A Counseling Approach

Approaches to Drug Abuse Counseling U.S. Department of Health and Human Services, National Institutes of Health Fred Sipe 1. OVERVIEW, DESCRIPTION, AND RATIONALE 1.1 General Description of Approach

This approach to counseling is based on the belief that a condition of susceptibility to chemical addiction exists prior to the first use, sometimes referred to as a “genetic predisposition.” It is also based on the belief that chemical addiction is a disease repeatedly reinforced by self-judgment; therefore, it is a disease of self-judgment.

This model views addicts and alcoholics as individuals chronically addicted to chemicals in spite of their attempts to change. They are in a vicious cycle of use, self-judgment, and avoidance that is repeated time and again. The model focuses on three elements of the cycle:

  1. Chemical use.
  2. Self-judgment.
  3. Avoidance behaviors.

The approach to counseling is strongly based on the 12 steps of Alcoholics Anonymous (AA).

The three elements of the addictive cycle are impacted by a process created by using:

  1. A therapeutic environment.
  2. A thorough assessment.
  3. A group process.
  4. Education.
  5. Self/peer assessment.

All five items are incorporated into a therapeutic process, which begins with the first contact.

The creation of an environment that supports the therapeutic process is essential to this approach. Clients must be provided with an opportunity to explore their self-judgments without fear of the judgment of others. They must feel they are listened to with empathy and respect. In earlier models of this approach, the counselor was the only one who possessed so-called counselor characteristics. Although this element is still critical, it now applies to the whole multidisciplinary team, a staff of professionals who are naturally therapeutic.

The counselor conducts an initial assessment, identifies the presenting problem, and, if indicated, schedules the client for treatment.

A thorough psychosocial assessment is conducted, and identified blocks to treatment or problems are noted. The counselor begins the bonding with the client during the assessment process. All counseling skills come into play. The counselor then prepares a therapeutic or treatment plan (i.e., the change model) to help the client deal with those identified problems or blocks that will prevent response to the treatment process.

The client follows a simple change model that closely aligns with the 12 steps of AA.

Model AA Step Identify the problem Step 1 Develop trust (renewed hope) Steps 2 and 3 Ventilate Steps 4 and 5 Gain new insight Steps 6 and 8 Change behavior Step 7 and Steps 9 through 12

A Psychotherapeutic and Skills-Training Approach to the Treatment of Drug Addiction

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