55810E Models 20and 20 Theories 1002

Section 3
Describe models and theories of approaches to working with AOD clients

(Community services)
Contents
Overview Before you do this topic Learning outcomes Models of work in the AOD sector Moral model Disease model Psychodynamic model Psychosocial model Socio-political model Public health model Methods used by AOD workers Casework Group work Community work Community education and research Research Pyschosocial theories and AOD work What are psychosocial theories? Developmental psychology Psychodynamic theory Behavioural theory Cognitive-behavioural theory Client centred Rogerian theory Narrative therapy Solution focused therapy Motivational interviewing Early and brief interventions Feminist therapy Family therapy Summary Additional resources 5 5 5 6 7 8 11 12 14 15 20 20 22 25 27 28 33 33 36 39 40 40 41 41 42 43 44 45 46 49 52
P0036708; Section 3 Book 1: Issues and approaches in AOD work; 3256 State of New South Wales, Department of Education and Training 2007 Version 1 September 2007
Overview
This topic focuses on the models and theories that underpin work in the AOD sector. It will explore concepts such as: the moral, disease, psychodynamic, psychosocial, socio-political and public health models of AOD work the main methods used in AOD practice: casework, group work, community work and research, and the role of sociological and psychological theories.
Before you do this topic

Before you do this topic you should already have a basic understanding of sociological theory and how it applies to the AOD sector, and other political, economic and cultural influences in society that impact on clients and AOD work. You should also have had an introduction to current issues and stakeholders in the AOD sector.
Learning outcomes
After completing this topic you will be able to: identify the different models of work in the AOD sector identify the different methods of practice identify the role of psychological and sociological theory in AOD practices.
Models of work in the AOD sector
Throughout history people have tried to understand the phenomenon of drug use and why some people become dependent on or addicted to certain drugs. Many theories have been put forward and around some of these theories models have been developed. A model is a way of classifying or defining a problem or situation so that it can be understood and communicated to others. Think of a street with a number of houses in it. Each of the houses is different, one is a three bedroom brick veneer, another, a cedar cottage, another a four-bedroom Hardiplank and tile, another a one bedroom fibro cottage, another a two bedroom duplexeach of these houses is based on a model, designed to meet a need. What follows is a description of the six models of drug use and dependency that have most influenced Australian drug policy and treatment of drug use behaviour. There is no right model; its a little like our houses, they have developed over time and often as part of social processes happening at that particular point in history. As with a house, what suits one person may not suit another, therefore, it is important that we are able to provide a range of options and that we work closely with our clients to establish what service based on what model will best suit clients particular needs.
Figure 1: Drug use models
Moral model
History
Historically this model has had an effect on how we have treated drug users since European settlement of Australia. Today we can still see its power in our legal system.
Philosophy
The basic belief underlying the moral model is that using drugs is morally wrong, deviant and antisocial. These moral judgments change between cultures. For example, in Australia marijuana and hashish are illegal (except in Canberra for personal use) and under this model the users would be thought of as wrong. Here, alcohol is legal, used widely and often not even thought of as a drug. However, in some countries the possessions and use of marijuana and hashish is acceptable and not illegal. As well, alcohol may be unacceptable within some cultural and religious groups wherever they live, and illegal for citizens of some countries. The moral model considers that drug dependent people are morally weak. Dependency, or addiction, is seen as a character fault. Drug users are viewed as victims of moral weakness who know that what they are doing is wrong but continue to do it.
Figure 2: Drug users are viewed as victims of moral weakness
Prevention
People subscribing to the moral model believe that to prevent drug problems, society needs to: make it well known that punishment and/or social rejection are the consequences of using drugs hold individuals responsible for their actions control the availability of drugs.
Treatment
Those subscribing to the moral model believe that users should receive the following treatment: spiritual direction a jail sentence (or in the good old days, a flogging) placement in an environment that promotes pro-social values (such as a religious institution or in the case of a juvenile a foster home that might provide a better influence than the parental home).
At the turn of the century many drug users were put in mental hospitals but this was only because the jails were full. They did not receive treatment (eg, AA support counselling or post-treatment follow-up) as they would today.
Figure 3: The moral model
Disease model
History
The use of the term drug habit was first used in Australia in 1887 and marked the beginning of the development of the concept of drug use as an
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addictionsomething over which the user had no control. Originally it was used in the context of cocaine and morphine use. By the turn of the century alcohol had also been included. This led to the development of the Inebriate Acts of the early 20th century, which not only identified the disease but also the treatmentincarceration as a form of treatment and not punishment, as had previously been the response and practice. This definition, however, did little to change the actual position of those with the problem. Being a medical inmate, as opposed to a criminal inmate did not guarantee any change to power over destiny. In fact the definition of alcoholism as a disease still deprived the sufferer of all power and freedom. To call addiction an illness simply created a medical condition out of a behaviour that had previously been seen as immoral, criminal or simply harmless and became yet another means of social control. The creation of this model led to the development of the Alcoholics Anonymous (AA) movement and, interestingly, was started by a doctor who also considered himself to be an alcoholic. His belief was that certain people were not morally weak but had a predisposition to becoming alcoholic. Alcoholism was a disease like diabetes and sufferers should be treated as though they had a disease. Although AA began in the 1930s in America, it did not have much impact in Australia until the 1950s. This is when the first hospital was opened strictly to treat alcoholism. The disease model has had a profound effect on treatment facilities in Australia up until the present. Most rehabilitation and detoxification centres have followed the philosophy of AA, although in the 1980s the public health model started to become a stronger influence. Other groups have developed along AA principles and the disease model philosophy. They are: Narcotics Anonymous (NA)this is for users of heroin and other illegal substances Al. Anonthis is for the families and friends of alcoholics Gamblers Anonymous (GA).
These groups are referred to as self-help groups as they are free to join and run entirely by the people who attend them. They are still very popular in Australia and around the world.
Philosophy
As with other diseases, like diabetes, some people have a natural predisposition to addiction. Addiction is controlled by physiological and genetic forces beyond the persons control. The classic disease model of addiction rests on three major assumptions: 1 Predispositionyou are born with the disease.
2 Loss of controlonce you start using, you will not be able to control it. 3 Progressionthe using behaviour becomes worse over time. There is only one direction while you are using and that is down the slippery slope to addiction.
Prevention
Identify people at risk and provide education about the dangers of beginning to use a particular drug.
Treatment
Addicts need to acknowledge their addictions and the fact that they have no control over their substance use. They need to remain abstinent from all mood-altering substances for the rest of their lives, otherwise their addictive behaviour could begin again. This means if you are an alcoholic, you cannot drink but neither can you use marijuana, even if you were not addicted to it before. Addicts need to attend self-help groups like Alcoholics Anonymous for support.
Figure 4: The disease model
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Psychodynamic model
History
Psychodynamic theory began with the work of Sigmund Freud, and its use in treating people with drug problems began in Australia with psychiatry in the 1950s. However, it does not have wide use in treatment as lengthy psychoanalysis is not considered cost-effective. Nonetheless, the basic philosophy, that what happens in our childhood can affect how we cope as adults, is accepted nowadays as an important principle in most treatment therapies.
Philosophy
Drug misuse is an unconscious response to difficulties experienced in an individuals childhood. This philosophy historically provided the basis of most counselling approaches. It has been widely replaced by psychosocial theories in more recent times but can still be practised in private psychiatry.
Figure 5: In this model, drug misuse is due to circumstances of an individuals childhood
Prevention
People whose personalities/behaviour place them at risk of developing substance use problems should be identified. They then can be provided
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with drug education or intervention at an early stage in the course of their difficulties.
Treatment
Psychodynamic counselling is used to gain insight into the persons unconscious motivations and to improve their self-image.
Figure 6: The psychodynamic model
Psychosocial model
History
This model is based on the cognitive behavioural theories in psychology and learningbeginning with the theories of B. E. Skinner. This theory initially gained acceptance in America in the 1950s, with the behavioural theories, and has been expanded to include cognitive (patterns of thinking) theories and in more recent times the exploration of links with the social environment (narrative and solution focused therapies). Psychological theories started to influence thoughts on treatment when American soldiers returned from the Vietnam War. Many of these soldiers had been heavily addicted to opiates while fighting in the war. On their return, they gave away the use of these drugs and got on with their civilian life. This put into question the disease model. That is the belief that, firstly, only certain people could become addicted and that the addiction was progressive unless you abstained totally from all mood-altering substances. These soldiers represented a group of people who used and became physically addicted to a substance to cope while they were in horrific
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circumstances. Once they were out of these conditions many returned to their previous level of social drug use.
Philosophy
The basic philosophy of the psychosocial model is that dependence or drug abuse is an acquired habit. It is maintained by powerful pyschological and social forces in the persons environment.
Prevention
This model promotes the idea of drug education programs and media campaigns to increase appropriate decision making skills and promote healthy life styles.
Treatment
The person can learn new coping mechanisms and social skills, and can adapt his or her beliefs and lifestyle to deal with the circumstances so as not to abuse drugs. Treatment under this model emphasises the importance of reinforcing the persons ability to manage their own life. Methods of treatment include: social skills or assertiveness training relaxation training or stress management cognitive behavioural treatments such as exploring the role of beliefs and attitudes in drug taking and other behaviour and working towards changing these patterns.
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Socio-political model
History
This model was popular in the 1970s and up until the last 10 years has been the least used model. As you can see from the models already discussed, there is an emphasis on the individual with little examination of the type of society they may live in and what effect this may have on their drug use, this model takes into account the society as a whole. With the Federal Governments Drug Summit in 1985, attitudes began to change. What came out of that summit was an acceptance that certain groups in society were disadvantaged (this had already been acknowledged in the 70s). These groups had to take priority in prevention and treatment policies of the future. The national drug strategy 199297 targets certain groups in the community for assistance. We will discuss these later.
Philosophy
The basic philosophy of the socio-political model is that people who lack power in the world and are alienated are more likely to experience substance use problems. Drug consumption patterns can be analysed in relation to the creation and maintenance of social inequality in our society. Society labels the disadvantaged users of certain substances as deviants, thereby creating further problems.
Figure 7: The socio-political model
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Prevention
Prevention strategies include: providing information on safe drug use practices community development to address poverty, poor housing and discrimination against powerless groups legislation to produce change in the social environment.
Treatment
Treatment of the individual may not be helpful or necessary. Powerless groups should be empowered by building support networks and enabling them to make decisions about their own lives.
Public health model

