Substance use has been a severe issue in the medical sphere for years. Current statistics from the Substance Abuse and Mental Health Service Administration (SAMHSA) reveal that approximately 136.7 million Americans aged 12 and above drink alcohol, 65.3 million engage in binge drinking, and 28.6 million had used an illicit drug in the month preceding the survey (Miller, 2020, p. 4). The Center for Disease Control (CDC) has also raised concern over the population’s addiction to prescribed medication. The CDC reports that the rates of opioid overdose have tripled in the last two decades (Miller, 2020, p. 4). Hospitalizations and emergency room visits from abuse or misuse of painkiller medication, narcotics, and opioids have also doubled (Miller, 2020, p. 4). These statistics accentuate the need for addiction counseling services and effective treatment strategies.
Empirical research shows that addiction counselors always find it challenging to work with alcoholics. Miller (2020) argues that health workers have reported difficulty working with alcoholics and addicts due to relapses, poor impulse control, emotional reactivity, or patients lying or denying their addiction (p. 4). However, Brooks and McHenry (2015) reveal that these traits and attributes are only natural given the circumstances and call for compassion, genuineness, understanding instead (p. 26). Unfortunately, most counselors, including the current workforce, lack these traits due to countertransference tendencies (Gladding, 2018, p. 42). Due to their past experiences, counselors can approach clients in a manner that invites anger or manipulation. Counselors’ personal and professional experiences with addicts can make them hesitant towards this population. For example, most counselors believe that the solution to addiction problems is a matter of choice. This perception is hugely problematic and counterproductive, given that most addicts and alcoholics deal with the psychological stress of substance use by eliciting negative behaviors. According to Brooks and McHenry (2015), factors such as relapse, denial, emotional sensitivity, and impulsive behaviors are patients’ natural ways of dealing with shame, rejection, and other psychological issues related to addiction (p. 2). Clients often feel a tremendous amount of shame, embarrassment, guilt, and terror from their substance use and, therefore, cope with negative behaviors. The behaviors are chemically induced as a defense mechanism to survive the isolation, rejection, and depression typical among addicts.
Counselors’ attitudes and conduct towards addicts can also be counterproductive towards treatment. For example, Miller (2020) asserts that most counselors commonly view addiction and alcoholism as a disease or moral failing; this perception is problematic because the American Psychiatric Association (APA) recognizes substance abuse as a medical condition (p. 43). Miller (2020) also notes that counselors often use language or word choices that strain therapeutic relationships (p. 43). For example, terms such as “abuse,” “addiction,” or “alcoholism” during treatment invites client manipulation and also contribute to social stigma. The terms have a negative connotation and are associated with social isolation and rejection, and should never be used in clinical settings.
From the above analysis, it is clear that counselors need to change their approach to their clients’ problems. According to Brooks and McHenry (2015), therapeutic relationships are pivotal to clients’ wellbeing and growth (p. 3). Counselors should understand their clients’ anger, blame, and dishonesty and “love them to wellness … with whatever means possible” (Brooks & McHenry, 2015, p. 2). Effective therapeutic relationships, characterized by a deep client-counselor connection, can make clients feel cared for and understood during their lowest moments. This connection can encourage them to open up and share their pain, creating a sense of relief. However, making this kind of relationship requires the counselor to possess specific attributes such as genuineness, compassion, empathy, and unconditional positive support. With the right treatment strategies, the clients can be motivated to change their behaviors.
For a counselor to implement effective addiction counseling strategies, they need to understand the etiology of addiction. The biopsychosocial model provides a comprehensive framework through which counselors can understand addiction’s etiology. The model states that addiction can result from genetic predisposition and socio-cultural factors. The model’s biological component argues that some genes are linked to alcoholism, making the condition hereditary (Brooks & McHenry, 2015, p. 156). Individuals with a family history of alcoholism are also likely to be alcoholics. The socio-cultural factors affiliated with substance use include nonadaptive coping styles, lack of parental support, stress, peer influence, and poor behavioral control.
Counselors also need to understand the condition’s progression continuum to manage clients effectively. While all clients might have an addiction problem, their condition’s progression might be in different stages. Brooks and McHenry (2015) contend that alcoholism starts with tolerance, followed by control loss, and eventually, premature death (p. 156). At the first stage, clients typically use substance use to deal with life-related stress. Treatment at this stage should mainly focus on alcoholism as the primary concern. The progressive stage is characterized by the chronic consumption of large amounts of drugs and alcohol.
