SRP for Clients with CD - Adapting the SRP Approach - Treatment

Excerpted from Structured Relapse Prevention: An Outpatient Counselling Approach.

• Adapting the SRP Approach
  • Introduction
  • Screening and Assessment
  • Treatment
  • Other Issues of CD-Adapted SRP
  • References
• PDF version of Adapting the SRP Approach

Harm reduction (see Skinner & Carver, 2004) is seen as the most desirable treatment philosophy in working with a population that may not be willing or able to accept abstinence-based goals. Despite the recognition among health care professionals that abstinence is an ideal goal for people with concurrent substance use and psychiatric disorders, most experts in the field acknowledge that returns to substance use (i.e., relapses), are a reality of working with this client population. A harm reduction approach brings with it an understanding of the need to continue to work with these clients even (and especially) when they are not abstinent.

Further clinical challenges include compliance issues with taking prescribed psychiatric medication and ambivalence about changing or stopping substance use. The recommended response is to set small, incremental goals. Keeping clients engaged in treatment is preferable to mandating abstinence, as treatment engagement increases opportunities to continue to facilitate and support positive change. Finally, treatment outcomes can be measured by more than just adherence to substance use goals or medication compliance. It is important to also assess a client’s overall level of functioning, use of coping strategies and support systems, community integration, vocational rehabilitation, social and interpersonal functioning, and other target areas as evidence of good treatment outcomes.

Modifications to Counselling Procedures and Clinical Tools

Research in Motivational Interviewing approaches suggests that clinical tools and techniques developed for people with substance use problems need some adaptation when they are used with clients who have concurrent disorders (Martino et. al., 2002; Graeber et. al., 2003; Steinberg et al., 2004). Given the motivational orientation of SRP, it is not surprising that the SRP treatment sessions and clinical tools require some modification for use with this population.

This section outlines such an adapted version of SRP for use with clients with concurrent disorders. While not as rigorously evaluated as the “generic” version of SRP, the CD-adapted protocols and tools were developed in collaboration with a group of inpatient-based and community-based clients with concurrent disorders, and reviewed and revised in light of responses by a cross-disciplinary mix of clinicians working in both substance use and mental health specialties.

Although further research is needed to establish the efficacy and effectiveness of SRP with clients who have concurrent disorders, the goal of sharing our understanding and experience is to allow others to take advantage of the gains that we have made, and to join us in pursuing further knowledge in this area. Therefore, we suggest that you let your clients be your guide in implementing these tools: they are the most expert in the treatment structure, format and content that will best fit their needs.

The revisions needed for running an SRP group for clients with concurrent disorders include:

• shortening group duration (90 minutes, as opposed to two hours in the “substance-use-only” SRP group)
• using fewer clinical tools per treatment session (we found that even one or two paper-and-pencil tools could be overwhelming for some clients with concurrent disorders)
• modifying clinical tools to incorporate CD-specific treatment goals (such as taking prescribed medications, or coping with the symptoms of mental illness and/or the side-effects of prescribed medications)
• spending more time in the group processing discussion around access to services, and navigating the mental health and substance use treatment system
• making the clinical tools easier to complete.
• including a follow-up SRP group three to four months after the last weekly session, in order to review ongoing or emergent treatment needs, to help clients progress toward their goals and to identify next steps.

This section includes CD-adapted Therapist Checklists for each session, as well as revised versions of the relevant clinical tools from parts II and III of the manual.

NOTE: We have indicated the tools that have been altered for clients with concurrent disorders by appending the notation “CD Adapted.” Any tools listed that are not identified as “CD Adapted” are identical to the non-adapted versions, which can be found earlier in this book.

Return to the index of excerpts from Structured Relapse Prevention: An Outpatient Counselling Approach.

• Print
  Share |