Drug abuse treatment occurs in a multitude of forms. It may be provided in outpatient or inpatient settings, be publicly or privately funded, and may or may not involve the administration of medication. The differences among the philosophies of, and the services provided in, various drug abuse treatment programs may be enormous.
What is remarkable is that some form of drug abuse counseling or psychotherapy is almost invariably a part of every type of comprehensive drug abuse treatment. Individual therapy or counseling is available in about 99 percent of the drug-free, methadone-maintenance, and multiple-modality drug abuse treatment units in this country (National Drug and Alcoholism Treatment Unit Survey 1982). It is also available in approximately 97 percent of the detoxification units.
Despite the fact that drug abuse counseling and psychotherapy are nearly universal in drug abuse treatment, surprisingly little is known about these forms of treatment. Much more research has focused on pharmacological treatments for drug abuse than on nonpharmacological, even though nonpharmacological interventions are almost always utilized and are sometimes the only form of treatment offered to the drug abuser.
In part, the paucity of research in this field is due to the inherent difficulties in scientifically investigating psychotherapy and counseling. It has not been uncommon for a psychotherapy/counseling research study to be denied funding because reviewers believed that fundamental, minimal standards for a scientific investigation had not been met.
Even the most basic experimental standard, the double-blind method, is a virtual impossibility in comparative psychotherapy research.
London provides an excellent synopsis and integration of the entire conference in the final contribution to this monograph. He also directs our attention to areas where further research is needed. He emphasizes the fact that although drug counselors are typically in positions of low pay and status, they are “on the treatment firing line” and that their work is extremely important. London believes that the study of drug abuse counseling and counselors, therefore, should be a primary focus of researchers in this field.
London also suggests that due to the repeated assertion (in the absence of firm data) of the importance of 12-step programs as part of drug abuse treatment by clinicians and researchers in the drug abuse field, the secular and scientific study of such programs is essential.
It is our hope that both beginning and experienced drug abuse researchers in the psychotherapy/counseling field will benefit from the insights put forth in this monograph and The Treatment Research Branch of NIDA has a strong interest in expanding and facilitating research on the psychotherapy and counseling of drug abusers. Following our Technical Review, we issued a program announcement entitled “Psychotherapy and Counseling in Drug Abuse Treatment” to solicit applications for the funding of original research studies in this area.
We have also initiated the development of a national, multisite collaborative study to maximize and compare the efficacy of psychodynamic psychotherapy, cognitive/behavioral therapy, and drug counseling in the treatment of cocaine abusers.not be too discouraged by the enormity of the problems intrinsic to this field. It is our belief that an understanding of these problems is the first step in dealing with them.
While no one research study can overcome all of the problems described in this monograph, systematic research that addresses our questions from many different perspectives may provide us with the answers we need.
It is our belief that the importance of the “talking” therapies in the treatment of drug abuse cannot be underestimated. Even where effective pharmacotherapies are already available for drug abuse treatment, few would argue that they should be administered without concurrent counseling or psychotherapy except under emergency circumstances when it is not possible to provide these services.
Many would argue that pharmacotherapy should never be given in isolation. In any event, effective pharmacotherapies do not exist for every form of substance abuse. The mainstay of drug abuse treatment is psychotherapy and/or drug counseling. It is crucial that we understand how and why they work.