Psychotherapy in Substance Use Disorders

Volume 6 Issue 1 January 2016

Psychotherapies are effective treatment methods for substance use disorders (SUD). Psychotherapy not only keeps the persons with SUD in treatment but works on to enhance motivation and prevent relapses. There are different psychotherapies used in the area of de-addiction. Among them, motivational interviewing and relapse prevention are most commonly used.

Motivational Interviewing (MI) is the therapeutic method which deals with different factors (including belief systems) related to poor motivation for behaviour change. Due to several misconceptions and myths related to substance use, people continue to use substances, despite knowing harms caused by substances. Motivational Enhancement Therapy and Brief Intervention are commonly used MI methods to improve motivation and maintain it. Some of the techniques used in such therapies are- giving personalized feedback, weighing cost and benefit of use and quitting substances, managing resistance for change, supporting self-efficacy etc. Therapists try to establish rapport with the patient, show concern and conduct the interview/therapy in an empathic manner. The therapist remains non-judgmental throughout the therapeutic relationship and never preaches or does moralistic counselling. Coercion and pressure techniques are never to be used by the therapist.

Relapse Prevention Therapy is generally used during maintenance stage (i.e. abstinent period) with the aim of preventing relapse by improving coping and problem solving skills. The focus of discussion between therapist and patient is to identify and manage different high risk situations (factors which cause relapse) and develop mastery on it by using healthy coping strategies. For example, managing negative mood state by spending time with family members or indulging in a hobby rather than improving mood by taking alcohol or any substances. The difference between lapse and relapse is explained to the patient and the role of its interpretation in relapse. Therapist has to find out different beliefs associated with substance use (e.g. its effect, reasons of relapse perceived by patients etc.) and correct or modify such beliefs using various cognitive-behavioural techniques.

Motivational interviewing and Relapse prevention therapy are usually tailor made to deal with individual case with different psychosocial milieu. Most of psychiatrists, psychologists, psychiatric social workers and other practitioners do find both the techniques quite effective in day to day clinical practice.