Level of Patient Insight in SUD Determines Treatment Methods and Influences Treatment Outcomes: Implications for Therapy
Review of “Raftery, D., Kelly, P. J., Deane, F. P., Baker, A. L., Ingram, I., Goh, M., Lubman, D. I., Carter, G., Turner, A., Dean, O M., Sinclair, B., & McKetin, R. (2020). Insight in substance use disorder: A systematic review of the literature. Addictive Behaviors, 111. Available at https://www.sciencedirect.com/science/article/abs/pii/S0306460320306791?via%3Dihub”
Background
The success of a mental health treatment program depends to a large extent on the willingness of the patients to go through the therapy, their engagement levels, and their optimism about the chances of recovery. But, individuals exhibit willingness only if they have insights into their condition. Insight, in this context, refers to awareness of and objectivity about one’s mental illness.
Unfortunately, lack of insight is quite common in psychiatric conditions (Thirioux et al., 2020). Many patients with alcohol use disorders do not believe that they have problem drinking habits. Some patients with schizophrenia or obsessive-compulsive disorders recognize one or more symptoms of their disease but are not convinced that their behavior is abnormal or irrational. So, they do not accept that they have a disease.
The present study investigates how important insight is in the context of substance use disorder (SUD). This study is significant because much of the research into psychiatric patient insight has concentrated on severe mental diseases, such as schizophrenia, dementia, bipolar disorder, and to a lesser degree, depression.
Psychotherapists and counselors should consider the following findings from the study to design treatment programs.
Study
The literature review under consideration searched five academic databases (Medline, SCOPUS, CINAHL, PsychINFO, and Web of Science) for terms related to insight and substance use. Under consideration were studies on humans with SUD who were aged 18 years and above. These studies used 13 different measures to quantify insight, the most common being the Hanil Alcohol Insight Scale (HAIS) that is designed for substance abuse, and specifically, alcohol use.
Observations
The review study throws up findings that point to a positive association between increased disease insight and negative consequences from substance use, greater treatment adherence, and lasting sobriety. The researchers conclude that insight is critical in the context of SUD.
Therapy Implications
In written assessments of a psychiatric patient’s mental status, psychologists tend to leave out the details associated with insight. At best, many practitioners use non-specific terms like “poor,” “fair,” “limited,” or “improving.” These terms do not shed light on the specific mental components of insight, such as awareness of one’s current mental disorder, the consequences of unabated drug use, the effects of the disease on their loved ones, triggers and/or causes of the addiction, and appreciation of the need for treatment.
A comprehensive evaluation of patient insight is critical for psychiatrists and counselors to decide several issues like:
- If someone has exhibited improved or increased insight into their substance use disorder after their first intervention meeting, they can be asked to attend a second meeting where they can be convinced to begin therapy.
- If someone is unable to comprehend the consequences of their drug use on their loved ones, family members might need to reassess issues like living arrangements, child custody, and access to joint finances.
- If someone is not capable of adhering to treatment protocols on their own, they may need to be admitted to an inpatient drug rehab center.
- If a recovering addict is unable to alter their coping mechanisms to emotional triggers, they may be advised to stay in a structured setting, such as a sober living home, after being discharged from an inpatient rehab facility.
References
Thirioux, B., Harika-Germaneau, G., Langbour, N., & Jaafari, N. (2020). The Relation Between Empathy and Insight in Psychiatric Disorders: Phenomenological, Etiological, and Neuro-Functional Mechanisms. Frontiers in Psychiatry, 10(966). Available at https://www.frontiersin.org/articles/10.3389/fpsyt.2019.00966/full.
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