DIGEST - Volume 10, Issue 3-FULL DIGEST

7 TPC Digest S u bstance use and misuse is at once exceptionally common and quite impactful individually and societally. Although the majority of individuals use without much consequence, many others develop substance use disorders. Substance use and misuse, whether rising to a diagnosis or not, can lead to a host of problems. Individually, it results in relationship conflict, including intimate partner violence, exacerbation of co-occurring mental health issues, and increased suicidality. Societally, substance use and misuse cost the United States billions of dollars from criminal activity, health-related issues, and occupational difficulties. In essence, client substance use and misuse goes well beyond the physical act of substance use and is often complex and multifaceted. T here are many approaches that have been shown to help client substance use and misuse. Among these are 12-step and other self-help groups, cognitive behavioral therapy, mindfulness-based approaches, and family counseling. Although these and other approaches can be effective, they may not always take into account the distinctiveness of clients. The Substance Abuse and Mental Health Services Administration favors approaches that address individual and unique client needs to better move them toward recovery. Thus, there exists a need for a more holistic method that goes beyond standard substance use and misuse treatment, while concomitantly being able to take advantage, where appropriate, of other approaches. There have been frameworks that have examined clients from a multidimensional lens, including causal, contributing, environmental, and personal features. One such framework is the Five Ps framework, which utilizes five factors that together potentially provide a wealth of information. They are Presenting problem , Predisposing factors , Precipitating factors , Perpetuating factors , and Protective factors . Using this framework, clients can be assessed thoroughly, systematically, and individualistically. It also provides the client and counselor with the opportunity to explore the relationships between and among each of the five factors. This then formulates routes in which to intervene. Client substance use and misuse can often be complicated and multifaceted, including variations in level of use; co-occurring mental disorders; health concerns; legal, occupational, and financial issues; and relationship and familial discord. As clients and counselors engage in the Five Ps, a clear picture emerges. A valuable and potentially beneficial feature of the Five Ps is its flexibility. It allows the client and counselor to enter and intervene at any point within the Five Ps. As with many of the previously cited approaches, the Five Ps can be used in many substance use and misuse settings, including outpatient, intensive outpatient, partial hospitalization, inpatient, residential, and as part of an aftercare program. T he application of the Five Ps to a case example for a client named Dax provides a practical demonstration. The various strategies demonstrate the idiographic nature of the Five Ps. As the case unfolds, there are interventions at each factor that are utilized to address this particular client with his particular set of concerns. Counselors using the Five Ps are open to use those approaches they feel competent in, as this framework is eclectic in nature and does not adhere to any particular theoretical orientation. The Five Ps is a potentially valuable way to address client substance use and misuse, which is often a very complex issue. Scott W. Peters, PhD, LPC-S, is an associate professor at Texas A&M University – San Antonio. Correspondence may be addressed to Scott Peters, One University Way, San Antonio, TX 78224, scott.peters@tamusa.edu . Case Formulation and Intervention Scott W. Peters Application of the Five Ps Framework in Substance Use Counseling |