Working with clients who use substances? It's not that scary!
Dr. Heather Fulton works with health care and helping practitioners to create awareness, confidence and competence to better treat clients with substance use challenges. Such clients may or may not have severe, diagnosable substance use disorders- but Dr. Fulton works with practitioners to be able to assess such issues, and then for practitioner to know how to create a tailored, individualized plan to address use (as necessary) for their client based on the latest, best-practice evidence.
Many practitioners say, “Clients who use substances? I don't see those clients”
Really? Research suggests that you do.
Estimates suggest almost 19% percent of the Canadian population meets criteria for a current substance use problems. Additionally, a study in California suggested that 38% of clients presenting to outpatient mental health services reported at least one alcohol dependence symptom in the previous 12 months (compared to 27% in the general population). Additionally, 21% of clients presenting to mental health services in this study reported using at least three different types of illicit substances in the past year (see this report for a review of the above prevalence studies)
Often, when practitioners tell me they don't see "those" clients, they may not actually be asking the right questions, or they ask the questions in a way that doesn't make it safe for a client to disclose any use. Think about it, would you really tell a therapist that you use a substance if you think they'll judge you for it, lecture you, or even worse, terminate treatment with you if you disclose? Knowing how- and even when- to ask clients about this important issue may be one of the reasons for health care practitioners' "blindness" to the issue of substance use in their practice.
Check out this article from the APA's Monitor on Psychology reviewing the opportunities for Psychologists to treat substance use issues.
Many practitioners say, “but I don't know what to do with those clients”
That may be true- but it may also NOT be true. Many of the techniques and skills a therapist uses with a client to work on substance use challenges are similar to other skills and techniques that are already widely used and implemented with other presenting issues. Namely, the fundamental skills and techniques used in Cognitive Behavioral Therapy still apply to substance use challenges- for example, thought records, behavior experiments, and coping cards may all be included in an individual's custom treatment plan.
Often practitioners are scared about working with substance use clients because of concurrent medical issues. For example, fears about knowing when a client is at risk for medically serious withdrawal can prevent a practitioner from seeing any clients who may use substances. This is an important consideration! Definitely good training and good consultation is essential. My goal in working with you as a practitioner is to help you learn the evidence to make these decisions (including when you need to consult with other health care disciplines) and to find a way for you to set up safe, competent, evidence based care that you can feel confident in offering to your clients.
If you need more convincing, check out this excellent article from Dr. Arnold Washton on Why Psychologists Should Treat Addiction. Miller and Brown (1997) also present several convincing arguments in this article (library access required unfortunately).
Can we stop using the term "those" clients anyways?
When we call out a subgroup of people as "those" people or "those" clients, really we're engaging in some subtle (or not so subtle) forms of stereotyping, stigma and bias. Substance use issues are stigmatized - even within the mental health treatment community. In fact, there are some very important reasons to stop using the term substance "abuse" and "addict" too. For a more eloquent summary than I could provide, check out this editorial from JAMA (there is a paywall, so here's a summary if you don't have library access). Instead of avoiding treatment of "these" clients, realize these clients are already here, and you're already seeing them. Why not do it more effectively by addressing any concurrent substance use issues?
Let's be objective, let's be supportive, and let's get to work!
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