Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

458 V. TREATMENTS FOR ADDICTIONSAlthough we believe that there are indications for referring addicts to psychotherapy,often patients themselves begin the treatment of their addictionwith psychotherapy (perhaps particularly those who are more psychologicallyoriented). Others start individual psychotherapy after first seeking treatmentthrough self-help groups or a more educationally based treatment program, suchas that offered in many inpatient settings and outpatient clinics. In either case,via exploring their emotional issues, patients begin to understand not only theirown psychology but also the place of substance abuse in their emotional lives.This understanding not only addresses the reasons for their continued problemseven when chemical free but also, by placing the substance problem in the contextof their emotional lives, provides a strong internal basis for avoidingrelapse.Another route into individual psychotherapy for addicted patients is viarepeated treatment failures in other, less introspective settings. Some of thesepatients repeatedly relapse, despite clear and conscious motivation to abstain,because they are unaware of the internal, largely unconscious factors that leadthem to resume substance use. Failing to recognize the role of unconscious processescauses patients to attribute their behavior to lack of willpower, whichcontributes further to their self-devaluation. Learning about themselves in individualpsychotherapy thus contributes not only to a more stable chemical-freestate and to overall general improvement in emotional function but also todiminished shame concerning their addiction.Many addicts may also successfully pursue individual psychotherapy inconjunction with other treatment (e.g., Alcoholics Anonymous [AA], NarcoticsAnonymous [NA], or a professionally led group therapy). In such cases,the individual work aims for the usual goals of insight and emotional growth,while the other modalities focus on supporting the patient’s chemical-free state.A number of studies substantiate the value of individual psychotherapywith addicts. Woody and colleagues (1983) noted that in seven investigationswith methadone-treated patients, where patients were randomly assigned topsychotherapy or a different treatment (most often drug counseling), five of thestudies showed better outcome in the psychotherapy group. Woody’s own groupalso found that patients who received psychotherapy and drug counseling hadbetter results than did patients who received drug counseling alone, when measuredin terms of number of areas of improvement, less use of illicit opiates, andlower doses of methadone required. This group (Woody, McLellan, Luborsky,& O’Brien, 1986) noted further that the patients with the most disturbedglobal psychiatric ratings benefited particularly from psychotherapy, as comparedwith drug counseling. A number of investigators documented early a highcorrelation between psychiatric disorders, especially depression, and addiction(Khantzian & Treece, 1985; Rounsaville, Weissman, Kleber, & Wilber, 1982).These findings have been substantiated in a more recent series of clinicaland epidemiological studies (Carroll & Rounsaville, 1992; Halikas, Crosby,