Claves y evidencias en la aplicación de la Terapia de Aceptación y Compromiso en el tratamiento de las adicciones

The key issues for the application of Acceptance and Commitment Therapy (ACT) in the field of substance abuse and addictions are presented. A functional-contextual approach to addictive behaviors is introduced. The role played by direct and derived effects in the maintenance of drug use is analysed. Drug use is regarded as part of a class of behaviors that are part of an experiential avoidance or psychological inflexibility pattern. The functional analysis and the main characteristics of the intervention proposed from ACT are illustrated through several representative cases of different patterns of problematic drug use. Recommendations are provided for the psychological assessment and the two fundamental processes of ACT: values clarification and cognitive defusion and differentiation of the dimensions of the self. Thus, the need to stablish life directions that are jointly built by patients and therapists is underlined. Likewise, the importance that patients learn to differentiate themselves from 1) the contents of their self-concept, 2) the thoughts justifying drug use, 3) the feelings of guilt after relapse, and 4) the craving sensations is emphasized. Finally, an update of the evidence on the effectiveness of ACT in addictions is presented. Results of 21 randomized clinical trials on the effect of ACT in opioid addiction, alcoholism and tobacco use are reviewed.