Therapist's Guide to Substance Abuse Intervention (Practical Resources for the Mental Health Professional) (Practical Resources for the Mental Health Professional)

690 Pages·2003·1.36 MB·English

by  Sharon L. Johnson

Therapist's Guide to
Substance Abuse
Intervention
Sharon L. Johnson
Academic Press
Therapist’s Guide to
Substance Abuse
Intervention

Therapist’s Guide to
Substance Abuse
Intervention
SHARON L. JOHNSON
Amsterdam Boston London New York Oxford Paris
San Diego San Francisco Singapore Sydney Tokyo

CONTENTS
Introduction xvii
Part I
Chapter 1
DEFINING SUBSTANCE ABUSE AND DEPENDENCE 3
Continuum of Substance Use Behaviors 5
DSM IV Criteria 6
Substance Abuse 6 • Substance Dependence 7 • Specifiers 7
Additional Considerations 8
Dual Diagnosis 8 • Codependents 8 • References 9
Chapter 2
CHARACTERISTICS AND CLASSIFICATION OF SUBSTANCES 11
Characteristics of Substances 11
Drug Dosage 12 • Potency 12 • Therapeutic Ratio 12
Drug Equivalence 12 • Frequency of Use 12 • Route of Admission 12
Drug Interactions 13 • Types of Drug Effects 13
Substance Use and Conditioning 13
Physiological Functioning 14
Pharmacokinetics 14 • Pharmacodynamics 16
Physiological Characteristics or Factors of
the Substance User 17
Psychological Characteristics of the User 18
Sociocultural Environment 19
v
Classification of Substances 19
Depressants 19 • Cannabinoids 22
Opioids 23 • Hallucinogens 26
Stimulants 29 • Nicotine 31
Anabolic Steroids 31 • Club Drugs 32
References 38
Chapter 3
DEVELOPMENT OF SUBSTANCE ABUSE AND DEPENDENCE 39
Models of Substance Dependence 40
Causal Factors of Substance Abuse and Dependence 41
Biological Mechanisms 42
Early Onset Variables 50
Late Onset Variables 51
References 51
Chapter 4
STAGES OF SUBSTANCE DEPENDENCE AND RECOVERY 53
A Causal Model for Substance Abuse 54
Problematic Behavior and Thought Patterns 54
Patterns of Use 55
Developmental Stages of Dependence 56
Preaddictive–Early Stage 56 • Addictive–Middle Stage 57
Chronic–Late Stage 58
Recovery stages 58
Experience of Object Loss 59
Relapse Symptoms 60
Relapse Autopsy 61
Process of Relapse 62
Special Issues of Substance Dependence 62
Dry Drunk 62 • Family System Response to Substance Dependency 64
Codependency 65 • Common Symptomatology of Substance-Dependent and
Codependent Individuals 66 • References 70
Part II
Chapter 5
ASSESSMENT 75
Purpose of Assessment 76
Motivational Interviewing 76
Individualized Treatment Plan 77
Assessment Questions 78
Multivariate Treatment Planning 79
vi Contents
Important Components of a Substance Abuse History 79
Objective Assessment 81
Psychological and Neuropsychological Assessment 82
Substance-Related Assessment Inventories 83
Mnemonic Screening Devices 86
CAGE (Ewing, 1984) 86 • TWEAK (Russel et al., 1991) 86
Functional Importance of Substance Use 86
Follow-up Assessment 87
Conceptual Assessment of Substance Abuse 87
Questionnaires 89
The Johnson Substance Use Psychological Questionnaire (Adapted From
Johnson, 1997) 89 • Adult Psychosocial (Adapted from Johnson, 1997) 100
The Johnson Brief Initial Assessment (Adapted from Johnson, 1997) 104
Substance Use Survey 108 • Chemical Dependency Assessment (Adapted from
Johnson, 1997) 113 • Chemical Dependency Psychological Assessment 114
Substance Use History 117 • Substance Use History: A Phase Review 118
Family Substance Use History 122 • Chemical Dependency Psychosocial
Assessment: Brief Form 123 • Alcohol Involvement Scale 127 • Substance
Abuse–Dependence Personal Evaluation 128 • Outline for Diagnostic
Summary 129 • Withdrawal Symptoms Checklist (Adapted from
Johnson, 1997) 131
Factors Indicating a Need for Adolescent Substance Use
Assessment 132
Psychological–Social Factors 132 • Substance Use Associated Factors 132
Adolescent Screening and Assessment 132
Screening 132 • Assessment 133
Diagnostic Criteria for Codependency 133
Special Topic: Employment Setting 134
Employer and Supervisory Training 134 • How to Constructively Confront the
