Abstract
Can mental health professionals treat the substance abuser? Sadly, the answer may be no. Addiction treatment is becoming an area of specialized expertise. Mainstream mental health clinicians have not yet addressed their responsibilities in this area, even though addictive illness is the most common psychiatric disorder. Relatively few therapists are experienced in offering proper care to addicted persons. Instead of setting abstinence as the goal, many engage the patient in exploratory therapy, hoping that a resolution of his internal conflict or social stress will end his substance abuse. Others may refuse to provide treatment, telling the patient to find alternative care and to return when the addiction problem has been resolved. Neither approach plays a meaningful role in securing the patient’s abstinence and subsequent rehabilitation. There are, however, a variety of techniques currently available to help substance abusers achieve abstinence. Clinicians can work closely and supportively with addicted patients while they become integrated into a self-help group such as Alcoholics Anonymous. They can engage the family and social network in conjoint therapy to initiate and maintain abstinence and even to monitor disulfiram administration. They can adopt active interventions as necessary to ensure the integrity of the treatment, just as they do in treating a psychotic illness, in which denial is also a prominent feature. Why do so many clinicians fail to apply these approaches? Few of them have had formal training in treating substance abusers, in contrast to their broad experience in the care of depressed, neurotic, or schizophrenic patients. The die is cast during their professional training, even though they generally have some exposure to such patients. Ironically this exposure actually detracts from training in the care of substance abusers. The emergency room serves as a training ground for rapid re