Facilitative Strategies for Retaining the Alcohol-Dependent Client in Outpatient Treatment

Abstract

Facilitative strategies for preventing early withdrawal from treatment among alcohol dependent clients are described. These strategies are amed at identifyin and resolving problems arising in treatment which might eventual k y lead to premature terrnination. Role induction, eliciting reflection on treatment, eliciting self-motivational statements, delaying commitment to change, immunization, exploring and interpreting noncompliant behavior are the techniques discussed in the paper. The various circumstances under which different strategies are employed are specified in order to demonstrate the utility of the intervention package. Tables and case illustrations are used to provide further detail on the implementation process.

Help-Seeking by Substance Abusers: The Role of Harm Reduction and Behavioral-Economic Approaches To Facilitate Treatment Entry and Retention

“…Interventions based on these motivational principles have been shown to facilitate referral for and continuation in alcohol treatment (Bien et al 1993;Zweben et al 1988); they have also been applied to drug users (Saunders et al 1991;van Bilsen 1991van Bilsen , 1994, although motivational interventions used to encourage drug treatment entry have varied in approach and outcome. Saunders and colleagues (1991), for example, described a two-session motivational intervention used with heroin addicts who were beginning methadone maintenance that appeared to incorporate the general principles described by Miller (1989;Miller and Rollnick 1991) as well as specific interventions derived from identified components in the self-change process among drug users.…”

Strategies for Preparing Clients for Treatment

“…Before addressing strategies for enhancing treatment involvement, it is worth noting that although a specification of client variables related to treatment dropout holds promise for understanding this complex issue, there must be caution against focusing too narrowly on client characteristics. A major reason for such caution is the resultant implication that client dispositions or "traits" are the major source of variance in dropout from treatment (Miller, 1985;Zweben, Bonner, Chaim, & Santon, 1988). This concern has led to development of a broader perspective on the problem of dropouts, namely an interactionist model that entails an appreciation of not only client characteristics, expectations, and needs, but also counselor behaviors and features of the therapeutic environment (e.g., Garfield, 1994;Kanfer, 1993;Miller, 1985;Miller & Rollnick, 1991).…”

Video-tape role induction for psychotherapy: Moving forward.

“…Research on RI continued in the 1980s; RI methods were applied to more specialized populations (e.g., Lambert & Lambert, 1984, with immigrant clients seeking services; Stark & Kane, 1985, in therapy targeting substance abuse, and Zweben, Bonner, Chaim & Santon, 1988, for therapy targeting alcohol dependence), with generally unilaterally favorable results. Thus, through the 1980s, there has been a large body of literature which appears to indicate that RI is effective in producing positive results for a variety of desired therapy measures.…”