TreatingAddiction Through Counseling and Motivational Interviewing
TreatingAddiction Through Counseling and Motivational Interviewing
Part1: Miller’s application of motivation interviewing
Counselors usually employ various techniques to conduct therapy to anindividual suffering from long-term addiction. Such methods includebrief intervention, check-up, brief motivational interviewing,motivational enhancement therapy, and motivational interviewing.Miller and Rollnick (2002) assert that these techniques areextensively effective in different situations. However, motivationalinterviewing is the most effective different situations since it ismore client-centered than the other methods. Some of the skills thatmake motivational interviewing the most successful technique includeempathy, avoiding argument, supporting self-efficacy, developingdiscrepancy, and rolling with resistance. Thus, it is significant toevaluate the discussion between Miller and his client to note themotivational interviewing skills or aspects used by Miller.
Miller employs empathy as a motivational interviewing aspect. Throughopen-ended questions, Miller is able to make Mike note thesignificance of behavior change by understanding his base ofreference. From 22:20 to 26:30 Miller utilizes open-ended questionsto motivate Mike to open up. William Miller asks, “Well, how would,how much you like things to be different?” he further asks, “Whatam I gonna be doing? Well, how do I spend my time?" (Miller,2000). When Mike reacts to the questions he opens up and convinceshimself that it is important he gets involved in something that willhelp him change his smoking habit. Miller effectively raises Mikes’desire and need to change his life.
When the discussion seems to take an aggressive approach, Milleravoids arguments. Miller increases the clients’ confidence andacceptance level by using affirmations rather than arguments. At59:50 when Mike explains about the steamroll, Miller assures him thatis what he needs to gain the real changes, “That`s, that`s the planthat works for you.” Moreover, when Mike explains on how alcoholcan mess an individual, Miller affirms his argument, “But if you`rekinda, with alcohol, you`re kinda getting a point where, No, thisisn`t worth it anymore,” (Miller, 2000). Instead of using counterarguments to challenge his client’s thoughts, Miller usesaffirmations that help in increasing the clients’ confidence andreducing any possible arguments.
Through reflective listening and assertions, Miller developsdiscrepancy. The development of discrepancy helps Mike in resolvingambivalence. Miller successfully elicits selective reinforcement ofMike’s self-motivational expressions of possible challenges,underlying problems, concern, intention and willingness to change.For instance, at 31:10 when Mike evaluates and analyzes the variousaspects of smoking and drinking alcohol, he does so by developingdiscrepancy. Miller affirms Mike’s statement by saying, “It`sonly when it`s a problem for you really that it matters.” Also,from 40:30 to 50:10 Miller uses “uh hmmm” to show he is inagreement and at the same time he is keenly following what the clientis saying.
On the other hand, he rolls with resistance. Miller fosters theclient’s commitment and dedication to change throughout theinterview. Through open-ended questions and reflective listening,Miller monitors Mike’s readiness to change. Miller ensures that hisquestions are within the current scope of discussion so as to avoidany possible resistance from the client. For example, at 31:55 afterthe customer explains about his experience with AA. Miller says,“That`s human nature, Yeah,” (Miller, 2000). From 51:00 to 54:10Miller limits his replies, questions, and suggestions to brief wordssuch as, yeah, ok and uh. Every act by Miller is designed to keepMike committed to change.
Miller supports self-efficacy in the discussion. Miller helps theclient examine several reform plans that will enable him to achievehis goal. Through affirmations and well-structured summaries, Milleris able to ensure the customer settles for a workable change plan. At53:30 when the client examines the possibilities of excuses, Millerassures him that the best option is to work, “Then you work,”(Miller, 2000). Further when the client seemed to have reached acourse of action and suggested a follow-up, Miller asks him to set adate. The opportunity to make decisions and settle on choices givesthe client the freedom of self-direction.
Part2: Aspects of an addiction treatment program
The desiredaddiction treatment program
Source (Center for Substance Abuse Treatment, 1997).
