Pharmacotherapy and psychotherapy

In research and clinical treatment of substance use disorders, pharmacotherapy and psychotherapy are frequently combined. Medication is often used as a maintenance drug, to reduce cravings or intoxication, or to produce aversion to a substance, while the focus of psychotherapy may be to encourage abstinence, teach the patient new coping skills, or improve motivation to address drug or alcohol problems. 

For years, psychiatric and drug abuse disorders were not even treated together. Now we know they commonly co-occur, which means for many years clients were getting only partial treatment. Even today we are still not sure how to treat these co-occurring conditions simultaneously in a consistently effective way with both psychotherapy and pharmacotherapy (see Chapter 5). The next century is likely to see many advances in both pharmacotherapy and psychotherapy to treat co-occurring conditions. There are effective methods to treat drug abuse and to treat other co-occurring psychiatric disorders. The next frontier in research is to learn how to combine these approaches in a way that can treat multiple disorders at once ... 

Nierenberg AA, Petersen TJ, Alpert JE. Prevention of relapse and recurrence in depression the role of long-term pharmacotherapy and psychotherapy. J Clin Psychiatry 2003 64(Supplement 15) 13-17. 

Combining pharmacotherapy and psychotherapy an evidence-based approach... 

Comorbid anxiety has been associated with differential treatment response. This association predicts at times a better response to CBT and TCAs (Hughes et ah, 1990 Brent et ah, 1998). Treatment of comorbid anxiety, which most often precedes depression, is essential because the treatment contributes to improvement and may prevent future depressive episodes (Ko-vacs et ah, 1989 Hayward et ah, 2000). Fortunately, pharmacotherapy and psychotherapy treatments found useful for the treatment of MDD have also been found to be beneficial for treatment of youths with anxiety disorders (Kendall, 1994 RUPP Anxiety Group, 2001). 

How does the combination of pharmacotherapy and psychotherapy compare with either alone ... 

Bellack, A.S., Hersen, M. Himmelhoch, J. Social skills training compared with pharmacotherapy and psychotherapy in the treatment of unipolar depression. Am. J. Psychiatry 138, 1562-1567, 1981. 

Grinspoon L, Ewalt JR, Shader Rl. Schizophrenia pharmacotherapy and psychotherapy. Baltimore Williams Wilkins, 1968 67-74. 

Avoiding drugs that lower the threshold for panic symptoms, such as caffeine or over-the-counter stimulants, may also help. Some phobic symptoms are managed by in vivo exposure or cognitive therapy. In general, the best approach is a combination of pharmacotherapy and psychotherapy, in particular, cognitive behavioral techniques. 

As with other anxiety-related disorders, there is growing support for the treatment of PTSD with combined pharmacotherapy and psychotherapy. Thus, data indicate that ... 

New discoveries in the neurosciences, refined technical advances in psychotherapy, and a large number of outcome studies in both pharmacotherapy and psychotherapy have made it abundantly clear People are complex. Mental health problems spring from many sources and reductionist, unidimentional models are simply inadequate to explain the wide array of mental and emotional problems people experience. Likewise, no single approach to treatment works for all problems. Certain disorders clearly respond better to certain interventions, whereas others require alternative approaches. 

Finally, both dinical-anecdotal and research studies have emerged that support the combined use of pharmacotherapy and psychotherapy in the treatment of paricular disorders. At times, the combined treatments have been shown to be superior to either single treatment alone. 

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