Treatment approaches

(See E Cognitive behavioural therapy in Chapter 5, pp. 172-84.)

Addiction disorders are chronic recurring disorders, often associated with enduring maladaptive behaviour patterns that have been developed over time; treatment involves identifying and addressing these behaviours, including factors that predispose the individual to substance use, that act to maintain substance use and are triggers for relapse. A major aspect of addiction treatment involves behaviour change.

Treatment for addiction utilizes a number of evidence-based pharmacological and non-pharmacological interventions, adhering to core basic principles: harm reduction, specific treatments, relapse prevention, and rehabilitation with individual recovery. pharmacological interventions, where clinically applicable, are most effective when administered in conjunction with psychological interventions.

Psychosociai interventions

The main UK guidelines for management of addiction recommend formal psychosocial interventions (PSI) in the treatment of drug misuse- related problems, including co-occurring mental disorders, e.g. CBT for depression, formal PSI or discrete packages of PSI which may be delivered alongside basic key working and pharmacological interventions, if appropriate. In the field of addiction practice, PSI are used to indicate psychological therapy, with some of the psychological therapies focusing on the social network. With a majority of the drugs liable to be misused, e.g. cannabis, novel psychoactive substances, or gambling, PSI are the only treatments available. This is because there are no evidence-based pharmacological treatments or substitute prescribing available for these substances.

As per guidance from Public Health England, the interventions are categorized as either low- or high-intensity, that allow ease of application of the ‘stepped approach’ to care (see Table 7.2).

PSI interventions can be delivered in an individual or group setting. They can be delivered in different formats, including therapist-facilitated, using maps or computerized manuals, and self-directed homework. Factors, such as clinical competence, empathy, warmth, congruence, and the therapeutic alliance, can influence outcomes.

In a typical service model employing the stepped-care approach to treatment, clients would first be offered a low- i ntensity intervention. If there are no successful outcomes, in terms of addiction or co-morbid mental health, then care is ‘stepped up’ to high-intensity interventions.

Table 7.2 Psychosocial interventions

Low-intensity PSI

High-intensity PSI

Delivered by

Keyworkers/clinical nurse specialists

Qualified psychologists


DANoS competencies, usually level 5 counselling skills

Specific training in psychological therapies, with a focus on addiction

To address drug use





Behavioural couples therapy

To address mental health problems

CBT by guided self-help Behavioural activation Treatment engagement

CBT for depression and anxiety

Formal psychological therapies


To reduce substance use To minimize harm To address relapse prevention

To address co-morbid mental health problems To work towards recovery and abstinence To bring about motivation to change in resistant patients

Suitable for/ideal client population

Suitable to engage service users in treatment, and supporting early changes in drug using behaviour, as well as achieving harm reduction goals

Suited to service users with a sufficient degree of stability and in those who may be working towards being drug-free


Suited for dual-diagnosis clients struggling to move towards recovery

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