Severity of psychiatric symptoms as a predictor of benefits from psychotherapy: the Veterans Administration-Penn study [published erratum appears in Am J Psychiatry 1989 Dec;146(12):1651]

One hundred ten nonpsychotic opiate addicts were randomly assigned to receive paraprofessional drug counseling alone, counseling plus cognitive-behavioral psychotherapy, or counseling plus supportive- expressive psychotherapy. Patients were classified low-severity, mid- severity, or high-severity on the basis of the number and severity of their psychiatric symptoms. Overall, the addition of professional psychotherapy was associated with greater benefits than was drug counseling alone. Low-severity patients made considerable and approximately equal progress with added psychotherapy or with counseling alone. Mid-severity patients had better outcomes with additional psychotherapy than with counseling alone, but counseling did effect numerous significant improvements. High-severity patients made little progress with counseling alone, but with added psychotherapy made considerable progress and used both prescribed and illicit drugs less often.