Chapter 6 - The Individual Drug Counseling Model

Addiction counseling addresses (1) the symptoms of the drug addiction and areas of impaired functioning that are related to it and (2) the content and structure of the patient's ongoing recovery program. Throughout the course of counseling, the addiction counselor will:

1. Help the patient to admit that he or she suffers from the disease of chemical addiction.
2. Point out the signs and symptoms of addiction that are relevant to the patient's experience.
3. Teach the addict to recognize and rechannel urges to use drugs.
4. Encourage and motivate the patient to achieve and sustain abstinence.
5. Monitor and encourage abstinence by using objective measures, such as urinalysis and Breathalyzer® tests.
6. Hold the chemically addicted person accountable for and discuss any episodes of use and strongly discourage further use.
7. Assist the patient in identifying situations where drugs were used to cope with life's problems and in understanding that using drugs to cope with or solve problems does not work.
8. Help the addict to develop new, more effective problem-solving strategies.
9. Introduce the patient to the 12-step philosophy and strongly encourage participation in NA, AA, and/or CA.
10. Encourage the chemically addicted person to develop and continue with a recovery plan as a lifelong process.
11. Help the addict to recognize and change problematic attitudes and behaviors that may stimulate a relapse.
12. Encourage the patient to improve self-esteem by practicing newly acquired coping skills and problem-solving strategies at home and in the community.

The drug counseling sessions have a clear structure. However, within the framework of that structure, the content of the discussion is largely up to the patient. We make an effort to address effectively the patient's individual needs at any point in treatment while also recognizing the commonality of many issues in addiction and recovery. People are indeed unique; however, the facets of a human problem like cocaine addiction usually follow familiar patterns. The validity of both realities should be respected.

The stages of addiction treatment described here are:

1. Treatment Initiation
2. Early Abstinence
3. Maintenance of Abstinence
4. Advanced Recovery

As with other stage theories of development, the stage theory of addiction recovery is only a model. Individuals pass through the stages at their own pace, the stages are overlapping rather than discreet, and individuals may slip back at points and need to rework issues from previous stages. This theory does not, however, discount the considerable usefulness of having a model of the typical process in mind so that the patient's place in his or her own recovery then can be compared with the model for better understanding the patient's process and the steps needed to be taken to proceed.

Appropriate treatment for chemical addiction varies and is sensitive and responsive to the changing needs of the patient throughout his or her recovery. The addiction counselor should understand that addiction treatment must be progressive, just as the patient's recovery process is progressive. To provide optimal counseling, the counselor must be sensitive to the patient's evolving needs in treatment. To ensure a progressive approach to addiction treatment, the counselor must be prepared to address different topics in recovery, use different kinds of interventions, and hold the patient to a different level of responsibility as he or she works toward recovery.

Preparing for the Session

The counselor should prepare for each session by checking the patient's recent urine results and recalling the major themes or issues from the previous session. The counselor must understand the progressive nature of treatment and be familiar with the topics that are appropriate to the patient's current phase in recovery. In summary:

1. Check urine results.
2. Recall themes from previous session.
3. Prepare to discuss the topics appropriate to the patient's phase in treatment.

During Each Session

At the beginning of each session, the counselor should inquire how things have been going since the last session and whether the patient has used any drugs. Reported drug use should be noted. If the patient relapses, the patient and counselor should analyze the relapse, determine what precipitated it, and develop alternatives that can be used to avoid relapsing again. This process will probably require the full session.

If the patient presents with an urgent, addiction-related problem like family arguments or financial problems as a result of the addiction, the counselor should address these problems in the session. Emphasis should be on how these problems are related to the addictive behavior. The counselor's goal is to help the patient develop strategies for dealing with the problems without turning to drugs. For example, the loss of one's job, the serious illness of a loved one, or severe relationship problems will require acknowledgment and some attention in the counseling session. However, the main purpose of the session is the promotion of recovery from addiction, not the resolution of the patient's other life problems.

The counselor should always give the patient feedback regarding the most recent drug screen results. If the urine test was positive for cocaine, the counselor should confront the patient with this information. Even if the patient has admitted to recent use, the counselor should discuss the urinalysis result, so the patient is reassured that the counselor is monitoring his or her efforts to abstain. If, however, the patient denies any use even though the urine sample is positive for cocaine (which is not uncommon), the counselor should view this behavior as most likely indicative of denial, underlying which might be feelings of shame. The counselor will probably want to use themes of shame or denial in addressing this disparity.

A useful approach is discussing how the patient would feel and what it would mean if he or she were using drugs. If the patient continues to insist that there has been no cocaine use, the counselor probably should just drop the matter and agree to disagree for the present. Continuing to confront without moving the counseling anywhere probably is unwise because the counselor risks severing the therapeutic connection. If the patient insists that there is some type of laboratory error, the counselor may be able to split the urine and have half analyzed with a different test, or use a different screening procedure, such as a saliva test.

If nothing urgent must be addressed in the session, the counselor and patient should discuss the addiction-related topic(s) most relevant to the patient's current needs in recovery. The topics central to recovery from cocaine addiction, and the stage of recovery they are particularly associated with, are described in the next section. No more than two new topics should be introduced to the patient in a session. However, any topics that have already been introduced to the patient can be reviewed, if appropriate.

To review, in each session, the counselor should:

1. Find out how the patient has been since last session.
2. Inquire whether the patient has used drugs since last session.
   • If the patient has used cocaine, analyze the relapse and develop strategies to prevent future relapses.
   • If the patient has used other drugs, discuss why abstaining from all drugs is important, particularly when one is attempting to recover from chemical addiction.
3. Inquire whether there are any urgent problems that need attention and, if so, deal with them.
4. Provide feedback about whether recent urine tests have come back showing any cocaine use or not.
5. Discuss the recovery topic that is most relevant to the patient's stage in recovery and his or her particular needs in treatment.
   
   

Next Chapter