The Practice of Treating Addiction

 

1. Thanks for taking the time today to be with us. Recently there have been a lot of news stories related to addiction treatment, but we also hear terms like recovery, rehab, and therapy. I’m wondering if you can help our viewers understand exactly what treatment is, and how it might be different than some of the other terms or images we may have seen on TV?

Treatment is the act of encouraging independence, showing empathy, being compassionate, encouraging rational thoughts through engagements that show that there is a possibility for recovery. This is done using contingency supervision which seeks to reduce harm to the patient. In the earlier years, the therapeutic communities used behavioral modification ideologies to encourage positive behavior changes that promoted recovery. These methodologies worked well for the residents at the time. It is important to note that as of now, addiction cannot be cured, meaning that there is no available way to bring back the brain of a patient who is dependent on a substance to where it was before they began abusing. One effective treatment is when a patient learns to change their lifestyles and begin to be in control, be industrious, and live a meaningful life (Carroll 2016). In the medicinal methodology of treatment, there is the use of pharmaceuticals which help to address several significant dysfunctions in the brain that are connected to addiction. Pharmaceutical cannot be able to address all the other social, economic, and political aspects and therefore require other interventions to be incorporated for it to be effective. Evidence-based practice interventions which include therapies such as behavioral therapies, coping skills, and other types of counseling programs are effective for addiction treatment because they focus on the individual and what they are struggling with. Combining the evidence-based practice with a universal treatment methodology that includes the earlier approaches yields better treatment results. A follow-up is done on the patient by their therapist or counselor to ensure that they can use the skills learned to cope in society and offer them moral support to do so.

2. Thanks for that insightful response. My next question relates to the best practices for the type of treatment programming you described. What should individuals or families be looking for in an addiction treatment program? 

In an addiction treatment program, approaches such as contingency management are used. This is a type of behavioral therapy that uses motivational incentives or rewards to enable an individual to abstain from drugs and alcohol. This approach helps to encourage soberness and actions that uphold a healthy existence. Rewarding clients when they can make lifestyle changes make them more determined to achieve their goals. Psychotherapies is another approach used in the addiction treatment program. This is the use of psychological methodologies to help a person change their behavior and is aimed at improving their cognitive and behavioral difficulties (Carroll & Rounsaville 2010). Behavior therapy focuses on learning how to develop the usual and unusual behaviors. Cognitive therapy focuses on people’s thoughts rather than what they do and this includes their emotions too. Humanistic therapy emphasizes the capability of an individual to make a rational choice and develop to their maximum potential. The holistic therapy also part of the treatment program is a blend of different approaches, tailored to fit the needs of the client. Pharmacotherapy is the use of medication which is also used in the program whereby medicines are used to decrease the strength of withdrawal symptoms. These kinds of medications also decrease alcohol and other substances cravings and the probability of consumption or relapse for particular drugs by stalling their impact. With the increase of technology, computer-assisted therapies are also available and this is a type of psychotherapy that uses a computer program to deliver an important part of therapy content.

3. And exactly how effective are these sorts of treatments?

These sorts of treatments are effective because each of the patients is treated according to their needs and the treatments are patient-centered to ensure that they serve the patient effectively. For a treatment to be effective, the person being treated has to be ready to address their addiction and by using these kinds of treatment, they will benefit the patient. Therapies help the patient treat their addiction problem while they develop new habits, behavior, and coping skills for recovering addicts. Medication is important in addiction treatment but when used alongside other kinds of psychotherapies and behavior therapies it becomes effective and serves the patient holistically. To address mental health conditions in a patient, these kinds of treatment work effectively because they use treatment methods that focus on their mental health (Hunsley, Elliott & Therrien 2013). This sorts of treatment allow the patient to be regularly assessed and if the method is not working for the patient, it is easy for it to be modified to fit the needs of the patient. Psychotherapy is important and makes the addiction treatment effective because addiction to drugs does not only mean being dependent on the substance but once detox is finished, and the body is no longer dependent on the substance, there is still a possibility of relapsing. This is because social and psychological factors can easily trigger a person to return to drugs. Psychotherapies ensure that the patient gets the required support even after their successful detox and the patients get the required skills and care that they need during this time.

