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

Other Psychotherapies28. Matching and Differential Therapies 649Other studies have evaluated other forms of psychotherapy as strategies toenhance outcome from opioid maintenance therapies. The landmark study inthis area was done by Woody and colleagues (1983) and replicated in communitysettings (Woody, McLellan, Luborsky, & O’Brien, 1995). While the originalstudy is now more than 20 years old, it is reviewed in some detail here,because it remains the most impressive demonstration of the benefits and roleof psychotherapy in the context of methadone maintenance programs. Moreover,it has generated several substudies that have added greatly to our understandingof the types of patients who benefit from psychotherapy in the contextof methadone maintenance programs.In this landmark study, 110 opiate addicts entering a methadone maintenanceprogram were randomly assigned to one of three treatments: drug counselingalone, drug counseling plus supportive–expressive psychotherapy (SE), ordrug counseling plus cognitive psychotherapy (CT). After a 6-month course oftreatment, although the SE and CT groups did not differ significantly fromeach other on most measures of outcome, subjects who received either form ofprofessional psychotherapy evidenced greater improvement in more outcomedomains than the subjects who received drug counseling alone (Woody et al.,1983). Furthermore, gains made by the subjects who received professional psychotherapywere sustained over a 12-month follow-up, while subjects receivingdrug counseling alone evidenced some attrition of gains (Woody, McLellan,Luborsky, & O’Brien, 1987). This study also demonstrated differential responseto psychotherapy as a function of patient characteristics, which may point tothe best use of psychotherapy (relative to drug counseling) when resources arescarce: While methadone-maintained opiate addicts with lower levels of psychopathologytended to improve regardless of whether they received professionalpsychotherapy or drug counseling, those with higher levels of psychopathologytended to improve only if they received psychotherapy. In addition,this study provides indications of differential response to psychotherapy by concurrentpsychiatric disorder. For example, depressed addicts improved with psychotherapy,while addicts with antisocial personality disorder tended to showlittle or no improvement, unless they are also had a depressive disorder (Woodyet al., 1995).New Maintenance TherapiesNew maintenance therapies that have recently been developed for opioiddependence hold the promise of making effective maintenance therapies morebroadly available. This is significant, because access to methadone treatment isquite limited; currently, fewer than one in five heroin users receives treatment