Addiction counselling training

1. Addiction (termed substance dependence by the American Psychiatric
Association) is defined as a maladaptive pattern of substance use leading to
clinically significant impairment or distress, as manifested by three (or more) of
the following, occurring any time in the same 12-month period:
1. Tolerance, as defined by either of the following:
(a) A need for markedly increased amounts of the substance to achieve
intoxication or the desired effect or
(b) Markedly diminished effect with continued use of the same amount of the
substance.
2. Withdrawal, as manifested by either of the following:
(a) The characteristic withdrawal syndrome for the substance or
(b) The same (or closely related) substance is taken to relieve or avoid withdrawal
symptoms.
3. The substance is often taken in larger amounts or over a longer period than
intended.
DSM-IV SUBSTANCE DEPENDENCE CRITERIA

2. 4. There is a persistent desire or unsuccessful efforts to cut down or control substance
use.
5. A great deal of time is spent in activities necessary to obtain the substance (such as
visiting multiple doctors or driving long distances), use the substance (for example,
chain-smoking), or recover from its effects.
6. Important social, occupational, or recreational activities are given up or reduced
because of substance use.
7. The substance use is continued despite knowledge of having a persistent physical or
psychological problem that is likely to have been caused or exacerbated by the
substance (for example, current cocaine use despite recognition of cocaine-induced
depression or continued drinking despite recognition that an ulcer was made worse by
alcohol consumption).
Source: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition. Washington,
DC: American Psychiatric Association, 2000.

3. Biology/genes Environment
Biology/
Environment
Interactions
Our nature
determines our
behaviour. Our
personality traits and
abilities are in our
nature.
Our environment,
upbringing and life
experiences
determine our
behaviour.We are
‘nurtured’ to
behave in certain
ways.

4. A BRIEF HISTORY OF DRUG AND ALCOHOL TREATMENT
1750 to Early 1800s
•Native American Alcoholic mutual aid societies (sobriety "Circles“
1800’s
•Lodging homes for alcoholics opened in the UK
•New York State Inebriate asylum opens (first rehab)
•Freud recommends cocaine to overcome alcoholism (later retracted)
•Lodging houses and Asylums close and alcoholics are sent to psychiatric asylums and ‘drunk tanks’.
•Opium use in the UK widespread (ending abruptly at turn of the Century and returning in the 1950’s)
1900-1950
•Charles B Towns hospital opens in New York ($350 a day- $6000 today) Bill W was a (failing) patient here.
•1906 Emmanuel clinic opens using therapeutic tools and spirituality.
•1910 Law is passed that allows Sterilisation of mentally ill (including alcoholics)
•1919 Morphine Clinics established
•1931 and 1932 The Oxford Group forms
•1935 AA formed
•1946 Pre Frontal lobotomies performed to treat chronic alcoholism
•1948 Minnesota model model birthed
•1948- 1950- Disulfiram drugs used (Antabuse)

5. 1950-2000
•1950’s AA membership reaches 90,000
•1952 American Medical Association defines alcoholism as chronic disease with genetic,
psychosocial and environmental factors
•1960’s UK drug market grows most notably with Illicit Pharmaceuticals
•1965 Insurance companies recognise treatment for addiction
•1964 Methadone introduced
•UK- Dangerous Drugs Act (1967) and the Misuse of Drugs Act (1971)
•1968 First NHS provision for drug addiction at Bethlam & Maudsley Hospitals
•1982 Betty Ford Clinic founded
•1982 Cocaine Anonymous founded
•1987 American Medical Association calls for all substance addictions to be called diseases
•1984 SMART recovery founded as a ‘non-spiritual’ alternative to AA fellowships.
•1994 Naltrexone approved for alcoholism
2000-
•2008 Insurance companies by law must all recognise addictions and mental health issues
in the U.S.

