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 can be with a psychiatrist, GP psychotherapist, family physician, psychologist, social worker or other trained therapist.
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.
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 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.
Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence (NICE guideline CG115, 2011)
BC Guidelines: Problem Drinking
Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain (National Opioid Use Guideline Group (NOUGG), 2010)
Canadian Smoking Cessation Clinical Practice Guideline (CAN ADAPTT, 2011)
Supporting smoking cessation: a guide for health professionals (Royal Australian College of General Practitioners, 2011, 2014)