Treating multiple substance abuse clients.

Abstract

The traditional separation of alcohol-dependent from drug-dependent persons no longer accords with contemporary patterns of substance abuse, especially for people below the age of 40. In ever-increasing numbers, the pattern of abuse is one of multiple substance abuse (MSA). Overwhelmingly, MSA involves the sequential or concurrent abuse of alcohol and one or more other drugs. Treatment centers need to be cognizant of this development, especially in taking accurate substance abuse histories and providing effective inpatient and aftercare services. A generic perspective of etiology, defenses, and treatment is provided, as well as a discussion of three varieties of combined treatment (conscious, overt; conscious, covert; and unconscious). Specific treatment interventions are suggested, as well as strategies for staffing and staff training. Finally, the need to provide a suitable therapeutic and living environment for the heterogeneity of clients likely to present with MSA is stressed.