Foundations of Addictions Counseling, 3/E David Capuzzi & Mark D. Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Chapter 8 Psychotherapeutic Approaches Updated by Melinda Haley, Walden University

Counselor Beliefs and Behaviors Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Addiction ideology (e.g., medical, humanitarian or empathic, moralistic) affects the selection of specific treatment strategies. No one tried and true approach Views influence acceptance and use of new therapeutic approaches

Informed Eclecticism Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved No single best approach for everyone Treatment systems should include a variety of effective approaches Different individuals respond to different approaches

Empirically Supported Treatment Approaches (NIDA) Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved 96 interventions Relapse prevention Family behavior therapy Motivational Interviewing Motivational enhancement therapy Multisystemic therapy Contingency management Seeking Safety Various brief interventions (i.e. BASICS)

Cognitive-Behavioral Practices Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Effective for alcohol and other drug dependencies behavioral self-control training community reinforcement contingency management and behavior contracting social skills training behavioral couples / family counseling

Cognitive-Behavioral Assumptions Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Substance abuse Involves complex cognitive and behavioral processes Is largely learned Can be modified A major goal is to teach coping skills to resist substance use and to reduce problems

CBT Assumptions, (continued) Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved CB counseling requires comprehensive case conceptualization warm, supportive, collaborative counseling relationship

Cognitive-Behavioral Interventions that Target “Triggers” Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Social interventions Environmental interventions Emotional interventions Cognitive interventions Physical interventions Useful Techniques ride the craving wave, surf the urge

Contingency Management and Behavior Contracting Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Counselor and client contract External incentives or tangible reinforcers Vouchers, groceries, movie theater tickets

Community Reinforcement Approach (CRA) Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Rearrange environmental stimuli to support sobriety Procedures according to client’s needs Goals for gaining/maintaining something positive

Community Reinforcement and Family Training (CRAFT) Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Work with concerned others More constructive ways of interacting Natural consequences

Mindfulness-based Relapse Prevention Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Several evidence-based approaches consider mindfulness a core skill and practice. MBRP is intended to promote increased awareness of triggers for substance use, habitual patterns of using, and “automatic” reactions that seem to control a person’s daily living.

Brief Interventions Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved All should include FRAMES Feedback Responsibility Advice Menu of alternatives Empathy Self-efficacy Often delivered by other professionals Target to those in early stage of change

Solution-Focused Counseling Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Focus on the successes, achievements, strengths, resources, and abilities of the client “Counseling of hope” Research is positive Treatment plan-based reinforcement (TP) Strengths based/Non-punitive form of treatment

Solution-Focused Counseling Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Pragmatism and parsimony Client-counselor collaboration Visitor-type, Complainant-type, Customer-type Language of hope Exceptions facilitate change Past exceptions Recent and recurrent exceptions Future exceptions (Miracle Question) Notice the difference Commendations

Harm Reduction Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Based on client advocacy Compassionate pragmatism (vs. moralistic idealism) Effort to reduce harm to individuals and/or society Meets individuals where they are Low threshold for services Goals of staying alive, maintaining health, and/or getting better

Harm Reduction (continued) Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Routes to abstinence “Warm Turkey” approach Sobriety sampling Tapering down Trial moderation Limiting intake Deemed inappropriate by some practitioners

Useful Web Sites Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved The Brief Family Therapy Center (SFC) The Harm Reduction Coalition