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Drug and alcohol addiction: do psychosocial treatments work?

  • Jason Luty

Summary

Methodological issues such as social desirability bias, subjective outcome measures, therapist enthusiasm and fidelity to the intervention remain a major problem in assessing the effectiveness of psychosocial treatments for substance misuse. Alcoholics Anonymous and other 12-step programmes are still widely used, although it is difficult to formally assess their effectiveness. Motivational interviewing is perhaps the most commonly used professional psychosocial treatment for substance misuse, but brief interventions based on this technique report a disappointing effect size (∼0.2). Contingency management is perhaps the most effective reported modality, although it remains politically controversial. Cognitive—behavioural therapy and community reinforcement have been widely studied, but the results are often disappointing (effect sizes seldom exceed 0.5, despite very large trials). Residential rehabilitation remains an established treatment, but patient selection prevents formal cost-effectiveness studies.

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Copyright

Corresponding author

Dr Jason Luty, Borders Addiction Service, The Range, Tweed Road, Galashiels TD1 3EB, Scotland. Email: jason.luty@yahoo.co.uk

Footnotes

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Learning Objectives

! Recognise the difficulty of conducting and appraising research on psychosocial interventions Be aware of the most common psychosocial interventions Understand the modest differences between different psychosocial treatments, especially as reported from large trials such as Project MATCH, UKATT, COMBINE and SIPS

Declaration of Interest

None.

Footnotes

References

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Drug and alcohol addiction: do psychosocial treatments work?

  • Jason Luty
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