Developing a policy on drugs and alcohol for a psychotherapeutic service

Abstract

This paper raises some of the issues that need to be considered in developing a policy rather than offering a template for one, since each service is unique in its combination of resources of personnel, range of psychotherapies available and setting. Psychotropic drugs whether prescribed, illegal, self-medication, social drugs or alcohol all affect the individual cognitively and emotionally in ways which might impinge on psychotherapy in helpful or unhelpful ways. Psychotherapy may also affect a person’s use of drugs, assisting reduction or withdrawal, but if ignored may precipitate an increase in drug or alcohol use.The implications of a policy are explored in terms of the service’s referral policy whether open or closed, how it might affect assessment and contracting with the client, in the light of the fact that such a service must operate within an ethical framework. The psychodynamic issues which occur within a three-way relationship of doctor, patient and therapist are brought into awareness, so that they may be acknowledged. The rationale for the policy includes allowing for the effects of drugs in research, evaluation and audit of the service at an organisational level, as well as the importance of not ignoring an issue that might undermine the therapy. Communicating the policy encourages realistic expectations, greater trust in the partnership between psychotherapists and doctors and may lead to better clinical outcomes.