4. Great, and would you say treatment programs can work for people from all walks of life, and if so, how do you ensure your services are being delivered in a culturally appropriate manner? 

Treatment programs work for every individual despite their culture or background. To ensure that the treatment services and programs are offered in a culturally appropriate manner, cultural competencies are followed. Cultural competence is the process where the one offering the treatment services attempts to accomplish the capability to work efficiently within the cultural framework of the person. This means following cultural competence components which include cultural awareness which is the self-evaluation of a person’s own culture and professional background. Cultural knowledge is important in ensuring that culturally appropriate services are offered. Cultural knowledge is the process of pursuing and gaining information about diverse racial and ethnic groups. Another cultural competence component is having cultural skills. Cultural skill is the capability of collecting significant cultural information that concerns the problem that the client presents and being accurate in conducting a culturally specific physical evaluation (Campinha-Bacote & Munoz 2001). Cultural encounter is another component that encourages direct commitment to cross-cultural relations with clients from culturally varied upbringings. Having cultural desire when offering addiction treatment to culturally diverse clients is an important component in ensuring that culturally appropriate treatment is offered. This is because cultural desire acts as a motivation to engage in the treatment process of becoming culturally aware, gaining knowledge and skills in seeking cultural encounters. Being culturally competent ensures that the cultural differences are respected, it builds on the strengths of a person’s cultural background and identifies any similarities between the client and their therapists. This ensures that the client gets culturally appropriate treatment services.

5. I’ve read somewhere that most people return to using at some point in time once they leave treatment. I’m wondering if you can speak to this and offer advice to individuals and families who may be in the midst of this process.  

Relapse is a slow progression with different stages and the main objective of treatment is to help clients identify the initial stages which have a high chance of being successful. Some of the main types of relapse include emotional relapse and through this relapse, people don’t think about using. Their emotions and behaviors are the ones that set them up for relapse. Signs of emotional relapse include holding up lots of emotions, isolating themselves, poor eating and sleeping problems among others. Therapy at this stage helps the client to realize what self-care is and the reason why it is essential. Self-care differs from one person to the other, some may require basic self-care such as diet and hygiene but for most clients, it is more about emotional self-care. Therapy helps clients identify their denial by comparing their behavior to know if their self-care is improving or getting worse (Melemis 2015). When a client gets a mental relapse it means that there is a battle inside their minds, battling if they should use or not use. When people get more into mental relapse, their cognitive resistance weakens and their need for escape escalates. Signs of mental relapse include cravings, having thoughts about people or places that are related to their past use, lying, and planning for relapse among others. Therapy at this point helps clients to avoid high-risk situations. Physical relapse is when an individual begins to use the substance again. Physical relapses mostly are relapses of opportunities. When a person gets a chance that they feel that they won’t be caught a relapse is likely to occur. This is the hardest stage to stop and the reason why people relapse. People need to learn about the essential coping skills for them not to return to drugs and alcohol to escape their situations.

6. For all the folks out there struggling with substance use, who may have tried treatment or counseling previously with little success, what advice would you have?

It takes a lot more than treatment and counseling for a person to successfully stop being dependent on a substance. First of all, you as the patient should be willing to go through all these stages of treatment and have a positive mind. Developing healthy coping skills is key to avoid the negative thinking that makes the treatment not to be successful. Negative thoughts such as, “I cannot handle a situation without using, I do not want to change my friends, life will be boring and recovery takes a lot of time” among others are some of the thoughts that interrupt the recovery process (Melemis 2015). The moment you as a person gives in to the negative thoughts, you convince yourself that it is not possible and it is too much work. These thoughts cause anxiety, depression, stress, a person becomes resentful and this can lead to a relapse. For treatment to be successful, a person has to be committed and true to themselves, own up to their mistakes, and identify with the help of their counselor which strategy to use when they start having negative thoughts. A person ought to learn from setbacks because the way an individual deals with a setback plays a big role in their recovery. It is important to note that setbacks are part of the progress and are normal. They are brought about by inadequate coping skills or planning which are disputes that can be amended. During recovery, patients ought to learn how to feel comfortable with being uncomfortable. The negative feelings and emotions are normal and are not signs of failure.

