The Addiction Counselor's Desk Reference

ROBERT HOLMAN COOMBS, PhD, is Professor of Biobehavioral Sciences at UCLA School of Medicine, a Certified Addiction Specialist (CAS), and a Fellow of the American Association for the Advancement of Science. He serves on the International Advisory Committee of the American Academy of Healthcare Providers in the Addictive Disorders and is author or editor of more than 200 publications, including eighteen books. WILLIAM A. HOWATT, PhD, EdD, is a faculty member of the Nova Scotia Community College School of Human Services. An Internationally Certified Addiction Specialist (ICAS), he recently completed a postdoctoral fellowship at the UCLA School of Medicine. Author of numerous publications, he is currently coediting (with Robert Holman Coombs) the Wiley Series on Treating Addictions.

Preface xvii

Acknowledgments xxi

Part I: Abused Substances and their Effects

Abused drugs 2

Opiates 2

Depressants 4

Stimulants 7

Cannabis 9

Hallucinogens 10

Inhalants 12

Steroids (Anabolic-Androgenic ) 12

Designer drugs 13

Control schedules for Abused drugs 15

Prescribing drugs 30

The five control schedules 30

Controlled substance analogues 32

Government decision making 32

Part II: Conceptual tools

Definitions of addiction 35

Moral model 35

Self-medication model 35

Medical/disease model 36

Spirituality model 36

Impulse-control disorder 36

Reward deficiency and Neurophysiological adaption 37

Genetic model 37

Biomedical model 37

Social learning model 38

Erroneous thought pat terns 38

Biopsychosocial model 38

Public health model 39

Characteristics of addiction 39

Compulsive use 40

Loss of control 40

Continued use despite adverse consequences 40

Tolerance 40

Withdrawal 41

Types of addictive disorders 41

The brain and psychoactive drugs 41

The brain and addictive behaviors 42

Addictive interaction disorder 45

Drug-use stages 46

Initiation 46

Escalation 47

Maintenance 47

Discontinuation and Relapse 47

Recovery 48

Levels of drug use 49

Type 1—Abstainers 50

Type 2—Social users 50

Type 3—Drug abusers 51

Type 4—Physically but not Psychologically dependent users 51

Type 5—Physically and Psychologically dependent users 52

Stages of behavioral change 53

Stage 1—Precontemplation 53

Stage 2—Contemplation 54

Stage 3—Preparation 54

Stage 4—Action 55

Stage 5—Maintenance and Relapse prevention 55

Stage 6—Termination 55

Prevention types and principles 56

The traditional classification 56

The institute of medicine classification 57

Prevention principles 57

Relapse prevention 59

Part III: Treatment planning and Assessment resources

Treatment planning 64

Competencies and goals 64

Screening and Assessment 65

Diagnostic summary 67

Treatment 68

Client placement criteria 68

Writing a treatment plan 69

Sample treatment plan 70

Levels of care 71

Assessment resources 75

Alcohol Assessment instruments 75

Other Drug Assessments 81

Nonchemical addictions 84

Mental health (dual diagnosis) Assessments 85

Recovery potential Assessments 89

Multiple measures resources 93

Dual diagnoses: Psychiatric illness with addiction 93

The diagnostic and statistical manual (Dsm-Iv-Tr) 94

Psychiatric diagnostic categories 94

Part IV: Clinical skills and resources

Clinical models 102

Sizgmund Freud’s psychoanalytic therapy 102

Carl G. Jung’s analytic psychoanalysis 103

Alfred Adler’s individual psychology 103

Carl Rogers’s person-centered therapy 104

Fritz Perls’s Gestalt therapy 104

Irvin Yalom’s existential psychotherapy 105

Viktor Frankl’s logotherapy 106

Albert Ellis’s rational-emotive behavior therapy 106

William Glasser’s choice theory and Reality therapy 107

Aaron Beck’s cognitive behavioral therapy 108

Eric Berne’s transactional analysis 108

Other behavioral approaches 109

Counseling techniques 109

Clinical microskills 115

Client homework exercises 117

Client health and Stress management 131

Nutritional counseling 131

Exercise counseling 132

Affect-regulation coping skills counseling 132

Stress-management training 134

Shaffer coping models 135

Common styles of negative self-talk 137

Rewriting old beliefs 138

Rewriting irrational beliefs 139

Part V: Treatment resources

Addiction recovery tools 142

Motivational tools 142

Medical and pharmaceutical tools 143

Cognitive-behavioral tools 146

Psychosocial tools 148

Holistic tools 150

Addiction Recovery programs 153

Residential and outpatient treatment programs 153

Support groups 155

Recovery programs for selected populations 167

Harm reduction programs 181

Characteristics of Harm reduction programs 183

Harm reduction goals 183

Harm reduction techniques 184

Other Harm reduction techniques 186

Part VI: Professional management

Record keeping 190

Crisis management 206

Crisis types 206

Crisis reactions 207

Crisis management goals 207

Crisis intervention principles 207

Crisis management steps 208

Chronically relapsing clients 208

Difficult Clients 209

Safety issues 210

When threats occur 211

Clients with weapons 212

Clients who appear dangerous to self 212

Suicide Prevention 213

Critical incident Stress debriefing 213

Legal and Ethical responsibilities 214

Universal professional values 214

Ethical codes 215

Ethical decision making 216

Confidentiality 216

Informed consent 217

Dual relationships 217

Duty to warn 217

Referral obligation 218

Rights of minors 218

Malpractice 218

Ethical dilemmas 219

Part VII: Career enhancement resources

Educational resources 222

Basic knowledge, skills, and attitudes expected of Addiction counselors 222

Selecting a training program 228

Certification and licensing 232

Continuing education 245

Business plan 248

Setting fees 248

Discussing fees 249

Home-based practices 249

Referrals 250

Multidisciplinary teams 251

Wellness plan 251

Burnout 251

Avoiding burnout 252

Malpractice insurance 253

Part VIII: Information resources

National and International organizations 258

Federal substance abuse agencies 258

Regional substance abuse agencies 266

State substance abuse agencies 266

Educational and training institutions 279

Professional addiction-related organizations 286

Canadian agencies 299

International substance abuse organizations 303

Grassroots alcohol and other Drugs Information 307

Grant-funding resources 309

Federal granting agencies 309

International granting agencies 310

Private granting agencies 311

Other funding databases 313

Publishing resources 314

Academic and professional journals 314

Addiction magazines and websites 336

Addiction newsletters and websites 341

Drug policy advocates 346

The Drug policy alliance 347

National organization for the reform of Marijuana laws 347

Harm reduction coalition 347

Law enforcement against prohibition 348

Multidisciplinary association for Psychedelic studies 348

Religious leaders for a more just and Compassionate Drug policy 348

Educators for sensible Drug policy 349

Canadian foundation for Drug policy 349

Glossary 353

References 381

Author Index 395

Subject Index 401