Employee 135 • Summary Outline of How to Constructively Confront an
Employee with a Problem 136 • Supervisors as Enablers 137 • Defensive
Strategies of Employees 138 • Warning Sign Checklist 139
Prevention 142
Prevention Models 143 • Prevention Programs 145 • Model for Effective
Health Education (Adapted from Green et al., 1980) 146 • References 146
Part III
Chapter 6
TREATMENT GUIDELINES 153
Biopsychosocial Perspective 154
A Simple Comparison of Recovery and Mental Health
Models 155
Theoretical Orientation 157
The Role of 12-Step and Other Self-Help Programs 157
Contents vii
Resistance and Other Problems 158 • Increasing Engagement 158
Alternatives to 12-Step Groups 159
Harm Reduction 159
Principles of Harm Reduction 160 • Integration of Harm Reduction and
Substance Abuse Treatment 160 • Clinical Rationale for Harm
Reduction 161
Special Considerations for Dual Diagnosis 161
Models of Treatment 162
The Individual Entering Treatment 162
Treatment Concerns 163
Rational Emotive Therapy Philosophy 164
Therapist Guidelines 165
Professional Codependent Versus Helper 166
Preparation of Individuals, Couples, and Families for
Recovery 166
Treatment Prioritization 169
Course of Treatment 170
Agents of Change 170
Areas of Personal Vulnerability for those in Treatment 172
Obstacles to Change 172
Overcoming Obstacles to Change 173
Individualized Treatment Planning 174
Formulating the Treatment Plan 175 • Record Keeping 176
The Johnson Independent Treatment Plan—Short Form 177 • The Johnson
Individualized Treatment Plan 178 • Basic Treatment Plan Format
Sample 180 • Understanding Your Experience of Treatment 181
Treatment Rules 182 • Treatment Contract 182
Guidelines for an Intervention 183
Criteria for an Intervention 183 • Guidelines for those Participating in an
Intervention 184
Legal Issues Associated with Screening and Assessing
Adolescent Substance Use 185
Role of Americans with Disabilities Act 185
Substance Abuse Services in Practice 186
References 186
Chapter 7
CONTINUUM OF CARE 191
Key Aspects of Treatment 191
Substance Abuse–Dependence Continuum of
Care Services 192
Outpatient Treatment Program 192 • Intensive Outpatient Treatment
Program 193 • Partial Hospitalization Substance Dependency Program 194
Residential Treatment Program 195 • Inpatient Detoxification 195
Treatment Groups 196
viii Contents
ASAM-PPC-2 Assessment Criteria 196
Assessment Dimensions 197 • Diagnostic Criteria for Determining
Level of Care 198
Specific Substance Class Treatment Considerations
Associated with Continuum of Care 201
Depressants 201 • Stimulants 205 • Polysubstance Abuse 205
Community Reinforcement 206
Controlled Drinking: A Treatment Alternative 207
References 212
Part IV
Chapter 8
SOLUTION-FOCUSED THERAPY 219
Potential Problems 221
Strategies for Improving Motivation (Miller &
Rollnick, 1991) 222
Predictive Measures of Outcome 222
Therapist Responses to Slips 222
Decreasing Treatment Dropout Rate 223
Role of Family Treatment 223
Inpatient Treatment 224
Patient–Treatment Matching 224
Discharge and Aftercare 225
Treatment Interventions Supported by Research 226
Treatment Models 227
Cognitive Restructuring 227 • Behavior Modification 228
Psychodynamic Therapy 231
Medical Treatment for Substance Dependence 234
Pharmacotherapy 234
Integration of Psychotherapy and Pharmacotherapy 235
Evidence for Effectiveness of Combined Treatment 236
Individual Therapy 237
Importance and Usefulness of the Support Group
Forum 238
Benefits of Support Groups 239
Therapeutic Group 240
Basic Areas of Education 241
Stages of Solution-Focussed, Outcome-Oriented
Treatment 242
Group Topics 245
Substance Use–Abuse Group 245 • Codependency 247 • Shyness 249
Anger Management 250 • Assertiveness Training 252 • Skills
Acquisition 253 • Social Skills Training 254 • Anxiety and Stress
Management 255 • Adult Children of Alcoholics (Dysfunctional Families) 256
Contents ix