Interview With Substance Abuse Counselor: Mr. Smith

Interview with substance abuse counselor: Mr. Smith

For my interview, I selected Mr. Smith (not his real name), a substance abuse counselor who approaches his practice from the point-of-view of Cognitive Behavioral Therapy (CBT). CBT has become one of the most popular therapies for treating substance abuse. When I asked why, Mr. Smith replied: "because it works." Substance abuse has long been regarded as one of the most intractable problems in the mental health profession. Substance abuse has a biological cause; is often exacerbated by environmental factors such as growing up in a society where drug abuse is normalized and prevalent; and then fundamentally rewires the subject's reward center in the brain, so the pleasures of the drug outweigh all other pleasures. One of the few techniques to 'unwire' this negative perspective has been CBT. Mr. Smith believes very strongly in the CBT format: he has a M.A. In clinical psychology but also received special training in the technique, which is quite specific in its orientation and approach

In previous forms of therapy, according to Mr. Smith, there was a focus upon the subject's past and trying to figure out what early experiences were at the root of the addiction. "This doesn't do much to cure the addiction," said Mr. Smith. "Often, you end up talking and talking about things that happened in the past that are really irrelevant to the subject's life. It's important instead to focus on the here and now." CBT helps the substance abuser identify irrational behavior patterns and replace them with rational thoughts. For example, instead of thinking, "it would be so much easier to get through this if I could just take a drink," CBT encourages the client to remind him or herself of all the times he tried to take a drink to relax, and actually made things worse. Mr. Smith would prompt the client: "did it make it easier when you took a drink at the last work function you went to?" To which the client would respond: "no, I got drunk and embarrassed myself." CBT also teaches the client positive coping mechanisms such as deep breathing, pausing before acting or speaking, and setting weekly goals to become abstinent.

CBT believes that by changing someone's thoughts, it is possible to change someone's actions and vice versa. Mr. Smith works with his clients to set positive, clearly-definable and concrete goals to help them change the structure of their lives, as well as to change their thoughts. Mr. Smith placed the emphasis on 'concrete' when he was talking about setting goals in CBT. A goal is not simply 'to do better.' Rather, the client must set a goal such as: "to go to the gym every day after work instead of going to a bar."

The goal-oriented nature is one of the advantages of CBT. Quite often, clients do not have an extensive amount of time to ruminate about their pasts. The nature of addiction is that it is a disease that can ravage the body and mind, and the longer someone is addicted, the harder it is to quit, thus a quick-acting therapy is essentially. Additionally, clients are often under pressures from the legal system because of drug possession or dealing charges, or DWI charges that force them to make a sudden break with the past. And insurance companies frequently pay for only limited mental health counseling sessions. CBT uses the compressed format to the therapy's advantage. Rather than cultivating a dependent relationship of the patient upon the therapist, the therapist encourages the client to meet objective goals, not merely to please the therapist, and stresses the client's independence of negative ways of thinking as well as the drug.

Of course, as Mr. Smith admitted, this is an idealized conception of how CBT works. Drug addiction is extremely difficult for clients, regardless of the therapeutic method, because it is such a multifactorial problem. The client is dealing with the psychological and physical withdrawal from a drug that has governed his or her physical life, which can complicate the therapy. The fact that withdrawal makes the client feel so bad can make the client discouraged and uncooperative. Also, the client's entire social life, sometimes from a very young age, has been structured around the drug. Finding new friends is one of the many challenges of a formerly addicted person when rehabilitating.

Clients may also be dealing with problems that have been spawned by their addiction, such as job loss, personal difficulties, and legal troubles. It is the therapist's duty to help the client to see his or her life clearly, neither better nor worse than it actually is, with rational eyes. Another challenge of substance abuse counselors like Mr. Smith is that clients may be co-morbid for other psychological disorders, such as depression, anxiety, eating disorders, and other conditions. Substance abuse may be a form of self-medication. Substance abuse can also exacerbate or precipitate psychological disorders because of the social and biochemical stressors it generates.