Drug Counseling and Treatment

When someone in your family suffers from an addiction, you might question what the next step is regarding right action. Any action is right action as long as it is proactive and in the interest of addiction recovery. Thankfully, family support services exist nation wide to help families and addicts cope with the illness over a broad spectrum of issues. Family support services include family counseling, family therapy, family health services, substance abuse counseling, addiction counseling, and various other family support services.

Most substance abuse programs work best when they target both the underlying psychiatric disorder as well as the substance abuse issue. For example, someone suffering from depression and alcoholism, is more likely to feed their own depressive tendencies by continuing to consume alcoholic beverages. Education on this reality helps the person come to terms with the reasons why a road to recovery is the best path. Family services incorporate all aspects of the family and the impact the addiction and/or alcoholism has had on the family dynamic. This way, the entire family recovers from the drug addiction and/or alcoholism as a healthy unit, functioning as a synergistic unit. Dual disorders recovery counseling (DDRC) is the name for treatment of substance abuse as well as underlying psychiatric disorders. “The DDRC model, which integrates individual and group addiction counseling approaches with psychiatric interventions, attempts to balance the focus of treatment so that both the patient’s addiction and psychiatric issues are addressed,” says Dennis C. Daley of the National Institute on Drug Abuse. Daley’s article on the overview, description, and rationale behind dual disorders recovery counseling advocates for change involving not only the addict/alcoholic but the family as well. It also recognizes that patients will go through a series of phases and the length of time spent in each phase will vary from addict to addict. Daley’s article describes the four phases as follows:

Phase 1: Engagement and Stabilization. “In this phase, patients are persuaded, motivated, or involuntarily committed to treatment. The main goal of this phase is to help stabilize the acute symptoms of the psychiatric illness and/or the drug use disorder. Another important goal is to motivate patients to sustain treatment once the acute crisis is stabilized or the involuntary commitment expires. Dealing with ambivalence regarding recovery, working through denial of either or both illnesses, and becoming motivated for continued care are other important goals during this phase. This phase usually takes several weeks, but for some patients it takes longer to become engaged in recovery and to stabilize from acute effects of their dual disorders.”

Phase 2—Early Recovery. This phase involves learning to cope with drug cravings; avoiding or coping with people, places, and things that represent high-risk relapse factors i.e. triggers; learning to cope with psychiatric disorder symptoms such as mood swings for bipolar sufferers; getting involved in fellowships such as Alcoholics Anonymous (AA), Narcotics Anonymous (NA), Cocaine Anonymous (CA), Dual Recovery Anonymous (CAA) or mental health support groups; initiating family support services and making sure family counseling is scheduled and maintained; emphasizing routine in sober life; and addressing goals to monitor throughout the process. The National Institue on Drug Abuse estimates that this phase” roughly involves the first 3 months following stabilization. However, some patients take much longer in this phase because they do not comply with treatment, continue to abuse drugs, experience exacerbations of psychiatric symptomology, or experience serious psychosocial problems or crises.”

Phase 3—Middle Recovery. “In this phase, patients continue working on issues from the previous phase as needed. In addition, patients learn to develop or improve coping skills to deal with intrapersonal and interpersonal issues. Examples of intrapersonal skills include coping with negative affect (anger, depression, emptiness, anxiety) and coping with maladaptive beliefs or thinking. Interpersonal issues that may be addressed during this phase include making amends, improving communication or relationship skills, and further developing social and recovery support systems. This phase also focuses on helping patients cope with persistent symptoms of psychiatric illness; drug use lapses, relapses, or setbacks; and crises related to the psychiatric disorder. It also focuses on helping identify and manage relapse warning signs and high-risk relapse factors related to either illness.” Family support systems are integrated into the recovery model for the client during this phase. Clinicians continue to monitor progress within the realm of family counseling and family therapy sessions. Again, the National Institute on Drug Abuse says, “The middle recovery phase involves months 4 through 12, although some patients never get much beyond early recovery even after a long time in treatment. Patients who are treated for an initial acute episode of psychiatric illness with pharmacotherapy in addition to DDRC and who do not have a recurrent or persistent mental illness may be tapered off medications during this phase. Patients are usually not tapered off medications until they have several months or longer of significant improvement in psychiatric symptomology.”

Phase 4—Late Recovery. This phase, also referred to as the maintenance phase of recovery, involves sustaining progress that has occurred from working the first three phases, as well as addressing issues that crop up as time passes. “Important intrapersonal or interpersonal issues may be explored in greater depth during this phase for patients who have continued abstinence and remained relatively free of major psychiatric symptoms.” This phase continues beyond year 1. Many patients with chronic psychiatric disorders such as major depressive disorder or schizophrenia will continue to engage in family therapy sessions, family counseling, as well as individualized counseling. He or she will engage in group therapy, anonymous fellowships for his/her addiction/drug of choice, and follow the steps outlined in the relapse prevention plan. Involvement in support groups continues during this final phase of recovery as well. Phase 4 should not have an end date assigned to it, as it should be extended throughout the patient’s life time. Family members of the addict/alcoholic should look at this phase in the same way, so that they are motivated to continue seeking family support services, maintain family counseling schedules, and support the addict and alcoholic in appropriate ways.

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