A Phenomenological Contribution to Substance Misuse Treatment: Principles for Person-Centered Care

Despite the significant need for coordinated approaches to the treatment of substance misuse worldwide, there are still major gaps in both the provision of services and in the development of a theoretically unified approach to care. We suggest that a phenomenological approach to care can provide comprehensive, theoretically grounded guidelines that coordinate and help choose between a range of interventions while respecting the values of the patient and other stakeholders. The aim of this paper is to present a framework for a person-centered approach to substance misuse care, based on general principles of phenomenology. In particular, we emphasize a dialectic conception of phenomenological care, one that considers the various tensions and conflicts of human life, and the ways these are managed by individuals. Two dialectics are presented here: the dialectic of anthropological proportions, involved in the existential situation of the substance misuser, and the dialect of decision, which is essential to all approaches to the treatment of substance misuse. The dialectic of proportions in the substance misuser's experience involves hyperpresentification, the tendency to emphasize the present moment to the relative exclusion or reduction of the past and future considerations, and feelings of plenitude, an oversimplification of experience that ignores the complexity present in every situation. Interventions should reflect a dialectic of decision, which allows the clinician and patient to choose pathways that promote movement and expand the limitations of hyperpresentification and plenitude. This phenomenological framework, we suggest, permits a collaborative and values-based approach to comprehensive clinical decision-making.