Alcohol and Drug Counseling « LCDC Exam Review

The Effects of Drugs

December 17, 2012 8:00 am

Drugs come from plants either as by-products of them or developed chemically.
In the US, $150 billion is spent on legal pharmaceutical drugs.
All pharmaceutical drugs have at least three names.
- chemical name of a drug is the organic chemistry chemical description of the molecule. Most will never know or understand this name of a drug they are taking.
- generic name of a drug is the official name of the drug. It is still a detailed chemical name but much simpler.
- brand name is for a specific formulation and manufacturer.
The big difference between the generic name and the brand name is that a generic name is public domain while a brand name is trademarked by the company that developed the drug. The developing company gets to name the drug but it must be FDA approved.
One drug can be a painkiller, a controlled substance, a schedule II substance or just morphine.
Categories of psychoactive drugs are:
- stimulants
- hallucinogens
- marijuana
- depressants
- opioids
- psychotherapeutics
- nicotine.
All drugs have defining characteristics.
The Physician’s Desk Reference has color photographs of most legally manufactured drugs; it also includes information like dose and potency.
The placebo effect is usually thought of in terms of a sugar or fake pill.
Many drugs effects are influenced by the users experiences, mood, how tired they are, in addition to other substances in the system, such as food to other drugs.
Dose-response refers to the correlation between the response and the quantity of drug administered.
- The response may vary due to factors such as tolerance.
- With a dose-response curve we hope to be able to answer a verity of questions; from what is an effective dose or a lethal dose.
Toxicity, in early animal studies, is measured in how many animals die as a result of taking the drug. After more studies, the therapeutic index is set as LD50 / ED50.
The margin of safety is the difference between doses necessary for an intended effect and toxic unintended effects.
Potency refers to the amount of drug necessary to cause an effect, while toxicity is the capacity of a drug to upset or destroy normal body functions.
The forms and methods of taking drugs greatly effect how the drugs will interact with the users system.
- Oral ingestion is the simplest way the drugs enter the body, but also the most complicated way to enter the bloodstream. Oral ingestion must make it through the acid in the stomach while avoiding neutralization by food and drink. When the drug gets past the stomach it still has to go through the liver, as well as other organs.
- Inhalation is when the drug is smoked or “huffed”. Nicotine, marijuana, crack are most effective when delivered this way. It is also rapidly absorbed due to all the capillaries in the lungs consequently moving quickly into the blood. This is the fastest way to get psychoactive drugs into the system.
- Injection put the drug into the system as well.
  - Intravenous injection puts the drugs right in the vein, so the onset of the effect of the drug is fast. You can so put a high concentration of drugs in because it does not have to pass through a membrane.
  - Intramuscular injection puts the drug into the muscle and subcutaneous goes just under the skin.
- Topical application is not used as often because many drugs are not absorbed effectively through the skin.
After drug administration, the body eliminates the drug through metabolism and excretion.
The drug will either leave the system or be changed so much that it will no longer have an effect on the body.
Prodrugs have been developed to start working only after they have been altered by the body.
The body has adaptive processes such as tolerance and dependence to protect against potential harm.
With drug disposition tolerance the more the drug is used the faster the metabolism or excretion.
Behavioral tolerance (conditioned tolerance) is when the behavior of the user changes even if the bio-chemical reaction in the body does not. There is strong evidence that tolerance effects are maximized when the drug-taking behavior occurs consistently in the same surroundings or under the same circumstances.

The Actions of Drugs – Slide show

Drugs, Society, and Human Behavior, by Carl Hart, Charles Ksir, and Oakley Ray

Drugs, Behavior, and Modern Society by Levinthal, C.

