Substance Abuse Counseling : Theory and Practice

by Stevens, Patricia; Smith, Robert L.

• ISBN13: 9780131133235
• ISBN10: 0131133233
• Edition: 3rd
• Format: Paperback
• Copyright: 2005-01-01
• Publisher: Prentice Hall

Summary

Known for clarity, accessibility, and practicality, this widely-used book thoroughly examines substance abuse in the population, addressing both ways to measure the problem and how to treat individuals and families who seek assistance. It educates prospective clinicians and counselors by guiding them, step-by-step, through the process of working with substance-abuse clients. Chapter content builds in sequence; however, each chapter can be taken as a stand-alone source of valuable information. Individual chapters on special populations add substantial depth to the text's treatment of its subject.

Table of Contents

Introduction to Substance Abuse Counseling	1	(35)
The Context of Substance Use/Abuse	2	(8)
Alcohol	3	(1)
Cocaine	4	(1)
Marijuana	5	(1)
Opioids	6	(1)
Amphetamines	7	(1)
Hallucinogens	7	(1)
Tobacco	8	(1)
Caffeine	9	(1)
Patterns of Use and Societal Costs of Substance Use/Abuse	10	(10)
Patterns of Use	10	(5)
Societal Costs	15	(5)
Substance Use and Sexuality	20	(2)
Alcohol	20	(1)
Amphetamines and Cocaine	21	(1)
Marijuana	21	(1)
Intravaneous Opiate Drug Use	21	(1)
Amyl Nitrate	22	(1)
Substance-Related Diseases	22	(1)
Hepatitis	22	(1)
HIV/AIDS	22	(1)
Working in the Field of Substance Abuse Counseling	23	(1)
An Overview of This Book	24	(6)
A Word About Process Addictions	30	(1)
Conclusion	30	(3)
References	33	(3)
The Major Substances of Abuse and the Body	36	(51)
The Brain	37	(6)
Psychoactive Substances and the Brain	42	(1)
Controlled Substances Schedules	43	(1)
Depressants	44	(17)
Alcohol	44	(9)
Benzodiazepines	53	(2)
Barbiturates	55	(1)
Nonbarbiturate Sedative-Hypnotics	56	(1)
Club Drugs	57	(1)
GHB	57	(2)
Opiates	59	(2)
Stimulants	61	(9)
Cocaine	62	(3)
Amphetamines	65	(2)
Minor Stimulant: Nicotine	67	(2)
Minor Stimulant: Caffeine	69	(1)
Cannabis	70	(3)
Hallucinogens	73	(4)
Lysergic Acid Diethylamide (LSD)	74	(1)
Phencyclidine (PCP)	75	(1)
Ketamine	76	(1)
Club Drugs	77	(2)
MDMA (Ecstasy)	78	(1)
Volatile Substances or Inhalants	79	(2)
Anabolic-Androgenic Steroids	81	(1)
Conclusion	82	(1)
References	83	(4)
Etiological Theories of Substance Abuse	87	(36)
Moral Theory	88	(1)
Disease Theory	89	(2)
Strengths and Limitations of Disease Theory	90	(1)
Summary	91	(1)
Biological and Genetic Theories	91	(8)
Genetic Studies on Alcoholism	92	(4)
Genetic Studies on Other Substance Abuse	96	(2)
Strengths and Limitations of Biological and Genetic Theories	98	(1)
Summary	98	(1)
Systems Theory	99	(7)
Malfunctions in the Family System	100	(1)
Alcoholic Families	101	(2)
Substance-Abusing Families	103	(2)
Strengths and Limitations of Systems Theory	105	(1)
Summary	106	(1)
Behavioral Theory	106	(4)
Strengths and Limitations of Behavioral Theory	109	(1)
Summary	109	(1)
Sociocultural Theory	110	(4)
Alcohol Abuse	110	(1)
Substance Abuse	111	(2)
Strengths and Limitations of Sociocultural Theory	113	(1)
Summary	114	(1)
An Integration of Theories	114	(2)
Strengths and Limitations of Integrated Theories	116	(1)
Summary	116	(1)
Conclusion	116	(4)
References	120	(3)
Assessment and Diagnosis	123	(36)
Assessment Case: Jon	123	(1)
Assessment Methods and Issues	124	(1)
The Diagnostic Interview	125	(12)
DSM-IV-TR Diagnosis	127	(1)
Behavioral Characteristics	128	(5)
Assessing Behavioral Symptoms	133	(2)
Family Characteristics	135	(1)
Assessing the Social and Family-Related Symptoms	136	(1)
Major Assessment and Diagnostic Instruments	137	(7)
The Michigan Alcoholism Screening Test (MAST)	138	(1)
Short Michigan Alcoholism Screening Test (SMAST)	139	(1)
The Drug Abuse Screening Test (DAST-20)	140	(1)
The CAGE Questionnaire	140	(1)
The Substance Abuse Subtle Screening Inventory-3 (SASSI-3)	141	(1)
The Alcohol Use Inventory (AUI)	142	(1)
The Addictions Severity Index (ASI)	142	(1)
The Millon Clinical Multiaxial Inventory (MCMI-III) and Minnesota Multiphasic Personality Inventory (MMPI-2)	143	(1)
Diagnosis	144	(7)
Differential Diagnosis	145	(1)
Dual Diagnosis	146	(5)
References	151	(2)
Appendix A: Michigan Alcohol Screening Test (Mast)	153	(1)
Appendix B: Drug Use Questionnaire (Dast-20)	154	(1)
Appendix C: Adult Cage Questionnaire	155	(1)
Appendix D: Substance Use History Questionnaire	156	(3)
Treatment Planning and Treatment Setting	159	(28)
What Is Treatment Planning?	160	(10)
Understanding the Terminology	160	(1)
Treatment Plan Requirements	161	(2)
The Elements of a Substance Abuse/Dependency Treatment Plan	163	(4)
External Reviewers of Treatment Planning: Health Care Accreditation Organizations and Managed Care	167	(3)
What is a Treatment Setting?	170	(2)
Types of Treatment Settings	172	(9)
Medical Detoxification and Stabilization	172	(1)
Dual-Diagnosis Hospital Inpatient	173	(2)
Free-Standing Rehabilitation and Residential Programs	175	(3)
Partial Hospitalization	178	(1)