6. 12 Steps of AA
1. We admitted we were powerless over alcohol - that our lives had become unmanageable.
2. Came to believe that a Power greater than ourselves could restore us to sanity.
3. Made a decision to turn our will and our lives over to the care of God as we understood
Him.
4. Made a searching and fearless moral inventory of ourselves.
5. Admitted to God, to ourselves and to another human being the exact nature of our wrongs.
6. Were entirely ready to have God remove all these defects of character.
7. Humbly asked Him to remove our shortcomings.
8. Made a list of all persons we had harmed, and became willing to make amends to them all.
9. Made direct amends to such people wherever possible, except when to do so would injure
them or others
10. Continued to take personal inventory and when we were wrong promptly admitted it.
11. Sought through prayer and meditation to improve our conscious contact with God as we
understood Him, praying only for knowledge of His will for us and the power to carry that
out.
12. Having had a spiritual awakening as the result of these steps, we tried to carry this message
to alcoholics and to practice these principles in all our affairs.

7. Substance Addictions
Alcoholics
Narcotics
Cocaine
Nicotine
All Addictions
Chemically Dependent
Crystal Meth
Heroin
Dual Diagnosis
Marijuana
Methadone
Pills
Prescription
Eating Addictions
Food Addicts
Food Addicts in Recovery
Overeaters
Anorexics and Bulimics
Compulsive Eaters
Eating Addiction
Eating Disorders
Overeaters
For the Family
Al-Anon/ Alateen
Adult Children of Alcoholics
Nar-Anon
Families Anonymous
Parents Anonymous
Co-Anon/ Cocaine
Co-Dependents
Sex Addictions
Love Addicts
Sex and Love Addicts
Sex Addicts
Sexaholics
Sexual Compulsive
Sexual Recovery
Other Anonymous Fellowships
Gamblers
Dual Recovery
Emotional Health
Debtors
Recoveries
Bettors
Bloggers
Clutterers Anonymous
Emotions
Gamblers
Hepatitis C
HIV AIDS
Kleptomaniacs and Shoplifters
Procrastinators
Recovering Couples
Schizophrenics
Self Mutilators
Spenders
Survivors of Incest
Trauma
Workaholics

8. WHAT DOES THIS DEBATE MEAN FOR
TREATMENT?
Education is important- but we don't know for sure, and therefore we need to be
‘maybe...’in our thinking and sharing.
People might negatively embrace the genetic theory and feel there is no way to
change. ‘ I am what I am’.
There might be some drive to pass the blame onto the genes or onto the nurture.
while sensitivity is important we must consistently remind people of their power
of agency.
Our nature determines our behaviour. Our addiction and our problems are in our
nature. We have no agency. We are trapped to family legacy
Our environment, upbringing and life experiences determine our behaviour. We
are ‘nurtured’ to screw up in certain ways. We are trapped to family legacy.

9. POTENTIAL RISK AND PROTECTIVE
FACTORS FOR ADDICTION:
RISK
• Weak attachments...
• Family history of addiction
• Lack of parental supervision
• Lack of strong family bonds
• Friends or family who use alcohol,
tobacco, or other drugs
• Availability of drugs
• Drug/ Alcohol use during
adolescence
• Mental health problems
• Stress
• Exposure to trauma or violence
PROTECTION
• Good attachments...
• Strong family bonds
• Parental supervision and
involvement
• Friends who are a positive influence
and don’t use drugs
• Strong neighborhood/ community
• Clear anti-drug use policies at home
and in school
• Participation in after-school activities
• Having strategies to cope with stress

10. TREATMENT STEPS
• Detoxification
• Behavioural change via Counselling
• Potentially medication ( for opioid or nicotine, and
sometimes alcohol)
• Evaluation for co-occurring mental health issues
• Long term follow up to help avoidance of risky situations
and relapse.

