Counseling Theories as Applied to Substance Abuse Patients - Literature review Example

Running head: COUNSELING THEORIES Counseling therapies and substance abuse Counseling Theories as Applied to Substance Abuse Patients Introduction Various counseling theories can be applied to substance abuse patients. These theories and therapies are meant to target different goals in mental health and substance abuse treatment. These theories with related therapies include the cognitive behavior therapy, the existential therapy, and the family systems theory. Psychologists and other mental health professionals have adapted various applications of these theories on substance abuse patients. For the most part, these therapies have achieved much progress, with some therapies being more successful than others. This paper shall now present a literature review of the three counseling theories identified and contrast these as they apply to substance abuse patients. This paper is being carried out in order to establish a clear pattern of recovery and treatment among substance abusers and related mental health sufferers. Body In a study by Liddle, et.al. (2008), the authors sought to evaluate the efficacy of two adolescent drug abuse interventions: individual cognitive behavioral therapy and multidimensional family therapy. Their study covered a community-based drug abuse clinic in the northeastern US. They managed to include about 220 respondents, mostly male, African-American, and coming from low income homes. All the respondents were drug abusers and they were assessed over a period of five years for their substance abuse severity, 30-day frequency of cannabis use, 30 day frequency of other drug use, and 30 day abstinence. The study revealed that both types of treatment were able to significantly decrease cannabis consumption; they were also able to slightly decrease alcohol use. However, there were no significant differences seen in the reduction on frequency of cannabis and alcohol use. Better and more significant treatment effects were seen in the use of the family therapy as it decreased the severity of the problem, as well as the use of all substances for up to 12 months after the end of treatment. The authors concluded that both treatments are comparable with each other in terms of impact on substance abuse; however family therapy is more sustainable in its treatment effects (Liddle, et.al., 2008). Waldron and Kaminer (2004) sought to integrate the findings of controlled trials of CBT among adolescent substance abusers. The review indicated that despite differences in methodology, the studies provided favorable results in impact of CBT on the reduction of adolescent substance use. The reduction in incidence of abuse, including the rates and frequency of drug use was seen among drug users in the adolescent population. In a study by Barrowclough, et.al., (2001), the study sought to investigate the relative benefits of including cognitive therapy and family caregiver therapy as well as motivational interviewing in the care of substance abusers. The study covered a period of 12 months and sought to measure the exacerbation of symptoms, as well as the increase in the percentage of abstinence from drugs and alcohol during the 12 month period. The authors concluded that combining the treatments of motivational interviewing, family and caregiver therapy, and cognitive therapy achieved more success as compared to separate applications of these treatments. Each field of aspect of treatment was able to address specific concerns for the patient, with concerns related to behavior, family issues, and motivations being specifically addressed by the different forms of therapy. This study establishes support for integrated therapy, utilizing the best features of each form or type of therapy in order to achieve improved patient outcomes and significant changes in the substance abuse patients. The existential approach to therapy covers six propositions, including the fact that all persons have the capacity for self-awareness; that as free human beings, all people must accept responsibility which comes with freedom; that each person has the unique identity which can only be established through relationships with others; that each person must also continue to recreate himself; that anxiety is also part of the human condition; and that death is a basic part of life which gives meaning to life (Cooper, 2004). The main question in this type of therapy is: How do I exist in the face of uncertainty and death? It is therefore important for the patient to make choices on the direction of his life and on his concerns on his freedom and isolation. For the substance abuse patient, the existentialist therapy would prompt him to be self-aware and to reassess his life and the direction which his life has taken (Cooper, 2004). Moreover, this type of therapy would also teach him that as free human beings, he cannot do anything he likes and not be responsible for his actions. In effect, the substance abuser is pressured to take responsibility and the consequences of his habits. By coming to terms with the consequences of these habits, it is possible for the patient to make changes in his life and to be deterred from his addiction. The cognitive therapy for substance abuse patients incorporates two types of learning which refers to learning by association and learning by consequences (Kadden, 2002). In learning by association, stimuli which was originally neutral can trigger drug or alcohol use. In order to deter this practice or habit, the cognitive therapy assists the patient in thinking through his actions and his triggers – and to act differently on these triggers. These triggers may both be internal and external and it is important for the psychiatrist or mental health professional to recognize the links between the habit and these triggers (Kadden, 2002). The mental health professional would likely also understand that as associations between the act and the triggers are strengthened, the habits of substance abuse or drug abuse would also be stronger. In effect, the manifestations of the habit are exacerbated (Kadden, 2002). Learning by consequences model refers to considerations on the consequences of drug use and substance abuse behavior. Introducing the patient to the fact that negative consequences to substance abuse can also result in prompting the patient to learn from the consequences of his habits (Kadden, 2002). This is similar in some ways to the existential approach which mentions that freedom comes with the consequence of responsibilities. And these consequences must be emphasized on substance abusers in order to deter them from acting impulsively and habitually. The existential theory also suggests hidden reserves of energy and pleasure, as well as interests (Vendegodt, et.al., 2003). In family therapy, these reserves of energy are founded on the patient’s family. In effect, by finding such reserves, it is possible to implement some very much needed changes into the patient’s life. Moreover, by opening up negative feelings within the existential therapeutic sessions, a transformation of the patient’s comprehension and existence can be seen. All three therapies speak of these transformations and are largely founded on the similar plains. A study by Liddle (2003) established that both