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Substance Abuse Counseling – The Profession

The substance abuse counseling profession is a vocation or occupation that requires advanced education and training. Twenty years ago, treatment was provided by people in recovery from alcohol and other drug (AOD) addictions, who would only use their own experiences to help others. The problem with this is that recovering individuals do not know how to treat different issues that co-occur with addiction such as poly-drug use and mental disorders. Although recovering individuals are able to relate to others dealing with addictions, mainly to the same drug of choice, they do not have the training and the skills to understand the differences among drugs of abuse, their effects on the brain and the body, and the believes and attitudes of people from diverse cultural and ethnical backgrounds.

The substance abuse prevention field is in its early stages, i.e., it is just developing as a discipline. The goal is to create standards of training and practice so that practitioners are able to handle the complexity of substance abuse and everything that comes with it. Part of the training for alcohol, tobacco, and other drug (ATOD) prevention professionals, is to explore their own attitudes about ATOD. It is not surprising to find practitioners who debate over terminology such as recovered vs. recovering addict, or the 12-Steps and the Big Book vs. religion and the bible.

Concepts such as use, abuse, misuse, dependence, and addiction vary from person to person. Substance abuse prevention professionals need to keep in mind that use and abuse of substances is not determined by their own experiences, but by standard definitions. For instance, substance use is the ingestion of alcohol or other drugs (AOD) without experiencing any negative consequences. Substance misuse is when a person experiences negative consequences from the use of AOD, or when the use of them is illegal. Substance abuse is the continued use of AOD in spite of negative consequences.

Addiction, also called dependence, is the compulsive use of alcohol, tobacco, and other drugs (ATOD) regardless of the consequences.

Substance abuse prevention strategies used in the past have been ineffective. Strategies such as Just Say No, Prohibition, and the illegalization of drugs that used to be legal, have not given the results expected. The criminalization of people who suffer from addiction is probably one of the least effective strategies.

Research in substance abuse prevention is helping develop effective theories that include risk and protective factors and resiliency, just to mention a few.

Reference: Substance Abuse Prevention – Julie A. Hogan 

Addiction Counseling Tools: The MSE – Mental Status Exam

The Mental Status Exam (MSE)

The Mental Status Exam is part of the assessment process. Skillful counselors and therapists are able to identify clients with co-occurring disorders. Well-trained substance abuse counselors and therapists can provide a more competent service when they possess the basic knowledge in mental disorders that co-occurred with substance abuse problems. The following is a brief outline of the MSE.
1. The Mental Status Exam (MSE)

  •  It is the process of noting the observable in some systematic way
  • It is different from the biopsychosocial assessment
    • Based mostly on facts about the client’s life
    • Description of the problem provided by the client
  • The MSE is basically our observations
  • It’s a very useful tool for assessing a client over time

2. Helpful questions for the MSE

  • What has changed?
  • When did it change?
  • Has it change for the better or the worse?
3. Two things to keep in mind
  •  Ask for further explanation when you don’t understand something the client has told you
  • Document what is worth noting
 4. Where to begin
  •  Start by describing those things that anyone looking at the client would notice
  • It does not matter when the MSE is completed
  • Remember that a good clinician is a good observer
 5. Avoid two real temptations
  • To infer meaning from what you are actually seeing
  • To see things that are in reality just your assumptions
 6.  Areas to address in the MSE
  •  Appearance
    • How does the client look and behave?
  • Speech
    • How does the client speak?
  • Emotions
    • What is the client’s mood/affect?
    • How does the client feel most of the time?
    • How does the client appear to be feeling during the interview with you?
  • Thought process and content
    • How does the client think?
      • Circumstantiality – takes a while to get to the point
      • Perseveration – repeating phrase or returning to same subject
      • Association – how does the client get from one idea to the next?
  • What does the client think about?
    • Delusions?
    • Compulsions?
  • Sensory perception
    • Illusions?
    • Hallucinations?
  • Mental Capacities
    • Is the client oriented in time, place, and person?
    • What is your estimate of the client’s intellingence?
    • Can the client remember and concentrate?
    • How are the client’s judgment and insight?
  • Attitude toward the interviewer
    • Client’s attitude towards you
    • Does it change over time?
    • Does he/she respond to empathy?
    • Does he/she appear to be capable of empathy?

