Substance Use Disorders
Substance-related disorders are divided into two groups: dependence and abuse of substances such as alcohol, opiates, cocaine, and nicotine. DSM-IV ( American Psychiatric Association, 1994) defines substance abuse as maladaptive use that leads to clinically significant impairment or distress. Substance dependence escalates the problem to include tolerance and withdrawal, and involves impairment of major role obligations, physical danger, legal problems, and the like.
IPT has been tested in two controlled trials for patients suffering from substance abuse or dependence. One used IPT to reduce psychopathology in methadone-maintained opiate addicts, the other to try to achieve cocaine abstinence. Both trials had negative outcomes for IPT relative to a standard comparison treatment. These are the only negative studies of IPT to date. Other applications are possible, however. Markowitz and colleagues are currently comparing IPT to supportive psychotherapy in conjunction with Alcoholics Anonymous (AA) attendance as a treatment for patients diagnosed with comorbid dysthymic disorder and alcohol abuse.
Because opiates and cocaine are illegal, it is difficult to estimate the precise epidemiology of their abuse, but estimates exceed 2 million Americans.