History
This model began in 1955 but achieved greater acceptance in 1985. The National Drug Strategy 199297, based on this model, has guided all treatment and prevention programs in Australia over the last five years.
Philosophy
The public health model is an integrated approach. It identifies the three key factors and the interrelationship between them. 1 2 3 The agentcharacteristics and effects of the drug itself. The hostthe characteristics of the individual or group of users. The environmentthe context of the drug use.
The basic premise of harm minimisation is acceptance that drug use is a reality within our society, and that trying to eradicate it is an unattainable goal. A more realistic goal is reducing the harm brought about by certain types of drug use.
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Prevention
What is most important in the public health model are: primary preventionthis is action which attempts to ensure that a problem will not occur in the first place. Strategies include: community development drug education media-based strategies secondary preventionor early intervention; this is when a problem is identified in its early stages and there is then intervention to halt further progress. This type of intervention would be used for someone with a controlled drinking problem.
Treatment
Treatment is seen as the final (or tertiary) stage of prevention. This is when a serious problem has developed and treatment is aimed at arresting the progress and restoring the person to health by all the means that are presently available.
Activity 1: Which model best fits your beliefs?
After you have read the descriptions of the models write down which one is closest to your beliefs. Maybe its not just one model but a combination of several. Explain why you believe this. _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________
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Feedback 1
There is no right or wrong answer to this question. What is more important is your ability to identify which model you feel most comfortable with and understand whydue to personal experience, personal beliefs and values, learning from experiences of others or impact of the media (TV shows, magazine articles, books, newspapers). You also need to be able to explore how other models may meet the needs of other groups eg, young people and the public health model (harm minimisation).
Activity 2: The great debate
The debate: Friday night drinkers scenario

