Rounsaville B J, Kleber H D
Int J Addict. 1985 Jun-Jul;20(6-7):869-96. doi: 10.3109/10826088509047757.
The authors review evidence from outcome studies of psychotherapy for opiate addicts and make recommendations regarding the use of psychotherapy on the basis of the findings. The place of psychotherapy is evaluated for three types of treatment settings: outpatient drug-free treatment, narcotic antagonist treatment, and methadone maintenance. The heterogeneity of opiate addicts is emphasized, as is the need for multidimensional assessment of clients in order to maximize the effectiveness of psychotherapies offered. In each of the treatment settings evaluated, psychotherapy appears to be most promising for a subgroup of those seen. For outpatient drug-free treatment, psychotherapy appears to be most useful for the new client with no treatment history, the successful client graduating from a more intensive program, the client who has temporarily relapsed, and the client leaving jail or a hospital. In a narcotic antagonist program, psychotherapy appears to be most useful for clients entering the program from illicit heroin use and not for those switching from methadone maintenance to a narcotic antagonist program. Moreover, in the maintenance phase of the program, preliminary evidence suggests the value of family therapy for aiding treatment retention. Regarding psychotherapy in the context of a methadone maintenance program, it appears to be best reserved for those addicts who present to treatment with relatively severe levels of psychiatric symptoms.
作者回顾了针对阿片类成瘾者心理治疗的结果研究证据，并根据研究结果就心理治疗的使用提出了建议。针对三种治疗环境评估了心理治疗的地位：门诊戒毒治疗、麻醉拮抗剂治疗和美沙酮维持治疗。强调了阿片类成瘾者的异质性，以及对患者进行多维度评估的必要性，以便使所提供心理治疗的效果最大化。在评估的每种治疗环境中，心理治疗对于所见到的一部分患者似乎最有前景。对于门诊戒毒治疗，心理治疗对于没有治疗史的新患者、从更强化项目毕业的成功患者、暂时复吸的患者以及刚从监狱或医院出来的患者似乎最有用。在麻醉拮抗剂项目中，心理治疗对于从非法使用海洛因进入该项目的患者似乎最有用，而对于从美沙酮维持治疗转为麻醉拮抗剂项目的患者则不然。此外，在该项目的维持阶段，初步证据表明家庭治疗有助于维持治疗。关于在美沙酮维持治疗项目背景下的心理治疗，似乎最好留给那些出现相对严重精神症状的成瘾者。
