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