Chapter 7 Individual Treatment

In the past when a person was wanting to attend substance abuse treatment they will be given 28 days
inpatient and an unlimited amount of time for outpatient therapy. Due to changes in the way insurance
work, this is no longer the case. An individual must get prior approval for treatment prior to entering an
inpatient rehab facility and the stay substantially less. Due to this change it is important for the therapist
to change their treatment plans to make sure they can provide the most amount of help in a shorter
amount of time. Treatment for substance abuse has shown to be more affective when the therapist
combines individual therapy, group therapy and family therapy into the treatment plan.
1. Beginning Individual Treatment
a. Believed that an individual who is going through substance abuse has formed an
emotional attachment to their drug of choice and will go through grief and loss when
they discontinue using the substance.
b. According to DiClemte there are five stages of change that an individual who uses
substances goes through.
i. Pre-contemplation (Not considering Change)
ii. Contemplation (Weighs all options for change and possible ambivalent)
iii. Preparation (Trying to Change
iv. Action (Changing behaviors)
v. Maintenance (Commitment and planning)
c. In order for change to be effective the individual must be in stage three prior to starting
treatment.
d. According to ASAM there are four different levels of treatment that an individual may
participate in:
i. Outpatient
ii. Intensive Outpatient and partial hospitalization program
iii. Medically monitored impatient (residential) treatment
iv. Medically manage impatient treatment
e. The level of treatment that a person receives is determined by the insurance company.
2. Interventions
a. can happen in many ways
b. Will typically include all significant members of the individuals life.
c. In order to complete and intervention successfully they need to be structured to
acknowledge the care and concern for the abuser but also needs to stress that the
continued abuse has both limits and significant consequences.
d. An intervention can be done without a substance abuse therapist involved
i. But do the level of emotional intensity it is recommended that a substance
abuse therapist be involved to assist with the planning of the intervention and
be present to supervise.
e. It is important to remember that even though there is conflict accruing during the
intervention that there should be no malice.
f. It is also important to have a group of individuals preform the intervention versus a
single individual.
i. Because it is harder for the individual to brush off his/her behavior and actions if
they are being held accountable to more than one person.
3. Ethical Concerns
a. The most important thing the therapist needs to remember prior to starting the
intervention is that everybody has rights and they need to be made aware of those
rights prior to the start of the intervention.
4. Therapeutic Alliance
a. It is important for the therapist to have a therapeutic alliance with their client in order
for therapy to be affective.
i. Listening to the individual without passing judgment verbally or nonverbally
ii. Validation
iii. Nonverbal communication and positive regard
iv. Language used by the counselor to create motivation toward behavior change
5. Direct Effect Strategies
a. Motivational Interviewing
i. Client Centered and directive
ii. Two main goals
1. Move the ATOD individual in a direction of making a positive change
toward recovery
2. Resolve ambivalence by increasing internal motivation and increasing
self-efficacy
b. Five principles
i. Express empathy
ii. Roll with resistance
iii. Develop discrepancy
iv. Support self-efficacy (Gaining confidence in ones self). Is necessary for therapy
to be successful and should be stressed at the beginning of therapy.
v. Avoid argumentation
c. Success of MI in relies heavily on the language of the therapist
i. Change Talk (the individual expresses the benefit for change and the hope for
change in the future)
ii. Therapist who use change talk have showed better sobriety outcomes.
iii. Techniques used to elicit change talk
1. Exploring the addiction
2. Examining past experiences
3. Looking forward to recovery and setting positive treatment goals
4. Examining values along with behavior
5. Identifying the positives and negatives of the current decision to change
6. Planning and committing to change
d. Cognitive-Behavioral Therapy
i. One of primary techniques is self-control
ii. According to the national institute on drug abuse and individual who abuses
substances must change behavior by first altering his/her thinking or frame of
reference.
iii. Some individuals use substances as a coping mechanism and CBT can be used to
teach those new coping skills and strategies to prevent relapse.
iv. CBT can be used in conjunction with Mindfulness
e. Mindfulness Technique
i. moment to moment non-judgmental awareness cultivated by paying attention
in a specific way, that is, in the present moment, and as non-judgmentally and
openheartedly as possible
ii. Individual learns through the therapist language to live in the moment of the
experience by using all senses.
iii. Participates are required to focus on a certain part of the body and meditate
which allows them to regulate their thoughts
iv. Can be used in all levels of treatment
v. Shown to be more effective then CBT in reducing the patients response to
psychological and physiological stressors
f. Pharmacotherapy
i. Should be used in conjunction with individual therapy
ii. Can be used in two ways
1. Safely withdraw from a substance (Detoxification)
a. Heroin: methadone, and sometimes also clonidine
b. Alcohol: benzodiazepine, or Phenobarbital (eases the
discomfort of withdraw and reduces the chances of seizures)
2. Prevent relapse
a. Disulfiram has been shown to be effective individuals with
alcohol dependency, cocaine dependency, and both.
i. Alcohol: Causes the individual to become violently ill
when they drink
ii. Cocaine: Helps reduce cravings
b. Acamprosate calcium (Campral) shown to be effective with
treating alcohol dependency
c. Subxone can be used with the opiate population and is safe for
pregnant women
d. Buprenorphine can also be used with the opiate population
3. Combination of individual and group therapy and self-help is
recommended as an adjunct to medication.
2. Broad Spectrum Strategies
a. Purpose of these strategies is to incorporate them into individual treatment and to
approach the client holistically while addressing concerns that could hinder individual
treatment.
b. Harm Reduction
i. Overall goal is to assist the individuals to identify coping strategies when faced
with harmful events and reduce risky behavior.
ii. Includes education about the drug of choice along with therapy to encourage a
decision in favor of abstaining or reducing harm.
iii. Meet the client where theyre at.
iv. Should set short term goals not long term goals
v. Long term goals can do more harm than good.
vi. Can be used in conjunction with motivational interviewing, CBT, and Solution
focused counseling.
c. Coping skills training/Life skills training
i. Some addicts have not learned social skills or have lost the ability to use them
due to drug addiction.
ii. Important to teach social skills during therapy
1. Modeling
2. Role play
3. Demonstration
d. Vocational Readiness
i. Research showed that an individual is more likely to succeed in recovery if they
are gainfully employed
ii. In 2008 it was shown that 78% of treatment facilities do not conduct vocational
assessments and did not provide vocational counseling as a standard practice
iii. Success of maintaining recovery relies heavily on the substance abusers ability
to work and to fill the day with positive activities
iv. Working becomes a self-fulfilling activity
e. Support Groups
i. 12-step self-help group such as NA, AA, and CA
ii. Help individuals with developing a clean and sober social network
iii. Should be used as a supplement to individual therapy
iv. Help to motivate the individual to be clean and sober
v. Provide peer support
vi. Provide goal direction, social values that are positive,
1. Encouraging strong bonds with family, friends, work and spirituality
vii. Can also be found online if face-to-face group is not available or preferred
viii. Utilization of self-help groups and spirituality with the development of self-
efficacy can lead to self-actualization, which allows the individual to be self-
aware of his/her ability as well as potential and take personal responsibility for
recovery.