Just curious, why do you think this is specifically related to Straight
per se? I'm not saying that it is
not (I don't actually know), but this guy
seems more mainstream and indeed appears to advocate
non-confrontational methods...
Of course, a "kinder, gentler mouse trap" is still designed to catch a mouse, no two bones 'bout
that.
Here is an article he wrote for
Counselor Magazine (the same publication that carried that piece on
Confrontational Therapy):
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Drug Courts and AdolescentsFeature Articles - Adolescents
Thursday, 31 January 2002 16:00A 1995 study by the U.S. Department of Justice and the National Institute of Justice showed the close link between drug abuse and criminal behavior. More than half of male defendants and 40 percent of female defendants were under the influence of at least one drug at the time of their arrest (Join Together, 1998). Because very few defendants are drug tested in the criminal justice system, let alone treated after conviction, the recidivism rate has been high (Join Together, 1998). Thus, it is not surprising that offenders with drug problems make up a substantial percentage of the burgeoning prison population in this country.
The "War on Drugs", with mandatory sentencing, has led to an additional enormous influx of drug offenders into the criminal justice system. These offenders severely strain the resources of the courts, and crowd the correctional system (NADCP, 1997). The failure of incarceration to rehabilitate drug abusers, plus the onslaught of the sheer number of new offenders, has put the criminal justice system in crisis.
The advent of drug courtsOne way the system has responded to this crisis has been by creating drug courts. They are designed as a diversion for non-violent drug offenders who can opt for intensive treatment in the community, coupled with strict court supervision. Their mission is to stop the abuse of alcohol and other drugs, as well as related criminal activity (NADCP, 1997). The underlying premise is that drug possession and use are not simply law enforcement/criminal justice problems, but public health problems with deep roots in society. Treatment gives drug abusing or drug dependent individuals a chance to confront and overcome their problems, rather than punishment for what they have done. At the same time, it saves the enormous expense and burden of prosecution and incarceration. There are currently 697 adult drug courts, with 427 more planned. It is estimated that 226,000 people have enrolled in these courts. There are 167 juvenile drug court programs, with 113 more planned. Juvenile drug courts are located in 46 states, plus the District of Columbia and Guam. It is estimated that 12,500 youth have been enrolled to date (Office of Justice Programs, 2001).
The idea of the drug court is to closely coordinate court and treatment services, with each party having a clearly defined role. The court uses its power of sanctions and rewards to modify behavior. The treatment side provides counseling. These roles combine well. Drug court participants face a system that spells out its rules clearly. The judge responds with appropriate sanctions and rewards, depending upon the behavioral choices of the individual. For example, participants either appear in court or don't; attend treatment sessions or don't; and test positive for drugs, or negative. Judges use a wide variety of sanctions, ranging from a couple of hours of community service, to a night in detention, to dismissal from the program and a return to the traditional criminal justice system.
The role of the treatment professionalTreatment professionals have the role of promoting clear thinking and good decision-making by drug court clients. This is consistent with the traditional role of counselors. Most counseling professionals would argue that they are not in the business of telling their clients how to behave, nor how to conduct their lives. The counselor's role has been to help people think through personal matters for themselves, perhaps also to provide respectful feedback, to make occasional suggestions, or even to give permission or support to try new behaviors. Warm, empathic relationships have been the hallmark of successful counselor/client outcomes. In a drug court setting, counselors help clients clarify cognitive/emotional distortions as they evaluate the benefits and costs of their drug use, including the impact of court imposed rewards and consequences.
However, there has been one domain of clinical practice in which counselors have often deviated from their traditional role: alcohol and drug abuse treatment. Here it has been common practice to try to persuade clients that they have a problem, sometimes with confrontational and harshly confrontational tactics, and to tell clients what to do about it, which is to become abstinent (Miller and Rollnick, 1991). This aggressive approach has been explained as an attempt to break through the walls of primitive ego defenses, such as denial and rationalization. "You have a problem," counselors argue, "and you better admit it now and do something about it ... You're in denial. You have a problem and don't see it, or won't admit it."
Adolescent alcohol and other drug counselingNowhere is the deviation from the traditional counseling role more obvious than in drug treatment for adolescents, which could best be characterized as
a mad rush for abstinence. Youth who enter treatment are barraged with information about the harmfulness of drugs. When they talk about what they like about drugs, treatment professionals generally make counter-arguments or accuse them of glamorizing drugs. Tremendous pressure is brought to bear on young people to get them to say that they will quit "using."
