While reviewing Brian’s collection of Classic Practices in Addiction Counseling, one unstated premise kept standing out to me.
That premise is the idea that addiction is a unitary entity.
Brian doesn’t present it as Classic Practices in Opioid Use Disorder Counseling or Classic Practices in Alcohol Use Disorder Counseling.
It’s Classic Practices in Addiction Counseling.
Brian specifies “chronic, severe, and complex” when he’s referring to addiction, so it’s important to keep in mind that some, but not all, OUD and AUD represent manifestations of addiction.
Why is this important? Because, as previously discussed in this blog, it determines how we approach a patient with chronic, severe, and complex opioid use disorder, stimulant use disorder, alcohol use disorder, and cannabis use disorder.
Do we view this patient as having four distinct illnesses requiring four different treatment plans? Or one illness — addiction?
Medical approaches emphasize each use disorder and vary significantly from one drug to another, as they should.
However, addiction counseling treats the chronic, severe, and complex use problems as primary and unitary. The patient may have other illnesses that interact with their drug problems, but the drug problems constitute one problem — addiction — and their resolution calls for one pathway to resolution — recovery.
Bill White summarizes this perspective well here:
If AOD problems could be solved by physically unraveling the person-drug relationship, only physicians and nurses trained in the mechanics of detoxification would be needed to address these problems. If AOD problems were simply a symptom of untreated psychiatric illness, more psychiatrists, not addiction counselors would be needed. If these problems were only a reflection of grief, trauma, family disturbance, economic distress, or cultural oppression, we would need psychologists, social workers, vocational counselors, and social activists rather than addiction counselors. Historically, other professions conveyed to the addict that other problems were the source of addiction and their resolution was the pathway to recovery. Addiction counseling was built on the failure of this premise. The addiction counselor offered a distinctly different view: “All that you have been and will be flows from the problem of addiction and how you respond or fail to respond to it.”
Addiction counseling as a profession rests on the proposition that AOD problems reach a point of self-contained independence from their initiating roots and that direct knowledge of addiction, its specialized treatment and the processes of long-term recovery provide the most viable instrument for healing and wholeness. If these core understandings are ever lost, the essence of addiction counseling will have died even if the title and its institutional trappings survive. We must be cautious in our emulation of other helping professions. We must not forget that the failure of these professions to adequately understand and treat addiction constituted the germinating soil of addiction counseling as a specialized profession.
White, W. (2004). The historical essence of addiction counseling. Counselor, 5(3), 43-48.
While not a “practice” in addiction counseling, this premise informs all of the practices and seems worth noting.
I love this sub-topic and inquiry. I would say “both”. Let me explain.
First, addiction is a thing in itself, irrespective of the substance(s) by type.
Second, the person may present with substance use patterns that require separate clinical attention specific to a particular drug class (e.g. alcohol withdrawal management, NRTs) while entering treatment “for” a cocaine use disorder.
Back in the mid/late 90s the “problem-oriented record” charting revolution made my distinctions I’ve outlined here very clear. Diagnoses and presenting problems are different matters entirely.
Unfortunately, those charting improvements became so embedded and operationalized in technocratic and empirical checklist-driven work that they replaced what our field knew and obliterated what it could have continued to learn – to the point that now your content here in this post of yours is helpful and refreshing.
It’s both. And yes, addiction itself is a thing.
For the shortest and easiest thing I’ve ever written about the topic/question you raise, click this: Sentences to Ponder (addiction medicine physician) – Recovery Review
For my longest and most comprehensive handling of this topic/question you raise, click this: Addiction and Alcoholism: The Form of the Disorder – Recovery Review
Brian doesn’t present it as Classic Practices in Opioid Use Disorder Counseling or Classic Practices in Alcohol Use Disorder Counseling. It’s Classic Practices in Addiction Counseling.
And yet, one whole section in that latest work of mine is dedicated to methadone maintenance, with an example of revolutionary innovations such as keeping that medication going while the person is referred “up” to residential addiction treatment for the initial care of their now-newly diagnosed severe alcohol use disorder.
So yeah, it’s both.
Yes. I imagined you were distinguishing between addiction counseling and other interventions found in various treatments. A methadone maintenance program and a residential program may, or may not, both contain addiction counseling.
If you believe in the effectiveness of addiction counseling, it would be the constant throughout an entire continuum of care. And, while it might integrate considerations specific to individual drugs, the elements that distinguish it from other therapeutic approaches will be consistent from patient to patient, drug to drug, and across various levels of care.
Yes, sir.