Psychosocial Treatments for Substance Use Disorders

Abstract

Our review of the literature indicates that among the most effective treatments for alcohol and illicit drug use disorders are cognitive-behavioral treatments, community reinforcement and contingency management approaches, 12-step facilitation and 12-step treatment, behavioral couples and family treatment, and motivational enhancement interventions. Most of these treatment modalities address not only drinking and/or drug use behavior but also patients’ life contexts, sense of self-efficacy, and coping skills; motivational interventions focus primarily on attempts to enhance individuals’ commitment to behavior change. Consistent with motivational interviewing principles, therapists who are interpersonally skilled, empathic, and less confrontational produce better patient outcomes, probably because they establish better therapeutic alliances with their patients. An effective strategy for many patients may be to provide lower intensity treatment for a longer duration—that is, treatment sessions spread at a lower rate over a longer period to match better the chronic, relapsing nature of many individuals’ substance use disorders. At this point, it seems wise to restrict brief interventions as a stand-alone treatment to patients with mild to moderate disorders. Longer term interventions and treatment in inpatient or residential settings should be reserved for patients with more severe, treatment-resistant substance use disorders, fewer social resources, more concomitant medical/psy…