Treatment for substance use disorders has gone through many transitions over the years. Early on treatment was non-existent and medical professionals would turn away individuals who were suffering from alcohol or drug related disorders. Substance and alcohol dependence was thought of as a moral weakness. As time went on a doctor by the name of Dr. Bob Smith was approached by Bill W. and listened to his experience of suffering from alcohol dependence and what happened to help him quit. This partnership was the beginning of the support groups that eventually became Alcoholics Anonymous (AA) which lead into the treatment for substance use disorders (Miller et al., 2006). AA has evolved into 12-step facilitation (TSF) which has become an evidence based practice (EBP) in substance use disorder treatment. This is one form of treatment, however, TSF is not the only EBP for substance use disorders. There are many forms of evidence-based treatments for substance use disorders. Many of these treatments are not utilized.
Treatment for substance use disorders is individualized and not all methods or models will work for every person. Some individuals may not connect to a 12-step facilitation or AA model, as a matter of fact some individuals may have an adverse reaction to 12-step facilitation and AA/NA. When this happens and the treatment provider continues to push the individual to “surrender” they may be doing more harm than good. This push may cause resistance to treatment, thoughts that treatment does not work, or dropping out of treatment. As treatment providers it is our job to know and understand the individual we are treating. When a client is struggling with a treatment model such as 12-step facilitation it is the job of the treatment provider to try a different model. Our job as a treatment provider is not to push our beliefs about substance use disorders or push for one treatment model; our job is to find a treatment that will work for the individual who is relying on us to help them.
Resistance does not mean the client will relapse. According to Burke, Arkowitz, and Menchola (2003) resistance is not a reason to oppose the client’s readiness to change but a way to roll with their resistance and understand it. Beginning to understand a client’s resistance to change can open up the communication and begin helping the client gain insight into their life. When an individual can express openly, without worry of being judged or criticized they are more open to other possibilities and suggestions. This is the beginning of the therapeutic process and relationship.
As a treatment provider it is important to understand and use many treatment models. For substance use disorders there is generally many underlying reasons for the substance use. These underlying reasons also need to be treated. Some of the underlying issues include, trauma, attachment issues, depression, anxiety, mood dysregulation disorders, and personality disorders. The client may also suffer from learning disabilities, or familial, legal, and social problems. As a treatment provider who specializes in substance use disorder treatment I use many treatment models and have had training in trauma, attachment, brain-based models, motivational interviewing, CBT, DBT, ACT, and have a good understanding of when there is a need for medications. Treatment is not a one-size-fits-all and it is our job as treatment providers to be trained in many treatment approaches to help those that suffer from substance use and co-occurring disorders.
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