Substance Abuse Counseling: Theory and Practice

379 Pages·2012·5.46 MB·English

by  Patricia Stevens

CONTENTS
Chapter 1 INTRODUCTION TO SUBSTANCE ABUSE COUNSELING 1
The History of Substance: No Wonder We Use 4
Alcohol 4
Cocaine 6
Heroin 7
Marijuana 7
Opioids 8
Amphetamines 10
Hallucinogens 10
Tobacco 11
Caffeine 12
Societal Costs of ATOD Use, Abuse, and Dependency 13
Substance-Related Diseases 14
Hepatitis 14
HIV/AIDS 16
The Importance of Terminology in Substance Abuse Counseling 17
The Profession in the 21st Century 19
An Overview of this Book 20
Conclusion 20
Chapter 2 ETHICAL AND LEGAL ISSUES IN SUBSTANCE ABUSE
COUNSELING 27
Education and Training of Substance Abuse Counselors 28
Ethics 30
Confidentiality 32
Code of Federal Regulations 42, Part 2 34
Health Insurance Portability and Accountability Act of 1996
(HIPAA) 35
Confidentiality in Group Counseling or 12-Step Groups 36
Confidentiality of Minors 37
Multiculturalism, Diversity, and Ethics 41
Ethical Conflicts Specific to Substance Abuse Counselors 42
Dual Relationships 42
Clients and Criminal Activity 43
Conflicting Laws 44
Ethical Code Conflicts 44
Contents xiii
Ethical Decision Making 44
Conclusion 50
Chapter 3 THE MAJOR SUBSTANCES OF ABUSE
AND THE BODY 51
The Brain 52
Neuroscience Research 52
The Structure of the Brain 53
Psychoactive Substances and the Brain 58
Controlled Substances Schedules 59
Depressants 59
Alcohol 60
Benzodiazepines: Prescription and Over-the-Counter
Medications 64
Barbiturates 66
GHB (Identified as a Club Drug) 67
Opiates (Prescription Drugs Often Abused) 69
Stimulants 71
Cocaine 71
Amphetamines 74
Minor Stimulant: Nicotine 76
Minor Stimulant: Caffeine 78
Cannabis 79
Hallucinogens 82
Lysergic Acid Diethylamide (LSD) 83
Phencyclidine (PCP) 84
Ketamine (Targeted as a Club Drug) 85
A Further Look at Club Drugs 86
MDMA (Ecstasy) 86
Volatile Substances or Inhalants 88
Anabolic-Androgenic Steroids 89
Conclusion 92
Chapter 4 ETIOLOGY OF SUBSTANCE ABUSE: WHY PEOPLE USE 98
Understanding Theory 98
Overview of ATOD Theories 99
Moral Theory 99
Aspects of Use Addressed by the Moral Theory 99
Disease Theory 101
Aspects of Use Addressed by the Disease Theory 101
xiv Contents
Genetic Theories 105
Aspects of Use Addressed by Genetic Theories 107
Behavioral Theories 110
Aspects of Use Addressed by the Behavioral Theory 111
Sociocultural Theories 114
Aspects of Use Addressed by Sociocultural Theories 115
An Integrated Approach 119
Conclusion 121
Chapter 5 ASSESSMENT AND DIAGNOSIS 122
Issues in Assessment 122
The Diagnostic Interview 124
DSM-IV-TR DIAGNOSIS 126
Criteria for Substance Dependence 126
Criteria for Substance Abuse 127
Behavioral Characteristics 127
Phase 1: The Prodomal Phase 128
Phase 2: The Crucial Phase 130
Phase 3: The Chronic Phase 131
Assessing the Behavioral Symptoms 132
Social Characteristics 132
Family Characteristics 132
Assessing the Social and Family-Related Symptoms 135
Screening and Assessment Instruments 136
The Michigan Alcoholism Screening Test (MAST) 137
The Short Michigan Alcoholism Screening Test (SMAST) 138
The Drug Abuse Screening Test (DAST-20) 138
The CAGE Questionnaire 138
The Substance Abuse Subtle Screening Inventory (SASSI-3
and SASSI-A2) 139
The Alcohol Use Inventory (AUI) 140
The Addiction Severity Index (ASI) 140
The Adolescent Diagnostic Interview (ADI) 141
The Millon Clinical Multiaxial Inventory (MCMI-II) and
Minnesota Multiphasic Personality Inventory (MMPI-2) 141
The ASAM Criteria for Patient Placement 142
