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.