In most cases it is fairly easy to get drug-abusing adolescents to
say that they want to be drug-free. The much bigger challenge, however, is to get them to say what they
truly think and feel, which in most cases is that they do not believe they have a problem, or if they do, they certainly are not ready to
honestly recognize and admit it.
What often happens in drug treatment for adolescents is that young people make an insincere commitment to abstinence. That is, they "fake it." In a criminal justice setting, this has been referred to as "false accountability." Then adolescents are taught the behavior of being drug-free, sometimes with the most advanced techniques of relapse prevention.
The problem with this approach is that counselors are teaching young people how to be drug-free before they have decided that they want to be drug-free. This illogical practice explains the common occurrence of adolescents leaving residential drug treatment and getting high their first day home, or soon thereafter. It also explains why so many relapsing adolescents begin their next episode of treatment by saying, "I told the adults what they wanted to hear." This probably goes a long way toward explaining the long history of dismal outcomes in adolescent drug treatment (Alcohol and Drug Abuse Weekly, 1998).
Impact of the mad rush for abstinenceAside from negating the traditional counselor role and stimulating a great deal of client dishonesty, the mad rush for abstinence in adolescent drug treatment also causes professionals to disregard what we know about adolescent development, and what research data indicate about stages of change in overcoming addiction.
In preparation for adulthood, adolescents face the developmental task of forming their own independent identities. In our drug-filled society, this process includes defining themselves in relation to drugs. Counselors should not be telling adolescents what to think and feel. They need to figure this out for themselves, ideally with the help and support of adults who care. We know that teens do not "take well" to being told what to think and what to do. At this stage in life, they benefit most from dialogue and interaction. When adults tell teens
not to use drugs, they actually may be reinforcing the opposite behavior.
The stages of changeImportant research has indicated that individuals go through six stages of change when overcoming addictions, or changing other problem behaviors (Prochaska et al., 1991). Three of the stages precede the action stage, which is when people begin to take decisive behavioral steps to overcome their problems. These preliminary stages are called pre-contemplation (not thinking they have a problem or not admitting to one); contemplation (reflecting upon the possibility of having a problem, and on what to do about it); and preparation (getting ready to take action). The vast majority of youth entering drug treatment would initially fall in the first two stages of change. It would be premature and inappropriate to teach them how to be drug-free. It would be far more timely and appropriate to engage them in a thought-provoking discussion about their drug use, trying to raise their consciousness.
Professionals need to recognize that few adolescent clients come to drug treatment of their own accord. Most have been dragged in by their collars, either by concerned parents or the courts. Counselors need to start where the clients are "at," not where they want them to be, or wish they would be. It would be naive, or at best, ill-advised, to believe that more than a small percentage of adolescents enter drug treatment ready to make a sincere commitment to abstinence.
Defiant and resistant youthAlthough many youth "fake it" when pressured to commit to abstinence, another common reaction is defiance. The more that adults condemn drug use and try to impose a certain type of behavior (in drug-counseling, it would be abstinence), the more adolescents will defend what they are doing. In part, this is the normal psychological reaction to situations in which individuals feel that their personal freedom is being reduced or threatened. They fight back. In part, it can be understood as adolescent behavior, teens saying, "I'm going to be my own person."
Miller and Rollnick (1991) have explained the resistance of drug abusing clients of all ages in terms of the psychological concept of ambivalence, which means simultaneously experiencing two different and opposing feelings and attitudes about something. Most drug-abusing clients are ambivalent about their drug use. They feel internal conflict. On the one hand, they see that they derive certain benefits from it. On the other hand, they also see potential harm. The nature of ambivalence is to maintain balance. If individuals go too far in one direction, they are likely to bounce back the other way. For example, consider a man who is ambivalent about a dating partner. If friends tend to be critical of the partner, he will defend her. If friends are supportive of the partner, he will tend to find fault. This situation will persist until the internal conflict is resolved.
This balancing characteristic of ambivalence can explain why, when counselors harp on the dangers of drugs, drug-abusing clients tend to defend their drug use. Unwittingly, counselors actually reinforce the attitudes they would like to challenge. When counselors single-mindedly talk about the dangers and harm from drug use, such as health consequences, addiction, or the possibility of getting in trouble, clients are likely to focus on the pleasure and fun they derive from indulging.