ASAM Dimension 2 – Biomedical Conditions and Complications

December 16, 2012 8:00 am

Contributor: Yvette McBride Thomas

Dimension 2: Biomedical Conditions and Complications

Problems (need)

Patient has a medical condition (e.g. high blood pressure, asthma, diabetes, etc.) and has not consistently participated in recommended medical care.
Patient has a serious illness and needs to continue medical care with his/her primary care physician/specialist
Patient is pregnant and needs to engage in regular high risk prenatal care
Patient is in need of dental treatment
Patient is in need of prophylactic for treatment /prevention of active TB
Patient is in need of healthcare information on HIV/AIDS, TB, and Hep that include the effects of illicit drugs on the body.
Patient is in need of CXR after positive PPD (TB)
Patient is in need of HIV education as part of preventive care
Patient needs to engage in regular preventive medical care
Biomedical condition may be exacerbated by illicit drug/alcohol use.
A positive test for HIV/AIDS
Patient has a history of neglecting his/her physical and medical health

Goal (I will)

Secure medical care
Engage in regular medical care for management of chronic medical condition
Continue specialized treatment for serious medical condition
Secure high risk prenatal care
Secure dental care
Receive screening and/or treatment for prevention of active TB
Learn effects of illicit use on medical condition
Participate in regular prevention medical care
Ensure coordination of care including primary medical provider and treatment provider
Medically stabilize physical condition
Accept chronic medical condition with proper medical attention given to it
Take responsibility for maintain physical health and well being
Establish chemical dependency recovery that leads to improved physical health

Intervention (objective)

Patient to secure medical appointment with primary care physician to follow up on abnormal labs within one month or earliest available appointment
Patient to discuss in counseling session the benefits of complying with recommended medical care; monitor on going medical compliance
Patient to verify available coverage and report back to staff: verify medical coverage as needed and offer patient appropriate referrals based on source of coverage.
Patient to become aware of negative effects of illicit drug use on biomedical condition after reviewing in counseling: address ongoing through course of treatment.
Patient to register all prescription medication and update prescription verification throughout course of treatment
Patient to use referral list and call for dental appointment: target date one month or first available appointment
Patient to bring verification of attendance at high risk prenatal clinic: monthly throughout the course of pregnancy
Patient to be able to name benefits of regular prenatal care: address in counseling throughout period of pregnancy
Patient to become aware of illicit drug/alcohol abuse/use on pregnancy: address in counseling session throughout period of pregnancy
Patient to receive HIV/AIDS as well as TB risk reduction education: target date within six(6) weeks of entering treatment and update as needed throughout the course of treatment
Patient to attend post-partum medical appointment within eight (8) weeks of delivery or first available appointment
Treatment staff to consult with patient primary medical doctor as needed to ensure ongoing appropriate care
Patient to discuss importance of preventive medical care for self and family
Patient to bring in verification of TB screen (PPD)
Patient to bring verification of prophylactic treatment for prevention or treatment of active TB

Diagnostic Suggestions (taken from DSM-IV codes associated with presenting problems)

Axis 1

303.90 Alcohol Dependence

304.20 Cocaine Dependence

304.80 Polysubstance Dependence

Behavioral Definitions

A positive test for HIV/AIDS
History of neglecting his/her physical and medical health
Medical complications secondary to chemical dependence

Long Term Goals

Accept chronic medical conditions with proper medical attention given to it
Take responsibility for maintaining physical health and well-being
Establish chemical dependence recovery that leads to improved physical health

Therapeutic Interventions

Make any necessary arrangements required for patient to obtain the medical services needed
Refer patient to physician for complete physical
Help patient understand his/her medical problem and the need to cooperate with doctor’s recommendations
Monitor treatment effectiveness and document patient’s follow-through on doctor’s orders; redirect when patient is failing to comply
Consult with physician and review doctor’s orders with patient
Provide patient with any appropriate literature that will increase his/her understanding of medical condition
Arrange for consultation with dietitian to explain proper nutrition that will enhance medical recovery
Explore and assess the role of chemical abuse/dependency has on medical condition
Refer patient to public health of physician for STD and/or HIV testing, education and/or treatment
Help patient identify and express his/her feelings connected with medical condition
Assign patient to make a list of things he/she could do to help maintain physical health; process list

Progress Note:

