Evaluation of the effectiveness of psychodynamic therapy in reducing alcohol abuse/use among homeless individuals


A wealth of research exists on the issue of drug addiction among the homeless as well as psychodynamic therapy (PDT). This paper will evaluate these literature sources with the aim of increasing knowledge on these phenomena. It also builds knowledge that will act as a precursor to further research on the topic.

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Alcohol abuse among the homeless

Alcohol use refers to a high frequency of the consumption of alcohol. Abuse is a much more severe form of drug use that leads to neglect of other aspects of an individual life or adverse implications on their health and wellbeing. It is the most appropriate starting point in describing the topic is addressing the problem. This strategy will allow for a seamless logical progression of literature about the issue. Huntley (2014) defines the term homeless as a state of deficiency of permanent shelter such as living on the streets.  She also describes it as residing in a temporary boarding facility such as a homeless shelter. The study claims that a substantial proportion of the homeless population has alcohol abuse problems. She presents data on the topic indicating that 38% of this population suffers from alcohol abuse. Her study tries to make a connection between the statuses of being homeless as a predictor for drug addiction. She also explores the issue of mental health and wellbeing as a significant aspect of alcoholism among this population. Ultimately, she creates the idea that homeless populations may be predisposed to mental health conditions that are manifested through excessive consumption of alcohol. The author used a study population of 60 consisting of both homeless and non-homeless respondents. The findings of the survey indicate that mental health and homelessness are major predictors of substance abuse severity, especially alcohol consumption. Therefore, people with homes did not engage in drug addiction as much as the homeless did. As such, the article makes a clear causal relationship between homelessness, mental health, and substance dependence.

A study by Opalach et al. (2016) further enhances the context of alcohol consumption among the homeless. The authors used the study to determine the coping mechanisms employed by the homeless to deal with their current situation. They also created a relationship between these coping mechanisms and alcohol abuse. The study does not claim to establish causality between homelessness and alcoholism. However, it places substance misuse in the homelessness context in a manner that presents consumption as a tool for coping. The authors differentiate two primary strategies used by the homeless to deal with their situation. They indicate emotional and avoidance responses as the primary strategy employed by a majority of this population. In fact, the authors determined that 75% of their sample population used these strategies in their lives. This descriptive study described emotional and avoidance responses as popular since they allowed the homeless to deal with a situation that they deemed beyond their influence. As such, homeless people who felt powerless in shaping the course of their lives seemed to adopt these strategies. Additionally, these approaches also led to significant health deterioration among its proponents in this population. It manifested itself in depression and consequently, excessive alcohol consumption in 75%-85% of the homeless demographic. The authors concluded that predisposition to avoidance or emotional responses to stressful situations led to increased drinking as an escape from the unalterable conditions of the homeless population.  Alcohol acted as a tool to soothe or numb the individuals from the harsh realities of their life that they felt that they did not have any control over.

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Psychodynamic Therapy (PDT)

Georgina (2016) uses her article to determine or rather, describe the value of psychodynamic therapy (PDT). As a psychiatric consultant, the author is a credible voice in defining the benefits of the therapy in facilitating mental wellbeing. She describes PDT as a broad range of techniques that aim to determine the cause of particular behaviors in the individual. She adopts a professional’s perspective in defining PDT. She claims that this kind of therapy interrogates the client on their behavior with the aim of determining what prompted the individual to act in the way that they did. For instance, why does one get angry when their intellect is questioned? This case would involve interrogative discussions that help to determine the causal factors that lead to this anger. She also expands the understanding of PDT as an exercise that requires full immersion or inclusion of both the patient and the professional in a discussion. The author goes further to establish the value of PDT in its flexibility as a tool for effecting lifestyle changes that applies to a wide range of situations. This experiential study suggests that PDT does not have prescribed outcomes. As such, it creates an intervention option that can apply to any given situations over an indefinite period. As such, the professional can implement any strategy that they deem valid to a particular scenario. In addition, the author also claims that PDT has the potential to reduce medication and improve personal consciousness to a particular behavioral pattern enabling them to exercise restraint and effect positive change in their lifestyle. However, the author also stresses that PDT’s success is dependent on the interactions between a patient and a professional rooted in trust.

However, PDT is not devoid of criticism. Leichsenring et al. (2016) try to discredit these criticisms. They address the criticisms of poor definition of the intervention as well as the deficiency of evidence detailing its effectiveness. The article indicates that the PDT is a broadly defined term referring to numerous approaches. However, they also suggest that its definition stands out from other interventions such as the cognitive behavioral therapy (CBT), which as a narrowed focus on the cognition of the patient. As such, despite its broad definition, PDT remains prominent and distinct from any other approach further invalidating the criticism of its inaccurate or inadequate description. The authors also use their article to dispel this notion by claiming that PDT has a growing body of evidence developed through past and current research.   The main criticisms of the PDT are the quality of the randomized controlled trials (RCTs) used to evaluate its effectiveness. However, this criticism is flawed since the PDT is an open-ended concept with numerous strategies for specific situations. As such, the quality of research does not necessarily determine its effectiveness. Instead, the outcomes of the PDT are primary determinants of its effectiveness. This conclusion indicates that PDT has the potential to create positive outcomes regardless of any unsystematic flaws in the research. Besides, the results of these trials provide evidence supporting its efficacy.

Application of PDT in treating substance abuse

Schwartz, Nickow, Arseneau, and Gisslow (2015) develop a study aimed at validating the use of PDT in resolving addiction behaviors. In their paper, they pay attention to a group model of the PDT as a tool that can help people with eating disorders such as overeating to cope with stressful situations. This article develops certain similarities to the topic at hand. In the paper, the authors indicate that PDT in the form of group therapy is advantageous to curbing substance abuse issues in a given population including addictions. The experiential study suggests that long-term PDT can help eliminate addictive behaviors in the patients. According to the authors, the PDT builds a ‘culture of resilience’ among its participants through continuous support, interaction, trust, and comradely in a group setting. It achieves this by breaking down barriers in communication between the individuals and the professionals and pave the way for enhancing self-reflection. The authors suggest that the PDT is essential in determining unconscious behavioral patterns that lead to substance abuse. Therefore, the PDT is an effective and appropriate approach to enhancing the individual’s ability to recognize and change disruptive and destructive behavioral patterns by addressing the underlying issues that lead to substance dependence among individuals. However, the authors also emphasize that PDT occur as a supplementary treatment by also including CBT. Nevertheless, the article clearly indicates the effectiveness of the intervention approach to addressing substance abuse.

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  1. Huntley, S. S. (2015). A comparison of substance abuse severity among homeless and non-homeless adults. Journal of Human Behavior in the Social Environment, 25(4), 312-321.
  2. Leichsenring, F., Abbass, A., Gottdiener, W., Hilsenroth, M., Keefe, J. R., Luyten, P., … & Steinert, C. (2016). Psychodynamic therapy: a well-defined concept with increasing evidence. Evidence-based mental health19(2), 64.
  3. Opalach, C., Romaszko, J., Jaracz, M., Kuchta, R., Borkowska, A., & Buciński, A. (2016). Coping styles and alcohol dependence among homeless people. PloS One, 11(9), e0162381.
  4. Parkes, G. (2016). Value of psychodynamic therapy. Learning Disability Practice (2014+), 19(4), 11.
  5. Schwartz, D. C., Nickow, M. S., Arseneau, R., & Gisslow, M. T. (2015). A substance called food: long-term psychodynamic group treatment for compulsive overeating. International journal of group psychotherapy65(3), 386-409.
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