1. Redefining Substance Abuse Beyond Drugs and Alcohol
We generally understand substance abuse to be defined as the overuse of a prescription or the excessive use of illegal recreational drugs. However, substance abuse is not limited to drugs or alcohol, and can be defined as anything that causes a person to escape their current mental and/or emotional reality.
2. Addiction as an Unintended Consequence of Repeated Behavior
Repeated overuse of either prescribed mind-altering medications, illegal drug and alcohol can be considered an addiction. Likewise, anything that numbs, stimulates, or changes one’s mental and emotional condition without being able to control, reduce or terminate destructive behaviors would also be considered addiction.
I believe that substance abuse can lead to addiction, and it mostly depends on the motive of the person using the substance and what they are trying to achieve by abusing the substance they are using. Addiction is part of a process that becomes an unintended consequence of repeating behaviors that change the person’s natural mental and emotional condition to an altered state.
3. The Role of Treatment in Creating Accountability and Safety
Treatment of a person struggling with addictive behaviors usually requires an interventional approach that attempts to help the individual struggling with behaviors that have led to negative consequences in their life. Treatment can be a helpful resource for those who need a separation from their natural home environments. Treatment options are a way to help the addict find a community that they feel safe around as they work out the attitudes, behaviors and the beliefs that have caused the person to feel powerless and unable to manage their life without some level of accountability.
4. Matching Clients to the Right Treatment Services
When assessing an individual, it would be important to first see if the person is a fit for the services being offered. For example, one would not be a fit for an agency that offers primary addiction treatment using CBT and 12-step programming, if while the individual is being assessed, it is discovered that they have a severe mental health disorder or trauma, which are generally the primary issue contributing issues to a substance abuse disorder.
Therefore, unless the agency can offer the person being interviewed the services they require, they would not be a fit for that agency. It is important to meet the client where they are, which means the client’s needs must be the most important priority of the person making the assessment, as well as the agency they represent.
Additionally, the assessment process is important to understand the reasons a person is seeking help, what their needs are, and to gain enough information to decide if that potential client is a fit for the agency that is offering treatment services.
5. Building Trust and Understanding the Client’s Background
My first goal with clients is always the same, I want to find a way to create an environment of trust with the person coming to me for counseling. Trust is the most important piece in every therapeutic setting.
Secondly, I believe it is important to gain an understanding of the client’s family, social, interpersonal, work, and spiritual backgrounds. It would be my goal to gain insight into what led to a person’s repeated addictive behaviors so I can add value to the client’s ability to see their dilemmas more clearly, and thereby, help them change what they believe about themselves, help them make adjustments to their attitudes toward the things that have led to their addiction, and lastly, to help the addict begin believing that life is worth living.
6. Integrative Treatment Planning and Long-Term Support
For me, the treatment process is an integrative approach to help a person reclaim their life. It is important to begin with an assessment to understand the initial needs that are important to be addressed, such as detox, stabilization, mental health needs etc.
Once the initial assessment has been completed and it has been determined that the client is a fit for our agency, it would be important to begin working on the goals of the client. During the assessment process, one can determine the level of motivation the client has for making positive change. Treatment goals can help the client move from one stage of change to a higher level of commitment and motivation.
The treatment plan is where the client gets to have “buy-in” into their journey of recovery. When writing a treatment plan, it is important to write the goals as they are spoken by the client. Once the goals are defined, it is important to understand the objectives (what the client hopes to achieve) and what the intervention will be.
Once the treatment plan has been written out and the client has signed it, the next phase would be to see who would be willing and able to participate in the client’s treatment. A release of information will need to be signed to contact the people the client would like to invite into their treatment experience.
Once the client agrees to the terms of their treatment, the counselor has called the family members that will be willing to participate with the client’s treatment and the referral process can begin with giving the family some information that may help them better understand what the client is going through.
As treatment progresses it will be important for the counselor to continue offering support to the client as they complete assessments given to them each week by validating, encouraging, and challenging the client’s attitudes, behaviors, and beliefs. Throughout the treatment process, the client will be given referrals to help them become more aware of themselves and the story they tell themselves, and during each individual session the counselor will assess the clients progress by checking in with the client using a formula to help provide insight into the client’s stages of readiness for change.
As the client becomes more aware of how their story has led to powerlessness and unmanageability, they are encouraged to use the tools they are acquiring in treatment to help them change how they see themselves and ultimately make positive changes to their life. The aftercare process begins when the client begins treatment.
