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| Principles of management of substance-abuse disorders
Establish a working/therapeutic relationship
- Identify the patient's current level of drug use (drug type,
daily dose, frequency of use); check for multiple drug use
- Determine the patient's "readiness for change"
- Help the patient weigh up the costs (and benefits) of their continued
drug use (affordability, health effects, legal consequences,
effects on relationships, job, family)
- Contrast with the benefits of a drug-free lifestyle
Establish an "environment of safety"
- Encourage the patient to cut down or stop using drugs
- Negotiate appropriate (and attainable) goals with the patient
- Discuss strategies to achieve these goals
- Identify the situations in which the patient is likely to use drugs
and the factors that will make it difficult to change the pattern of use
- Provide positive reinforcement for goals achieved and arrange
appropriate social supports
Discuss HOW to cease substance use (i.e.,
detoxification)
- Inform the patient of the symptoms that are likely to occur and
discuss strategies for ameliorating them
Facilitate working through grieving for the losses sustained
due to former lifestyle choices
Discuss strategies for coping without drugs, including
involvement with self-help groups
Remember that relapse is common
- Identify any gains made during the previous attempt and
encourage the patient to try again
- Examine the factors that led to the relapse and discuss strategies to
deal with them
Discover why the substance-oriented lifestyle developed
(optional)
Modified from Goldman.1
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