Focus on

In light of the high rates of dual diagnoses in substance abusers who present for treatment (Castaneda et al. 1989; Evans and Sullivan1990; Nace et al. 1991; Rounsaville et al. 1991), it is likely that these patients will be suffering from affective disorders, anxiety disorders, or other psychological maladies when they enter treatment. If therapists show an interest in sympathizing with and addressing these emotional problems, in contrast to focusing exclusively on the substance abuse per se, they can demonstrate that they are interested in the entirety of the patient's well-being. In this manner, therapists show that they are interested in getting to know the patient as a person, and not simply as an addict.

Such an approach is especially indicated for substance-abusing patients who also meet diagnostic criteria for antisocial personality disorder (ASPD). These patients typically are unmotivated to change unless they are in emotional distress, in which case there is a desire to participate in therapy to gain relief (Alterman and Cacciola 1991; Woody et al. 1990). By helping these ASPD/depressed drug abusers to improve their mood, therapists may be able to form an interpersonal alliance with patients who otherwise might not bond with a helper.

Even when patients do not technically meet criteria for dual diagnoses, they may often experience emotional suffering related to having reached points of crisis in their lives (Kosten et al. 1986; Newman and Wright 1994; Sobell et al. 1988). Therefore, it is quite appropriate for therapists to put such topics as current areas of stress and family problems on the therapeutic agenda. In addition to providing the patients with understanding and empathy, this approach also calls patients' attention to the fact that substance abuse is an important cause of their general malaise in life. This may further motivate patients to consider the cessation of substance abuse as a major goal of treatment.

II. Establishing Rapport at the Outset of Treatment
3. Focus on the Patient's Distress
In light of the high rates of dual diagnoses in substance abusers who present for treatment (Castaneda et al. 1989; Evans and Sullivan1990; Nace et al. 1991; Rounsaville et al. 1991), it is likely that these patients will be suffering from affective disorders, anxiety disorders, or other psychological maladies when they enter treatment. If therapists show an interest in sympathizing with and addressing these emotional problems, in contrast to focusing exclusively on the substance abuse per se, they can demonstrate that they are interested in the entirety of the patient's well-being. In this manner, therapists show that they are interested in getting to know the patient as a person, and not simply as an addict. Such an approach is especially indicated for substance-abusing patients who also meet diagnostic criteria for antisocial personality disorder (ASPD). These patients typically are unmotivated to change unless they are in emotional distress, in which case there is a desire to participate in therapy to gain relief (Alterman and Cacciola 1991; Woody et al. 1990). By helping these ASPD/depressed drug abusers to improve their mood, therapists may be able to form an interpersonal alliance with patients who otherwise might not bond with a helper. Even when patients do not technically meet criteria for dual diagnoses, they may often experience emotional suffering related to having reached points of crisis in their lives (Kosten et al. 1986; Newman and Wright 1994; Sobell et al. 1988). Therefore, it is quite appropriate for therapists to put such topics as current areas of stress and family problems on the therapeutic agenda. In addition to providing the patients with understanding and empathy, this approach also calls patients' attention to the fact that substance abuse is an important cause of their general malaise in life. This may further motivate patients to consider the cessation of substance abuse as a major goal of treatment.
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