Treating Substance Use Disorders

Motivational Interviewing

  • Client-centered method to enhance a client's intrinsic motivation to change.
  • Focuses on validating, summarizing, and addressing the client's ambivalence about change.
  • Collaborative and goal-oriented, without pressuring the client.
  • A brief process to prepare clients for future treatment, typically one to four sessions.
  • It can be thought of as interviewing the client to get them ready for future therapy.

Four Processes

  • Engagement:
    • Careful listening, nodding, and patience.
    • Summarizing the client's thoughts and feelings.
  • Focusing:
    • Developing and maintaining a specific direction in the conversation about change.
    • Talking about change goals and ensuring the client is ready to make choices.
    • Exploring the client's own motivations for change.
    • Helping the client talk themselves into change without therapist pressure.
  • Planning:
    • Addressing the next steps once the client's motivation reaches the threshold for readiness.
    • Discussing potential treatment approaches to delve into after motivational interviewing.

Research Support

  • Motivational interviewing is an evidence-based approach with significant research support.
  • Engaging in motivational interviewing before other forms of therapy can lead to greater success rates.

Skills Used

  • Open-Ended Questions:
    • Instead of "Do you want to stop drinking?", ask "What do you find beneficial about drinking alcohol?"
    • Also, ask about the non-beneficial aspects of drinking.
  • Affirmations:
    • Provide affirmations for any slight improvements or steps taken by the client.
    • Acknowledge small steps and validate their efforts.
  • Reflections:
    • Reflect the client's ambivalence by summarizing their feelings and acknowledging their conflict.
  • Summarizing:
    • Summarizing communicates that the therapist is hearing what the client is saying.

Training

  • Motivational interviewing is commonly taught early in master's or doctoral programs.
  • These skills prepare clients for change and assess their willingness to change without pressure.

Example

  • The video demonstrates open-ended questions and validation of ambivalence.
  • Example: Asking about what the client likes about alcohol and what they don't.

Cognitive Behavioral Therapy (CBT)

  • Helps individuals identify and change behaviors that lead to continued substance use.
  • Thoughts impact feelings, which impact behavior, creating a cycle.

Thought-Feeling-Behavior Cycle

  • Example:
    • Someone gets bad feedback on a work project and thinks, "I can't do anything right."
    • This creates feelings of sadness and isolation.
    • They may use a substance to feel better, leading to thoughts like "I shouldn't have done that."
    • The cycle perpetuates.
  • Intervention:
    • A CBT therapist intervenes at the level of thoughts.
    • Teach the client to question negative thoughts and focus on evidence that contradicts them.
  • Maladaptive Thoughts:
    • CBT targets thoughts labeled as maladaptive, which perpetuate negative feelings and actions.

Contingency Management Programs

  • Focused on operant conditioning (rewards and punishments).
  • Rewarding a behavior makes it more likely; punishing it makes it less likely.

Example: Mental Health Courts

  • Individuals charged with a crime can participate in a program in exchange for a lesser charge or sentence.
  • The year-long program includes phases, curfews, group participation, mentorship, and drug testing.
  • Incentives:
    • Clean drug tests can lead to rewards.
    • Moving to the next phase with fewer restrictions (e.g., later curfew).
  • Punishments:
    • Losing privileges (e.g., attending a specific event) for violating rules.