Diagnosis 143
Differential Diagnosis 143
Dual Diagnosis 144
Contents xv
Chapter 6 TREATMENT SETTING AND TREATMENT
PLANNING 155
What Is a Treatment Setting? 156
Types of Treatment Settings 157
Medical Detoxification and Stabilization 157
Dual-Diagnosis Hospital Inpatient 158
Free-Standing Rehabilitation and Residential Programs 159
Partial Hospitalization 164
Temporary Recovery or Halfway Homes 164
Intensive Outpatient 164
The Importance of Matching Treatment to Client Needs 167
What Is Treatment Planning? 168
How to Develop a Treatment Plan 170
The Elements of a Severe Substance Use Disorder
Treatment Plan 171
Sample Substance Use Treatment Plan:
Relationship Factors 171
External Reviewers of Treatment Planning: Health Care
Accreditation Organizations and Managed Care 175
Conclusion 178
Treatment of Drug and Alcohol Problems
in the Military 185
Chapter 7 INDIVIDUAL TREATMENT 188
Beginning Individual Treatment 189
Intervention 189
Individual Therapy 191
Therapeutic Alliance 191
Direct Effect Strategies 191
Motivational Interviewing 191
Cognitive-Behavioral Therapy 192
Mindfulness Technique 193
Pharmacotherapy 193
Broad Spectrum Strategies 195
Harm Reduction 195
Harm Reduction from the Therapist's Perspective 196
Coping Skills Training/Life Skills Training 197
Vocational Readiness 197
Support Groups 198
Conclusion 201
XVI Contents
Chapter 8 GROUP TREATMENT IN THE CONTINUUM OF CARE 203
Evolution of Group Treatment 204
Group Dynamics, Process, and Structure 207
Curative Factors in Group Treatment 207
Group Dynamics 209
Stages of Group Development 212
Structural Considerations 216
Group Treatment in the Continuum of Care 217
Prevention 218
Detoxification and Inpatient Treatment 218
Residential Treatment 219
Partial Hospitalization and Day Treatment 219
Aftercare and Sober Living 220
Outpatient Groups and Community Care 220
Pragmatics of Group Treatment 221
Therapeutic Community 221
Self-Help Groups 222
Psychoeducational Groups 222
Cognitive and Behavioral Interventions 223
Group Psychotherapy 228
Relational Therapy and Family Groups 229
Group Treatment Efficacy 232
Conclusion 238
Chapter 9 FAMILY TREATMENT 240
Defining Family 242
General Systems Concepts 243
Homeostasis 244
Feedback Loops 244
Hierarchy, Roles, Rules, Subsystems, and Boundaries 245
Wholeness 246
Change 247
Values 247
Systems and Addictive Families 247
The Marital Dyad and Substance Abuse 248
The Family and Substance Abuse 250
Children in the Addicted Family 252
Treatment with Addictive Families 253
Contents xvii
The Process of Treatment 255
Programs Utilizing Family Therapy 255
How Successful Is Family Therapy? 256
Conclusion 260
Chapter 10 RETAINING SOBRIETY: RELAPSE PREVENTION
STRATEGIES 261
Determinants of Relapse 263
Environmental 263
Behavioral 264
Cognitive 265
Affective 265
Interpersonal Determinants 266
Summary 267
Models of Relapse Planning and Management 267
The Disease Model 267
Developmental Models 268
A Cognitive-Behavioral/Social Learning Model 271
Self-Help Recovery Organizations: Adjuncts to Professional
Intervention 274
Alcoholics Anonymous Model 275
Spirituality as a Resource 277
AA-Associated 12-Step Programs 278
Moderation Management (MM) 278
Rational Recovery 280
Secular Organizations for Sobriety/Save our Selves (SOS) 281
Women for Sobriety (WFS) 281
Self-Help for Dually Diagnosed Persons 283
A Well-Rounded Life with Joy 283
Conclusion 286
Chapter 11 WORKING WITH SELECTED POPULATIONS:
TREATMENT ISSUES AND CHARACTERISTICS 287
