SUDs Treatment Goals

Before attempting treatment with substance abusing patients, professionals must assess their needs and problems and establish goals for treatment. Without doing so, both the patient and professional run the risk of being side-tracked during the process and missing their objectives. Just as the assessed needs and problems of each person develop into a unique configuration for that individual, the treatment goals and plans also must be distinctive and realistic. The goals become the guide by which the rest of the treatment plan is directed, implemented, and evaluated. Among the possible goals that may be appropriate for individuals entering treatment are the following (Institute of Medicine, 1990; Schuckit, 1989; Vuchinich, Tucker & Harllee, 1988):

End substance abuse. Recovery is the process of initiating and maintaining abstinence from alcohol or other drug use. It also involves making personal and interpersonal changes (Daley & Marlatt, 1992). Whether an individual is addicted to or abusing alcohol, illegal drugs, prescription drugs, or a combination of these, the most important goal is to discontinue the use of alcohol and/or drugs. In some cases, it may be a feasible aim for a person to control his or her alcohol consumption or the use of prescribed medicines. However, most chemically dependent persons will have difficulty with this, and many will find they must adopt a goal of abstinence if they are to enter recovery.

Improve health. Chemically addicted persons typically have concomitant health problems. These vary widely, and some illnesses are closely associated with the use of specific substances. In some cases, health problems may have preceded the initiation of substance abuse. Medical care. Appropriate medical attention should be a high priority for many patients. It is especially important that patients who are pregnant, at risk for HIV disease, or exhibiting symptoms of severe illnesses, such as pain and convulsions, receive immediate medical attention. General health. Overall improvement of health includes helping the individual develop positive health practices. This may include a regular and enriched diet, vitamin supplements, sufficient sleep, and regular exercise. Routine and corrective dental care may be needed, as well. Risk reduction. Patients need education and assistance in ending specific practices that place themselves at risk for diseases. Drug injection practices, as well as unsafe sexual behaviors, are associated with the transmission of HIV (the causative agent of AIDS) and other infectious diseases. The spread of tuberculosis also is increasing rapidly among drug-involved persons.

Treat psychiatric disorders and psychological problems. Long-term use of several substances of abuse, including alcohol, can result in neurological damage, as well as other psychiatric and emotional problems. Brain impairments can affect a person's mental and physical abilities and emotional control. Other psychiatric disorders, such as manic depression, antisocial personality, or schizophrenia, may be present before the development of chemical addiction. Emotional, psychological, and psychiatric disorders may interfere with treatment efforts. Treatment providers should recognize the indicators of these problems and provide or refer patients for evaluation and treatment.

Meet employment and educational needs. School performance and attendance problems are highly correlated with substance abuse among young people. For adults, addiction often affects employment, sometimes resulting in under- or unemployment. Treatment not only needs to help individuals resume patterns of productive employment or educational involvement, it also may be necessary to address deficits that have accrued during the period of substance abuse and addiction. Youth may need remedial education services; both youth and adults may need vocational training and other skill development related to seeking and maintaining appropriate employment. Reduce criminal behavior and resolve legal problems. There is a strong possibility that many persons who are chemically dependent also may be involved in illegal activities. This may include income-generating crimes (e.g., shoplifting, burglaries, prostitution), expressive crimes (e.g., assault, homicide), and drug-related charges (e.g., drug possession, drug sales). Treatment for substance abuse has been linked with decreases in the amount of criminal activity in which an individual engages. Whether individuals are within the criminal justice system or not, many will be facing legal problems. In some cases these may be related to civil matters, such as divorce, child custody, and other suits. Those who are aliens to this country may need to resolve issues related to their immigration status. All of these persons may need help in understanding the complex legal system. They also may need the services of an attorney to represent their interests. However, they may be unable to locate or pay for such help. Therefore, an important goal is to help the person understand and resolve legal problems so his or her attention can be more firmly focused on the substance abuse treatment.

Improve personal circumstances: Personal values. Through treatment, the individual's beliefs and attitudes in various spheres should be examined. Exposure to other viewpoints and discussion of problems that may have resulted from previous perspectives can be helpful in bringing values about work, family, and the law more closely in concert with those of society.

Coping skills. Substance abuse is often a result of inadequate coping skills, or the inability to function satisfactorily in the environment. The coping skills needed often include stress management, decision making, assertiveness, parenting skills, financial management, personal care (e.g., nutrition and physical hygiene), and many others. The lack of these coping mechanisms may interfere with progress in treatment programs. Basic needs. Many persons with serious alcohol or drug dependencies may not be able to meet even their basic subsistence needs for shelter, food, and clothing. Providing assistance in these areas will, again, help center attention more clearly on the individual's treatment goals. It is also important that individuals learn skills to help them achieve greater control, independence, and autonomy in these areas in the future. Positive social support systems. Formal and informal support systems are vital to every person. These support systems are composed of family members, friends, co-workers, churches, and social organizations, among others. They help persons with basic needs and personal care, provide a sense of belonging, and afford opportunities for emotional expression. For many chemically dependent persons, previous social relationships have been lost, were never formed, or were part of the substance abuse problem or environment. Thus, it is important to help them develop positive, trusting relationships within and outside the treatment setting.