Psychosocial Treatments

Although this chapter has presented only pharmacotherapies for opioid addiction, it is crucial that psychosocial interventions be used to help these patients change their lifestyles. It is generally accepted that escape from drug seeking and the accompanying antisocial impulses requires a change in deeply rooted behavioral patterns. Individual and group psychotherapy may be useful in approaching this goal. Contingency management may be very helpful (Robles, Stitzer, Strain, Bigelow, & Silverman, 2002). The various 12-step programs such as Narcotics Anonymous are also useful adjuncts to treatment and facilitate significant degrees of change. For those persons who continue to relapse in less restrictive treatment settings, a "therapeutic community" may be the appropriate next step (O'Brien & Biase, 1981); these nonhospital, community-based, 24-hour, live-in programs are geared to subject the addict to continuous treatment pressure for as long as 1 or 2 years. Personal freedom is severely curtailed, and community rules are rigorously enforced. The goal is to use nonviolent but highly confrontational tactics, in the context of peer pressure, for the purpose of breaking down denial and exposing destructive attitudes and behaviors that formerly led to drug use (Rosenthal, 1989). A growth process may then occur, allowing the individual to achieve a degree of personal integrity that is unrelated to the former identity of drug abuser. When successful, this type of personal transformation can lead to permanent recovery. However, this form of treatment requires total commitment, which many opioid addicts are unable to make; thus, the dropout rate is high. As with any treatment modality, selection of appropriate candidates leads to greater success.

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