ED435893 1999-00-00 Substance Abuse

and Counseling: A Perspective. ERIC

Digest.

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Substance Abuse and Counseling: A Perspective. ERIC Digest.......... 1

PERSPECTIVE................................................................. 4

SUMMARY....................................................................... 5

REFERENCES.................................................................. 6

ERIC Identifier: ED435893

Publication Date: 1999-00-00

Author: Sales, Amos

Source: ERIC Clearinghouse on Counseling and Student Services Greensboro NC.

Substance Abuse and Counseling: A

Perspective. ERIC Digest.

THIS DIGEST WAS CREATED BY ERIC, THE EDUCATIONAL RESOURCES

INFORMATION CENTER. FOR MORE INFORMATION ABOUT ERIC, CONTACT

ACCESS ERIC 1-800-LET-ERIC

OVERVIEWSubstance abuse is a critical problem in the United States across

allsegments of the population and impacts in some way all members ofour society. It is

the most prevalent mind disorder, the number onecontinuing health problem, and the

number one prison problem in theUnited States (Inaba, Cohen, and Holstein, 1997).

The significantnumber of the United States population having substance abuseproblems

ED435893 1999-00-00 Substance Abuse and Counseling: A Perspective. ERIC Digest. Page 1 of 7
is indicated by approximately 6% abusing illegal drugs, 12%having problems with

drinking, 25% being addicted to nicotine and,conservatively, 10% addicted to

prescription medications.

All counselors no matter what their specialty or setting willencounter clients with

presenting or related problems of substanceabuse. However, counselor education

programs and their accreditingbodies do not require knowledge or skill development in

this area.Thus, it is critical that we implement strategies to insure that allcounselors in

practice and in counselor preparation programsunderstand the process of substa

Substance abuse is defined as the categories classified in the Diagnostic and Statistical

Manual IV (DSM-IV) (American Psychiatric Association, 1994) as Substance-Related

Disorders and Substance-Induced Disorders. These disorders include the active use

and/or dependency on any mood-altering substance. Substances include alcohol,

sedatives, amphetamines, cannabis, cocaine, hallucinogens, inhalants, opiods, caffeine,

nicotine, and prescription drugs, as well as legal drugs. Similar addiction processes to

those of substance abuse include experiences such as eating, gambling, sex, and work

addiction. Addictive behavior is characterized by preoccupation with the substance or

the experience, withdrawal symptoms after not engaging in the substance or

experience, increased tolerance for the substance or activity in order to achieve the

same effect, and continued use despite negative consequences. While similarities of

behavior exist across all types of substance abuse, individuals cannot be categorized,

defined, and treated in relation only to their substance abuse problem. An individual with

a substance abuse problem is unique in his/her history, pattern of use and abuse, and

counseling and related treatment needs.

While many models of causation of substance abuse have been proposed, no clear

etiology has been identified. Models emphasize morality or individual conscious choice,

biological or disease vulnerability, behavioral learning patterns, cultural-environmental

concerns, or biopsychosocial impact. The biopsychosocial model views substance

abuse as a complex interaction of all of the other models and endorses multiple

strategies for counseling from these models as appropriate. Counselors need to review

these models to develop a conceptual position regarding causation upon which he/she

can make consistent therapeutic assumptions and decisions to guide counseling

practice.

Counseling

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Page 2 of 7 ED435893 1999-00-00 Substance Abuse and Counseling: A Perspective. ERIC Digest.
Conclusions regarding effective counseling strategies for counseling individuals with

substance abuse are limited in that this counseling specialty area has been driven more

by experience and clinical intuition than by research. As a result, most traditional

substance abuse treatment programs (e.g., Alcoholics Anonymous, alcoholism

education, half-way houses and therapeutic communities utilizing confrontation, group

therapy, individual counseling, and use of medication) have not demonstrated their

efficacy. Some successful treatment outcomes have been linked to short-term

interventions, aversion therapy, stress management, solution-focused brief therapy, and

social skills training, yet seldom are these methods utilized in traditional substance

abuse treatment programs in the United States. Given this, conclusions regarding

counseling and substance abuse have to come from general counseling research data.

Counselors, regardless of their settings, impact as change agents within the context of

therapeutic relationships with individuals. Successful relationships are facilitated by a

skilled counselor who helps the client become more invested in the process and who

utilizes therapeutic techniques appropriate to the client. A thorough review of counseling

outcome research (Sexton, Whiston, Bleuer, and Walz, 1997 pp. 58-62, pp. 87-93)

concludes the following:

1. Counseling is a process beneficial to most clients of skilled counselors. However, it is

not always so. A significant number of clients get worse.

2. Counseling models (e.g., cognitive, experiential, behavioral, dynamic) are effective

and, when compared, seem equivalent in their effect on counseling outcome.

3. Successful counseling has process factors which are common across the various

counseling models. These factors include the counselor's establishing an open, trusting,

collaborative relationship, facilitating client cognitive learning through reframing,

feedback, and insight, and assisting the client in behavior changes through behavioral

regulation, reality testing, and successful experiences.

4. Successful counseling outcome is dependent on counselor therapeutic skills such as

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focusing conversations on life problems, addressing presenting problems directly, and

providing structure for counselor-client intervention.

5. Successful counseling progresses through various process stages, wherein different

types of counselor-client interactions are reflected by different counseling techniques.