Now that you have looked at the different models of drug use, read the scenario below.
Every Friday afternoon a group of office workers go down to the their local pub after work to celebrate the end of the week with a few drinks. By 8 pm they have had quite a few drinks and their departure from the pub is very noisy and disruptive to the surrounding residents and businesses. The local community is up in arms, they feel that their businesses are affected by this chaos. They have spoken to the group and to the publican with no success in containing this situation. They have now taken the problem to their local politician who is concerned about the effect it is having on the district and the residents. The politician needs to choose a framework or model from which to approach the problem. She has chosen certain groups in the community to put forward their ideas to her on how to deal with the problem.
Form a debate: community versus government body. 1 Imagine that you are a member of the community representing one of the models. Put forward an argument from the point of view of this model on how this situation should be dealt with. For example, moral modelthese people (the drinkers) should be punished and the police should be brought into to control the situation. Remember, you are not arguing your own view but that of a particular model and you really want to convince the politician that this is the best model. Sometime it is fun and sharpens your negotiating skills to argue from the point of view of a model you do not agree with. So give that a go.
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Argument for the community: _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ 2 Now you are to give an argument from the point of view of the public health model: _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________
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Feedback 2
This activity illustrates what goes on in the real world when it comes to deciding what to do about drug problems. Different groups in the community will try to influence politicians on how they consider the problems should be dealt with. There is nothing wrong with this and it is part of the normal political process in a democracy. In recent times the public health model has been predominate. Society is very concerned about young people using drugs and you may have seen the major media campaigns. It is important that you start developing an understanding of the public health model and how it addresses AOD issues.
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Methods used by AOD workers
This section of the topic will explore the different methods that are used by workers in the AOD sector. They include: casework (counselling) group work community work (including Community Development, Community Planning and Community Action) community education research.
We will look at each of these in some detail.
Casework
Casework involves working on a one to one basis with a client. At one end of the continuum casework can be very informal, a simple one-off session together, where a client speaks with the worker, raises some issues and the worker provides the client with some information and knowledge. That is the end of their contact. The worker may keep a few brief notes about the exchange, perhaps a name, date and a brief outline of issues discussed and decisions made, including information and possible referrals provided. This is called informal and unstructured casework. Some examples may include information and referral services and drop in centres. At the other end of our casework continuum we will have workers who provide a highly structured and formalised approach, that often involves detailed record keeping.
Case management
The most commonly used example of a structured and formal type of casework in the AOD sector today is case management. Case management is a concept that developed during the 1970s in the USA and 1980s in Great Britain. It was first used in the aged care and disability sectorsareas where clients may have quite complex needsthat require a
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range of services. Its purpose is to find a better fit between clients and services. The worker, who is usually referred to as the case worker or case manager is responsible for: assessing the clients needs organising the services from available sources monitoring the service delivery process.
It involves a number of key tasks including: case finding (intake) assessment/Goal setting care planning organising services purchasing services (where brokerage is required) advocacy (speaking up on behalf of, or with clients to make sure their needs are addressed) monitoring and support (ensuring that service is being provided, that clients needs are being met receiving feedback form services) review evaluation case closure.
The tools that are required to ensure that case management is effective include: Making sure that you have a clear and effective process that includes: assessment, planning, action and evaluation. If these processes are unclear or not well carried out and documented, then the process is likely to falter. A clear, well-documented plan that clearly spells out the roles and responsibilities of those concerned, including the client and caseworker. It also needs to include details about services that are being provided to the client, why (what is the need the client has that the service is meeting) who, how, where and when. This allows the case worker to coordinate and monitor the plan. Accurate documentation of meetings, phone calls, referrals, etc. Effective coordination skillsIt is essential that caseworkers are able to effectively coordinate and manage processes, including assessment, planning, implementation and evaluation. Effective feedbackCaseworkers need to be able to receive and provide feedback from the client and other services at a range of levels. They need to be able to hear how services are/are not meeting a clients needs, how the service views what it is providing to the client (and if it
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is not able to meet the need why not and what can change) and also feedback about their own performance and role in the process. Effective assessment and referral skillsCaseworkers need to be able to make accurate assessment and then refer to appropriate services. Effective use of time framesAn important part of effective case management is the establishment of realistic and achievable time frames, including both with clients and other services involved in providing care. Informed consentCase workers have an ethical and legal obligation to make sure that their clients understand the process that is taking place. Clients need to consent to any referrals made, information provided to other services, and feedback given to services via the caseworker. ClosureCaseworkers need to be able to effectively review and evaluate the process of a clients progress and close/end the working relationship effectively once needs have been met.
Many government departments use a case management approach to work, including Probation and Parole, Department of Community Services, Corrective Services, Drug and Alcohol Services and increasingly this approach is also being adopted by non-government organisations including therapeutic communities.
Effective case workers

In order to be effective case workers and get the best possible outcomes for their clients workers need to: be able to develop trusting relationships with their clients and other service providers encourage clients to take an active role in developing, monitoring and evaluating their case plans effectively link clients and service providers together and support these networks in a way that enhances the clients life be accountable for their actions (or lack of action) to clients, service providers and other relevant parties.
Group work
This method involves a worker working with a group of clients. As with casework it can be a structured and formal process, that involves a set format that the group process will follow and includes the keeping of detailed records about who attended the group, their input, issues explored by the group, and outcomes achieved or it may be as simple as an informal
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discussion group or get together. In the AOD sector group work is used extensively as a method of working with clients. Group work may occur as a one off meeting or get together, it may occur on a regular basis over a number of weeks or it may be an ongoing process that occurs for a number of years. Group membership may be closed, that is, once the group forms no new members are taken into the group, or it may have an open membership, where members come and go and new members are welcome.
Families as groups
A group that is often the focus of intervention is the family. It is identified as a significant social institution in Australian society and a critical element in an individuals psychosocial development, and is, therefore, often the target of intervention processes. Both the current NSW Government Plan of Action and the National Drug Strategy recognise the importance of family, particularly in the prevention of drug related harm. Both these policies focus on providing support to families through strategies that aim to expand prevention and early intervention services to families (such as the Families First and Schools as Community Centres programs and raise family awareness of AOD issues, particularly in relation to young people). This approach seeks to provide support to families that may be seen to be at risk, particularly in rural, remote and other disadvantaged communities, and to also provide information and support that will strengthen families and their ability to deal with AOD issues.
Figure 8: Group work is used extensively as a method of working with clients
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Examples of group work

