Interventions Used in the Alcohol and Other Drugs Counselling and Psychosocial Intervention - Literature review Example

Interventions used in the Alcohol and other Drugs Counselling and Psychosocial Intervention Name: University: Instructor: Course Title: Date: 1.0 Introduction The use of alcohol and other illegal drugs causes harm to both individuals and to society in general. This harm is usually medically and psychologically related and takes many forms. Within the large environment/ policy level there are two intervention approaches. These are proactive approaches that aim at deterring involvement in alcohol and other drugs through legislations. Secondly is the reactive approach that aims at rehabilitating those already hooked in the process through medical/ pharmacological and non-medical/ psychosocial approaches. The aim of this paper is to compare and contrast two brief interventions used in the Alcohol and Other Drugs field. In this regard the discourse will highlight the practical implication of the selected approaches for effective Alcohol and Other Drugs counselling and psychosocial intervention. The paper narrows down on psychosocial approaches with the specific approaches for comparison and contrast being motivational interviewing (MI) and cognitive-behavioural therapy (CBT). 2.0 Alcohol and other Drugs Abuse/ Dependence/ Addiction and Need for Intervention Various statistics across the globe point towards a worrying situation in relation to alcohol and other drugs abuse/ addiction. According to the World health Organization (WHO) between the year 1998 and 2002 it was approximated that 185 million people around the world had used illegal drugs (World Health Organization, 2006). Meaning drug problem is a global phenomenon. According to Murthy (2002:1), in India, it is estimated that there 62.5 million alcohol users, 8.7 million cannabis consumers and a total of 2 million opitate consumers. For Australia, the country is ranked 14 as per capita consumption of pure alcohol within OECD. AS PER THE National Drug Strategy Household Survey of 2007 it is estimated that nine out of ten Australians had one time indulged in alcohol (Australian Government Department of Health and Ageing, 2009: 7). The consequences of using alcohol and other illicit drugs like opioid products are usually devastating and may result into serious psychosocial, physical and economic impacts. Some of the social consequences of illegal drug use on individuals include drug overdoses, accidents due to intoxication, and violence. The consequences of illegal drug problem on the society may include minimal productivity of members of the society as result of impairment. The society also suffers higher illegal drug-related costs involved when seeking criminal justice and also treatment within the health care systems (World Health Organization, 2006). Various research studies have shown that people who abuse drugs are more likely to suffer from mental disorders, physical health problems, and family problems. Health consequences may include substance dependence, increased mortality and morbidity rates as a result of overuse of alcohol. Alcohol related deaths occur due to accidents, drug overdose, suicide and violence associated with the use of these hard drugs like heroine (Galanter & Kebler, 2008). Mortality also occurs due to other health considerations like irresponsible sexual activity which may lead to the drug users acquiring the HIV epidemic, hepatitis B and C viruses and also the Human Pappiloma virus that may cause cervical cancer in female users (Klimas et al., 2013:1). 3.0 Intervention Approaches From a broader perspective, there are two main approaches to rehabilitation of alcohol and other drug addicts. These are Psychosocial/ non medical intervention and pharmacological/ medical intervention (Klimas et al., 2013:1). Intervention to drug use abuse and control are usually advanced in two fronts. These are the macro level/ policy level which are usually proactive and reactive in nature. The second is micro/ individual level which is reactive and involves application of pharmacological or medical approaches and non medical approaches like psychosocial analysis so as to disengage an individual from substance abuse and addiction. The focus of this paper is on the psychosocial intervention programmes. Psychosocial approaches include motivational interviewing, cognitive behavioural therapy, relapse prevention strategies and residential rehabilitation programme. On the other hand, pharmacotherapies treatments include naltrexone, acamprosate, combined naltrexone & acamprosate and dislulfiram among others (Australian Government Department of Health and Ageing, 2009). 