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Substance Abuse Counseling – The Profession

The substance abuse counseling profession is a vocation or occupation that requires advanced education and training. Twenty years ago, treatment was provided by people in recovery from alcohol and other drug (AOD) addictions, who would only use their own experiences to help others. The problem with this is that recovering individuals do not know how to treat different issues that co-occur with addiction such as poly-drug use and mental disorders. Although recovering individuals are able to relate to others dealing with addictions, mainly to the same drug of choice, they do not have the training and the skills to understand the differences among drugs of abuse, their effects on the brain and the body, and the believes and attitudes of people from diverse cultural and ethnical backgrounds.

The substance abuse prevention field is in its early stages, i.e., it is just developing as a discipline. The goal is to create standards of training and practice so that practitioners are able to handle the complexity of substance abuse and everything that comes with it. Part of the training for alcohol, tobacco, and other drug (ATOD) prevention professionals, is to explore their own attitudes about ATOD. It is not surprising to find practitioners who debate over terminology such as recovered vs. recovering addict, or the 12-Steps and the Big Book vs. religion and the bible.

Concepts such as use, abuse, misuse, dependence, and addiction vary from person to person. Substance abuse prevention professionals need to keep in mind that use and abuse of substances is not determined by their own experiences, but by standard definitions. For instance, substance use is the ingestion of alcohol or other drugs (AOD) without experiencing any negative consequences. Substance misuse is when a person experiences negative consequences from the use of AOD, or when the use of them is illegal. Substance abuse is the continued use of AOD in spite of negative consequences.

Addiction, also called dependence, is the compulsive use of alcohol, tobacco, and other drugs (ATOD) regardless of the consequences.

Substance abuse prevention strategies used in the past have been ineffective. Strategies such as Just Say No, Prohibition, and the illegalization of drugs that used to be legal, have not given the results expected. The criminalization of people who suffer from addiction is probably one of the least effective strategies.

Research in substance abuse prevention is helping develop effective theories that include risk and protective factors and resiliency, just to mention a few.

Reference: Substance Abuse Prevention – Julie A. Hogan 

Reasons for Using Substances

Contributor: Yvette McBride Thomas

People like to feel good. Many experiences in our world are geared toward altered states of consciousness–natural highs. These “natural highs” are derived from many experiences: roller coaster rides, skydiving, white water rafting, dancing, or anything else that can produce an adrenaline rush. Our enjoyment of these sensations begins at an early age. Small children will spin around in circles or scare each other in order to feel this altered state of consciousness. Unfortunately, “artificial highs” from drugs or alcohol are easier to obtain than natural highs, and drugs are readily available to children at an early age. The following seem to be the most common reasons for drug use today.

Parental or Guardian Influence

As seen in the previous section, the “pill for every ill” attitude that is seen in the home has a major impact on children. Approximately 80% of children’s values, morals, work ethic and attitude are derived before age 8. A child is exposed to his/her parents for the majority of his/her life before age 8. Therefore, parents will have the greatest influence on their children. A child learns many lifelong habits and attitudes from his/her parents. Unfortunately, in about 80% of cases, a child’s first exposure to alcohol and drug use is in the home. Children may see a parent drinking alcohol, popping pills or doing other drugs. Parents may have a liquor cabinet, a steady supply of beer in the refrigerator, or other drugs in the home. The influence of a child’s parents cannot be emphasized enough. Parents need to understand this and be proper role models for their children. What is the subliminal programming that is occurring every time a child opens the refrigerator and sees beer? It becomes the norm. We are not saying that parents should never drink beer in the home, but rather that they must assess the role that alcohol plays in their home.

Unfortunately, too, some children are exposed to illegal drugs from the time of their birth. Worse, some are exposed even before birth, if the mother uses during pregnancy. Such babies may be born addicted to drugs (i.e., “crack babies”). Infants may be exposed to drugs in the mother’s breast milk or in the home environment. One client in drug treatment described a baby picture of himself, in which a bottle of beer and a marijuana “joint” were photographed with him in his crib. He grew up believing that drug and alcohol use was normal for everyone. He began using at age eight and was chemically dependent and involved in the courts by age 17. Another client in treatment, an adolescent, shared a story of being beaten by her father-for smoking his marijuana. She had the black eye to prove it.

