Drug, Alcohol & Smoking Counseling

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Drug, Alcohol and Smoking Counseling

Case Study of The Cyclical Nature of Substance Abuse

Laurie is a 32-year-old woman with a long history of poly-substance abuse. She is dependent on nicotine, alcohol, amphetamines and barbiturates and has been in and out of treatment for 15 years. She suffers from chronic depression. She works as a night-shift janitor at a local department store.

Like many substance abusers, Laurie believes that taking substances is an automatic process, beyond her control. While she recognises that sometimes she might use to “feel better”, often she says she uses just because her drug of choice is available.

As Laurie and her therapist were reviewing the events of the past week, Laurie admitted she had used marijuana one night after work. Laurie said she smoked because she ran into a friend who also smoked, someone she had been trying to avoid.

With careful questioning, however, Laurie and the therapist discovered that the incident was actually part of a cycle, not just something that happened while hanging out with a friend.

Laurie tells her therapist that usually when she gets off work, she’s so tired she goes straight to bed. However, this particular night, she called her friend to get together. It turns out that as she was leaving work, Laurie began to think about a minor mistake she made. She had a mental image of her boss glaring down at her and angrily uttering, “Get out of here, you’re fired” (automatic thought). She felt sad and hopeless and began to search for ways to lift her low mood.

Her belief, “If I feel bad, I should smoke and feel better” was activated and she thought “I might as well do it”. Laurie began to experience cravings and next gave herself permission to use, thinking “My life sucks; I deserve to feel better”. Next thing she knew, she was on the phone with her friend, who brought over some marijuana. This typical sequence of events occurred in just seconds and, to Laurie, seemed automatic and uncontrollable.

The erroneous assumption that she’ll better if she uses, in turn leads to the problematic behaviour. Laurie also discovers that using doesn’t make her “feel better”, but instead worse, because she feels guilty and hopeless, thinking “I’m such a loser! I’m just a no good druggie!” By breaking the cycle down into a series of identifiable parts, Laurie can learn a variety of methods to intervene at each stage along the way, and to cope more adaptively with her problems.

Gradually, Laurie’s sense of hopelessness (“I’m a loser and a druggie”) gives way to hopefulness (“Even though in the past I’ve used when I’m sad or upset, now I’m learning other ways to cope, like talking a walk or calling a non-using friend”). Eventually, Laurie learns a whole new set of skills to identify and prevent the cycle before it gets out of control.

Adapted from: Beck, J.S., Liese, B., & Najavits, L.M. (2005). Cognitive therapy. In R.J. Frances & S.J. Miller (Eds.), Clinical Textbook of Addictive Disorders, 3rd ed. New York: Guilford.

Drug, Alcohol and Smoking Counseling

Motivational Enhancement Therapy

Motivational Enhancement Therapy has been found to be particularly effective in helping patients with tobacco, alcohol and illicit drug problems.

This approach is effective for patients who are ambivalent about changing. These patients are referred to as being in the “contemplative” stage of change, and motivational interviewing approaches are effective in shifting these patients to where they make the firm decision to take action to change their alcohol or drug use.

Motivational interviewing has also been found to be an effective approach to patients who are not thinking of changing their consumption. “Unmotivated patients” can be shifted through the use of these to a stage where they are prepared to change.

The goals of Motivation Enhancement Therapy are to support and promote people’s perceptions of their own capabilities – their ability to draw on their own resources and strengths to overcome obstacles and difficulties without relying on their addictive substance to cope.

Studies also show that training of patients in skills to identify high-risk consumption situations and apply alternative coping strategies (relapse prevention) results in behaviour change. Cognitive restructuring involves both the challenging of positive effects attributed to the consumption and other thoughts that may well precipitate relapse

Drug, Alcohol and Smoking Counseling