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| Recommendations from the Nation’s Leading Addiction researchers: Part II |
| Columns - Research to Practice | |
| Written by Michael Taleff, PhD | |
| Tuesday, 26 June 2007 | |
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This column continues to summarize the results of the new book,
Rethinking Substance Abuse: What the Science Shows, and What We Should
Do About It (Miller & Carroll, 2006). The book brought together
some of the best addiction minds in the country to discuss the best
addiction research, and issued recommendations for the addiction field.
The authors speculate as to what our field would look like free of its continuing politics. A set of 10 principles derived from the best research were presented as a foundation to revamp substance abuse treatment. The first five constituted the core of the last column; the last five constitute the core of this column. The book ended with a set of broad recommendations for the field. This column focuses on the more practical, day-to-day sets of treatment recommendations derived from each of the principles. 1. Drug Problems Do Not Occur in Isolation, but as Part of Behavioral Clusters. Long ago, it was believed that drug problems were somehow isolated from the client’s other problems. Programs set a treatment philosophy of dealing with drug abuse first, to the exclusion of other problems. Today, we know that all drug problems are just one part of a larger cluster of problems that may include: family issues, homelessness, neglect and a host of psychological and mood problems. This newest research indicates treatment planning that addresses a range of client problems will tend to be more successful. For many of our clients, stopping drug use is not a high priority when other life problems are consistently prevalent. Therefore, your treatment planning needs to address the major issues in a client’s life. Again, that will vary with each client, and will require a little effort on your part to assess. Basically, you need to determine which of the issues is causing the most problems and direct your interventions accordingly. 2. There Are Identifiable and Modifiable Risk and Protective Factors for Problem Drug Use. Substance abuse does not randomly affect people. There are clear risk and protective factors that influence onset, progression, and continued abuse. Basically, some folks really get off using drugs, while others do not find drug use pleasurable. Other risk factors include: easy access to drugs; positive reinforcement from stimulating surroundings; not having the coping skills to deal with stress; using escapist methods; and the lack of positive relationships. One recommendation to offset risk is to utilize skill building into your treatment plan. Many varieties of skill building can be found in any good cognitive behavior book, or even on the Internet. Any good counselor knows the value of solid support and positive relationships often found in 12-step groups, religious organizations and sober friendships. 3. Drug Problems Occur within a Family Context. Family influence certainly affects drug use. By example, parents who abuse chemicals pose a risk factor for their children. They cannot provide adequate self-regulation skills and other forms of guidance. Such parental abuse is further complicated by violence in such families. The risk is compounded if this occurs before the child is six years old. Moreover, children who are susceptible to negative peers, more extroverted, not future-focused, and who have low self-esteem, are more at risk. Children of parents who are less permissive and who exhibit a parental style that is consistent, supportive, and moderately authoritarian are less likely to abuse substances tobacco, alcohol, and other drugs. Also, later onset of use of tobacco, alcohol and other drugs generally equals lesser abuse. 4. Drug Problems Are Affected by a Larger Social Context. It’s no surprise that the social realm around the client affects drug use. Availability serves as a risk factor, while positive reinforcers that compete with drug abuse serve as protective factors. Research from this area notes that certain social models (i.e., rock stars, celebrities) can promote or deter drug use. Social isolation may act as both a consequence of abuse, or promoter, whereas bonding to nonusers can help remedy abuse. Lastly, the research is fairly clear that criminal sanctions are relatively ineffective in the suppression of drug use. From the main elements of this principle, create a short list (e.g., availability, social models, meaningful role, etc), and use it to help you assess what social elements influence your client. Build your treatment plan to address those troubled areas. 5. Relationship Matters. The relationship between you and your client MATTERS. Even if the same treatment is applied to a sample of clients, some clients do better — not because of the applied treatment, but because of the counselor. The counselor who is warm and empathetic generally will achieve better results. Motivation to change even appears to emerge from this kind of interpersonal relationship. What clearly makes for worse outcomes are high case loads, and a counselor who resorts to a general confrontational style. Basically, confronting your clients day after day doesn’t work — so, stop it! Rather, pay close attention to counselors who get better outcomes. Most likely they are warm and empathetic. Learn to model that approach. Supervisors should videotape staff in action so they can provide feedback, and so staff can see themselves in action. Be sure to survey your clients and ask what is helpful about each session. I suspect you will find it is the relationship. Research you can do First, evaluate your program or practice on whether you currently utilize these principles. If not, or if you are only using a few principles, establish a baseline for measurement, to observe in terms of change. The baseline in this case will be the outcome of your program. Variables could include abstinent time, reduction of drug use, number or arrests post treatment, emergency room visits, etc. Second, train your staff or yourself on these principles and institute them within your program. Once you begin to institute the principles, re-assess your baseline from that point to about six months out. Again, use the same outcome variables (see above) for your second baseline by measuring the two baselines, and looking for differences. This research is not going to be very strict in terms of classical research procedures, but it might give you some useful knowledge and ideas. I remain interested in your findings. Reference: Miller. W.R & Carroll, K.M. (2006) Rethinking Substance Abuse: What the science shows and what we should do about it. New York: Guilford One person has commented on this article. 1. Untitled mj, Unregistered    hahay Posted 2008-01-28 00:42:22              |
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