Combining Stages of Change
Motivation and Coping Skills to Promote Recovery:
In fact, many of these individuals engage in alcoholism or substance abuse to cope with their debilitating depression or anxiety. The co-occurrence of addiction and psychiatric disorders is the norm, not the exception. In fact, it has now been shown that people exposed to stress are more likely to be involved in alcohol or drug abuse, continue using, or to experience a relapse. This means that for a successful recovery, the effective treatment for substance abuse must address both the addiction and co-occurring mental health disorders.
The treatment of both the alcohol and / or drug abuse and co-occurring psychiatric problems in a single program is referred to as “integrated treatment”. This form of treatment strives to treat and alleviate both the alcoholism and drug abuse, as well as the psychiatric dual disorders simultaneously, rather than focusing on one disorder, while ignoring the other, as has commonly occurred in treatment for substance abuse programs.
Given the complexity of alcoholism, drug abuse and psychiatric co-occurring disorders, it is not likely that there is a single method of treatment that is best for everyone. It is more likely that certain common factors underlie effective treatments in rehab programs. Treatment for substance abuse and dual diagnosis disorders is a specialized endeavor that requires expertise in treating both mental health and substance abuse problems.
Treatment of Substance Abuse
The common factors that have been demonstrated to induce change in the treatment for substance abuse:
Feedback regarding personal risk and impairment may be provided; Responsibility for change must rest squarely with the individual; Advice is consistent with change principles; a Menu of alternative change options is provided which may include treatment for substance abuse; Empathy about obstacles to change is provided; and Self Efficacy is promoted. Therapeutic interventions providing some or all of these common factors have been shown to be effective in reducing alcoholism and drug abuse in rehab programs. Contrary to popular belief, aggressively confronting the patient has not been shown to be effective in reducing use.
To help people involved in alcohol or drug abuse who want to change, it is important to understand where they are in the change process. People who are not considering, or do not desire to change, are in the Pre-contemplation stage and have no desire to enter treatment for substance abuse. They are not even thinking about the idea of change and will not go for treatment. People who are beginning to think about change are in the Contemplation stage of change. They are considering that they may have a problem that requires change, but are very ambivalent about whether they want to change or not. Those in the Determination stage have weighed the pros and cons of their behavior and have made a decision to change.
Once they begin to take steps to modify this behavior, such as entering treatment for substance abuse, they are in the Action stage of change. After the successful implementation of Action strategies that have resulted in the desired behavior change, one moves into the Maintenance stage, where behaviors designed to sustain the change are used. As with most chronic conditions, relapse should be expected and do not constitute failures. Following a relapse, patients are encouraged to learn from their behavior and then enter the change cycle again, only this time they will likely progress more rapidly and move farther along the change process and their recovery.
Stage Model of Drug & Substance Abuse Treatment
Using this Stage model of change, one can see that the goal is to join with the patient and help them develop the tools they need to progress from one stage to the next. In this model, it makes sense that simply confronting the patient about his/her substance and drug abuse is insufficient for change to occur. Instead, the therapist must join the patient where they are in the process of their recovery and attempt to facilitate their progression from one stage to the next along their treatment for substance abuse journey. Similarly, one can see that most patients will require time and ongoing treatment to move from one stage to the next, and that they cannot simply stick to a decision they are not emotionally ready to make. For most people, several cycles through the stages of change are necessary to learn to sustain the changes and their recovery successfully.
Motivational Interviewing is a relationship based cognitive behavioral technique that is grounded in theory and research that has been proven effective in the treatment for substance abuse by reducing and/or eliminating substance and drug abuse. It draws upon years of motivational interviewing research and differs from traditional addiction treatment in a number of ways.
First, motivational interviewing does not rely on confrontation, but on understanding. Motivational interviewing emphasizes that alcoholism or drug mis-use is a choice, and not entering treatment for substance abuse is also a choice. Because it is a choice, it can be stopped when the patient reaches the point of Determination, Action and Maintenance. To do this, the patient requires help analyzing the personal pros and cons of using alcohol or drugs. In motivational interviewing, the patients “denial” is not seen as resistance to treatment, or as something to be argued about, but as a result of interpersonal dynamics that have resulted in the patient being stuck and unable to accurately assess the pros and cons of their chemical abuse, from their own point of view.
Similarly, motivational interviewing views abstinence in the treatment for substance abuse is a choice that not all patients are ready to commit to, depending on where they are in the Stages of Change outlined above. Motivational Interviewing uses strategies for building motivation to change in increments or “baby steps”. Motivational interviewing is used with the stages of change to help the patient develop change strategies and assume responsibility for implementing the changes as part of their recovery and substance abuse and addiction treatment. Abstinence in the treatment for substance abuse is not a choice that all patients are ready to make. Instead they may be ready to “cut down” or “cut back” their use, which is often a first step towards recovery.
Even with Determination and Action, however, most people involved in alcohol or drug abuse have additional co-occurring psychiatric problems, such as depression and anxiety, that must be addressed if they are to maintain abstinence. For example, learning how to manage depressive symptoms, analyze high risk situations for relapse, and cope with internal triggers of anxiety must all be solved in an integrated treatment for substance abuse if a patient’s motivation to change and achieve recovery is to remain strong.
Coping with major depression, anxiety and relationships that the patient finds stressful must also be addressed in the treatment for substance abuse. Various psychosocial treatment approaches have been proven to remedy these problems and when integrated into a substance abuse and addiction intensive outpatient treatment program contribute to successful recovery.
Treatment for substance abuse in an integrated intensive outpatient program must involve Coping Skills Training, which teaches new ways of thinking and behaving in problem situations that may contribute to relapse. Coping Skills Training addresses the emotional, cognitive and situational factors that could contribute to relapse by teaching coping skills necessary to manage depression and anxiety and promote recovery.
Your life can be better, with you at the helm. Don’t let substance abuse and psychological disorders rob you of peace, fulfillment and a sense of purpose any longer. Effective treatment for substance abuse and treatment for dual diagnosis disorders in Memphis, TN is available now.
Call us at 901-682-1434 to schedule an appointment.
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