COUC 691 Week 6 DB Forum 3 (NA) Example

Discussion Board Forum 3 (NA): Thread and Two Replies

COUC 691 Substance Abuse: Diagnosis, Treatment and Prevention, Discussion Board Forum 3, NA (thread and two replies)

Thread by [Student Name]

The prompt, the writer's observations and the classmates' posts are composites standing in for the course's own forum, and no NA member is described in identifying detail; the textbooks, Scripture and published studies are real; COUC 691 shares its course guide with CEFS 691, and the requirements follow that public guide.

Thread

At the noon clubhouse meeting I attended, the chair held up keytags one color at a time: white for anyone willing to try, then a new color for each milestone after that, from the first month through the first year and beyond. Each person who came forward got applause, and the loudest applause went to a man taking his third white tag. I wondered why a piece of plastic worth a few cents could bring a grown man close to tears, and why a room full of people would cheer someone for starting over rather than for staying clean.

Behavioral research offers one answer. Contingency management gives tangible rewards when a client shows objective evidence of abstinence. Prendergast et al. (2006) meta-analyzed 47 treatment and control comparisons published between 1970 and 2002 and found a mean effect of d = 0.42, with larger effects for opiate use (d = 0.65) and cocaine use (d = 0.66) than for tobacco. Effects declined after treatment ended, and larger effects came from shorter treatments and studies with more researcher involvement, so the approach is strongest as a way to build early abstinence that other treatments can then sustain.

NA's keytags are not contingency management, but they work on a similar principle: clean time is noticed, named and rewarded in front of people who matter. The reward is social rather than financial, and it is available to every member at no cost. For a counselor, that suggests building recognition of progress into sessions, such as naming a client's milestones aloud, and encouraging clients to take keytags rather than treating them as childish, which some new members do at first. Miller and Rollnick (2013) note that affirming a client's efforts strengthens the working relationship, and a keytag is a public affirmation. It may matter most for members whose families and employers have stopped noticing anything they do well, since the meeting becomes the one place where progress is seen.

One caution: several members at the meeting were taking medication for opioid use disorder, and recognition should not depend on whether a member's recovery fits someone else's definition. Capuzzi and Stauffer (2016) describe medication as part of evidence-based care for opioid addiction.

Proverbs 25:11 likens a well-timed word to golden apples set in silver (English Standard Version Bible, 2001/2016). Each color of keytag is a word fitly spoken.

Classmates: what other practices at your meetings recognized progress, and how might a counselor use them?

Reply to Kayla

Kayla, you wrote that after your NA meetings you started calling your practicum clients "addicts" too, since that is how members describe themselves and it seemed more honest than the clinical terms we learn in class. I understand the appeal, because the self-introduction at my meetings felt honest as well. But research suggests that the words matter differently when clinicians use them.

Ashford et al. (2018) recruited 1,288 participants through a national research registry and assigned them to groups that saw different terms, measuring both implicit associations and social distance. Four labels, "addict," "alcoholic," "substance abuser" and "opioid addict," lined up with the negative side of the association task, clearly apart from their positive counterterms. "Relapse" was also linked with the negative, and "recurrence of use" drew a stronger positive association than "relapse." Positive terms such as "long-term recovery" and "medication-assisted recovery" carried positive associations. The authors recommend that professionals stop using "addict" and "substance abuser."

A member who calls himself an addict is claiming an identity within a fellowship; a counselor who uses the word in a chart or a team meeting may shape how others see the client. Perhaps the best approach is to let clients choose their own words while we use person-first language. It may also help to notice how often our own notes use the word "relapse," since the study found that even that common term leaned negative. How do you think your clients would react if you asked which words they prefer?

Reply to Luis

Luis, you described the Spanish-language NA meeting you visited and how different it felt from the English meeting across town, with members who were mostly immigrant fathers and readings in the language they pray in. Your observation that two clients at your site had stopped attending English-language meetings after one visit each made me think about how much fit matters.

Hettema et al. (2005) reviewed 72 clinical trials of motivational interviewing and found an average short-term effect of 0.77 that shrank to 0.30 by the one-year follow-ups. Two findings stand out for your point: the method helped minority clients more than White clients, and it helped more when counselors were not tied to a manual. The authors suggest that a respectful, flexible style may be especially valuable for clients who expect to be judged or misunderstood. The same principle seems to apply to referral: a meeting in a client's own language and culture may communicate respect before anyone says a word. It also gives clients a sponsor and a network who share their language and family expectations, which may make the steps easier to apply at home. For clients who are bilingual, offering both meetings and letting them choose respects their autonomy, which is the same spirit Miller and Rollnick describe.

Would your site be willing to keep a current list of Spanish-language meetings and to invite a member to speak to clients about them?

References

Ashford, R. D., Brown, A. M., & Curtis, B. (2018). Substance use, recovery, and linguistics: The impact of word choice on explicit and implicit bias. Drug and Alcohol Dependence, 189, 131-138. https://doi.org/10.1016/j.drugalcdep.2018.05.005

Capuzzi, D., & Stauffer, M. D. (2016). Foundations of addictions counseling (3rd ed.). Pearson.

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Hettema, J., Steele, J., & Miller, W. R. (2005). Motivational interviewing. Annual Review of Clinical Psychology, 1, 91-111. https://doi.org/10.1146/annurev.clinpsy.1.102803.143833

Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change (3rd ed.). Guilford Press.

Prendergast, M., Podus, D., Finney, J., Greenwell, L., & Roll, J. (2006). Contingency management for treatment of substance use disorders: A meta-analysis. Addiction, 101(11), 1546-1560. https://doi.org/10.1111/j.1360-0443.2006.01581.x