Counselling in Addiction Disorders

Dr Yeo has such sense of humor one cannot help but overlook the facts he is trying to present. That was precisely what took place on a few occasions during lecture because some coursemates got him to repeat some facts a couple of times.

There are two broad concepts of addiction according to Dr Yeo. Addicts are viewed as bad criminals and must be punished under the Social model while the Medical model deem addicts sick and therefore need to be treated.

I benefited from Dr Yeo’s painstaking description of the different types of substance abuse. For the first time, I heard of Shyabu, Adam, Yaba, FRY and Ketamine. During assessment of drug addiction, check for poly-drug abuse, look for coexisting diagnosis, depression, anxiety disorder, psychosis and underlying personality disorder.

Medical detoxification is the first stage of addiction treatment. It safely manages the physical symptoms of withdrawal but does little to change the long-term drug use.

Motivation is the strongest factor in facilitating change in an addict. Counselor has to adopt Rogerian concepts of empathy, warmth and genuineness. Roll with the resistance and refrain from imposing and labeling. Patient is offered different perceptions and self-efficacy – You CAN do it. Each slip or relapse is viewed as one step closer to recovery. (An addict may relapse 4 times before permanent change.)

Dr Yeo advocated Confrontational Models in Group Psychotherapy dopted in Alcoholic Anonymous & Narcotic Anonymous and ‘Hot Seat’ (Minnesotta Model). Such models may not be suitable for patients who are depressed, anxious or have low self esteem.

The patient goes through stages of change and the therapist’s tasks will be:

- Precontemplation stage (To raise doubt, perception of risk)
- Contemplation (Tip the balance, evoke reason tochange)
- Determination (Help choose best course of action)
- Action (Help take steps to change)
- Maintenance ( Identify and use strategies to prevent relapse)
- Relapse (Help renew process of contemplation, determination & action without demoralization of being stuck)

Non-drug interventions for addiction - counseling and other behavioral therapies - that help will be Replacing Drug Using Activities, Drug Resistance Skills, Motivation, Problem Solving Skills and Interpersonal Relationships.

I am to identify trigger points, cue avoidance, offer alternate forms of stress relief – exercise, pilates and meditation. Time freed up when trying to quit addiction has to be filled up with alternate interests and a healthier lifestyle. I will also facilitate family intervention by helping patient set goal and earn trust of family members. There must be financial accountability. The issue of co-dependency will be looked into to ensure the patient is not being empowered to carry on with addiction.