PERSPECTIVE

The above research conclusions support the following perspective regarding counseling

clients with substance abuse problems. Counselors, to be effective, first must have the

ability to develop an open, collaborative relationship with clients wherein clients

perceive trust and commitment. Carl Rogers identifies, and research supports, this

ability as related to the counselor's skill in conveying, in interaction with clients,

unconditional positive regard and empathic understanding (Austin, 1999). Within this

relationship, the counselor must provide focus for the process by addressing the client's

presenting problems directly and identifying client need for change. Counselors of

clients with substance abuse problems often find this process difficult because of the

chronic nature of interrelated destructive attitudes and coexisting disorders these clients

often bring to counseling. Once problem identification and client need for change are

identified, the counselor must be able to articulate and implement counseling

intervention strategies perceived by both the counselor and the client as appropriate to

the client's need to change.

These process considerations in counseling clients with substance abuse problems hold

to be true for specialists in this area and for counselors working in school, rehabilitation,

mental health, and social work settings. The counselor emphasis is on the person not

the substance abuse problem. Additional knowledge and skill on the part of the

counselor relates to being able to assess the extent and impact of a client's substance

abuse problem and the client's need to change. Familiarity with and ability to utilize

standardized assessment instruments specific to substance abuse will help the

counselor in this assessment process. Familial and social environment assessment also

is required to identify the extent of and to utilize the client's support systems. The

counselor's ability to identify the needs of the client and the quality of counseling and

related treatment intervention strategies obviously linked to his/her assessment and

diagnostic skills.

Counselors should be thoroughly familiar with the facilities and services in his/her

community to insure proper referral for clients with substance abuse problems. Referral

options are determined by client need and are collaboratively agreed upon as

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Page 4 of 7 ED435893 1999-00-00 Substance Abuse and Counseling: A Perspective. ERIC Digest.
appropriate by the counselor and client. These include short-term, inpatient care lasting

three to seven days for withdrawal from substance abuse, or intensive, outpatient

programs lasting eight to twelve weeks wherein clients maintain vocational and family

responsibilities while participating in treatment. Another option, the half-way house,

provides moderately structured and supportive residential treatment lasting for three to

six months, wherein successful living within the environment becomes part of the

treatment plan. Other options include therapeutic communities, structured, highly

intensive, residential treatment program such as Synanon, where clients may remain up

to two years, and out-patient alcoholism treatment programs of two kinds, drug-free

clinics with services lasting four to six months, and methadone or opiate clinics that a

client may attend by medical referral for two to five years. Within these settings, group

treatment is the predominant mode of therapy with individual counseling viewed as an

adjunct.

SUMMARY

Substance abuse is a major social problem and concern for counselors. It is the most

prevalent mind disorder, encompassing some 40 percent of the diagnoses in the

DSM-IV (American Psychiatric Association [APA], 1994), the number one continuing

health problem, and the number one prison problem in the United States (Inaba, Cohen,

& Holstein, 1997). Yet, school, rehabilitation, and mental health counselor education

programs do not require expertise in this area as a prerequisite to receiving a degree.

Given this, a need exists to implement strategies to insure that all counselors have

expertise in this area.

This digest focuses on identification of counseling outcome research implications for

counseling individuals with substance abuse problems. The following conclusions

regarding counseling individuals with substance abuse problems have been highlighted.

1. All counselors, no matter what work setting or clientele, will counsel individuals with

presenting or related problems of substance abuse.

2. Counselors counsel and empower individuals with substance abuse problems versus

treat the substance abuse problem.

3. Counselors must be able to establish the same open, collaborative, therapeutic

relationship in counseling individuals with substance abuse problems as they do with

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other client populations. This ability is viewed as a prerequisite to successful outcome in

any counseling setting.

4. Counselors must focus the counseling relationship on addressing the client's

presenting problems directly and identifying client need for change.

5. Counselors must be able to articulate and implement counseling intervention

strategies perceived as appropriate by both the counselor and the client.

6. Counselors must know community resources and procedures for referral to be able to

insure access to effective and appropriate support services for clients.

REFERENCES

American Psychiatric Association (1994). Diagnostic and statistical manual (4th ed.),

Washington, D.C.: Author.

Austin, L. (1999). The counseling primer. Philadelphia, PA: Accelerated Development,.

Inaba, D. S., Cohen, W. E., and Holstein, M. E. (1997). Uppers, downers, and

all-arounders: physical and mental effects of drugs of abuse. Ashland: CNS

Publications.

Sexton, T. L., Whiston, S. C., Bleuer, J. C., and Walz, G. (1997). Integrating outcome

research into practice. Alexandria, VA: American Counseling Association,

Amos Sales, Ed.D., CRC, is a Professor of Special Education, Rehabilitation, and

School Psychology and Coordinator, Rehabilitation Specialties, the College of

Education, University of Arizona, Tucson, Arizona.

This publication was prepared with funding from the Office of Educational Research and

Improvement, U.S. Department of Education. The ideas and opinions expressed in the

Digest do not necessarily reflect the positions or policies of OERI, ED, or the

Clearinghouse. This Digest is in the public domain and may be freely reproduced.

Title: Substance Abuse and Counseling: A Perspective. ERIC Digest.

Document Type: Information Analyses---ERIC Information Analysis Products (IAPs)

(071); Information Analyses---ERIC Digests (Selected) in Full Text (073);

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Available From: ERIC Counseling and Student Services Clearinghouse, University of

North Carolina at Greensboro, 201 Ferguson Building, P.O. Box 26171, Greensboro,

NC 27402-6171. Tel: 336-334-4114; Tel: 800-414-9769 (Toll Free); Fax: 336-334-4116;

e-mail: ericcass@uncg.edu; Web site: http://ericcass.uncg.edu.

Descriptors: Bias, Counseling Effectiveness, Counselor Attitudes, Counselor Client

Relationship, Counselor Performance, Counselor Training, Drug Abuse, Drug Addiction,

Drug Use, Individual Counseling, Substance Abuse

Identifiers: Diagnostic Statistical Manual of Mental Disorders, ERIC Digests

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