Psychotherapeutic interventions with substance abusers--the clinical context.

Drug/alcohol dependent individuals need to discover and understand how they have adopted extraordinary drug solutions for a range of problems. I believe human relationships can best provide this opportunity through either a professional psychotherapeutic relationship or peer group experiences such as group therapy and self-help groups such as AA or NA. Addicts need to learn that drug solutions preclude more ordinary solutions to life problems, and that therapeutic and peer groups experiences can provide the creative challenges, tools, and impetus to find alternative solutions. Clinical work with severe and disabling human problems teaches the humbling nature of our work as health care professionals. Clearly, work with substance abusers is no exception. As we gain in our scientific, technical and clinical understanding of these problems, we are able to help our patients make enlightened choices about what is useful and effective in their treatment and recovery. However, there is much we do not understand about substance abuse, and there are many affected by the problem who cannot accept what we have to offer. Effective practice in this case, then, must still be guided by practical and empirical measures of what is safe and what works. Health care professionals do not have a corner on this market of what is safe and what works. Practitioners need to honor their traditions where treatment is guided by careful collection of data and continual pursuit of root causes, mechanisms, and etiologies. But, above all, rigid attitudes about the advantages of our own approach and the limitations of other approaches need to be avoided. In this respect we honor "above all" the primary tradition in clinical practice--"to do no harm".