Counselors or clinicians need to understand that their responsibilitydoes not end with the addict’s entry into the prescribed treatment,but they should become a collective part of the treatment program. Inthis regards, the prescribed program should be comprehensive, but notstandardized across facilities since aspects of addiction differsacross patients (Center for Substance Abuse Treatment, 1997). Forexample, an alcohol addict may not present the same symptoms as acocaine addict. However, any effective treatment program shouldconsider some fundamental principles since addiction is an intricatebut correctable condition that affects the function of the brain andindividual behavior. Moreover, no single plan is suitable for everypatient thus, individuals need quick access to the treatment.Helpful treatment program considers every need of an individual notonly their drug use but also social or work life. In addition,staying in a treatment program long enough is significant. Counselorsor designers of addiction treatment approaches should understand theneeds of the patient and consider alternatives in case the originalapproach fails. This means that the program should be flexible butcognizant of key principles that help in solidifying the approach.
An addiction treatment program should be comprehensive, flexible,effective, regularly monitored or reviewed, and consistent with allthe needs of the addict. In this regards, one should consider thetype of person to hire as counselors for the program. Professionalssuch as nurses, psychiatrists, certified drug abuse counselors,licensed therapists and other required specific professionals arecritical to the program. These individuals have the necessary skills,knowledge, and experience to develop personalized treatment plans,and assist clients to deal with cravings, and recognize the majorcause of their drug abuse. However, the counselor style is importantfor the outcome due to the specific treatment methods they use.Counselors who show empathy have the highest effectiveness intreating addictions (Miller,Forcehimes, & Zweben, 2011, p.50). Moreover, empathiccounselors have strong relationships with their clients thusreduction of relapse rate after counseling. Effective counselorspossess reflective listening skills to understand all that is in theclient’s minds (Miller et al., 2011, p.52). They should also befocused and show genuine active interest in helping the client.Effective counselors have warmth and acceptance, compassion, andeffective expressiveness and modulation. Addicts need to feel lovedand a counselor should exhibit compassion and interpersonal insightto manage the treatment program effectively.
On the other hand, the designer should consider how to conductscreening, evaluation, and diagnosis. Screening helps to identifypossible existence of a problem as well as the requirement for moreassessment. Screening procedures should be carried carefully due tothe possibility of two mistakes including a false negative and afalse positive. Therefore, the procedures need high sensitivity inorder to accurately detect true positives. A test’s specificity isalso required for accuracy and precision in avoiding false positiveerrors (Miller et al., 2011, p.66). For proper screening, clearinstructions are necessary for complete screening task. The patientalso needs correct and precise concern for privacy andconfidentiality (Miller et al., 2011, p.67). Moreover, the patientshould be assured that this a routine procedure applied to allpatients. Some of the screening tools include clinical questions,subtle tests and biological markers (Miller et al., 2011, p.68).Evaluation helps to understand the nature and basis of the person’sspecific condition and to address possible ways to change. Effectiveevaluation entails knowing the specific substance use, offeringmotivation for change, understanding the patient’s strengths andresources, considering social support, and conducting a practicalanalysis of substance use (Miller et al., 2011, p.72). The diagnosishelps to understand the gravity of a situation, and preferablysuggest proper treatments. American Psychiatric Association’s DSMand WHO’s ICD are two related classification systems for making adiagnosis (Miller et al., 2011, p.82).
Individualized treatment plans play different roles in addictiontreatment program. Personalized treatment plans are effective inhelping people fully recover from the addiction, customizedtreatments address all the patient’s needs. This may be carried outthrough group therapy, family counseling, individual counseling aswell as educational programs. Use of case management is anotherimportant aspect of addiction treatment program. When fullyimplemented, it enhances the scale of addictions treatment as well asthe recovery continuum. Conducting proper case management requiresseveral activities. They include case finding and conducting outreachdecision offer assessment plus continuing reassessment assisting inobjective planning, making referrals to required resources andmonitor referrals aid develop informal support systems connect inadvocacy on behalf of a particular client, and support for resourceexpansion and other helpful activities.
