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 Daley Integrated 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 Goals Achieve and maintain abstinence Stabilize acute psychiatric symptoms Improve physical, emotional, social, family, interpersonal., occupational, academic, spiritual, financial, & legal functioning Make positive lifestyle changes Early intervention in relapse to either

Dual Disorders Recovery Change Agent Patient-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 Goals Assess global lifestyle patterns Construct personalized list of early warning signs Warning sign management strategies Structured recovery program Relapse early intervention plan.

Relapse Prevention Rationale Integrates the disease model of chemical dependency and abstinence-based counseling with cognitive and social therapies. Agent of Change A 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 issues Provide information about treatment and recovery Skills for recovery and relapse prevention Practical living skills Open 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 Goals 1. 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 Rational The 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 Change Change 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 Goals Alter 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 Change client

Twelve Step Facilitation Joseph Nowinski A 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 Goals Facilitate an acceptance of the for abstinence (surrender) Establish a willingness to participate in actively in 12-step recovery fellowships

Twelve Step Facilitation Rationale Willpower alone is not sufficient to sustain recovery and long-term recovery consists of spiritual renewal Agent of Change Active 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 Goals Abstinence Personality change (thinking, feeling, and acting) Spiritual

Minnesota Model Rationale Changing a client’s beliefs about his or herself occurs as a result of meetings, self- reflection, and learning new coping skills. Agent of Change Group affiliation 12 steps

Psychotherapeutic/ Skills Training Arnold Washington Combines psychotherapeutic techniques with abstinence-based counseling. Combines cognitive behavioral, motivational, and insight- oriented techniques.

Psychotherapeutic/ Skills Training Goals Enhance the clients motivation for change Teach the client how to break the addictive cycle Teach coping and problem-solving skills Support and guide the client through trouble spots and setbacks

Psychotherapeutic/ Skills Training Rationale Addiction is a multi-determined addictive behavior and maladaptive (self medication) coping style with biological, psychological, and social components. Agent of Change A 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.