Enhancing Health-Conscious Behaviors Among Clients in Substance Abuse Treatment Programs: Strategies for Social Workers

Purpose:  Substance abuse clinicians have long noted how the physical health of clients deteriorates when clients engage in prolonged use of alcohol and other drugs and the perpetual neglect of healthy behaviors such as diet and exercise.  Researchers have recommended a balanced approach to substance abuse treatment that includes developing health-conscious behaviors.  Thus, the specific aims of this study were:

1. To understand how substance abuse clinicians cognitively process the health needs of their clients.
2. To identify the mechanisms through which clinicians seek to enhance health-conscious behaviors among their clients.
3. To identify how substance abuse clinicians view their role in enhancing health-conscious behaviors among their clients.

Because there is a plethora of dynamics involved in treating substance use disorders, the perspective and expertise of substance abuse clinicians is critical.  Substance abuse clinicians have up-close experience with these dynamics, and as such, can offer pragmatic, in-depth insight into enhancing health-conscious behaviors.

Methods:  A qualitative study was conducted using in-depth, semi-structured interviews with substance abuse clinicians (N = 16) from four residential substance abuse treatment centers in California.  Study participants were predominantly Caucasian (69% Caucasian; 19% African American; 19% Hispanic) and female (56%), with an average age of 49 (sd=11.66).  The interview guide used for this study was based on the theory of planned behavior because of its ability to explain clinical intentions to enhance health-conscious behaviors among clients.  Interviews were audio-recorded and transcribed.  Atlas.ti was used to thematically code important information from each interview. 

Findings:  Enhancing health-conscious behaviors among substance abuse clients is dependent on three factors. First, the successful enhancement of health-conscious behaviors is dependent upon the willingness of the substance abuse clinician to educate the substance abuse client on what constitutes health-conscious behaviors.  This willingness, however, is influenced by a number of factors, including the clinician’s own health-conscious behaviors, beliefs regarding the importance of health-conscious behaviors, and the clinician’s ability to establish rapport with the client. Second, the successful enhancement of health-conscious behaviors is dependent upon the willingness of the substance abuse treatment center to provide programmatic support for the promotion of health-conscious behaviors among people in substance abuse treatment.  This factor is influenced by the availability of critical resources and by policy demands of external funding agencies.  Finally, even when health-conscious behaviors are successfully promoted in treatment programs, clinicians believed that clients are ultimately in control of whether health-conscious behaviors are adopted. 

Implications:  Understanding clinical views on physical health and recovery provides ground-level knowledge that can be used to develop programmatic strategies to enhance health-conscious behaviors among clients in substance abuse treatment. Critically, without the treatment center’s programmatic support for the enhancement of health-conscious behaviors among clients in treatment, substance abuse clinicians may find themselves less willing to educate and encourage their clients on what constitutes health-conscious behaviors.  Identifying the formal and informal recommendations clinicians make as to how clients can enhance their physical health during substance abuse treatment can help administrators justify the outlay of resources to support clinicians and clients in this area.