CHAPTER 7: Individual Treatment Substance Abuse Counseling: Theory and Practice Fifth Edition Patricia Stevens Robert L. Smith Prepared by: Dr. Susan Rose, University of the Cumberlands

Overview of Chapter Introduction Beginning Individual Treatment Individual Therapy Direct Effect Strategies Broad Spectrum Strategies

Introduction Insurance Providers have changed amount of time allowed for treatment Requires counselors to provide swift, yet efficient techniques

Beginning Individual Treatment First step for treatment: Individual’s mental and emotional readiness for treatment DiClemente’s 5 Stages of Change: Precontemplation Contemplation Preparation Action Maintenance

Beginning Individual Treatment Type of treatment depends on: Type of treatment available in the community The level of treatment that might be paid for by insurance Amerian Society of Addiction Medicine’s 4 Levels of Treatment Outpatient Intensive Outpatient and Partial Hospitalization Medically Monitored Inpatient Medically Managed Inpatient

Beginning Individual Treatment Intervention: an action or occurrence that causes an individual to try quitting the use of substances Process of intervention can involve all significant people in the individual’s life Individuals involved in the intervention decide to “break the silence” Ethical and Legal Concerns State all rules and actions at the outset All participants should be fully aware of their rights and responsibilities After the intervention and into effective treatment

Individual Therapy Assortment of approaches: Cognitive-behavioral therapy Social skills training Behavior therapy Therapeutic Alliance (Counselor Relationship): Concept central to all therapeutic relations Fundamental principle: listening to the ATOD individual without passing judgment Important part of Therapeutic Alliance Validation Nonverbal communication Positive regard Language used by the counselor to create motivation toward behavioral change

Direct Effect Strategies Effective Strategies in the past: Aversion therapy Solution focus therapy Reality therapy (later replaced by Choice theory) Current Strategies: Motivational interviewing Cognitive-behavioral therapy Mindfulness training Pharmacotherapy

Direct Effect Strategies: Motivational Interviewing Two main goals: To move the ATOD individual in the direction of making a positive change toward recovery To resolve ambivalence by increasing internal motivation and increasing self-efficacy Five principles of MI: Express empathy Roll with resistance Develop discrepancy Support self-efficacy Avoid argumentation

Direct Effect Strategies: Motivational Interviewing Success of MI relies heavily on the language of the therapist Change talk: a technique in which the individual expresses the benefit for change and the hope that change will come in the future Techniques of “Change talk”: Exploring the addiction Examining past experiences Looking forward to recovery and setting positive treatment goals Examining values along with behavior Identifying the positive and negatives of the current decision to change Planning and committing to change

Direct Effect Strategies: Cognitive-Behavioral Therapy Based on a theory of personality which maintains that people respond to life events through a combination of cognitive, affective, motivational, and behavioral responses Goals of Cognitive Therapy To correct faulty information processing To help patients to modify assumptions that maintain maladaptive behaviors and emotions Primary Technique: Self-control training

Direct Effect Strategies: Mindfulness Technique An avenue to effectively control stress and undesirable feelings “Live in the moment” “Sitting” with one’s emotions

Direct Effect Strategies: Pharmacotherapy Way to use medications in conjunction with therapy: Detoxification: To safely withdraw from a substance Relapse prevention Alcohol: Disulfiram (trade name Antabuse) or Acamprosate calcium (trade name Campral) Opiate: Suboxone, buprenorphine, or methodone

Broad Spectrum Strategies: Harm Reduction Harm reduction includes education about the drug of choice along with therapy to encourage a decision in favor of abstaining or reducing harm. Harm reduction includes activities other than substance abuse, ie: Safe sexual contact, HIV, Gambling Harm reduction offers an alternative for individual to reduce risky behaviors in the event that s/he is not ready to separate from the drug of choice or other harmful behaviors. Overall goal is to assist the individual to identify copying strategies when faced with harmful events and reduce risky behaviors.

Broad Spectrum Strategies: Harm Reduction Harm Reduction from the Therapist’s Perspective Therapeutic relationship is vital Goal setting is part of the relationship One of the principles of harm reduction: “Meet the client where s/he is at” Set proximal (short-term) goals

Broad Spectrum Strategies Coping Skills Training/Life Skills Training Vocational Readiness The success of maintaining recovery relies heavily on the substance abuser’s ability to work and to fill the day with positive activities Support Groups Twelve Step Groups