Professionals and patients divided on treatment options

A recent survey of mental health workers conducted by Wakefield Research for Adelphi University Center for Health Innovation found a significant divide between professionals and their patients when it comes to goals for treating the problem of substance abuse.  While the majority of the professionals viewed abstinence as the most appropriate goal for their substance-dependent clients, they believe that the majority of their patients favor a goal of harm reduction, which focuses on reducing the harm related to alcohol and other drug use rather than prioritizing abstinence.

How to explain this intriguing result?   Perhaps professionals are well aware that most people wouldn’t relish the idea of totally and immediately giving up a substance that – while causing significant harm to themselves or others – also provided them with a quick and easy fix to life’s ups and downs.  Moreover, someone who has regularly used chemical substances to solve their problems has in the process missed out on developing the emotional and cognitive tools needed to navigate and cope with life as a mature adult.   

How easy is it to give up something we like or are in the habit of doing?  In my master’s level course on Social Work Practice in the Prevention and Treatment of Substance Abuse, I ask my students to abstain for one week from some habit, for example, drinking coffee, eating sugar, or biting their nails.   Inevitably, hard as they try, less than half the class is able to abstain completely for one week.  And, since they get to choose what they abstain from, many are not even attempting to abstain from their “favorite” substance or behavior!   Interesting, some students who fail to abstain during the week report switching mid-week to a goal of cutting down and having more success with that.

Thus, while abstinence may be viewed by substance abuse clinicians as the “safest” option,  it may not be the most feasible or practical option for all.  Luckily, the mental health professionals surveyed were also open to utilizing newer chemical dependency intervention methods, such as cognitive-behavioral therapy and motivational interviewing, many of which are congruent with a more flexible approach to setting goals for treatment.   Ultimately, professionals need to collaborate with their clients to clarify their preferences and goals, and help motivate them to being working towards their goals. 

written by Judy Fenster, Ph.D., LCSW

Associate Professor
Faculty Chair for Curriculum and Instruction at Adelphi’s School of Social Work.