Psychosocial interventions

There is strong evidence for the effectiveness of psychosocial treatments for addiction disorders and it follows that psychiatrists should ensure competence to deliver these treatments as part of their repertoire of knowledge and skills. Specific protocol-based structured treatments have been demonstrated to be delivered effectively by therapists from across the spectrum of disciplines, including psychiatry. Many service users move out of problem substance use without recourse to professional help. For help-seekers, the specific intervention delivered is important, but equally important are therapist characteristics, social stability, psychological morbidity and the occurrence of positive life events after treatment. This contribution reviews the evidence base for some psychosocial interventions suitable for use by psychiatrists. The evidence supports the use of motivational, coping and social network therapies. Different treatments are likely to be most beneficial at different stages in the process of change – the nature of the interventions and when to use them are both covered here. Finally, there is some discussion of what constitutes effective therapy and how outcomes might be measured. It is concluded that psychosocial interventions should be the basis of bringing about change in substance use behaviour and that these may be enhanced by pharmacotherapies.