Evidence-based practices should be important to include in theprogram. Different evidence-based approaches are designed to caterfor particular aspects of substance addiction plus its effects forthe person, family, and society. One of the practices is behavioraltherapies that help patients to change their behaviors and attitudesconnected to drug use (Miller et al., 2011, p.7). In addition, theyhelp in healthy life skills development and continue with other typesof treatments including medication. Another evidence-based practiceis pharmacotherapies. Pharmacotherapies offer opportunities forreplacing individual’s substance of choice with a lawfullyprescribed or dispensed alternative (Miller et al., 2011, p.153).Evidence-based plans and approaches allow the program to providealternatives if the already developed plan fails. For example, thecounselor might decide to include medication in treating theaddiction.
The program shouldalso address client’s co-occurring syndromes. Some of theco-occurring conditions include psychological health illnesses suchas anxiety, depression, schizophrenia or bipolar disorder thatcontribute to the individual’s addiction. Co-occurring conditionsare manageable through medications that help treat the mentalconditions. Individuals with drug addiction problems are at a highrisk of non-adherence to treatment and a host of negative impacts.Therefore, there is a need to increase adherence through briefintervention to the problem. Brief intervention entails between oneto four visits that may vary in the period from 10 minutes to onehour or longer (Miller et al., 2011, p.148). During this period,different approaches are taken which include feedback,responsibility, advice, menu, emphatic counseling style andencouragement (Miller et al., 2011, p.148). Feedback entailsinformation to the client of individual relevant information abouttheir addiction and its consequences. There is also an emphasis onpersonal responsibility for change. Clear advice to recommendbehavior change and a menu of options for the patient to choose ifthey need change. An emphatic counseling approach that is supportiveand considerate of the client’s needs. Encouragement is necessaryto increase adherence by helping the patient be effective inchanging. An addiction treatment program should be comprehensive butnot necessarily standardized since addiction itself is complex. Thismeans that there exist underlying problems, which the counselor musteffectively address. Furthermore, the counselor must ensure thatpsychological and mental aspects are recognizable and comprehensibleto avoid scenarios where they interfere with the treatment program.
Part3: characteristics of effective drug counselors
Substance abuse addiction is a complex and grave social issueaffecting societies across the world. Regrettably, the social stigmaattached to substance abuse and addiction often leaves the addictalone and isolated and incapable or reluctant to find the neededhelp. In the process of rehabilitation, treatment, and recovery, acounselor can usually make the difference between an addict’ssuccess and failures (Brorson,Arnevik, Rand-Hendriksen, & Duckert, 2013). This ispartly because counselors get the patients to effectively completethe detoxification program, counsel the patients by focusing on notonly the addiction problem, but also the patients psychological andmental issues, and offering aftercare and checkups. This means thatbecoming a substance abuse and addiction counselor requires more thaneducation (Brorsonet al., 2013). Treating drug addiction involvesextensive skill sets that include good professional judgment, being agood listener, being capable of developing intervention approaches,and being capable of establishing rapport with the addicts.Furthermore, effective counselors should be aware of the bestresearch evidence and the psychological process, have effectivesocial skills, maintain boundaries, and should be flexible, andpersuasive.
Effective counselors should have an effective and cultured set ofinterpersonal skills such as verbal fluency, warmth and acceptance,interpersonal perception, empathy, and effective expressiveness andmodulation. An addiction counselor must exhibit compassion, effectivecommunication skills, and interpersonal insight into the addict’sissues or traits. It is important to note that a counselor cannotmanage to provide an effective treatment approach without firstunderstanding the mental and psychological issues of the patient(Lewis, Dana, & Blevins, 2014).To do so, the counselor needs to have a good interpersonaldiscernment. After understanding the aspects connected to aneffective treatment program, the counselor should exhibit compassion,acceptance, and expressly present the treatment process to thepatient in an appropriate manner. This means that withoutestablishing communication skills such as verbal fluency, thecounselor cannot manage to cultivate an effective relationship withthe patient.
