Contributor: Yvette McBride Thomas

Characteristics

• About 25% of counseling cases relate to substance abuse and addiction.
• Substance abusers have dysfunctional dynamics making them difficult to work with.
• Three most common ways counselors work with addicted persons include outpatient, residential, and inpatient.
• Addicts must be “dry” or “dried out” for 30 days or more to give them a “clean” body and mind to use in doing something different and positive.
• Alcoholic family systems have an overresponsible/underresponsible phenomenon.
  • Over-responsible people are codependent and seek to control others and feel inadequate when faced with disappointments but are easier with whom to work in counseling situations.
  • Underfunctioning people are less motivated to change.

Factors Affecting Treatment include:

• Motivation – Most substance abusers/addicts do not desire to change and are self-centered and are comfortable where they are.
• Denial – is minimizing the effects of substance abuse/addiction on either oneself or others.
• Dual Diagnosis – An abuser/addict has more than one aspect of personality that needs treatment (i.e., addiction and depression).
• Matching – Finding the right treatment for a disorder.
• Control – the regulation of a behavior
• Relapse – the reoccurrence or recidivism of dysfunctional behaviors one they have been treated.

Treatment Strategies for Individuals

• Motivational Interviewing (MI) is used to lower resistance in substance abuse/addiction cases.
  • This approach draws from person-centered counseling and includes such skills as active listening, reflection, and reframing.
• Bibliotherapy
  • Bibliotherapeutic approach may work with some individuals.
  • Abusers and addicts read books or view/listen to media and discuss ideas related to what they have experienced.
• Cautions to remember for counselors working with adolescents regarding alcohol and substance use:
  • Working with adolescents is a treatment specialty.
  • Family and significant people in their lives should be included for counseling to be effective.
  • Adolescents need to be educated about what counseling is.
  • Therapeutic techniques need to be specifically tailored to adolescents.
  • Counselors cannot function as the adolescent’s friend.
  • Counseling focus should be centered on problem solving, skill building, and just being heard.
  • “Therapeutic moments” are more uneven with adolescents.

Specific Treatments

• Treating Alcohol Abuse/Addiction – Alcoholics Anonymous (AA)
• Background of AA
  • AA is the oldest successful treatment program in the world and was founded in the 1930s.
  • AA is a fellowship and a rehabilitation program.
  • Alcoholics have “character defects” that “are feelings, beliefs, and behaviors that dispose them to seek a sense of well-being by abusing alcohol.
  • Meetings are conducted with small groups and literature.
  • Key component in AA
  • A 12-step program that has its basis on a spiritual foundation
  • Group discussions center on the need and availability of support of others and a dependence on a higher power.
  • Members are never “cured;” rather they are “in recovery.”
  • Emphasis is also given to responsibility, forgiveness, restitution (when possible), affirmation, ritual, and fellowship.

Treating Nicotine Addictions

• Over 25% of Americans smoke cigarettes, three million of whom are adolescents.
• About 80% of those who abuse or are addicted to alcohol smoke.
• Most nicotine dependent people are not successful as a group in their goal of smoking cessation.

Successful techniques for counselors

Telephone counseling

• Counseling consists of a 15- to 30- minute phone call where counselors give positive, nonjudgmental feedback to those who are trying to quite smoking.
  • The goal is to promote self-efficacy.
• Rapid smoking
  • After counseling, smokers go through a series of six 1-hour sessions where they inhale a cigarette every 6 seconds until they feel too sick to continue.
  • The goal is to produce a conditioned negative response to the taste of cigarettes.
• Skills training
  • Coping skills are taught after clients have learned to recognize the triggers that produce the urge to smoke.
• Most successful skills taught:
  • Self-statements about the financial and health benefits of discontinuing smoking
  • Oral substitutes
  • Increased physical activity
  • Buddy system

Treating Substance Abuse/Addiction Part II

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