Temporary Recovery or Halfway Homes	178	(1)
Intensive Outpatient	179	(2)
The Importance of Matching Treatment to Client Needs	181	(2)
Conclusion	183	(1)
References	183	(2)
Appendix: 12-Step, 12-Tradition Groups	185	(2)
Individual and Group Treatment	187	(26)
Getting the Individual Into Treatment	188	(4)
Coercive versus Voluntary Treatment	188	(1)
The Process of Intervention	189	(3)
Summary	192	(1)
Individual Therapy	192	(8)
Direct-Effect Strategies	193	(2)
Broad-Spectrum Strategies	195	(5)
Summary	200	(1)
Group Therapy	200	(6)
Therapeutic Factors in Group Therapy	202	(1)
Group Dynamics	203	(3)
Psychoeducational Groups	206	(1)
Summary	206	(1)
Other Types of Treatment	206	(1)
Counselor Characteristics	206	(2)
Conclusion	208	(1)
References	208	(5)
Family Therapy in Substance Abuse Treatment	213	(26)
Defining Family	215	(1)
General Systems Concepts	215	(5)
Homeostasis	216	(1)
Feedback Loops	216	(1)
Hierarchy, Roles, Rules, Subsystems, and Boundaries	217	(2)
Wholeness	219	(1)
Change	219	(1)
Family Values	219	(1)
The Addictive Family System	220	(2)
The Marital Dyad and Substance Abuse	220	(2)
The Family and Substance Abuse	222	(6)
Children in the Addictive Family	224	(1)
Siblings in the Addictive Family	225	(1)
Children's Roles	225	(2)
Summary	227	(1)
Treatment with Addictive Families	228	(5)
The Process of Treatment	230	(3)
How Successful is Family Therapy?	233	(1)
Conclusion	233	(3)
References	236	(3)
Working with Selected Populations: Treatment Issues and Characteristics	239	(27)
Children and Adolescents	239	(5)
Risk Factors	241	(2)
Prevention and Intervention	243	(1)
Women	244	(4)
Risk Factors	245	(2)
Prevention and Intervention	247	(1)
The Gay/Lesbian/Bisexual/Transgender Community	248	(4)
GLBT Identity Development	249	(1)
Risk Factors	250	(1)
Prevention and Intervention	251	(1)
People With Disabilities	252	(3)
Risk Factors	253	(1)
Prevention and Intervention	254	(1)
The Elderly	255	(2)
Risk Factors	256	(1)
Prevention and Intervention	257	(1)
The Homeless	257	(3)
Risk Factors	259	(1)
Prevention and Intervention	260	(1)
Conclusion	260	(1)
References	261	(5)
Working with Diverse Cultures: Revisiting Issues in Prevention and Intervention	266	(25)
American Indians and Alaskan Natives	266	(5)
Risk Factors	268	(2)
Barriers to Treatment	270	(1)
Prevention and Intervention	270	(1)
Asian Americans	271	(5)
Cultural Values	272	(1)
Risk Factors	273	(2)
Prevention and Intervention	275	(1)
African Americans	276	(5)
Risk Factors	277	(1)
Cultural Values	278	(1)
Barriers to Treatment	279	(1)
Prevention and Intervention	280	(1)
Hispanics	281	(5)
Cultural Values	282	(2)
Barriers to Treatment	284	(1)
Prevention and Intervention	285	(1)
Conclusion	286	(1)
References	287	(4)
Sustaining Behavior Change: Relapse Prevention Strategies	291	(23)
Determinants of Relapse	294	(4)
Environmental	294	(2)
Behavioral	296	(1)
Cognitive	296	(1)
Affective	296	(1)
Relational	297	(1)
Summary	298	(1)
Alcoholics Anonymous Model	298	(5)
Giving Up Control to Gain Control	299	(1)
Self-Examination	300	(1)
Making Amends	300	(1)
Group Participation	301	(1)
Daily Reminders	301	(1)
How Effective Is AA?	301	(1)
AA Associated 12-Step Programs	302	(1)
A Psychoeducational Model: Rational Recovery	303	(1)
Developmental Models	304	(2)
The Gorski Model	304	(1)
The Stage Model	305	(1)
A Cognitive-Behavioral/Social Learning Model	306	(4)
Social Learning Theories	307	(1)
Cognitive-Behavioral Model	308	(2)
The Concept of Re-Joyment	310	(1)
Conclusion	311	(1)
References	311	(3)
Prevention	314	(25)
Types of Prevention	317	(1)
Prevention: A Brief History	318	(4)
Comprehensive Prevention	322	(9)
Project Hope: Comprehensive Prevention in Practice	323	(2)
Risk and Protective Factors	325	(4)
Life Skills Training (LST): Effectiveness of a Comprehensive Prevention Approach	329	(2)
Steps to an Effective Prevention Program	331	(1)
Implications for Counseling	332	(2)
Conclusion	334	(1)
References	335	(4)
Research and Contemporary Issues	339	(34)
Research	339	(10)
Problems with Substance Abuse Research	339	(2)
Alcoholism Outcome Research	341	(3)
Methadone Maintenance Outcome Research	344	(1)
Cocaine Studies	345	(1)
Outpatient Programs Research	346	(2)
Inpatient Programs Research	348	(1)
Specific Practice Effectiveness	349	(7)
The 12-Step Programs	349	(2)
Individual Counseling Programs	351	(1)
Group Counseling Programs	352	(1)
Family Therapy	353	(1)
Multidimensional Programs	354	(1)
Best Practices	354	(1)
Summary	355	(1)
Contemporary Issues	356	(10)
The Disease Concept of Alcoholism: Still Questions	356	(2)
Defining Abuse within the Context of Diagnosis	358	(1)
Determining Treatment Goals	358	(1)
Funding	359	(1)
Gender Issues and the Use of Drugs	360	(1)
Training and Background of Substance Abuse Counselors	361	(1)
Ethical Issues and Substance Abuse Counseling	362	(1)
Burnout	363	(1)
Ethnic Minorities and Substance Abuse	363	(1)
Medications and Alcohol, Tobacco, and Other Drugs	364	(1)
Dance Floor Pharmacology	365	(1)
Conclusion	366	(1)
References	366	(7)
Index	373

