PSYCHOSOCIAL INTERVENTIONS
ADDRESSING MOTIVATION
Most substance misusers seeking treatment will have a certain degree of ambivalence regarding cessation of use.Ambivalence must be addressed if the client is to function as an active participant in treatment; if the patient perceives treatment as wholly imposed on him or her by external forces and has no clear sense of personal goals for treatment, then the treatment is likely to be of limited usefulness. Thus motivation must be 'internal' at least to some extent, rather than purely 'external'. Motivationally based treatments such as 'Motivational Interviewing' and 'Motivational Enhancement Therapy' concentrate almost exclusively on strategies intended to bolster the patient's own commitment to change. Most psychosocial interventions also include some exploration of what the patient stands to lose or gain through continued substance misuse as a means to enhance motivation for treatment and abstinence (Carroll K, 1997).
TEACHING COPING SKILLS
Social learning theory posits that substance misuse may represent a means of coping with difficult situations, positive and negative affects etc.. At the severer end of the spectrum, substance misuse may have become the only means of coping with a variety of situations, settings and states. Recognition of high-risk situations and the development of new means of coping with them through skills training or relapse prevention techniques forms the central core of cognitive-behavioural techniques in substance misuse treatment (Carroll K, 1997).
CHANGING REINFORCEMENT CONTINGENCIES
A central component of dependency is the narrowing of the social repertoire to the exclusion of all rewards other than those derived from substance misuse. Most psychosocial treatments encourage patients to identify and develop fulfilling alternatives to substance misuse, as exemplified by the Community Reinforcement Approach (CRA), which stresses the development of alternative reinforcers (e.g. fulfilling social activities with non-drug using others) and vocational rehabilitation (Carroll K, 1997).
FOSTERING MANAGEMENT OF PAINFUL AFFECTS
Difficulty in tolerating strong feelings may be a central dynamic underlying the development of compulsive
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- Addressing Motivation.
- Teaching Coping Skills.
- Changing Reinforcement Contingencies.
- Fostering Management of Painful Affects.
- Improving Interpersonal Functioning and Enhancing Social Supports .
- Fostering Compliance with Pharmacotherapy.
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drug use. To foster the development of mastery over dysphoric affects, most psychotherapies include techniques for eliciting strong affects within a structured or protected therapeutic setting, and then enhancing the client's ability to identify, tolerate and respond appropriately to them (Carroll K, 1997).
IMPROVING INTERPERSONAL FUNCTIONING AND ENHANCING SOCIAL SUPPORTS
A consistent finding in the literature on relapse to drug misuse is the protective influence of an adequate network of social supports (Longabaugh et al, 1993). Typical issues presented by drug misusers are loss of or damage to valued relationships occurring when using drugs was the principle priority, failure to have achieved satisfactory relationships even prior to having initiated drug use, and inability to identify friends or intimates who are not themselves drug users. Many forms of treatment, including family therapy, marital behavioural therapy, twelve-step approaches, interpersonal therapy and network therapy, make building and maintaining a network of social supports for abstinence a central focus of therapy (Carroll K, 1997).
FOSTERING COMPLIANCE WITH PHARMACOTHERAPY
Approaches aimed at fostering a sense of personal responsibility for compliance include diary-keeping, clear communication regarding the effects and risks of medication use (truly informed consent), contracting with the client for adherence, general education and advice regarding the effects of non-compliance.Other approaches are numerous and include pill counts, serum monitoring, positive and negative reinforcement approaches, frequent contact, written reminders for appointments or taking medication, support such as transportation or creches for children of clinic attendees (Carroll K, 1997).
Next page .. SPECIFIC INTERVENTIONS
The above information is copyright of Dr Bruce Trathen MBBS MRCPsych (2006). ISBN 0-9545164-0-0. The author grants permission for these guidelines to be downloaded, copied and distributed freely, but does not grant permission for their sale.
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