Approaches to Chemical Dependency Counseling

Bruce K. Barnard

Background

“Where the scientist is searching for empirical truth, the alcoholic and addict are searching for a workable answer to their painful entrapment. The objectivity and detachment of the scientist stand in stark contrast to the passionate belief and commitment that marks most avenues of recovery”. Bill White

Possibilities

Addiction is a primary disease

Addiction is the result of psychiatric, social, or other conditions

Both are true

Neither is true

It depends

I don’t know, it is a mess!

Treatment Activities

Self-Reflection

Prayer and Meditation

Relationships with Others (Counselor, Group, Peers, Family, Mentors)

Insight & Confrontation

Education & Skill Development

Experiential (Psychodrama, Recreation)

Questions

What is treatment?

What is the most important aspect or aspects of treatment?

How do we know if treatment is successful?

The Conundrum

Our paradigm, or how we view addiction and treatment, modifies our perception of treatment itself including the role of the counselor, client, and group. The treatment process, preferred outcomes, and activities are determined by our perception of the problem or solution. Consequently real progress and innovation often requires a shift in our own paradigm.

Evaluation of Models

Who is the proponent?

What are the goals?

What is the rationale?

What is the agent of change?

Evaluation of Models

Who is responsible for the services? Who has the skills and resources?Who determines reality?

Client Others

Dual Disorders Recovery

Dennis DaleyIntegrated approach for clients with addiction and psychiatric disorders.Clients will go through a series of phases in treatment engagement early recovery middle recovery maintenance

Dual Disorders Recovery

GoalsAchieve and maintain abstinenceStabilize acute psychiatric symptoms Improve physical, emotional, social, family,

interpersonal., occupational, academic, spiritual, financial, & legal functioning

Make positive lifestyle changesEarly intervention in relapse to either

Dual Disorders Recovery

Change AgentPatient-counselor relationship, community

support system including the team relationship (counselor, psychiatrist, psychologist, nurse, case manager, family therapist)

Appropriate medication

Relapse Prevention (CENAPS)

Terry Gorski

An applied cognitive-behavioral approach

Disease Model/ Abstinence Based

Relapse Prevention

GoalsAssess global lifestyle patternsConstruct personalized list of early warning

signsWarning sign management strategiesStructured recovery programRelapse early intervention plan.

Relapse Prevention

Rationale Integrates the disease model of chemical

dependency and abstinence-based counseling with cognitive and social therapies.

Agent of ChangeA structured clinical protocol in a process-

oriented interaction among clients, group, and therapist

Living In Balance

Hoffman, Jones, Caudill, Mayo, & Mack

Practical, group-oriented treatment sessions based on cognitive and experiential approaches including daily relaxation and visualization.

Living In Balance

Goals Consistent content and scope of treatment

issuesProvide information about treatment and

recoverySkills for recovery and relapse preventionPractical living skillsOpen confrontation

Living in Balance

Rationale Persons addicted to drugs and alcohol develop an

imbalance in major life functioning. A broad and holistic approach is necessary to restore balance.

Agent of Change Interaction among counselor, group, and group

members as well as intrapersonal responsibility for visualization, meditation etc.

Addiction Counseling

Delinda Mercer

Addresses the symptoms of drug addiction and related areas of impaired functioning and the content and structure of a recovery program. Focuses on behavioral change and participation in 12-step recovery

Addiction Counseling

Goals1. Assist client in maintaining abstinence

2. Assist client in recovering from the damage addiction has caused in client’s life

Addiction Counseling

Rationale Addiction counseling works by helping clients

recognize the existence of a problem and associated irrational thinking. The approach encourages recovery and abstinence by developing psychosocial skills and spiritual development

Agent of Change Client responsibility and support from others

Solution Focused/Brief Therapy

Scott Miller

Designed to assist clients to engage their own unique resources and strengths to solve problems that they bring to treatment.

Solution Focused/Brief Therapy

Goals Focused on client rather than therapist or program Small rather than large Described in specific, concrete, and behavioral

terms Described in situational rather than psychological

terms Stated in interactional and interpersonal terms

Solution Focused/Brief Therapy

RationalThe approach proposes that the solution to

the problem may have little or no relationship with the problem. The number of approaches to any problem is limitless

Agent of ChangeChange is constant and inevitable. The

counselors role is to tap into and utilize existing changes and solutions.

Motivational Enhancement Therapy

William Miller

Seeks to evoke from clients their own motivation to change and consolidate a personal decision and plan for change.

Motivational Enhancement Therapy

GoalsAlter harmful use of drugs Clients establish their own goals

Motivational Enhancement Therapy

Rationale Intrinsic motivation is a necessary and

often sufficient factor in instigating change. No advise or skill training is offered.

Agent of Changeclient

Twelve Step Facilitation

Joseph NowinskiA brief, structured, and manual-driven

approach to facilitating early recovery. The approach is directly based on the principles of AA and NA.

Twelve Step Facilitation

GoalsFacilitate an acceptance of the for

abstinence (surrender)Establish a willingness to participate in

actively in 12-step recovery fellowships

Twelve Step Facilitation

RationaleWillpower alone is not sufficient to sustain

recovery and long-term recovery consists of spiritual renewal

Agent of ChangeActive participation in 12-step fellowship

Minnesota Model

Patricia Owen

Based on a thorough and on-going assessment of the client and a multi-modality approach to services. A multi-disciplinary team develops the treatment program and plan to provide tools and incorporate a 12-step recovery program.

Minnesota Model

GoalsAbstinencePersonality change (thinking, feeling, and

acting)Spiritual

Minnesota Model

RationaleChanging a client’s beliefs about his or

herself occurs as a result of meetings, self-reflection, and learning new coping skills.

Agent of ChangeGroup affiliation12 steps

Psychotherapeutic/ Skills Training

Arnold Washington

Combines psychotherapeutic techniques with abstinence-based counseling. Combines cognitive behavioral, motivational, and insight-oriented techniques.

Psychotherapeutic/ Skills Training

GoalsEnhance the clients motivation for changeTeach the client how to break the addictive

cycleTeach coping and problem-solving skillsSupport and guide the client through

trouble spots and setbacks

Psychotherapeutic/ Skills Training

RationaleAddiction is a multi-determined addictive

behavior and maladaptive (self medication) coping style with biological, psychological, and social components.

Agent of ChangeA therapeutic alliance between client and

counselor

ASSIGNMENT

What activities or types of services are used with this approach?

What types of clients is this approach especially suited to – what types of clients is it not suited to?

Other things of interest about this approach.