Am J Psychiatry 1993; 150:28-36
Copyright © 1993 by American Psychiatric Association
Network therapy for addiction: a model for office practice
M Galanter
Department of Psychiatry, New York University School of Medicine, NY 10016.
Individual therapists in office practice are often considered to have
limited effectiveness in treating alcohol and drug dependence. In this
article the author describes network therapy, an approach developed to
assure greater success in such treatment. It uses psychodynamic and
behavioral therapy while engaging the patient in a support network composed
of family members and peers. A cognitive-behavioral model of addiction,
based on the role of conditioned withdrawal in relapse, is described.
Related techniques for securing abstinence are then reviewed; they augment
individual psychotherapy to help patients avoid relapse caused by the
affective and environmental cues that precipitate drug seeking. The role of
social cohesiveness as a vehicle for engaging patients in treatment is
outlined next, along with a related technique for enhancing an addicted
patient's commitment to the therapy. This is done by using the patient's
family and peers as a therapeutic network to join the patient at intervals
in therapy sessions. The network is managed by the therapist to provide
cohesiveness and support, undermine denial, and promote compliance with
treatment. The author presents applications of the network technique
designed to sustain abstinence and describes means of stabilizing members'
involvement. Applications of network therapy to ambulatory detoxification,
disulfiram and naltrexone administration, relapse prevention, and
contingency contracting are reviewed.
