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Substance use problems: Psychosocial treatment

The counselling relationship

Basic counselling can be provided even in a busy family practice. Perhaps the most important elements of counselling are a trusting relationship with the patient and an open-minded approach. The primary care provider's relationship with the patient and knowledge of the patient's background are invaluable.

Types of counselling for substance use problems

Individual counselling

Individual counselling can be with a psychiatrist, GP psychotherapist, family physician, psychologist, social worker or other trained therapist.

Group counselling

Groups provide social support, acceptance, mentoring and practical advice. Groups may be inappropriate for some patients, for example, those with severe social phobia or low-functioning psychotic illness.

Motivational interviewing

This directive, patient-centred counselling style elicits behavioural change by helping individuals explore and resolve ambivalence around change. Using the concept of the stages of change, motivational interviewing is oriented toward reaching goals and moving through the stages, from pre-contemplation to action to maintenance.

Other counselling techniques

Settings and approaches vary widely, thus knowledge of local community resources is advantageous. 

Psychoeducation

Psychoeducation involves counselling patients and their families or caregivers about the nature of addiction and how to treat it. Psychoeducation teaches key concepts and strategies for supporting the person's recovery:

  • Addiction is a disease process that is amenable to treatment.
  • Addiction is a chronic, relapsing, remitting condition and single episodes of treatment rarely lead to a permanent remission.
  • People must be ready for change to accept advice.
  • Exploring the factors contributing to substance use rather than lecturing is more effective.
  • If the person is not ready to change, the role of families or caregivers is to support the person and to not enable continued use.