The need for changeThe mad rush for abstinence that characterizes adolescent drug treatment tends to evoke either dishonesty or resistance in young people. It leads the counseling profession far astray of its mission to help individuals make decisions for themselves, and it leads to poor outcomes. It also puts counselors into the policing or pressuring role that the courts are supposed to serve in a drug court partnership. Poor outcomes, or at best diminished effectiveness, are likely to persist in adolescent drug treatment until the counseling field moves back to its traditional role, and pays attention to what we know about adolescent development, and about how people change.
The deviation from the traditional counselor role in drug treatment has become so commonplace that few people notice it. About a year ago I listened in as a judge who presided over an adolescent drug court gave a presentation about her experiences. She spoke with great enthusiasm about the way that she, in her courtroom, made sure that young people felt the impact of their drug use or other relapse type behaviors. She said it was doubly powerful because the treatment component of the program also hammered the kids. "There's no escaping," she said. "They get it in every direction." Her remarks are indicative of the general acceptance of an aggressive approach to drug treatment. It appears that to get back on track in adolescent drug treatment, counselors not only need to rethink and redefine their own role, but also must ask the public to take notice.
Drug courts as an opportunityThe drug court movement is sweeping the nation. Drug courts offer a unique opportunity to move the field of adolescent drug treatment back to where it belongs. The power of the judge to impose sanctions in a drug court provides an ideal condition for counselors to leave behavioral control to others, and to resume the legitimate and important role of helping young people think through their problems for themselves, including their use of drugs and to make their own wise choices. Counselors can rest assured that a powerful voice, the judge, will make the consequences of drug use abundantly evident, and will reward positive behavior.
Getting back on trackThe following are a few guiding principles and practical recommendations concerning how counselors and treatment programs can respond appropriately to the challenge of drug courts, and work effectively with young people with substance abuse problems, without resorting to harsh confrontational methods.
Redefine the AOD counselor's role. The role is not to convince young people to stop using drugs. Rather, it is to help them rethink their use of alcohol and other drugs, and make their own wise choices/decisions.[/list]
Measure success in smaller increments. Instead of setting a criterion that is so high it can be intimidating, the decision to be drug-free, redefine success as making progress through the stages of change. For example, clients who enter treatment without any concerns about their drug use can be considered successful if they advance to the stage of contemplating that they might have a problem.[/list]
Rethink accountability. Instead of promoting dishonesty and resistance by demanding immediate abstinence, hold individuals accountable for reevaluating their lives and moving through the stages of change.[/list]
Undo client expectations that the drug counselor's job is to make him or her quit using drugs. Due to of the reputation of drug counselors as trying to persuade young people not to use drugs, and even trying to coerce them to quit, clients start with the assumption that this is the counselor's mission. Counselors should shed themselves of this role, and actively undo this expectation held by clients. Counselors should be open-minded with adolescents and provide a space for them to really look at their own lives and explore their feelings.[/list]
Allow young people to talk about what they like about drugs. If they are to make their own wise choices, then they need to consider both the costs and the benefits of their drug use.[/list]
Acknowledge that people use drugs to meet their personal needs, not to get in trouble. They are trying to find ways to cope with life. If they are ever going to be in a position to give up drugs, they must learn other ways to meet these same needs. Toward that end, AOD counselors can position themselves as problem-solving partners, helping young people learn new ways to meet their needs, without using alcohol or drugs. This puts adolescents in a position of strength from which they could choose to become drug-free.[/list]
Stop harping on the harm. When counselors singularly focus on the harm caused by drugs, it makes them seem narrow-minded, and suggests that they have the agenda of trying to make a young person quit.[/list]
Do not rush for decision-making about the use of drugs. First help young people consider the costs and benefits of their drug use, the needs they are satisfying by using drugs and the harm they are causing for themselves and others. Refrain from pushing for drug decisions, but allow the harm to become obvious.[/list]
SolutionsThe Seven Challenges (Schwebel, 2000) is an example of an effort to design a developmentally appropriate program, which recognizes that most adolescents come to treatment in the early stages of change, and that a counselor's role is to help young people think through their drug use, including its effect upon their lives, in order to make their own wise choices.