3.1 Psychosocial Treatment Interventions According to Klimas et al. (2013:1) “psychological interventions are best described as psychologically-based interventions aimed at reducing consumption behaviour or alcohol-related problems which excludes any pharmacological treatments”. Tasmania Department of Health and Human Services (2013) indicates that psychosocial approach entails interventions and support services that are geared towards behaviour change by supporting individuals affected by alcohol and drug abuse. The intervention programmes under these approaches are normally concerned with the beliefs, feeling and behaviour of an individual. Secondly they take into consideration that individuals social context such as family, community and cultural factors and how the two spheres interact. The success of this process is tied the strength of involvement, interpersonal ability and capability of the two parties (clinician & patient) to work on shared treatment goals (Marsh and Dale 2006). Miller et al., (1995:12) observes that there are over 25 psychological therapies used to treat alcoholism. These approaches have varying success rates. Curran & Drummond (2007:6) in their discourse posits that there are four key psychological therapies. They include cue exposure treatment (CET), community reinforcement approach (CRA), contingency management (CM), cognitive therapy (CT), cognitive behavioural therapy, (CBT), relapse prevention, (RP), motivational interviewing (MI) and motivational enhancement therapy (MET). For instance, one of the psychosocial is Dialectical Behavioural Therapy (DBT). This approach was initially developed to help treat people with borderline personality disorder. However, it has been proven that the same can be applied to people with substance addiction. This treatment integrates cognitive-behavioural strategies with mindfulness (acceptance) so as to educate patients on how to regulate (change) their emotions, withstand stress and improve relationships. In a nutshell, it is about empowering one to gain control over his/ her behaviour. This has given birth to bio-social framework. This programme is normally extensive as opposed CBT and is undertaken at individual and group level. While undertaking skills training, the clinician engages the patient to know what they need to change at individual level and what was discussed at group therapy (McMain, Korman & Dimeff, 2001: 184 & 185). The first step under this plan is on basic skills training/ mindfulness. In this phase one is taught on how to gain control over his behaviour since these are the triggering factors for alcohol consumption. The second step is to allow one experience the emotions fully without relapsing to the negative activities. The third is for them to know how to manage everyday problems which might force them to alcoholism. The last is to be connected completely to the world realities by connecting it to previous steps. The second phase is core skills training. Under this the patient is tough mindful exercises such as observing, describing, participation and non-judgemental stance among others (McMain, Korman & Dimeff, 2001: 189 & 192). 3.2 Approaches to be Compared and Contrasted Raistrick and Tober (2004:37); Carroll and Onken (2005: 1454) indicates that the most applied and empirically supported psychosocial programmes include brief interventions, motivational interviewing and cognitive behaviour therapy (CBT) which entails behavioural couples therapy, relapse prevention and coping skills training. Klimas et al. (2013:2) affirms the same, but also expands the list and notes that the most common approaches utilised in psychosocial treatment include motivational interviewing (MI), cognitive-behavioural therapy (CBT), psychodynamic approaches, screening and brief interventions (SBI), family therapy, drug counselling, 12-step programs, therapeutic communities (TC) and vocational rehabilitation (VR). In this regard, the paper will compare and contrast motivational interviewing (MI) and cognitive-behavioural therapy (CBT). 3.2.1 Cognitive-Behavioural Therapy (CBT) This model uses cognitive and behavioural frameworks to explain and treat addiction. Kadden (2002:2) indicates that cognitive-behavioural theory adopts two kinds of learning that have been developed in behavioural discipline. This is learning by association and learning by consequences. Learning by association is premised on pavlovian or classical conditioning. In this it is noted that stimuli that were initially neutral can cause one to crave for alcohol as a result of association between the stimuli and alcohol. These triggers can be external to ones environment or internal and include settings, location, emotions and psychological changes. On the other hand learning by consequences is grounded on the fact that behaviours are strengthened by the consequences that follow their use. For instance if one uses alcohol and feels high or confident, he derives what is called positive reinforcement (Kadden, 2002:3). This feel good result would make one resort to the same action and this now turns to be negative reinforcement (Kadden, 2002:3). Further, Kadden (2002:4) notes that out the model, there are numerous treatment plans that have been formulated. The first plan is cue exposure approach which aims at identifying the salient causative factor. After identification the client is exposed to the same factors, but without following it with alcohol usage. This helps the patient loose the craving and subsequent relapse. The other plan adopted is the use of coping skill training. This adopts different perspective by accepting are given and thus, aims at training the patient on alternative responses that allows one to respond to the trigger in different ways rather than alcohol use (Kadden, 2002:4). The other treatment plan which is closely tied to the second one is the relapse prevention which strives to examine antecedent and consequences of alcohol use by gays that drives them back into drinking and it can be tackled. The other treatment approaches under this theory include contingency management and community reinforcement approach. These two plans are geared towards consequences instead of antecedents (Kadden, 2002:5). 