[Long-term effectiveness of psychodynamic outpatient treatment of addiction]

Gambling disorder in the context of outpatient counselling and treatment: Background and design of a prospective German cohort study

OBJECTIVE

The prospective naturalistic study 'Katamnese-Studie' conducted between 2014 and 2019 gathers evidence on the course of gambling disorder in German routine outpatient addiction care. This study elucidates design and methodological advantages and caveats of the study.

METHODS

Participants of the multi-centre cohort received written questionnaires at admission and at 6-, 12-, 24- and 36-month follow-up to assess socio-demographic data, gambling behaviour, gambling-related consequences and care offers sought. Subsequently, self-reports were linked to client-individual routine documentation for the German Addiction Care Statistical Service. Furthermore, employees of participating outpatient addiction care facilities were surveyed regarding experiences with and attitudes towards gambling disorder. Multivariate longitudinal regression models will portray changes in the severity of gambling disorder and gambling behaviour and explore associated client- and care-related factors.

CONCLUSION

The 'Katamnese-Studie' covers the whole spectrum of outpatient gambling care. Keeping the design-related caveats in mind (reliability of self-reports, loss-to-follow-up and issues regarding causal inference), the study is anticipated to draw a comprehensive picture of routine outpatient gambling care and key factors related to sustained remission. In the medium term, this information might support the development and subpopulation-specific adaptation of recommendations on how to structure process and content of outpatient gambling care.

[Evaluation of outpatient psychodynamic psychotherapy: results of a controlled field study ]

OBJECTIVES

The discussion about the effectivity of psychodynamic psychotherapy is being renewed by recent meta-analyses. Although some well-designed studies have been presented, there is still a dearth of research in this field.

METHODS

In a controlled prospective field study we investigated the outcome of outpatient psychodynamic psychotherapy in a pre-post design. This evaluation includes data from the symptom inventories VDS90, VDS30, and HEALTH for 90 patients with different mental disorders before therapy and after the regular end of therapy, compared to a waiting list control group.

RESULTS

We found a significant improvement in symptoms, dysfunctional personality features, and quality of life. Rates of statistically and clinically significant improvement were markedly higher after therapy than in the waiting list condition.

CONCLUSIONS

Psychodynamic psychotherapy shows an effect on symptoms, dysfunctional personality features, and quality of life.

A comprehensive approach to addiction medicine as an appropriate response to the HIV epidemic among drug users

The services for drug-dependence treatment and care, particularly in low-income countries, should not be fragmented and uncoordinated. A basic package of interventions should be provided in the same place and managed by the same team, with a one-stop shop approach. The services for substance use disorders should be appealing, accessible, voluntary-based, and science-based. They should also, like efforts to fight other diseases, be included in the community and the public health systems; that is, those who are affected by drug use and those who serve them should not face discrimination. The first-line assistance and the second-line essential elements of the comprehensive package will be described. The work of the United Nations Office on Drugs and Crime (UNODC) and World Health Organization (WHO) to promote science-based and voluntary-based ethical treatment in Asia will be illustrated.