The management of psychiatric comorbidity in an outpatient individual therapeutic program of addiction

Abstract

During last years there is an increasing tendency to develop treatments specifically tailored for addicted patients with psychiatric comorbidity. The Counseling Center offers an outpatient, drug counseling individual psychotherapeutic program. No medical treatment is administered except naltrexone which is prescribed to some selected heroin addicted users.

As substance use disorders and psychiatric disorders (psychotic, affective and anxiety disorders) commonly co-occur it is of great importance to facilitate early diagnosis so the therapist will be able to design the optimal management of users with a comorbid psychiatric disorder. If there is an evidence of comorbidity the user is also referred to a psychiatrist other than the drug counseling therapist who diagnoses and has the responsibility for the medical and psychotherapeutic treatment of this disorder.

The therapists' collaboration has two main intents: the abstinence from drug use and the recovery from the psychiatry disorder. In case abstinence is not succeeded or the comorbid disorder is not optimally treated the outcome of the treatment effort will not be successful.

Furthermore it is also important to give detailed information to the user about the therapeutic process and the way in which drug use contributes to the development and the maintenance of the psychiatric disorder. As for heroin users with psychiatric comorbidity the prescription of naltrexone will also be very helpful.