Addiction treatments have come a long way in the past few years. It is not so long ago that we were electrocuting our clients to cure them from their disease! More recently our attempts to “break through their resistance” included confrontational and directive approaches which, in hindsight, can only be seen as directly oppositional to the techniques we now utilise. The breakthroughs in science with tools such as fMRI which image the living brain have supported the disease model of addiction in which 12 step facilitation is based and further research has informed techniques such as motivational therapy and interviewing and cognitive behavioural therapy. These three models of treatment are in the forefront of most current treatment services along with humanistic-existential therapies such as person centred and gestalt modalities.
In this article we will briefly look at each of these treatment options with a view of understanding and educating rather than prescribing specific treatment plans. It cannot be stressed enough that each individual treatment plan must take into consideration the client, their environment and the addiction of choice.
Motivational therapy is an appropriate start as when a client initially makes contact, they may be in various stages of change. These stages are known as
Contemplation – Acknowledgement of a problem but ambivalent to change)
Preparation - (preparing for change)
Action - (Changing behaviour)
Maintenance (Maintaining the desired behaviour change)
Relapse (Return to unwanted behaviours)
The idea behind motivational interviewing or therapy is to work with the particular stage in which your client is presenting. For example, if your client has been coerced by their family to seek help but is apparently a “happy user” it would be counterproductive to pursue a commitment to abstinence. This pre-contemplation stage is a point whereby a therapist would work to move their client from content with their current use to a point of acknowledgement that they may desire a change thus moving from one stage to the next and rather than breaking through resistance we work with the resistance.
CBT is an important tool for an individual who has progressed to an active desire to stay clean or possibly maintain moderation management. This modality works on the connections between feelings, thoughts and actions and teaches the client how to observe their own (and others) processes which lead to discomfort and the urged to use. This is known as the ABC – activating event, belief and consequence. A powerful tool for those struggling with an addiction that is extremely vulnerable to feelings of resentment, shame and isolation. CBT also teaches the skills of observing our negative self-talk (automatic negative thoughts) which may swing a successful recovery into crisis when not recongised.
Our final tool in this article is twelve step facilitation (NA, AA) – a much maligned recovery support in some quarters yet the principles of 12 step programs are now supported by both science and most rehab facilities. The aspect of a higher power is not one of religion but individual spirituality (the human spirit) and this higher power may be god, an addict’s family, their connection to nature or simply the power of the group in a meeting. This is a powerful tool and not one to be dismissed due to its origins. The sense of acceptance, belonging and support, particularly for those in early recovery is therapeutic in its own right and working the steps is not dissimilar to the process utilised in many counselling and rehab settings. Recovery can be a very lonely and frightening experience and even the most socially isolated and damaged in the recovery community heal within this environment of unconditional positive regard.
The humanistic existential and family inclusive approaches to recovery are appropriate modalities to utilise when working with this client base and will be discussed independently of this article due to the large body of information to be addressed.
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