11. PRIMARY TREATMENT
( RESIDENTIAL OR DAY PROGRAMME)
• Individual counselling- Where the client works through
their recovery in a safe, kind and confidential environment-
in order to explore their feelings, beliefs, behaviours in
order to better understand them selves and their
engagement with others and work towards desired change.
• Group work- working with up 12 other people who will
challenge, encourage and develop the individuals sense of
self in an environment of self identification and community
• Psycho education- understanding about the biology of
addiction and the process of change and other
psychotherapeutically informed interventions.

16. WHY DO PEOPLE TAKE SUBSTANCES IN THE FIRST
PLACE?
To feel good
To have novel: feelings sensations experiences AND to share them
To feel better
To lessen: anxiety, worries ,fears, depression, hopelessness

17. TYPES OF DRUGS
Stimulants include cocaine or methamphetamines. They cause hyperactivity and increase
heart rate and brain activity.
Opioids are painkillers that also affect chemicals in the brain that regulate mood. They can
also depress or slow down the central nervous system and affect breathing.
Hallucinogens: Marijuana, psilocybin mushrooms, and LSD are all considered
hallucinogens. They alter the user’s perception of space, time, and reality.
Depressants or sedatives: These drugs aren’t always illicit. But people may get addicted to
prescription medications of all kinds. If drugs are used in ways they weren’t prescribed by
someone addicted to illicit drugs, they may end up stealing to maintain their supply.

18. A TO Z GUIDE TO COMMON DRUGS
Alcohol – Booze, Bevvies
Amphetamines - Speed, Billy, Whiz, Phet
Cannabis - Dope, Hash, Weed, Pot, Skunk, Ganga, Zoot, Spliff, Green
Cocaine and Crack - Coke, Charlie, White, Snow, Sniff, White Lady
Ecstasy - E, Beans, Pills, Doves, Apples
G
Heroin - Smack, Junk, H, Brown, Gear, Skag
Ketamine - Green, K, Special K, Super K, Khat Qat, Quat, Chat
LSD- Acid, Tabs, Trips
Magic Mushrooms - Shrooms, Mushies, Magics
Mephedrone - Meow Meow, M-Cat, Drone, Bubbles, Bounce
Tobacco - Ciggies, Fags, Tabs
Volatile substances (solvents)

19. BEHAVIOURAL
ADDICTIONS
• Shopping Addiction
• Eating Disorders
• Exercise Addiction
• Video Game Addiction
• Gambling Addiction
• Love Addiction
• Porn Addiction
• Sex Addiction
• Internet Addiction
• Work Addiction
• Co-Dependency

20. “I was powerless over that,” says Joe, who is 35. “I ended up
relapsing for two weeks.” Within two days he was playing video
games almost constantly, pausing only to sleep for a few hours
each day. He stopped eating proper meals and washed only
once every three or four days. On phone calls to his girlfriend
he would lie about how much he was gaming and try and hurry
the conversation along, telling her he was about to go to sleep
when he really was playing games until six or seven in the
morning. Although he’d been in recovery from drug addiction
since he was 31, he stopped attending his Narcotics
Anonymous meetings altogether to spend more time bingeing
on video games.

22. C O N S EQ U E N C E S O F A D D I C T I O N

23. SOME ‘POTENTIAL’ CHARACTER
TRAITS...
Limited Impulse Control and Impulsivity
Difficulty dealing with Stress and Anxiety
Denial/Poor Self awareness
Lack of Patience
Emotional Instability ( poor attachment)
Difficulty in asking for help
Manipulative traits
NO ADDICT IS THE SAME> REMEMBER THEY ARE AN INDIVIDUAL> FEARFULLY AND
WONDERFULLY MADE

24. DUAL DIAGNOSIS
When a patient is diagnosed with both a substance abuse disorder and a mental health issue, then
it is termed a Dual Diagnosis. : Depression, Personality disorders, schizophrenia, Anxiety, ADHD,
Bipolar
Research shows that those with an addiction are twice as likely to have co-existing psychological
disorders
• Those who have mental illness are twice as likely to struggle with addiction issues..
• The link between the two statistics is obvious. However, there is no clear evidence that
one causes the other.
• Drug Use Can Create Symptoms of Other Mental Health Issues
• Many drugs have side effects that mimic psychological and mental health disorders. For
instance, long-term marijuana use has a connection with an increase in psychosis. Long-
term cocaine addiction can cause paranoia. These side effects may be permanent even
after an individual stops drug use. As a result, they must be treated as co-existing
conditions.

