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close this bookResponding to Drug and Alcohol Problems in the Community (WHO, 1991, 109 p.)
close this folder5. Helping the individual with drug- or alcohol-related problems
View the document(introduction...)
View the documentHelping a drug-dependent person
View the documentAssessment
View the documentDetoxification
View the documentSpecialized interventions
View the documentFollow-up and after-care

Specialized interventions

Social supports and relationships

A person with a drug- or alcohol-related problem needs to have regular contact with other people, who can often help simply by listening and giving encouragement. One role of the PHC worker is to identify people who might be able to help in this way. They might be relatives or friends, former drug users, a priest, or volunteers.

Another valuable role for the PHC worker is to encourage better communication between clients and their families. One simple method of helping people to communicate is outlined below.

Helping communication

If a husband and wife are communicating badly, the PHC worker should concentrate on teaching them ways of improving their communication skills. First of all select an object, such as a piece of fruit or a stone. Explain that only the person holding the stone is allowed to talk. Give the stone to the husband, who should then talk for about one minute. His wife should then take the stone and summarize what her husband said. When a correct summary has been made, the wife should continue to talk, expressing her own views for about one minute. She then passes the stone back to her husband and he summarizes her statement. This whole cycle is then repeated.

This simple strategy can help to develop good communication skills involving active listening and summarizing.

Helping a family usually involves the following components:

- increasing ability to communicate in order to solve family problems more efficiently;
- increasing the amount of praise, and the frequency of positive comments, within the family;
- reducing the frequency of conversations about negative incidents in the past.

Developing confidence In ability to change

Most people with drug or alcohol problems have tried to change many times. After repeated failures they usually experience feelings of helplessness whenever they try to change, or even when they think about trying. The PHC worker should discuss these feelings and provide encouragement and hope by:

- pointing out that nearly every person suffering from drug problems actually tries to stop many times before finally succeeding;

- discussing any small (or large) successes in the past and pointing out that the same can be achieved again;

- as treatment progresses, keeping an eye open for small successes, praising these, and encouraging the patient to keep trying;

- when a relapse occurs, pointing out that this is bound to happen from time to time; preventing relapse is a skill that has to be learned.

Clarifying reasons for changing

Some patients know exactly why they need to reduce their drug use. If this is the case, then they should be reminded of their reasons regularly and vividly. The following strategy can help:

· Identify the two or three main reasons why the patient should stop or reduce his/her drug or alcohol use. For example:

- to save his/her marriage,
- to improve health and fitness,
- to save money in order to take a family holiday.

· Now find an activity that your patient does regularly every day (e.g., drinks eight cups of tea throughout the day).

· Ask your patient to think about the reasons for stopping or reducing drug or alcohol use and to build up a positive image, e.g., of a good marriage, a healthy body, or a happy holiday.

· Now ask him or her to bring these images to mind every time he or she has a cup of tea; in this way, the patient is more likely to have these images in mind when faced with a tempting situation.

Alternatives to drug use

If a patient lives alone and has no job, no friends, no interests, and no hope, commitment to change will be low and relapse will be likely. The PHC worker should try to get the patient to take up one or more pleasurable activities that do not involve drugs. One possible strategy involves the four steps outlined below:

· devise a short list of possible activities;
· select one or two activities that are of interest to the patient and can be easily taken up;
· obtain the patient's commitment to become involved in these activities;
· take a keen interest in your patient's achievements.

Initially, tasks should be small, specific, and achievable, e.g., walk to the next village and back on Monday, Wednesday, and Friday (not simply, go walking).


Encourage the patient to take up a specific activity.

Preventing relapse

One of the tasks of assessment is to identify high-risk situations and mood states that have, in the past, resulted in relapse. For example:

· a family row;
· when the patient is in the company of a particular person;
· when the patient has a whole weekend ahead with nothing to do.

The PHC worker and the patient should together try to think of ways of coping with or avoiding these situations. List possible coping strategies and then select the most appropriate ones. For example:

Problem:

What to do about my desire to use drugs when I have nothing to do at the weekends?

Solutions:

1. Always plan weekends as far ahead as Wednesday.


2. If the desire to use drugs starts to increase, then take a bus to go and see an uncle in the country.


3. Think of the reasons why I have given up drugs when I am doing a pleasurable task, such as digging the garden.


4. Go for a very long walk.

Selection:

3 and 4.

Crises and relapse situations are bound to occur during the follow-up period. One approach to crisis intervention is to build on a simple but systematic approach to problem-solving, such as the one outlined above. Crisis intervention is described in more detail below.