Arnold M. Washton - Treating Alcohol and Drug Problems in Psychotherapy Practice: Doing What Works

Written specifically for the office-based mental health practitioner, this book is intended to describe what psychotherapists in private practice need to know in order to address alcohol and drug problems competently and routinely in their patients. We describe how therapists can approach and intervene with a range of patients, including those presenting with substance abuse problems and those presenting with other types of mental health problems who also abuse alcohol and drugs.

In very practical and specific terms, we describe how office practitioners can screen, assess, diagnose, engage, motivate, treat, and appropriately refer patients who are using alcohol and other psychoactive substances. This book is intended to serve as a practical how-to guide for practitioners from a variety of professional disciplines and schools of thought and for those at all levels of expertise in treating substance use disorders (SUDs), ranging from general psychotherapists with little or no clinical experience in treating alcohol and drug problems to dedicated specialists who, like us, have worked in the addiction treatment field for many years. Our intended readers include psychologists, psychiatrists, social workers, mental health counselors, marriage and family therapists, psychiatric nurses, addiction counselors, and other practitioners who encounter substance-abusing patients in their clinical work. The information in this volume is potentially of value not only to practicing clinicians, but also to students and trainees in advanced courses seeking to enter professional practice. Counselors working in substance abuse treatment settings will find this book useful because it describes an individualized approach to treating alcohol and drug problems that they may not have encountered or had an opportunity to practice in programmatic or agency-based treatment settings.

This book attempts to fill a critical void in the existing literature. Most of what has been written about treating SUDs is geared toward patients with severe addiction problems seen by addiction counselors in agency-based treatment programs. In contrast, this book is geared toward patients presenting with a range of alcohol and drug problems seen by mental health practitioners in office-based psychotherapy practice. These differences are significant in several respects. As compared with those in agency-based treatment programs, office practitioners are in a better position to offer more flexible, individualized care and to engage patients where they are when they first appear for treatment. They also are more likely to see patients in the earlier stages of developing or coming to grips with an alcohol or drug problem, including those already in therapy for other mental health problems. Office-based treatment offers an easier entry point for many people who, for a variety of reasons, choose not to seek help at addiction treatment programs. It also offers the option of individual psychotherapy, which is scarcely available in addiction treatment programs owing to a combination of limited resources and the prevailing view in these programs that group therapy is the only effective treatment modality for people with SUDs. Nonetheless, patients often need and want both the personalized attention and the stronger therapeutic relationship that only individual therapy can offer. Individual sessions within drug treatment settings are usually focused on current life challenges and case management issues. Many patients also want the help of a mental health practitioner who has the professional training and skills to address some of the complex psychological issues that are frequently intertwined with alcohol and drug problems. Among such patients are individuals who realize that their personal growth in later stages of recovery requires them to address certain issues (e.g., intimacy, self-esteem, developmental traumas) in ways that Alcoholics Anonymous (AA) or standard addiction treatment programs cannot. The role of mental health training in treating SUDs has become increasingly clear in recent years with recognition of a high rate of comorbidity between SUDs and a broad range of other mental health problems (Kessler et al., 1994, 1997; Kessler, Nelson, & McGonagle, 1996; Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995; Mueser, Noordsy, Drake, & Fox, 2003; U.S. Department of Health and Human Services & Substance Abuse and Mental Health Services Administration, 2002) and that positive treatment outcomes can be expected only when both sets of problems are adequately addressed.