Learning the Language of Addiction Counseling

GERI MILLER, PHD, is a Diplomate in Counseling Psychology, American Board of Professional Psychology (ABPP); Licensed Psychologist (LP); Licensed Clinical Mental Health Counselor (LCMHC); Master Addiction Counselor (MAC) (NCCAP); NCASPPB Licensed Clinical Addictions Specialist (LCAS) and Certified Clinical Supervisor (CCS). She is a Professor in the Department of Human Development and Psychological Counseling at Appalachian State University. Dr. Miller has worked in the mental health counseling profession since 1976 and in the addiction counseling field since 1979. She has published and presented research related to mental health and addiction counseling. She has also presented extensively to mental health counselors and addiction counselors.

Preface ix

Acknowledgments xiii

Chapter 1 Introduction 1

Personal Reflections 1

Addiction Counseling Influences 6

Models of Addiction 17

Appendix 1A: Language of Recovery 25

Appendix 1B: Summary of Peer Recovery Movement (June 2019) 27

Appendix 1C: SAMHSA-NAADAC Addiction Professional Education & Career Ladder 29

Chapter 2 Theories of Counseling Applied To Addiction Treatment 31

Personal Reflections 31

Development of a Theoretical Framework for Addiction Counseling 32

Dangers in Developing a Theoretical Framework and Recommendations 34

General Counseling Theories Applied to Addiction Treatment 38

Chapter 3 Assessment and Diagnosis of Addiction 49

Personal Reflections 49

Stages of Change 50

DWI/DUI/OWI/OUI Assessments 51

Assessment 51

Interviews 53

Behavioral Observations 61

Physiological Instruments 62

Psychometric Instruments 62

Diagnosis 77

Chapter 4 Co-Occurring Disorders and Behavioral Addictions 82

Personal Reflections 82

Co-Occurring Disorders 83

Collaboration Between the Mental Health and Substance Abuse Fields 85

Assessment 87

Treatment 90

Behavioral Addictions 104

Chapter 5 The Core Treatment Process of Addictions 113

Personal Reflections 113

Integrated Care 114

The Experience of the Addict as It Relates to Treatment 115

Crisis Intervention 115

Individual Therapy 122

Group Therapy 131

Family Therapy 144

Chapter 6 Treatment-Related Issues and Counseling Approaches 154

Personal Reflections 154

Sexual Issues 156

HIV/AIDS 165

Intimate Partner Violence 173

Homelessness 184

Specific Counseling Approaches 188

Chapter 7 Relapse Prevention 202

Personal Reflections 202

Counselor Approaches 203

Relapse-Prevention Models 208

Counseling Techniques 216

Influencing Factors 224

Case Studies of Special Populations 225

Co-Occurring Disorders 228

Chapter 8 Self-Help Groups 231

Personal Reflections 231

Suggestions for Counselors 233

12-step Groups 235

12-step Alternative Groups 244

Matching Self-help Groups to Meet Client Needs 251

Special Issues 258

Appendix 8A: Stories of Recovery 265

Chapter 9 Elaboration On Specific Therapies and Techniques Relevant To Addiction Counseling 267

Personal Reflections 267

Client Resilience 268

Positive Psychology 271

Stages of Change Model 275

Overview of Evidence-Based Practice (EBP) 280

Motivational Interviewing 282

Brief Therapy 289

Behavioral/Cognitive-Behavioral 296

Chapter 10 Culturally Sensitive Addiction Counseling 302

Personal Reflections 302

Defining Multicultural 305

Social-Environmental Aspects 306

Breakdown of Communication 310

Multicultural Competence/Multicultural Orientation 310

Dialogue 313

General Counseling Suggestions 316

Assessment, Treatment, and Aftercare Issues 316

Overall Substance Use/Abuse Exploration Multicultural Exercises 377

Chapter 11 Chronic Pain Assessment and Treatment 381

Personal Reflections 381

Definition of Pain 386

Issues of Living Sober with Chronic Pain 387

Assessment and Treatment 389

Appendix 11A: Opiate Addiction & Pain Management: Overview of Counseling Approaches 409

Chapter 12 Incorporating Spirituality Into Addiction Counseling 411

Personal Reflections 411

The History of Incorporating Spirituality into Addiction Counseling 412

Incorporation Barriers and Bridges 414

Spiritual Identity Development 419

Spiritual Identity Development with Addicted Clients 420

Counseling Resources and Techniques 421

Appendix 12A: Emotional Sobriety 430

Chapter 13 Personal and Professional Development of The Counselor 437

Personal Reflections 437

Ethical Issues 441

Testifying in Court 451

Working in Difficult Systems 456

Working with Addicts 463

Self-Care 469

Appendix 13A: Suggestions for Dealing with Stress 482

Chapter 14 Obtaining Addiction Professional Credentials 483

Personal Reflections 483

Self-Care on the Journey 485

Credentialing 488

Chapter 15 Supervision and Mentoring 494

Personal Reflections 494

Supervision 494

A Definition 496

Choosing a Supervisor 497

Notes to the Supervisee 499

Notes to the Supervisor 499

Specific Diversity Concerns 501

Ethical Concerns 502

Mentoring 505

A Definition 506

Choosing a Mentor/Mentee 506

Appendix 15A: North Carolina Substance Abuse Professional Practice Board (NCSAPPB) Supervisor Credential Requirements 511

Clinical Supervision Contract: LCAS 515

Sample Supervision Documentation 518

Ethics Decisional Model 519

References 521

Name Index 585

Subject Index 609