Professional Counseling versus Specialized Programs for Alcohol and Drug Abuse Treatment

By Polcin, Douglas L. | Journal of Addictions & Offender Counseling, October 2000 | Go to article overview

Professional Counseling versus Specialized Programs for Alcohol and Drug Abuse Treatment


Polcin, Douglas L., Journal of Addictions & Offender Counseling


This article reviews major recent studies supporting the effectiveness of professional counseling, Alcoholics Anonymous, and specialty programs for treating alcohol and drug problems. The American Society of Addiction Medicine's guidelines for referral to substance abuse services are described along with examples of integrated treatment approaches.

Counseling professionals, regardless of their area of expertise, will inevitably be faced with clients who present with substance use disorders. Epidemiology studies indicate a lifetime prevalence rate of 8%-14% for alcohol dependence (American Psychiatric Association, 1994) and approximately 29% of clients with a current mental health problem also have a history of a substance use disorder (Regier et al., 1990). Among some populations, these percentages are higher. For example, clients with a diagnosis of schizophrenia have a 47% lifetime history of substance abuse or dependence (Regier et al., 1990). The effects of alcohol use disorders on family members are even more widespread. A review conducted by the National Institute of Alcohol Abuse and Alcoholism (1997) found that 40% of all Americans reported having a direct family experience with alcohol abuse or dependence.

Historically, mental health professionals often have not fared well in their treatment of substance abuse (Brown, 1985; Khantzian, 1985; Vaillant, 1995). Khantzian (1985) argued that the proliferation of self-help groups such as Alcoholics Anonymous (AA) occurred because professional responses to substance abuse problems were ineffective. Shaffer (1986) noted that professionals were faced with a confusing array of professional and self-help models for substance abuse problems, none of which had demonstrated superior effectiveness. Some reviews of the history of substance abuse treatment have argued that the traditional psychodynamic approach of treating substance abuse as merely a symptom of an underlying psychiatric disorder has been especially ineffective (Polcin, 1997b). However, several therapies specifically adapted to the needs of substance-abusing clients are finding support in recent literature.

Several noteworthy studies have documented the effectiveness of cognitive-behavioral and motivational-interviewing therapies in treating substance use disorders (e.g., Miller & Brown, 1997; Ouimette, Finney, & Moos, 1997; Project MATCH Research Group, 1997). Studies also have supported the effectiveness of a variety of specialty programs for substance abuse treatment (Gerstein et al., 1994) and self-help groups such as AA (Ouimette et al., 1997; Project MATCH Research Group, 1997). With recent findings supporting various approaches, counselors are faced with the daunting task of deciding which of the aforementioned interventions is most appropriate for each client.

The purpose of this article is to highlight major recent studies supporting professional counseling, AA, and specialty programs for substance abuse treatment. These studies were selected because they represent recent large-scale, multisite, and clinically relevant investigations. The article identifies some of the possible limitations of various approaches and suggests that counselors rely on guidelines established by the American Society of Addiction Medicine (ASAM; 1996) when assessing clients and referring them to appropriate services and levels of care. When counselors are evaluating specific interventions, it is suggested that consideration be given to the complexities of the treatment context and the population served. Examples of integrating professional counseling, AA, and specialized programs are presented.

RESEARCH ON PROFESSIONAL COUNSELING

In a review of alcoholism treatment, Miller and Brown (1997) made a strong case for psychologists to more often treat clients with alcohol use disorders rather than refer them to specialty treatment programs. The authors pointed out that the training psychologists receive is relevant to substance abuse treatment and that fundamental therapy skills such as empathy and cognitive-behavioral treatment have been associated with positive treatment outcomes. …

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