cognitive therapy and multidimensional family therapy was able to reduce symptoms which relate to drug use – from their intake to their termination. However, for both therapies, different trajectories were apparent. The family therapy was able to maintain symptomatic gain from termination to treatment with continued improvements seen even after termination. As compared to CBT, symptomatic progress was only seen up to termination (Liddle, 2003). In this regard, the family therapy may be the more effective alternative, as far as cognitive therapy is concerned. The importance of face-to-face sessions was also shown in both studies and these sessions were meant to discuss on a more personal note the different issues which the patients are going through. Family therapy for substance abusers is founded on the context of family and social systems where drug abuse habits can sometimes be developed and supported (Carroll and Onken, 2005). The societal networks can sometimes be a significant predictor of change in the substance abuser and including family members in the therapy can help reduce attrition, especially among adolescents. Family therapy has also been known to address different problem areas, thereby allowing for a more holistic mental health care for the patient (Carroll and Onken, 2005). The efficacy of this approach has also been seen both among adult and adolescent users. The fact that this therapy usually combines various techniques, including skills and communication training implies the significant value of this practice. Family therapies have been mostly effective among drug using adolescents and some of them combine behavioral contracting with contingency management which has been seen as especially effective among drug using adolescents with or without conduct disorders (Carroll and Onken, 2005). The multidimensional family therapy incorporates the individual and the family format, targeting substance-abusing adolescents, as well as family members. Family therapies have also manifested strong results among adolescents referred to the criminal justice system due to substance abuse issues (Carroll and Onken, 2005). All in all, family therapies show much significance in applicability among adolescents because they reconnect the patient with his family, forcing him to face the possible issues he is going through with them, and examining the issues which may be driving him towards substance abuse. The application of cognitive therapy also includes relapse prevention, and like family therapy, it is also grounded in social learning theories, as well as applications of operant conditioning (Carroll and Onken, 2005). This type of therapy considers functional analysis of drug use, understanding the use of drugs and alcohol in terms of its causes and effects. It also includes skills training where an individual tries to understand when his substance abuse habits are triggered, and how he can avoid these high-risk situations as much as possible. Cognitive therapy has a strong empirical support among alcoholics and other psychiatric disorders (Carroll, et.al., 2004). Various studies have illustrated the efficiency of cognitive therapy in the management of cocaine-dependent outpatients, especially those who are severely depressed and severely dependent to the drug, and its effects have particularly been beneficial when combined with psychotherapies like disulfiram (Carroll and Onken, 2005). This type of therapy has also reflected positive results because of its support for skills development which is usually used to support abstinence. As a result, the impact of cognitive therapy on the patient is considered to be durable, even beyond the treatment period (Carroll, et.al., 2004). Cognitive therapy has also been considered an element of multimodal treatments, especially in relation to the use of psychopharmaceutical meds, and in the use of other types of therapies like motivational interviewing (Miller and Wilbourne, 2002). Studies however point out some limitations of cognitive therapies among drug dependent individuals. Moreover, it is comparatively complex in relation to other therapies. Each form of therapy has its distinct focus and the cognitive therapy is focused on the thought processes of the alcoholic which lead up to the substance abuse (Reinecke and Clarke, 2003). The cognitive therapists believe that by focusing on these thought processes, it is possible to change the behavior of the substance abuser. The substance abuser may be used to thinking that if he is stressed or if he is angry, drinking and taking drugs would help him relax (Reinecke and Clarke, 2003). The cognitive therapist would teach the substance abuser to act differently and to adapt healthier habits in relation to negative life experiences. The family therapies are a collection of therapeutic approaches which share an understanding in the family-level assessment and interventions (US Department of Health and Human Services, 2004). Families are a related system and each system is linked with the other parts. As a result, changes in one part of the system would also impact on other parts. Family therapies for substance abusers focus on the strengths and weaknesses of families. Among substance abusers, this type of therapy seeks to use the family’s strength in order to develop ways to live without the substance abuse; secondly, it reduces the impact of the substance abuse on the family (US Department of Health and Human Services, 2004). Finally, while the cognitive therapies focuses on the substance abuser’s thought processes, and the family therapy incorporates the family in the patient’s treatment, the existentialist model highlights the experiences of the person on the here and no, helping him keep in touch with himself and the environment (Belzman, 2010). It then encourages the individual to take charge of his life and to take responsibility for his actions. It highlights self-awareness in the client, helping him to focus on the subjective world and to understand various options (Belzman, 2010). These therapies approach the substance abuser differently, but they seek the same goals – that of curbing the client in his usual reactions and in his dangerous habits. Conclusion The cognitive, existential, and family therapies are all effective therapies for the substance abuser. They focus on different aspects of an abuser’s life, highlighting the importance of adjusting his habits towards less self-destructive tendencies. The cognitive therapy focuses on the thought processes which lead to the substance abuse; the family therapy incorporates the family in the patient’s recovery; and the existential therapy highlights the importance of taking responsibility for one’s actions. All in all, these three therapies approach substance abuse recovery based on problem areas and specific patient qualities. In the end, this is part of the patient-centered and evidence based treatment of patients. Works Cited Barrowclough, C., Haddock, G., Tarrier, N., Lewis, S., Moring, J., O’Brien, R., Schofield, N., & McGovern, J. (2001). Randomized Controlled Trial of Motivational Interviewing, Cognitive Behavior Therapy, and Family Intervention for Patients With Comorbid Schizophrenia and Substance Use Disorders. Am J Psychiatry, 158:1706-1713. Belzam, M. (2010). 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