Learning the Language of Addiction Counseling

GERI MILLER, PD, Diplomate in Counseling Psychology, ABPP, is a Professor in the Department of Human Development and Psychological Counseling at Appalachian State University. She is a Licensed Psychologist, a Licensed Professional Counselor, a Licensed Clinical Addictions Specialist, and a Substance Abuse Professional Practice Board Certified Clinical Supervisor in North Carolina. She has also received a Certificate of Proficiency in the Treatment of Alcohol and other Psychoactive Substance Use Disorders from the American Psychological Association College of Professional Psychology. Dr. Miller has worked in the mental health counseling profession since 1976 and in the addiction counseling profession since 1979. She has conducted research related to mental health counseling and addiction counseling. She has also presented extensively to mental health counselors and addiction counselors.

Preface xi Acknowledgments xv CHAPTER 1 INTRODUCTION 1 Personal Reflections 1 Addiction Counseling Influences 3 Models of Addiction 6 CHAPTER 2 THEORIES OF COUNSELING APPLIED TO ADDICTION TREATMENT 13 Personal Reflections 13 Development of a Theoretical Framework for Addiction Counseling 14 Dangers in Developing a Theoretical Framework and Recommendations 16 General Counseling Theories Applied to Addiction Treatment 19 CHAPTER 3 ASSESSMENT AND DIAGNOSIS OF ADDICTION 31 Personal Reflections 31 Interviews 33 Behavioral Observations 40 Physiological Instruments 41 Psychometric Instruments 41 Diagnosis 52 Stages of Change 53 CHAPTER 4 CO-OCCURRING DISORDERS AND BEHAVIORAL ADDICTIONS 58 Personal Reflections 58 Co-Occurring Disorders 59 Collaboration Between the Mental Health and Substance Abuse Fields 60 Assessment 63 Treatment 67 Behavioral Addictions 80 CHAPTER 5 THE CORE TREATMENT PROCESS FOR ADDICTIONS 91 Personal Reflections 91 Philosophical Approaches 92 Crisis Intervention 97 Individual Therapy 103 Group Therapy 110 Family Therapy 123 CHAPTER 6 TREATMENT-RELATED ISSUES AND COUNSELING APPROACHES 138 Personal Reflections 138 Sexual Issues 139 HIV/AIDS 149 Intimate Partner Violence 158 Homelessness 169 Specific Counseling Approaches 173 CHAPTER 7 RELAPSE PREVENTION 196 Personal Reflections 196 Counselor Approaches 197 Relapse-Prevention Models 201 Counseling Techniques 209 Case Studies of Special Populations 217 Co-Occurring Disorders 220 CHAPTER 8 SELF-HELP GROUPS 226 Personal Reflections 226 Suggestions for Counselors 227 12-Step Groups 229 12-Step Alternative Groups 238 Matching Self-Help Groups to Meet Client Needs 247 Special Issues 253 Appendix 8A: Stories of Recovery 260 Appendix 8B: Emotional Sobriety 261 CHAPTER 9 ELABORATION ON SPECIFIC THERAPIES AND TECHNIQUES RELEVANT TO ADDICTION COUNSELING 266 Personal Reflections 266 Client Resilience 267 Positive Psychology 270 Stages-of-Change Model 273 Motivational Interviewing 278 Brief Therapy 284 Evidence-Based Practices (EBPs) 290 CHAPTER 10 CULTURALLY SENSITIVE ADDICTION COUNSELING 301 Personal Reflections 301 Defining Multicultural 303 Social-Environmental Aspects 305 Breakdown of Communication 308 Multicultural Competence/Multicultural Orientation 309 Dialogue 311 General Counseling Suggestions 314 Assessment, Treatment, and Aftercare Issues 314 Overall Substance Use/Abuse Exploration Multicultural Exercises 370 CHAPTER 11 CHRONIC PAIN ASSESSMENT AND TREATMENT 379 Personal Reflections 379 Definition of Pain 382 Issues of Living Sober with Chronic Pain 383 Assessment and Treatment 385 CHAPTER 12 INCORPORATING SPIRITUALITY INTO ADDICTION COUNSELING 398 Personal Reflections 398 The History of Incorporating Spirituality into Addiction Counseling 399 Incorporation Barriers and Bridges 401 Spiritual Identity Development 406 Counseling Resources and Techniques 408 CHAPTER 13 PERSONAL AND PROFESSIONAL DEVELOPMENT OF THE COUNSELOR 417 Personal Reflections 417 Ethical Issues 419 Testifying in Court 428 Working in Difficult Systems 432 Working with Addicts 436 Self-Care 442 CHAPTER 14 OBTAINING ADDICTION PROFESSIONAL CREDENTIALS 453 Personal Reflections 453 Self-Care on the Journey 455 Supervision 458 Credentialing 460 Appendix 14A: Sample Supervision Documentation 467 References 469 Author Index 523 Subject Index 535