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National Institute on Drug Abuse approaches U.S. Department ofHealth and Human Services onal Institutes ofHealth approaches to drug abuse counseling Editors: John Boren, Ph.D. J. Lisa Simon Onken, Ph.D. National Institute on Drug Abuse Kathleen M. Carroll, Ph.D. Yale University National Institute on Drug Abuse Division ofTreatment and Research Development Behavioral Treatment Development Branch 6001 Executive Boulevard MD Bethesda, 20892 U.S. Department ofHealth and Human Services National Institutes ofHealth ACKNOWLEDGMENTS This publication contains information on various drug abuse counseling approaches, written by representatives ofmany well-known treatment programs. Although the counseling approaches included are used in some ofthe best known and mostrespected treatment programs in this country, it has not been determined whether all ofthese counseling models are equally effective. These various approaches are presented in an identical outline form so that the reader can compare and contrast the many treatment models described and learn more about the roles ofthe counselor and subject in a particular model. COPYRIGHT STATUS All material in this volume is in the public domain and may be used orreproduced without permission from the National Institute on Drug Abuse (NIDA) or the authors. Citation ofthe source is appreciated. DISCLAIMER Opinions expressed in this volume are those ofthe authors and do not necessarily reflect the opinions or official policy ofNIDA or any other part ofthe U.S. Department ofHealth and Human Services. The U.S. Government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this publication are used only because they are considered essential in the context ofthe models reported herein. PUBLIC DOMAIN NOTICE All material appearing in this report is in the public domain and may be reproduced without permission from the National Institute on Drug Abuse or the authors. Citation ofthe source is appreciated. National Institute on Drug Abuse NIH Publication No. 00-4151 Printed July 2000 ARC LIBRARY MD BALTIMORE, CONTENTS Introduction and Overview 1 John J. Boren, Lisa Simon Onken, andKathleen M. Carroll Dual Disorders Recovery Counseling 5 Dennis C. Daley The CENAPS® Model ofRelapse Prevention Therapy (CMRPT®) 21 Terence T. Gorski The Living In Balance Counseling Approach 35 JeffreyA. Hoffman, BenJones, BarryD. Caudill, Dale W. Mayo, andKathleen A. Mack Treatment ofDually Diagnosed Adolescents: The Individual Therapeutic Alliance Within a Day Treatment Model 55 Elizabeth DriscollJorgensen andRichardSalwen Description ofan Addiction Counseling Approach 73 Delinda Mercer Description ofthe Solution-Focused BriefTherapy Approach to Problem Drinking 83 ScottD. Miller Motivational Enhancement Therapy: Description ofCounseling Approach 89 William R. Miller Twelve-Step Facilitation 95 Joseph Nowinski Minnesota Model: Description ofCounseling Approach 103 Patricia Owen A Counseling Approach Ill FredSipe A Psychotherapeutic and Skills-Training Approach to the Treatment ofDrug Addiction 121 ArnoldM. Washton Introduction and Overview John J. Boren, Lisa Simon Onken, andKathleen M. Carroll The consequences ofdrug and alcohol abuse in Elizabeth Driscoll Jorgensen and Richard Salwen the United States are enormously costly. and by Scott D. Miller illustrate innovative Although the costs can be evaluated in dollars, counseling strategies designed for special they are more readily understood in human terms: populations and settings. Each chapter was family discord, neglect ofchildren, personal written by an authoritative spokesperson for the misery, financial straits, medical problems, fetal counseling model being described. alcohol syndrome, HIV infection, legal problems, incarceration, automobile accidents, lower work After surveying a number ofchapters in a typical — productivity, andjob loss and the list goes on. edited book on treatment models, the reader may Combating and reducing the source ofthese have a difficult time comparing them, seeing how problems have proven to be difficult indeed, but they are similar, seeing where they differ. Each one ofthe most straightforward and author typically finds different topics important, noncontroversial ways is to provide effective emphasizes different issues, and writes a chapter treatment to drug abusers. whose coverage is unlike any other author’s. Furthermore, ifthe chapter focuses on the This book is about treatment. In particular, it is theoretical background, it may be hard to gain a about the basic component ofmost treatment practical understanding ofthe counseling — programs group and individual counseling. The interventions and what the counselor actually intent ofthis book is to present information on does with the client. In an effort to make the various counseling approaches used in some of comparison ofthe various models less difficult the best known and most respected treatment and to clarity how the model is applied