25. TRAUMA

26. 2 APPROACHES-
ABSTINENCE AND HARM
REDUCTION
Abstinence is a term used in the addictions field to describe the process
of abstaining -- meaning avoiding, or not engaging in -- certain
potentially addictive substances or behaviours.
Harm reduction is a proactive approach to reducing the damage done
by alcohol, drugs, and other addictive behaviours. Often, harm
reduction strategies are used in conjunction with other approaches,
which require abstinence
Harm reduction can be utilised as a tool to enable people to reach
abstinence.
We need to be mindful of the dangers of abstinence from alcohol, that
can lead to death.

27. SCREENING/ ASSESMENT
•Current drug/ alcohol use
•Primary Drug of Choice
•Last drink or drug
•Treatment history
•Co-occurring disorders (both physical and mental)
•Prescribed medication
•Education and Employment Housing Circumstances
•Social Functioning
•Offending history
•Housing Circumstances
•Clients Goals
Screening- to test or examine someone or something to understand
The screening function is the process by which a client is determined to be appropriate and eligible
for a admission to a a particular programme. Taking into consideration: Physical condition/
psychological profile/ outside resources/ other factors

28. WHO
ALCOHOL
SCREENING
TOOL

29. TREATMENT
PLANNING
• Drawn up counsellor/agency and the client in order to meet the clients needs in line with
agencies rules.
• Take full account of information taken in the assessment
• Work with the client to formulate goals, objectives, and acceptable;e alternatives that will
increase treatment efficacy
• Consider a wide range of options utilising various modalities and formal and informal support
groups (12 step/Smart/Church/ Sport etc)
• When possible give the client resources and partner with them as they navigate their daily life.
• Be gentle, caring, open minded and curious. Do not overwhelm. One step at a time.
• Don't be afraid to challenge thinking
• Treatment plan is never static and should flex as the client grows in confidence and recovery
capital

30. TREATMENT PLANNING
1. Diagnostic Summary
Your provider will review your substance use patterns, medical history, and mental health conditions.
Based on these assessments, they will summarize the main problems that brought you to treatment, and recommendations like
medication and behavioral therapy.
2. Problem List
This list outlines specific issues that you want to target during treatment and a summary of the signs and symptoms that
illustrate the problem.
Example
Problem: Inability to reduce or stop alcohol intake
As evidenced by: Two DWI arrests in the past year
As evidenced by: Heavy drinking (more than 5 drinks) multiple times per week
3. Goals
After you come up with your problem list, it’s time to think about solutions. Goals are brief statements about what you want to
change and should be:
•Based on your problem list (at least one should directly relate to the substance abuse)
•Broad (instead of focusing on eliminating a behavior, focus on how to replace a harmful behavior with a healthy one)
•Reasonably achievable during the treatment period
Examples
1. Learn anger management skills.
2. Learn how to express negative emotions to family members.
3. Develop a healthy diet.

