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Article Excerpt
Mental health counselors increasingly work with a wide variety of client issues, including substance abuse. This article addresses the use of solution-focused counseling as a viable treatment option for clients who experience problems with substance abuse and addiction. A brief overview of traditional substance abuse treatment is offered. The basic assumptions of solution-focused counseling are then discussed, and differences from traditional approaches are delineated. Benefits of using solution-focused counseling with substance abase issues, such as the collaborative and client-centered nature of the approach, are presented; and sample interventions are described. Difficulties to using solution-focused counseling techniques with substance abuse issues are also discussed.
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Mental health counselors (MHCs) are increasingly working in a variety of treatment settings (American Mental Health Counselors Association, 2004). These settings include medical settings, private practices, community mental health centers, non-profit organizations, primary and secondary schools, institutions of higher education, and substance abuse treatment clinics. As a result of this diversity in practice, MHCs are encountering a greater variety of clients and clinical issues. One client population encountered by MHCs in all treatment settings is persons with substance abuse issues.
Whether accurate or not, many clients with substance abuse (SA) problems are labeled as unmotivated and treatment resistant (Berg & Miller, 1992; Connors, Donovan, & DiClemente, 2001; Miller & Rollnick, 2002). When encountering substance-abusing clients who are accurately labeled as treatment resistant, MHCs need new, diverse, and evidence-based techniques to address issues of addiction, motivation, and resistance. Because many MHCs have been trained in programs emphasizing the scientist-practitioner model (Pistole, 2002), these practitioners have the knowledge and ability to choose and apply these new, research-tested techniques. Solution-focused counseling (SFC) has emerged in recent years as one such viable treatment model for use with SA issues. The purpose of this article is to introduce MHCs to solution-focused counseling for use with unmotivated and resistant clients who have substance abuse issues. I provide a brief overview of traditional approaches to substance abuse treatment, discuss solution-focused counseling theory and techniques, and outline the advantages and difficulties to using SFC interventions with the target population of treatment resistant substance abusing clients. The article concludes with a brief discussion of future areas for research development.
TRADITIONAL MODELS OF SUBSTANCE ABUSE TREATMENT
Most traditional models of SA treatment are founded on the disease model of addiction (Stevens & Smith, 2001). The disease model views addiction as an incurable, lifelong, and potentially fatal physiological disease over which afflicted persons are powerless. The disease model, which is the basis for many 12-step self-help groups including Alcoholics and Narcotics Anonymous (Doweiko, 2002), further delineates that persons are in denial of their addiction problem until they admit their powerlessness over alcohol and other drugs (AOD). Once this admission occurs, individuals are no longer considered actively addicted to AOD. Disease-based approaches, therefore, view heavy confrontation of denial as the central tool of treatment, with the overall goal of counseling being total abstinence from AOD. Because addiction is viewed as a disease, persons are never cured of their addiction problem; once attaining abstinence, they are labeled as being in recovery from the disease and must actively work to control it one day at a time.
Newer models of substance abuse treatment informed by social learning and cognitive behavioral theory (CBT) have emerged in recent years (Craig, 2004; Fisher & Harrison, 2000; Stevens & Smith, 2001). In these models, which are progressively being incorporated into traditional treatment approaches, problematic use of AOD is thought to result from "overlearned habits that can be analyzed and modified in the same manner as other habits" (Fisher & Harrison, p. 241) rather than from a physiological disease. Mental health counselors operating from a CBT orientation work collaboratively with clients to identify unrecognized (a) determinants or "triggers" of their AOD use (e.g., social settings, affective states such as anxiety or stress, times of day or week), (b) errors in thinking related to problematic AOD use (Wanberg & Milkman, 1998), (c) irrational beliefs about the role of AOD use in other life problems, and (d) previously unacknowledged consequences of excessive AOD use (e.g., driving offenses, conflict with friends and family, financial problems, physical health issues). The MHC and client then collaborate to identify, understand, and change problematic determinants, thinking errors, and irrational beliefs. To complete these tasks MHCs employ confrontation as a central tool of treatment to assist their clients to identify and change unrecognized triggers, thinking errors, and irrational beliefs. Total abstinence from AOD is not necessarily the goal of CBT treatment and some clients are thought to be able to return to moderate AOD use after appropriate intervention.
Disease-based and CBT models of SA treatment are problem-based approaches to treatment. Mental health counselors using the disease-based approach seek to address clients' deficits and foster coping skills to manage the incurable disease of addiction. Likewise, MHCs using CBT assist clients to develop skills to cope with triggers and identify and change problematic patterns of thinking related to AOD use. As a result, MHCs operating from either the disease-based or CBT theoretical orientation take the stance that treatment should focus on seeking out and fixing clients' problems and deficits relative to their AOD use.
SOLUTION-FOCUSED COUNSELING
Solution-focused counseling (SFC) can provide MHCs with an alternative approach to disease-based and CBT models of SA...
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