Reference: Where to Start and What to Ask – Susan Lukas. (This is by far one of my favorite books. I highly recommend it) 
 Dual Disorders – David O’Connell

Drug Addiction and Co-occurring Disorders

Dual disorders is a term used in the past to refer to clients who deal with substance abuse problems and mental disorders. Nowadays we use terms such as co-occurring or comorbid disorders. All it means is that there is one or more problems in addition to the original problem. Clients with substance abuse problems usually deal with poly-substance abuse and one or more mental disorders. Then, it is much more complex than just thinking of a client with cocaine addiction and bipolar disorder. In reality, we encounter clients abusing more than one substance and presenting symptoms for one or more mental disorders. Therefore, it is important for substance abuse counselors and therapists to be well-trained in both substance abuse assessment and mental disorders assessment. Clients are often misdiagnosed with mental disorders as the main problem, when the real case is that the client’s symptoms could be the product of the substance(s) being abused. Since several symptoms of substance abuse and mental disorders overlap, counselors and therapists need to have the skills to identify the main problem and the co-occurring problem.This is a brief outline about dual/co-occurring/comorbid disorders

  1. Co-Occurring Disorders
    • Substance abuse problems combined with mental disorders
    • Counselors/therapists can treat clients with co-occurring disorders by mastering basic approaches
  2. Models of Training
    • Scientific Professional Model
      1. Training of psychologists and psychiatrists
      2. Classroom teaching of “facts”
  • Craft Model
  1. Traditional addictions counseling training
  2. Based on personal experience and on-the-job apprentice-style training and supervision

There advantages and disadvantages of both, but can be overcome by combining them.

  • First Steps
    • Learn about the disorder
  1. Read available literature on the topic
  2. DSM-IV
  • Assess the client carefully
  1. Avoid misdiagnosing clients due to overlapping of symptoms between the effects of a drug and a mental disorder
  2. Is there a mental disorder, regardless of the substance abuse problem?
  3. Is the substance causing the symptoms? (e.g. schizophrenia, paranoia, depression due to substance use)
  • Learn what to avoid in treatment
  1. Do no harm
  • Learn appropriate treatment strategies
Other Considerations
  • Continuing Care
  1. Help the client maintain sobriety and the mental disorder under control by providing good after-care.
  • Role of Medication
  1. Become familiar with the client’s medication
  2. Medication should be monitored closely

Psychiatric and Psychological reports

  • Impulse control
    • Client’s tendency to act on feelings, thoughts, or impulses
  • Level of functioning
    • How well clients manage their impulses
  • Affective expression
    • Client’s style of emotional expression
  • Cognitive functioning
    • Client’s level of intelligence
  • Perceptual functioning
    • Nature and frequency of client’s perceptual disturbances
  • Reevaluation
Discussing the diagnosis with the client
  • Avoid undermining treatment
  • Encourage AA or NA involvement
  • Supervision
Other Considerations
  • Well-trained addictions therapists/counselors can skillfully treat the psychiatric disorder and the substance abuse disorder
  • Competence in the brief therapies is needed
  • Cognitive Behavioral Therapy (CBT) is one of the most effective ones.

Reference: Dual Disorders – David F. O’Connel 

Effective Counseling Skills

Shared by contributor Yvette McBride Thomas

Hello everybody!

Here is the pdf document that you can download.

Effective Counseling Skills

Let me know if you have any problems downloading the document.

Good day!

Gestalt – Fritz Perls

1. View of Human Nature

a. A Gestalt means a whole, and Gestalt therapy is based on the person feeling whole or complete in their life.

b. Gestalt therapy is considered to be a here-­and-­now therapy focusing on awareness with the belief that when one focuses on what they are and not what they wish to become, they become self-­actualized. The idea being that through self acceptance one becomes self-­actualized.

c. The Gestaltists believe that the individual naturally seeks to become an integrated whole, living productively.

d. Gestaltists are antideterministic because they believe that people have the ability to change and become responsible.

e. Gestalt borrows heavily from the viewpoints of existentialist, experientialist, and phenomenologicalist with the emphasis on the present and awareness. Gestalt focuses on the client’s own inner world of interpretation and assessment of the present life situation

f. Gestaltists believe that individuals emphasize intellectual experience, diminishing the importance of emotions and senses, resulting in an inability to respond to the situations or events in their life

g. Gestaltists believe that thoughts, feelings, and reactions to past events or situations can impede personal functioning and prevent here-­and-­now awareness. The most common unfinished business is that of not forgiving one’s parents for perceived mistakes in one’s parenting.

h. Awareness is considered on a continuum with the healthiest person being most aware. These people are aware of their needs and deal with them one at a time. The emphasis in on reality and not on embellished or imagined needs. The individual recognizes their internal need and meets that need through manipulation of the need and the environment.

