'Counseling Strategies Paper\r'

'Research indicates that the majority of individuals drinks slight frequently and consume little inebriantic drink when they do drink following intoxication focal point, although short-term subjects (e. g. 3 months) ar to a greater extent(prenominal) favorable than those from studies with at least a year follow-up. Positive outcomes yield benefits for alcoholic drinkics and their families, as well as leading to nest egg to society in terms of decrease costs for medical, sociable and criminal justness services.Reviews of focal point outcome for alcohol problems submit genuine from early efforts to summarize followings, to reports which derived outcome statistics, to more(prenominal) recent publications examining efficacy in controlled studies with data on cost trenchantness. Clearly, the literary productions suggests that a variety of approaches lavatory be effective, somewhat more than other(a)s beca character of the nature of the hash out and preaching and the intensity of the approach.The community wages approach (CRA) attempts to gain clients’ access to dogmatic activities and makes involvement in these activities contingent on abstinence. This approach combines many of the comp atomic number 53nts of other styleal approaches, including monitored disulfiram, behavior contracting, behavioral marital therapy, kind skills reproduction, wantal counseling and mood wariness. more or less of the largest counseling effects in the literature prepare been associated with the community living approach (Miller et al. , 1995).Compared to more traditional word approaches, the CRA has been shown to be more successful in wait on in persevering or outpatient alcoholics remain good and employed. Although community reinforcement is a more intense treatment approach, it is consistent with the base philosophy of several other effective approaches. The ability to establish rewarding relationships, to charge on changing the soc ietal environs so that positive reinforcement is available, and to write out reinforcement for drinking are emphasized with the community reinforcement and other approaches.The lynchpin appears to be helping the client to find and become involved in activities that are more rewarding than drinking. To the degree that centering ca determinations un dulcet physical sensations and associated dysphoric moods, it is a defective situation for extravagant alcohol use. An measurable head skill for clients to check off is how to use the physical and emotional signs of form as cues to â€Å"stop, look and listen” and to canvas something to cope besides heavy drinking. residuum training is a fundamental coping skill in the repertoire of a person trying to avoid unreasonable drinking.It can help clients to hack their misgiving and tension when facing stressful situations and smear their typical levels of motor and psychological tension. slackening training can also assis t a person to remain compose and to think clearly in good extend that require effective problem hold out out and fast action. Many individuals believe in the tension- bring down properties of alcohol, whether or not they are true, and, without an substitute(a) nub to relax, excessive drinking whitethorn be a persons still means of coping with painful sensations and unpleasant emotions.Relaxation training fosters general stress-reduction and can be taught to clients utilise various techniques that either reduce sinew tension, develop deep breathing skills or focus on the use of pleasant imagery (Monti et al. , 1989). In addition to peace of mind training, both meditation and exercise have been shown to have similar stress reducing properties. Contingency management procedures assist clients to re-structure their purlieu to decrease the rewards associated with alcohol use and increase the costs of excessive drinking.The principles of contingency management are base on o perant or instrumental learning approaches to human race behavior. Contingency management techniques include providing incentives for meekness with alcohol treatment and positive reinforcement from spouses or friends for sobriety. This approach is combined with punishment, in the form of withdrawal of financial aid and approving contingent on the resumption of excessive drinking, and provisions for social support, recreational activities and vocational counseling.In recent years there has been a growing recognition of the importance of providing treatment for alcoholism that is tailored to patients level of sagacity and motivation to draw on their tenderness utilize. Rather than emphasizing direct coming upon of patients who deny problems related to their union demoralize, social pressure to acknowledge the evils of alcohol corrupt and immediate endorsement of abstinence as a treatment priority, motivational approaches initially focus on relationship formation and harm reduction.While motivational strategies have gained some ascendance in the treatment of primary quill spirit misuse, their importance has been even more rapidly accepted in work with individuals with comorbid disorders, whose psychiatric disorders are often inextricably tied to their use of alcohol and drugs. A useful overarching heuristic in work with all comorbid disorders is provided by the concept of microscope stage wise counseling.The stages of counseling are based on the observation that people with an alcohol misuse problem who replace their behavior over the course of treatment typically progress through a serial of stages, and that each stage is characterized by unlike attitudes, behaviors and goals. By makeing a patients accredited stage of counseling, exponent can hone treatment so that it matches his/her current level of motivation, and avoid driving the person out-of-door from treatment by attempting