Substance Use Disorders: Assessment and Treatment, 2nd Edition _ ___________________________________
PSYCHOEDUCATIONAL APPROACHES In spite of showing mixed evidence for effectiveness, didactic education is a commonly used evidence-based strategy in the treatment of substance abuse. Providing psychoeducation regarding SUDs, signs and symptoms of substance use, reasons for engaging in substance use, the effects of different substances on physical and mental health (e.g., the euphoric binges and depressive crashes of cocaine use), relapse prevention, and the effect of substance use on relationships can be worthwhile. In addition, discussions on such topics as communication skills, stress management, sexuality, and assertiveness train- ing improve participants’ understanding of substance use dynamics and provide practical information for clients about helping themselves in recovery. Although these discussions are not considered to be treatment, they may provide individuals with information that could help them progress through the stages of change. Psychoeducation is typically a component of evidence-based treatments for SUDs and can be provided in individual, family, or group formats. GROUP INTERVENTIONS Although research is limited, group therapy is a commonly used treatment modality for individuals with SUDs. Not only is group therapy more cost-effective than individual therapy, but it also lets individuals receive support from abstaining peers and allows clients to learn skills from each other, which can be helpful when therapists do not have personal experience with recovery. Group therapy can also be a space for peers to con- front a substance-using group member’s attitude and behavior and the consequences of such attitudes and behaviors (Wenzel et al., 2012). Many individuals with substance use disorder end up feeling isolated, alone, and alienated. Additionally, they fear the harsh moral judgments of others. To be together with other people who understand and accept the realities of life with a SUD is a great comfort. In such a context it is much easier to be honest and to accept the legitimate criticism of others who have had similar experiences. Also, advice from one’s peers rings truer because it comes from those who are themselves striving for recovery. Gender-specific groups can be helpful for several reasons. Offering women-specific groups can, for example, be helpful (Brady & Moran-Santa Maria, 2015). Mixed-gender groups can be difficult for women who have been sexually assaulted by a man, can introduce unneces- sary gender power dynamics that are not helpful in recovery, and do not allow women to learn skills from each other in an empowering environment. Another type of group intervention is activity groups. Not to be confused with psychotherapy, these groups provide a venue for social interaction and distraction that does not include using substances. These groups offer a range of experiences, includ- ing outdoor activities, art projects, cooking, and interacting with animals. Some activity groups include “psychodrama,” which allows individuals to express their feelings (Shrand, Shrand, & Texeira, 2016).
TWELVE-STEP PROGRAMS Self-help “12-step” programs are structured peer-support groups that employ behavioral, spiritual, and cognitive prin- ciples aimed at helping individuals abstain from substance use. Examples of these programs include Alcoholics Anonymous (AA), Narcotics Anonymous (NA), Pills Anonymous (PA), and Cocaine Anonymous (CA). These free programs are available in most communities and allow individuals to connect with other people who are going through the recovery process. These programs provide ongoing support and assist individuals with developing a social support system for nonusers (Fewell & Spiegel, 2014). Before referring any client to a 12-step program, it is recommended that providers attend a few open meetings. This experience can help providers be aware of the peer-support group modality and understand what methods are used within the program. Twelve-step facilitation therapy (TSF) is typically implemented in 12 to 15 sessions and is a behavioral, spiritual, and cognitive structured approach to early recovery from alcohol and drug abuse. The underlying principle of TSF is that the individual must accept that addiction is a disease that he or she is power- less over and that it is necessary to surrender to a higher power for successful recovery (Fewell & Spiegel, 2014). Sessions 1 through 11 focus on an introduction to 12-step programs, acceptance of one’s dependence on substances, surrender to some power other or greater than oneself, and becoming active in 12-step programs. Sessions may include completing a genogram (exploring the genetic basis of addiction); exploring enabling (when another person acts so as to excuse, tolerate, or encourage substance use); identifying people, places, and things that trigger the urge to use substances; use of HALT (not permitting oneself to become too hungry, too angry, too lonely, or too tired); engaging in a fearless moral inventory; and implementing sober living skills. One or two conjoint sessions for individuals in a close relationship may also be helpful. These conjoint sessions are built around the topics of enabling and detaching (i.e., understanding that no one can keep someone else sober; NIAAA, 2020; NIDA, 2021g). In addition to 12-step groups, other self-help groups for substance abusers can be accessed when appropriate; these groups include Women for Sobriety, SMART Recovery (Self- Management and Recovery Training), and Double Trouble/ Recovery groups for those with dual diagnoses. (See the Resources section of this course.) MEDICATION-ASSISTED TREATMENT One barrier to maintaining abstinence is the difficulty of being abstinent when faced with strong physical cravings for substances. Medications can help diminish the cravings for a substance and assist clients in re-establishing normal brain functioning. Three medications are currently approved for treating alcohol dependence: naltrexone (Vivitrol), acampro- sate (Campral), and disulfiram (Huebner & Kantor, 2011; SAMHSA & NIAAA, 2020).
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