Alcoholics Anonymous, Narcotics Anonymous, Al-Anon, Nar-Anon and Al-Ateen meetingsThese groups provide an opportunity for people with AOD issues to get together and explore their problems and situations. AA and NA provide support to users themselves; and Nar-Anon, Al-Anon and Al-teen provide support to family members and friends whose lives have been affected by those who use. Meetings are held on a regular basis and membership is open to those who have AOD issues. Although the group meetings have a structure and process, little record keeping occurs due to the philosophical commitment to confidentiality and privacy. Groups that are run in therapeutic communities as part of the program In these groups, clients of the service (members of the community) attend to explore a whole range of issues that can be linked to their AOD issues, recovery processes and personal development (eg self esteem, who am I? leisure activities, relaxation) or the management of the program (eg whats happening in the house? work detail groups). Groups that are run in detox centres as part of the programOften these groups will focus on issues linked to the group members use, AOD issues and personal development. They will have a similar focus to those groups run in therapeutic communities. Often they will vary according to the philosophy of the individual service. Outpatient services groupsOften outpatient facilities providing AOD services will require that clients attend groups as part of their program. These will often focus on relapse prevention and stress management. Outreach groupsThese may be groups that are provided by AOD services, particularly non-government organisations, that work in the community to provide support networks for clients with AOD issues who, for a range of reasons, dont access mainstream AOD services. They will often use other non-government organisations to access clients. An example of an outreach group: On the Central Coast of NSW a womens AOD rehabilitation service, Kamira Farm, provides AOD outreach to women through local Womens Health Service Centres. AOD services offering groupsThese groups may be provided as part of a service by either government or non-government services. The focus of the groups will often vary according to the client group of the service or a specific need that may have been identified by the local community, eg the Manly Drug and Alcohol Education Centre on Northern Beaches, Sydney, runs Trimming the Grass, a 4-week program for young people that looks at cannabis use.
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Community work
Community work is a method whereby the AOD worker will work with a community, rather than with an individual or a group of clients. It relies on a collective approach to solve problems and make decisions about needs, goals, priorities and programs. An example may be when local residents in a community raise concerns about alcohol related vandalism in their community. The AOD worker might organise a meeting whereby the local residents, police, local government and other relevant parties get together to explore the issue and develop some strategies to respond to the problem. The target community may be geographically defined (eg the Moree community, the Orange community, the Wyong Shire Local Government community) or it may be a community that is based upon a specific identification or need (eg the gay community or the drug injecting community). There are three approaches within community work and community workers will often use all three approaches in their work. These are: 1 2 3 community development community planning community action.
Community development
Community development is a form of community work where communities work together to identify and explore issues and problems that exist. As a result of this exploration, strategies are developed to deal with an issue or problem. Often this process of identifying and exploring problems may involve a number of people getting together. The people involved can include: representatives from the community services industry, local organisations, local businesses, local residents, local government and representatives from state and Federal government departments (depending on the nature of the issue and relevant stakeholders). Where there is involvement from a number of sectors it is an inter-sectoral approach to issues and problems. Community development, using the inter-sectoral approach, is the method that underpins the current Community Drug Action Team concept. It recognises, as does all community work, that communities can essentially be quite different, particularly in relation to their ethnic or racial backgrounds, their age-related populations (some have higher numbers of younger or older people than others), their incomes and status, and access to resources, particularly if they are in rural or remote parts of Australia. Therefore, communities will, as a result of their differences, need different strategies to help them deal with the problems and issues they face.
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Although, at times all communities experience similar social problems such as unemployment, poverty, AOD problems and domestic violence.
Community planning
As part of community work it is recognised that any development that takes place, particularly if it involves public funding, needs to be planned. Often community workers will be involved in the development of a community plan that identifies the key issues and problems that face a community and the strategies that need to be put into place. Sometimes this planning role in a community is undertaken by local council, but may also involve local community services (both government and non-government), local businesses and residents.
Community action
As part of raising community awareness about issues, workers will often be involved in community action. These are strategies designed to capture attention and make demands of the larger community for increased resources to deal with issues and problems. It includes activities such as demonstrations, street marches, awareness days or awareness weeks. Examples include: Breast Cancer Awareness Week, Daffodil Day, World AIDS Day, Red Nose Day (Sudden Infant Death Syndrome) and Jeans For Genes Day. One of the most famous examples in Australian history of community action was the Tent Embassy, held on the lawn outside Parliament House in Canberra by Aboriginal people seeking to raise political and public awareness of their situation. As well as these kinds of events occurring at a national or state level, they might also happen at a local level. In the AOD sector, community action strategies are being used by Community Drug Action Teams to raise community awareness about AOD issues. An example is the Goats Festival that was organised on the Central Coast of NSW to raise drug awareness amongst young people. The festival consisted of a number of events including music, sausage sizzles and information stalls at a local shopping centre.
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Community education and research

Community education has long been recognised as a form of community work as it focuses on working with communities to help them address issues and problems, using education as the tool. Education has long been recognised as a means for bringing about change in peoples behaviours, beliefs and attitudes. The aim of AOD education at a community level focuses on increasing knowledge, promoting positive and healthy attitudes and encouraging specific changes in behaviour related to the safer use of both licit and illicit drugs. Part of community education also focuses on identifying target groups that have particular issues and creating strategies to meet their needs. This may mean the strategies used to target young people and alcohol use may look different to a campaign that targets older alcohol consumers. Both campaigns are addressing the same issue (alcohol use) but use different strategies to meet the needs of different groups. A campaign to meet the needs of a predominately Italian community or Aboriginal community may look different again. Community education may use the following broad strategies in creating AOD campaigns: targeted training and education for AOD professionalsThere is wide recognition that key workers and professionals in the education, health, welfare and law enforcement sectors as well as AOD sector need to be educated to adopt a consistent approach to AOD issues. peer education techniquesEducating some members of a target (peer) group to provide information to other members of that target group (based on the idea that we will listen to our peers rather than professionals). Its strength lies in its ability to identify and work with specific cultures and groups that identify with cultures, and to use this cultural identification to change cultural norms, eg HIV Peer Education programs as used in the goal communities. media campaignsThese use television, radio and the print media (newspapers and magazines) to raise community awareness and knowledge about issues. Some AOD examples include TV ads that focus on teenage drinking, drink driving (eg Its a Crime) campaigns and anti-tobacco smoking campaigns. school based drug educationThis is where learning is integrated into school learning. For example, the Personal Development, Health and Physical Education syllabus and The Life Education Program. workforce training and education that is directed at workers in the workplace can also address drug education in relation to work matters, for example, under Occupational Health and Safety training.
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the use of art based techniques to explore AOD issues and to provide a tool for education and changeincluding visual arts and drama.
Health promotions
Health promotions play a significant role in providing AOD community education in Australia. Current health promotions philosophy is underpinned by the Ottawa Charter for Health Promotion, a policy that was created at the First International Conference on Health Promotion, held in Ottawa Canada in 1986. It outlines health promotion as the process that enables people to increase control over, and improve, their health. To reach a state of complete physical, mental and social wellbeing an individual, group or community must be able to identify and realise aspirations, to satisfy needs and to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, not the objective of living. Health promotion is not just the responsibility of the health sector, but goes beyond healthy lifestyles to wellbeing. The fundamental conditions and resources for health are peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice and equity. The Ottawa Charter also identified community education as one of the five methods of health promotion. Health Promotion Units form part of Area Health Services and use the strategies discussed above in community education in order to meet their outcomes.
Research
Research is a method which begins with people asking questions and then seeking to find answers. This is done by systematic collection of information and evidence from observation, which is then analysed and explained. It is something that is done in our everyday livesthink about the process that you use if you are going to buy something. You decide what you want (based on your need) then you look at the options available (model, cost, availability, etc) and then you make a decision based on your research.
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Figure 9: Research begins with asking questions and then uses information and observation to find answers.
Guidelines for good research practice include: 1 2 3 4 5 6 Work out what you want to know and then what your questions are. Work out what your interests and values arewhat you want and what is stopping you getting it now. Work out who and what your research is forwho is your target group? If you want to know what people need or what they do, ask them! Start talking to them. Be prepared to interact, to see, to hear and to communicate. Be rigorous, be scepticaldont make assumptions. Make sure your findings are genuinely what people are saying or doing and not what you want to hear. Use your imagination. Look at what else is going on that people may not be aware ofstep back and look at the big picture, particularly the role of social structures and social institutions (eg the health system, education, family, legal system and political system).
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Good research analyses (takes to pieces) the findings of research, and then synthesises (puts them back together in a better form). It links theory, evidence, explanation and description.
10 Communicate, act! Use your research to bring about positive social change. Research is an important method used in the AOD sector. It is undertaken through health promotion programs to investigate problems and issues, and then to create programs to meet identified needs. It is also undertaken by health professionals as they establish problems, issues and strategies that can be used by their services to address issues. It is done by community workers as they develop community work strategies to deal with AOD issues, and it is also undertaken by those responsible for creating government policies, as they investigate problems and issues and then create policies to deal with identified issues and problems. An essential part of good policy and program development is the use of research.
Some examples of AOD current research include:

National Drug Strategy: Executive Summary National Drug Strategy: Counting the Cost Statistics on Drug Use in Australia 2000 Australian Secondary School Students Use of Alcohol in 1999 Australian Secondary School Students Use of Over The Counter and Illicit Substances in 1999 NSW Health University Drug and Alcohol Survey 2001 Australian Illicit Drug Report 20012002 National Drug Strategy: Counting the Cost National Drug Strategy: Household Survey 2001
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Web visit
The reports listed above are available on the Internet at the following websites: National Drug Strategy at: http://nationaldrugstrategy.com.au National Drug Strategy, Lawlink website at: http://www.lawlink.nsw.gov.au NSW Alcohol Summit 2003 at: http://www.alcoholsummit.nsw.gov.au NSW Drug Summit 1999, Australian Drug Foundation at: http://www.adf.org.au Australian Institute of Health and Welfare at: http://aihw.gov.au/publications Dept Health and Ageing at: http://www.health.gov.au National Drug and Alcohol Research Institute at: http://www.ndarc Australian Institute of Health and Welfare at: http://www.aihw.gov.au Australian Drug Foundation at: http://www.adf.org.au Alcohol and Other Drugs Council of Australia at: http://www.adca.org.au Australian Drug information Network at: http://www.adin
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Activity 3: Health promotions
Think about health promotion over the next few weeks as you watch TV, read local and other newspapers and read magazines, and generally look around your community. Find billboards, advertisements, articles, TV shows and documentaries that target AOD issues. Keep a diary of examples that you find. In your diary identify each example and then link it to a type of community education strategy (as discussed in this topic). (a) Which group is being targeted by the strategy that you identified? ___________________________________________________________________ ___________________________________________________________________ (b) What are the different strategies that are used for different target groups? ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ (c) Why do you think different strategies are used for different target groups? ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________
Feedback 3
You will no doubt discover a range of strategies that are used to educate the community about AOD issues. This activity gives you an opportunity to identify these strategies and then think about the groups being targeted and why the strategies differ to meet differing needs.
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Pyschosocial theories and AOD work
In this last section of this topic you will be given a brief overview of common psychosocial theories and therapies used in the AOD sector. This is not a definitive list as there are many more psychological theories. To further investigate this area, refer to any general psychology text book which you will find in libraries. (See the recommended books listed at the end of this topic.) It is important to note that the purpose of this section is to give you some background knowledge only, not to provide you with training in these areas. Any AOD worker intending on practising psychological therapies will need to obtain the relevant formal qualifications in psychology and/or the specialised area and undertake supervised clinical practice. Theories that will be covered in this section are: developmental psychology psychodynamic theory behavioural theory client centred Rogerian theory narrative therapy solution focused therapy motivational interviewing early and brief interventions feminist therapy family therapy.
Today, gradually more and more treatment programs are incorporating psychological therapies into their programs, particularly CBT (Cognitivebehavioural therapy), narrative and solution focused therapies.
What are psychosocial theories?

