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Continued Decline in Youth Substance Abuse

Current illicit drug use among teens is continuing to decline, according to a new report by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) released today. The study also shows positive signs that teens are seeing the dangers of abusing prescription drugs and methamphetamine and are pushing back. Among youth ages 12-17, the 2007 National Survey on Drug Use and Health (NSDUH), the Nation's largest substance use survey, shows that the significant decline in overall past month illicit drug use that began in 2002 continued through 2007, from 11.6 percent to 9.5 percent.

The survey, released at the start of the 19th Annual National Alcohol and Drug Addiction Recovery Month, shows that the reductions in youth drug use occurred for nearly every type of illicit drug including marijuana, cocaine, hallucinogens, LSD, and Ecstasy. The survey also shows dramatic declines in meth use, down by 67 percent (from 0.3% to 0.1%) and prescription drug abuse among teens, which declined overall by 18 percent, from 4 percent to 3.3 percent between 2002-2007.

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Treating alcohol and drug problems in Psychotherapy Practice: doing what works

Columns - Media Review

Written by Alissa Mallow, DSW, LSCSW

Thursday, 30 November 2006

The debate between agency addiction treatment providers and private practitioners regarding the best milieu to treat substance using individuals has raged on for years, with addiction treatment providers being adamant about clinic-based treatment, citing gaps in knowledge for the practitioner in office-based practice. Some office-based practitioners have been wary about treating a client with a chemical abuse problem, usually secondary to a lack of knowledge and experience with the population, and have referred clients to agency treatment even though the client is concerned about such.

Treating
alcohol and
drug problems
in
Psychotherapy
Practice: doing
what works
by Arnold M. Washton
and Joan E. Zweben
New York: Guilford Press

Then, this book comes along. Written by two highly respected addiction treatment professionals, Dr. Arnold Washton and Dr. Joan Zweben, Treating Alcohol and Drug Problems in Psychotherapy Practice: Doing What Works, addresses issues that office-based practitioners may encounter when working with substance-using individuals.

By the authors' accounts, this book is directed toward office-based practitioners and is a "what you need to know" and "how to" book. It is well written in a clear and concise manner, devoid of jargon and sensitive. In reading the book, I felt as if I was in "supervision" with Drs. Washton and Zweben, making it even more accessible to me as a practitioner. Organized into two parts - basic issues and perspectives and clinical strategies and techniques - the book covers various drugs of abuse; an integrated approach to addiction treatment, assessment, goal setting and treatment planning; and relapse prevention.

All too often, readers skip the Preface; however, to do so in this book would be to cheat oneself out of valuable information. The Preface is necessary, as it describes the purpose of the book as well as describing the authors' clinical orientation, and the limitations of the book. Noteworthy is the authors' statement that pejorative terms of "addict" and "alcoholic" are not used throughout the book, citing that use of these terms further serves to stereotype and discriminate the population. This is of the utmost importance, as "discrimination by disease" must be addressed in this population.

In the introduction, the authors address why psychotherapists have traditionally avoided treating substance-using individuals and the conflicts that have traditionally existed between psychodynamic psychotherapy and addiction treatment.
The authors further remind the reader that all psychotherapists should have some basic knowledge regarding the treatment of substance-using individuals; as such, issues are prevalent in mental health treatment.

The authors address a number of important topics in the various chapters. For example, the second chapter includes a discussion on the continuum of substance abuse, including a discussion of the DSM-IVTR. The authors explain how office-based practitioners can identify where on the spectrum their clients might fall, and assist the practitioner in arriving at a more accurate diagnosis of substance dependence or abuse.

Another chapter, Pharmacology and Overview of Psychoactive Substances, takes a look at the basic pharmacological concepts of substance use, such as route of administration, half-life, and tolerance, cross-tolerance and physical dependence. Basically, the chapter is a detailed review on the substances of abuse. This is an extremely important chapter for a "novice" addiction treatment professional and a terrific review for even the most experienced clinician.

The chapter on the Integrated Approach describes the "workings" of addiction treatment, highlighting various models of treating addiction including the "Stages of Change" model (Prochaska & DiClemente, 1986). This chapter provides good practical models for treating addiction and advice on how clinicians can apply them in their practice.

There are also two chapters devoted to a discussion on the problems of dual diagnosis in the substance using population and the use of medication when treating clients who are struggling with both.

The second part of the book provides the reader with clinical interventions and strategies for treating substance-using individuals. One chapter specifically addresses the issues of assessment. Washton and Zweben speak not only to gathering information in a manner that tackles the substance use, but also reminds the reader that there is a person behind the addiction.

Basically, the authors explain that there is a total person with history and feelings, and they remind the reader that all assessments should be conducted in a manner that conveys, among other things, empathy and nonjudgmental acceptance. The chapter also provides suggestions for how to gather the information through self-administered questionnaires, exploration techniques designed to target specific information, and assessing the client's readiness to change.

Several chapters are dedicated to the goals of treatment, intervention strategies, and preventing relapse. These chapters help the therapist to work past the initial stages of treatment and get into the "nitty gritty" with the client. The authors provide helpful interventions, and reading these chapters will make the reader feel as if he/she is in supervision with the authors, which is a tremendous strength of the book. Here again, as in other chapters of the book, the authors are careful to address the therapist's possible countertransferential responses to working this population.

In other chapters the authors address continuing treatment issues and strategies that arise once abstinence is obtained; and other modalities such as group therapy and self-help programs.

The Appendix section of the book includes useful screening tools, tips for helping patients, and important websites geared to addiction treatment and information.

This book, in my opinion, is not to be missed!

This article is published in Counselor,The Magazine for Addiction Professionals, December 2006, v.7, n.6, pp.66-67.