31. 4. Objectives
Goals are things you want to change, while objectives are concrete steps you will take to achieve each of those goals. Objectives
should be “SMART”:
•Specific
•Measurable (actions that can be observed)
•Attainable (reasonable to achieve within the treatment time)
•Relevant (related to the issues on your problem list)
•Time-limited (have a target date for completion)
Examples
1. Attend weekly counselling sessions with therapist.
2. Take daily prescription medications, including antidepressants.
3. Practice the 12 steps of Alcoholics Anonymous.
5. Interventions
These are the methods your treatment specialist will use to help you complete each of your objectives.
Example
1. Problem: Inability to control drinking
2. Goal: Develop healthy stress management skills
3. Objective: Attend weekly support group meetings
4. Intervention: Treatment specialist will refer the client to local support groups, monitor weekly meeting attendance, and help
resolve barriers to attendance, such as access to transportation or childcare services.
6. Tracking and Evaluating Progress
Keep comprehensive notes in your chart to track your progress and evaluate whether a treatment is working. This typically
includes details about your response to treatment, changes in your condition, and adjustments to the plan
7. Planning Long-Term Care
Discuss and note long-term maintenance care and relapse prevention. After you've completed initial counselling ( 3 months),
your continuing care plan may include:
•Attending regular 12-step meetings or support groups
•Continuing therapy sessions with a counsellor
•Taking prescription medications, treatment for opioid and alcohol use disorders

32. EXTERNAL SUPPORT AND
RECOVERY CAPITAL
12 step fellowships
SMART RECOVERY
Faith Groups
Family
Friends
Sports/ Culture
Education
Volunteering
FUN

34. LOCAL SERVICES AND THE
PRIVATE SECTOR

35. PRIVATE SECTOR
Places can be funded by local council
Last anything from 4 months to 6 months (generally 3)
Insurance might be an option.
Each treatment centre has a differing modality with differing boundaries. All will be
abstinent based.
Most will include: Group Work, 12 step- CBT- Complimentary therapies- strict guidelines in
regards to substance use, relationships, personal conduct and adherence to certain rules
around appearance and attending groups and 1:1’s. There will be timetables of various
activities that will generally start at 8 am and can go as late as 8-9pm (some with attendance
of AA/SMART as part of contract)
Costs: Between £2-3k for detox and 4-6k for 28 days treatment. High end rehabs can cost
£1000 a day and above.

36. RELAPSE PREVENTION
Relapse is seen as both an outcome and a transgression in the
process of behaviour change. An initial setback or lapse may
translate into either a return to the previous problematic
behaviour, known as relapse, or the individual turning again
towards positive change, called prolapse.
A relapse often occurs in the following stages: emotional
relapse, mental relapse, and finally, physical relapse. Each
stage is characterised by feelings, thoughts, and actions that
ultimately lead to the individual returning to their old behaviour.

37. RELAPSE PREVENTION SKILLS
•Acknowledging that a lapse can be part of the recovery experience and can be used to help the recovery journey
•Strengthening the motivation to change throughout the change process.
•Identifying high-risk situations (Triggers)
•Developing coping strategies and skills to avoid high-risk situations and to deal with them when they are unavoidable.
•Developing coping strategies and skills to deal with lapses.
•Recognising and implementing changes to the young person's environment and lifestyle
•Positive self-talk
•Problem-solving skills
•Anger and depression management
•Coping with craving
•Identify the build-up to relapse
•Relaxation Skills
•Self Care
•Support Networks
Constant review of these elements is required.

39. f.ryan@psychology.bbk.ac.uk
Scope and aims of CBT in Substance Misuse (1)
‡ Engaging and motivating individuals into therapeutic
programmes
‡ Placing substance misuse in a personal context for the
individual (formulating).
‡ Facilitating the acquisition of skills to cope with impulses
driving drug seeking and taking
‡ Enhancing affect regulation
‡ Relapse prevention and follow-up (maintenance
strategies)

40. Scope and aims of CBT in Substance Misuse (2)
Motivation, Motivation, Motivation!
Conceptualising, formulating and treatment planning
Identify high risk stimuli: internal and external
Correct maladaptive beliefs about substances e.g d
d c I d d d a a
Identify the involvement of early maladaptive schemas e.g.
defectiveness or unloveability as contexts for misuse
N a a a c : W ca I d ?
C c a : . . d a a d d ac
Ra a a b . . I d
C c c b a / : O a d a a !

