16 - An overview of psychological interventions for addictive behaviours

Summary

Summary The efficacy of psychological interventions for the treatment of addiction problems has received considerable attention in the research literature as well as within the policy and service arenas. Psychological interventions can be used on their own or as an adjunct to pharmacological treatments. In UK drug treatment services attempts have been made to disseminate interventions based on psychological models of understanding addictive behaviours. There is an encouraging evidence base for the effectiveness of psychological interventions for a wide variety of addictive behaviours. Evidence-based psychological treatments include cognitive–behavioural and motivational treatments, contingency management, 12-step approaches and family and social interventions. Although the literature suggests that such treatments lead to improved outcomes when compared with no treatment at all, the evidence favouring one type of psychological intervention over another is less clear. Further research comparing the effectiveness of a broad range of psychological interventions delivered as brief or longer-term treatments needs to be undertaken with particular emphasis on pragmatic trials delivered in routine clinical settings and cost-effectiveness analyses. Other factors such as therapist characteristics and service variables are important in determining treatment effectiveness and need to be the focus of further research studies.

Psychological approaches to the treatment of drug and alcohol problems vary depending on the specific theoretical model on which they are based (e.g. cognitive, behavioural or social). Most psychological approaches, however, make use of the interaction between a therapist and a client (or client and family and/or other members of the social network) in order to raise awareness of and elicit changes in the client's behaviour (e.g. drug or alcohol use) as well as related factors, including thoughts and emotions.

Psychological interventions for clients misusing drugs or alcohol can be said to fall within two broad categories: (i) those that aim to help the individual make changes in their substance misuse behaviour, through reduction, stabilisation or abstinence; and (ii) those that aim to address co-occurring psychological difficulties such as anxiety, low mood, trauma, obsessive–compulsive problems and personality disorder (Wanigaratne et al, 2005). In practice, these psychological adjustment difficulties might be important in the origin and/or maintenance of an individual's substanceusing behaviour and so to some extent these may need to be addressed even when the main focus of treatment is attempting to change that behaviour.