Contributor: Yvette McBride Thomas
- 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.
- 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.
- 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
- 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