• Impairment in social functioning is a key presenting feature for most drug abusers seeking treatment and presence of a social network that is supportive of a drug-free life has been shown to be a powerful predictor of positive treatment outcome. Interpersonal therapy has been adopted for patients with cocaine and/or opioid dependence with the aim of fostering recovery through creating such a supportive social network. The overall rationale for IPT, the therapist's stance and the phases of treatment are unchanged from those which characterize the treatment of depressed patients (Klerman et al, 1984). The focus on depressive symptoms has been changed to a focus on reducing or eliminating drug use and the handling of current interpersonal problem areas has been adapted to the kinds of issues presented by drug-abusing patients.



• Just as the two primary goals of interpersonal psychotherapy of depression are symptom reduction and improved social functioning, the major aims in treating drug abusing patients are (1) to help the patient stop using drugs and (2) to help the patient develop more productive strategies for dealing with social and interpersonal problems associated with the onset and perpetuation of drug use. Achieving cessation of drug use involved helping the drug-abusing patient reach three subgoals: (1) acceptance of the need to stop; (2) management of impulsiveness and (3) recognition of the context of drug use and of supply. This focus on substance use, per se, plays a part of each session, especially when the patient reports recent drug use or intense urges to use. An important aspect of helping the patient stop drug use is encouraging the patient to utilize available social resources to support his efforts to stop.



• As with IPT for depression, the therapist attempts to focus interventions toward resolving interpersonal problems of four types: interpersonal role disputes, role transitions, grief and interpersonal deficits. However, while depression is seen as resulting from a sense of loss at being unable to resolve interpersonal problems, drug abuse represents a dysfunctional attempt to cope with interpersonal problems. Thus, when attempting to help a drug abusing patient resolve problems in one of the four areas, the therapist must not only address the patient's problem but also help the patient find a replacement for the function that drugs have played in the past. Simply removing the drugs without replacing their function will leave the patient vulnerable to relapse. For example, drug abuse can play a major, unrecognized role in the balance of power within a marriage or family. Attention must be paid to the need for reconfigured roles once drug abuse ceases.



• The efficacy of IPT for drug abuse has been evaluated in one clinical trial of methadone maintained opioid addicts and another trial with ambulatory cocaine abusers (Rounsaville et al, 1983, Carroll et al, 1992). In both studies patients receiving IPT experienced improvements in outcome measures of drug use and social functioning. However, comparable improvements were seen in comparison conditions consisting of Clinical Management(CM) for opioid dependent patients and Relapse Prevention (RP) in cocaine abusers. Moreover, in the latter study, a significant interaction effect was detected such that more severely dependent cocaine abusers experienced more improvement in RP than in IPT, while less severe patients experienced comparable outcomes in the two conditions. Limitations in both studies preclude a definitive answer about the utility of IPT for drug abuse. However, clinical experience suggests the following uses: (1) to introduce drug-abusing patients into treatment, (2) to treat patients with low levels of drug dependence, (3) to treat patients who did not benefit from other modalities, (4) to complement other ongoing treatment modalities for selected patients with Impaired social functioning and (5) to help patients solidify gains following achievement of stable abstinence.

References

Rounsaville, B.J., Glazer, W., Wilber, C.H., Weissman, M.M., Kleber, H.D. Short term interpersonal psychotherapy in methadone maintained opiate addicts. Archives of General Psychiatry, 40: 629-636, 1983.

Carroll, K.M., Rounsaville, B.J., Gawin, F.H. A comparative trial of psychotherapies for ambulatory cocaine abusers: Relapse prevention and interpersonal psychotherapy. American Journal of Drug and Alcohol Abuse, 17(3): 229-247, 1991.

Klerman, G.L., Weissman, M.M., Rounsaville, B.J., Chevron, E. The Theory and Practice of Interpersonal Psychotherapy for Depression. New York: Basic Books, 1984.

Rounsaville, B.J., Carroll, K. Interpersonal psychotherapy for patients who abuse drugs. In: M.M. Weissman and G.L. Klerman (eds.) New Applications of Interpersonal Psychotherapy. Washington, DC: American Psychiatric Association Press, 1993. pp. 319-352.