Treating Adolescent Substance Abuse Using Family Behavior Therapy: A Step-by-Step Approach

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The therapy has two main components:.

Supportive techniques to help patients feel comfortable in discussing their personal experiences. Expressive techniques to help patients identify and work through interpersonal relationship issues. Special attention is paid to the role of drugs in relation to problem feelings and behaviors, and how problems may be solved without recourse to drugs. The efficacy of individual supportive-expressive psychotherapy has been tested with patients in methadone maintenance treatment who had psychiatric problems.

In a comparison with patients receiving only drug counseling, both groups fared similarly with regard to opiate use, but the supportive-expressive psychotherapy group had lower cocaine use and required less methadone. Also, the patients who received supportive-expressive psychotherapy maintained many of the gains they had made. In an earlier study, supportive-expressive psychotherapy, when added to drug counseling, improved outcomes for opiate addicts in methadone treatment with moderately severe psychiatric problems. Luborsky, L. New York: Basic Books, Woody, G. Psychotherapy in community methadone programs: a validation study.

American Journal of Psychiatry 9 : , Twelve month follow-up of psychotherapy for opiate dependence. American Journal of Psychiatry , Individualized drug counseling focuses directly on reducing or stopping the addict's illicit drug use. Through its emphasis on short-term behavioral goals, individualized drug counseling helps the patient develop coping strategies and tools for abstaining from drug use and then maintaining abstinence.

The addiction counselor encourages step participation and makes referrals for needed supplemental medical, psychiatric, employment, and other services. Individuals are encouraged to attend sessions one or two times per week. In a study that compared opiate addicts receiving only methadone to those receiving methadone coupled with counseling, individuals who received only methadone showed minimal improvement in reducing opiate use.

The addition of counseling produced significantly more improvement. In another study with cocaine addicts, individualized drug counseling, together with group drug counseling, was quite effective in reducing cocaine use. Thus, it appears that this approach has great utility with both heroin and cocaine addicts in outpatient treatment. McLellan, A. The effects of psychosocial services in substance abuse treatment.

Journal of the American Medical Association 15 : , Is the counselor an 'active ingredient' in substance abuse treatment? Journal of Nervous and Mental Disease , Psychotherapy for opiate addicts: Does it help?

Crits-Cristoph, P. Archives of General Psychiatry in press. Motivational enhancement therapy is a client-centered counseling approach for initiating behavior change by helping clients to resolve ambivalence about engaging in treatment and stopping drug use. This approach employs strategies to evoke rapid and internally motivated change in the client, rather than guiding the client stepwise through the recovery process.

This therapy consists of an initial assessment battery session, followed by two to four individual treatment sessions with a therapist. The first treatment session focuses on providing feedback generated from the initial assessment battery to stimulate discussion regarding personal substance use and to elicit self-motivational statements. Motivational interviewing principles are used to strengthen motivation and build a plan for change. Coping strategies for high-risk situations are suggested and discussed with the client.

In subsequent sessions, the therapist monitors change, reviews cessation strategies being used, and continues to encourage commitment to change or sustained abstinence.

Substance Abuse Counseling Techniques

Clients are sometimes encouraged to bring a significant other to sessions. This approach has been used successfully with alcoholics and with marijuana-dependent individuals.

Budney, A. College on problems of drug dependence meeting, Puerto Rico June I would recommend this program to any of my clients! Elizabeth Floyd. Donohue and Azrin have done an outstanding job of putting onto paper the intricacies of their exemplary FBT approach. This is an extremely positive and strength-focused text that provides therapists with a structure and the tools to implement interventions that have a long history of promoting the types of clinical changes desired by family members and community stakeholders.

Henggeler, Ph. Kudos to Donohue and Azrin for writing a book that includes all the materials needed to implement FBT with adolescents, including prompting checklists, handouts, and worksheets. Karol Kumpfer , Ph. The assessment guidelines, checklists for each component, and the CD-ROM with all therapy forms will be invaluable resources for implementing the FBT approach. Susan Harrington Godley , Rh. Mark D. Godley , Ph. The therapies augment other forms of therapy to increase abstinence during counseling.

Studies show contingency management and motivational incentives reduce drug use in patients in recovery from addiction involving:. The therapies incorporate vouchers or chances to win prizes to promote abstinence. Voucher-based therapy involves rewarding clean drug screens with vouchers that can be exchanged for food, movies and retail goods.

Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition)

Prize-based incentives reward drug-free screens with a chance to win a prize by drawing from a bowl. Some experts worry that prize-based incentives might promote gambling behavior, but studies do not show an association between the therapy and gambling. The community reinforcement approach plus vouchers is commonly used on an outpatient basis.

The therapy involves motivational incentives in the form of familial, social and recreational rewards in addition to vouchers to motivate abstinence from substance abuse. The goal is to help patients maintain sobriety so they can develop skills for long-term recovery. CRA usually lasts 24 weeks, and patients attend individual counseling once or twice per week. During counseling sessions, they learn skills to minimize substance abuse, improve relationships, develop hobbies, build social support and receive vocational counseling. Patients also undergo urine tests two or three times per week and are awarded vouchers for retail goods for drug-free tests.

Counseling and therapy for addiction often involve counseling for family members in addition to the person in recovery. Therapy teaches families the underlying causes of addiction, how to reduce risk factors for relapse and how to properly support their loved one in recovery.

Dialectical Behavior Therapy DBT Made Simple: Counselor Toolbox Episode 73

It helps each family member learn about the impact his or her actions have on others, and it teaches families how to effectively communicate and function. Family behavior therapy addresses problems that affect the entire family. The goal is to reduce risk factors for addiction, such as unemployment, family conflict, abuse and conduct issues. It uses techniques such as contingency management and behavioral contracting, in which a patient agrees to a written contract with a therapist. Therapy sessions involve multiple family members, such as spouses or parents and their children.

Therapists teach strategies and skills for improving communication and the living environment. Each patient sets behavioral goals that are reviewed during each session by other family members. Multisystemic family therapy is primarily used to correct severe antisocial behavior in children and adolescents affected by addiction.

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Treatment occurs in natural environments such as the home, school or neighborhood, and it has been proved to reduce rates of incarceration and substance abuse. Multidimensional family therapy is an outpatient treatment for teens who abuse drugs. It focuses on individual, family, peer and community networks to reduce problematic behavior and encourage healthy behavior.

MDT occurs in clinics, family court, school or homes. It usually involves individual sessions and family sessions in which the adolescent learns decision-making and problem-solving skills. During family sessions, parents examine their parenting style and learn to positively and effectively influence healthy behavior. Therapists use brief strategic family therapy to reduce family interactions that support or exacerbate teen drug abuse or problematic behavior.

Such behavior includes problems at school, delinquency, association with anti-social peers, aggressive tendencies and high-risk sexual behavior. The therapist identifies and corrects family interactions that provoke problematic behavior. The approach can be used in mental health facilities, rehab clinics, homes and a variety of other settings.

Functional family therapy is also based on the idea that dysfunctional family interactions create and support problematic behavior. The goal of FFT is to improve communication, problem-solving skills and parenting skills. Each therapy session involves the adolescent and one or more family members. FFT engages families in the treatment process to encourage motivation for change.

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It also incorporates contingency management techniques and other types of behavioral therapy. Adolescent community reinforcement approach is similar to the community reinforcement approach used for adults, but it involves standardized procedures for improving communication, solving problems and coping with stress. Role playing and behavioral rehearsal techniques are key aspects of the therapy.

Assertive continuing care involves weekly home visits during the three-month period after a teenager is discharged from a drug rehab facility. The therapy teaches teens and their caregivers problem-solving skills, communication techniques and other tools for promoting recovery. Therapists often encourage patients to participate in step programs such as Alcoholics Anonymous and Narcotics Anonymous to support long-term recovery. Such step programs are founded on a few key principles: Individuals with substance use disorders have no control of the disease, must surrender to a higher power and actively participate in support group meetings.


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Many therapists refer patients to step groups, and some treatment facilities host support group meetings. Decades of scientific research on addiction treatment have found behavioral, motivational and family-based therapies to effectively treat substance use disorders. Other therapies such as EMDR and step facilitation therapy are also backed by a plethora of research.

There are no other evidence-based replacements for these traditional therapies, but studies do support a variety of complementary treatments for addiction. Yoga is an exercise that emphasizes controlled breathing and body postures to promote physical strength, concentration and serenity. Clinical trials involving yoga and mindfulness found the therapies were effective complements to preventing and treating addiction, according to a study published in Complementary Therapies in Medicine. A meta-analysis of studies on meditation published in Alcoholism Treatment Quarterly found that the technique can reduce stress, anxiety, tobacco smoking, and alcohol and drug abuse.

Additionally, a clinical trial on mindfulness therapy published in the Journal of Consulting and Clinical Psychology found yoga was a feasible and effective treatment for opioid abuse and chronic pain. Several therapies for addiction involve animals.