In Treatment for a Substance Use Disorder: How to Better Equip Counselors to Help Clients

With an explosion of science suggesting that treatment for a substance abuse disorder can work, how do we get laboratory-demonstrated evidence based practices (EBPs) into the hands of our treatment counselors? By using strategies that complement counselors’ existing skill sets, and in formats that are immediately useful to counselors’ day-to-day job demands, I’m betting the outcome would be better for clients.

For many years we’ve been concentrating on that at the Treatment Research Institute (TRI).

One strategy we’re employing is called Toolkits. As the name implies, Toolkits are a simple combination of tools that counselors can use to enhance the amount of evidence-based content they introduce to group therapy patients.

Our team introduced one kit – RoadMAP^TM– embracing the concept of relapse prevention. RoadMAP consists of a number of helping tools – reusable interactive posters, linked assignment sheets and an engaging, humorous video – that counselors can use to model, explain and engage their patients around this critical EBP.  After all, in a chronically relapsing disease, teaching clients about relapse is essential.

Another Toolkit focuses on 12-Step Facilitation, another important EBP. All patients undergoing treatment for a substance use disorder should know about and be encouraged to consider engaging in this continuing care strategy that can be a cornerstone of recovery. The Toolkit is inspired by the corresponding EBP; the difference is in the delivery, as the Toolkit consists of props a treatment counselor can learn on his/her own and, more importantly, can teach to his/her clients easily, without supervision, extensive preparation or lots of funding.

Regardless of the EBP the Toolkit corresponds to, the approach is to empower the counselor through modeling and using a “learning-by-teaching” strategy that assumes that counselors can and will teach themselves how to deliver and use the EBP as they prepare for group. Above all, each Toolkit assumes that clients need to learn about, sample, and incorporate the EBP through practice into their everyday lives, or it won’t work.  Toolkits embody the approach that counselors help clients, but that some investment in equipping counselors can improve their consistency and effectiveness in delivering EBPs.

At TRI we extensively tested the Toolkits concept at each stage of development, including acquiring expert input, using client focus groups and having counselors use the Toolkit in actual practice and provide feedback. Early results indicate that counselors like this new approach, and so do clients. Our research also suggests when counselors employed the Toolkit in their relapse prevention groups, their adherence in delivering EBP content increased by a statistically significant amount, with minimal training.

As a researcher, I’m inclined toward evidence-based practices. Yet having been a clinician in a former life, I sincerely come by my bias for approaches that work in real-world, actual conditions under which a counselor operates and a patient is treated.  If science can “point the way” in treatment, why not apply science in a way that brings out the best in our clinicians – the front-line agents in our field?

Toolkits resulted from conversations between researchers and clinicians – conversations centered on what counselors really need to do their work.  If helping clients is the goal of both science and clinicians, and it is, we need to keep these kinds of conversations going.