Monday, July 20, 2015

Self Concept Model of Substance Abuse Treatment

Apparently, sometimes I sit down to write an article and develop a new treatment model. When you begin applying this model to your treatment center, please provide feedback as to how your clients respond. --AH

Daryl Bem's view of how one sees the self, Self-Perception Theory, is defined as: we are what we repeatedly do. That is, you only know how to define yourself by the things you have observed yourself doing. If you do something frequently, you must enjoy that thing, or you would be doing another thing.

Leon Festinger's view of how one sees the self, Cognitive Dissonance Theory, is defined as: we have views of ourselves that cause internal conflict when what we do or think is at odds with those views. That is, when we feel we are challenging our own core beliefs, it causes stress.

Both theories are valid, and in different ways. Both can also be challenged, of course. You might quickly assume that Self-Perception Theory does not hold up when a person hates her job, but still goes every day, or that Cognitive Dissonance Theory simply causes her to change her opinion about her job, simple as that. But neither is so simple nor are they necessarily mutually exclusive.

When applied to substance abuse, the person who has been displaying addictive behaviors (the client) can apply Self-Perception Theory and state "I have been a drug addict because I have been abusing drugs," or Cognitive Dissonance Theory and state "I have a history of drug abuse, but I am in treatment because I'm not a person who really wants to use drugs."

Add the Expectation-Value Theory of Achievement Motivation, which states that the more a person believes in his or her own ability to make a change, the more change will be made.

What you now have are the following client statements:

  1. I have evaluated my past behavior as having engaged in substance abuse recently, but there was at least some period of time where I was not abusing substances (even if this is early childhood). 
  2. I do not want to continue to see myself in that way. 
  3. Changing my present and future behavior will eliminate the internal stress of seeing myself as I no longer want to be. 
  4. I believe I can be substance-free (because I have been in the past).
  5. Belief in something valuable (reduced stress, elimination of substance use) makes it more likely to exist.
  6. I can accomplish this goal.

Substance abuse treatment teams utilizing theories such as these in tandem can show great results in clients by empowering them to change what it is they choose to change about themselves.

With a focus on client-centered positivity, this 6-step model can be implemented as early as the pre-contemplation stage, and reinforced at each of the Stages of Change, including during and after relapse.

The challenge of the treatment team in implementing this Self Concept Model is:
  1. Allow the client to see their behavior as being in the past, despite how recently it may have taken place. Provide for a future that is changeable and accent the positivity of engaging in treatment at this moment, which they can control. Discuss times the client was sober, even if it was only in early childhood. Keep the atmosphere light and positive. There is no allowance for guilt or shame; there is no judgment of the substance-using behavior, only description and clarification between the two states.
  2. It is key that the client sees herself/himself as ready for change, not that others are projecting this. There is a readiness in treatment, and it is most useful to strengthen the person in front of you, to his/her best self, whatever that means to them. Keep your values out of the room. 
  3. The client must be bothered by the behavior for there to be dissonance. It is the job of the treatment team to show the client that there are other ways, and they are attainable. This strengthens the client's resolve and gives necessary support during treatment. Assist, if necessary, with making the description of their future clear and reachable. Set short-term and long-term goals with due dates and ways of evaluating successes. Discuss a safety net of persons to help achieve these goals. 
  4. Frequently remind the client of their own belief in self and the treatment team must show a genuine belief in the client. If the team is guarded in their prognosis, remind them of Expectation-Value Theory and that this moment is the one in which the client draws strength from the team to support change in the future. Strengthen the client to believe in the future they have described. 
  5. Discuss what will change, and what has already changed, by ceasing substance abuse. Encourage the client to be curious about what might happen next. Ask them questions like "On a typical Saturday night, you described that you used to go out with certain friends and do certain drugs at the night club. What would happen if you went to that same club with those same friends on a Saturday night? What do you want to happen?" This is not setting the client up for negative feelings, but reality testing. The treatment team is not to induce guilt or shame, but allow the client to explore a real-life situation in the safety of treatment on their own terms. Ask open-ended questions and allow the client to discover other situations that they would like to explore before finishing treatment, or before in-vivo exposure to those situations. Discuss what the client thinks is and will be valuable that they are changing? This is highly personal and should not be presumed to simply be "not using drugs," but could include "quality parenting time," "closer relationships with my friends," and any number of things.
  6. Assist the client with accomplish their goals in every way possible, including linking them with community contacts and services, and requesting fellow members to assist one another. Recommend continued counseling in a supportive system that tapers off slowly.
This model can further be extrapolated to any addictive behavior, and many other negative behaviors that we do not term as addictive.

Autumn Hahn is a Licensed Mental Health Counselor and Certified Clinical Hypnotherapist practicing at Clear Mind Group in Weston, Florida. Call 954-612-9553 for a consultation. Follow Autumn on TwitterFacebook, and Google+. Sign up for the e-newsletter HERE.

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