Alcohol and Substance Use Issues
I’m a harm-reduction therapist, meaning I work collaboratively with clients to help them reach their stated goals while reducing the negative effects of their alcohol and substance use. This is different from traditional addiction treatment approaches that impose goals such as abstinence, force attendance at 12-step meetings like AA or NA and use confrontation to break through a client’s “denial”. This is an outdated, overly-simplistic and destructive approach to treatment that is simply not supported by current research. Of course some clients want abstinence as a goal or might benefit from 12-step meetings, but to say that a client who refuses to pursue these treatment options is in “denial” is not only wrong—it’s dangerous. I firmly believe in “meeting the client where they are”. Here is a preview of how I work with clients attempting to stop or moderate their use.
- I take time to clarify the client’s treatment goals and then assess readiness, willingness and confidence in order to enhance motivation toward his or her stated goals.
- One way to look at problematic alcohol or drug use is as a form of self-medication. When we can identify the feeling being medicated we can find new, more adaptive ways to address that feeling.
- Developing a support network can be helpful. To that end, I sometimes recommend that clients attend at least one AA, NA, or SMART meeting to just see if they find it helpful.
- Vagueness is an enemy of progress in addiction treatment. When clients articulate a desire to moderate their use of alcohol or drugs, I ask them to track their use over the course of the previous week. This is a way that we can gain insight into the nature of the problem and make necessary adjustments.
- I provide education regarding the latest research in trauma, attachment theory, neuroscience, and mindfulness in session and recommends relevant books, articles, videos, podcasts and movies between sessions to accelerate and deepen the treatment.
- I use “here-and-now” techniques in the session to increase clients’ capacity for self-observation, a gateway skill to learning how to tolerate difficult feelings. Helping clients identify, tolerate and express negative feelings (instead of medicating them) is perhaps the most important skill I help clients acquire.