Interpersonal therapy in substance use recovery

Interpersonal therapy, usually shortened to IPT, is a structured talking therapy that treats relationships as the main place to look for change. It was built for depression, and its use in substance use treatment is much newer and much less studied. That makes it a good example of an approach with a sensible rationale and only preliminary evidence, and this page keeps the two apart.

The National Institute on Drug Abuse (NIDA) describes counseling and psychotherapy, sometimes called behavioral therapies, as the most common treatments for substance use disorders. IPT is one of many options within that group, and it is less widely offered than cognitive behavioral therapy.

What interpersonal therapy is

An NHS talking therapies service in Camden and Islington describes IPT as a time-limited, structured approach whose basic task is to help a person link mood with relationships and to see that handling interpersonal situations well can improve both. Typically the work focuses on one of four areas of difficulty: conflict with another person, life changes that affect how a person feels about themselves and others, unresolved grief, and trouble starting or keeping relationships going in a satisfying way. The therapist and the person choose the focus together during the first sessions.

The same service notes that CBT is the most common treatment it offers and that capacity for IPT is limited, a reminder that availability varies by service and country.

How it works in outline

A 2013 pilot study by Gamble and colleagues, published in the journal Substance Abuse, adapted IPT for women who had both alcohol dependence and major depression. The authors explain that IPT proposes a two-way relationship between how a person functions with others and how they feel. They describe four problem areas in the original model: role transitions, interpersonal conflicts, loss and grief, and interpersonal sensitivity.

In the addiction setting, the authors say, a role transition can include moving away from a lifestyle built around substance use toward a substance-free one. Interpersonal conflicts are tackled with behavioral techniques, including a method called interpersonal incident analysis, which teaches people to spot the situations and people most likely to cause trouble. A practical point the authors make is that IPT does not require a partner, unlike some couples-based treatments, so it can apply to people who are single, separated or in difficult relationships.

What sessions can look like

The Camden and Islington service says a course of IPT may involve 8 to 16 sessions, with the aims of easing depression symptoms and improving the quality of relationships. In the pilot study, participants attended individual sessions alongside their routine addiction care, with a typical attendance of all 8 planned sessions. Therapists used a manual written for the study, received training and weekly group supervision, and had their sessions audio-recorded for review.

Because the work is tied to one agreed problem area and a fixed number of sessions, IPT is more focused and time-limited than open-ended exploratory approaches such as psychodynamic therapy.

What the research says

The Gamble pilot was small and uncontrolled. Fourteen women took part in an outpatient community addiction program and were assessed at the start, during treatment, after 24 weeks and at 32 weeks. They reported high satisfaction, and their drinking, depressive symptoms and interpersonal functioning improved over treatment and stayed improved at follow-up. The authors called IPT a feasible and highly acceptable add-on treatment for this group.

They were equally direct about the limits. There was no comparison group, the sample was small, adherence to the IPT method was not rated, and keeping people in the study was a challenge. The authors state that improvements may have come from other causes, such as the rest of the addiction treatment, a placebo effect, natural improvement, or dropout of people who were not responding. They say randomized controlled trials are needed.

Earlier trials gave a less encouraging picture. The same paper recounts that weekly IPT added to group methadone maintenance did not differ at six months from a monthly brief intervention, and that there were still no differences at a follow-up two and a half years later. In another trial, 12 weeks of stand-alone IPT was compared with relapse prevention in 42 people with cocaine problems: results were similar for people with less severe use, but IPT was not as effective for those with more severe use. Most participants in those trials were men, so it is unclear whether sex, substance or program setting explains the mixed results.

Limits and who it may not suit

The evidence for IPT in substance use is preliminary and comes mainly from people with co-occurring depression, so it should not be assumed to apply to everyone. The pilot authors note that depression and alcohol dependence frequently occur together, with estimates of 50 to 70 percent in clinical samples, and that combined treatments were scarce. The page on co-occurring conditions covers that wider picture.

Because the method centers on relationships, it may suit people whose main struggles involve conflict, loss or isolation more than people who want a skills program for managing cravings. Families and partners often form part of those relationships; the page on supporting a family member covers the family side. Anyone considering IPT should also ask whether a clinician in their area is actually trained in it, since the Camden service notes that availability varies with staff.

Questions to ask a clinician

• Is IPT available here, and is the therapist trained in the method?
• Which of the four problem areas would we work on, and why?
• How many sessions are planned, and will it run alongside my other treatment?
• Given the limited research in addiction, what other options should I compare it with?