Substance Abuse Counseling: Theory and Practice (5th Edition) (Merrill Counseling

432 Pages·2012·15.48 MB·English

by  Patricia Stevens

The MerrillCounselingSeries
5TH EDITION
SUBSTANCE ABUSE COUNSELING
theory andpractice;
PATRICIA STEVENS ROBERT L. SMITH
CONTENTS
Chapter 1 INTRODUCTIONTO SUBSTANCE ABUSE COUNSELING 1
The Historyof Substance:NoWonder We Use 4
Alcohol 4
Cocaine 6
Heroin 7
Marijuana 7
Opioids 8
Amphetamines 10
Hallucinogens 10
Tobacco 11
Caffeine 12
SocietalCostsof ATOD Use,Abuse,andDependency 13
Substance-Related Diseases 14
Hepatitis 14
HIV/AIDS 16
TheImportanceofTerminologyinSubstanceAbuseCounseling 17
The Professioninthe21stCentury 19
An Overviewof this Book 20
Conclusion 20
Chapter 2 ETHICALAND LEGAL ISSUES INSUBSTANCE ABUSE
COUNSELING 27
EducationandTrainingof SubstanceAbuse Counselors 28
Ethics 30
Confidentiality 32
CodeofFederalRegulations42, Part2 34
HealthInsurancePortabilityandAccountability Act of 1996
(HIPAA) 35
Confidentiality inGroupCounselingor 12-StepGroups 36
Confidentialityof Minors 37
Multiculturalism,Diversity,andEthics 41
EthicalConflictsSpecifictoSubstanceAbuse Counselors 42
Dual Relationships 42
ClientsandCriminalActivity 43
Conflicting Laws 44
EthicalCodeConflicts 44
Contents xiii
EthicalDecisionMaking 44
Conclusion 50
Chapter 3 THE MAJOR SUBSTANCES OF ABUSE
AND THE BODY 51
The Brain 52
NeuroscienceResearch 52
TheStructureofthe Brain 53
PsychoactiveSubstancesandthe Brain 58
ControlledSubstances Schedules 59
Depressants 59
Alcohol 60
Benzodiazepines:PrescriptionandOver-the-Counter
Medications 64
Barbiturates 66
GHB (Identifiedasa Club Drug) 67
Opiates(PrescriptionDrugsOftenAbused) 69
Stimulants 71
Cocaine 71
Amphetamines 74
MinorStimulant:Nicotine 76
MinorStimulant:Caffeine 78
Cannabis 79
Hallucinogens 82
LysergicAcid Diethylamide(LSD) 83
Phencyclidine(PCP) 84
Ketamine(Targetedasa Club Drug) 85
A FurtherLookat ClubDrugs 86
MDMA(Ecstasy) 86
Volatile Substancesor Inhalants 88
Anabolic-Androgenic Steroids 89
Conclusion 92
Chapter 4 ETIOLOGY OF SUBSTANCE ABUSE: WHY PEOPLE USE 98
UnderstandingTheory 98
OverviewofATODTheories 99
MoralTheory 99
Aspectsof UseAddressed bythe MoralTheory 99
DiseaseTheory 101
Aspects of UseAddressed bythe DiseaseTheory 101
_
xiv Contents
GeneticTheories 105
Aspects of UseAddressed byGeneticTheories 107
BehavioralTheories 110
Aspectsof UseAddressed bythe BehavioralTheory 111
SocioculturalTheories 114
Aspects of UseAddressed bySocioculturalTheories 115
An IntegratedApproach 119
Conclusion 121
Chapter 5 ASSESSMENT AND DIAGNOSIS 122
IssuesinAssessment 122
The DiagnosticInterview 124
DSM-IV-TRDIAGNOSIS 126
Criteriafor SubstanceDependence 126
Criteriafor SubstanceAbuse 127
BehavioralCharacteristics 127
Phase 1:The Prodomal Phase 128
Phase2:TheCrucial Phase 130
Phase3:TheChronic Phase 131
Assessingthe BehavioralSymptoms 132
SocialCharacteristics 132
FamilyCharacteristics 132
Assessingthe SocialandFamily-RelatedSymptoms 135
ScreeningandAssessment Instruments 136
The MichiganAlcoholism ScreeningTest (MAST) 137
The Short MichiganAlcoholism ScreeningTest (SMAST) 138
The DrugAbuse ScreeningTest (DAST-20) 138
The CAGE Questionnaire 138
TheSubstanceAbuse SubtleScreening Inventory(SASSI-3
andSASSI-A2) 139
TheAlcohol UseInventory(AUI) 140
TheAddiction Severity Index(ASI) 140
TheAdolescent Diagnostic Interview(ADI) 141
The MillonClinical MultiaxialInventory(MCMI-II)and
