Considerations for Treatment and Recovery
The growing body of knowledge related to personal change has shaped current approaches to treating addiction. This unit examines the process of change as it applies to the treatment of addiction. Based on these insights, we will address key elements of effective treatment, from the traditional and more cutting-edge approaches.
The influences, factors, and processes of personal change are emerging areas in addiction research. Researchers want to better understand what makes an individual change, how they adapt within the change process, and the role of change in an individual’s motivation—either to change or to fight change. If researchers can gain a better understanding of this important human condition, they can apply these lessons to interventions and treatment programs to aid the addict in fighting unhealthy behavioral choices.
Current theories about motivation and change, within the traditional setting, support the notion of a cyclical process that is neither linear nor based on outcome. Rather, people with substance abuse issues vacillate between different phases of change—sometimes moving forward, sometimes relapsing or regressing. Progress through each stage is also very individual, and people cycle through stages at varying rates. To maintain long-term behavioral change, the abuser walks through various stages: considering change, planning for the change, initiating behavior change, and maintaining change. Many abusers cycle through all the stages of change more than once—sometimes several times—in order to establish long-term behavioral change.
Readiness to change is central to effective treatment for substance abuse or addiction. While the family or loved ones of a person with addiction issues may understand the critical importance of readiness to change, it is that individual’s readiness that determines effective outcomes. Readiness to accept or seek treatment can be influenced by factors that are similar to other life changes, including:
• Underlying health problems.
• Lack of financial resources.
• Patterns of substance use and abuse in the family.
• Lack of social supports.
• Individual personality characteristics.
As previously noted, in traditional notions of recovery, addiction is characterized by relapse, remission, and recovery cycles and is known as the addiction career (Dennis, Scott, Funk, & Foss, 2005). Recognition of the nature of the addictive process, by treatment professionals as well as by members of the individual’s support system, informs some of the interventions used in both structured institutional and community programs.
Treatment for substance abuse may be mandated by a court jurisdiction as part of sentencing, voluntary through admission to an inpatient program, or it may follow a structured intervention procedure. The method of entering treatment can directly affect treatment efficacy (Fiorentine & Hillhouse, 2004). For example, court-mandated treatment may be focused on addicted individuals who have preexisting and often serious medical problems. When mandated to enter a treatment program as part of sentencing, perhaps as part of a drug court forum, outcomes for those who remain in the program reflect significant improvements in health as well as in abstinence (Fiorentine & Hillhouse, 2004).
Substance abuse treatment outcomes cannot be evaluated by simplistic or uniform measurement methods. The differences in patterns of usage, the environments in which drugs are obtained and used, the length of time as a drug- or alcohol-dependent individual, dual diagnoses, and availability of appropriate and long-term treatment resources are all factors that can directly affect treatment outcomes. When considering a patient’s readiness, as well as other factors not identified here, it is clear that drug and alcohol treatment is complicated, particularly in the implementation and establishment of realistic expectations for treatment outcomes.
Many patients oppose the AA model’s emphasis on religious beliefs and a higher power, but alternative treatments are available. For those who reject turning their power over to a higher being, per the AA model, and decline partaking in the impatient environment, the SFBT process represents a different approach to recovery and will be explored as a viable treatment approach in place of conventional treatment. It is also possible to integrate the SFBT approach once a conventional program is completed (Berg & Miller, 1992).
Berg, I. K., & Miller, S. D. (1992). Working with the problem drinker: A solution-oriented approach. New York: Norton.
Dennis, M. L., Scott, C. K., Funk, R., & Foss, M. A. (2005). The duration and correlates of addiction and treatment careers. Journal of Substance Abuse Treatment, 28(Supplement), S49–S60.
Fiorentine, R., & Hillhouse, M. P. (2004). Addictive behavior cessation: Does it predict recovery for gender, ethnic, age, and drug preference populations? American Journal on Addictions, 13, 268–280.
To successfully complete this learning unit, you will be expected to:
1. Identify the stages of behavior change related to recovery.
2. Explain the principles of effective substance abuse treatment.
3. Compare and contrast the principles of SFBT, SFGT, and motivational therapy to the traditional setting.
4. Consider the dual diagnosis issues of comorbid mood disorders with the use of substances.
Use your Concepts of Chemical Dependency textbook and the Capella library to complete the following:
• Read Chapter 24, “The Dual-Diagnosis Client: Substance Use Disorders and Mental Illness,” page 339–358. This chapter discusses psychopathology and problems in working with this population.
• Read Chapter 31, “The Process of Treatment,” pages 454–465. This chapter discusses stages of treatment and recovery.
• Read Chapter 33, “Relapse and Other Problems Frequently Encountered in Substance Abuse Rehabilitation,” pages 491–513. This chapter discusses relapse and related aspects of the addicted person.
• Read Chapter 36, “The Debate Over Drugs: The Relationship Between Drugs and Crime,” pages 546–564. This chapter discusses criminal activity and designer drugs.
Assignment 1: 4 pages needed with references as needed.
The project draft includes 15 peer-reviewed journals and references to course texts. For your paper, you must select a specific client population you currently serve or intend to serve (for example, homeless youth, women, minority groups, adolescents and college students, senior citizens, or people with AIDS). Consider the complexities of assessing and treating comorbid, dual diagnosis conditions within the population. Develop a paper that examines the impact of substance abuse on this population, along with the theory, including solution-focused brief therapy (SFBT), motivational therapy, and evidence-based approaches to providing treatment services for them, both on an individual (micro) and systems (macro) level. Include any historical and current policy issues that may have prevented or supported treatment-service delivery to this client group. Make some preliminary assessments for enhancing service delivery for this population.