OUT-PATIENT THERAPY

Efficacy of Treatment Approaches in Out-Patient Therapy



Efficacy of Treatment Approaches in Out-Patient Therapy

Introduction

Outpatient treatment for substance abuse refers to services that address a client's substance abuse or dependence while permitting the client, as much as possible, to continue daily life functioning outside of treatment. Examples of outpatient treatment include medication maintenance, standard outpatient, intensive outpatient, and day treatment. Services that may overlap with outpatient treatment include ambulatory detoxification, continuing care, and street outreach. Determination of appropriate treatment placement involves a number of factors, including medical history and status, co-occurring psychiatric conditions, environmental risk issues, and history of previous treatment.

According to the most recent data available from the National Survey of Substance Abuse Treatment Services, at least 80% of all substance abuse treatment facilities are outpatient programs, and approximately 90% of clients receiving treatment are in outpatient programs. As of March 2006, of all clients receiving treatment, 52.1% were seen in standard outpatient and another 22.5% in methadone maintenance, 11.4% received intensive outpatient treatment, 2.1% were in day treatment, and an additional 1.1% were undergoing detoxification on an outpatient basis. Outpatient treatment in its many forms is by far the most commonly used group of treatments for substance abuse in the United States (Weisz, 2009).

Pharmacotherapy Therapy

In general, pharmacotherapy involves the use of drugs to improve behavior, whereas behavior therapy involves the use of procedures based on principles of learning to achieve the same objective. Drugs that are intended to improve mood, cognitive status, or overt behavior are termed psychotropic drugs. Since the 1950s, when the first generally effective antipsychotic drug, chlorpromazine (Thorazine), was introduced, psychotropic drugs have played a major role in treating adults with a wide range of behavior disorders. Dozens of different psychotropic drugs currently are available, and millions of prescriptions are written for them. With few exceptions, pharmacotherapy is under the control of psychiatrists and other physicians.

Not surprisingly, therefore, discussions of pharmacotherapy often are couched in terms of a medical model, in which a patient's signs and symptoms are assumed to be indications of an underlying disease that involves a neurochemical aberration. A deficiency in serotonergic activity, for example, is widely assumed to be responsible for the signs and symptoms of depression. Effective psychotropic drugs are assumed to alter the neurochemical processes responsible for the disease, which, in turn, leads to improvements in behavior. For example, effective antidepressant drugs increase serotonergic activity. They also improve mood and overt behavior in most people diagnosed with depression.

Since the 1960s, behavior therapy has been widely and successfully used to treat many different behavior disorders. Behavior therapy comprises many different therapeutic techniques. Although most contemporary behavior therapists acknowledge the role of neurochemical events in controlling behavior, they typically do not emphasize events at this level of analysis. Instead, they concentrate on how learning contributes to the genesis and maintenance of behavior disorders and how procedures based on principles of operant and classical conditioning can be used to treat them. For example, a real or perceived decrease in the quantity or ...