Assessment and goal setting

Assessment is an important first stage of treatment. It should not be relegated merely to the role of an impersonal procedure to be completed prior to treatment. Just as the drinker or drug-taker is actively involved in his or her own addictive behaviour, so they must be actively involved in their own recovery. It is the responsibility of the therapist to use assessment as an important opportunity to encourage that involvement. Indeed, it may be more appropriate to regard this first stage of treatment as reaching a mutual agreement about goals rather than simply setting goals.

Psychology has always had a primary interest in behaviour, and among the general themes of psychological treatments for addiction problems two prominent issues have been the focus upon the psychosocial context in which drug-taking occurs, and the targeting of interventions at addictive behaviour. Psychology has also shown a particular interest in the antecedents of the overlearned habits that are the addictions, including the situational and environmental circumstances in which the behaviour occurs, the beliefs and expectations of the user, and his or her prior learning experiences with the drug itself. In addition, psychology has an equal interest in the consequences of these behaviours, and specifically in the reinforcing effects that may lead to increased use and the negative consequences that may serve to inhibit the behaviour.

Traditional types of assessment procedures for behaviour modification programmes as described by Kanfer and Phillips (1970) have been found to be directly applicable to the treatment of addictive behaviour. Information is needed about target behaviours, the reinforcement parameters maintaining them, opportunities in the environment for maintaining other more desirable responses, and the individuals’ ability to observe and reinforce themselves.

For all types of drug problems that require treatment, the intervention offered should be tailored to the needs and circumstances of the individual. This apparently simply and uncontentious statement turns out to have complex and far-reaching implications for policy and services if it is seriously applied in clinical practice (Gossop, 1987). There is not, nor can there be expected to be, any single best treatment for these problems. Both aetiology and outcome are influenced by a broad range of different factors that will differ in important respects from person to person.