Note: each note ins is the order of the therapeutic intervention

The patient presented with serious medical problems that are having a negative impact on his/her daily living
The patient has pursued/refused treatment for his/her medical condition
The patient has not sought treatment for his/her medical condition because of a lack of insurance and financial resources
The patient’s serious medical condition has been under treatment and is showing signs of improvement
The patient reports that he/she has tested positive for HIV/AIDS
Patient has been HIV positive for several months but has had no serious deterioration in his/her condition
The patient is obtaining consistent medical care for his/her HIV status
The patient has refused medical care for his/her HIV-positive status and tends to be in denial about seriousness of this situation
The patient’s HIV-positive status has resulted in the development of AIDS
Because of the patient’s chronic chemical dependency history, he/she has developed medical complications
The patient has accepted that he/she has deteriorated medically because of his/her chemical dependency pattern and has terminated substance abuse
The patient is in denial about the effects of his/her substance abuse and continues this self-destructive pattern
The patient’s medical condition has improved subsequent to termination of substance abuse
The patient described a history of neglecting his/her physical and medical problems
The patient continues to refuse medical evaluation and treatment for physical problems
The patient agrees to seek medical treatment and has followed through on this recommendation
After receiving medical treatment, the patient’s physical and medical condition has improved significantly.

Reference: Jongsma, A.E. Jr and Peterson, L. Mark The Complete Adult Psychotherapy Treatment Planner 2^nd edition

Substance Abuse Treatment for Persons with HIV/AIDS. Treatment Improvement Protocol (TIP) Series, No. 37.

INFORMATION SOURCES

The National AIDS Treatment Information Project – http://www.natip.org/index.html
The Measurement Group – www.themeasurementgroup.com
JAMA HIV-AIDS information center – http://www.ama-assn.org/special/ hiv/hivhome.htm
Critical Path AIDS Project – http://www.critpath.org/critpath.htm
HIV/AIDS Treatment Information Service (ATIS) – http://www.hivatis.org
AIDS Clinical Trial Information Service (ATCTIS) – http://www.actis.org
Centers for Disease Control and Prevention (CDC) – http://www.cdc.gov

Drug Use in Today’s Society

December 15, 2012 8:00 am / 1 Comment on Drug Use in Today’s Society

Drug use is taking an aspirin for a headache, or a single dose of cough syrup for a cough or a hit of acid.
How the drug is taken has an effect on how the body reacts.
How much and how often are points that make the difference between normal use and abuse.
Four principles of psychoactive drugs:

Drugs are not bad or good; they are not evil, they are a substance. By itself a drug cannot do anything until it enters a body. Some drugs help the body function when taken correctly but can cause harm when misused or abused.
Every drug has multiple effects. No part of the body works independently from the rest; all systems are connected. When a drug is taken it affects all parts of the body it passes through.
Both size and the quality of the drug affect the effects of the drug. The better the quality, or the larger the dose the larger the response or the more severe the response.
The effects of a drug depend on the person. Not only personality, but age, race, weight… all of them influence how the body takes in and responds to the drug.

History tells us that humans have used, misused and abused some plants or substances for as long as humans have been around.
Four pharmacological revolutions

19th century – vaccines. This is the first time drugs were used to help stop the number one killers at the time: communicable diseases. For the first time there were drugs that were powerful and have selective beneficial effects. This helped people have faith in medicine stopping illness.
WWII – antibiotics. Not only did they help cure diseases but also helped prevent infection. This got us to the point that we are now; we expect to take something to fix everything.
1950’s – anti-psychotic drugs. This was the first time that drugs were used to treat psychotic disorders. This changed the way people saw and treated mental illness. We have new drugs that effect how we think, our emotions, and perceptions.
Oral contraception – now we have control of our body through chemicals. Some drugs are not meant to treat anything but to control and change the way the body was meant to work.

Then there were many social changes in the US: The Beatles, civil rights, Vietnam, LSD, etc. Drugs became more common and accepted.
In 1971 Nixon declared the first “War on drugs”; yet during this time the legal drinking age was lowered and penalties for having marijuana were eased.
In the 80’s tolerance lessened. The legal drinking age was raised to 21 again and penalties were stiffened on all drugs, including marijuana.
Perception of the risk – when the perception of the risk is low the use is high and vice versa. This differs from perception of availability.
Longitudinal studies are one way we have looked for antecedents of drug use.
Evidence tells us not to do things but we do them anyways; from eating too much, driving too fast,drinking too much, texting while driving, and driving while intoxicated
Cultural trends influence what drugs are being used.