Since 1978 AOD centres have started employing psychologists to provide these skills and develop them with other workers. Others use them for clinical supervision of their staff (a process whereby staff are able to
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recognise, explore and develop strategies to help them deal with a variety of workplace situations). Today, most programs also include harm minimisation practices (public health model). Psychological theories are worldviews and are means of conceptualising and thinking about human behaviour. Psychosocial theories are those that also include the impact of social roles and interactions with others into how we conceptualise and think about behaviour. From these theories usually comes a set of intervention techniques through which people may be helped. This is usually placed under the general heading of therapy. Therapy includes: helping interviewing psychotherapy counselling.
The distinction between these words often becomes blurred in practice. Helping can be defined as one person giving aid to another. In AOD work, help is usually in the form of interviewing, counselling or psychotherapy Interviewing is most commonly associated with collecting information from clients about their lives and helping them make decisions, but is often a brief intervention. Psychotherapy can be brief or long-term contact with clients where the therapist helps clients connect their behaviour with their underlying thoughts. Counselling occupies the broad territory between interviewing and psychotherapy. However, counsellors may conduct interviews and be involved in therapy as well. Therapy is a word that is becoming more popular and may become the generic description for both counselling and psychotherapy.
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Activity 4: What do you already know?
Before learning more about psychology, take some to think about what you already know. Answer the next two questions based on your knowledge or experience, rather than what the text books say. 1 How would you define psychology? _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ 2 There are various theories of psychology. Describe any theories you are familiar with. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________
Feedback 4
Psychology can be thought of as the study of the mind, or as the study of behaviour, or simply as the study of human beings, although a large part of psychology has also been concerned with studying animal behaviour. Over the hundred or so years that it has been in existence, psychology has been defined in any number of different ways, each one reflecting the interests and ideas which were current at the time. The areas that are of interest to human psychology are the study of perception, memory, language, thinking, personality and lifespan development.
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Developmental psychology
In theory
Developmental psychologists believe that all humans develop through common sequences of life stages. This development is influenced by both physical development and the environment. The following table shows one example of a developmental theory by Eric Erikson (1969). At each developmental stage, the individual faces a psychosocial crisis from which they emerge having either completed the developmental task of that stage or developing the opposite. Resolution means achieving a healthy balance between each side of the conflict before moving on to the next stage.
Developmental stage Psychological crisis Social outcome
Infancy
Basic trust vs mistrust
Hope and certainty in relationships, rather than insecurity and suspicion Self-confidence and willpower rather than self-doubt, shame and secrecy A sense of purpose rather than passivity or irresponsibility
Toddlerhood
Autonomy vs shame or doubt
Early childhood
Initiative vs guilt
School age
Industry vs inferiority Mastery of skills and acceptance of mistakes rather than humiliation or obsession with achievement Ego identity vs role confusion Developing personal values, a sense of identity and future direction rather than role confusion or identification with antisocial attitudes Emotional commitment with others instead of withdrawal and isolation
Adolescence
Early adulthood
Intimacy vs isolation
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Developmental stage
Psychological crisis
Social outcome
Middle adulthood
Generativity vs stagnation
Giving to future generations through creative activity (eg. parenting, teaching, creative work) rather than stagnation or selfindulgence Integrating life experiences with satisfaction and acceptance rather than looking back with bitterness
Maturity and old age Ego integrity vs despair
Erikson (1969) Childhood and Society
In practice Activity 5: Using Eriksons concept to explore AOD issues
After looking at the table showing Eriksons developmental theory, answer the following questions: 1 In what developmental stages does substance abuse typically start? _____________________________________________________________________ _____________________________________________________________________ 2 How do you think an individuals development might be affected by his or her own or someone elses substance abuse? _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________
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Do you think these developmental stages are the same for all races and cultures? How might they be different? _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________
How do you think the amount of power an individual has will influence their development? _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________
What have you learnt about the limitations of applying this theory (or other psychological theories) to all people? _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________
Feedback 6
1 2 Substance abuse can start at any stage but typically starts either in adolescence or early adulthood. Some ways that substance abuse might influence an individuals development include: The impact of parental substance abuse on consistency of early child-care, influencing the resolution of early psychosocial crises. During adolescence, substance abuse can interrupt education and other developmental activities. Drug dependence can lead people into crime and other antisocial activities, thereby influencing the values and self-identity they form.
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Alcohol or other drugs might become a substitute for meaningful relationships or the person might rely on substances to deal with uncomfortable emotions rather than trying to resolve them.
The physical and psychosocial effects of substance abuse could limit a persons life options in a way that leads to stagnation or regret. Different cultures and races vary in child-rearing practices, marital arrangements, age of work commencement, social roles and other practices that might influence life stage development. Within different cultures, males and females may have different limitations and expectations placed on their development. Power relationships might also have an impact on individual development. For example, limited access to education or employment and experiences of discrimination might influence a persons mastery of skills, sense of identity and opportunity to contribute to their culture in a creative way. This and other models might not apply in the same way to all individuals. Differences in culture, gender and power could influence the relevance of psychological theories.
Psychodynamic theory
In theory
Psychodynamic theory states that human beings are moved in the present by unconscious forces from their own past, including the internal drives we are born with and how these are dealt with in childhood.
In practice
The relationship between the client and the therapist is central to bringing about changes in the clients life. The therapist supports the clients exploration of personal relationships and deep feelings. Through this process the client comes to understand his or her unconscious motivations.
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Behavioural theory
In theory
Behavioural theory states that human behaviour is shaped by environmental influences (for example, family and life experiences and socioeconomic background). In turn, human behaviour shapes these environmental influences.
In practice
The behavioural therapist helps clients change their responses to the environment and replace unwanted behaviour with behaviours that are more adaptive
Cognitive-behavioural theory
In theory
The cognitivebehavioural approach can be summed up by the following expression: It is not things that trouble us, but our view of things. (Epictetus) Each individual constructs (creates) their own unique meaning or thoughts about events and the world around them. As a result of their thoughts they then behave in certain ways, as they seek to explain themselves and their reality. Sometimes, they develop faulty thinking or irrational ideas which may lead to ineffectual behaviours.
In practice
The cognitive behavioural therapist believes that people have the capacity to think in other ways that could lead to changes in their behaviour and consequently experience less pain in their lives. A cognitive behavioural therapist would analyse the clients thinking patterns, then reframe the clients cognitions (thinking) to teach the person new ways of thinking and behaving. This is called cognitive restructuring. The goal is the elimination of self-defeating thinking and the development of more rational and tolerant view of self and others that is reflected in an individuals behaviour and concept of self.
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CBT is popular because: It links into the public health model with its emphasis on harm minimisation. It is easier to research (evidence based practice model) and therefore results can be put forward to funding bodies that show where and how it works (it is more readily accountable than some therapies). Treatment is structured and there is an emphasis on early and brief interventions (this, too, is popular with funding bodies and researchers). It uses Rogerian micro skills of counselling as a foundation for working with clients. These skills have been well developed over the years and form an integral part of respected counselling practice.
Client centred Rogerian theory

In theory
This theory supports the idea that people have a potential to move in natural positive directions. Inherent in each client is their self worth and dignity and the ability to direct their own life and move towards self-actualisation. The emphasis is on the present moment, and the provision of warmth, genuineness and caring in an empathic relationship.
In practice
The therapist will keep the focus on the clients immediate experience using reflective listening and empathy. This is a holistic approach where the therapist aims to help the client explore any mixed and ambivalent emotions and find his or own resolution.
Narrative therapy
In theory
This is a recently developed approach where the theorist believes that the client is a competent person who is blocked from achieving their goals by a problem dominated narrative or old story. It is also based in sociological as well as psychosocial theory as it says that many of the stories we learn are actually stories that have been created by the dominant groups in a society These groups (dominant ruling class) create and maintain these stories in order to maintain their domination over non dominant groups. Think of the stories we have learnt in Australian society about Aboriginal people, about the place of women, about migrants, about homosexuals. Many of these stories have led to stereotyping and discrimination.
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The client is prevented from finding a solution because they define their identity or situation according to this problem story or narrative.
In practice
The therapist invites the client to see the problem as something separate from him or herself and to identify restraints or stories that have kept the problem alive. The therapist helps the client to identify instances when she or he has had control over the problem, thereby focusing on the clients ability to create or work with existing stories that exist in their lives where the problem or situation looked different. The therapist then works with the client to help this alternative story become their dominant story, which allows change to occur.
Solution focused therapy

In theory
Solution focused therapy is a short-term, goal focused approach which focuses on helping the individual by creating solutions rather than focusing on problems. It helps the client articulate the impact of positive change on their lives rather than understanding the problem or focusing on the history of the problem. It concentrates on helping the client relate to how change happens, rather than how problems develop. Solution focused therapy focuses on the here and now of the client and their ability to change. It is also underpinned by the concept that the solutions often already exist in the clients lives that will provide the basis for ongoing change.
In practice
Solution focused therapy helps the client develop a clear and detailed picture of how things will be when they are better, which creates a sense of hope and expectation. It focuses on solutions that are practical, realistic and achievable by the use of clear and well-defined goals. These goals direct the process and help to keep it focused and brief. The number of sessions is not set; the focus is not on limiting sessions but helping the client set their goals and developing strategies to achieve them. It also encourages independence, and allows clients the opportunities to create and develop their own solutions to problems they may be experiencing, which can be a powerful and empowering experience, particularly for AOD clients.
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Motivational interviewing
In theory
Motivational interviewing draws on the theories and strategies of client centred counselling, cognitive therapy, systems theory and the social psychology of persuasion. It also draws on the concept of ambivalence and the conflict an individual often experiences between indulgence and restraint. It works from the clients worldview, rather than that of the worker, and the belief that the client is responsible for choosing and carrying out personal change. Motivational interviewing also works on the belief that the client is a valuable resource in finding solutions to problems. New perspectives can be offered by the worker, but are not imposed.
In practice
The interview is always client centred, yet the worker maintains a strong sense of purpose and direction, just choosing the right moment to intervene in penetrating ways that add depth and meaning to the process. Workers express empathy (an understanding and acceptance of the clients worldview) develop discrepancy (allowing the client to examine consequences of thoughts and actions) and facilitates (creates) a process whereby the client presents arguments for change. They also avoid arguments, which are seen as counterproductive, work with resistance (seeing it as an opportunity to develop new perspectives and inviting the client to be part of this process) and do not label clients thoughts or behaviours. They are also able to reflect the core belief that the possibility of change can be an important motivator, that there is always hope in the range of alternatives available and the client is responsible for choosing and carrying out personal change. Motivational interviewing can be used throughout the intervention process, but is especially useful in an initial interview when the client may be at the pre-contemplation stagewhen the client first begins the process of thinking about change or contemplation stage, Do I want change or dont I? It can also be useful when the client is highly motivated as it can help to reinforce the motivation, due to its emphasis on a client centred approach and the valuing of support and empathy.
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Early and brief interventions

