Table Of ContentNational Institute on Drug Abuse
approaches
U.S. Department ofHealth and Human Services
onal Institutes ofHealth
approaches
to
drug
abuse
counseling
Editors:
John Boren, Ph.D.
J.
Lisa Simon Onken, Ph.D.
National Institute on Drug Abuse
Kathleen M. Carroll, Ph.D.
Yale University
National Institute on Drug Abuse
Division ofTreatment and Research Development
Behavioral Treatment Development Branch
6001 Executive Boulevard
MD
Bethesda, 20892
U.S. Department ofHealth and Human Services
National Institutes ofHealth
ACKNOWLEDGMENTS
This publication contains information on various drug abuse counseling approaches, written by
representatives ofmany well-known treatment programs. Although the counseling approaches
included are used in some ofthe best known and mostrespected treatment programs in this
country, it has not been determined whether all ofthese counseling models are equally effective.
These various approaches are presented in an identical outline form so that the reader can compare
and contrast the many treatment models described and learn more about the roles ofthe counselor
and subject in a particular model.
COPYRIGHT STATUS
All material in this volume is in the public domain and may be used orreproduced without
permission from the National Institute on Drug Abuse (NIDA) or the authors. Citation ofthe
source is appreciated.
DISCLAIMER
Opinions expressed in this volume are those ofthe authors and do not necessarily reflect the
opinions or official policy ofNIDA or any other part ofthe U.S. Department ofHealth and Human
Services.
The U.S. Government does not endorse or favor any specific commercial product or company.
Trade, proprietary, or company names appearing in this publication are used only because they are
considered essential in the context ofthe models reported herein.
PUBLIC DOMAIN NOTICE
All material appearing in this report is in the public domain and may be reproduced without
permission from the National Institute on Drug Abuse or the authors. Citation ofthe source is
appreciated.
National Institute on Drug Abuse
NIH Publication No. 00-4151
Printed July 2000
ARC LIBRARY
MD
BALTIMORE,
CONTENTS
Introduction and Overview 1
John J. Boren, Lisa Simon Onken, andKathleen M. Carroll
Dual Disorders Recovery Counseling 5
Dennis C. Daley
The CENAPS® Model ofRelapse Prevention Therapy (CMRPT®) 21
Terence T. Gorski
The Living In Balance Counseling Approach 35
JeffreyA. Hoffman, BenJones, BarryD. Caudill, Dale W. Mayo, andKathleen A. Mack
Treatment ofDually Diagnosed Adolescents: The Individual Therapeutic Alliance Within a Day
Treatment Model 55
Elizabeth DriscollJorgensen andRichardSalwen
Description ofan Addiction Counseling Approach 73
Delinda Mercer
Description ofthe Solution-Focused BriefTherapy Approach to Problem Drinking 83
ScottD. Miller
Motivational Enhancement Therapy: Description ofCounseling Approach 89
William R. Miller
Twelve-Step Facilitation 95
Joseph Nowinski
Minnesota Model: Description ofCounseling Approach 103
Patricia Owen
A Counseling Approach Ill
FredSipe
A Psychotherapeutic and Skills-Training Approach to the Treatment ofDrug Addiction 121
ArnoldM. Washton
Introduction and Overview
John J. Boren, Lisa Simon Onken, andKathleen M. Carroll
The consequences ofdrug and alcohol abuse in Elizabeth Driscoll Jorgensen and Richard Salwen
the United States are enormously costly. and by Scott D. Miller illustrate innovative
Although the costs can be evaluated in dollars, counseling strategies designed for special
they are more readily understood in human terms: populations and settings. Each chapter was
family discord, neglect ofchildren, personal written by an authoritative spokesperson for the
misery, financial straits, medical problems, fetal counseling model being described.
alcohol syndrome, HIV infection, legal problems,
incarceration, automobile accidents, lower work After surveying a number ofchapters in a typical
—
productivity, andjob loss and the list goes on. edited book on treatment models, the reader may
Combating and reducing the source ofthese have a difficult time comparing them, seeing how
problems have proven to be difficult indeed, but they are similar, seeing where they differ. Each
one ofthe most straightforward and author typically finds different topics important,
noncontroversial ways is to provide effective emphasizes different issues, and writes a chapter
treatment to drug abusers. whose coverage is unlike any other author’s.