Children and Adolescents 287
Risk Factors 290
Prevention and Intervention 291
Women 294
Risk Factors 294
Prevention and Intervention 295
xviii Contents
The Gay/Lesbian/Bisexual/Transgender Community 297
Gay/Lesbian/Bisexual/Transgender Identity Development 298
Risk Factors 298
Prevention and Intervention 299
People with Disabilities 300
Risk Factors 301
Prevention and Intervention 302
Older Adults 304
Risk Factors 304
Prevention and Intervention 305
Homelessness 306
Risk Factors 307
Treatment 308
Conclusion 310
Chapter 12 WORKING WITH DIVERSE CULTURES: EXPLORING
SOCIOCULTURAL INFLUENCES AND REALITIES
IN ATOD TREATMENT AND PREVENTION 311
American Indians and Alaskan Natives 312
Cultural Values 314
Risk Factors 315
Barriers to Treatment 316
Prevention and Intervention 317
Asian Americans 318
Cultural Values 320
Risk Factors 321
Prevention and Intervention 322
African Americans 324
Risk Factors 325
Cultural Values 326
Barriers to Treatment 327
Prevention and Intervention 327
Hispanics 328
Cultural Values 330
Barriers to Treatment 331
Prevention and Intervention 333
Conclusion 334
Contents xix
Chapter 13 PREVENTION 336
Types of Prevention 339
Prevention: A Brief History 340
Comprehensive Prevention 343
Community Prevention 344
Risk and Protective Factors 346
Life Skills Training (LST): Effectiveness of a Comprehensive
Prevention Approach 349
Steps to an Effective Prevention Program 350
Implications for Counseling 353
Conclusion 356
References 358
Index 392
Introduction to Substance
Abuse Counseling
Patricia Stevens, Ph.D.
MyCounselingLab
Visit the MyCounselingLab' site for Substance Abuse Counseling, Fifth Edition to
enhance your understanding of chapter concepts. You'll have the opportunity to
practice your skills through video- and case-based Assignments and Activities as
well as Building Counseling Skills units, and to prepare for your certification exam
with Practice for Certification quizzes.
Icohol, tobacco, caffeine, prescription drugs, illegal drugs—all are commonplace words
today. Alcohol, tobacco, and other drugs (ATOD) are used for celebrations,
for mourning, for religious rituals, for pain relief, and recreationally. We read
about them in the newspaper daily, we hear about them on the radio and television,
and we can find just about anything, from what they are to how to make them, about
any substance use and abuse on the Internet. We see children abusing at younger ages
and elders abusing. Drugs are misused to forget, to feel better or not feel at all, to be
friendly, to disinhibit, and because of peer pressure. Tobacco and alcohol, legal drugs,
are used and abused with social sanction and are easily available. If we don't use them,
we probably have a user/abuser in the family or a close friend who has abused, or
know someone who uses alcohol or other drugs inappropriately.
Consequences of use and abuse of legalized substances continue to be minimized
in a variety of settings. Until the mid-1990s, the tobacco industry denied addiction
while people were dying from lung cancer and others continued to smoke. After
multiple suits against the companies, they tried to settle, paying out $10 billion per
year in perpetuity and placing in the public domain over 35 million pages of internal
documents on the effects of smoking.
In 2009, an estimated 69.7 million Americans aged 12 or older were current
(past month) users of a tobacco product. This represents 27.7% of the population
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