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Table of Contents

Chapter 1: Understanding Addiction..................................................................................................1 Overview..................................................................................................................................... 1 Factors that Influence Addiction............................................................................................. 1 The Continuum of Alcohol and Other Drug Use........................................................................ 4 Reinforcers Within the Cycle of Addiction ............................................................................ 7 Theories of Causation ............................................................................................................. 9 The Stages of Change ............................................................................................................... 10 Drugs of Abuse ......................................................................................................................... 12 Commonly Abused Drugs..................................................................................................... 13 Alcohol.................................................................................................................................. 20 Prescription Drugs ................................................................................................................ 21 Withdrawal from Drugs of Abuse......................................................................................... 22 What Is Recovery?.................................................................................................................... 25 Stuck Points in Recovery ...................................................................................................... 29 Toward a New Recovery Paradigm ...................................................................................... 29 References................................................................................................................................. 32 Optional Resources for Further Reading/Use ....................................................................... 33 Chapter 2: Clinical Evaluation...........................................................................................................35 Screening................................................................................................................................... 35 Screening Interviews and Instruments .................................................................................. 36 Assessment................................................................................................................................ 37 Purpose and Definition of Assessment ................................................................................. 37 Information Gathering .......................................................................................................... 39 Data Analysis ........................................................................................................................ 44 Protocols Common to both Screening and Assessment............................................................ 45 Criteria for Substance Dependence Diagnosis and Placement ................................................. 46 Diagnostic and Statistical Manual of Mental Disorders, IV-TR........................................... 46 International Classification of Diseases (ICD) ..................................................................... 48 American Society of Addiction Medicine (ASAM), Patient Placement Criteria, 2R .......... 49 Chemical Testing ...................................................................................................................... 49 Risk Assessment ....................................................................................................................... 51 Risk Assessment for Violence .............................................................................................. 52 Risk Assessment for Suicide................................................................................................. 53 Screening and Assessment for Co-Occurring Disorders .......................................................... 54 Mental Health Disorders ....................................................................................................... 55 Engaging the Client in Treatment ............................................................................................. 58 Goals of the Initial Interview ................................................................................................ 59 The Interview Climate .......................................................................................................... 59 Building the Helping Relationship........................................................................................ 60 Communication Techniques ................................................................................................. 60 Intake and Orientation............................................................................................................... 61 The Intake Process ................................................................................................................ 61

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Orientation to Treatment....................................................................................................... 62 References................................................................................................................................. 65 Resources for Further Reading/Use ...................................................................................... 66 Chapter 3: Counseling Skills ..............................................................................................................67 Overview................................................................................................................................... 67 Individual Counseling............................................................................................................... 68 Group Counseling ..................................................................................................................... 69 How Is Group Work Different From Individual Counseling?.............................................. 69 Group Counseling Theory..................................................................................................... 70 The Counselor as Group Leader ........................................................................................... 71 Stages of Group Treatment ................................................................................................... 71 Groups Commonly Used in Substance Abuse Treatment..................................................... 72 Family Counseling .................................................................................................................... 73 Conceptualizing Client Motivation and Change....................................................................... 75 Building Motivation for Treatment....................................................................................... 76 Client-Counselor Relationship.................................................................................................. 78 Transference and Counter-Transference............................................................................... 79 Therapeutic Alliance............................................................................................................. 80 Behaviors to Avoid ............................................................................................................... 80 Counseling Skills .................................................................................................................. 81 Understanding "Normal" Human Behavior.............................................................................. 82 Emotional Development ....................................................................................................... 83 Developmental Tasks............................................................................................................ 83 Defense Mechanisms ............................................................................................................ 84 Healthy Personality............................................................................................................... 85 Crisis Prevention and Intervention............................................................................................ 85 Defining a Crisis ................................................................................................................... 85 Crisis Prevention and Intervention Models........................................................................... 86 Crisis Prevention................................................................................................................... 87 Steps in Crisis Intervention....................................................................................................... 90 References................................................................................................................................. 92 Optional Resources for Further Reading/Use ....................................................................... 93 Chapter 4: Treatment Issues, Approaches and Planning ..............................................................95 Evolving Models of Treatment ................................................................................................. 95 Current Perspectives on Addiction Treatment.......................................................................... 96 Changes in the Addiction Treatment Field ........................................................................... 98 Self-Help Approaches............................................................................................................... 99 Alcoholics Anonymous....................................................................................................... 100 Evidence-based Treatment Practices/Clinical Practice Guidelines ........................................ 102 Types of Treatment Programs................................................................................................. 105 Detoxification (Detox) ........................................................................................................ 105 Outpatient Treatment .......................................................................................................... 107 Residential Treatment ......................................................................................................... 108 Medication-Assisted Treatment .............................................................................................. 109