In theory
Across the community there is a wide range of drug use that encompasses those who consume occasionally to those who consume regularly and whose use may be chronic or problematic. There is evidence that suggests that a large percentage of the harm that occurs in the community arises from not only those who have AOD problems, but also form those who are occasional users Brief intervention offers the opportunity for workers to provide a brief and often early intervention (information and therapy) that may alert a client to problems or issues that may be arising, or arise, as a result of their use. These workers may not necessarily be AOD workers, but are often generalist workers in a wide range of settings who may be in a position in an individuals life to offer a brief intervention. Some worker roles targeted as those presenting an opportunity for intervention include: AOD counsellors; workers in supported accommodation services (refuges, half way houses, medium term accommodation); operational police; juvenile justice convenors; district officers; child protection specialists; generalist welfare workers; TAFE and school counsellors; youth workers; aged care workers; disability support workers; mental health support staff; general practitioners, generalist health workers; chamber magistrates and nursing staff (both community and hospital based). It is an opportunity for facilitating behavioural change in a short period of time and has the potential to reach a large number of clients as it is less time consuming than conventional approaches. Intervention may be offered over 5-20 minutes, several hours or over more extensive programs spanning several months. It draws on the skills of motivational interviewing, particularly during the assessment process, where often some degree of ambivalence is encountered. Motivational interviewing skills can also be used to explore any discrepancy that may exist for the client between their current behaviour and goals and values that they may hold (eg valuing of personal health, yet drinking alcohol in a way that may damage health; being a good parent and yet using in a way that compromises parenting abilities) and help support a commitment to change. Motivational interviewing skills may also be enhanced by relapse prevention strategies that will help the client identify risk situations and develop strategies to deal with them.
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Highly developed communication skills are an essential component of effective brief interventionsthe ability to listen, respond, provide knowledge at an appropriate level and use empathy are vital to the process.
In practice
The key components to a brief intervention process are: 1 Assessmentan often very brief interview process to establish the level of use, frequency, duration, risk practices, symptoms, effects and motivation for change. The plan for changebased on the provision of clear, credible and easily understood information regarding continued use and its possible consequences. This is a negotiated process between worker and client. This may also include information and referral to other services, if required. Monitoring process and feedbackvia either a single or series of follow up appointments, depending on the level of support required.
Usually the client is given some information to take away with them including information about how to reduce or stop their usedepending on the goals set. Total abstinence is not always seen as an appropriate or relevant goal for brief interventions, often a reduction in use is far more realistic and appropriate to the need. Brief interventions are not appropriate to the user whose patterns and behaviour are highly problematic and deeply entrenched. Their usefulness in relation to illegal drug use is questionable, due to the level of honesty and trust that is required between client and worker to use this approach. Often illegal drug users are less willing to identify themselves.
Feminist therapy
In theory
This theory challenges the patriarchal male worldview and seeks to gain an understanding of how power in relationships affects people. This theory aims to redefine and make more equal the roles of men and women and to eliminate societal sexism, ageism and racism.
In practice
This therapy is for women and seeks to empower women to define their own goals via counselling or community action.
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Did you know?