Peer-Group Influence 

Most people are aware that during the adolescent years, a person’s most influential group is their peer group. When their peers are using substances, teens often feel a need to use them as well, in order to gain acceptance, to be “tight” with their friends. Using substances because “everyone else does” may not seem to be a valid reason to adults, but to high school and junior high students, it is compelling. Failure to join in can cause a teen to become an outcast from the group-the worst fate imaginable to many teenagers. So they will often do whatever it is that their friends are doing so that they can fit in.

Even “good” kids may submit to peer pressure. For many adolescents, using drugs or alcohol can make them feel rebellious, as if they are being independent and carving out their niche in the world. It may also make them feel “grown up”. As a person grows older, he/she may decide to continue using or to stop using for many different reasons. He/she may outgrow the peer group influence but may not outgrow the substance involvement.

To Get An Effect or To Get High (Pleasure)

The majority of people using substances do so to get the mood-altering effect or some type of pleasurable sensation. Many available substances will induce a feeling of euphoria. People who use substances for pleasure, who have few problems with their substance use, are often labeled “social” users. These individuals can drink or get high on weekends just to feel good and have no resulting problems. Other persons who get involved in this type of substance use will eventually develop major substance abuse problems. No one can predict before beginning use if he/she will become drug- or alcohol- dependent.

Curiosity and Boredom

Curiosity is the most familiar reason given for first trying a substance. Curiosity is quickly satisfied. Therefore, if the person chooses to continue using the drug, he/she does so for other reasons. With the current availability of many substances, people are aware that if they want to try substances, they can. Young people are naturally curious; they are attracted to new and exciting things. Adolescents want immediate gratification and often don’t look at the possible consequences. This also leads them into trying many different drugs, to experiment with the different highs. This need for immediate gratification also allows them to get bored very easily. Obtaining and using illegal drugs is often viewed as exciting or “cool” by adolescents and can take up a large amount of time, thus alleviating their boredom.

Internal Issues

Internal issues correlate with serious substance abuse problems. Internal pressures to use include: stress, low self-worth, depression, anxiety and nervousness. Low self-esteem has been found to be a major factor in an individual’s choice to begin using substances. Alcohol and drugs are called mood-altering substances for a reason. Drugs alter (change) the mood (emotions) of the individual. They may either exacerbate an existing problem or create a new one. Many drugs also contribute to additional internal issues, such as depression, anxiety, or low self-esteem. Once again, substances may provide an easy but temporary method of dealing with these internal issues but usually cause additional problems. Often, the user doesn’t realize that substance use does not solve problems. When the substance wears off, the problem is still present, and often there are additional problems resulting from the substance use.

External Pressures

An individual may use substances to escape external pressures. These external pressures–situations with which an individual may feel uncomfortable-may include school problems, work difficulties, family problems, peer pressure, relationship issues, etc. If an individual feels upset about a certain situation and gets drunk or high, he/she may feel relief from the problem. This escape, however, will only last for a limited period of time. When the individual is no longer high, the problem will return. Using drugs or alcohol as an escape is only temporarily effective–and very dangerous.

An individual may begin to regularly rely on the drug or alcohol as a coping mechanism. This leads to addiction and produces an individual who has no other coping skills for difficult situations. Often, the use of drugs creates additional external pressures and exacerbates the existing ones. A vicious cycle occurs: the individual uses drugs or alcohol to deal with existing problems and the use causes more problems. The individual then uses more drugs to deal with these new problems. This additional use then causes more problems, which leads to more use. It is a never-ending cycle of use and problems.

 

How Substance Abuse Starts

Contributor: Yvette McBride Thomas

There is a debate in this country about how substance abuse begins. In the past, it was believed to be a moral issue. At that time, alcoholics and addicts were seen as morally deficient. This is not the view of clinicians today. Today physicians, psychologists, and counselors identify chemical dependency as a disease. The question still remains, however: why can some people use alcohol or drugs safely while others become chemically dependent? The debate points to heredity or environment, or a combination of these. Many experts theorize that chemical dependency is hereditary. If we examine the background of someone who is alcohol- or drug-dependent, we often see a family history of the illness. One thing is certain: in order to become chemically dependent, an individual must first begin using alcohol or drugs. As mentioned previously, the United States, though comprising only 5-6% of the world’s population, consumes three-quarters of all illegal drugs produced in the world! Additionally, Americans are the leading abusers of alcohol and prescription drugs in the world. Why is this?

