It is commonly thought, amoung counseling professionals, that a client with a substance use problem must be abstinent to achieve any therapeutic progress. Although I agree that it can be productive to work with such a client this does not preclude working with those who are still actively using.
Through much trial and error counselors have been attempting to work effectively with substance users. Many theories regarding recovery have evolved from those methods which have gained the most popularity down through the years. The disease model as exemplified by Alcoholics Anonymous is the most prominent example of this; in fact the AA philosophy dominates the substance abuse field. Originating as a grass roots movement, AA has become part of the establishment in a sense and it’s proponents are often viewed as authorities on substance abuse treatment. This authority is based upon the experience of those who have had substance use problems themselves. Their testimony as to what works and what does not has been powerfully essential to building the consensus among counselors regarding total abstinence as a prerequisite to positive life changes.
The unfortunate thing is, as useful as this view is, it is not the total picture. The prevailing view of those in the recovery community, in both lay and professional roles, has ultimately led to the exclusion of those whose recovery does not fit neatly into this box. The reality is that professionals can assist those who are still actively using to use more safely and to move toward abstinence when ready and prepared to do so. In the end we need to be flexible in our approach and provide the right kind of help at the right time. More about this in another post…
This information is for educational purposes only and should not in any way be considered a substitute for professional help. If you feel that you need immediate assistance please call your local psychiatric emergency services or the SAMSHA Disaster Distress Hotline at 1-800-985-5990.