Most psychological theories have been developed by white, European men. This does not mean we should ignore them but we need to be cautious when we apply them to all people. Feminist therapy is based on feminist theory. In therapeutic practice, the effect on the individual of the social and cultural context that they live in is considered of paramount importance. Feminist theory questions the effectiveness of other theories that do not take into account the individuals race, ethnicity, culture, gender and so on.
Family therapy
It is only in recent times that in AOD work we have begun to look beyond the individual and their drug use and examine their family unit. This focus on family now forms a major part of government policy and, increasingly, programs that work with families and explore the role of family influence on AOD use are receiving support and funding. The role of working with families in helping them support and educate family members about AOD use (particularly young people) and recognise problematic use is also being explored and developed. In other areas of psychology, family therapy is well established and has been practised for a number of years. The emergence of family therapy in AOD work was influenced by the 12-step programs and the effects on the family which may be described as a system of relationships that influence and prescribe the behaviours of its members. Rather than consider an individual in isolation, the person is always seen in the context of relationships. Familyin this situation means not only blood relatives but could be the main support person or people in an individuals life.
In practice
The family therapist sees more than one family member at the same time to help negotiate new understandings and agreements between family members. This might include changing old patterns of interaction and replacing them with new forms of communication that benefit both the family as a whole and its individual members.
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Activity 6: Looking at families
List some types of families present in society today. For example, an extended family. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________
What is your understanding of the terms functional family and dysfunctional family? _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________
Feedback 6
1 Your response to this question will be personal as we all have different ideas as to what constitutes a family. The traditional western definition of a family has broadened in Australia in recent times and now covers a variety of living styles and living arrangements in addition to the traditional nuclear family. The single-parent household, the step-family, de-facto relationships, child-free marriages, and gay couples, not to mention the larger extended Aboriginal family, all represent alternatives to the traditional nuclear family. Reference: Freeman E (1993) Substance Abuse Treatment: A Family Systems Perspective, Sage Publications. 2 Functional and dysfunctional are probably dubious terms when used to describe families because there is an implication that a family must be either one or the other, whereas in reality the definitions are not absolute. The terms can also be used to label or stereotype certain families or groups of families.
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Activity 7: Looking at theories
The Rogerian approach emphasises empathy as a micro skill. When talking to someone, what do you think is the difference between expressing sympathy and showing empathy? It is okay to look up definitions in the dictionary but have a guess first. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________
The cognitive part of cognitive-behavioural therapy looks at how the clients thinking might influence their experiences. How might the way a person thinks influence their substance abuse? Try and think of two different ways. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________
Feedback 7
1 In verbal communication, sympathy usually means expressing compassion for somebodys feelings, especially where a person feels sorrow (eg Im sorry for your sadness) whereas empathy means expressing an understanding about a persons feelings, as though we could imagine being in that persons shoes (eg You are feeling a big loss). There are many ways that thinking processes can influence AOD problems. Here are some suggestions: thinking about using increases the persons cravings thinking I cant might undermine a persons confidence in their own ability to change negative self-appraisals can lead to low self-esteem and thereby increase the chances of substance abuse.
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Summary
In this topic you have looked at the models that support the intervention processes in the AOD sector, the methods that are used by workers to work with AOD clients and their communities, as well as a range of psychosocial theories and related therapeutic interventions. You have also had the opportunity to explore your own knowledge and understanding of the concepts that have been explored. It is important to recognise that psychology has only started to emerge as a major influence in the AOD field in the last 15 years. The cognitive behavioural approach has made the biggest impact because it fits in with the public health model and harm minimisation programs. Most psychological theories have been developed by white, middle class men. They have not taken into account the social context of drug use. Therefore, they need to be applied cautiously to all people as a definitive understanding of why people may use or abuse substances.
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Check your progress
Make a list of headings from this topic. Write down the main points that you have learnt under each heading. 1 What surprises you about this list? _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ 2 Which sections have you enjoyed the most? _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ 3 Which have you enjoyed the least? _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ 4 Which sections did you find most difficult? Why were they difficult? _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________
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How well do feel you understand the links between social context and alcohol and other drug use? _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________
How has your learning changed your perceptions? _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________
What areas would you like to explore further and how can you do this? _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________
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Additional resources
Books
Hamilton M, Kelleher A and Rumbold G (1998) Drug Use In Australia Oxford University Press, Australia Freeman E (1993) Substance Abuse Treatment: A Family Systems Perspective Sage Publications Manderson, D (1993) From Mr Sin to Mr Big: A history of Australian drug laws Oxford University Press, Melbourne
Methods and strategies for working with AOD clients and target groups
Bessant J, Sercome H and Watts, R (1998) Youth Studies Longman, Australia Broom D (1994) Double Bind Allen & Unwin, Sydney, Australia Jarvis T, Tabbult J & Mattick R (1995) Treatment Approaches For Alcohol and Drug Dependence John Wiley & Sons, Chichester Wilkinson C & Saunders B (1996) Perspectives on Addictions William Montgomery, Pty Ltd. Perth, WA
Casework
Biestek F P (1961) The Casework relationship Loyola University Press, USA Brammer L (1970) The Helping Relationship Prentice Hall, USA Corey M & Corey G (1998) Becoming A Helper Brooks Cole Publishing Co, USA Geldard D (1998) Basic Personal Counselling Prentice Hall, Australia Healy J (1998) Welfare Options Allen and Unwin, Sydney, Australia Rose S (1992) Case Management and Social Work Practice Longman, USA
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Group work method

Mullender A (1991) Self Directed Group work Users take Action for Empowerment Whiting and Birch, London, England
Community work
Kenny S (1994) Developing Communities for the Future Thomas Nelson, Australia Flood M and Lawrence A (ed) (1987) The Community Action Handbook NSW COSS, Sydney Shields K (1991) In The Tigers Mouth Millennium Books, Sydney
Psychosocial theories and therapies used in the AOD sector

Berger K (1988) The Developing Person Through the Life Span Worth Publishers, Inc. Erikson E H (1969) Childhood and Society NY: Norton Freeman E (1993) Substance Abuse Treatment: A Family Systems Perspective Sage Publications Goldenberg I, Goldenberg H, Family Therapyan overview Brook/Cole Publishing Company Hayes N (1994) Foundations of Psychologyan introductory text Routledge Ivey A, Bradford Ivey M and Simek-Downing L (1980) Counselling and Psychotherapy: Integrating Skills, Theory and Practice Prentice-Hall International Editions Miller W, Rollnick S (1991) Motivational InterviewingPreparing People to Change Addictive Behaviour The Gulford Press Schultz D (1986) Theories of Personality Brook/Cole Publishing Company
Using the Internet

Psychosocial theories and therapies used in the AOD sector
Australian Drug Information Network at: www.adin.com.au Network of drug and Alcohol Agencies at: www.nada.org.au
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As sites can change the following key words may be useful to help searches: Drug and alcohol counselling Alcohol counselling Brief interventions therapy/counselling Solution focused counselling/therapy
AOD sectorcurrent research

National Drug Strategy at: http://nationaldrugstrategy.com.au National Drug Strategy, Lawlink website at: www.lawlink.nsw.gov.au NSW Alcohol Summit 2003 at: www.alcoholsummit.nsw.gov.au NSW Drug Summit 1999, Australian Drug Foundation at: www.adf.org.au Australian Institute of Health and Welfare at: http://aihw.gov.au/publications Dept Health and Ageing at: www.health.gov.au National Drug and Alcohol Research Institute at: www.ndarc Australian Institute of Health and Welfare at: www.aihw.gov.au Australian Drug Foundation at: www.adf.org.au Alcohol and Other Drugs Council of Australia at: www.adca.org.au Australian Drug information Network at: www.adin
Other websites
A useful website is Manly Drug Education Centres website which outlines the range of programs this service offers to the local community and provides examples of the different methods at: www.mdecc.org.au A recommended website for exploring the use of community work is: Community Builders NSW (Department of Community Services) at: www.communitybuilders.nsw.gov.au
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55810E Models 20and 20 Theories 1002

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Section 3

Describe models and theories of approaches to working with AOD clients

Before you do this topic

Models of work in the AOD sector

Figure 1: Drug use models

Figure 2: Drug users are viewed as victims of moral weakness

Figure 3: The moral model

Figure 4: The disease model

Figure 5: In this model, drug misuse is due to circumstances of an individuals childhood

Figure 6: The psychodynamic model

Figure 7: The socio-political model

Public health model

Activity 1: Which model best fits your beliefs?

Activity 2: The great debate

The debate: Friday night drinkers scenario

Methods used by AOD workers

We will look at each of these in some detail.

Effective case workers

Figure 8: Group work is used extensively as a method of working with clients

Examples of group work

Community education and research

Some examples of AOD current research include:

Activity 3: Health promotions

Pyschosocial theories and AOD work

What are psychosocial theories?

Activity 4: What do you already know?

Basic trust vs mistrust

Autonomy vs shame or doubt

Maturity and old age Ego integrity vs despair

Erikson (1969) Childhood and Society

In practice Activity 5: Using Eriksons concept to explore AOD issues

Client centred Rogerian theory

Solution focused therapy

Early and brief interventions

Did you know?

Activity 6: Looking at families

Activity 7: Looking at theories

Check your progress

Group work method

Psychosocial theories and therapies used in the AOD sector

Using the Internet

AOD sectorcurrent research

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