Successful therapists should have cultured and effective socialskills. Counselors should relate well with the addicts and establishan effective rapport within the first sessions. For the treatmentprogram to become a success, patients need to trust their counselorsand they cannot do so without an establishment of a good rapport.Lewis et al. (2014) assertthat counselors should seek to cultivate an amiable relationship withtheir clients through discussions, developing effective interpersonalskills, and relating patients’ encounters with their own or fromprevious experience. The counselor should judge situationsprofessionally, become non-judgmental, and avoid censuring theaddict’s past mistakes or actions. If the addict relapse, thecounselor should be empathetic, accept what has happened, and try todevelop alternative approaches or modify the existing strategies.Furthermore, when the patient relapse, the counselor should bewilling to stick with the addict, but also hold them answerable fortheir deeds.
It is imperative to note that successful therapists should maintainboundaries and form a working alliance with a variety of clientseasily. A counselor should be skilled in collaborating with thepatients by creating conducive situations and bonding with thepatient. The therapist should gain the patient’s trust and thenbuild on the trust to form a solid alliance. Additionally, thetherapist should have the capacity to understand a client well inorder to effectively navigate through the maze of manipulations andnarcissism elements that some clients might show. Thus, the counselormust establish firm and professional boundaries that seek to onlyhelp the client overcome the addiction problem.
Counselors should be convincing, persuasive, and influential. Thetherapist should present the treatment approach or plan to thepatient in a manner that convinces the patient on the benefits of theplan. The therapist should convince or influence the patient that thedeveloped plan will work and assist the client in inhibiting theaddiction. Persuading the client creates hope and ensures that theclient complies with the treatment. Furthermore, these aspects ensurethat the counselor forms a working alliance with the client.
They should be flexible and easily adaptable to various effectivetherapies. Sometimes, the existing approach may fail to work orbecome obsolete thus, the therapist needs to be flexible inadjusting the therapy if the client fails to make an adequate processor become resistant to the program. Brorsonet al. (2013) contend that the counselor should beaware of non-verbal and verbal cues that the patient is unaffected bythe treatment and uses the indication garnered from evaluatingtherapeutic improvement with outcome tools. A flexible counselorshould be willing to be wrong on some developed approaches, take newinformation, and test suppositions about the patient. In making theadjustment, the counselor might use an alternative approach, referthe patient to another counselor, or use adjunctive services such asacupuncture or medication.
Conclusively, positive therapists should have extensive skills tomanage stress and aware of the existing mental and psychologicalissues. Lewis et al. (2014)assert that counselors should not attempt to inject their materialinto the treatment plan and should reflect on their response to theclient to determine of the reactions are rational. Besides, Brorsonet al. (2013) opine that failure to reflect on one’spsychological and mental aspects means that the counselor cannotcomprehensively treat the client. This is because most clientsusually relapse by utilizing exasperating strategies that can drainthe counselor who lack effective stress-management skills. Counselorswho fail to manage stress can show emotional fatigue, low sense ofattainment, and despair hence, failing to treat the client asdesired.
Brorson, H.H., Arnevik, E. A., Rand-Hendriksen, K., & Duckert, F. (2013).Drop-out from addiction treatment: A systematic review of riskfactors.Clinical psychology review, 33(8),1010-1024.
Center for Substance Abuse Treatment. (1997). A guide to substanceabuse services for primary care clinicians. Treatment ImprovementProtocol (TIP) Series, No. 24. Center for Substance Abuse Treatment.Rockville (MD
Lewis, J. A., Dana, R. Q., &Blevins, G. A. (2014). Substanceabuse counseling.Cengage Learning. Lewis, J. A., Dana, R. Q., & Blevins, G. A.(2014). Substanceabuse counseling.Cengage Learning.
Miller, W. R., Forcehimes, A. A., &Zweben, A. (2011). Treatingaddiction: A guide for professionals.Guilford Press.
Miller, W. R. (2000). Motivational Interviewing. In BriefTherapy for Addictions. Retrieved July 26, 2016, fromhttp://search.alexanderstreet.com/preview/work/534915
Miller, W. & Rollnick, S. (2002). Motivational interviewing.New York: Guilford Press.