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Addiction psychotherapy consists of evidence-based psychosocial treatments to treat individuals with substance use disorders. Optimal treatment of addiction requires the incorporation of addiction psychotherapy. There are many different forms of psychotherapy for addiction which can be delivered through in-person or virtual modalities. This activity reviews the theory, application, and evidence of addiction psychotherapies and highlights the role of the interprofessional team in treating addiction. Objectives: Explain the importance of incorporating addiction psychotherapy in treating substance use disorders. Describe the basic features of motivational interviewing, mutual help groups, family therapy, cognitive-behavioral therapy, contingency management, psychodynamic, and supportive psychotherapy applied to addiction psychotherapeutic care. Summarize the evidence behind the different types of addiction psychotherapy. Explain how to choose between different addiction psychotherapies. Access free multiple choice questions on this topic.

Substance use disorders (SUDs) currently affect over 19 million people in the United States over the age of 18.[1] SUDs result in significant individual and societal costs, resulting in medical and psychiatric complications, lost employment, criminal justice system involvement, social impairment, and an estimated 13.2 billion dollars per year in hospital admissions attributed to medical complications of substance use.[2] The prevalence of SUDs has been increasing, and the number of overdose-related deaths has skyrocketed in the past several decades, with an estimated 92,000 individuals dying from an illicit drug overdose in 2020.[3] Individuals with SUDs persist in addiction despite mounting adverse consequences. Their chronic use is maintained through neurobiological brain changes caused by recurrent substance exposure that leaves the individual in an uncomfortable and unstable state in the absence of the drug. The individual becomes dependent on the drug and becomes caught in a spiral of intoxication, withdrawal, and preoccupation with obtaining the substance. Social factors also influence substance use, although these tend to predominate primarily in early decisions around substance use before physical dependence develops. Many patients with SUDs also have pre-existing psychiatric conditions predisposing them to recurrent substance use and addiction. Ultimately, treatment of the comorbidity is needed to treat SUD successfully.[4] Ideal substance use treatment, therefore, requires a multimodal, multidisciplinary approach incorporating both medication and psychosocial interventions to address multiple risk factors contributing to ongoing use.[5]

Substance use disorders are heterogeneous conditions with multiple contributing biological, psychological, and environmental risk factors. There is no one approach to treating SUDs, and optimal healthcare outcomes require individualized care.[42] The primary goal is to engage and retain patients in care, which requires a multidisciplinary approach involving case managers, physicians, pharmacists, nurses, and therapists. In the context of an interprofessional team, team members have both overlapping and unique roles. Psychologists, psychiatrists, social workers, and mental health counselors can all work with patients in an individual or group psychotherapeutic setting. For example, although the physician’s primary role in the team may be to prescribe medications and treat medical and psychiatric complications, motivational interviewing techniques are useful for exploring ambivalence toward medication adherence and overall treatment engagement. These same techniques may be helpful for nurses working with patients in a CM program to provide positive reinforcement for treatment attendance and continued sobriety. Understanding the basic concepts of addiction psychotherapy will help the provider in building a therapeutic alliance of understanding and trust, avoiding a lost opportunity for treatment engagement. Learning basic concepts of addiction psychotherapy can help build understanding, trust, and therapeutic alliance, which provide universal benefits to treatment engagement regardless of the discipline. Psychotherapy for SUDs is a crucial part of a comprehensive treatment program. Medication alone is often insufficient to address all of the triggers and risk factors resulting in ongoing use. Although there are different schools of psychotherapy used to treat SUDs with a seemingly different theoretical basis, there is substantial overlap between different forms of therapy. Many head-to-head studies comparing two or more specific kinds of therapy have demonstrated similar efficacy for different forms of therapy. Therefore, various therapies may rely on common drivers of change, such as exploring triggers and developing coping skills upon a strong therapeutic alliance. Increased knowledge and training in addiction psychotherapeutic care will improve the quality of addiction care.[18] [Level 2]