At the chronic phase, the client has become an addict, and the substance use has structurally or chemically affected the brain. The condition becomes a disease, and healthcare providers would approach it as a typical disease (Brooks & McHenry, 2015, p. 85). The client’s alcohol/drug use will be compulsive, excessive, and out of control. The fatal stage, which is also identified as the condition’s final phase, is where clients continue to consume drugs despite being addicts. At this point, they may succumb to death due to liver failure, overdose, and accidents. Instead of assuming that all alcoholics and addicts have the same problem, counselors should acknowledge that addiction is a process and clients might be at different stages.
Addiction treatment relates to an intervention approach intended to help addicted persons quit compulsive drug or alcohol seeking and utilization behaviors. It refers to the process of delivering professional service to an individual, group, or family to alter their problematic relationship with substance use and alcohol (Brooks & McHenry, 2015, p. 138). Its primary goal is to educate, counsel, and equip clients with appropriate coping skills to generate healthy behaviors. When a counselor receives a client, the first step is to conduct an initial assessment to establish the disease etiology and progression stage. The initial examination will include ascertaining the condition’s severity, including acute intoxication/withdrawal potential, biomedical complications, emotional/behavioral complications, treatment acceptance/resistance, relapse potential, and recovery (Capuzzi & Stauffer, 2016, p. 46). The clients will then be assigned to different treatment settings based on the severity of the condition. The counselor’s role in addiction treatment is to encourage positive social connections and motivate and instill hope in their clients (Frost et al., 2018, p. 6). Counselors will always need to examine their clients and determine whether to refer them to detoxification centers, inpatient facilities or to see them individually. It is always best to prepare the clients to accept referrals to prevent treatment resistance.
Strategies/Approaches to Treating Addictions
To effectively treat patients, counselors need to understand the underlying factors contributing to the diseases’ etiology. Numerous theories attempt to explain the origin of distress, and counselors can use these theories to diagnose and treat their patients. Three main theories try to explain clients’ behaviors; they include counseling theories, personality theories, and learning theories.
Counseling theories assert that ineffective relationships and thoughts are the root cause of problems. Counseling theories include person-centered theories, rational-emotive behavior therapy (REBT), cognitive-behavioral therapy (CBT) (Capuzzi & Stauffer, 2016, p. 79). Person-centered theories assert that human goodness can be blocked by conditional positive regard, leading to low self-esteem and self-efficacy (Capuzzi & Stauffer, 2016, p. 79). Self-efficacy refers to an individual’s belief that they can successfully implement the behaviors required to produce desired effects (Nikmanesh et al., 2017, p. 2). Self-efficacy is a predictor and mediator of several treatment outcomes, including substance use. Individuals with self-efficacy skills can muster the effort needed to resist drug use (Nikmanesh et al., 2017, p. 2). Self-efficacious people will acknowledge a relapse and reinstate control, while an individual with low self-efficacy will continue it to a full-blown relapse.
The person-centered theory asserts that individuals with low self-efficacy lack unconditional support and regard in their life. The counselor’s role is to encourage confidence, self-reason and bring the clients to a discourse directed toward searching for truth. The assumption that undergirds this theory is that the client has the innate capacity or knowledge to solve a given problem (Capuzzi & Stauffer, 2016, p. 57). Therefore, the counselors help the client realize these abilities to encourage them to implement the behaviors needed to abstain from substance use. The counselor’s ability to help a client will depend on their therapeutic relationships, client vulnerability, counselor’s congruence/genuineness, and unconditional regard for the client.
REBT/CBT theories focus on evaluating clients’ reactions to real-life stressors. As mentioned earlier, life stressors are one of the significant socio-cultural factors that contribute to alcoholism and addiction (Capuzzi & Stauffer, 2016, p. 67). The REBT/CBT theory asserts that distress results from a combination of an adverse event and the individual’s perception and interpretation of the event. The counselor’s role, in this case, is to evaluate the client’s understanding of the “activating” event that led to the substance use problem. With the counselor’s help, the client will assess their beliefs and interpretation of the activating event and identify their irrational perceptions. The counselor will help the client identify alternative explanations of the activating event.
The counselor can use reality therapy to help clients to focus on the present rather than the past. This approach is beneficial to clients that use substances to deal with trauma and adverse events in the past. The counselor will help the client develop practical coping skills that will change their feelings. According to the reality therapy theories, clients need to spend less time thinking about what they cannot change and focus on what they can (Gladding, 2018, p. 125). The client should educate the patient on the importance of avoiding negative behaviors such as blaming, complaining, and criticizing. Given the subject’s sensitivity, the counselors need to be neutral and non-judgmental when using this approach.