in programs in the United States. Certainly all practice, two ofthe editors (K.M.C. and L.S.O.) meritorious counseling models are not designed a comprehensive outline oftopics that represented and, as a practical matter, could not could be applied to almost any counseling be represented. However, chapters have been approach. The topics ranged from theoretical written by representatives ofsuch well-known rationale to specific counseling practices. The treatment programs as the Hazelden Foundation authors were asked to follow a specific format, (chapterby Patricia Owen), the Betty Ford Center and they did so, with only an occasional (byFred Sipe), CENAPS® (byTerenceT. Gorski), exception in a few chapters. The format is: Living In Balance (by JeffreyA. Hoffman), and the Washton Institute (by Arnold M. Washton). Other 1. OVERVIEW, DESCRIPTION, AND chapters were prepared by representatives of RATIONALE nationally known research centers on the 1.1 General Description ofApproach treatment ofdrug abuse, including William R. 1.2 Goals and Objectives ofApproach Miller (University ofNew Mexico), Delmda 1.3 Theoretical Rationale/Mechanism of Mercer (University ofPennsylvania), and Dennis Action C. Daley (Western Psychiatric Institute and 1.4 Agent ofChange (e.g., patient, Clinic). Two ofthe three treatments in Project therapist, group affiliation) Match, the monumental clinical trial sponsored 1.5 Conception ofDrug Abuse/Addiction, by the National Institute on Alcohol Abuse and Causative Factors Alcoholism, are described in this volume. (See William R. Miller’s Motivational Enhancement Therapy and Joseph Nowinski’s Twelve-Step Facilitation.) Finally, chapters prepared by 1 % '*</- 1454*..^ JC.- A CONTRASTTO other counseling ASSESSMENT 2. 7. (before, during, or after APPROACHES treatment; major domains assessed; 2.1 Most Similar Counseling Approaches instruments typically used) 3. 2.2 Most Dissimilar Counseling Approaches 8. SESSION FORMAT AND CONTENT 8.1 Format for a Typical Session (How does FORMAT the session begin and end?) 3.1 Modalities ofTreatment 8.2 Several Typical Session Topics or 3.2 Ideal Treatment Setting (inpatient, Themes (Is the theme ofthe session outpatient, residential, other) determined by the patient or the 4. 3.3 Duration ofTreatment (fixed or open counselor?) ended; length and usual number of 8.3 Session Structure sessions) 8.4 Strategies for Dealing With Common 3.4 Compatibility With Other Treatments Clinical Problems (lateness, missed (e.g., pharmacotherapy, family therapy) sessions, patients who attend underthe 3.5 Role ofSelf-Help Programs influence) 8.5 Strategies for Dealing With Denial, COUNSELOR CHARACTERISTICS AND Resistance, or Poor Motivation TRAINING 8.6 Strategies for Dealing With Crises 4.1 Educational Requirements 8.7 Counselor’s Response to Slips and 4.2 Training, Credentials, and Experience Relapses Required 4.3 Counselor’s Recovery Status (essential, 9. ROLE OF SIGNIFICANT OTHERS IN helpful, irrelevant) TREATMENT (Are other family members 4.4 Ideal Personal Characteristics of involved and in what way?) Counselor 4.5 Counselor’s Behaviors Prescribed With all chapters following the format, the reader 4.6 Counselor’s Behaviors Proscribed can not only compare the various counseling (techniques and interventions that are models on any selected characteristic but also discouraged or contraindicated) have a better idea ofwhat a counselor actually 4.7 Recommended Supervision (e.g., role, does while following a particular model. format, goals) The work for this book began in October 1993 5. CLIENT-COUNSELOR RELATIONSHIP when the Treatment Research Branch ofthe 5.1 What Is the Counselor’s Role? (teacher, National Institute on Drug Abuse (NIDA) held a collaborator, therapist, peer, adviser) conference in Rockville, MD, on counseling 5.2 Who Talks More? models. Many ofthe authors represented in this 5.3 How Directive Is the Counselor? volume attended this conference, described their 5.4 Therapeutic Alliance (the quality counseling approaches, and exchanged views. desired, strategies the counselor uses to Subsequently, chapters were prepared and then build the alliance, strategies to address updated in the summer of 1996. The editors hope a poor alliance) that the chapters will show how well-developed treatment programs counsel drug abusers and will 6. TARGET POPULATIONS serve as a resource to counselors, treatment 6.1 Clients Best Suited for This Counseling providers, and interested readers who seek Approach knowledge on counseling theory and practice. 6.2 Clients Poorly Suited for This Counseling Approach 2 9 EDITORS John J. Boren, Ph.D. (retired) MD Chevy Chase, Lisa Simon Onken, Ph.D. National Institutes ofHealth National Institute on Drug Abuse Division ofTreatment and Research Development Behavioral Treatment Development Branch Neuroscience Center Building, Room 4227 600 Executive Boulevard 1 MD Bethesda, 20892 Kathleen M. Carroll, Ph.D. Yale University School ofMedicine 34 Park Street New Haven, CT 065 1