CHAPTER 31
The Treatment of Substance Use Disorders
LEARNING OBJECTIVES
After studying this chapter, students should be able to:
•
31.1: Identify effective characteristics of a clinician working with substance
use disorders
•
31.3: Understand the purpose of treatment plans
•
31.4: Consider typical components of continuing care programs
CHAPTER OUTLINE
Characteristics of the Substance Rehabilitation Professional
Confrontation and Other Techniques
The Minnesota Model of Substance Use Treatment
Reaction to the Minnesota Model
Other Treatment Formats for Substance Use Disorders
Acupuncture
Computer Simulations
Detoxification
Family/Marital Therapies
Individual Therapy Approaches
Group Therapy Approaches
Biofeedback Training
Harm Reduction (HR) Model
Hypnosis
Videotape/Self-Confrontation
Yoga or Meditation
The Treatment Plan
Aftercare Programs
The Treatment/Research Disconnect
CHAPTER OVERVIEW
The purpose of this chapter is to provide a brief overview of the different treatment modalities
that have been developed (or modified) to address the problem of substance use disorders
(SUDs). Each of these treatment modalities dovetails into the treatment settings discussed in
the last chapter. Thus, an intensive outpatient treatment program might have provisions for
couple’s therapy, while a residential treatment program might have provisions for acupuncture
as an adjunctive treatment modality to help control the individual’s “craving” for drugs. This
chapter should also help to illustrate how “treatment” or “rehabilitation” is a multifaceted
process.
DISCUSSION QUESTIONS
Break-Out Discussion #1:
The goals of treatment: In the United States, the vast majority of treatment programs profess
that total abstinence from alcohol or drugs is their goal. They do so with the knowledge that
only a minority of those who complete treatment remain abstinent from further alcohol or illicit
drug use. In virtually every other disease state, the patient’s wishes are discussed with the
patient by the health care provider, and a course of treatment is decided upon. If the patient
should wish only palliative care, this wish is accepted as the appropriate treatment goal. If the
patient should desire that intravenous fluids not be administered after a certain point, this wish
is accepted by the health care professionals. Should the patient not wish to be resuscitated
1
or
have “extreme measures” used to extend their lives, or should there be no hope of recovery,
the patient’s desires are used to guide treatment.
Before answering this question, consider a comparison to a hypothetical form of cancer. In spite
of the best of treatment, 95% of those patients afflicted with this hypothetical condition die
within a year. Should the physician work toward the goal of a complete cure? This hypothetical
problem parallels the state of SUD treatment at this time: It is imperfect and most patients
relapse after treatment, but the time between discharge and the relapse, and the intensity of
chemical use following discharge, are often markedly reduced. Post-treatment assessments to
demonstrate the effectiveness of substance rehabilitation are based on the assumption that it is
possible to produce a lasting elimination of subsequent substance use: a “cure” (McLellan, 2009,
p. 1220). For many medical disorders, such as congestive heart failure or chronic obstructive
Questions
1. Should total abstinence be a goal of treatment? Why or why not?
2. How should treatment goals be determined, and by whom? Why?
3. Is treatment a viable option when so many patients relapse? What factors influence your
answer?
4. What would you consider to be important goals for a patient entering treatment? How would
1
“Do Not Resuscitate,” or “DNR” in the jargon of health care professionals.
these goals vary between patients?
Break-Out Discussion #2:
Harm reduction: In your text, the concept of harm reduction (HR) was introduced. A central
tenet of the HR model is that it is impossible to prevent substance misuse, but it is possible to
limit the impact of substance misuse or addiction on society, at least to some degree. Having a
“designated driver” or taking a taxicab to reach home after a night’s drinking can be viewed as a
Questions
1. Do such programs promote the use of alcohol or illicit drugs, or just limit the harm forced
upon society through the misuse of these chemicals? Explain your answer.
2. Do HR programs qualify as a form of “treatment” in your opinion? Detractors of the HR model
often argue the latter point. What do you think, and why?
References
KEY CONCEPTS AND TERMS
Detoxification: Process of removing a toxin from the body; medical management of a person’s
withdrawal from alcohol/drugs
Marital and family therapy: A generic term applied to a number of different therapeutic
approaches including the psychodynamic, family systems, structural and behavioral family
therapy approaches
Cognitive-behavioral therapy (CBT): Therapy that helps the individual learn how to change
cognitions and behaviors, in part by confronting irrational thoughts or beliefs
Motivational interviewing: A therapeutic technique used in short-term intervention therapy
2
See Chapter 34.
that places great emphasis on helping the individual identify how one is currently living and how
one wishes to be living in the future
Biofeedback: Process in which the individual is provided real-time information about internal
body functions such as brain wave or skin resistance patterns
LO/STANDARDS CORRELATION CHART
A-head
LO
Standard—CACREP
Characteristics of the
Substance Rehabilitation
Professional
31.1: Identify
effective
characteristics
of a clinician
working with
substance use
disorders
1b: the multiple professional roles and
functions of counselors across specialty
areas, and their relationships with
human service and integrated behavioral
health care systems
The Minnesota Model of
Substance Use Treatment
Other Treatment Formats
for Substance Use
Disorders
31.2: Describe
the different
treatment
modalities
that may be
implemented
to address
substance use
disorders
5a: theories and models of counseling
The Treatment Plan
31.3:
Understand
the purpose
of treatment
plans
5h: developmentally relevant counseling
treatment or intervention plans
Aftercare Programs
31.4: Consider
typical
components
of continuing
care
programs
5h: developmentally relevant counseling
treatment or intervention plans
