Substance Use Treatment
Role of the MHP in Prevention & Treatment of SUDs
✺ The frequency of SUDs is so pervasive in the helping field that the lack of training in this area would result in inadequate preparation for MHPs
✺ MHPs should be knowledgeable about the different models of addiction, as well as evidence-based treatment strategies
“The SUD field requires an openness on the part of the MHP to consider a wide variety of possible causes of SUDs and to employ a multitude of methods by which people recover from these problems”
The 4 Transdiciplinary Foundational Competencies
✰ Understanding SUDs
✰ Treatment Knowledge
✰ Application to Practice
✰ Professional Readiness
Prevention
✰ The Substance Use Disorder Counseling Competency Framework: An Overview
Functional 10 page doc regarding SUD treatment competencies
✰ TAP 21 - Addiction Counseling Competencies: The knowledge, Skills, and Attitudes of Professional Practice
Foundational text of SUD treatment field
Alcohol & Tobacco
✰ Legal substances cause more harm to society than all illegal drugs combined & cause more health-related problems
✰ “Gateway drugs” typically include alcohol, tobacco, & marijuana
✰ They are more readily available & viewed as exciting & adult-like
✰ The alcohol & tobacco industries put billions of dollars into their advertising campaigns
✺ Most prevention efforts are directed towards young people
✺ Important to prevent the use of legal drugs, as well as illegal & illicit drugs
✺ Most treatment & prevention dollars are distributed through SAMHSA grants
✺ Policy DOES affect prevention
✺ The amount of money dedicated by the government to supply reduction (through law/military) is not justified
✺ Prevention programs funded by the federal government have 3% the budget that the alcohol industry has for ads
Drug-Free
✺ More productive to advocate for a logical and comprehensive discussion of our policies regarding alcohol, tobacco, and illicit drugs than to discuss the legalization of illegal drugs in isolation from other substances
✺ Extremely controversial policy issue
✺ Often confused with decriminalization, which would prevent the incarceration of drug users who do not commit other crimes, while keeping distribution illegal
✺ Discussing the legalization of THC, cocaine, methamphetamines, & heroin together does not make sense as the chronic effects and dangerousness of these drugs are vastly different
Legalization
VS
✰ Drug free goals often do not include tobacco and alcohol
✰ While “Drug-Free” may be politically popular, this idea may divert attention & resources from effort to prevent the use of alcohol & tobacco
✰ Based on the premise that drug use cannot be eliminated from society, that the abuse of any drug can cause harm, & that strategies can be inplemented to reduce the harm caused
✰ Examples include needle exchanges, sobriety checkpoints
Harm Reduction
Resources
Principles of Drug Addiction Treatment: A Research-Based Guide (NIH, 2014)
✰ Includes: Principles of effective SUD treatment, FAQs, overview of SUD treatment landscape in the US, & outlines evidenced-based treatment approaches
✰ Long-document, but LOTS of good information & resources
Citations
✺ Fisher, G. L., & Harrison, T. C. (2018). Substance Abuse : Information for School Counselors, Social Workers, Therapists, and Counselors (6th ed.). Pearson.
“In the same way that people deny that a relationship has become destructive, the addicted individual may deny that AODs have become destructive in spite of objective evidence to the contrary”
✺ The defense mechanisms of denial, minimization, projection, and rationalization are used
Racial Disparities in SUDs
Systemic Racism and Substance Use Disorders
There are racial disparities in SUDs
✺ The burden of disease is disproportionate among Black, Latinx, and Indigenous people
Factors that underpin SUD-related racial disparities in the US
✺ Deeply-rooted institutional racial biases that structure the experience of all Americans
✺ The effect of racism-related stressors on the biopsychosocial functioning of non-White people
✺ The conscious and unconscious biases that shape behaviors directed at people of color
✺ Current racial disparities in SUD outcomes find their beginnings in the overtly racist framework of early drug policy
Systemic racism operates differently and has diverse effects on producing health disparities in different racial groups
✺ These are often understudied
✺ Other forms of systemic discrimination cause health disparities as well
Structural Factors
✺ Structural racism refers to how the collective practices of multiple interlocking institutions within a society have discriminatory effects based on race (ie housing, education, health care, banks, and media representation)
✺ The way that SUDs have been criminalized have targeted and negatively impacted specific communities (ex: war on drugs movement)
Racism & Stress
✺ sychological stress increases likelihood of developing a SUD
✺ Racism and other discriminatory acts increase stress and likelihood of substance use
✺ Differing views and models regarding cause of the racial disparities within SUDs
Biases within Substance Use Treatment Systems
-Implicit Bias: unconscious mental processes that lead to unrecognized mental processes that lead to unrecognized negative feelings and judgments toward specific people based on their group affiliation or identity
-Clinician bias shapes health care decision making
-A discriminatory implicit bias becomes discriminatory treatment actions
Recommendations
-Best practices in the treatment of SUD are clearly defines and should be distributed equally to all
-It’s crucial when working with minority communities in SUD treatment to address additional factors like decades of violence, poverty, stigmatization, widespread incarceration, and generational SU
-Should collaborate with as many systems as needed/possible