I am a 49 year old married man with three children. This is a second marriage so I have a step daughter as well as three natural children of my own. I am currently in recovery from alcohol and drugs and have been coming up on 12 years. I am first and foremost a husband and father, son, brother, as well as now a clinician, certified substance abuse counselor. And I am a consultant and trainer. I am training nationally in substance abuse issues.

I have a private therapy practice here out of my office. And I take on just a few clients because my training schedule is so extensive. I was just in New Hampshire two days ago and I was in New York the week prior to that. Next week it’s California.

My focus is strength-based strategies, how to help mandated clients and staff working with mandating clients to bring more dignity, respect, and motivation to clients who are court-ordered to cooperate with counseling and substance abuse treatment services. Agencies, courts, substance abuse centers contract with me to come provide training to their staff.

Q: Should treatment differ based on whether patients come voluntarily or through the courts?

Yes, it is very much a different- it is trying to gain more of the perceptions and goals and methods to reach those goals from the client rather than from us. It is to share in the helping process more with the addict and the alcoholic rather than telling them in a very heavy-handed fashion. Traditional treatment can be highly confrontive and strength-based treatment stresses that most behavior change happens naturally, without any contact with the treatment world. Research shows that 40% of behavior change comes from the client- what they already come in the door with. Another 30% comes from the relationship, what we develop with them. Only 15% comes from us.

What that means is that it’s not about, it’s not similar to the disease model from medicine. In other words, if you have problems with sugar diabetes, well you go in and see a doctor and through the doctor’s expertise, they can prescribe medications to get your body back to normal. This doesn’t work that way. Therapy, psychotherapy, working with patients in the behavior realm is not the same. It’s not the expert doctor telling the patient what meds to take. This is very different in the mental health field. The relationship has to be shared. Yes, they do want some expertise from you, but any help that gets going is by the shared nature of the endeavor.

The last 15% is hope and expectancy, that you can instill hope in hopeless clients. Sometimes it’s called the “placebo effect.” If the client think they are going to be helped, that certainly does well for their problems.

It means the real engine to change is the client, not the counselor. It’s the client that truly brings the change. And that’s not how the field looks at it. And I think this impacts drug policies across the country. We look at addicts and alcoholics as… less than, unable to think or provide for themselves, as needing something put into them, education, confrontation. This model says we need to draw things out of them. I am doing a lot of training in motivational interviewing, an evidence-based practice as deemed by the Department of Justice, the Department of Health and Human Services as it can draw out of the client motivational aspects. It’s more of a partnership. The real crux of that is- where is an addict or alcoholic’s life right now? And where do they want it to be?

Behavior change is very complicated. There’s not one route to behavior change. With addicts and alcoholics, we have to focus on their perceptions, values, their way of living. Some people do very well with the disease concept, with 12-step groups. They like the thought that they aren’t responsible for having the disease, but they are responsible for coming out of it. They like to take on the mantle and label of alcoholic and addict. It is helpful for them. There are people who are refractory to that. They don’t like to take on labels, they want it to be more of a singular process. The field of treatment is set up to accept labels- accept powerlessness and addict and alcoholic. Which would be fine, but that’s not founded in research. Labels and diagnoses are not robustly correlated at all with outcome. What this amounts to, is if it’s important to my client, then it is important to me as their counselor. But I don’t want to come into my work with an alcoholic-addict with my pre-ordained theories of what they need. I need to hear it from them and then fit my techniques and strategies based on how they’re put together.