Drug Use: An Overview – Slide show (recommended)

Drug Use as a Social Problem – Slide Show

Reference:

Drugs, Society, and Human Behavior, by Carl Hart, Charles Ksir, and Oakley Ray

Drugs, Behavior, and Modern Society by Levinthal, C.

LCDC Exam Review is alive! Contribute to it with your knowledge.

December 14, 2012 3:33 pm / 1 Comment on LCDC Exam Review is alive! Contribute to it with your knowledge.

Hello dear readers, subscribers, and followers,

More and more people subscribe by email to LCDC Exam Review everyday! And because some of you suggested it through the Feedback survey, now you can contribute to this study guide by sharing your knowledge and experience. Visit the new page Notes Dropbox!

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Become part of the contributors, whether you are a counselor, a student, or someone with experience in this field, share your thoughts.

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ASAM Dimension 1 – Acute Alcohol and/or Drug Intoxication

December 14, 2012 8:00 am / 1 Comment on ASAM Dimension 1 – Acute Alcohol and/or Drug Intoxication

Contributor: Yvette McBride Thomas

Dimension 1: Acute Alcohol and/or Drug Intoxication

Problems: (need)

Patient presents with opiate withdrawal symptoms
Patient reports continued opiate dependency for ____ years and urine toxicology confirms opiates in system
Patient reports pattern of acute cocaine intoxication
Patient reports/evidence episodic alcohol intoxication
Patient reports pattern of THC abuse or dependency
Patient is opiate dependent and in need of continued outpatient methadone treatment
Patient has been maintained in OMT and patient in consult with staff have determined he/she is ready for therapeutic detoxification
Patient shows signs of continued opiate use on current methadone dosage

GOALS (I will)

Stabilize on methadone maintain dosage
Cease use of illicit opiates as evidence by urine screen results
Cease use of alcohol
Cease use of non-narcotic illicit drugs as evidence by urine results
Successful therapeutic detoxification from methadone/methadone
Continued stability o OMT

INTERVENTION (objective)

Medical review of history and physical by MD: target date within 72 hours of admission
Begin induction of methadose and monitor for needed dose adjustments. Patient to be observed at dosing 6x per week initially and patient to report any symptoms of intoxication or withdrawal to medical personnel: target date for dose stabilization: three weeks and monitoring ongoing
Patient to be randomly breathalyzer for monitoring due to history of ETOH abuse: target randomly breathalyzer throughout the course of treatment
Patient to have a urine toxicology screen within six (6) weeks of treatment to monitor for evidence of illicit drug use/pattern of intoxication and random urine screens per FDA regulations throughout treatment
Counselor and medical team to consult MD to order appropriate therapeutic detox plan
Patient to monitor self during therapeutic detox and report any symptoms to staff for MD review
Counselor to discuss possible need for increase in meth dose with patient and document on medical review
MD to review patient urine screens and symptoms for possible meth dose change per medical review

DIAGONOSTIC SUGGESTIONS (taken from DSM-IV codes associated with presenting problems)

AXIS 1

303.90 Alcohol Dependency

305.00 Alcohol Abuse

304.30 Cannabis Abuse

304.20 Cocaine Dependence

305.60 Cocaine Abuse

304.80 Polysubstance Dependence

BEHAVIORAL DEFINITIONS

Consistent use of alcohol or other mood-altering drugs until high, intoxicated, or passed out
Inability to stop or cut down use of mood altering drug once started, despite the verbalized desire to do and the negative consequences continued use brings
Denial that chemical dependence is a problem despite direct feed-back from spouse, relatives, friends and employers that the use of the substance is negatively affecting them and others
Amnesiac blackouts have occurred when using alcohol
Increase tolerance for the drug as there is the need to use more to become intoxicated or to attain the desired affect
Continued alcohol/drug use despite experiencing persistent or reoccurring physical, legal, vocational, social, or relationship problems that are directly caused by the use of drugs/alcohol