One environmental theory is based on the fact that American society today over-emphasizes the importance of “feeling good.” In our society, if a person doesn’t feel well, we

After alcohol, marijuana has the highest rate of dependence or abuse among all drugs.

reach for substances as a solution. As a result, our society has developed a “pill for every ill” attitude. These “ills,” regardless of type or severity, are often being treated with drugs or alcohol. Our “pill-for-every-ill” attitude influences many individuals in our society to believe that a chemical cure is the only solution for any societal problem. (We’re not referring here to the appropriate use of medication, as prescribed by a physician or other health care professional, for physical, mental, or emotional disorders, but rather to the abuse of alcohol and drugs.)

As adults, we demonstrate this “pill for every ill’ attitude to our children. We may take pills to get started in the morning, to get to sleep at night, to deal with mild pain, or to deal with situational sadness. This vicious cycle of chemical cures is paraded in front of our children on a daily basis. This behavior does not provide a proper example for our children. Today, the morals we teach our children have changed. Unfortunately, the breakdown in discipline of children and the many changes in family structure (such as families where both parents work, single-parenting situations, etc.) have eroded the traditional family structure. It is often replaced with a loose structure, in which children may doubt their parents’ authority and values.

Community is another area where society has weakened. Changes in the community have contributed to a breakdown, a lack of respect, in the general moral standards of the past. We live in a society where “anything goes.” Often, there are no repercussions when moral standards or laws are broken. Looking at our society, we see gang wars, prostitution, drug trafficking and theft. Many people do not know who their neighbors are and have little concern for them. Children are being taught (by the example of the adults in their lives) to “look the other way,” and to avoid confronting important issues.

Drugs are in our children’s lives at an early age. Often children face major decisions before they are twelve years old as to whether or not to smoke, drink or use drugs. Because of this, information about alcohol, drugs and appropriate decision making must be presented early by knowledgeable individuals in the school system. This education of our youth should not stop with the school system but should be reinforced in the home, in athletics, in the workplace and in the community.

Childhood and adolescence is a time of tremendous change in a child’s life. Teens, in particular, undergo rapid changes in emotions, coinciding with the numerous physiological changes taking place. This is also the age at which a child begins to create his/her own value system. It is very important for parents to understand that substance use by children and teens is a very critical issue. Substance abuse affects a young person’s emotional, physical, and moral development. It contributes to emotional immaturity, improper physical development, poor moral standards, an inability to learn and faulty decision making. But we must start setting the right example even before the teen years. For pre-school age children and toddlers, parents should reinforce the concept that medicine is taken only for illnesses or by direction of a physician. Drug education in primary schools is extremely important. Teachers, administrators and parents should all provide educational information to the children and reinforce the consequences associated with substance use.

Substance abuse is on the rise by our adolescents. During the teenage years, experimentation with alcohol and/or drugs is common; this is when most drug problems begin. Most people are unaware that alcohol is classified as a mood-altering drug. Use of alcohol by teenagers often leads to use of other drugs. Experimentation with substances may occur in the home, at school, in social situations or at a stressful time in youngsters’ lives. Alcohol and drugs are used on a regular basis by a large percentage of our teenagers, many of whom later become alcoholics or drug addicts. Sadly, we know that some will even die as a result of their substance use.

Today, an alarming number of adolescents are smoking cigarettes. Once they begin using tobacco, marijuana is the logical next step. Over half of adolescents admitted to drug treatment programs are seeking treatment for marijuana addiction. Adolescents who smoke marijuana are 85 times more likely to eventually turn to cocaine and other “hard” drugs, compared to those who have not smoked marijuana. Thus, tobacco, alcohol, and marijuana are known as “gateway” drugs. Use of these “gateway” substances may lead to “harder” drugs, especially for adolescents who are already chemically dependent upon alcohol or marijuana.

