The differences among the philosophies of, and the services provided in, various drug abuse treatment programs may be enormous. What is remarkable is that some form of drug abuse counseling or psychotherapy is almost invariably a part of every type of comprehensive drug abuse treatment.

Individual therapy or counseling is available in about 99 percent of the drug-free, methadone maintenance, and multiple-modality drug abuse treatment units in USA. It is also available in approximately 97 percent of the detoxification units.

Despite the fact that drug abuse counseling and psychotherapy are nearly universal in drug abuse treatment, surprisingly little is known about these forms of treatment. Much more research has focused on pharmacological treatments for drug abuse than on non-pharmacological, even though non-pharmacological interventions are almost always utilized and are sometimes the only form of treatment offered to the drug abuser.

In part, the paucity of research in this field is due to the inherent difficulties in scientifically investigating psychotherapy and counseling. It has not been uncommon for a psychotherapy/counseling research study to be denied funding because reviewers believed that fundamental, minimal standards for a scientific investigation had not been met. There are two major dilemmas here:

(1) Thousands of drug abusers are being treated every day with psychotherapy and counseling, and no one can say for certain what forms of psychotherapy and counseling are most effective, what types of therapists and counselors can best provide it, how long it should be provided, when psychotherapy is necessary, when counseling is sufficient, and so on;

(2) Doing research in this field is so messy that many a scientist would hesitate to attempt it, and those that do may end up discouraged by their difficulty in acquiring funds.

In order to address the complexity of clinical methods, programmatic research as well as individual investigations on drug abuse treatment is needed. Only in planned programmatic efforts will researchers be able to tease apart the various components and interactions among components that contribute to treatment efficacy.

Research proceeds most efficiently by following theory. While the usual theories that guide clinical research are based upon the etiology of behavior, there is also a significant need for the development of models of treatment selection and decision-making that combine psychosocial interventions from different theoretical systems. Only by implementing a systematic program of research based upon a rational set of dimensions and principles of influence, however, can we hope to sort out the processes that make the drug treatment maximally successful.