41. f.ryan@psychology.bbk.ac.uk
The Four Ms
‡ Motivate (and engage)
‡ Manage impulses to use
‡ Manage your mood
‡ Maintain lifestyle change

42. THE COGNITIVE-BEHAVIORAL
MODEL OF THE RELAPSE
PROCESS- ( M A R L A T T 1 9 8 5 )
Marlatt GA, Gordon JR, editors. Relapse Prevention: Maintenance Strategies in the Treatment of Addictive Behaviors. New
York: Guilford Press; 1985.

43. DETERMINANTS OF RELAPSE AND
INTERVENTION STRATEGIES FOR IDENTIFYING
AND PREVENTING OR AVOIDING THOSE
DETERMINANTS.
A L C O H O L R E S H E A L T H . 1 9 9 9 ; 2 3 ( 2 ) : 1 5 1 – 1 6 0
Marlatt et al; Alcohol Res Health. 1999; 23(2): 151–160

44. Or, just do two things!
Facilitate impulse
control
Facilitate affective
regulation

45. f.ryan@psychology.bbk.ac.uk
Tried & Tested:
Summary of useful CBT techniques
R a a a
Goal setting
Reality testing/behavioural experiments
Cognitive rehearsal
Identifying underlying beliefs and assumptions
C ( . . a a a ; a )
Problem solving skills
Relapse prevention skills: identifying high risk situations
and rehearsing how to cope with them

46. Conclusion:
You know most of it already! (but please stay until
end of workshop just to make sure)
From a cognitive social learning perspective,
there are no entirely novel mechanisms or
compensatory strategies involved in the
acquisition, maintenance or regulation of
addictive behaviour.
f.ryan@psychology.bbk.ac.uk

47. f.ryan@psychology.bbk.ac.uk
Treatment barriers:
The possible effects of repeated setbacks
Scenario 1: C : I
I
Scenario 2: Therapist blames client ( sometimes with their
/ :
, ( . .
wasting my time!)
Scenario 3: T : I
,
Scenario 4: C :
understand me or my problems and the treatment is
.

48. f.ryan@psychology.bbk.ac.uk
Motivational Interviewing 1
• Opening strategy:
• ask about lifestyle, stresses and problem behaviour
• A typical day
• The good things and the less good things about the
current drug use
• Current concerns

49. Motivational interviewing 2
Elicit self-motivational statements:
. . I d a d
about your drinking, but I was wondering
ab ?
Listen with accurate empathy:
I d a b
tried treatment before you went back to
c ca

50. Motivational interviewing 3
R :
P :
drinking is a big problem, but people who care
C : I ,
.

51. B a a .
Establish rapport through empathy
Focus on raising the issue (i.e. substance
misuse)
Build commitment
Agree goal
Use self-monitoring and reinforcing
feedback
f.ryan@psychology.bbk.ac.uk

52. Dealing with ambivalence
Identify an issue or situation about which
you are ambivalent about taking steps to
change.
In pairs: One to explore the pros and cons of
changing
f.ryan@psychology.bbk.ac.uk

53. : 20 20 20
20 minutes: Review substance misuse, give
motivational feedback, note current
concerns
20 minutes: Introduce session topic (e.g.
coping with craving) & relate to current
concerns
20 minutes: assign homework /practice
exercise for coming week & anticipate high
risk situations

54. f.ryan@psychology.bbk.ac.uk
Session by session monitoring:
COMET
Continuous
Outcome
Monitoring
During
Engagement
In
Treatment

55. Just say no!
When offered drugs:
Say no first
Make direct eye contact
D b a a a
offering
D a
( . . I a )
Be assertive, not aggressive

