Substance Abuse and Addiction

Double Trouble

Ofttimes a client will enter treatment for substance abuse also diagnosed with a mental illness. Having both substance abuse issues and mental illness is otherwise known as a co-occurring disorder, a dual diagnosis, a comorbid condition or ‘double trouble’.

So why is this an issue? Because it’s near impossible to figure out if the mental illness caused the substance abuse or if the substance abuse resulted in the mental illness making treatment options very ’sticky’. Sometimes when there is a diagnosis of depression with alcohol abuse, a detoxing period will purge the alcohol and the depression in some cases, but this will probably not be the case most of the time.

So how to treat a comorbid psychiatric condition and substance abuse…both must be treated because the conditions probably reinforce each other. This is where detox and inpatient rehab with psychoactive drugs and a lot of therapy are indicated. There are also available drugs to reduce drug cravings which seem to work very well.

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CFR 42

This refers to the HIPAA confidentiality laws otherwise known as the unbreakable doctor/patient relationship.

But…nothing is unbreakable. It is true that what is said to the counselor stays with the counselor and cannot be revealed except to colleagues and others for which a signed Release of Information is provided. All confidential unless child abuse and neglect or elder abuse and neglect are revealed in which case the counselor is obligated to immediately call the police and reveal this.

Confidential information can also be revealed in a medical emergency if deemed a crisis situation, for example a client has overdosed on a medication and the counselor must reveal which medications the client is taking in order to save the client’s life.

So if a client tells the counselor he is selling cocaine from his apartment, this information is confidential. If a client tells a counselor he is selling cocaine from his apartment and while conducting business, locks his 2 year old in the closet…the police must be called.

Issues of confidentiality as described are clearly explained to the client during the intake process.

The 12 Core Functions of Counseling

The process of counseling is the the process of change. In order for this process of change to be consistent and provide measurable services it has been divided into 12 basic core functions.

In the bygone days before this process was established, therapeutic change was not really measurable and, even worse, a different quality of service may be provided depending on counselor personality or facility type. Now, the treatment process has been defined, is measurable and the same quality treatment is provided to all by each counselor and facility.

So when I say ‘the 12 core functions of counseling’, I’m really saying that a person with a substance abuse problem starts the process of change in a certain way and ends it the same way as everyone else.

As an example let’s say someone with an addiction enters the system for treatment. Starting with the first core function:

Screening – Is this person or client appropriate for the treatment program in question? Is he the proper age, income level, gender, etc. and does the treatment facility have the appropriate services to offer? The client and treatment program must match perfectly according to a long list of criteria.
Intake – Screening went well so now it’s time to really delve into the client to gather information for a treatment plan. Information gathered could include demographics, family, hospital stays, mental health history, current medications, past and pending litigation to name a few. And the treatment facility may still not be the right match to the client. Confidentiality is discussed and release of information forms are signed.
Orientation – Intake went well and the process continues…now the client tours the facility, learns about the program and his responsibilities.
Assessment – The client’s strengths, weaknesses and personality are assessed for what he needs for positive growth.
Treatment Plan – Measurable goals for the client to work towards and time periods are agreed upon.
Counseling – Involves individual as well as group counseling to help the client understand himself better and grow.
Case Management – The client is hooked up to outside services to facilitate change.
Crisis Intervention – A plan is developed in case of a crisis. How is a crisis determined for this particular client and how will it be dealt with?
Client Education – Positive growth is enhanced by education whether by group or individual.
Reports and Record Keeping – The measurable change outlined in the Treatment Plan must be documented.
Referral – At any time in this treatment process it may be determined that the facility does not possess the resources to adequately help the client in which case a referral to another facility that is more ‘tailored’ to the client’s needs is made.
Consultation – Sometimes, during the treatment process, a facility knows it has adequate resources to help the client but may need to consult with an outside source for guidance.

And these are the stages of change essential to treatment of substance abuse…

Group Counseling

A group is an amazing therapeutic tool! Something happens to even the most rigid and resistant person in a group where they eventually participate and benefit from the participation.

Groups can mild or explosive, structured or wild and at the least probable time will lead you into a personal revelation as to why you are like you are, kind of like being hit with a rubber mallet.

I facilitate groups meaning I need to get people talking, participating and generally ‘playing nice’ with each other with the least amount of interference I can manage. This takes skill and I’m sure I’ll always be learning this skill.

My first experience with a group was in a 1977 encounter group (yes, I’m that old…). Back then group technique was not as well documented as today so were run a bit different than now.

I remember walking into a room with other people sitting around and no one talking. I sat down too and we all looked at each other silently for what seemed to be hours although it was no more than two hours at the most.

I remember feeling the tension in the group building until it was so thick ‘you could cut it with a knife’…then someone cracked. Some poor soul just broke down, crying that she could not take it and she sensed we all disliked her. This did get people participating but it also produced an emotional casualty – the poor soul who broke down should have been supported and counseled but was not…

Such were the encounter groups which at times seemed to cause more harm than good. In current times, group dynamics is pretty well documented, groups are divided by function and thus run differently from each other.

I run a support group in the morning with daily readings, meditation and discussion while my afternoon group is focused on personal growth and more lively.

Do I personally benefit from participation in these groups? All the time…but my focus (any facilitator’s focus) is on the group and not on my personal goals. I’m there to facilitate and not to be counseled although at times this is a fine line.

There is an awful lot to say about the benefit of groups, how they are structured and facilitated but I’ll leave that to future posts…

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We hear about substance abuse and addiction almost everyday but do we really know what they mean?

Take, for example, the person who comes home from work and immediately drinks three beers every single night – is this alcohol abuse and is he addicted?

Or the high school student smoking a joint every morning? How about the office worker who drinks vodka with his morning coffee for that needed ‘eye-opener’ or the office manager who retires to the bathroom every afternoon for that needed shot of heroin… I could go on and on with these scenarios but the main question is, how does one know when they have a problem with a drug?

Even experts disagree as to what addiction and abuse are but the main consensus is: when the use of a substance persists even though life and daily functioning are severely affected then we have ’substance abuse’.

And if withdrawal symptoms occur when a drug is suddenly stopped then we have addiction.

So, is the daily three beer drinker described earlier abusing alcohol? If he has no physical problems caused by alcohol use and can adequately function while drinking then…no, there is no problem. Of course if he had sclerosis of his liver complicated by hepatitis and still drinks then…yes, there is a problem.

So the line between recreational substance use and substance abuse is blurred to say the least. The fact of the matter is that some people can stop using a drug at anytime without withdrawal and some cannot. Some people can become addicted at the first ‘taste’ even.

But no matter how you define addiction and abuse there are now tried and true methods to receive help for anyone with any kind of substance problem. And that is what I am studying to do and what I will talk about here…

Substance Abuse and Addiction

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Double Trouble

CFR 42

The 12 Core Functions of Counseling

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