The client is encouraged to take things slow and to re-integrate back to their natural environment in a way that helps the client feel impowered to stay on the path of recovery. Usually, aftercare planning will include ongoing counseling with a qualified addiction counselor and or mental health provider.
Aftercare resources may include medical checkups, psych appointments and other related services as needed. Additionally, the client may be encouraged to step down from a residential setting to some form of outpatient services, then a sober living environment and ultimately back to their life.
7. Deciding When to Step Down from a Level of Care
Consequently, when a client is being considered to step down from one level of treatment to another, it is important for the client and their counselor to be open to sharing important details with each other to help give clarity for making a decision to step down to a lower level of treatment care.
The factors that would need to be considered are benchmarks in a client’s treatment progress, such as, how motivated the client is to complete the assignments they are given by the treatment team each week, behavioral contracts would be discussed in determining the options for stepping down.
Clients are often dropped from a higher level of care to a lower level of care by their insurance provider. However, the caveat to insurance having the authority to weigh in on a client’s treatment is largely dependent on the treatment team providing good charts that represent the exact nature of the client’s progress and setbacks.
Often insurance will plan to change a clients treatment status, but once they are given a clear picture of the client’s acuity level by the treatment team through good charting strategies, they will often allow the client the flexibility to go back to a more suitable level of care for their needs.
8. Recognizing When a Client is Ready to Terminate Treatment
I would say that a client is ready to terminate treatment when they along with their treatment team agree that the client has achieved the necessary goals to step down to a lower level of care or to terminate treatment and go back to their everyday life. The objective is to help the client realize what went wrong, what needs to change, what the tools and skills are that will help the client make a commitment to practicing those tools and skills they are learning in treatment.
Moreover, a client is ready to terminate treatment when they have demonstrated growth in achieving their treatment goals, staying motivated to do their recovery work and going in a positive direction that includes accountability as part of a successful recovery equation.
9. Client Privacy Rights and Mandated Reporting
Clients should be informed of areas that may not be protected under the client’s rights to privacy rules. It is the right of the client to understand that if they share certain details that represent harm to a minor that is ongoing, including sexual acts, they will need to be reported to the proper authorities. The client also needs to be informed of their right to know that we as counselors have a duty to report any harm to an elderly, or non-autonomous adult.
The client will need to be informed that if they are threatening to harm themselves or anyone else, we as therapists have a duty to warn the proper authorities. The clients’ rights to privacy are of the upmost importance to building trust with a client and to maintain that trust, it is vitally important to help the client understand that certain ethical guidelines must be maintained to continue the clinical relationship.
Past crimes are not mandated to be reported. Only plans to kill oneself or others. However, because the client’s privacy is at risk it would be important for the therapist to consult with their immediate supervisor to decide as to whether the information needs to be reported.
10. My Evolving Role as a Therapist and the Modalities I Use
I am often challenged to let go of the responsibility of believing that it is up to me to change a client’s self-image and behaviors due to my own codependent patterns of wanting to rescue people from themselves. I have learned that my weakness of having a “savior” complex can often be my greatest weakness and my challenge is, to make sure I have good boundaries about what my role is as a counselor and to stay in surrender to the process of each client I serve.
I view myself as an integrative therapist who uses a multidisciplinary approach to meet the clients where they are. I use CBT and DBT modalities to engage the clients and educate them in the areas of recovery. I believe in the 12 steps; I also believe there are other formulas that a person can use for long-term recovery. For example, some people use the 12 steps and they are not aware that they can integrate other recovery strategies into the 12-step program.
I often work with people who are not interested in using the 12 steps, so I use other methods that help the client feel empowered to choose their own recovery strategy. Some of those alternatives to the 12 steps would be, S.M.A.R.T recovery, The Four Agreements, inner child and relationship work, and a simple strategy that I have developed using the word “Love” as an acronym.
My favorite therapeutic methods are gestalt therapy that helps the client experience the weight of their trauma in their body and then help them address the who, what when and how questions that got them stuck in a cycle of addiction. I also use Carl Rogers’ Person Centered Therapy to help me focus on meeting the client where they are.
I also like to use experiential therapy which means, engaging the client in a tactile way that helps them release their internal pain and let go of what has led to their chronic addictions. I also like to use experiential therapies to help clients in group settings learn team and trust building exercises.
I believe it is important to help the client become more aware of what their story is, how to acknowledge it in a safe environment, find ways to accept the story they themselves and ultimately, find the empowerment they need to take action to change their attitudes, behaviors and what they believe about themselves and the world around them.
