Drug abuse is a serious illness affected millions of young people in the USA. Again, a number of different causes of death are analyzed separately and attributable mortality is estimated. However, the basis of this estimation is in general far from clear, and certainly cannot accord with attributable risk estimation, since the references cited do not in general provide sufficient information to permit estimation of the attributable risk of mortality due to alcohol. They either report associations between alcohol and deaths from various causes without controlling for other risk factors, notably smoking, or are simply earlier guesstimates of the proportions of deaths from various causes due to drug abuse. Attempts to establish the costs to society of drug consumption are not uncommon, in the form of calculations of revenues and costs to the state of dealing with the effects of abuse. Researchers admit that effective counseling could help many drugs addicts and their families in stressful situations.
The main and the most effective counseling method is group therapy. Group therapy helps the counselor to share ideas and opinions and create a positive and friendly climate. In group therapy, all clients begin to concentrate their attention on their bodily feelings when they move toward a situation in which they have previously had a problem. The more the clients concentrate their attention on these problems and solutions, the stronger the positive feelings become. The meeting points to the importance of the client’s imagery and misinterpretation in the genesis of the emotional problems (Cinebell, 1998). Clients are somewhat more successful when the information regarding the emotional nature of their feelings is presented to them by another person. When they change focus from their symptoms and refocus on affirmations from another person, the corrective data becomes more salient or perhaps, the "closed system" quality of frightened thinking becomes more permeable to external information (Craig, 2003)
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In group therapy, internal experiences are typically instigated by social situations, phobic events, or being alone, but from time to time occurred as the result of emotional factors such as hypotension or hypoglycemia. The next stage in the treatment of the cognitive disorders is the interpretation of these feelings. Such problems as severe distress, total disability, and duration are usually similar to signs and symptoms observed by other clients. These issues support the opinion that drug addiction and psychological disorders are characterized by ideation associated with fixation on physical or mental experiences. The counselor can guide the discussion with the help of direct questioning, induction of imagery through forced fantasy method, induction of imagery through hyperventilation, and use of questionnaire. The group therapy helps clients to feel support and interact with people who experience the same problems and troubles (Craig, 2003)
Community groups that promote open and honest communication, have formal and informal mechanisms for exchanging information regularly, and agree on a common purpose have the essential building blocks for mounting a successful community health program. Coordination refers to organizational planning, objective setting, and health services delivery. By definition, comprehensive community health programs require diverse community organizations and constituencies to coordinate efforts. Significant barriers to coordination include territoriality, competition, ineffective communication, and lack of resources. Collaboration is the most complex function faced by community groups because it requires multiple constituencies to work for jointly determined goals and objectives (Cinebell, 1998).
Underlying adaptation are the concepts of change and coping used by counselors. Thus, adaptation refers to the components in systems, and the systems themselves, being in a constant stage of influence, flux, accommodation, and change. Fmality is a concept taken from systems theory and refers to the idea that there are many paths to a final state (Cinebell, 1998). Succession refers to the notion that over time, forms of life change in a regular sequence. In addition, an ecological approach is oriented toward studying naturally occurring phenomena and contributing to improving or maintaining the functioning of bio-psychosocial systems. The ultimate goal of most health interventions, regardless of the level of analysis, is to improve the health status of individuals as individuals, not systems or environments, experience illness and health. In the case of a community intervention to reduce tobacco use, for example, the focus of macro-level interventions (e.g., increasing the tax on cigarettes) may also influence the actions that individuals take (e.g., not purchasing cigarettes). Similarly, a goal of many micro-level interventions (e.g., teaching worksite employees how to quit smoking) may influence actions taken at higher levels of analysis (e.g., implementation of a worksite smoking policy). There are interactional and synergistic connections among levels of analysis. The means by which individuals are reached and influenced, however, can vary as a function of the level at which one intervenes. In more cases than not, there is a reciprocity of influence between levels of analysis. Focusing on one level has concomitant costs and benefits. Curtailing and eventually eliminating smoking in the workplace may require changes in organizational policies that are mutually agreeable to management and labor, implementation of coworker support programs, and availability of cessation programs for individuals attempting to quit smoking. Outcome expectancy refers to a person's belief that a behavior will result in a specific outcome. It is unlikely that a person will expend time and effort to bring about a change if it is perceived that the change will not have the intended effect. Perceived incentive value refers to the relative importance placed on a possible outcome. In general, people are more likely to engage in a behavior if they consider the behavior to be important (i.e., valuable) (Craig, 2003)
The best counseling interventions applied to drug abusers achieve changes in a small proportion of the target population, many of whom were motivated to make a change in the first place. Furthermore, many changes achieved in the short term are not sustained over the medium, and long term. Because there is publication bias favoring interventions with positive effects, it can be assumed that taken together, the true effectiveness of all interventions in a particular health area is lower than published studies. The clinical approach is concerned primarily with disease etiology among individuals and targeted methods to reduce risk or treat disease among these individuals (Powell, 2002).
