1. 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

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

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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

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

13. 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

14. 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.

15. 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

16. 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