Substance Use

Treatment Philosophy

There is not “one way” to achieve recovery. There are many roads to recovery and our objective is to help each person find the path that works best for them rather than dictate a single path. Thus, it is important that treatment be individualized to reflect the needs and goals of each individual and to treat any relapse that may occur as a bump in the road to recovery. We also believe that it is important to build on an individual’s strengths rather than solely focus on one’s problems or diagnosis.

This philosophy is based on another Fayette project titled Behavioral Health Recovery Management (BHRM). Details on the principles of BHRM may be read at http://www.bhrm.org/papers/principles.htm

Co-occurring mental health and primary health care problems are common with substance use disorders. Mental health problems may include depression, anxiety, including post-traumatic stress disorder, bipolar, or schizophrenia. 
                       
Our goal is to address these problems simultaneously and in an integrated manner. Every attempt is made to link persons to a primary care provider if an ongoing relationship does not already exist. Our goal is to integrate our treatment with a person’s primary care physician with the individual’s consent.

CRA - Community Reinforcement Approach

The Community Reinforcement Approach is a behavioral program for people with a substance use disorder. It is based on the belief that environmental contingencies can play a powerful role in encouraging or discouraging drinking or drug use. Consequently, it focuses on social, recreational, familial, and vocational domains to assist consumers in the recovery process. Its goal is to make a sober lifestyle more rewarding than the use of substances.

CRAFT-Community Reinforcement and Family Training

The C.R.A.F.T. intervention, based on CRA, is a scientifically-based model that teaches concerned significant others – family members and caring friends – how to engage treatment refusing substance abusers to seek treatment by using positive reinforcement rather than coercion. The intervention emphasizes learning new skills to cope with old problems and helps concerned significant others improve the quality of their own lives even if their loved one does not enter treatment. C.R.A.F.T. research has shown that almost 7 out of 10 people who use the program get their loved one to attend treatment.

Cognitive-Behavioral Skills Training

Skills training can be used to help manage symptoms, recover from substance use, improve interpersonal relationships, and improve quality of life. Skills training can help foster a range of skills including drink and drug refusal skills, problem solving, assertiveness skills, and communication skills. This approach accepts that triggers will occur and works to develop alternative coping skills to meet the needs that substance use has satisfied. Training strategies consist of modeling, behavior rehearsal or practice in session and in real life, and feedback.

Contingency Management or Motivational Incentives

Contingency management techniques, sometimes referred to as motivational incentives, are an effective way to enhance behavioral change. Contingency management is based on the premise that if behavior is reinforced or rewarded it is more likely to occur again. This technique can be used to reward behavior inconsistent with substance use thereby encouraging new behaviors and promoting a drug-free lifestyle. Using rewards instead of punishment fosters the development of new behaviors that can be generalized to different settings and situations. Additionally, rewards encourage positive expectations and focus on accomplishments.

Relapse Prevention

Relapse Prevention Therapy is a cognitive-behavioral approach to addiction treatment that addresses the relapse process and incorporates coping strategies to maintain change. It is important to focus on strategies for maintaining change because when attempting to make a change, most people experience set backs or slips that may worsen and become relapses. After potential relapse triggers and high-risk situations are identified, specific interventions to prevent relapses or manage them if they occur can be set in place. Lifestyle changes can also replace needs previously met through drug and alcohol use. Another component of relapse prevention is working to increase the individual’s self efficacy as a way to increase commitment to therapy and willingness to persist when obstacles arise.

12-Step Facilitation

We encourage 12-Step or other mutual-help involvement as an addition to the treatment approaches utilized at White Oaks. Overlapping support group attendance with the other treatment approaches helps familiarize the individual with mutual-help groups and aids in the transition to continuing care. White Oaks counselors can help introduce 12-Step or mutual-help philosophies and meeting structures, as well as help integrate concepts from treatment with mutual-help material.

Seeking Safety

Seeking Safety is a “present-focused” treatment approach developed for trauma/PTSD and substance abuse. The treatment is presented in a manual; however, it has been designed for flexible use. Treatment can be conducted individually or in group format, in different settings, and with a variety of people. The 25 topics are designed to be independent of each other to increase the flexibility for therapists and individuals. The treatment is based on five key principles: 1) safety as the overarching goal (safety in relationships, thinking, behaviors, and emotions; 2) integrated treatment of PTSD and substance abuse; 3) a focus on ideals to counter the loss of ideals in both PTSD and substance abuse; 4) four content areas: cognitive, behavioral, interpersonal, and case management; and 5) helping therapists work on counter-transference, self-care, and other issues.

Motivational Enhancement

Motivational Enhancement is a therapeutic approach to help the consumer resolve his or her ambivalence about change and enhance the consumer’s motivation and commitment to change. This approach is based on the idea that the consumer holds the responsibility and capability for change. The relationship between the consumer and therapist is collaborative and emphasizes consumer choice, self-efficacy, and the responsibility of the consumer to determine his or her life goals.