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About this book

Social care and health professionals encounter people with drug and alcohol problems on a daily basis, but many feel ill-equipped to respond. Although people working across different professions will approach substance users from various perspectives, the knowledge and skills needed to intervene effectively are the same for all.

With a strong emphasis on the core skills needed for practice, this up-to-date and accessible text provides a complete guide to working with substance users and their relatives. It covers the nature of problematic use and introduces theories as to why people experience substance problems and why people change. The book moves on to examine a number of effective interventions and how they can be applied, including assessment and care planning, pharmacological treatments and cognitive behavioural therapy. Distinctively, in addition to chapters on working with specific groups such as adolescents and involuntary service users, it also addresses the implications of parental problems for children and explores ways of helping adults affected by a relative's substance use.

Supported throughout by case examples and activities to help apply theories and concepts to practice, this comprehensive text equips readers with the knowledge and skills needed to work with substance users.

Table of Contents

Context and Theory


Chapter 1. Defining and Experiencing Substances

  • It is important to use language precisely as it influences both how we view people experiencing difficulties with substances and society’s efforts to devise strategies to reduce the harms.
  • Dependency and addiction are central to our understanding of substance problems but are difficult to define. Many concepts surrounding substance use remain contentious.
  • Psychoactive substances can be categorised by their different effects on the central nervous system.
  • Phenomena such as tolerance, withdrawals and overdose can be explained to a great degree, but not entirely, from a physiological perspective.
  • The chemical properties of a drug alone do not account for how a person experiences it. This is predicated on a complex interaction between the individual, the environment and the substance itself.
George Allan

Chapter 2. What Is a Substance Problem?

  • Substance use is associated with a wide range of problems and a preoccupation with addiction and dependence can restrict our understanding of risk.
  • Drugs themselves can cause harm but much of the damage comes from how people use them.
  • ‘Significant others’, both adults and dependent children, can experience serious problems related to a person’s substance use.
  • Substance use can affect the wellbeing of the wider community.
George Allan

Chapter 3. Why Do People Develop Substance Problems?

  • A number of theories attempt to explain why people develop substance problems.
  • Some theories focus on the concept of addiction, whereas others seek to understand the causes of problematic use in its wider sense.
  • Many theories reflect wider questions regarding the nature of human personality.
  • The perceived inadequacies of individual theories have led to the emergence of the bio-psycho-social paradigm, an integrated model.
  • The importance for practitioners is that interventions are based on these different theoretical perspectives.
George Allan

Chapter 4. Cultural Trends; Social Control

  • What is considered to be problematic use and how best to reduce the harms differs between countries and shifts over time.
  • Societies use both formal and less formal methods of control but these are often shaped as much by economics and perception as by evidence or logic.
  • Successive governments remain ambivalent as to whether substance use and its consequences should be primarily a health matter or a criminal justice issue.
  • Attempts by the state to lessen problems involve measures aimed at either reducing the supply or reducing demand or addressing specific harms.
  • Practitioners should bear in mind that how services are structured and what treatment entails reflect, to a significant degree, current political priorities and social attitudes.
George Allan

Chapter 5. Why and How Do People Change?

  • To be effective, interventions must be based on what we know about human change.
  • Change can occur surreptitiously or it can involve considerable conscious struggle.
  • For many people with problems, change occurs without formalised help.
  • Motivation is a fundamental issue.
  • The ‘cycle of change’, a model which describes how people progress through various stages, remains popular. It has, however, been subject to criticism.
George Allan

Interventions in Practice


Chapter 6. Effective Interventions, Competent Practitioners, Successful Services

  • A range of indicators is used to evaluate whether interventions are effective.
  • Research demonstrates that motivational interviewing, cognitive behavioural therapy, pharmacotherapy, relapse prevention and 12-step approaches can be effective, but not with everyone.
  • A combination of interventions is more likely to lead to a positive outcome than one on its own.
  • Controlled drinking and how recovery from drug problems should be defined remain controversial issues.
  • Practitioner attributes and skills are factors in successful outcomes.
  • What makes a good service is a somewhat neglected topic.
George Allan

Chapter 7. Assessment and Care Planning

  • Assessment is a continuous interactional process and not an event.
  • Assessment should include the positive factors in a person’s situation as well as the risks and difficulties.
  • Assessment should include the implications of the person’s substance use for those who are dependent on him.
  • Care planning is the person’s own statement of how he would like his life to be and what needs to happen to realise this.
George Allan

