How Do I Choose A Good Substance Abuse Therapist?
If you are reading this article, this means that you are taking the first step to getting a handle on a drug or alcohol problem for you or someone for whom you have concern. There are several things you need to know and understand before either entering into treatment yourself or discussing treatment options with a loved one. The first is the difference between substance abuse and addiction; and how the two can still bring about the same financial, occupational, and personal consequences. The second is the qualities and experience that you should look for in a therapist. The third is the treatment modality used by the therapist. There are other factors that bear consideration, and a growing amount of research on the topic for the continued education of medical and mental health practitioners.
Abuse or Addiction
Every addict begins by abusing a substance or substances (Robinson & Berridge, 2003). Addictions are formed and most anyone can become addicted to an addictive substance. Some substances are more addictive than others, such as heroin, cocaine, and prescription painkillers. How the substance abuse started and other mitigating factors are important to the historical background of the substance abuser and where he or she lies on the addictions track.
Abuse is the overuse of a substance, drinking until drunk, or taking a medication for something other than its intended use (Robinson & Berridge, 2003). Recreational drug use falls under the heading of substance abuse because drugs are not intended for "fun." Marijuana, heroin, cocaine, LSD, ecstasy, and similar drugs are used recreationally. Apart from ecstasy and LSD (drugs called acids), these drugs also have medicinal purposes. Heroin and cocaine are both opiate derivatives of the coca plant used in morphine, codeine, OxyContin and other opiate based pain medications (Vocci, 2007). These are used recreationally, but are highly addictive. These drugs are narcotics and the sale, possession, and use of these carry various penalties depending upon the state depending upon their DEA classification ("DEA / Drug Scheduling," n.d.).
In short: The use of any substance that is illegal for possession or use is substance abuse.
When addicted to a substance, one must have it. The progression begins by a buildup of tolerance to the substance and the need for more of it at more frequent and shorter intervals (Robinson & Berridge, 2003). The use of the substance begins to interfere with job performance/attendance, financial responsibility, and personal relationships. The need and use of the drug supersedes all and anyone else.
Some addicts will lose everything, and others are what are known as functioning addicts. Functioning addicts are those who continue on with their lives, are at least moderately successful at work, and while family and friends may have concerns about the amount of substance the individual consumes or uses, the fact that he or she is functioning is a strong argument against accusations of addiction ("5 Telltale Signs of a High-Functioning Addict," 2015). The functioning addict is often the most difficult to get into a treatment program because he or she has not hit rock bottom.
Education and Training of Therapist
Licensing requirements for substance abuse counselors vary from state to state (Rieckmann, Farentinos, Tillotson, Kocarnik, & McCarty, 2011). In some states counselors do not even have to have a post-secondary degree in order to receive a license. Others require a minimum of a Master's degree and a specialization in the field. Some therapists go into the field of addictions counseling because they themselves are addicts (Rieckmann et al., 2011). According to some, and espoused by many, once a person is addicted, he or she is always considered an addict, albeit a recovering addict ("Once an Addict, Always an Addict | Psychology Today," n.d.). Most agree there is no cure for addiction; however, there is treatment for abuse (Koehn & Cutcliffe, 2012).
Therapists who look at the whole individual, and do not just treat the act of substance abuse are considered the most effective (Koehn, O'Neill, & Sherry, 2012). Some argue that too much focusing on the past is counter-productive, but the past is often what shapes the substance abuser or the addict. Past issues, family dynamics, and current triggers are all very relevant to treatment success.
Recent research into the viability and success of online substance abuse treatment programs suggest because of the accessibility of the online therapists and online groups they may prove more successful for some individuals (King et al., 2009). While strong proponents of AA and NA might argue that they should not replace physical meetings, others (King, Brooner, Peirce, Kolodner, & Kidorf, 2014) counter with the argument that the meetings are about transparency and support. One of the reasons AA and NA has been so successful is due to the commitment to confidentiality. Addiction therapists at large are bound by strict Federal and ethical rules regarding confidentiality ("Code of Ethics," n.d.), seeking help through an online program such as Betterhelp.com can provide extra measure of confidentiality as sessions take place in the privacy of one's home or office.
Again, if you are seeking information on substance abuse counseling for yourself, congratulations for taking an important first step in your recovery. If seeking information on behalf of another individual, beware of the pitfalls of attempting to coerce that individual into treatment. The failure rates are higher for those who have attended court ordered or some other form of coerced treatment (Shearer, 2000). The continuum of substance abuse and addiction is one that follows its own course (Robinson & Berridge, 2003), and each individual must make the decision for treatment for him or herself first in order to be successful.
Good luck on your path. For more information about substance abuse and how online therapy might be the path for you, visit Betterhelp where you can be matched with a licensed therapist who is available 24/7 via email, text or video chat.
5 Telltale Signs of a High-Functioning Addict. (2015, April 7). Retrieved May 17, 2017, from http://drugabuse.com/5-telltale-signs-of-a-high-functioning-addict/
Code of Ethics. (n.d.). Retrieved May 17, 2017, from https://www.naadac.org/code-of-ethics
DEA / Drug Scheduling. (n.d.). Retrieved May 17, 2017, from https://www.dea.gov/druginfo/ds.shtml
King, V. L., Brooner, R. K., Peirce, J. M., Kolodner, K., & Kidorf, M. S. (2014). A randomized trial of Web-based videoconferencing for substance abuse counseling. Journal of Substance Abuse Treatment, 46(1), 36-42. https://doi.org/10.1016/j.jsat.2013.08.009
King, V. L., Stoller, K. B., Kidorf, M., Kindbom, K., Hursh, S., Brady, T., & Brooner, R. K. (2009). Assessing the effectiveness of an Internet-based videoconferencing platform for delivering intensified substance abuse counseling. Journal of Substance Abuse Treatment, 36(3), 331-338. https://doi.org/10.1016/j.jsat.2008.06.011
Koehn, C., & Cutcliffe, J. R. (2012). The inspiration of hope in substance abuse counseling. The Journal of Humanistic Counseling, 51(1), 78-98.
Koehn, C., O'Neill, L., & Sherry, J. (2012). Hope-Focused Interventions in Substance Abuse Counselling. International Journal of Mental Health and Addiction, 10(3), 441-452. https://doi.org/10.1007/s11469-011-9360-3
Once an Addict, Always an Addict | Psychology Today. (n.d.). Retrieved May 17, 2017, from https://www.psychologytoday.com/blog/minority-report/201602/once-addict-always-addict
Rieckmann, T., Farentinos, C., Tillotson, C. J., Kocarnik, J., & McCarty, D. (2011). The Substance Abuse Counseling Workforce: Education, Preparation, and Certification. Substance Abuse, 32(4), 180-190. https://doi.org/10.1080/08897077.2011.600122
Robinson, T. E., & Berridge, K. C. (2003). Addiction. Annual Review of Psychology; Palo Alto, 54, 25-53.
Shearer, R. A. (2000). Coerced substance abuse counseling revisited. Journal of Offender Rehabilitation, 30(3-4), 153-171.
Vocci, F. J. (2007). Opiates and Addiction. In Handbook of Contemporary Neuropharmacology. John Wiley & Sons, Inc. https://doi.org/10.1002/9780470101001.hcn041