Exploring Substance Use Treatment at TAP
Updated: Dec 17, 2019
We sat down with TAPs Substance Use (SU) experts Kirk Mochrie, PhD and Daniel Merwin, LPC to understand more about substance use treatment broadly, as well as substance use treatment at TAP more specifically. If you haven’t read Dr. Mochrie’s first blog post on understanding substance use symptoms, it might be helpful to start there.
Q: What should a person do first if they think they may have a substance use (SU) problem?
A: If a person thinks they may have a problem with substance use (SU), it is important they seek additional information regarding drug or alcohol addiction. Because substances elicit a strong reaction in the pleasure center of the brain and reinforces alcohol and drug use, thoughts threatening continued use can make it difficult for a person to openly consider the impact substances have in their life. As quick as the thought of “I might have a problem” comes to mind, addiction-driven thoughts such as “it’s not that bad”, “I can manage it”, naturally surface. Therefore, if you notice yourself thinking that your SU is problematic, it is important that you do not ignore these thoughts and reach out for help in exploring your SU.
Once you decide treatment may be helpful, you can search for providers and schedule an initial assessment appointment. It is important to choose a provider or treatment facility that have clinician(s) who specialize in Substance Use Disorders (SUDs), as their expertise and knowledge are essential to assess factors contributing to SU, determine an accurate diagnosis, and to make appropriate treatment recommendations and referrals.
In addition, attending free support groups such as Alcoholics Anonymous (AA), Narcotics Anonymous (NA), and/or SMART recovery are useful for some (Visit https://aanorthcarolina.org/meetings/ for a list of AA meetings in NC). Lastly, if you are experiencing significant withdrawal symptoms from alcohol, benzodiazepines, and/or barbiturates, you NEED to enter a detox program first as withdrawals from these substances can be life threatening.
Q: What is an abstinence-based treatment approach to SU?
A: The goal of abstinence-based treatment is for a person to stop using substances completely. The treating provider works with a client to help them cease their SU through identifying and avoiding triggers, ending relationships with other users and dealers, and increasing coping skills (e.g., drink and drug refusal skills). People with more severe addiction problems benefit the most from this approach and may begin recovery with inpatient detoxification, next stepping down to a residential rehabilitation program (e.g., 28-day program) or intensive outpatient program. Additionally, individuals who experience intense cravings and/or who have experienced difficulty controlling their SU in the past will likely benefit more from this approach. It is often recommended that clients who are considering changing their SU start with abstinence for several months before attempting a harm-reduction approach to treatment.
Q: What is a harm-reduction approach to SU treatment?
A: More recent models of addiction treatment often utilize a harm-reduction approach. This approach recognizes that not all people will permanently stop using substances and instead works to reduce the negative consequences associated with SU. Harm-reduction approaches help clients explore ways to decrease their use and/or use substances in ways that reduce risk of harm to themselves or others or negative consequences of their SU. Harm reduction includes psychoeducation about substances used, risks of use, and may include education on safe amounts/doses of a drug. Treatment can focus on reducing use of a specific substance, reducing SU in certain situations, or limiting the frequency and/or quantity of use per week. For example, an individual may decide not to drink alcohol or use drugs while on business trips; others may limit their alcohol use to only one time per week. This approach is often most helpful for individuals who have not experienced severe consequences from their SU, are using in moderate to low amounts, and/or have a desire to continue using while ensuring their own and others safety, and avoiding other negative consequences of use.
Q: What are some of the current substance use (SU) treatment options out there?
A: There are a wide variety of SU treatment options available; determining which is best suited for each person varies based on the severity of the individual’s SU, status of their current use, and which specific therapies and treatment approaches are available. It is important to be assessed by a substance use disorder (SUD) expert to collaboratively determine what might be best for you. Below, we share information about Cognitive Behavioral Therapy (CBT), which is an evidence-based outpatient treatment for SU that informs our treatment at the TAP Clinic.