3.2.2 Motivational interviewing (MI) According to Department of Health, NSW (2013: 27), the approach is an integral stand-alone-therapeutic tool. The concept of motivational interviewing was developed by Miller and Rollnick in 1991. This psychosocial approach to rehabilitation of alcohol and illicit drug addicts whereby in the counselling process empathy is deeply employed so as to convince the patient that what he or she is engaging in is not fruitful or the implications far outweigh the benefits. This approach is client centred and aims at motivating the patient to see the need for change. (Miller and Rollnick, 2002: 2). The motivational interviewing normally consists of between one to four sessions to patients who have not responded to initial brief intervention. Moreover, to greater extent it can be used in combination with initial brief intervention (Department of Health, NSW, 2013: 27). This is like cost benefit analysis approach where one is made to see the sense between consuming alcohol and abstaining from it. The core to motivational interviewing is the motivational enhancement therapy (MET). Benegal and Nikketha (2002: 26) postulates that the basis of this thought is anchored on the premise that change involves “ recognising a problem, searching for a way to change, and then beginning, continuing and complying with that change strategy”. Motivational enhancement therapy/ interviewing is grounded on the various stages of change model ads outlined by Prochaska and Diclemente. The model provides a five step change process which includes pre-contemplation, contemplation, preparation, action and maintenance Department of Health, NSW, 2013: 27). 4.0 Discussion on Comparison and Contrast Klimas et al. (2013:2) observes that psychosocial approaches are integral in rehabilitation of drug addicts even in their brief version. Nevertheless, they indicate that there do exist performance gap and variations in terms of effectiveness. For instance, motivational strategies are best applied in the earlier phases of treatment with the aim of creating behaviour change while cognitive behaviour approach is critical in empowering the addict to have the requisite skills to maintain change imparted on one earlier. This segment outlines the emerging similarities and differences between motivational interviewing (MI) and cognitive-behavioural therapy (CBT). 4.1 Similarities The first point similarity is based on their strength to rehabilitate problematic alcohol and drug use. The two approaches are all rated at 3 stars (Department of Health, NSW, 2013: 4). The same statement is corroborated by Benegal and Nikketha (2002: 27) who notes that the two systems are effective in rehabilitating an individual who has drinking problem. The second ground is on the informing or guiding principle. Curran & Drummond (2007:4) notes that psychological frameworks embrace the use of psychological principles in evaluating and treating substance abuse by modelling patient’s mental environment so that the patient can change his/her internal reality. Moreover, these frameworks are grounded on the behavioural and cognitive theories (Curran & Drummond, 2007:5). 4.2 Differences One of the divergence points is that motivational enhancement therapy is meant to create an urge for change within a patient who is addicted to alcohol and other drugs. The chore is to awaken patient’s internal resources that favour change. Consequently, the approach is expected to be brief and best utilised during the initial stages of contact between the clinician and the patient. Pivotal to the system is the realisation that it is critical if applied in one session (Benegal and Nikketha, 2002: 27). In a nutshell, motivational interviewing focuses on promoting engagement, reducing resistance & defensiveness and encourages behaviour change (Department of Health, NSW, 2013: 27). On the other hand, cognitive behavioural interventions are anchored on the need for the patient to retain the change he or she has acquired so that he or she may not relapse to alcoholism or drug abuse in general (Australian Government Department of Health and Ageing, 2009: 85). The essence of these treatment approaches based on cognitive-behavioural theory is to advance coping skills training, problem solving, interpersonal skills like managing thoughts & craving for use, decision making, negative thinking, pleasant activities, relaxation skills refusing skills and anger management (Kadden, 