Rehab 101, Article 7: Counselling

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All addiction treatments incorporate counseling along the entire process. Counselling comes in a variety of methods, and they include:

  • Twelve-step programs
  • Client-centered approaches
  • Psychoanalysis
  • Relapse prevention
  • Cognitive therapy
  • Emotion regulation and mindfulness

The role of a counselor is to provide support and advice during the whole rehabilitation process. Counselors are found aiding families as well as addicts. They are professionals trained to identify and intervene when an addict is reported, to develop and adjust recovery programs, and to offer continuous support for as long as the addict requires it.

Counselors are the first to help the addict break down denial, which means getting the addict to recognize their addiction and agree to rehabilitation. Counselors never work alone, they are part of a multi-disciplinary team that includes medical, psychological, and social welfare professionals. Visit ibogaine clinics for consultation.

Now let’s look at the six counseling models:

Twelve-step programs
This is the most popular and known method and is used in 74% of all substance abuse cases. It is mostly known when discussing alcoholics anonymous, which is because it was AA that developed the process. The success of the 12-step program enabled counselors to adapt it for many other substance cases of abuse, and that is why it is used in 74% of all cases.

Bill Wilson, the founder of Alcoholics Anonymous (AA), developed the idea for the 12-Step model in 1938. The “Big Book” as Wilson’s writing was known as was developed using observation and sharing stories of alcoholics, and being inspired by Christian teachings. The Big Book was printed for members that could not attend meetings, and this helped proliferate the model.

The 12-step model is based on the premise that abusers can help each other overcome addiction. This can be reached through organized and maintained meetings, sharing experiences, and supporting each other in the effort to fight the addiction.

Research has shown that the 12-step model leads to an 84% of all members that adhere to the model will recover between 6 months and a year and will flourish in their new fought for sobriety.

The 12-Step model is a framework for surrendering the addiction, removing denial, discussing the experiences, and forging relationships that enable a member to move forward in life.

The 12 Steps, as outlined in the original Big Book and presented by AA are:

    1. Admitting powerlessness over the addiction
    2. Believing that a higher power (in whatever form) can help
    3. Deciding to turn control over to the higher power
    4. Taking a personal inventory
    5. Admitting to the higher power, oneself, and another person the wrongs were done
    6. Being ready to have the higher power correct any shortcomings in one’s character
    7. Asking the higher power to remove those shortcomings
    8. Making a list of wrongs done to others and being willing to make amends for those wrongs
    9. Contacting those who have been hurt, unless doing so would harm the person
    10. Continuing to take personal inventory and admitting when one is wrong
    11. Seeking enlightenment and connection with the higher power via prayer and meditation
    12. Carrying the message of the 12 Steps to others in need

Alternatives to the 12-Step Model
There are many other options to the 12-step model, and they include personalized approaches that are tailor-made to each individual need. There are pros and cons for both the 12 step and customized models, while proponents of the 12-step model tend to say that additional counseling is always better if the individual will benefit from it. Here is the breakdown of each approach that was listed above.

Client-centered approaches

  • Client-Centered Therapy, an approach developed by Carl Rogers, requires the individual to accept unconditional positive regard, accurate empathy, and genuineness as the three necessary and sufficient conditions for personal change.
  • Unconditional Positive Regard is where the therapist accepts the patient for who they are and provides support no matter their opinion.
  • Genuineness is for a patient to feel un-inhibited, opening up with every secret and detail that can help a therapist understand the roots and causes, as well as help, develop a healthy relationship of trust between the therapist and the patient.
  • Empathetic Understanding means that the therapist must be emphatic at all times, offering positive feedback and helping the patient reach an understanding through reflecting the patient’s thoughts like a mirror, and giving the patient a better understanding of their problems.

Source: https://positivepsychologyprogram.com/client-centered-therapy/

Psychoanalysis
This is the brainchild of Sigmund Freud and modified over time by his students and followers. This school of thought relegates all addictions to homosexual and perverse fantasies, which is no longer an acceptable approach to the issue and is now directly opposed to the social cognitive theory and to modern behavior sciences. Unfortunately, some practitioners still use psychoanalysis as a tool in dealing with addiction counseling.

Relapse prevention
This is Alan Marlatt’s approach to handling risk of relapse and is an interesting tool to consider using in daily life. The core of the concept is handling risk, which means determining which actions will lead to a fork, where a decision must be made which option should be taken. In the case of an addict, it could mean the decision of driving through an area that has historical significance to the recovered addict, taking him/her near to a place that supplies the substance they were abusing. This raises the risk of being exposed to a strong trigger.

Cognitive therapy
Aaron Beck provides us with another cognitive model for substance abuse recovery. “Three types of acute drug-related beliefs have been described that contribute to urges, cravings, and ultimate use of drugs: anticipatory beliefs, relief-oriented beliefs, and permissive beliefs, and various ways have been described to assess more general, long-term beliefs pertinent to drug use. The role of the cognitive therapist is to assess, examine, and test these beliefs with the patient in order to develop more adaptive beliefs ultimately. The active application of skills and homework that tap into the patient’s adaptive beliefs helps the patient to become and remain drug-free.” This was published in his book Cognitive Therapy of Substance Abuse in 1993. Source: https://www.ncbi.nlm.nih.gov/pubmed/8289917

Emotion regulation and mindfulness
This refers to how society regulates inputs from advertising and sources of information regarding substance abuse. The most common example is the use of very graphic imagery on tobacco packages showing the most diseased of patients. The approach has not yet been tested fully and is still in its infancy, but research is showing how reduced usage of substances can be reached using negative incentives and language. Acceptance and commitment therapy (ACT) is an approach that views the core of many problems through four concepts.

FEAR:

  • Fusion with your thoughts
  • Evaluation of experience
  • Avoidance of your experience
  • Reason-giving for your behavior

The way to battle FEAR is to ACT:

  • Accept your reactions and be present
  • Choose a valued direction
  • Take action

ACT employs six core principles which are:

    1. Cognitive defusion: Learning methods to reduce the tendency to reify thoughts, images, emotions, and memories.
    2. Acceptance: Allowing unwanted private experiences (thoughts, feelings, and urges) to come and go without struggling with them.
    3. Contact with the present moment: Awareness of the here and now, experienced with openness, interest, and receptiveness.
    4. The observing self: Accessing a transcendent sense of self, a continuity of consciousness which is unchanging.
    5. Values: Discovering what is most important to oneself
    6. Committed action: Setting goals according to values and carrying them out responsibly.

Source: Harris, Russ (August 2006). “Embracing your demons: an overview of Acceptance and Commitment Therapy” (PDF). Psychotherapy in Australia. 12 (4): 2–8.