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

644 V. TREATMENTS FOR ADDICTIONSered alone, without any supportive or compliance-enhancing elements, are usuallynot considered feasible. Even where pharmacotherapy is seen as the primarytreatment approach (as in the case of methadone maintenance), someform of psychosocial treatment is used to provide at least a minimal supportivestructure within which pharmacotherapeutic treatment can be conducted effectively.Furthermore, medication effects can be enhanced or diminished withrespect to the context in which they are delivered; that is, a medication administeredin the context of a supportive clinician–patient relationship, with clearexpectations of possible medication benefits and side effects, close monitoringof compliance, and encouragement for abstinence, is more likely to haveenhanced effectiveness than a medication delivered without such elements.Thus, even for primarily pharmacotherapeutic treatments, a psychotherapeuticcomponent is almost always included to foster patients’ retention in treatmentand compliance with pharmacotherapy, and to address the numerous comorbidpsychosocial problems that occur so frequently among individuals with SUDs(Carroll, 2001).TREATMENT OF ALCOHOL DEPENDENCEThere is now a comparatively wide range of empirically supported behavioraltherapies for alcohol use disorders, including brief intervention, social skillstraining, cognitive-behavioral therapies, family/couple and network therapies,and motivational interviewing (DeRubeis & Crits-Christoph, 1998; Miller &Wilbourne, 2002). The availability of a much broader array of effective treatmentoptions led in part to Project MATCH, a large, multisite study of a prioritreatment-matching hypotheses, in which 1,726 alcohol-abusing or -dependentpatients were randomly assigned to either motivational enhancement therapy(Miller, Zweben, DiClemente, & Rychtarik, 1992), 12-step facilitation(Nowinski et al., 1992), or cognitive-behavioral therapy (Kadden et al., 1992),all delivered as individual treatments over 12 weeks. While the results of thislandmark study indicated few strong indicators of matching or differentialresponse to these treatments, a major finding of Project MATCH was thatthese three therapies were followed by marked and sustained reductions in alcoholconsumption (Project MATCH Research Group, 1997, 1998). To illustrate,in all three conditions, patients, on average, entered treatment drinkingmore than 80% of days, rapidly reduced their consumption to less than 15% ofdays, and kept those levels down at follow-up visits over 3 years. Thus, oneimplication of these findings is that delivery of a high-quality individual behavioraltherapy can be associated with meaningful change in individuals with awide range of alcohol disorders and associated problems.There have been a number of developments in the pharmacotherapy ofalcohol use disorders as well. The most commonly used pharmacological