CHAPTER 7: Individual Treatment

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