Addiction counseling training and scope of practice

[Fan_of_Meehl]

---

Members do not see this ad.

"

My patients who have serious mental health conditions get worse when they use substances and it is my recollection that this is supported in the literature. I also recall that for co-occurring disorders, treating both disorders predicts better outcomes. Patients also tend to report that they use substances to deal with symptoms, but that often seems like a justification to continue use despite negative consequences. My concern about the thinking about self-medication (referring more broadly to what I see in clinical practice as opposed to research on the SMH) is that it feeds into a problem of the disorder that we are trying to treat and that it reflects a type of fuzzy logic regarding the above mentioned findings. The danger with fuzzy logic when dealing with substance use is that those tend to be the types of patients most likely to drive a hole through the logic to their own detriment. I find it vital to be solidly grounded when working with people with substance abuse.

"Alcohol...the cause of--and solution to--all of life's problems"

-The Simpsons? 🙂

 

[PsyDr]

@PsyDr You happen to know off hand any articles that sum up this stuff and other review and critiques of the existing AA model and limited literature? Looking for something to pass along to some one and not be 'the bad guy.'

Just ask them:

1) define "alcoholism".
2) define "recovery"

They won't be able to, because there are no definitions.

If you want, have them explain why the Cochrane reviews from 2020 and 2006 show that AA ,as given in the community, doesn't produce long standing abstinence.

 

[erg923]

Just ask them:

1) define "alcoholism".
2) define "recovery"

They won't be able to, because there are no definitions.

If you want, have them explain why the Cochrane reviews from 2020 and 2006 show that AA ,as given in the community, doesn't produce long standing abstinence.

An extremely academic Clinical Psychologist told us years ago (2003?) that the AA model was "dangerous" because it instilled many myths. Some of his points I agreed with, and some I took to be a bit ridiculous. However, one point that always stuck with me was the (painfully forced) academic argument (and I don't really know how this plays out clinically because this is not my area) that the whole explanatory model is indeed teleological. As in, symptoms and disease are never the same thing.
-"I have the "disease" of "Alcoholism."
- "Oh Yea? What are the symptoms?"
-"I drink to much."
-"Whats the disease?"
-"That I drink too much."

I don't have a particular opinion on this, but for some reason it has always stuck with me. And... I frankly admit to bristling somewhat when I hear people who drink to much say that they have the "disease" of drinking too much.

 

[cara susanna]

An extremely academic clinical psychologist told us years ago (2003?) that the AA model was "dangerous" because it instilled many myths. Some of his points I agreed with, and some I took to be a bit ridiculous. However, one point that always stuck with me was the (painfully forced) academic argument (and I don't really know how this plays out clinically as this is not my area) that the whole explanatory model is teleological. As in, symptoms and disease are never the same thing.
-"I have the "disease" of "Alcoholism."
- "Oh Yea? What are the symptoms?"
-"I drink to much."
-"Whats the disease?"
-"I drink too much."

I don't have a particular opinion on this, but for some reason it has always stuck with me,

I can think of a lot of diagnoses--including non-mental health ones--that would fail under that standard.

 

[erg923]

I can think of a lot of diagnoses--including non-mental health ones--that would fail under that standard.

Yes. A bit of a row ensued (especially how Diabetes Mellitus would have fit into this argument at some point), but I still maintain it is something to think about.

That particular professor, who was perhaps less enamored with myself than some, would have none of it at the time.

 

[PsyDr]

An extremely academic clinical psychologist told us years ago (2003?) that the AA model was "dangerous" because it instilled many myths. Some of his points I agreed with, and some I took to be a bit ridiculous.

It's also dangerous because it shifts the blame when it fails, and takes credit when it succeeds. Requires people to say they are powerless, but also says that it only works for people who really try.

 

[beginner2011]

If you want, have them explain why the Cochrane reviews from 2020 and 2006 show that AA ,as given in the community, doesn't produce long standing abstinence.

I'm no fan of AA, but are you referring to this review?

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012880.pub2/full

Authors' conclusions
There is high quality evidence that manualized AA/TSF interventions are more effective than other established treatments, such as CBT, for increasing abstinence. Non‐manualized AA/TSF may perform as well as these other established treatments. AA/TSF interventions, both manualized and non‐manualized, may be at least as effective as other treatments for other alcohol‐related outcomes. AA/TSF probably produces substantial healthcare cost savings among people with alcohol use disorder.

What am I missing here?

 

[beginner2011]

My patients who have serious mental health conditions get worse when they use substances and it is my recollection that this is supported in the literature. I also recall that for co-occurring disorders, treating both disorders predicts better outcomes. Patients also tend to report that they use substances to deal with symptoms, but that often seems like a justification to continue use despite negative consequences. My concern about the thinking about self-medication (referring more broadly to what I see in clinical practice as opposed to research on the SMH) is that it feeds into a problem of the disorder that we are trying to treat and that it reflects a type of fuzzy logic regarding the above mentioned findings. The danger with fuzzy logic when dealing with substance use is that those tend to be the types of patients most likely to drive a hole through the logic to their own detriment. I find it vital to be solidly grounded when working with people with substance abuse.

I think it's possible to acknowledge and validate that individuals with SUD may intend to reduce unpleasant experiences through substance use (self-medicate) despite negative consequences while also helping the individual recognize that there are other ways of reducing unpleasant experiences that don't involve substance use. I find (and a ton of MI research supports) that empathy, validation, and affirmation are some of the most useful paths to take when working with individuals with SUDs. I'm not sure how assuming my patient is engaging in fuzzy logic (especially when a glut of empirical evidence is consistent with their self-report) would be particularly useful.

 

[AbnormalPsych]

"Drug abuse doesn't cause mental illness, mental illness causes drug abuse, failure to get a hold of people and deal with their anxieties." - Joe Biden (directly to a black man), 10/15/2020.

Our work is so important...

 

[Ollie123]

Yeah, I winced at least 2-3x during that response....

 

[WisNeuro]

Yeah, that wasn't great, but at least it was miles better than the alternative. I prefer that to lying about military discharge conditions due to addiction and calling someone a crackhead on a national radio show.

 

[DynamicDidactic]

Yeah, that wasn't great, but at least it was miles better than the alternative. I prefer that to lying about military discharge conditions due to addiction and calling someone a crackhead on a national radio show.

I did not see the town hall but, out of context, this statement is miles ahead of what politicians were saying in the past.

 

[WisNeuro]

I did not see the town hall but, out of context, this statement is miles ahead of what politicians were saying in the past.

Yeah, I'll take any progress over huge backsliding any day.

 

[beginner2011]

Yeah, that wasn't great, but at least it was miles better than the alternative. I prefer that to lying about military discharge conditions due to addiction and calling someone a crackhead on a national radio show.

Whoa! You weren't lying. As we're closing in on election day the Trump camp seems to be getting more and more desperate.