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Therapeutic Approaches ......................................................................................................... 111 Behavioral and Cognitive/Behavioral Approaches............................................................. 111 Motivational Approaches.................................................................................................... 112 Trauma-Specific Models..................................................................................................... 112 Couples and Family Approaches ........................................................................................ 113 Treatment Planning................................................................................................................. 113 Understanding Relapse ........................................................................................................... 116 Relapse Prevention.............................................................................................................. 117 Principles and Procedures of Relapse Prevention............................................................... 118 Specific Treatment Considerations ......................................................................................... 119 Co-Occurring Mental Health and Substance Use Disorders............................................... 119 HIV/AIDS ........................................................................................................................... 121 Physical and Cognitive Disabilities .................................................................................... 122 Women................................................................................................................................ 123 Older Adults........................................................................................................................ 125 Adolescents ......................................................................................................................... 126 References............................................................................................................................... 128 Optional Resources for Further Reading/Use ..................................................................... 132 Chapter 5: Service Coordination, Case Management and Referral..........................................133 Overview................................................................................................................................. 133 Working Principles of Service Coordination.......................................................................... 134 Making Referrals .................................................................................................................... 135 Case Management................................................................................................................... 137 Case Management Principles.............................................................................................. 137 Strengths-Based Case Management.................................................................................... 139 The Role of Case Manager ..................................................................................................... 140 Service Planning ................................................................................................................. 141 Planning, Goal-Setting, and Implementation...................................................................... 141 Linking, Monitoring and Advocacy........................................................................................ 142 Making It All Work ................................................................................................................ 143 Summary ................................................................................................................................. 144 References............................................................................................................................... 145 Optional Resources for Further Reading/Use ..................................................................... 147 Chapter 6: Client, Family, and Community Education ...............................................................149 Overview................................................................................................................................. 149 The Counselor as an "Educator"............................................................................................. 150 Characteristics of Adult Learners ....................................................................................... 150 Motivation........................................................................................................................... 151 Effective Education Efforts..................................................................................................... 152 Learning Styles ................................................................................................................... 153 Teaching Strategies............................................................................................................. 154 Culturally Responsive Teaching ......................................................................................... 156 Adapting for Cultural and Linguistic Relevance ................................................................ 156 Psychoeducation ..................................................................................................................... 157

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Delivering Psychoeducation ............................................................................................... 158 Family Psychoeducational Groups ..................................................................................... 159 References............................................................................................................................... 160 Chapter 7: Documentation................................................................................................................163 Overview................................................................................................................................. 163 Role of Documentation ........................................................................................................... 163 Access to Documentation ....................................................................................................... 164 Sharing Information within an Agency............................................................................... 164 Client Access ...................................................................................................................... 164 External Parties ................................................................................................................... 165 Records Retention and Storage............................................................................................... 165 Regulations That Apply to Client Records ............................................................................. 165 Single State Authority (SSA) for Substance Abuse............................................................ 165 Accreditation Bodies........................................................................................................... 166 Third Party Payers............................................................................................................... 166 Provider Agencies............................................................................................................... 166 Types of Documentation......................................................................................................... 166 Screening Documentation................................................................................................... 166 Intervention Documentation ............................................................................................... 167 Treatment Documentation .................................................................................................. 167 Comprehensive Assessment Documentation...................................................................... 168 Treatment Plans .................................................................................................................. 170 Progress Notes .................................................................................................................... 172 Discharge Summary............................................................................................................ 173 Documentation Skills.............................................................................................................. 174 Some Technical Considerations.......................................................................................... 175 References............................................................................................................................... 176 Chapter 8: Professional and Ethical Responsibility.....................................................................177 Overview................................................................................................................................. 177 Professional Ethics.................................................................................................................. 177 Codes of Ethics ................................................................................................................... 178 Foundations of Ethics ......................................................................................................... 179 Ethical and Moral Decision Making ................................................................................... 180 Guidelines for Ethical Conduct........................................................................................... 181 Competence and Established Theory.................................................................................. 182 Ethical Issues in Confidentiality ............................................................................................. 186 Other Ethical Issues ................................................................................................................ 187 Honoring Diverse Values.................................................................................................... 189 Supervision and Consultation ................................................................................................. 189 Definition of Clinical Supervision ...................................................................................... 190 Models of Supervision ........................................................................................................ 190 Critical Issues in Supervision.............................................................................................. 191 Role of Clinical Supervision in Evidence-Based Practice.................................................. 192 Applicable Laws and Regulations .......................................................................................... 192

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Responding to Individual Differences .................................................................................... 193 Cultural Competence .......................................................................................................... 195 Evidence of Cultural Competence ...................................................................................... 196 Specific Cultural Groups..................................................................................................... 196 Summary ................................................................................................................................. 198 References............................................................................................................................... 199 Optional Resources for Further Reading/Use ..................................................................... 201

Appendices

Appendix A: Candidate Guide for International Certification Examination for Alcohol and Other Drug Abuse Counselors (IC&RC, March 2008) Appendix B: Ethical Issues - Practice Scenarios

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