Excerpts

Substance abuse ranks as one of the major public health issues in today's society. Whether directly or indirectly, abuse is responsible for increased risk of violence in the home, suicide, mental illness, work-related accidents, and approximately half of all fatal automobile crashes. The use and abuse of substances span gender, socioeconomic levels, ethnicity, age, religion, profession, geography, and most dimensions of human existence and background. All people during their lifetimes will be touched by substance abuse or addiction; therefore, clinicians should be adequately trained to recognize the enormity of this problem, how to assess it, and ultimately how to treat individuals and families who come for assistance. Comprehensive programs at undergraduate and graduate levels are now in place in many settings, systematically studying substance abuse and subsequent treatment modalities. This book was developed to be helpful for the general clinician as well as for students in beginning substance abuse classes and as an adjunct to, but not a replacement for, counseling theory and techniques books and coursework. Contributors to this edition have extensive backgrounds in substance abuse work as well as special knowledge in a particular segment of the field. Space and time limitations prevent us from examining many of the issues in the field: public policy, working in a school setting, substance abuse in the workplace, HIV/AIDS and drug use, and a more in-depth study of the dualdiagnosis issues of mental illness and substance abuse. The book takes the reader through the process of working with substanceabusing clients. Chapters build on each other, yet can be used independently as resources for information. Because it is impossible to portray a "real" client, case histories were developed and are used to offer a sense of practical application in each chapter. These case discussions provide a sample of the types of issues presented when working with this population. The authors believe that knowing about all aspects of the treatment process are essential to assisting clients toward recovery. We have endeavored to structure the book in a manner that reflects treatment from first contact to recovery. We hope that you find this book to be an enjoyable and practical read as well as helpful in your practice.