PSYCHOTHERAPY IN COMMUNITY METHADONE PROGRAMS - A VALIDATION-STUDY

Objective: The authors tested the efficacy of individual psychotherapy in the rehabilitation counseling of psychiatrically symptomatic opiat e-dependent patients during methadone maintenance treatment in communi ty programs. Method: Volunteers in three community programs were rando mly assigned to 24 weeks of counseling plus supplemental drug counseli ng or to counseling plus supportive-expressive psychotherapy. Follow-u ps were done 1 and 6 months after treatment ended. A total of 84 subje cts were evaluated at both follow-up points. Results: During the study the patients receiving supportive-expressive psychotherapy and those receiving drug counseling had similar proportions of opiate-positive u rine samples, but the patients receiving supportive-expressive psychot herapy had fewer cocaine-positive urine samples and required lower dos es of methadone. One month after the extra therapy ended both groups h ad made significant gains, but there were no significant differences b etween groups. By 6-month follow-up many of the gains made by the drug counseling patients had diminished, whereas most of the gains made by the patients who received supportive-expressive psychotherapy remaine d or were still evident; many significant differences emerged, all fav oring supportive-expressive psychotherapy. Conclusions: Psychotherapy can be delivered to psychiatrically impaired patients in community met hadone programs. Additional counseling is associated with early benefi ts comparable to those from psychotherapy, but these gains are not sus tained. The gains associated with psychotherapy persist and in some ca ses strengthen for at least 6 months after the end of therapy.