Counselling Strategies in Addictions

Safety or Sobriety

• What should come first: domestic violence counseling or substance abuse treatment?
• It is not a question of either safety or sobriety first, but rather safety and sobriety, since one is less likely without the other.
• The presence or threat of abuse often interferes with a victim’s ability to achieve abstinence.
• Continued use of substances interferes with safety.

Signs of Alcohol or Drug Use

• Smell of alcohol
• Signs of IV drug use (tracks)
• Unusual or extreme behavior Nodding off
• Overly alert
• Slurred or rapid speech
• Staggering
• Tremors
• Glassy-eyed/pupils dilated or constricted
• Unable to sit still
• Disoriented or confused for no apparent reason
• Argumentative, defensive, or angry

Signs of Substance Use

• Isolation, shame, and guilt.
• Behaviors that others describe as bizarre or dysfunctional.
• Traumatization.
• Initial denial of the problem.
• Loss of support systems and fear of losing children as a result of admitting their problem.
• Magical thinking (a person’s belief that the problem will simply go away as if by magic).
• Impairment of their ability to make logical decisions.
• Involvement in the criminal justice system, either as a victim or offender.
• Several returns to the substance, or to a relationship where battering continues, before making a lasting change.

Supporting IPV Survivors

• While providing advocacy-based counseling for substance-abusing victims, help them recognize the role substance abuse plays. It can keep them tied to the abusive relationship, increase their risk of harm, and impair their safety planning ability.
• Assist victims by helping them find an alternate means of empowerment as replacement for the sense of power induced by substances.
• Encourage and facilitate linkage with substance abuse treatment resources and abstinence-based support groups.
• Include plans for continued sobriety as part of the safety plan. Help the victim understand the ways the batterer may attempt to undermine sobriety before the victim exits the shelter or completes advocacy-based services.
• Minimize blame for use or relapse, as blame may further disempower the victim and empower the batterer.

Person-Centered Language

• Using person-centered language situates the person as the most important instead of the problem.
• It allows for a person’s strengths, personal characteristics, challenges, relationships, and individual qualities to become the focus which builds on helper’s empathy and compassion by removing the “us” or “expert” versus “them” or “other” mindset.
• The person is recognized as the expert of themselves and therefore assumes the responsibility for themselves and their lives.
• Choice and decision making becomes the responsibility of the individual which in turn builds on their self-awareness, self-esteem, and self-efficacy.

Try: “Person with problematic drinking” or “Person with problematic drug use”

Dr Covington’s Research

• Dr. Covington’s initial interest was spurred by her own recovery from an alcohol use disorder – it inspired her to want to help other women to not only stop using alcohol and drugs, which she’s said in some ways is “the easiest part,” but to change their lives in a broader way. She recognized the need to help newly sober women develop and expand their inner lives (thoughts feelings, beliefs, and values) along with their outer lives (their behavior and relationships.)
• As her career progressed, she identified the role that trauma played for many addicted women, particularly in the criminal justice system. Over the course of the past 35 years, Dr. Covington has developed multiple programs and manuals that have been tested in studies published in peer-reviewed journals and are used in residential and outpatient addiction treatment programs as well as correctional settings.
• Dr. Covington: ”All the language in AA materials is male-based and archaic. For some women, especially well-educated ones, it seems simplistic and reductionist. What really motivated me to write A Woman’s Way Through the Twelve Steps was working with women in my own clinical practice at the time. I saw a lot of women struggling with the 12 steps.  That became A Woman’s Way Through the Twelve Steps. The stories of women in the book show how women interpret the steps their own way and share how that works for them. I receive letters from women saying they hated meetings until they read the book, and then they could “get it.”

(Stephanie Covington: Pioneering a Woman’s Way to Recovery – Drug Rehab Options (rehabs.com))

A Gender-Responsive Approach

According to Dr. Covington – Service Providers should take an approach that is:

• Non-judgemental, supportive, respectful, and hopeful
• Reflective of unconditional positive regard for the client
• Understanding and accepting of women and various cultural groups, abilities, sexual orientations, and gender identities.
• Aware of attitudes about race, sex, disability and so on
• Cognizant of one’s own biases and assumptions

Service Provision

According to Dr. Covington – Service Providers should have the ability to:

• Help create a safe, atmosphere and engage people with empathy, warmth, and sincerity
• Maintain clear professional boundaries and a sense of one’s own identity
• Conduct assessments that are thorough and sensitive to a potential history of trauma
• Create a therapeutic relationship that models and fosters mutuality, respect, and connection for people
• Facilitate experiential learning activities
• Develop individually focused and outcome-oriented treatment plans
• Work with interdisciplinary teams
• Perform crisis intervention
• Apply trauma-coping skills and tolerate one’s own distress in hearing trauma information
• Deliver person centered treatment; focus on what the person says they need
• Maintain confidentiality

The opposite of addiction is connection

Being present, empathetic, and compassionate will support a Survivor of IPV with substance abuse to move towards sobriety. 

Sobriety is a process and each individual’s path is unique.