7. Now I imagine there are several people out there who might not be ready for therapy, but who may need help organizing their lives and figuring out what they want to do. Is that possible or is counseling the only service available? 

The first rule for such people is to change their lives and the way they live. Recovery is not achieved only by not using substances. It involves developing a new life whereby it is easier not to use. When a person is not willing to amend their life, then everything that led to their addiction, in the long run, catches up with them. Avoiding people, places, and things that are associated with substance use is important. People need to completely be honest with themselves, their mistakes, and work towards correcting them. People can talk to their family members about their plan to stop using or could join a self-help group where people share their experiences and offer support to each other (Melemis 2015). When a person chooses a recovery circle, it is important for them to be honest because it is significant in their recovery. Joining a self-help group increases the chances of a person getting a full-term recovery. In the self-help groups, the person feels that they are not alone, they hear other people talking about their addiction and they learn how other people achieved or are on their way to achieve recovery. They also can learn about the coping skills that have worked for others and the best part about it is that they have a place that they feel secure to go to where they do not get any judgment. Self-help groups support people in overcoming their shame and guilt about addiction seeing that they are not alone and this acts as a motivation for their recovery.

8. Great, I’m wondering if you have any advice for anyone out there who may be accessing the help that doesn’t seem to be helping. What should they do, and is the right way to end services and find something that might be more helpful?

For an individual to achieve successful counseling, they ought to have a significant change in the way they feel, act, or think. If the counseling relationship appears not to be helpful, termination is appropriate. The counselor needs to discuss with the client about termination immediately they notice the signs that the client is not committed. Discussing it helps them identify what the problem is and know if it could be resolved and if not termination is allowed. When the counselor finds that the client wants to quit, an exit interview may be done to help the client resolve any negative feelings that could have been a result of the counseling experience. An exit interview is also a way of inviting the client to continue with counseling if they wish to. In an exit interview, another counselor or strategy might be considered if the client is willing and it also increases the chances of the client considering counseling again if they need help (Gladding & Alderson). In this case, the client feels that they are not getting the help that they need or expected, and the termination is appropriate. The client should discuss openly with their counselor their reasons for termination. This will help the counselor not beat themselves up about the termination. They may even come up with a solution or suggestion on what you should do to get the help that you need.

9. Last question. For many of our viewers, your work seems intense, meaningful, and potentially draining. What would you say are the keys to maintaining healthy work-life boundaries? 

Taking care of yourself is important because experiencing job stress and burnout in our career is inevitable and normal. Maintaining a healthy work-life boundary includes remembering your mission. Since our career’s mission is to facilitate the survival of people with mental illness and help them live a productive life in society, we have to accomplish that. Accomplishing the mission is so fulfilling seeing that a client has been able to achieve their goals (Eack, Anderson & Greeno 2013). Defining your job in a way that makes it doable is important in our career. Professionalism is key for us and it means doing whatever it takes to get the job done. Sometimes the days are long, working for many hours but there are days that the demands are minimal. This is where you balance and take advantage of the minimal demanding days to take it easy on the job. Making reasonable schedules with the clients is also important so that none of you gets frustrated. It is also important to nurture yourself in your career. This involves accepting that your needs are also legitimate and require your attention. Self-care includes taking care of your mental and physical health by getting enough sleep, have healthy eating, and exercise lifestyles. Listening to your body and maintaining an attitude of self-acceptance by avoiding negative self-talk helps in keeping you energetic and positive. We need to maintain a healthy balance between our profession and personal lives to be able to maintain a healthy work-life boundary.

 

References

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Carroll K.M. & Rounsaville B.J. (2010) Society for the Study of Addiction Journal Compilation

Eack S.M., Anderson C.M. & Greeno G.C. (2013). Mental Health Case Management: A

Practical Guide: Taking Care of yourself. SAGE Publications, Inc.

Gladding T. S & Alderson G. K. Chapter 8: Termination of Counseling Relationships.

Hunsley, J., Elliott, K., & Therrien, Z. (2013). The efficacy and effectiveness of psychological

treatments. Ottawa, Canada: Canadian Psychological Association.

Melemis, S. M. (2015). Focus: Addiction: Relapse Prevention and the Five Rules of Recovery.

The Yale journal of biology and medicine, 88(3), 325.