Crisis Intervention with Individuals who have Substance Use Problems

Facts & Figures: Lifetime prevalence of A & D diagnosis: 25%. 11% of Americans are currently experiencing an alcohol or drug problem. Alcohol is the nation’s #1 drug problem, involved in approximately 50% of all crimes (including traffic fatalities).

About half of individuals with A & D disorders have additional psychiatric diagnoses (dual diagnosis). 1/3 are misusing another drug. A large proportion of crisis interventions and other emergency services (e.g., ER visits) are associated with substance misuse.

Substance Abuse: Failure to fulfill role obligations. Recurrent use in potentially dangerous situations. Recurrent legal problems. Continued use despite psychosocial problems resulting from substance use.

Substance Dependence: Tolerance. Withdrawal. Loss of control/compulsive use. Excessive time involvement. Reduce involvement in other activities because of substance use. Continued use despite obvious negative consequences.

Crisis as a Window of Opportunity

Potential Presenting Crises: Severe intoxication, overdose, medical problems, or withdrawal symptoms. Suicidal ideation/attempts. Unemployment & financial losses. Interpersonal problems (e.g., separation, date rape or partner violence). Legal crises (e.g., DV/aggravated assault, child abuse/neglect, DUI’s, PD’s). “Intervention”

Assessment Issues: Typically referred by others and expected to undertake non-discretionary change. Denial & Concealment: need collateral information. Ask about what and how much was ingested. Need for medical evaluation? Clients may present with consequences of abuse, rather than abuse itself. Dual diagnosis (as much as 50%).

Intervention Strategies: Try to prevent intoxicated clients from driving away. Help client make connections between substance use and current problems. Help client find leverage & incentives for change. Education about process of addiction. Referral for family members. Reframe relapse as common and an opportunity for learning.

Referral Options: Self-helps groups (AA, NA, Rational Recovery). Psychoeducation (e.g., DUI programs). Outpatient: individual, group, or family therapy. Intensive outpatient treatment. Partial Hospitalization/Day Treatment Residential treatment setting (e.g., Minnesota Model = 28 days). Medical/Psychiatric hospitalization, which is typically reserved for clients who are dually-diagnosed or need medical detoxification. Long-Term Behavioral Modification (e.g., Synanon).