844.Crossref 28. McLellan AT, Luborsky L, O'Brien CP, et al: Improved diagnostic instrument for substance abuse patients: The Addiction Severity Index . J Nerv Ment Dis 1980;168:26-33.Crossref 29. Dole VP, Nyswander ME, Des Jarlois D, et al: Performance-based rating of methadone maintenance programs . N Engl J Med 1982;306: 169-172.Crossref 30. McGlothlin WH, Anglin D: Long-term follow-up of clients of high- and low-dose methadone programs . Arch Gen Psychiatry 1981;38:1055-1063.Crossref 31. Fenichel O: The Psychoanalytic Theory of Neurosis . New York, WW Norton and Co Inc, 1945. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of General Psychiatry American Medical Association

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References (38)

Publisher
American Medical Association
Copyright
Copyright © 1983 American Medical Association. All Rights Reserved.
ISSN
0003-990X
eISSN
1598-3636
DOI
10.1001/archpsyc.1983.04390010049006
Publisher site
See Article on Publisher Site

Abstract

Abstract • Opiate addicts beginning a new treatment episode on a methadone maintenance program were offered random assignment to drug counseling alone or to counseling plus six months of either supportive-expressive psychotherapy or cognitive-behavioral psychotherapy. Sixty percent of patients meeting the study criteria expressed an interest and 60% of these actually became engaged. One hundred ten subjects completed the study intake procedure and kept three or more appointments within the first six weeks of the project. Measures including standardized psychological tests, independent observer ratings, and continuous records of licit and illicit drug use were done at baseline and seven-month follow-up. All three treatment groups showed significant improvement, but patients receiving the additional psychotherapies showed improvement in more areas and to a greater degree than those who received counseling alone, and with less use of medication. More than a third of opiate addicts in our treatment program thus both were interested in professional psychotherapy and apparently benefitted from it. Certain administrative procedures appear necessary to maximize the chances that psychotherapy can be used effectively with drug-addicted patients. (Arch Gen Psychiatry 1983;40:639-645) References 1. Khantzian EJ, Mack JE, Schatzberg AF: Heroin use as an attempt to cope: Clinical observations . Am J Psychiatry 1974;131:160-164. 2. Wurmser L: The Hidden Dimension: Psychopathology of Compulsive Drug Use . New York, Jason Aronson Inc, 1979. 3. Rounsaville BJ, Weissman MM, Wilber CH, et al: The heterogeneity of psychiatric diagnosis in treated opiate addicts . Arch Gen Psychiatry 1982;39:161-166.Crossref 4. Bourne PG: Methadone: Benefits and Shortcomings . Washington, DC, Drug Abuse Council Inc, publication MS-12, 1975, pp 11-12. 5. Karkus HD: Methadone vs. psychotherapy in the treatment of addiction . Int J Addict 1973;8:427-434. 6. Nyswander M, Winick C, Bernstein A, et al: The treatment of drug addicts as voluntary outpatients: A progress report . Am J Orthopsychiatry 1958;28:714-729.Crossref 7. Willett EA: Group therapy in a methadone treatment program: An evaluation of changes in interpersonal behavior . Int J Addict 1973;8:33-39. 8. Abrams J: A cognitive behavioral versus nondirective group treatment program for opioid addicted persons: An adjunct to methadone maintenance . Int J Addict 1979;14:503-511. 9. Stanton MD, Todd T, et al (eds): The Family Therapy of Drug Abuse and Addiction . New York, Guilford Press, 1982. 10. LaRosa JC, Lipsius JH, LaRosa JH: Experiences with a combination of group therapy and methadone maintenance in the treatment of heroin addiction . Int J Addict 1974;9:605-617. 11. Connett G: Comparison of progress of patients with professional and paraprofessional counselors in a methadone maintenance program . Int J Addict 1980;15:585-589. 12. Resnick RB, Washton AM, Stone-Washton N, et al: Psychotherapy and naltrexone in opioid dependence , in Harris LS (ed): Problems of Drug Dependence, 1980 , NIDA research monograph 34, DHHS publication (ADM) 81-1058. US Dept of Health and Human Services, National Institute on Drug Abuse, 1981, pp 109-115. 13. Rounsaville BJ, Glazer W, Wilber CH, et al: Short-term interpersonal Psychotherapy in methadone-maintained opiate addicts. Arch Gen Psychiatry, in press. 14. Luborsky L, Singer B, Luborsky L: Comparative studies of psychotherapies: Is it true that 'everybody has won and all must have prizes'? Arch Gen Psychiatry 1975;32:995-1008.Crossref 15. Smith M, Glass G, Miller T: The Benefits of Psychotherapy . Baltimore, Johns Hopkins University Press, 1980. 16. Andrews G, Harvey R: Does psychotherapy benefit neurotic patients? Arch Gen Psychiatry 1981;38:1203-1212.Crossref 17. McLellan AT, Luborsky L, O'Brien CP, et al: Is treatment for substance abuse effective? JAMA 1982;247:1423-1428.Crossref 18. Woody GE, Carr EK, Stanton ME, et al: Program flexibility and support , in Stanton MD, Todd TG, et al (eds): The Family Therapy of Drug Abuse and Addiction . New York, Guilford Press, 1982, pp 393-402. 19. Malan D: A Study of Brief Psychotherapy . Philadelphia, JB Lippincott Co, 1963. 20. Sifneos P: Short-term Psychotherapy and Emotional Crisis . Cambridge, Mass, Harvard University Press, 1972. 21. Wallerstein R, Robbins L, Sargent H, et al: The psychotherapy research project of the Menninger Foundation . Bull Menninger Clin 1956;20:221-280. 22. Orne M, Wender P: Anticipatory socialization for psychotherapy: Method and rationale . Am J Psychiatry 1968;124:88-98. 23. Beck AT, Beck AW: Screening depressed patients in family practice . Postgrad Med 1972;52:81-85. 24. Eysenck HJ: The Manual of the Maudsley Personality Inventory . London, University of London Press, 1959. 25. Derogatis L, Lipman R, Rickels K: The Hopkins symptom checklist (HSCL): A self-report symptom inventory . Behav Sci 1974;19:1-16.Crossref 26. Nunnally J: Psychometric Theory . New York, McGraw-Hill Book Co, 1967. 27. Endicott J, Spitzer RL: A diagnostic interview: The schedule for affective disorders and schizophrenia . Arch Gen Psychiatry 1978;37: 837-844.Crossref 28. McLellan AT, Luborsky L, O'Brien CP, et al: Improved diagnostic instrument for substance abuse patients: The Addiction Severity Index . J Nerv Ment Dis 1980;168:26-33.Crossref 29. Dole VP, Nyswander ME, Des Jarlois D, et al: Performance-based rating of methadone maintenance programs . N Engl J Med 1982;306: 169-172.Crossref 30. McGlothlin WH, Anglin D: Long-term follow-up of clients of high- and low-dose methadone programs . Arch Gen Psychiatry 1981;38:1055-1063.Crossref 31. Fenichel O: The Psychoanalytic Theory of Neurosis . New York, WW Norton and Co Inc, 1945.

Journal

Archives of General PsychiatryAmerican Medical Association

Published: Jun 1, 1983

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