Substance Use Disorder Treatment: Therapy and More

Diciembre 6, 2021

Some clients may need to explore existential concerns or issues stemming from their family of origin. These emphases do not deny the continued importance of universality, hope, group cohesion and other therapeutic factors. Instead it implies that as group members become more and more stable, they can begin to probe deeper into the relational past.

The therapist uses whatever leverage exists—such as current job or marriage concerns—to power movement toward change. The goal is to help clients perceive the causal relationship between substance abuse and current problems in their lives. Counselors should recognize and respect the client’s position and the difficulty of change. The leader who leaves group members feeling that they are understood is more likely to be in a position to influence change, while sharp confrontations that arouse strong emotions and appear judgmental may trigger relapse (Flores 1997).

Modifying Group Therapy To Treat Substance Abuse

The U.S. General Accounting Office (1988) reviewed 10 other surveys of employers from 1985 to 1989. None of them were representative samples, and most had low return rates similar to the Backer and O’Hara survey. Most companies indicated a willingness to refer current employees with positive drug screening results to a rehabilitation program on a case-by-case basis, but there was no indication how often referral took place in practice. In 439 EAPs surveyed by Blum and Roman in 1984–1985, those with DSPs reported the same rate of drug-related referrals as those without screening programs. Clients may formulate exterior motives for entering treatment as “to get [someone] off my case.” External pushes are usually allied to some degree with positive pulls or motivation to change. The positive motives are often not strong enough in themselves to initiate or sustain compliance with treatment, but reinforcement through external pushes into treatment and therapeutic pressure within treatment may be effective in doing so.

More than 20 years ago, John Wallace (1978) wrote about this important issue in an informative essay on the defensive style of the individual who is addicted to alcohol. He referred to these character-related defensive features as the preferred defense system of the individual addicted to alcohol. Some of the numerous advantages to using groups in substance abuse treatment are described below (Brown and Yalom 1977; Flores 1997; Garvin unpublished manuscript; Vannicelli 1992). Also outside the scope of this TIP is the use of peer-led self-help groups such as Alcoholics Anonymous (AA) or group activities like social events, religious services, sports, and games. Any or all may have one or more therapeutic effects, but are not specifically designed to achieve that purpose.

Residential treatment

Furthermore, although some parties to treatment deal with each other only in a single episode, others do so across episodes. Drug treatment clinicians have devised ways to respond to these varying client features and have incorporated these methods into program policies and goals. Program policies are not all dry abstractions and pious sentiments; rather, they are rules of thumb for selecting clients for admission, dispensing discipline or extra attention, or deciding on discharge. Every program admits applicants to some degree according to its reading of an applicant’s motives and situation, including the role of third parties such as the law and third-party payers. Programs vary in how eager they are to accept or avoid the harder cases, how intensively they are willing (or able) to work to treat the most difficult problem clients, and how heavily or swiftly or carefully they impose sanctions for noncompliance with the treatment plan.

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