The Effects of Psychosocial Services in Substance Abuse Treatment

Abstract

Objective.\p=m-\To examine whether the addition of counseling, medical care, and psychosocial services improves the efficacy of methadone hydrochloride therapy in the rehabilitation of opiate-dependent patients.Design Results.\p=m-\Whilemethadone treatment alone (MMS) was associated with reductions in opiate use, 69% of these subjects had to be "protectively transferred" from the trial because of unremitting use of opiates or cocaine, or medical/ psychiatric emergencies. This was significantly different from the 41% of SMS subjects and 19% of EMS subjects who met the criteria. End-of-treatment data (at 24 weeks) showed minimal improvements among the 10 MMS patients who completed the trial. The SMS group showed significantly more and larger improvements than did the MMS group; and the EMS group showed significantly better outcomes than did the SMS group. Minimum methadone services subjects who had been "protectively transferred" to standard care showed significant reductions in opiate and cocaine use within 4 weeks.Conclusions.\p=m-\Methadonealone (even in substantial doses) may only be effective for a minority of eligible patients. The addition of basic counseling was associated with major increases in efficacy; and the addition of on-site professional services was even more effective. (JAMA. 1993;269:1953-1959

Trends in comprehensive service availability in outpatient drug abuse treatment

“…The current study could not detect changes in the reported availability of most medical and psychosocial services during the 1990s, despite research demonstrating the benefit of these services (McLellan, Arndt, et al, 1993;McLellan et al, 1997). One exception was physical examinations, whose reported availability increased in the early 1990s, confirming earlier findings ; however, that increase leveled off from 1995 to 2000.…”

“…Because a range of 'secondary' problems, such as physical or mental illness, unemployment, and homelessness, contribute to the progression of addictive disorders, substance abuse treatment programs may also make available comprehensive or 'wrap-around' services to address 'secondary' problems (Institute of Medicine, 1990;Moos & Finney, 1995). These problems may cause distress and trigger relapse even among persons who successfully reduce their substance use (Friedmann, Saitz, & Samet, 1998;McLellan & Weisner, 1996), and delivery of comprehensive services to address these issues has been shown to improve functioning, treatment retention, and outcomes (McLellan, Arndt, Metzger, Woody, & O'Brien, 1993;McLellan, Grisson, et al, 1993;McLellan & Weisner, 1996;McLellan et al, 1998). Despite their importance to quality substance abuse treatment (Leshner, 1999;Leukefeld, Pickens, & Schuster, 1992), the availability of comprehensive services declined from 1980to 1990(D'Aunno & Vaughn, 1995Etheridge, Craddock, Dunteman, & Hubbard, 1995;McLellan & Weisner, 1996;Widman, Platt, Lidz, Mathis, & Metzger, 1997).…”

A behavioral treatment for opioid-dependent patients with antisocial personality

“…While the present study could not determine if antisocial personality increases non-adherence because a non-APD comparison group was not included in the design; the results do show that the experimental intervention was associated with a four-fold increase in the likelihood of attending scheduled counseling sessions. The high rate of counseling attendance (80%) observed in the experimental group is considerably better than the average attendance rate (about 50%) reported across other treatment outcome studies of opioid-dependent patients receiving methadone (Fiorentine & Anglin, 1997;Kidorf, King, & Brooner, 2006;McLellan, Arndt, Metzger, Woody, & O'Brien, 1993). The high rate of attendance in the present study is also consistent with earlier reports showing that behavioral incentives can be used contingently to motivate good patient attendance to a variety of types and intensities of routine and specialized counseling and therapy in drug-dependent patients (Brooner et al, 2004;Kidorf et al, 2006).…”

Drug Addiction, Dysregulation of Reward, and Allostasis

“…Assuming that the reductionist approach is useful in bringing about precise knowledge concerning biologic aspects of addiction, new conceptual frameworks will be required to understand what has been labeled as "the quintessential biobehavioral disorder" (Leshner 1999), a disorder deeply imbedded with psychosocial vulnerability as well as genetic vulnerability (Koob and Le Moal 1997). Such an integrated pathogenic view of addiction has profound implications for the treatment of drug abuse, and the best therapeutic approaches include social, behavioral and biological aspects, in combination with pharmacotherapies (Baxter et al 1992(Baxter et al , 1996McLellan et al 1993;O'Brien 1997;Project MATCH Research Group 1997;Schwartz 1999).…”