While counseling theories focus on ineffective relationships in adulthood, personality theories focus on innate attributes that stem from childhood experiences. The personality approach is based on the assumption that distress results from childhood experiences. The main personality approach theories include:
- Erickson’s developmental theory
- Adler’s perfection theory
- Freudman’s Psychoanalysis theory
The developmental theory helps counselors to understand client’s individual needs. The theory mainly focuses on experiences during the first five years of a child’s life. It asserts that individuals who have experienced difficulty and trauma in their early childhood may find it challenging to develop healthy and supportive relationships. For example, a Kindergarten child who experiences guilt for making decisions is less likely to function well (Capuzzi & Stauffer, 2016, p. 85). An infant (children aged below two years) who lacks supportive parents who are consistent develops trust issues. The child will find it difficult to create connections with other people as well as build feelings of unworthiness. Since parents were not constantly present in the child’s life, they will learn to self-soothe and mistrust other people. They will develop self-defeating talk and fear of being abandoned or feeling unloved.
The counselor’s responsibility is to assess the clients’ current behaviors and link them to their childhood experiences. This approach is fundamental to addiction counseling because recovering clients routinely examine their thoughts, emotions, and behaviors when they abandon drug and substance use. The exploration of early childhood experiences will prepare the client for behavior change. The counselor will provide the client with the necessary support to deal with any previous issues that influence their current lives. Counselors can use the motivational interviewing technique to establish a trusting relationship that will allow clients to open up about their childhood experiences and adverse events.
The Psychoanalysis Theory
Psychoanalytic psychotherapy is a viable treatment option for patient populations whose substance use has progressed to the “progressive” stage. As indicated earlier, the progressive stage refers to the phase in which the client is involved in uncontrollable alcohol drinking and substance use. The Psychoanalytic theory asserts that a person’s identity is influenced by pleasure and the desire to have its needs taken care of immediately (Gladding, 2018, p. 130). The ego will help the person search for items or objects that will satisfy the id’s innate need to find pleasure. The ego keeps track of the obstacles experienced in looking for pleasure and records the consequences. The internalization of the adverse effects is referred to as the superego, and it helps people develop appropriate defense mechanisms to deal with pain. The counselor’s role in this approach is to help the client build a more profound awareness of their unconscious desires, motivations, and conflicts. The counselor will focus on an individual’s unconscious pleasures and aggressive drive to use drugs or alcohol to self-medicate stress and suffering.
So far, the paper has highlighted clients’ drug dependence based on various theories, including rational choice theory and pre-existing behavior tendencies (personality). The last approach to treatment is based on a learning or conditioning model. Learning theories assert that individual behaviors are learned from exposure to rewards and treatments. Counselors can use this approach to encourage clients to discover and implement the behaviors needed to control their addiction. The counselors can create or modify behaviors by reinforcement (increase a positive behavior by rewarding), extinction (decrease behavior by omitting rewards), and punishment (Gladding, 2018, p. 130). Through effective education on the consequences of behavior, clients can increase or decrease behaviors as appropriate. The clients need to have self-efficacy and self-regulation techniques to learn and retain positive behaviors.
Relapse Prevention and Recovery
The last stage of addiction counseling is relapse prevention and recovery. Relapses are typical in addiction treatment and recovery and counselors (Brooks & McHenry, 2015, p. 225). Counselors should continually educate first-time clients about relapses and the appropriate coping strategies. According to Brooks and McHenry, relapses occur during the first ninety days of recovery (2015, p. 226). Therefore, counselors should encourage clients to create longer abstinence days goals so that sobriety can be a continuous process. The counselors should always be non-judgmental and empathetic towards clients that have relapses.
Brooks, F., & McHenry, B. (2015). A contemporary approach to substance use disorders and addiction counseling. John Wiley & Sons.
Capuzzi, D., & Stauffer, M. D. (2016). Counseling and psychotherapy: Theories and intervention (6th ed.). American Counseling Association.
Frost, H., Campbell, P., Maxwell, M., O’Carroll, R. E., Dombrowski, S. U., Williams, B., & Pollock, A. (2018). Effectiveness of motivational interviewing on adult behaviour change in health and social care settings: A systematic review of reviews. PLoS One, 13(10), 1–39. Web.
Gladding, S. (2018). Counseling: A comprehensive profession (Merrill counseling) (8th ed.). Pearson.
Miller, G. (2020). Learning the language of addiction counseling (5th ed.). John Wiley & Sons.
Nikmanesh, Z., Baluchi, M. H., & Motlagh, P. A. A. (2017). The role of self-efficacy beliefs and social support on prediction of addiction relapse. International Journal of High-Risk Behaviors and Addiction, 6(1), 1–6. Web.