Furthermore, ifthe chapter focuses on the
This book is about treatment. In particular, it is theoretical background, it may be hard to gain a
about the basic component ofmost treatment practical understanding ofthe counseling
—
programs group and individual counseling. The interventions and what the counselor actually
intent ofthis book is to present information on does with the client. In an effort to make the
various counseling approaches used in some of comparison ofthe various models less difficult
the best known and most respected treatment and to clarity how the model is applied in
programs in the United States. Certainly all practice, two ofthe editors (K.M.C. and L.S.O.)
meritorious counseling models are not designed a comprehensive outline oftopics that
represented and, as a practical matter, could not could be applied to almost any counseling
be represented. However, chapters have been approach. The topics ranged from theoretical
written by representatives ofsuch well-known rationale to specific counseling practices. The
treatment programs as the Hazelden Foundation authors were asked to follow a specific format,
(chapterby Patricia Owen), the Betty Ford Center and they did so, with only an occasional
(byFred Sipe), CENAPS® (byTerenceT. Gorski), exception in a few chapters. The format is:
Living In Balance (by JeffreyA. Hoffman), and the
Washton Institute (by Arnold M. Washton). Other 1. OVERVIEW, DESCRIPTION, AND
chapters were prepared by representatives of RATIONALE
nationally known research centers on the 1.1 General Description ofApproach
treatment ofdrug abuse, including William R. 1.2 Goals and Objectives ofApproach
Miller (University ofNew Mexico), Delmda 1.3 Theoretical Rationale/Mechanism of
Mercer (University ofPennsylvania), and Dennis Action
C. Daley (Western Psychiatric Institute and 1.4 Agent ofChange (e.g., patient,
Clinic). Two ofthe three treatments in Project therapist, group affiliation)
Match, the monumental clinical trial sponsored 1.5 Conception ofDrug Abuse/Addiction,
by the National Institute on Alcohol Abuse and Causative Factors
Alcoholism, are described in this volume. (See
William R. Miller’s Motivational Enhancement
Therapy and Joseph Nowinski’s Twelve-Step
Facilitation.) Finally, chapters prepared by
1
%
'*</- 1454*..^ JC.- A
CONTRASTTO other counseling ASSESSMENT
2. 7. (before, during, or after
APPROACHES
treatment; major domains assessed;
2.1 Most Similar Counseling Approaches instruments typically used)
3.
2.2 Most Dissimilar Counseling
Approaches 8. SESSION FORMAT AND CONTENT
8.1 Format for a Typical Session (How does
FORMAT
the session begin and end?)
3.1 Modalities ofTreatment 8.2 Several Typical Session Topics or
3.2 Ideal Treatment Setting (inpatient, Themes (Is the theme ofthe session
outpatient, residential, other) determined by the patient or the
4.
3.3 Duration ofTreatment (fixed or open counselor?)
ended; length and usual number of 8.3 Session Structure
sessions) 8.4 Strategies for Dealing With Common
3.4 Compatibility With Other Treatments Clinical Problems (lateness, missed
(e.g., pharmacotherapy, family therapy) sessions, patients who attend underthe
3.5 Role ofSelf-Help Programs influence)
8.5 Strategies for Dealing With Denial,
COUNSELOR CHARACTERISTICS AND Resistance, or Poor Motivation
TRAINING 8.6 Strategies for Dealing With Crises
4.1 Educational Requirements 8.7 Counselor’s Response to Slips and
4.2 Training, Credentials, and Experience Relapses
Required
4.3 Counselor’s Recovery Status (essential, 9. ROLE OF SIGNIFICANT OTHERS IN
helpful, irrelevant) TREATMENT (Are other family members
4.4 Ideal Personal Characteristics of involved and in what way?)
Counselor
4.5 Counselor’s Behaviors Prescribed With all chapters following the format, the reader
4.6 Counselor’s Behaviors Proscribed can not only compare the various counseling
(techniques and interventions that are models on any selected characteristic but also
discouraged or contraindicated) have a better idea ofwhat a counselor actually
4.7 Recommended Supervision (e.g., role, does while following a particular model.
format, goals)
The work for this book began in October 1993
5. CLIENT-COUNSELOR RELATIONSHIP when the Treatment Research Branch ofthe
5.1 What Is the Counselor’s Role? (teacher, National Institute on Drug Abuse (NIDA) held a
collaborator, therapist, peer, adviser) conference in Rockville, MD, on counseling
5.2 Who Talks More? models. Many ofthe authors represented in this
5.3 How Directive Is the Counselor? volume attended this conference, described their
5.4 Therapeutic Alliance (the quality counseling approaches, and exchanged views.
desired, strategies the counselor uses to Subsequently, chapters were prepared and then
build the alliance, strategies to address updated in the summer of 1996. The editors hope
a poor alliance) that the chapters will show how well-developed
treatment programs counsel drug abusers and will
6. TARGET POPULATIONS serve as a resource to counselors, treatment
6.1 Clients Best Suited for This Counseling providers, and interested readers who seek
Approach knowledge on counseling theory and practice.
6.2 Clients Poorly Suited for This
Counseling Approach
2
9
EDITORS
John J. Boren, Ph.D. (retired)
MD
Chevy Chase,
Lisa Simon Onken, Ph.D.
National Institutes ofHealth
National Institute on Drug Abuse
Division ofTreatment and Research Development
Behavioral Treatment Development Branch
Neuroscience Center Building, Room 4227
600 Executive Boulevard
1
MD
Bethesda, 20892
Kathleen M. Carroll, Ph.D.
Yale University School ofMedicine
34 Park Street
New Haven, CT 065
1