56. Managing craving
Recognise ab d e. e b c ca e
I de e e a d . I c de ca e e testing personal control
and permission giving beliefs.
Avoid situations rich in drug cues e.g. parties where drugs are
ubiquitous- setting alternative goals is often a good strategy
Identify and rehearse coping strategies e.g. drink refusal skills;
distraction; challenging your thoughts ; review negative
consequences focus on benefits of restraint; talk to supportive
friends or associates on programme

57. f.ryan@psychology.bbk.ac.uk
Implementing intentions to change
If situation X occurs I will perform behaviour Y e.g.
I I a I d b
c ca d a
I I a d a c d a a I a
a , b I d a a a .
Prestwich et al (2006)

58. f.ryan@psychology.bbk.ac.uk
Mindfulness
Mindfulness disrupts automatic flow of cognitions
< contrasts with ironic or paradoxical effects of
effortful suppression>
Mindful acceptance should influence outcomes by
reducing intrusion

59. f.ryan@psychology.bbk.ac.uk
Maintenance
‡ Relapse Prevention Skills Training: identify high risk
situations and how to deal with them.
‡ Attend Twelve Step based groups such as AA/NA
‡ Use self-help materials
‡ Practice mindfulness meditation or other meta-cognitive
techniques
‡ Remember that addiction casts a long shadow:
appetitive responses are enduring and can be re-
established by exposure to stress, small amounts of the
drug of choice (possibly accidental?) and slight or
ambiguous stimulation associated with drug.
f.ryan@psychology.bbk.ac.uk
Summary
‡ CBT can be usefully applied to the spectrum of
substance misuse and commonly co-occurring
problems.
‡ Particular attention must be given to enhancing
therapeutic alliance: Continuous feedback is used to
motivate the client to remain engaged in treatment
despite the inherent treatment resistant nature of
addiction.
‡ Impulse control and emotional control strategies
should be addressed sequentially, but as part of a
formulated treatment plan in a framework that
accentuates cognitive control.
f.ryan@psychology.bbk.ac.uk
References
Newman, C. Substance Abuse in Contemporary Cognitive Therapy.
Leahy, R.L Guilford Press New York, 2004 (pp-206-227)
Irvin, J.E, Bowers, C.A, Dunn, M.E. & Wang, M.C.(1999)
Efficacy of Relapse Prevention: A Meta-Analytic Review.
J. of Consulting and Clinical Psychology. 67.563-570
Witkiewitz, K & Marlatt, G A. (2004) Relapse Prevention for Alcohol and
Drug Problems. American Psychologist. 59. 224-235.
Ryan, F. (2006) Appetite Lost and Found :Cognitive Psychology in the
Addiction Clinic. In Cognition and Addiction. Munafo, M. & Albery, I.
(Eds) OUP.
Routes to Recovery(2009)
http://www.nta.nhs.uk/areas/workforce/routes_to_recovery.aspx

60. PRINCIPLES OF EFFECTIVE TREATMENT-
SUMMARY
1. Addiction is a complex but treatable disease that affects brain function and behaviour.
2. No single treatment is appropriate for everyone.
3. Treatment needs to be readily available. And quickly.
4. Effective treatment attends to multiple needs of the individual, not just his or her drug
abuse.
5. Remaining in treatment for an adequate period of time is critical.
6. Behavioural therapies—including individual, family, or group counselling—are the most
commonly used forms of drug abuse treatment.
7. Medications may be an important element of treatment for many patients, especially when
combined with counselling and other behavioural therapies.

61. 8. An individual's treatment and services plan must be assessed continually and
modified as necessary to ensure that it meets his or her changing needs.
9. Many addicted individuals also have other mental disorders
10. Medically assisted detoxification is only the first stage of addiction treatment and by
itself does little to change long-term drug abuse.
11. Drug use during treatment must be monitored continuously, as lapses during
treatment do occur.
12. Treatment programs should test patients for the presence of HIV/AIDS, hepatitis B
and C, tuberculosis, and other infectious diseases as well as provide targeted risk-
reduction counselling, sign-posting patients to treatment if necessary.