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A Better Way to Predict Aberrant Drug Behavior in Pain Patients

Though opioid pain medications are effective for treating chronic pain, many physicians are reluctant to prescribe them fearing potential for addiction and abuse. Harvard researchers may have an answer to this problem with a new screening tool, published in The Journal of Pain, to predict which pain patients are most likely to exhibit aberrant medication-related behavior.

The estimated prevalence of addiction to any substance in pain patients is about 10 percent, yet most physicians who prescribe potent pain drugs have little training in addiction or confronting aberrant drug behavior. Even though substance abuse is evident in chronic pain patients, potential addiction risk does not outweigh the benefit of effective pain management. Optimal use of opioids, therefore, requires physicians to evaluate potential drug-abuse risks in their patients. But how?

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Counseling Difficult-to-Reach Adolescent Males with Substance Use Disorders: Strength-based Approach

Feature Articles - Treatment Strategies or Protocols

Written by Shannon Mayeda, PhD, LCSW, CRADC and Mark Sanders, LCSW, CADC

Monday, 06 August 2007

Difficult-to-reach adolescent males with substance use disorders often engage in behaviors that can lead to a “failure identity,” including delinquency, crime, truancy, academic failure, destructive peer group affiliation, substance use and relapse. Our traditional approach is in dire contrast to the strength-based approach, in that it can leave difficult-to-reach adolescent males feeling more inadequate, incapable, labeled, stigmatized, defiant and more difficult to reach than before they entered our program (Sanders, 2006). The strength-based approach views difficult-to-reach adolescent males with substance use disorders in light of their capabilities, talents, gifts, competencies, accomplishments, resilience, values, hopes, visions, dreams and possibilities. This approach zeros in on what clients know, what they can do, and resources that exist within and around them to help with the change process (Saleebey, 2002).

There are aspects of the traditional approach that, while well intentioned, can contribute to poor self-image, resistance to counseling and premature termination. These aspects include:

1) Deficit-centered intake questions. Even prior to the establishment of rapport, these young males are asked questions such as:

• How much alcohol have you
consumed in the past month?
• Have you ever used cocaine?
• Have you ever sold drugs?
• How many times have you gone to treatment?
• How many times have you relapsed?
• Have you ever shared a “dirty needle?”
• Have you ever been treated for mental illness?
• Have you ever taken psychiatric medication?
• Have you ever been suspended from school?
• Have you ever been evicted from school?
• How many times have you been arrested?
• Do you have a criminal record?
• Are you in a street gang?

One of the greatest difficulties with this line of questioning is that often it is not balanced with questions that suggest the adolescent male has strengths and/or accomplishments.

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