Two factors consistently appear in the literature regarding the treatment of substance abusers in counseling programs. One factor is the importance of accurate assessment and diagnosis in establishing successful counseling relationships (Lewis, Dana, & Blevins, 1988). Professional counselors, regardless of the setting in which they work, must have command of assessment procedures to assist clients who are substance abusers. Assessment is important for school counselors who are the first-line helpers because they need accurate information with which to make referral decisions on behalf of students and families. Counselors who work with alcohol and other drug abuse cases in public and private agencies also use assessment processes to make diagnoses and choose appropriate treatment strategies.
The second factor is that the qualities needed in these counseling relationships are not unlike those required for most helping relationships. Lewis et al. (1988) noted that empathy, genuineness, warmth, and immediacy must be paired with effective helping skills, such as questioning, confronting, self-disclosing, clarifying, and other skills common to the counseling process. Although these qualities and skills are identical to those expected in other types of helping relationships, their use must be tailored to the unique needs of the chemically dependent client.
The abusing client is characterized by various social and psychological factors that "differentially predict initiation of different kinds and levels of drug use" (Marlatt & Baer, 1988, p. 229). Frequently, abusers who are affected by external events, such as the loss of a loved one to drugs, will attempt to change and may make a successful internal commitment to stop the destructive behavior. Those who are unsuccessful with self-change commitments continue their abusive behaviors or seek assistance from counselors and other professional helpers.
No definitive treatment research has shown which strategies and approaches are most successful. Marlatt and Baer (1988) indicated that many of the treatment modes chosen by counselors are inconsistent with current research findings. To some extent, procedures that match treatments with clients show promise, but much more research is needed. Counselors and other professionals need to keep up with the current thinking and most recent information in this area.
Relapse prevention and after-care monitoring, as noted in an earlier section of this article, are essential components of treatment for substance abuse (Daley, 1987; Marlatt & Gordon, 1985). Marlatt and others (Daley, 1987; Marlatt, 1988; Marlatt & Baer, 1988; Marlatt & Gordon, 1985) have identified specific intervention strategies to prevent relapse, including self-monitoring, imagery, relaxation training, skill development, and cognitive restructuring. Effective use of these approaches is possible when counselors and agencies design cooperative and flexible services that offer education, training, and support for clients, their families, and the institutions that will interact with this clientele.
Cohen (1985) proposed that prevention services complete the range of treatment alternatives, particularly in terms of what is available in school settings. As noted earlier, he suggested that prevention includes peer assistance programs with student helpers trained and supervised by counselors. This belief that prevention is a vital approach to treatment is echoed by the Tennyson Center in its Student Assistance Guide for Chemical Dependency (1987). This guide states that procedures for supporting teens who are being treated for chemical dependency may be more important than any other direct interventions. Modifying academic expectations, educating the school staff about chemical dependency, respecting student confidences, and becoming familiar with community programs are a few supportive measures that schools can take to help students who are receiving direct treatment for substance abuse.
The Student Assistance Program (SAP) model, developed in Westchester County, NY, evolved from the employee assistance model used in business and industry. According to Milgram (1989), a SAP has six functions:
Early identification of problems
Assessment of the situation
Referral to appropriate services
Support for the student
Organization of SAPs varies from program to program and can be coordinated by a part-time or full-time school counselor, another educator in the school who is assigned to SAP during certain periods of the day, or by a team consisting of a counselor, principal, nurse, teachers, and others. Some schools contract with community agencies who assign their counselors to the school on a regular schedule to facilitate the program (Milgram, 1989). Referrals to the SAP can come from the individual experiencing the problem, another student, or an adult who has observed a need.
Caudill, Kantor, and Ungerleider (1990) reported on another school intervention program called Project Impact. This program is based on a social learning-community intervention model that includes a wide range of professionals and resources to help school administrators deal effectively with drug use. In addition to social learning and other interventions with at-risk students, Project Impact establishes a "core team" of school personnel to deal with future substance abuse issues. Caudill et al. (1990) surveyed high school principals in five states and six school districts who had implemented Project Impact, and their results showed that administrators perceived the program as a highly effective intervention with at-risk students and as a preventive approach to use at the high school level.
SAPs and other approaches in which schools cooperate with agency counselors and community professionals incorporate ingredients that all counselors should include in substance abuse prevention and intervention services. Clear policies and procedures are essential as are the assessment, intervention, and support for the student during and after participation in the program.
Alcohol and other drug abuse continues at an alarming pace in our society, and few signs of progress are on the horizon. The position taken in this article is that any successful war on drugs by a nation, state, or community requires the cooperative efforts of helping professionals in many settings and at all levels of practice. An expanded perspective of professional roles and effective services is required among all counselors regardless of the setting in which they work. Such an expanded perspective includes the services provided by schools, governmental agencies, law enforcement officials, health professionals, and recreational specialists. Counselors who work directly with chemically dependent clients and their families must work with professional helpers in other settings, so that educational and prevention services can be coordinated with direct interventions. Without this coordination, the battle zones remain fragmented and little progress will be observed.
- Schmidt, John, Substance Abuse Prevention and Intervention: An Expanded Perspective for Counselors, Journal of Counseling & Development, May/Jun 2000, Vol. 72, Issue 5.
Reflection Exercise #2
The preceding section contained information
about the counselor's role in substance abuse prevention and intervention. Write
three case study examples regarding how you might use the content of this section
in your practice.
What are the six functions of the Schmidt's Student Assistance Program (SAP) model? Record the letter of the correct answer