In general, one should be cautious when generalizing the results before applying them to typical treatment situations since many studies have been carried out in university clinics with the participation of highly competent therapists and selected subjects. Individuals with multiple problems and who are socially unstable are generally excluded from controlled studies, and those selected must agree to the conditions imposed by the research. This includes agreeing to be randomly assigned to treatment, thus excluding those who wanted a particular treatment and those who wanted to participate in their treatment planning.

Dual Pathology8. 

In addictive behaviours, the presentation of various diagnoses is not uncommon. It is common to find individuals with various diagnoses of abuse or dependence, and also very frequently additional diagnoses of disorders other than addictive disorder. It is known that the presentation of several diagnoses darkens the prognosis and makes intervention difficult. In addition to having validated treatments for addictive disorders, therapists must have specific skills to manage these cases since they are the most difficult comorbid pathologies to manage9.

Treatment Adherence. 

Many people with addictive problems have difficulty adhering to treatment. On the one hand, the difficulties are derived from the very nature of the disorders (in many cases chronic and with a tendency to cause frequent relapses), which means that many of the patients have been treated by various healthcare resources with little success. In other cases, many patients and families expect to receive a fundamentally pharmacological treatment, with few implications for more laborious work such as that required by a psychological treatment program. In addition, various barriers hinder good treatment compliance: availability to attend the sessions (often having to be absent from work), social stigma (problems related to substance drugs still generate certain reluctance among the population), etc. Facilitating access to services, offering a wide range of treatment alternatives, and considering and facilitating access to additional services, advice, support, and treatment, if necessary, for family members are some variables that improve retention in the programs.

Matching Of Subjects With Treatments And Therapists.

 The concept that certain subjects respond better to specific treatments and certain therapists is a topic that has aroused interest for some time. Overall, the evidence favouring matching patients to the treatment method is weak. However, this does not mean that one treatment will work for all. The diverse needs of patients demand a flexible and personalized approach. Some patients need services for their psychiatric problems, and others need help for unemployment problems, and others for various social problems. Attention to these issues is essential if the goal is for patients to permanently change their substance use.

 Care Pressure.

 In addictive behaviours, practically all cases are considered “urgent.” The demand for drug use problems increases every year, and one of the variables that determine the effectiveness of the treatments is the degree of motivation on the part of the patients at the beginning and during the treatment process (NIDA, 1999), therefore that immediacy of assistance is a crucial factor. It is already known that people with addictive problems frequently present great ambivalence regarding the need to change their addictive behaviours, which implies avoiding waiting lists and attending to any demand made as soon as possible, to the detriment of some of the “scheduled” sessions.

 Duration Of The Treatments. 

One of the issues that concern clinicians is the duration of treatments. Patients frequently report that aftercare helps maintain abstinence after primary treatment (Maisto et al., 1989). For example, in the case of alcoholism, participation in aftercare programs is a more powerful predictor of outcome than the length of hospitalization, neuropsychological function, measures of alcohol use, stability prior to treatment (Walker et al., 1983), and relapses in substance use (McLatchie & Lopm, 1988). The cognitive deterioration and the low cultural level of some patients.…

One of the traditional problems that psychology, in general, has faced, and the psychology of addictive behaviours in particular, is the scant collaboration between research (fundamentally focused on the university environment) and clinical practice, which hinders progress. Necessary knowledge in the area. The relationship between the university field and the clinical field should be strengthened, facilitating the research resources of the latter through collaboration between university researchers and clinicians who carry out their daily work with actual cases. Said collaboration is scarce (sometimes non-existent), significantly hindering knowledge of reality and preventing the necessary treatment adjustments. The University and the College of Psychologists should promote this collaboration. Clinicians, in turn, should be accredited as researchers (doctoral training and research adequacy).

Teamwork and updating. Let us not forget that the approach to these disorders is based on comprehensive care. The lack of communication between the different professionals and the ignorance of the different approaches is absurd and inoperative. The interaction between the different interventions (psychological and pharmacological) enhances the therapeutic results. Clinical sessions, coordination (intra-between services and units), ongoing training, updating through participation in related scientific societies, and attendance at professional meetings are essential for updating and adequate knowledge of the area’s advances.

In the day-to-day with the people affected, various difficulties frequently arise for which it is not easy to find solutions; it is then when it is necessary to count on the skill and experience of the professional and with common sense. In short, the real problems with which clinicians work are, in many cases, far from those same problems when they are studied and analyzed at a theoretical level. Some authors (Denis, 1996) suggest developing control systems that allow a better understanding and evaluation of patients, interventions, and organizational and financial problems as they appear. This approach differs from experimental research in that treatment efficacy is addressed in a natural context, not predetermined.

Evaluation Of Efficacy Or Therapeutic Effectiveness 

The factors that summarize the interest in the evaluation of efficacy or therapeutic effectiveness can be summarized as follows: the evolution of psychological science, the incessant development of psychopharmacological treatments in stiff competition with psychotherapeutic treatments, and the increasing access of citizens of advanced countries to health services, together with the necessary cost containment by payers (Perez et al., 2003). There are currently psychological treatments of proven effectiveness; however, not all psychological treatments have the same value. There are also ineffective psychological treatments. The progress of psychotherapy in addictive behaviours requires the delimitation of effective specific interventions for this type of disorder12. The evaluation of the efficacy and effectiveness of the interventions is, therefore, a necessity. The economism criteria present in today’s society are not alien to the field of work in which interventions in addictive behaviours are framed (fundamentally health system). Third-party payers have generated a dynamic of rationalizing therapeutic means that necessarily justifies the effectiveness and efficiency of the interventions (Santolaya, 2003). In addition, therapeutic efficiency has led to the rise of procedures that tend to make treatment cheaper and more accessible. Developing self-help manuals allows the patient and people close to him to apply the treatment more autonomously. Practical treatment guides and manuals pose some limitations (none of them insurmountable), which in the case of addictive behaviours are fundamentally related to the difficulties inherent to the disorders, which in many cases make it necessary to make treatments more flexible and personalized. , and with the training of professionals.

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