Minnesota MultiphasicPersonalityInventory(MMPI-2) 141
TheASAM Criteriafor PatientPlacement 142
Diagnosis 143
DifferentialDiagnosis 143
Dual Diagnosis 144
_
Contents xv
Chapter 6 TREATMENT SETTING AND TREATMENT
PLANNING 155
What IsaTreatment Setting? 156
TypesofTreatment Settings 157
Medical DetoxificationandStabilization 157
Dual-DiagnosisHospitalInpatient 158
Free-StandingRehabilitationand ResidentialPrograms 159
PartialHospitalization 164
Temporary Recoveryor HalfwayHomes 164
IntensiveOutpatient 164
The Importanceof MatchingTreatment to Client Needs 167
What IsTreatment Planning? 168
Howto DevelopaTreatment Plan 170
The Elementsof a SevereSubstance UseDisorder
Treatment Plan 171
SampleSubstance UseTreatment Plan:
RelationshipFactors 171
External ReviewersofTreatment Planning:HealthCare
Accreditation Organizationsand ManagedCare 175
Conclusion 178
Treatment of DrugandAlcohol Problems
inthe Military 185
Chapter 7 INDIVIDUALTREATMENT 188
BeginningIndividualTreatment 189
Intervention 189
IndividualTherapy 191
Therapeutic Alliance 191
DirectEffectStrategies 191
MotivationalInterviewing 191
Cognitive-BehavioralTherapy 192
MindfulnessTechnique 193
Pharmacotherapy 193
BroadSpectrumStrategies 195
HarmReduction 195
HarmReductionfrom theTherapist's Perspective 196
CopingSkillsTraining/Life SkillsTraining 197
Vocational Readiness 197
Support Groups 198
Conclusion 201
xvi Contents
Chapter 8 GROUPTREATMENT INTHE CONTINUUM OF CARE 203
Evolutionof GroupTreatment 204
Group Dynamics,Process,andStructure 207
CurativeFactorsinGroupTreatment 207
Group Dynamics 209
Stagesof GroupDevelopment 212
StructuralConsiderations 216
GroupTreatment intheContinuumof Care 217
Prevention 218
Detoxificationand InpatientTreatment 218
ResidentialTreatment 219
PartialHospitalizationand DayTreatment 219
Aftercare andSober Living 220
OutpatientGroupsandCommunityCare 220
Pragmaticsof GroupTreatment 221
Therapeutic Community 221
Self-HelpGroups 222
PsychoeducationalGroups 222
Cognitiveand BehavioralInterventions 223
Group Psychotherapy 228
RelationalTherapy and FamilyGroups 229
GroupTreatment Efficacy 232
Conclusion 238
Chapter 9 FAMILYTREATMENT 240
DefiningFamily 242
GeneralSystemsConcepts 243
Homeostasis 244
Feedback Loops 244
Hierarchy,Roles,Rules,Subsystems,and Boundaries 245
Wholeness 246
Change 247
Values 247
SystemsandAddictive Families 247
The MaritalDyadandSubstanceAbuse 248
The FamilyandSubstanceAbuse 250
ChildrenintheAddicted Family 252
Treatment withAddictive Families 253
Contents xvii
The ProcessofTreatment 255
ProgramsUtilizingFamilyTherapy 255
HowSuccessful IsFamilyTherapy? 256
Conclusion 260
Chapter 10 RETAININGSOBRIETY: RELAPSE PREVENTION
STRATEGIES 261
Determinantsof Relapse 263
Environmental 263
Behavioral 264
Cognitive 265
Affective 265
InterpersonalDeterminants 266
Summary 267
Modelsof RelapsePlanningand Management 267
The DiseaseModel 267
DevelopmentalModels 268
A Cognitive-Behavioral/Social LearningModel 271
Self-HelpRecoveryOrganizations:Adjunctsto Professional
Intervention 274
AlcoholicsAnonymous Model 275
Spiritualityasa Resource 277
AA-Associated 12-StepPrograms 278
ModerationManagement(MM) 278
RationalRecovery 280
Secular Organizationsfor Sobriety/Saveour Selves (SOS) 281
Womenfor Sobriety (WFS) 281
Self-Helpfor DuallyDiagnosedPersons 283
A Weil-Rounded Lifewith Joy 283
Conclusion 286
Chapter 11 WORKING WITH SELECTED POPULATIONS:
TREATMENT ISSUESAND CHARACTERISTICS 287
ChildrenandAdolescents 287
Risk Factors 290
Preventionand Intervention 291
Women 294
Risk Factors 294
Preventionand Intervention 295
xviii Contents
TheGay/Lesbian/Bisexual/TransgenderCommunity 297
Gay/Lesbian/Bisexual/Transgender IdentityDevelopment 298
Risk Factors 298
Preventionand Intervention 299
Peoplewith Disabilities 300
Risk Factors 301
Preventionand Intervention 302
Older Adults 304
Risk Factors 304
Preventionand Intervention 305
Homelessness 306
Risk Factors 307
Treatment 308
Conclusion 310
Chapter 12 WORKING WITH DIVERSECULTURES: EXPLORING
SOCIOCULTURAL INFLUENCESAND REALITIES
INATOD TREATMENT AND PREVENTION 311
American IndiansandAlaskan Natives 312
CulturalValues 314
Risk Factors 315
BarrierstoTreatment 316
Preventionand Intervention 317
AsianAmericans 318
CulturalValues 320
Risk Factors 321
Preventionand Intervention 322
AfricanAmericans 324
Risk Factors 325
CulturalValues 326
BarrierstoTreatment 327
Preventionand Intervention 327
Hispanics 328
CulturalValues 330
BarrierstoTreatment 331
Preventionand Intervention 333
Conclusion 334
Contents xix
Chapter 13 PREVENTION 336
Typesof Prevention 339
Prevention:A Brief History 340
ComprehensivePrevention 343
CommunityPrevention 344
Riskand ProtectiveFactors 346
LifeSkillsTraining(LST):Effectivenessof a Comprehensive
PreventionApproach 349
Stepstoan EffectivePreventionProgram 350
Implicationsfor Counseling 353
Conclusion 356
References 358
Index 392
CHAPTER
1
Introduction to Substance
Abuse Counseling
PatriciaStevens,Ph.D.
MyCounselingLab
Visit the MyCounselingLab' site for Substance Abuse Counseling, Fifth Edition to
enhance your understandingof chapter concepts. You'll have the opportunity to
practice your skills through video- and case-based Assignments and Activities as
wellas BuildingCounselingSkillsunits,andto preparefor your certificationexam
with Practicefor Certificationquizzes.
Alcohol,tobacco,caffeine,prescriptiondrugs,illegaldrugs—allarecommonplacewords
today. Alcohol, tobacco, and other drugs (ATOD) are used for celebrations,
for mourning, for religious rituals, for pain relief,and recreationally. We read
about them inthe newspaper daily, we hear about them on the radioand television,
andwe can findjust about anything, fromwhat they areto howto makethem,about
anysubstance useandabuseonthe Internet.We seechildrenabusingat younger ages
and elders abusing. Drugsare misused to forget, to feel better or not feel at all, to be
friendly, to disinhibit, and because of peer pressure.Tobacco and alcohol, legaldrugs,
areusedandabusedwithsocialsanctionandareeasilyavailable.Ifwe don't usethem,
we probably have a user/abuser in the family or a close friend who has abused, or
knowsomeonewho usesalcoholorotherdrugsinappropriately.
Consequences of use andabuse of legalizedsubstances continueto be minimized
in a variety of settings. Untilthe mid-1990s, the tobacco industry denied addiction
while people were dying from lung cancer and others continued to smoke. After
multiple suits against the companies, they tried to settle, payingout $10 billion per
year inperpetuity andplacinginthe public domain over 35 millionpages of internal
documentsontheeffectsof smoking.
In 2009, an estimated 69.7 million Americans aged 12 or older were current
(past month) users of a tobacco product. This represents 27.7% of the population