The Seven Challenges are as follows:
1. We decided to open up and talk honestly about ourselves and about alcohol and other drugs.
2. We looked at what we liked about alcohol and other drugs, and why we were using them.
3. We looked at our use of alcohol or other drugs to see if it has caused harm or could cause harm.
4. We looked at our responsibility as well as the responsibility of others for our problems.
5. We thought about where we seemed to be headed, where we wanted to go, and what we wanted to accomplish.
6. We made thoughtful decisions about our lives and about our use of alcohol and other drugs.
7. We followed through on our decisions about our lives and our drug use. If we saw problems, we went back to earlier challenges and mastered them.
The Seven Challenges program is based on building a relationship in which honest dialogue can take place (Challenge One). In this context, young people can look at what they have liked about drugs, and understand what needs they were meeting by using drugs (Challenge Two).
Then they can explore the harm from their drug use (Challenge Three) and the potential harm in the future (Challenge Five). They are taught how to make balanced criticism of themselves and the world around them (Challenge Four), so they do not "blame the world" for everything, nor place entire blame upon themselves. With this groundwork in place, young people are helped to understand what it entails to make a decision to change their lifestyle and behavior, and asked to do so (Challenge Six). Finally, adolescents are helped to succeed in the choices they have made (Challenge Seven).
This program allows counselors to stop trying to control the behavior of their clients, which doesn't work anyway. It allows them to return to their legitimate and important role of helping clients evaluate their own lives. That is, clients must weigh the costs versus the benefits of their behavior, in particular, their drug use.
In a drug court setting, counselors know that the judge will make the consequences of drug use abundantly evident at all times, and will reward young people who are making progress toward overcoming their drug problems. With these contingencies in place, counselors are better able to make the transition from behavioral control agent to empathic listener.
In training counselors for the Seven Challenges program, it has been clear that the "mad rush for abstinence" is deeply ingrained in their consciousness. Many counselors find it hard to listen to what young clients like about drugs. They want to provide an immediate rebuttal concerning the dangers.
When a client acknowledges one danger, even "laid back" counselors are often quick to add a litany of additional dangers. They find it hard
not to push for immediate abstinence, and are much more eager to reinforce decisions to quit, whether real or faked, than to reinforce significant progress in earlier stages of change.
On the other hand, it also has been clear that many counselors have been seeking something different, and are impressed with how honest young people can be when no one is "in their face." They are relieved to find that they can break free of the confrontational model and build warm, empathic relationships and still have a powerful, positive influence on reducing the substance abuse of young people.
It can be doneClearly the new thinking that led to the creation of drug courts has provided a unique opportunity for new thinking in AOD treatment. We can stop this mad rush for abstinence. We can respect our knowledge about adolescent development and about how people change. Instead of promising the world (drug free adolescents overnight) and delivering nothing, we can slow down, set realistic goals, and help young people work their way through the stages of change. Instead of locking horns with clients, which leads to resistance and insincere commitments to abstinence, we can build strong counseling relationships, and use the powerful tools of our profession, to do what we do best -- help people make wise decisions about their lives.
We need to do this with all drug-abusing clients in every setting. But it is easier to assume our proper role as counselor in a setting in which we know the judge is ever-present. Both the "carrots" a judge can offer to reinforce good behavior and the "hammer" that could come slamming down for violations provide a powerful impetus toward drug court clients making positive choices. We can be their allies as they make these choices.
Robert Schwebel, PhD, a psychologist living in Tucson, AZ, is the author of Saying No is Not Enough
and Keep Your Kids Tobacco-Free.
He has developed The Seven Challenges program for adolescent drug treatment, now used around the country. He also provides training and workshops, and is active in the media with appearances on Oprah, The Today Show, The Early Show and a number of CNN interviews.ReferencesAlcoholism and Drug Abuse Weekly. (1998). Federal report: treatment system is failing youth (September, 1998).
Join Together. (1998). Drug Courts Proving Effective in Reducing Crime, Substance Abuse.
Join Together 1, 1, 8-9.
Miller, S. & Rollnick, S. (1991).
Motivational Interviewing. New York: The Guilford Press.
(NADCP) The National Association of Drug Court Professionals, Drug Court Standards Committee. (1997).
Defining Drug Courts: The Key Components. United States Department of Justice.
Office of Justice Programs, Drug Court Clearinghouse and Technical Assistance Project. (2001). Drug court activity update: composite summary information, June 2001. School of Public Affairs, American University.
Prochaska, J.O., DiClemente, C.C. & Norcross, J.C. (1992), In search of how people change.
American Psychologist, 47, 1102-1114.
Schwebel, R. (2000).
The Seven Challenges (3rd edition). Tucson: Viva Press.