Once our children become adults, the cycle doesn’t end. As adults, they become part of our nation’s workforce. In our corporations today, we see many problems caused by substance abuse. The list is staggering: increased absenteeism and illness, lower productivity, theft, an increased number of accidents and fatalities, greater use of medical benefits, violence, altercations, and lower employee morale are all related to drug and alcohol abuse in the workplace.

To combat experimentation and substance abuse, all aspects of society must join together and provide educational information to our children on the dangers of substance use. We must be good role models. We must provide community support, and encourage effective law-enforcement programs. We must arm our youth with the knowledge they need to make important decisions about alcohol and drug use.

Reasons for Using Substances

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Treating Substance Abuse/Addiction

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

DYI! Get ready with me.Samantha DeLint - Youtube Channel

DYI! Get ready with me.
Samantha DeLint – Youtube Channel

Preventing Substance Abuse/Addiction

Contributor: Yvette McBride Thomas

Prevention Programs

“Just Say No”

  • Sponsored by local governments and found in schools and public agencies.
  • The program’s message is incorporated into public service announcements on television to influence preteens and teens by their peers to say “no” when offered a cigarette or other addictive or dangerous substance.

D.A.R.E.

  • Drug Abuse Resistance Education
  • Found in late elementary and early middle school grades
  • Uses police as instructors and provides case scenarios that challenge fifth and sixth graders to think about and answer them.

S.A.D.D. and M.A.D.D.

  • Students against Drunk Driving
  • Mothers against Drunk Driving
  • These associations help educate and orient young people about the hazards of drug abuse and the dangers of addiction

Tobacco and Cocaine Programs

  • These programs focus on the external and internal factors important to teens. External factors
  • External factors include: breath, teeth, clothes, and costs.
  • Internal factors include: lifestyle choices, time management, and nutrition.
  • Group pressure and dynamics are common elements in prevention.
  • Adolescents who get involved in the use of drugs do so because of friends who use drugs.
  • When a group perceives drugs as hazardous, its members are less likely to engage in the behavior.
  • Educational and support groups are a valuable tool to help ward off abuse and addictive behaviors
Reference:
Gladding, S.T. (2011). Counseling: A comprehensive profession (7th ed.). Upper Saddle, NJ: Pearson-Merrill.

Professional Readiness

Professional readiness is an ongoing process. It should not be understood as something you get done one time and you don’t look at it again. Professional readiness is directly linked to continuing education.

Understanding Diverse Cultures

A competent substance abuse counselor  is constantly learning about:

  • Information and resources in regards to diverse cultures, lifestyles, gender and age.
  • Information and resources to provide quality care to people with special needs and disabilities.
  • How culture, lifestyle, gender, etc. influence behavior.
  • How culture, lifestyle, and values influence substance use.
  • Assessment and intervention methods that are appropriate to culture and gender.
  • Counseling methods that match the needs of people from multicultural backgrounds, and people with disabilities.
  • Legislation related to human, civil, and client’s rights.

Self-awareness is Important

If we want to become competent substance abuse counselors, we must be open to evaluation, supervision, and change. In order to grow both personally and professionally, we need to:

  • Be aware of our personal and professional strengths and limitations.
  • Be aware of cultural, ethnic, and gender biases.
  • Look for resources available for continuing education.
  • Make a commitment to continuing professional education.
  • Know the benefits of self-assessment, clinical supervision, and consultation with other professionals.
  • Find ways to enhance our personal and professional growth.

Substance Abuse Prevention

Addictions professionals are not only involved with treatment and recovery. We also have the obligation to participate in prevention programs.

Substance abuse treatment and substance abuse prevention are two different fields. Research shows that for every dollar spent on prevention, 7 to 18 dollars are saved on treatment and recovery.

What we need to learn about substance abuse prevention includes:

  • Research-based prevention models and strategies.
  • The relationship between prevention and treatment.
  • Environmental strategies and prevention campaigns.
  • Benefits of working with community coalitions.

I recommend this book Substance Abuse Prevention: The Intersection of Science and Practice, by Julie Hogan et al. I am currently reading this book for my class on substance abuse prevention.

Setting-specific Policies and Procedures

It is our responsibility to learn, understand, and apply our agency’s (the place in which we are currently working) policies and procedures to handle crisis and dangerous situations, such as safety measures for clients and self.

TAP 21

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