Psychotherapy for addictions: Motivation is key, research finds

Psychotherapeutic approaches are, at best, moderately effective in helping people with substance abuse or addiction problems reduce their dependence.

That is the conclusion of a meta-review of the literature by a research team led by Alexandre Dumais, a professor in the Department of Psychiatry and Addiction at Université de Montréal and a researcher at the Institut universitaire en santé mentale de Montréal.

Their findings were published in June in the journal Psychiatry Research.

The team looked at 23 meta-analyses of studies with samples ranging from 130 to 33,000 subjects and sought to evaluate the efficacy of various psychotherapeutic approaches to treating repeated abuse of alcohol, cannabis, stimulants (cocaine, amphetamines, etc.), opioids (morphine, fentanyl, etc.) and anti-anxiety drugs.

The approaches evaluated included cognitive-behavioral therapy (CBT), contingency management, voucher-based reinforcement therapy, motivational interviews and motivational enhancement therapy.

Dumais' team analyzed studies that measured the effectiveness of therapies for up to 12 months after the intervention.

Persistence not clear

For the treatment of alcohol use, they found that studies that measured the effect of brief psychotherapeutic intervention with adolescents and adults showed small reductions in frequency and/or quantity of alcohol consumption in the first few months, but the persistence of the effect at 6 or 12 months was not clear. CBT produced no statistical difference in drinking frequency or quantity when used alone and a modest effect when combined with motivational interviews.

For cannabis dependence, brief psychotherapeutic interventions had a negligible effect while CBT combined with motivational approaches moderately reduced the frequency of use four months after the intervention.

For addiction to stimulants, some studies found that CBT reduced the number of days participants used amphetamines in the course of a month, while contingency management reduced stimulant use during the intervention but abstinence was not maintained in the following months.

Finally, motivational approaches had no significant effect on benzodiazepine abuse, while CBT combined with a gradual reduction in benzodiazepine doses enabled some subjects to maintain abstinence for up to three months.

'Positive change in the short-term'

While the studies reviewed suggest that psychotherapies do not yield major long-term improvement, "they can produce positive change in the short-term," said Dumais.

He noted that the effectiveness of psychotherapeutic approaches can be influenced by the experience, training and skill of the therapists, which can lead to significant variability in the delivery of addiction treatments.

As the studies reported an average dropout rate of 30%, motivation is an important factor in achieving positive outcomes in addiction treatment, Dumais noted.

"The results of our meta-review show that while the results are modest, some approaches do work and are worth trying," he concluded. "It is best to approach therapy for addiction with moderate expectations, but the important thing is to get help and be motivated to change one's behavior."