interventions that are ill-matched to his/her motivation. Four stages of counseling have been identified: mesh, persuasion, agile treatment and get worse prevention (Mueser et al. , 2003). Efforts to change another persons behavior are goddamn to visitation if a therapeutic coalescency has not first been established. Therefore, at the engagement stage the primary goal of counseling is to establish a on the job(p) trammel (or therapeutic relationship) between the patient and advocate. A working alliance can be operationally defined as uninterrupted contact (e. g. weekly) between the patient and counselor (McHugo et al. , 1995).Until this relationship is established, no efforts are order at changing the substance misuse. A wide range of strategies exist for piquant the patient in treatment, including assertive outreach, terminate a crisis, attending to basic necessarily (e. g. medical, housing), and legal constraints (e. g. outpatient commitment). At the persuasion stage, the counselor has a working alliance with the patient, precisely the focus of the relationship is not on addressing the patients substance misuse. Therefore, at this stage the patient is still fighting(a)ly misusing substances, or has only recently begun to cut down on substance use.The goal of this stage is to change the patient that his/her substance misuse is an important problem, and to marshal motivation to begin working on that problem. Motivational interviewing (Miller & angstrom unit; Rollnick, 2002) is one useful strategy for helping patients understand the negative impact of their substance use on their own personal goals. mentation groups (Mueser et al. , 2003), in which patients are provided with an opportunity to parcel of land their experiences with substance use with a lower limit of direct confrontation or social censure, can help patients develop motivation to address their substance misuse.Commitment to work on substance misuse can be operationally defined as an authentic reduction in substance misuse (McHugo et al. , 1995), or another change in behavior that is associated with a reduction in risk (e. g. ceasing intravenous administration of a drug). In many cases, the duration of these attempts may at first be curb by the self-control skills the patient can marshal: in these instances, re-engagement occurs in stodgy conjunction with training in skills to deal with situations in which previous lapses occurred.Miller &type A; Rollnick (2002) emphasize that commitment to change is a hunt down of both motivation and self-efficacy or potency in being able to change. As previously researchers like Bandura noted, preceding(a) achievements are much more powerful influences on self-efficacy than verbal persuasion that is unrelated to yesteryear performance. The attention of patients is drawn to successful aspects of past control attempts, rather than to their ultimate failure to deal with the substance-related problems up to now.While a moxie of self-efficacy tends to have limited generalizat ion crosswise performance domains, commitment to change may sometimes be aided by success in another domain, such as work-related skills that open up options for a viable substance-free life-style. Once the patient has begun to reduce his/her substance use, the motivation to work on substance misuse is harnessed, and the goal of treatment shifts to further reduction of substance use or the maintenance of abstinence. Many of the strategies developed for people with a primary substance use disorder can be used with dually diagnosed patients once they reach the active treatment stage.Examples of interventions at this stage of counseling include cognitive-behavioral counseling to address â€Å"high-risk” situations, self-help groups, and social skills training to address substance use situations. Structured activities, such as work preparation or empty pursuits that decrease opportunities for using substances and divert attention from substance use, can assist in development o f substance control. In reversal prevention, the patient has achieved substance control for a substantial period (e. g. at least 6 months).The goals are to both defense against a relapse of substance misuse and to extend the gains made to other areas of functioning, such as social relationships, work and housing. sensory faculty of vulnerability to relapse can be achieved through continued participation in self-help groups, or individual or group work with substance misuse as a focus. The focus in the relapse prevention stage on other areas of functioning, such as relationships, leisure activities and work, reflects the tone that the better a patients life is, the less vulnerable he/she will be to a relapse of substance misuse.References Miller, W. R. , Brown, J. M. , Simpson, T. L. , Handmaker, N. S. , Bien, T. H. , Luckie, L. F. , Montgomery, H. A. , Hester, R. K. & Tonigan, J. S. (1995). What works? A methodological epitome of the alcohol treatment outcome literature. In R. K. Hester & W. R. Miller (Eds), Handbook of inebriation Treatment Approaches: Effective Alternatives, 2nd edn (pp. 12â€44). Needham Heights, MA: Allyn and Bacon. Monti, P. M. , Abrams, D. B. , Kadden, R. M. & Conney, N. L. (1989). Treating Alcohol Dependence. cutting York: Guilford.Mueser, K. T. , Noordsy, D. L. , Drake, R. E. & Fox, L. (2003). Integrated Treatment for dual Disorders: A Guide to Effective Practice. advanced York: Guilford Publications Miller, W. & Rollnick, S. (2002). Motivational Interviewing: Preparing People to assortment Addictive Behavior, 2nd Edition. New York: Guilford. McHugo, G. J. , Drake, R. E. , Burton, H. L. & Ackerson, T. H. (1995). A scale for assessing the stage of substance abuse treatment in persons with grim mental illness. Journal of Nervous and noetic Disease, 183 (12), 762â€767.\r\n'