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Am J Psychiatry 1995; 152:1302-1308
Copyright © 1995 by American Psychiatric Association
Psychotherapy in community methadone programs: a validation study
GE Woody, AT McLellan, L Luborsky and CP O'Brien
Department of Psychiatry, University of Pennsylvania/Philadelphia, USA.
OBJECTIVE: The authors tested the efficacy of individual psychotherapy in
the rehabilitation counseling of psychiatrically symptomatic opiate-
dependent patients during methadone maintenance treatment in community
programs. METHOD: Volunteers in three community programs were randomly
assigned to 24 weeks of counseling plus supplemental drug counseling or to
counseling plus supportive-expressive psychotherapy. Follow-ups were done 1
and 6 months after treatment ended. A total of 84 subjects were evaluated
at both follow-up points. RESULTS: During the study the patients receiving
supportive-expressive psychotherapy and those receiving drug counseling had
similar proportions of opiate-positive urine samples, but the patients
receiving supportive-expressive psychotherapy had fewer cocaine-positive
urine samples and required lower doses of methadone. One month after the
extra therapy ended both groups had made significant gains, but there were
no significant differences between groups. By 6-month follow-up many of the
gains made by the drug counseling patients had diminished, whereas most of
the gains made by the patients who received supportive-expressive
psychotherapy remained or were still evident; many significant differences
emerged, all favoring supportive-expressive psychotherapy. CONCLUSIONS:
Psychotherapy can be delivered to psychiatrically impaired patients in
community methadone programs. Additional counseling is associated with
early benefits comparable to those from psychotherapy, but these gains are
not sustained. The gains associated with psychotherapy persist and in some
cases strengthen for at least 6 months after the end of therapy.
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