Considerations on the psychotherapy of the substance abuser

Psychotherapy is an important treatment option for many substance abuse patients. There are some similarities but important differences in psychotherapeutic procedures with substance abusers as compared to other psychiatric patients. The primary goal of the treatment process must be abstinence; resolution of psychological conflicts is not a necessary condition for the achievement or maintenance of abstinence. The initial treatment phase including development of a therapeutic alliance often requires the therapist to take an active educational and conforntative role. The pharmacology and patterns of abuse of the drugs should be well understood. Twelve-step programs such as Alcoholic Anonymous (AA) are a valuable component of the treatment process; psychotherapists must be sensitive to the ethos and procedures of these programs.