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Contributor: Yvette McBride Thomas
Treating Illegal Drug Addiction
- Around half a million Americans are heroin addicts, and four million are regular users of marijuana.
- Treatment is often based on the AA model.
- Because of incarceration of illegal drug abusers, jail is the usual context for treatment.
- “Stay’n Out” is a prototype of a jail treatment program that works well and has a recidivism rate of only 25%.
Treating Families where there is Substance Abuse/Addiction
- Families either promote or enable substance abuse behaviors. The whole family has to be included in the treatment.
- Children with chemically dependent parents are at risk.
- Alcoholic families tend to be isolated and lack positive role models.
- Young people from dysfunctional families use substance abuse to
- Relieve stress and anxiety and structure time.
- Keep their minds off family dynamics and on predictable problematic behaviors.
- Substitute for sex and promote pseudo-individuation (a false sense of self).
- Counselor can provide information.
- Counselor may have to be confrontational with the family over the effects of substance abuse on the family and individual. An intensive systems approach must be used that also involves agencies.
- Counselor can work to help family deal with feelings, such as anger and defense mechanisms.
- Counselors can also help the family take responsibility for their behaviors.
- Developmental issues are also worked on by the family.
Treating Women and Minority Cultural Groups in Substance Abuse
- Approximately five to seven million women abuse alcohol in the US alone.
- Women face societal rebuke and chastisement for alcohol abuse.
- Barriers to treatment include need for childcare, cost, family opposition, and inadequate diagnosis.
- Little evidence exists on the benefits of AA and NA on the one-third of the AA membership that women represent due to gender differences and cultural differences.
- “Women for Sobriety” is an alternative help group program that is based on a cognitive-behavior modification approach. Thinking is changed to overcome feelings of helplessness, powerlessness, guilt, and dependence.
- Cultural differences may play a part in the recovery process. Spiritual elements may be different for women and different ethnic backgrounds.
Affiliation, Certification, and Education of Substance Abuse Counselors
- The International Certification & Reciprocity Consortium.
- IC&RC’s credentials include
- Alcohol and Drug Counselor (ADC)
- Advanced Alcohol and Drug Counselor (AADC)
- Clinical Supervisor (CS)
- Prevention Specialist (PS)
- Certified Criminal Justice Addictions Professional (CCJP)
- Certified Co-Occurring Disorders Professional (CCDP)
- Certified Co-Occurring Disorders Professional Diplomate (CCDPD)
- The IC&RC is currently developing a Peer Mentor (PM) credential.
- Texas Certification Board of Addictions Professionals
- International Association of Addictions and Offender Counseling
- Focuses on the prevention, treatment, and description of abusive and addictive behaviors.
- Publishes the Journal of Addictions & Offender Counseling
- National Association of Alcoholism and Drug Abuse Counselors
- A national organization that certifies addiction counselors
- In 1994 the National Board of Certified Counselors added a certification process for becoming a substance abuse counselor.
Two types of counselors
- Recovering counselors
- Nonrecovering counselors
Gladding, S.T. (2011). Counseling: A comprehensive profession (7th ed.). Upper Saddle, NJ: Pearson-Merrill.
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
Service coordination is the action that brings the client, treatment services, and community resources together in order to address issues and needs identified in the treatment plan. It includes case management and client advocacy; all of this to enable the client to achieve specified goals.
Services coordination includes these three main activities:
- Implementing the Treatment Plan
- Continuing Assessment and Treatment Planning
Implementing the Treatment Plan
Our goals in this area are:
- To initiate collaboration with the referral sources.
- To obtain, review, and interpret information from screening and assessment processes.
- To make sure that our client is eligible for admission into specific treatment.
- To assess readiness for treatment and change.
- To complete necessary administrative procedures for admission to treatment.
- To establish accurate treatment and recovery goals with the client, making sure the family is also involved. Things to discuss with our client and his/her family are:
- Nature of services
- Program goals
- Rules of conduct
- Schedule of treatment activities
- Cost of treatment
- Duration of care
- Client’s rights and responsibilities
- Effects of treatment and recovery on client and significant others
Our main goal here is to continuously evaluate our client’s recovery process and the problems interfering with this progress, always considering the client’s background and treatment plan. This action will provide us, the counselors, with good feedback to adjust the treatment. Our main responsibilities are:
- To be familiar with methods for assessing the client’s past and present biopsychosocial status.
- To understand the terminology, procedures, and functions of other disciplines related to the treatment of substance abuse disorders.
- To collaborate as part of a multidisciplinary treatment team.
- To maintain confidentiality and respect regulations.
- To establish and maintain nonjudgmental relationships with clients and service providers.
Continuing Assessment and Treatment Planning
We are responsible for maintaining an ongoing contact with client and involved significant other to make sure they are following the treatment as planned. Although we cannot make the client do anything, including staying in treatment, we can still try to engage the client and significant others in the treatment process. Therefore, we need to:
- Understand the stages of change
- Assess treatment and recovery progress in consultation with our client and significant others
- Make appropriate modifications to the treatment plan
- Describe and document the treatment process, progress, and outcomes accurately
- Engage the client and significant others with continuing care
- Help the client develop a relapse prevention plan
- Address confrontation, conflict resolution, and problem-solving with the client
- Discuss discharge planning with the client and significant others.