Management of substance-abuse disorders

Principles of management of substance-abuse disorders

With empathy and positive management, many alcohol and drug dependent people can be liberated from their addictions.

Establish a working/therapeutic relationship
Identify the patient’s current level of drug use (drug type, daily dose, frequency of use); check for multiple drug use
Determine the patient’s â€œreadiness for changeâ€
Help the patient weigh up the costs (and benefits) of their continued drug use (affordability, health effects, legal consequences, effects on relationships, job, family)
Contrast with the benefits of a drug-free lifestyle
Establish an â€œenvironment of safetyâ€
Encourage the patient to cut down or stop using drugs
Negotiate appropriate (and attainable) goals with the patient
Discuss strategies to achieve these goals
Identify the situations in which the patient is likely to use drugs and the factors that will make it difficult to change the pattern of use
Provide positive reinforcement for goals achieved and arrange appropriate social supports
Discuss HOW to cease substance use (i.e., detoxification)
Inform the patient of the symptoms that are likely to occur and discuss strategies for ameliorating them
Facilitate working through grieving for the losses sustained due to former lifestyle choices
Discuss strategies for coping without drugs, including involvement with self-help groups
Remember that relapse is common
Identify any gains made during the previous attempt and encourage the patient to try again
Examine the factors that led to the relapse and discuss strategies to deal with them
Discover why the substance-oriented lifestyle developed (optional)

Research extract from; Tobie L Sacks and Nicholas A Keks. Alcohol and drug dependence: diagnosis and management. Medical Journal of Australia Practice Essentials #14.