Difficulty may arise in several ways:

i. Loss of contact with the environment and its resources.
ii.. Loss of contact with self through over involvement with environment.
iii. Fail to put aside unfinished business.
iv. Loss the Gestalt resulting in fragmentation or scattering.
v. Experience conflict between what one should do and what one wants to do.
vi Experience difficulty with life’s dichotomies, i.e. love/hate, pleasure pain, masculinity/femininity.

2. Role of the Counselor

a. The counselor creates an environment for the client to explore their needs in order to grow.
b. The counselor is fully with the client in the here-­and-­now with intense personal involvement and honesty.
c. The counselor helps the client to focus on blocking energy and to positively and adaptively use that energy.
d. The counselor also helps the clients to discern life patterns.
e. Among the rules that counselors use to help client:

i. The principle of the now requires the counselor to use present tense.
ii. I and Thou means that the client must address the person directly rather than talk about them or to the counselor about them.
iii. Making the client use the I instead of referring to own experiences in the second (you) or third (it) person.
iv. The use of an awareness continuum that focuses on how and what rather than on why.
v. The counselor has the client convert questions into statements.
vi. DSM-­IV categories and standardized assessment is not considered necessary within this theory (Gladding, 1996)

3. Goals

a. The emphasis is on the here-­and-­now of the client’s experience
b. The client is encouraged to make choices based on the now as opposed to past
c. Help the client resolve the past
d. Assist the client to become congruent.
e. Help the client to reach maturity intellectually.
f. Help the client shed neuroses.

4. Techniques

a. Techniques in Gestalt therapy one of two forms, either an exercise or an experiment

i. Exercises include activities such as:

  1. frustration actions
  2. fantasy role playing
  3. fantasy
  4. psychodrama

ii. Experiments are unplanned creative interventions that grow out
of the here-­and-­now interaction between the client and the
counselor.

b. Dream work in Gestalt therapy consist of the client telling the dream and then focusing their awareness on the dream from the perspective of each character or element in the dream.

e. Empty chair is a process where the client addresses parts of the personality , as if it were an entity sitting an empty chair. The client may switch perspectives by switching chairs or may simply address the chair. The technique is contraindicated for severely disturbed clients.

f. Confrontation is another of the Gestalt exercises that is very powerful. Basically, the counselor calls attention to the incongruence between the client’s verbalizations and observed emotions or behaviors.

g. Making the rounds is a group exercise in which the client is instructed to say the same sentence to each member of the group and then adding something personal to each person.

h. I take responsibility is the phrase that follows each statement expressing statements or perceptions that the client states. The process is to help the client to integrate their internal perceptions and their behaviors.

i. Exaggeration is over-­dramatizing the client’s gestures and movements to help gain insight into their meaning.

j. May I feed you a sentence is the question that the counselor asks before giving the client a more specific expression of what the counselor believes is the underlying message of the client.

Existential Counseling – Rollo May and Viktor Frankl

1. View of Human Nature

a. Existentialists believe that the individual writes their own life story by the choices that they make.

b. Psychopathology is defined by existentialists as neglecting to make meaningful choices and accentuating one’s potential.

c. Anxiety is seen as the motivational force that helps the clients to reach their potential. Conversely, anxiety is also seen as the paralyzing force that prevents clients from reaching their full potential. Therefore, through awareness, this anxiety can be helpful in living more fully.

d. Frankl shares that each person searches for meaning in life, and that while this meaning may change, the meaning never ceases to be.

e. According to Frankl, life’s meaning can be discovered in three ways:

i.by doing a deed (accomplishments or achievements),

ii. by experiencing a value (beauty, love, nature, and arts)

iii. by suffering (reconciling ourselves to fate)

2. Role of the Counselor

a. Each client is considered a unique relationship with the counselor focusing on being authentic with the client and entering into a deep personal sharing relationship

b. The counselor models how to be authentic, to realize personal potential, and to make decisions with emphasis on mutuality, wholeness and growth.

c. Existential counselors do not diagnose, nor do they use assessment models like the DSM-­IV.

3. Goals

a. A goal of existential counseling is to have the clients take responsibility for their life and life decisions.

b. A goal of existential therapy is to develop self-­awareness to promote potential, freedom, and commitment to better life choices

c. A major goal is to help the client develop an internal frame of reference, as opposed to the outward one.

4. Techniques

a. The most common technique used in existential counseling is the relationship with the client .

b. Confrontation is also used by existential counselors, when they challenge the clients with their own responsibility for their lives.

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The Structure of the IC&RC ADC Exam

IC&RC ADC Exam.

Hello everyone,

I added information about the structure of the exam. Visit the new page for more information.

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