Academic journal article Journal of Addictions & Offender Counseling

The Benefits of a Self-Efficacy Approach to Substance Abuse Counseling in the Era of Managed Care

Academic journal article Journal of Addictions & Offender Counseling

The Benefits of a Self-Efficacy Approach to Substance Abuse Counseling in the Era of Managed Care

Article excerpt

This article examines the clinical value of self-efficacy theory for substance abuse counselors practicing in a managed core environment. The authors delineate how a self-efficacy approach can be adapted to provide time-limited or brief therapy substance abuse counseling.

The definition and delivery of substance abuse services are undergoing dramatic changes. In an effort to curtail the upwardly spiraling costs of substance abuse counseling, utilization review boards put in place by managed care organizations are scrutinizing and challenging traditional counseling procedures (Garnick, Hendricks, Dulski, & Thorpe, 1994). One ostensible result of this scrutiny is that long-term counseling approaches are being abandoned in favor of effective time-limited interventions. Thus, to secure third party reimbursement, substance abuse counselors are finding it necessary to adapt their practices to these changes (Alperin & Phillips, 1997). Currently, substance abuse counselors are in critical need of interventions that effectively attend to both the needs of their clients in the least amount of time and the mandates of managed care.

Although several innovative substance abuse counseling strategies have emerged recently, none have exhibited greater promise than those based on self-efficacy theory. Numerous studies provide evidence of the clinical effectiveness of a self-efficacy approach to addictive behaviors (Baer, Holt, & Lichtenstein, 1986; Lichtenstein & Glasgow, 1997; Rollnick & Heather, 1982; Rychtarik, Prue, Rapp, & King, 1992). However, the benefits such an approach offers counselors whose practice is closely regulated by third party payers has not been reviewed thoroughly. Therefore, our purpose, here, is to present the advantages a self-efficacy approach has for substance abuse counselors working in a rapidly changing health care environment. Specifically, a rationale for self-efficacy addiction counseling, a review of the tenets of self-efficacy theory, a model to operationalize self-efficacy theory for addiction counseling, and the implications a self-efficacy approach has for substance abuse counselors who work in managed care settings (including different levels of care, brief interventions, and outcome evaluation) are discussed.

RATIONALE

Although many different managed care organizations exist, they share at least one common goal. As Alperin and Phillips (1997) observed, "Despite specific differences, all managed care companies share a preference for a philosophy of treatment and style of practice that ... requires the most efficient, effective, and minimally intrusive therapeutic intervention" (p. 6). Current expectations transform the practice of counseling in three very important ways. First, managed care organizations are primarily concerned with the prudent use of fiscal resources. Accordingly, they require substance abuse counselors to diagnose accurately and deferentially and then to match each client to the most appropriate and effective intervention. Thus, substance abuse counselors in today's health care environment can no longer rely on interventions that treat substance abusers homogeneously because individuals who abuse the same drug often vary in problem severity and, as a result, have different therapeutic needs. For example, an individual diagnosed with early stage alcohol dependence--without major physical, social, or psychological problems--might benefit most from an intensive outpatient program. Conversely, a person with severe alcohol dependence who exhibits signs of withdrawal and has no social or financial support would respond most favorably to services provided by inpatient treatment. Thus, substance abuse counselors operating in a managed care environment need a clinical framework that can be adapted to help individuals at different levels of care.

Second, managed care groups advocate the use of short-term interventions whenever appropriate. …

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