Management of substance-abuse disorders

Principles of management of substance-abuse disorders

With empathy and positive management, many alcohol and drug dependent people can be liberated from their addictions.

  • 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)

Research extract from; Tobie L Sacks and Nicholas A Keks. Alcohol and drug dependence: diagnosis and management. Medical Journal of Australia Practice Essentials #14.

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