Drug Counselling

Addiction Drug Counseling addresses the symptoms of drug addiction and related areas of impaired functioning and the content and structure of the client's ongoing drug recovery program.

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Goals and Objectives of Approach

The primary goal of addiction counseling is to help the client achieve and maintain abstinence from addictive chemicals and behaviors. The secondary goal is to help the client recover from the damage the addiction has done to the client's life.

Theoretical Rationale / Mechanism of Action

Addiction counseling works by first helping the client recognize the existence of a problem and the associated irrational thinking. Next, the client is encouraged to achieve and maintain abstinence and then develop the necessary psychosocial skills and spiritual development to continue in recovery lifelong.

Agent of Change

Within this addiction counseling model, the agent of change is the client. The client must take responsibility for working a program of recovery. However, although recovery is ultimately the client's task, he or she is encouraged to get a great deal of support from others such as the client's counselors, treatment staff, sponsor, drug-free or recovering peers, and family members.

Conception of Drug Abuse/Addiction, Causative Factors

Drug abuse is thought to be a multi-determined, maladaptive way of coping with life problems that often becomes habitual and leads to a progressive deterioration in life circumstance. Habituation of drug abuse is addiction, seen as a disease in its own right, which damages the addict physically, mentally, and spiritually. Causation is not a prominent focus of treatment.

Counselor Characteristics and Training for Educational Requirements

For purposes of the research protocol for which this treatment was designed, the educational requirement for group or individual addiction counselor was no higher than a master's degree. The range of education is associate's to master's degree in a human services field.

Counselor's Recovery Status

Many counselors in this field are either in recovery themselves or have had a family member who was addicted. An in depth knowledge of addiction and the tools for recovery and ability to empathize with the client are essential for an addiction counselor. One way to develop this knowledge and ability is for the counselor to be in recovery. The best situation is a mixture of recovering and non-addicted counselors, because this fosters maximum learning from one another.

Ideal Personal Characteristics of Counselor

Addiction counselors should exhibit good professional judgment, be able to establish rapport with most clients, be good listeners, be accepting of the client for who he or she is (and not have a negative attitude toward working with addicts), and use confrontation in a helpful versus an inappropriate or overly punitive manner. A good addiction counselor must also be personally organized so as to be prompt for all sessions and able to maintain adequate documentation.

Counselor's Behaviors Proscribed

The counselor should not be harshly judgmental of the client's addictive behaviors. If the client did not suffer from addiction he or she would not need drug counseling, so it is useless to blame the client for exhibiting these symptoms. Also, because clients often feel a great deal of shame and guilt associated with their addictive behaviors, to help resolve those feelings it is important that they be encouraged to speak honestly about drug use and other addictive behaviors and to be accepting of each client's story.

It is also important that the counselor be respectful of clients. The counselor should not be late for appointments and should never treat or talk to clients in a disrespectful manner.

The counselor should avoid too much self-disclosure. While occasional appropriate self-disclosure can help the client to open up or motivate the client by providing a role model, too much self-disclosure removes the focus from the client's recovery. A good rule regarding self-disclosure, if the counselor is so inclined, is that the counselors first have a clear purpose or goal for the intervention and then think about why he or she is choosing self-disclosure at this time.

Finally, the counselor should be aware of when his or her own issues are stimulated by a client's problems and therefore refrain from responding to the client out of his or her own dynamics. For example, if a counselor in recovery feels it extremely important to break ties with addicted peers, but a particular client with an addicted spouse or partner cannot break free of the relationship, it is imperative that the counselor respond flexibly and creatively to the client's perception of the situation and not rigidly adhere to the notion that breaking ties with all addicts is the only way to recovery.

Recommended Supervision

Ongoing supervision is a necessary part of counselor training and support. Lack of adequate supervision can contribute to counselor stress and burnout, both of which are seen frequently.

The ultimate goal of supervision is to enhance the quality of client care. Focus to achieve this goal is twofold. First, it is centrally important that the supervisor provide support and encouragement to the counselor along with the opportunity to expand his or her skills. Second, it is important that the supervisor have the opportunity to review the clinical status of clients and offer suggestions or corrections.

What Is the Counselor's Role?

The role of the counselor is to provide support and education and to hold the client accountable through nonjudgmental confrontation. Ideally, the recovering person sees the counselor as an ally in the struggle to achieve sobriety.

Who Talks More?

The client should talk more than the counselor. The counselor should structure the session and provide information and direction, but also do a lot of listening.

How Directive Is a Counselor?

The counselor must find a balance between being directive and allowing the client to be self-directed. The counselor must be directive in many ways. The counselor imposes a session structure that includes giving feedback on the most recent urine drug screens and the client's progress in recovery as well as processing any episodes of use or near use. The counselor identifies the relevant topic for discussion, based on what the client seems to need, and introduces that topic. Also, the counselor may directly and gently pressure the client to change certain behaviors, for example, to start attending three meetings a week. However, the client is also encouraged to be self-directed in this counseling approach. For example, within the framework of a particular topic, such as coping with social pressure to use, the client will ventilate or explore the direction he or she needs to take, and the counselor will respond to the client's direction. Also, when the client is unable to change an addictive behavior, such as being in a dangerous situation, the appropriate counselor response is to accept where the client is and assist in exploring what the client can do to handle the situation differently the next time.

Ultimately, recovery is seen as the client's responsibility, and the counselor wants to encourage self-directed movements toward the recovery. However, the counselor will discourage movements toward addiction in a number of ways, many of which are directive.