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Treatment of Substance Disorders

Updated: Dec 3, 2021

The treatment of substance abuse or addiction disorders is a large and complex topic, research over the years has led to the development of different methods and protocols of evidence-based intervention.

Among the types of intervention, we can identify two distinct classes: psychotherapies and pharmacological interventions.

The choice of one class of intervention over the other derives from an accurate analysis of the case taken in charge and from the history of the patient in question. It is also important to remember that one type of intervention is not necessarily exclusive of the other, in fact, the cases in which the patient taken in charge follows a double therapy, i.e. undertakes both a path of pharmacological treatment and a path of psychotherapy.

The medication is used, mainly, to manage withdrawal symptoms and prevent relapse.

In the first place, therefore, the medications will help eliminate painful symptoms that occur during smoking cessation and prevent it from the restart to assume the substance: this is not, in itself, the treatment, but is a necessary first step for change.

Furthermore, possibly co-existing psychological disorders could contribute to the maintenance of addiction: their treatment is a further objective that facilitates cessation.

Among the psychotherapies used to treat addiction to substances, particularly the therapy Cognitive-Behavioral Therapy (CBT), the Motivational Approach and Dialectical-Behavioral Therapy (DBT) have proved to be among the most effective in achieving the results and in the prevention of relapses.

Cognitive-Behavioral Therapy for the Treatment of Addictions

The theoretical approach of Cognitive Behavioral Therapy considers addiction as a dysfunctional behavior for the subject that the latter has learned and maintains over time. In this perspective, CBT aims to correct these dysfunctional behaviors and replace them with new, more functional behaviors and adaptive for the life of the subject.

To achieve this goal, however, it is necessary and fundamental as a first step to establish a solid therapeutic alliance, to allow the therapist to have a concrete and profound understanding and acceptance of the client's situation of discomfort and suffering.

CBT has Two Fundamental Components:

  • Functional analysis

  • Learning skills

The first step of CBT for addiction to substances is to help patients recognize why they use a certain type of drug and simultaneously establish the actions to be taken to avoid or learn to handle situations - urge to use the substance.

Through the functional analysis, therefore, a "map" is created that shows:

  • Situation management skills and patient strengths

  • Potential barriers to change and vulnerability factors

  • Factors determining the use of the substance (when, how, where, with whom, for what reason, for what purpose)

Regarding the second aspect of CBT applied to substance abuse, therapy focuses on helping patients unlearn old behaviors associated with abuse and learn new habits, attitudes and behaviors that are more adaptive to the family's socio-family life. Individual, as well as for himself and his health.

According to CBT, the establishment of abuse derives from some cognitive processes, the goal of therapy is to use and exploit those same mechanisms that led to the abuse to interrupt and terminate it, and in particular, CBT refers to the theoretical concepts typical of the cognitive-behavioural approach of:

  • Modelling

  • Operant conditioning

  • Classic conditioning

The Motivational Interview

The motivational interview applied to substance abuse treatment is a type of counselling intervention, which aims to reinforce the client's motivation to end his self-destructive behavior, especially in cases where the lack of motivation to change is the main obstacle to the cessation process.

The theoretical assumption behind this type of intervention lies in the belief that every individual who is faced with a substance addiction is (at least partially) aware of the negative consequences deriving from their drug abuse.

Rather than "convincing" the person, it can be more useful and effective to try to understand what he wants or fears because this could be the basis of dysfunctional behavior.

Dialectical Behavioral Therapy (DBT) for the Treatment of Substance Addiction

DBT (Dialectical behavioral therapy) is a branch of Cognitive-Behavioral Therapy, to which several changes and additions have been made, and which was initially developed by M. Linehan for the treatment of Borderline Personality Disorder (BPD), but which Over time, it has also been recognized to be effective in treating conditions related or independent of BPD.

DBT is a form of psychotherapy whose ultimate goal is to help the patient build a full and worthy life for himself.

In this path towards abstinence, DBT requires a permanent and immediate cessation of any type of substance intake, combined with the understanding that a possible relapse does not represent a failure: through the learning of non-judgmental problem-solving methods, the patient learns to focus his energies only on the aspects that can be changed, accepting those that, on the contrary, cannot be changed.


Over time, therapies have also been developed for the treatment of subjects with substance abuse problems focused on the Mindfulness approach, which aims to promote and encourage greater awareness of the triggers related to the use of substances, to the usual patterns involved. in addictive behaviors and "autopilot" reactions that lead to dysfunctional behavior of use and abuse.

Finally, more recently a new model has been studied, the Triphasic Model (Caselli & Sapda) of pathological addictions.

This therapeutic approach refers to the theoretical framework of Wells' Metacognitive Therapy and goes to deepen some aspects and mechanisms of the functioning of the person with a pathological addiction.

Precisely this intervention aims to reduce:

  1. A series of positive and negative thoughts that the person has about his or her pathological addiction, which increase and maintain it over time (eg drinking helps me to be more relaxed, smoking helps me increase concentration, etc.);

  2. Psychological mechanisms, such as brooding, that the person puts in place and that lead to the escalation of negative emotions which then increase the urgency to implement the problematic behaviour to reduce stress; or as the wishing thought, which is the mechanism that activates and increases the desire for the desired object to which the person can no longer resist.

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