Cognitive Behavior Therapy (CBT) for substance abuse is an evidence-based treatment modality that includes many different specific therapies. Traditional CBT therapies includes the goal of recognizing and changing thought patterns (i.e. cognitive restructuring) that lead to substance use as well as to increase behavioral coping skills to reduce SU. Over the past 20 years, contemporary or “3rd wave” Behavioral/Cognitive Behavioral therapies have emerged. Contemporary CBT’s often removes the goal of directly changing thought patterns and instead includes components such as mindfulness, acceptance, values, and self-compassion to address SU maintaining thoughts and behaviors.
Examples of specific CBT approaches
● Motivational Interviewing (MI) is a common set of therapeutic techniques utilized for individuals who are considering making a change in their use. The goal of MI is to help clients explore their SU patterns and discuss their desire and motivation to change their current use. This is an extremely important first step in substance abuse treatment, as many individuals who experience these problems have difficulty maintaining motivation for change.
● Dialectical Behavior Therapy (DBT) for SUDs (DBT-S) is an evidenced-based treatment for individuals with significant emotion dysregulation problems and comorbid substance abuse difficulties. DBT-S is an adaptation from standard DBT and adapts specific skills within the Distress Tolerance module that directly address SU.
● Acceptance and Commitment Therapy (ACT) has a primary treatment goal to help clients know, move towards, and fully experience their chosen values in life. SU treatment in ACT includes assisting clients openly explore the functions and effectiveness of their use, 2) better understand the role thoughts, emotions, and bodily sensations play in how we cope and 3) develop coping strategies to effectively identify and avoid ineffective behaviors, while engaging behaviors that are consistent with chosen values. Interventions are tailored to address SU specific issues and involve mindfulness and values-based approaches to experiencing emotions.
● Mindfulness-Based Relapse Prevention (MBRP) uses mindfulness meditation, along with traditional relapse prevention interventions to help people avoid returning to problematic SU after a period of decreased use and/or abstinence. It is most often utilized with people who have completed a more intensive substance abuse program. The goal of MBRP is to assist people develop a detached awareness of addictive thoughts, feelings, and bodily sensations through mindfulness practice. When cravings or other high-risk situations arise, mindful awareness and acceptance of these addictive thoughts, feelings, and bodily sensations can provide the space needed for a person to avoid engaging in relapse behaviors and instead utilize effective non-using coping strategies.
Q: What substance abuse treatments does TAP clinic offer?
A: Dr. Mochrie – I have worked in a variety of treatment settings (i.e., outpatient clinics, college counseling centers, VA) using a variety of treatment modalities (i.e., MI, CBT, DBT-S) to assist individuals experiencing substance abuse difficulties. As an initial starting point, I offer MI for clients who are considering making a change in their SU patterns. I also offer CBT and DBT-S as primary treatment modalities and take a non-judgmental approach to understanding a client’s SU and the difficulties resulting from this use. I like to begin by collaboratively developing a treatment plan with my clients in the first several sessions and I offer both an abstinent and harm-reduction approach to treatment based on a client’s individual needs.
For clients experiencing a co-occurring mental health disorder (e.g., anxiety, depression, etc.); I integrate general skills/techniques to help address these symptoms in addition to the addiction problems. Using an integrative model, I work with clients to reduce their SU and symptoms of other mental health disorders through increasing motivation, psychoeducation, coping skills, and helping them to progress towards self-identified life goals.
Daniel – I have extensive training and expertise in Acceptance and Commitment Therapy (ACT) and 18+ years of experience working with people experiencing SU problems in a variety of treatment settings and modalities. At TAP, I provide outpatient individual and/or group treatment to address mild to moderate SU concerns using either an abstinence based or harm reduction approach, as determined by the client’s preference. I specialize in the treatment of SU in the context of co-occurring mental health symptoms, such as anxiety or depression. I primarily work within the ACT model of SU treatment and often utilize interventions from traditional evidence based CBT models, or contemporary CBT therapies such as DBT, MI, and MBRP. My experience working in community based evidence based SU services highlighted for me the importance of family and other social supports in helping people overcome SU problems. With this in mind, I offer family and psychoeducation support as an adjunct to individual therapy whenever this is in line with client goals.
More information about Dr. Mochrie and Daniel, their training, and treatment approaches can be found on the TAP clinic website under “Providers” or using the links above.