2002). This implies that motivational interviewing will always precede cognitive behavioural interventions. The other departing point is the tools and techniques applied in each approach. MET/MI relies on empathy and questioning as its key tool to rehabilitating patients. Secondly, the approach relies on creation of discrepancy where the current behaviour of patient is compared to the overall life goal of an individual. Equally the process calls for reduction of argument with the client. Instead it calls for sense making so as to convince the patient. The last stage would to support self-efficacy (Australian Government Department of Health and Ageing, 2009: 85; Benegal and Nikketha, 2002: 20-37). On the other hand, cognitive behavioural interventions rely to four principal tools. These include behavioural self management or self control. This aims at empowering patient to develop controlled drinking. The second is coping skills training. This empowers the patient to cope without alcohol and anything that might influence one to drinking. The third is cue exposure or factors that drive one to abuse a drug and lastly is the behavioural couple’s therapy (Australian Government Department of Health and Ageing, 2009: 86). Lastly, CBT is ranked as the most effective approach to rehabilitating alcohol and drug addicts. It is proven that is has equal effectiveness as the pharmacotherapy (Department of Health, NSW, 2013: 31). 5.0 Conclusion The aim of this paper was to compare and contrast two interventions used in the alcohol and other drugs counselling and psychological intervention. The psychological intervention considered in this regard as means for counselling are motivational intervention and cognitive behavioural theory. The similarity among these two is that they are anchored on social cognitive learning theory. Moreover, all of them are effective if overcoming drug addiction since they are rated as three stars. In terms of difference, the paper established that MI is used to initiate behaviour change while CBT is used to sustain the change that has been accrued. Thus, MI precedes CBT. References Australian Government Department of Health and Ageing (2009). Guidelines for the treatment of alcohol problems. Retrieved on 19 August, 2013 from: http://www.health.gov.au/internet/ministers/publishing.nsf/Content/76AE6384CE9A3830 CA2576BF003073F8/$File/DEZEM_Alcohol%20Guide_FA.pdf. Benegal, V.and Nikketha, S. (2002). Enhancing motivation to change: steps in practice. Retrieved on 19 August, 2013 from: http://www.nimhans.kar.nic.in/cam/CAM/Psychosocialintervention_2.pdf. Carroll, K. M. & Onken, L. S. (2005). Behavioural therapies for drug abuse. Am J Psychiatry, 162:1452-1460. Curran, V. and Drummond, C. (2007). Psychological treatment of substance misuse and dependence. Foresight Brain Science, Addiction and Drugs Project, Vol., pp. 1- 34. Retrieved on 19 August, 2013 from: Department of Health, NSW (2013). Drug and Alcohol Psychosocial Interventions Professional Practice Guidelines. Retrieved on 19 August, 2013 from: http://www0.health.nsw.gov.au/policies/gl/2008/pdf/GL2008_009.pdf. Galanter, M. & Kleber, H. D. (2008). The American Psychiatric Publishing Text Book of Substance Abuse Treatment. Arlington: American Psychiatric Publishing Inc. http://www.bis.gov.uk/assets/foresight/docs/brain-science/psychological-treatments.pdf Kadden, R. M. (2002). Cognitive-behaviour therapy for substance dependence: coping skills training. Farmington, CT 06030-3944. Retrieved on 19 August, 2013 from: http://www.bhrm.org/guidelines/CBT-Kadden.pdf. Klimas, J., Field, C. A., Cullen, W., O’Gorman, C. S., Glynn, L. G., Keenan, E., Saunders, J., Bury, G. & Dunne, C. (2013). Psychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users: Cochrane Review. Systematic reviews, 2(3): 1-7. Marsh, A. & Dale, A. (2006). Addiction counselling: Content and process. Victoria: IP Communications. McMain, S., Korman, L. M. & Dimeff, L. (2001). Dialectical behaviour therapy and the treatment of emotion dysregulation. Psychotherapy in Practice, 57 (2): 183–196. Miller, W. R., Brown, J. M., Simpson, T. L., Handmaker, N. S., Tbien, T. H., Luckie, L. F., Montgomery, H. A., Hester, R. K. and Tonigan, J. S. What works? A methodological analysis of the alcohol treatment outcome literature. In: Hester, R. K. and Miller, W. R. eds. (1995). Handbook of Alcoholism Treatment Approaches: Effective Alternatives, 2nd ed. Needham Heights, MA: Allyn & Bacon. Murthy, P. (2002). Psychosocial Interventions for Persons with Substance Abuse. Retrieved on 19 August, 2013 from: http://www.nimhans.kar.nic.in/cam/CAM/Psychosocialintervention_2.pdf. Raistrick, D. & Tober, G. (2004). Psychosocial interventions. Psychiatry, 3 (1): 36-39. Tasmania Department of Health and Human Services (2013). Psychosocial Intervention. Retrieved on 19 August, 2013 from: http://www.dhhs.tas.gov.au/mentalhealth/alcohol_and_drug/services/psychosocial_interv ention. World Health Organization (2006). Disease Control Priorities Related to Mental, Neurological, Development and Substance Abuse Disorders, Geneva: World Health Organization Publication Read More