Responsibility is a key consideration the moment you take on a professional relationship. Both the therapist, and the client, has responsibilities that must be articulated and observed. Two key considerations are the individual’s responsibility for having an addiction and the individual’s responsibility for obtaining treatment. The purpose of this essay is to leverage core competencies to identify strategies that ensure these two considerations are adequately addressed. As a measure of efficacy and efficiency, objective measures are required to ensure that the interventions we employ provide maximum therapeutic benefit. Finally, some key roles and responsibilities of the human services provider are presented in effort to provide clarification on the issue of responsibility.
When we discuss the responsibility of the individual client to obtain treatment, most clients rely wholly on the providers themselves to determine which constellation of services represents a best fit solution for any one individual client. “As a provider of human services, you take on the responsibility of meeting the needs of your clients to the best of your abilities. This means providing those services for which you have been trained and which the law permits you to provide and not withholding these services from persons in need.” (Center for Substance Abuse Treatment, 2008, p. 15) Clients should be prepared to ask questions about scope of practice. Clients should be prepared to inquire about case management and the ability (or inability) of any individual player to work within and within a multidisciplinary team environment. Clients whom wish to make informed decisions about treatment need to know that there are a wide variety of options available to them, and they should expect a treatment program provider to have some measure of acumen when it comes to identifying which resources are likely to be leveraged in treatment. As an example, take a typical case of nicotine dependence… Smokers who really want to quit will typically seek help from a general practitioner or primary care physician, not a licensed alcohol and drug counselor. How many general practitioners have you met that can provide “pharmaceutical treatment, education about common problems associated with cessation, and emotional support to patients attempting to quit[?]” (Center for Substance Abuse Treatment, 2006, p. 94) General practitioners have a moral and ethical obligation to provide referrals for those services which they cannot adequately provide. After all, if the patient is in the general practitioner’s office, they are already in the contemplation stage of change. If there is to be any real progress for the addict, we as providers must be competent enough to provide a clear path to complete recovery. It is our responsibility as professionals to motivate the client to take personal responsibility for the referral and follow-up. In the event that suitably referrals are unable or unwilling to fulfill the needs of the client, it is the responsibility of the human services professional to advocate for the client when needed. (Center for Substance Abuse Treatment, 2006, p. 71)
“Although counselors want their work to be successful, the client’s future is the client’s responsibility. For the treating clinician, the task at hand is to let go and allow the process to work. The importance of this concept can’t be understated – It’s not my recovery, IT’S YOUR RECOVERY. “Clients must assume responsibility for their recovery.” Human service providers can’t do the work for you – our role is to facilitate the process of identifying and selecting a competent treatment provide. Although we will certainly provide strategies, knowledge, skills, and attitudes needed for maintaining treatment progress and representing relapse – a toolbox is only as good as the mechanic. (Center for Substance Abuse Treatment, 2006, p. 111) The very definition of sobriety is the quality or condition of abstinence from psychoactive substance abuse supported by personal responsibility in recovery.” (Center for Substance Abuse Treatment, 2006, p. 174) Without personal responsibility, the clients’ prognosis will almost assuredly plummet. To that end, human services provide interventions intended to augment personal responsibility and awareness of the problem. Personally, I subscribe to the diathesis stress model that would attribute the disease/disorder to a genetic predisposition that is exacerbated by environmental factors like adequate social support. Most clients I have experienced need guidance in understanding the basic process of addiction. Availability of competent chemical dependency treatment, or, dual diagnosis treatment in the case of patients whom suffer from comorbid psychiatric issues, is an issue that should be addressed with the utmost urgency. Inevitably, resistance will appear and we will collaborative address factors that diminish personal responsibility such as social or cultural dissidence, latrogenic addiction, and adverse environmental factors that inhibit the progression of recovery. Onother significant obstacle to overcome addiction is to address addiction as both a disease and a lifestyle. (Walters, 1992) Finally, from a neurobiological perspective, we are steeped in controversy around the notion that “self-control” is impaired in addicts due to a pervasive “disease mentality” which erroneous attributed addicts’ behavior to chemicals rather than individual responsibility. (Lyvers, 2000) Motivational interviewing plays an integral role in overcoming ambivalence to change. Clients need to be able to voice personal goals and values in a safe environment. Individualized client centered treatment is a responsibility that is shared by provider and client. Missteps will be made by both parties: compassionate and competent treatment provides preemptive plans for success and failure so there are no surprises in future crises.
Center for Substance Abuse Treatment. (2006). Addiction counseling competencies: The knowledge, skills, and attitudes of professional practice. Technical Assistance Publication (TAP) Series 21. Retrieved from DHHS Publication No. (SMA) 08-4171 Rockville, MD: Substance Abuse and Mental Health Services Administration
Center for Substance Abuse Treatment. (2006). Detoxification and substance abuse treatment. Treatment Improvement Protocol (TIP) Series 45. DHHS Publication No. (SMA) 06-4131. Rockville, MD: Substance Abuse and Mental Health Services Administratio
Center for Substance Abuse Treatment. (2008). Managing depressive symptoms in substance abuse clients during early recovery. Treatment Improvement Protocol (TIP) Series 48. DHHS Publication No. (SMA) 08-4353, 15. Rockville, MD: Substance Abuse and Mental Health Services Administration
Lyvers, M. (2000). “Loss of control” in alcoholism and drug addiction: A neuroscientific interpretation. Experimental and Clinical Psychopharmacology, 8(2), 225-245. http://dx.doi.org/http://dx.doi.org/10.1037/1064-12126.96.36.199
Walters, G. D. (1992, Apr). Drug-seeking behavior: Disease or lifestyle? Professional Psychology: Research and Practice, 23(2), 139-145. http://dx.doi.org/http://dx.doi.org/10.1037/0735-7028.23.2.139