Chapter 8. Motivational Interviewing

  • Motivational interviewing is a staple intervention.
  • The purpose of motivational interviewing is to help resolve ambivalence and prepare a person for change. As such, it is only appropriate at particular points in the cycle of change.
  • It is effective but not more so than other interventions known to help reduce substance problems.
  • Its application involves the practitioner adopting a particular orientation and learning specific skills.
George Allan

Chapter 9. Harm Reduction; Less Intensive Treatment; Brief Interventions

  • Harm reduction, less intensive interventions and brief interventions are separate but overlapping.
  • Harm reduction can be used as both a first stop and an ongoing intervention for both drug and alcohol problems.
  • Less intensive interventions can be effective, particularly where problematic use is not engrained.
  • Brief interventions involve non-specialist practitioners in a variety of settings engaging, opportunistically, with large numbers of people whose use may be problematic or potentially harmful.
George Allan

Chapter 10. Pharmacological Treatments

  • From stabilisation to relapse prevention, drugs can be prescribed for various purposes.
  • Pharmacological options are only available for some substances and some types of problematic use.
  • In certain circumstances, detoxification is a critical step.
  • The effectiveness of pharmacotherapy is enhanced if it is used in conjunction with psychosocial and recovery-orientated interventions.
  • Effective inter-agency working is crucial.
George Allan

Chapter 11. Interventions: Specific Approaches

  • Cognitive behavioural therapy (CBT) is a core psychosocial intervention used with people with substance problems. Contingency management and community reinforcement are also based on behavioural principles.
  • Mutual aid groups, such as Alcoholics and Narcotics Anonymous, have now been joined by other communities. There has been increasing interest in aligning these options more closely with formal services as part of the recovery agenda.
  • Controlled drinking remains controversial; it is also often confused with reduced alcohol consumption, a different concept.
  • Whilst the interventions for stimulant users are broadly similar to those employed with people who use opiates and other substances, a somewhat different mode of working is required with this group.
  • Practitioners need to feel confident to engage with people experiencing problems with new psychoactive substances and club drugs.
George Allan

Chapter 12. Relapse Prevention, Endings and Follow-up Care

  • Relapse is commonplace but not inevitable.
  • Helping people to avoid relapse or prevent a lapse from escalating are key interventions.
  • The most commonly used approaches to relapse prevention are based on CBT.
  • Reintegration into the community should be an ongoing strand of formal treatment.
  • Endings are not always smooth and systematic follow-up procedures should be put in place.
George Allan

Specific Populations


Chapter 13. Psychological Distress and Substance Problems

  • The relationship between psychological distress and substance use is multifaceted.
  • People with co-occurring psychological and substance problems are also more likely to experience a range of other social and personal difficulties.
  • Trying to help people experiencing both types of problem can be particularly challenging.
  • It is critical that both substance problem and mental health services in each area are structured so as to provide a coordinated approach.
George Allan

Chapter 14. Children Affected by Parental Problems

  • Major policy initiatives have ensured that the wellbeing of children is now a priority for services working with adults with substance problems.
  • Effective inter-agency working is essential to ensure that children’s needs are met and that they are protected from harm.
  • Developing best practice regarding children affected by parental substance use remains a work in progress for services providing for adults with alcohol or drug problems.
George Allan

Chapter 15. Significant Others:Adults

  • A person’s substance problem often has serious implications for the wellbeing of other adult family members and close friends; family structures can be altered profoundly.
  • The involvement of ‘significant adults’ in the treatment of the person with the substance problems can improve outcomes. However, it is essential that the needs of such adults are also considered separately.
  • Services to support significant adults remain underdeveloped.
George Allan

Chapter 16. Young People: Substance Use and Substance Problems

  • Experimentation with substances by young people is normal but not risk free.
  • Ongoing problematic use of substances by young people is usually associated with other psychological or social problems.
  • Dependence on substances, nicotine excepted, is rare among young people.
  • Educational inputs and brief interventions will be adequate for many young people experiencing lower levels of harm.
  • Interventions for adolescents with more ingrained problems are not dissimilar to those for adults; however, they should be adjusted for age and maturity and delivered by agencies specialising in this area of work.
George Allan

Chapter 17. Offenders and Other Involuntary Service Users

  • People may be channelled into treatment via workplace policies or the criminal justice system but voluntary service users are also often under pressure to change.
  • The links between substance use and crime are complex; they are not a matter of simple cause and effect.
  • Various points within the criminal justice system provide opportunities to engage with offenders with substance problems.
  • Interventions used with involuntary service users are the same as those used with people who attend voluntarily; however, particular attention needs to be paid the processes of engagement and the negotiation of goals.
  • The outcomes of treatment for involuntary service users and for people who engage of their own accord are similar.
George Allan
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