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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
Referral is the process through which the counselor helps the client find available support systems and community resources to meet the needs identified in the clinical evaluation and treatment planning. As competent counselors, we must be familiar with the mission, function, resources, and quality of services of:
- civic groups, community groups, and neighborhood organizations
- health and allied healthcare systems (managed care)
- employment and vocational services
- cultural enhancement organizations
- faith-based organizations
- governmental entities
- criminal justice systems
- child welfare agencies
- housing administrations
- childcare facilities
- crisis intervention programs
- abused persons programs
- self-help groups
- advocacy groups
We must be familiar with the criteria to be eligible to receive community services, including fee and funding structures; how to access community agencies and service providers; and community resources for both affected children and other members of the family.
Since some of the resources in the community might end or be closed down, we need to continuously evaluate the available resources and make sure they are appropriate for our client. We also need to evaluate the motivation and ability of our client to make use of the referrals.
Remember, it is not enough with being a counselor and making the referral; how we do it, is also very important. The skills we need in this area, are:
- Professional oral and written communication for successful referrals
- Use of appropriate technology to access, collect, and deliver necessary documentation
- Document the referral process accurately
Just as with everything mentioned in previous topics, we want to explain to our client, in clear and specific language, the necessity for referral and process of it. If our client understands this step, there is an increased likelihood the she/he will follow through.
Finally, we want to evaluate the outcome of the referral. We must know the methods and procedures used to assess the client’s progress toward treatment goals.
Referral is the process of identifying the needs of the client that cannot be met by the counselor and the agency and therefore assisting the client in finding support systems and community resources that he/she can use.
- Identify needs and problems that the counselor and agency cannot meet.
- Explain the rationale for the referral to the client.
- Match client needs and problems to appropriate resources.
- Protect client’s confidentiality by following laws, regulations, and agency policies.
Miller, Geri. “Learning the Language of Addiction Counseling.” 2nd ed.