Counseling can be oriented to active prevention (i.e., policies that require individuals to take action in order to be protected) or passive prevention (i.e., policies that protect individuals without the individual engaging in a health protective behavior). In the case of interventions to reduce motor vehicle fatalities, for example, active strategies might include driver education around safe driving habits or seatbelt education programs. The tradition of counseling is to persuade individuals to change their behavior patterns. Drug- related policy interventions might include regulations requiring labeling of social policies and advertising to facilitate informed choice. Community interventions are popular because they have the potential to improve health above and beyond what can be achieved by individual approaches alone. Indeed, part of the rationale underlying the efficacy of community intervention is the belief that changing the community at-large is a more cost-effective means to achieving societal health goals then reaching individuals one person at a time. Also, community interventions have the potential advantage of delivering beneficial programs both to those who explicitly desire assistance as well as to those who could benefit from intervention but who do not know if they could benefit or who do not have access through more traditional service delivery mechanisms (Powell, 2002).
An important result of skillful entree is the health promotion specialist's cultivation of trust among community constituencies who are most concerned and/or affected by a presenting health issue. The concept suggests that trust engenders the absence of perceived harm. The entree process, if well-organized and based on an accurate understanding of community dynamics, enables the community health promotion specialist to be sensitive to community concerns and to approach community members in a way that produces trust. Often, the health promotion specialist will have to overcome citizen reservations in order to gain their support (Juhnke 2005).
With respect to monitoring and evaluation of community drug abuse initiatives, it is often the case that community groups do not have the expertise and financial resources to monitor progress and results. Consequently, community development experts have begun to develop monitoring and evaluation systems that can be implemented in collaboration with nonprofessionals. A goal of such evaluations is the transfer of expertise to the community members to build capacity and to empower community groups to implement self- monitoring and evaluation of community health promotion initiatives. Approaches that establish partnerships with community members and build monitoring and evaluation skills may be viewed as a type of capacity building intervention. From the standpoint of democratic principles, the most effective health education strategy is one that raises the levels of awareness and concerns for groups at health risk and enables them to devise their own strategies to reduce risk, strategies that are valid culturally and contextually. On practical grounds, change in health behavior and status is more likely to occur when the social and cultural context is altered to support pro-health options (Juhnke 2005).
Drug addicts can be quite persuasive and dramatic with their presenting complaints. It is important for the therapist not to overreact or inappropriately become part of the drama. Although the intensity of the client's pain can be quite real, the therapist must not become too enmeshed in the client's alarmed view of the world. In the exquisite sensitivity may be intense focus on the belief that he or she has no productive creativity left and that because the state of the world in which the artist must create is so dismal and appreciation so limited, there is no hope. It is the therapist's task to keep focus on productive accomplishment, past and future. Empathizing with the depth of the client's current feelings does not mean accepting despair as the inevitable condition of the artist. The therapist should seek an expertly struck balance between pushing the client toward a goal just beyond his or her current state and empathically communicating an in-depth understanding of the client's current withdrawal and despair. It is on the therapist's more optimistic and accurate perceptions of reality that a depressed or otherwise withdrawn creative client may need to rely to experience initial therapeutic progress (Craig, 2003).
Generally, a simple acknowledgment of the client's fear is sufficient to keep the therapy on track. For others, however, a firm and embedded source of resistance requires careful exploration and may constitute a prolonged focus of a particular phase of the therapy. Assessment should establish whether such clients are resistant because of serious underlying ego weakness, major depression, or other major psychopathology. In such instances, the therapist may need to work creatively around the resistance or confront the underlying issue squarely (e.g., through psycho-pharmaceutical treatment of a depressive or psychotic condition). When the fear appears neurotically motivated, the therapist may wish to explore with the client fantasies of what life would be like without the cherished creative gift. However, as a practical matter, the client will generally know whether the therapist is supportive of creative people and creative work and will respond accordingly. Those who do not find the messy complexities of creativity and creative people appealing might do best to consider referring such clients elsewhere (Juhnke 2005).
In one sense, the drug addictive client in psychotherapy is just another client. While respecting the powerful defense of "differentness," of seeing oneself as isolated and alienated from the rest of the world, the therapist must also address the psychological problems directly and substantively. Failure to intervene aggressively, for example, in cases of obvious manic depression or other serious psychopathology simply because the client is well-known or works in a so-called glamorous occupation is to abandon the psychotherapeutic responsibility. Certain psychological problems arise with characteristic predictability in the course of psychotherapy. The fear of loss of control, the likelihood of affective disorders, estrangement from modal values, a self-view as a martyr of sorts in maintaining artistically high standards, and an expectation (and reality) of chronic rejection are all aspects of the psychotherapeutic relationship that can be expected to occur with greater than chance probability (Juhnke 2005).
In sum, drug addictive counseling is the complex activity which involves personal and community work and interventions. Although not the easiest population with whom to work, individuals can be among the most rewarding because their potential contribution is so great and they tend to approach the therapeutic process with unusual perspectives, as they do other aspects of their lives. The task of the psychotherapist working with drug addicts, as with clients more generally, is to assist the individual in becoming more able to fulfill personal potential and more able to make volitional choices rather than respond neurotically to externally imposed conditions. Drug addicts differ from other clients in often being more dramatic and having greater potential if successfully assisted. Psychiatric morbidity and mortality explicitly recorded as due to drug abuse are unlikely to be an adequate representation of the contribution of alcohol to such conditions. Admissions to mental hospitals for drug dependence syndrome or related conditions in different regions of the country have been found to reflect medical policy rather than real differences.
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