1. Substance Abuse Prevention Facts About Substance Abuse  Alcoholism is considered the third most prevalent public health problem in the United States today.  It is estimated that 32 million Americans smoked marijuana in the last year. 20 million use it monthly. Approximately 12 million use cocaine yearly.  Approximately 40% of hospital admissions and 25% of deaths each year are related to substance abuse.  Approximately ½ of all traffic fatalities involve alcohol. “Copyright © Allyn & Bacon 2004”

2. Substance Abuse Prevention Considerations For Clients With Substance Abuse Problems  Diagnosis: Substance abuse or substance dependence?  Special Treatment Issues: Substance abuse problems exist on a continuum. Treatment plans should be individualized, multidimensional, un-intrusive and sensitive to diversity issues.  Counseling goals: Abstinence or controlled use? “Copyright © Allyn & Bacon 2004”

3. Substance Abuse Prevention Treatment Strategies For Clients With Substance Abuse Problems  The Minnesota Model: A comprehensive treatment team does an analysis, followed by a 28-day inpatient hospitalization.  Alcoholics Anonymous Model: Incorporates the disease model and advocates for abstinence. Uses the 12-steps and has a strong spiritual component.  The Medical Model: Also adheres to the disease model, uses medical approaches (e.g. antibuse, methadone and detoxification), and believes there are biological components to addiction. “Copyright © Allyn & Bacon 2004”

4. Substance Abuse Prevention Treatment Strategies For Clients With Substance Abuse Problems (continued)  Cognitive-Behavioral Therapies: Helps clients develop the skills to deal with their addictions (e.g. self-control, coping mechanisms, relapse prevention.)  Behavioral Therapies: Operant conditioning (reward and punishment), systematic desensitization and aversion training.  Individual Psychodynamic/Interpersonal Therapies: Formulation of the counseling relationship and skill development. “Copyright © Allyn & Bacon 2004”

5. Substance Abuse Prevention Treatment Strategies For Clients With Substance Abuse Problems (continued)  Group Therapies: Gives support and encouragement and generates problem-solving strategies.  Family Therapy: Some feel family therapy is necessary as the addiction affects the family and the family affects the addiction. “Copyright © Allyn & Bacon 2004”

6. Substance Abuse Prevention Stages of Change  Precontemplation: Clients are resistant and deny they have a problem.  Contemplation: Clients are aware they have a problem and are actively wondering what they should do about it.  Preparation: Client have taken some action, were unsuccessful, but plan to try again.  Action: Clients are taking action and are making changes.  Maintenance: Efforts are on relapse prevention. “Copyright © Allyn & Bacon 2004”

7. Substance Abuse Prevention Relapse Prevention  It is estimated that 90% of all clients have a relapse within four years of treatment.  Factors that influence: Comorbidity and changes or stressors in lifestyle.  Preventative factors: Coping mechanisms and self-efficacy. “Copyright © Allyn & Bacon 2004”

8. Substance Abuse Prevention The Counseling Process  Develop trust  Assess the problem  Establish goals  Implement a plan  Train for relapse avoidance or minimization  Termination “Copyright © Allyn & Bacon 2004”

9. Substance Abuse Prevention The Counseling Process (continued)  Structuring the Sessions: Most counselors provide strict guidelines (e.g. come straight; do homework etc.)  Assessment: Examples of questions that need to be answered are: –How significant is the problem? –How long has the client been a user? –Has the client tried to stop? –Does the client have a another disorder? –How has the client been functioning socially? “Copyright © Allyn & Bacon 2004”

10. Substance Abuse Prevention The Counseling Process (continued)  Goal Setting: It is usually either abstinence or controlled use. It might also include intrapersonal change, behavioral change or lifestyle change.  Plan Implementation: Before plan implementation, detoxify if needed. Otherwise implement the plan to meet goals (e.g. AA or antibuse). “Copyright © Allyn & Bacon 2004”

11. Substance Abuse Prevention The Counseling Process (continued)  Relapse Prevention: Relapses are most likely to occur within six months. Help the client become aware of what his or her triggers for relapse are and develop a plan to deal with these.  Termination: Termination occurs when both counselor and client feel the client can cope without the substance. “Copyright © Allyn & Bacon 2004”