Psychotherapy for opiate addicts.

An opportunity to receive a six-month course of professional psychotherapy in addition to paraprofessional counseling was offered to opiate addicts who were beginning a new treatment episode on a methadone maintenance program. The treatments offered were drug counseling alone (DC), counseling plus supportive-expressive psychotherapy (SE), or counseling plus cognitive-behavioral psychotherapy (CB). Sixty percent of patients meeting the study criteria expressed an interest in the psychotherapy program and 60% of these actually became engaged. One hundred and ten subjects completed the study intake procedure, were randomly assigned to one of the three treatment conditions and kept three or more appointments within the first six weeks of the project. A variety of outcome measures showed that patients in all three treatment groups improved. Patients receiving the additional psychotherapies improved in more areas and to a greater degree than those who received counseling alone. The specific improvements seen appear to be related to the focus of the therapy used. Patients with antisocial personality disorder, as defined by Research Diagnostic Criteria, did not benefit significantly from therapy, but those with depression did. Patients with high levels of psychiatric symptoms made many significant gains if they received additional therapy, but improved only in drug use if they received counseling alone. Patients in all three treatment groups having low levels of psychiatric symptoms improved significantly in many areas. We conclude that more than a third of opiate addicts in our treatment program are interested in psychotherapy and many of these can benefit from it. Certain administrative procedures appear necessary to maximize the chances that psychotherapy can be used effectively with drug addicted patients.