Psychosocial treatment Combined drug and

While a full discussion of treatment planning procedures is beyond the scope of this chapter (for additional discussion, see Chapters 31, 32, and 33 in this volume), several important principles merit elaboration insofar as they apply to combining drug and psychosocial interventions. The discussion here is primarily clinical in orientation. A seminal discussion of methodological issues that arise in comparative treatment trials can be found in a series of articles describing the MTA study (Arnold et ak, 1997a Hinshaw et ak, 1997 Greenhill et ak, 1998 Wells, in press). 

Muller and Schoneich (1992) also reported on favorable experience with intensive outpatient psychotherapy combined with antipsychotic drug treatment. On the basis of a before-and-after comparison over 2x5 years in a university outpatient clinic, they were able to show that the duration of rehospitalizations required by 89 patients could be reduced from a mean of 10 weeks to 2 weeks per year when a special schizophrenia outpatient service offering individualized psychotherapy and psychosocial treatment was available to the patients instead of the routine psychiatric outpatient service. A beneficial effect of psychotherapy was demonstrated both in those patients taking antipsvchotics continuously for long-term prophylaxis and in those taking the drugs intermittently when prodromal symptoms appeared in order to prevent relapse. 

In one sense, designating treatments as pharmacological or nonpharmacological misrepresents clinical practice because, especially in recent years, treatment for illicit drug use often combines pharmacological and psychosocial therapies. In fact, rarely is a... 

Antipsychotics versus combined antipsychotic therapy and psychotherapy (five studies). Here, too, the results were clearly in favor of drug therapy because there were virtually no relevant differences between patients receiving antipsychotics alone and those treated with antipsychotics phis psychotherapy. Three of the five studies involved group therapy and the other two individual psychotherapy neither of these forms of psychosocial treatment augmented the effect of the simultaneously administered antipsychotics to any demonstrable extent. 

Treatment of acute overdoses of opioids can be lifesaving and is described in Chapters 31 and 59. In long-term treatment of opioid-dependent persons, pharmacologic and psychosocial approaches are often combined. Chronic users tend to prefer pharmacologic approaches those with shorter histories of drug abuse are more amenable to detoxification and psychosocial interventions. 

BCT also can reduce drug use and improve psychosocial problems when combined with methadone treatment. Fals-Stewart et al. (2001) randomly as-... 

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