Psychodynamic Therapies for Treatment of Substance Addictions: Comparison
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Please note this is a comparison between Version 2 by Peter Tang and Version 1 by Eleonora Topino.

Psychodynamic therapy has been used for a broad range of mental health disorders. From Freud to modern psychoanalysts, ideas have changed, and the range of theories that is currently enclosed has grown disproportionately. Psychodynamic interventions were shown to be as effective as other psychological treatments in treating substance dependence and proved to be an empirically-supported treatment for the above addictions.

  • substance dependence
  • substance abuse
  • psychodynamic therapy
  • participation in treatment
  • comorbidities
  • opiate use disorder
  • alcohol use disorder
  • cocaine use disorder

1. Introduction

Psychodynamic therapy has been used for a broad range of mental health disorders in the last century. From Freud to modern psychoanalysts, ideas have changed, and the range of theories that is currently enclosed has grown disproportionately. Much clinical work has been performed, and many hypotheses have been created on that basis. Despite the abundance of non-experimental literature addressing the efficacy of psychodynamic therapy, assessments that adhere to updated methodological standards are still scarce, and further research is needed [1]. In the field of addiction, the studies of Glower [2], Radó [3], Knight [4] and Simmel [5] were pioneers of a revolutionary psychodynamic vision in this domain. They improve the approach, with new ideas relative to causes, processes and intervening variables within the treatment process. Many others after them have tried to understand the problem of addiction more deeply within the psychodynamic matrix (a good report on the subject, extraneous to the objectives of this work, is available from Yalisove [6] and Potik [7]). However, most of their theories lack adequate and solid methodologically evidence. Only in the last few decades have psychodynamic authors approached evidence-based research and tried to adapt their abstract indicators of efficacy from clinical reports to strict measurements. These modifications made the growth of new supporting evidence possible for evaluations. However, studies relating those works to addiction treatment are few and provide little help in exploring therapy efficacy, especially without having the differences between drugs in mind. Filling this gap and providing a review of those adequate studies is precisely the goal of this mreseta-analysisarch.
Looking for evidence of the efficacy of psychodynamic therapies regarding psychological problems as a whole, results are variable between different reviews and meta-analyses [1]. Some authors declare that dynamic treatment is effective for major depressive disorder, panic disorder and borderline personality disorder [8], others observe efficacy for depression, some anxiety disorders, eating disorders and somatic disorders, and in general, it proves to be neither superior nor inferior to the compared interventions [9], and some others have instead found evidence of efficacy for dysthymia, complicated grief, panic disorder and generalized anxiety disorder [10]. One of the most recent meta-analyses on this topic was conducted by Leichsenring and his team [11], who found moderate quality evidence indicating that psychodynamic therapy (PDT) is just as effective as other active therapies for treating depressive, somatic symptoms, anxiety and personality disorders. In 2022, the same author published an umbrella review of recent meta-analyses to explore the efficacy of psychotherapies and pharmacotherapies for mental disorders, finding small effects for both of those protocols [12]. Regarding substance dependence, Gibbons and Crits-Cristoph et al. [8] and Leichsenring et al. [10] report evidence. In the first study, efficacy is highlighted for alcohol and opiate treatment, while in the second study, general efficacy for substance abuse/dependence is reported.

2. Psychodynamic Therapies for the Treatment of Substance Addictions

In general, no significant differences were found between treatments. As far as alcohol is concerned, for all three outcomes taken into consideration, the observed differences from the data analysis do not appear to be significant in any case. As far as cocaine is concerned, only two evaluations were possible, as the symptomatic condition outcome was exposed only in one study. From the little evidence that emerged about the treatment of cocaine use, results highlight the insignificant differences in treatments both for the consumption outcome and for the participation outcome. As far as opiates are concerned, on the other hand, the most heterogeneous results between the conditions can be seen. Looking at “Substance use” and “Other symptomatic condition”, no differences between treatments were observed.  These results could confirm the various observations according to which it was not the techniques used that make the difference, but what really matters is that the people involved in the therapeutic relationship believe in what they are implementing and create a good therapeutic alliance, as stated by various researchers, which follows the “common factor” or “contextual” model of psychotherapy [53,54][13][14]. In most comparisons, the dynamic treatment proved to be as effective as other treatments, i.e., other psychological therapies or specific interventions for substance-dependent patients. Furthermore, a slightly greater effect for the Relapse Prevention protocol compared to dynamic therapy within alcohol use treatment has been observed [37][15]; however, this is not corroborated by other studies, like Ito, Donovan and Hall [35][16], where the study’s findings showed that the Relapse Prevention protocol is just as effective as other treatment approaches. Other paradigms did not show convincing evidence to tip the assessment to one side or the other in this meta-analytic work. However, psychotherapy works and, looking at specific results in gathered studies, psychodynamic-based treatments appear to be equal [19,52][17][18] or slightly superior [14][19] to non-psychotherapy treatments, like counselling; equal to Cognitive-Behavioral Treatment [14,19,37,42][15][17][19][20]; and report no differences with the treatment-as-usual intervention [27,34][21][22]. As described by Santa Ana et al. [48][23], this includes a mix of different strategies from different psychotherapy and psychosocial theories and focuses on the reference problem, so it is based on principles shared by those of psychotherapies. These results indicate, once again, that a general equivalence in the efficacy of the treatments that engage psychotherapeutic principles emerges from the analyses. These are consistent with other precedent reviews and meta-analyses on psychodynamic therapy efficacy [7,9][7][9]. Two other important aspects that emerge from the review of different studies are that the majority of experimental designs combined psychological with medical and pharmaceutic treatment. According to Carrol [55][24], who expresses the necessity of integrated psychological and pharmacological treatments, the combination of these two interventions is necessary to improve the chance of a successful recovery. This result was also confirmed in other two studies [56,57][25][26]; however, the literature on this topic is very broad and tends to agree. The last aspect pointed out is the very high rate of multiple diagnoses in this population, which complicates interventions and adds another layer to overcome toward recovery. This is visible in studies gathered for this research and is coherent with previous findings on the high rate of multiple diagnoses in a substance-dependent population [58,59,60][27][28][29]. To summarize the conclusions highlighted by the restudyearch, psychodynamic treatment performance does not differ significantly from other types of treatment, like cognitive-behavioral interventions or drug-specific counseling in regard to drug consumption, participation in treatment and the severity of other symptomatic conditions. However, more complex themes emerge besides the statistical meta-analytic work, highlighting the dropout problem, comorbidity mental illness and integration of treatment, which need to be acknowledged to improve therapies and develop innovative solutions to problems that have become part of the experience of everyday addiction centers.

References

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