Substance abuse can refer to alcoholism, illegal drug use, overuse of prescription drugs and addiction to nicotine. The causes can be behavioral, genetic, psychological and biochemical. The more complex the mix of causes for the addiction, the more complex and difficult the treatment will be.
History
Getting to know the social, medical, behavioral and personal history of a patient will aid greatly in composing a counseling approach. The approach should be weighted toward the areas of most substance abuse activity for the patient. If social acceptance and identification were major factors in forming the addiction, social pressure and group therapy may be the best approach in treating the abuse problem.
Identification
Without the active cooperation of the patient, little permanent success can be achieved in counseling. The patient must be invested in change and open to possibilities for positive growth. Finding a positive skill or interest in the patient, such as music, cooking, a sport or handicraft, could go a long way toward investment in positive change and direction away from abuse. Getting to know the patient and experimenting with possible directions of interest could be very important in this approach.
Types
Counseling techniques with certain common attributes have been shown to be most effective in positive change from addiction behaviors. Establishing trust between the counselor and therapist is the foundation upon which any process of counseling technique can move forward. Once trust is established, the identification of substance abuse as destructive with a need for change is the next step. Whether cognitive (understanding the problem and solution), behavioral (making new habits more comfortable than the old destructive habits), family systems (realizing the dynamics formed in childhood that affect adult actions), or other modalities of counseling are used, the foundation of trust, identification of abuse, need for positive change and participation in a new future away from old habits by the patient must be agreed upon as a goal worth the effort.
Significance
Positive reinforcement, comfortable social attachments within the new activities and direction away from old cycles of abuse must be part of any therapy. One effective application of the existing system to include each of the above is drug court. In this approach, a judge can give a convicted drug abuser the option of participating in drug court activities, therapy and positive change. The referee is mentored by successful drug court graduates. The abuser finds social acceptance and self-worth in community related projects that give back to the locale where the illegal activities occurred and help the person become invested in positive change by looking outside toward others' well being.
Considerations
Counseling approaches voluntarily entered into by the patient can be effective outside the more established and professional modalities of counseling. Alcoholics Anonymous and similar groups offer a place for self-examination, mutual support and growth at the patient's own pace. Each type of approach has adherents and detractors, and it is difficult to find a totally objective analysis of the most successful approach. Success may lie in the motivation and resolution of the patient to effect positive change.