LONG TERM GOALS

Accept chemical dependency and begin to actively participate in a recovery/support program
Establish a sustained recovery, free from the use of all mood-altering substances.
Establish and maintain total abstinence while increasing knowledge of the disease and the process of recovery
Acquire the necessary skills to maintain long-term sobriety from all mood-altering chemicals
Withdraw from mood-altering substance, stabilize physically and emotionally, and then establish a supportive recovery plan

THERAPEUTIC INTERVENTIONS

List recreational and social activities and places that will replace substance abuse related activities
- Assist client in developing insight into life changes needed in order to maintain long term sobriety
- Assist client in planning social and recreational activities that are FREE from association with substance abuse
- Write a good-bye letter to drug of choice telling it why it must go
  - Direct patient to write a good-bye letter to drug of choice; read it and process related feelings with counselor/therapist.
  - Ask client to make a list of the ways substance abuse has negatively impacted his/her life and process it with therapist

PROGRESS NOTE

Note: each note is in the order of the therapeutic intervention

Consistent abuse of alcohol/drug

The patient described a history of alcohol abuse on a frequent basis and, often, until intoxicated or passed out
Family members confirmed a pattern of chronic abuse by the patient
The patient acknowledges that his/her alcohol abuse began in adolescence and continued into adulthood
The patient has committed him/herself to a plan of abstinence from alcohol/drugs and to participate in a recovery/support program
The patient has maintained total abstinence, which is confirmed by his/her family

Inability to reduce alcohol/drug abuse

The patient acknowledges that he/she frequently has attempted to terminate or reduce usage of the mood/mind altering substance, but has found that once use has begun, he/she is unable to follow through.
The patient acknowledges that in spite of negative consequences and a desire to reduce or terminate the use of drugs/alcohol he/she is unable to do so.
As the patient has participated in a total recovery program, he/she has been unable to maintain abstinence.

Denial

The patient presented with denial regarding the negative consequences of his/her substance abuse, inspite of direct feedback from others about its negative impact
The patient’s denial is beginning to breakdown as he/she is acknowledging that substance abuse has created problems in his/or life
The patient now openly admits to the severe negative consequences in which substance abuse has resulted

Amnesiac blackouts

The patient has experienced blackouts during alcohol abuse, which have resulted in memory loss for periods of time in which the patient was still functional
The patient stated that his/her first blackout occurred at a young age and that he/she has experienced many of them over the years of his/her alcohol abuse
The patient acknowledged only one or two incidents of amnesiac blackouts
The patient has not had any recent experiences of blackouts, as he/she has been able to maintain sobriety

Increase tolerance

The patient described a pattern of increasing tolerance for the mood-altering substance as he/she needed to use more of it to obtain the desired affect
The patient described the steady increase in the amount and frequency of the substance abuse as his/her tolerance for it increased

Continued alcohol/drug use

The patient has continued to abuse alcohol/drugs in spite of recurring physical, legal, vocational, social, or relationship problems that were directly caused by the substance use
The patient has denied that the many problems in his/her life are directly caused by alcohol/drug abuse
The patient acknowledged that alcohol or drug abuse has been the cause of multiple problems in his/her life and verbalized a strong desire to maintain a life free from using all mood-altering substances
The patient is now able to face resolution of significant problems in his/her life as he/she has begun to establish sobriety
As the patient has maintained sobriety, some of the direct negative consequences of substance abuse have diminished

REFERENCE USED: Jongsma, A.E. Jr and Peterson, L. Mark The Complete Adult Psychotherapy Treatment Planner 2^nd edition

Alcoholics Anonymous (1975). Living Sober. New York: A.A. World Services

Alcoholics Anonymous (1976). Alcoholics Anonymous: The Big Book. New York: A.A. World Services

Carnes, P. (1989). A Gentle Path Through the Twelve Steps. Minneapolis, MN: CompCare.

Nuckals, C. (1989) Cocaine: From Dependency to Recovery. Blue Ridge Summit, PA: TAB Books

Diagnosis

December 12, 2012 8:00 am / 3 Comments on Diagnosis

Contributor: Yvette McBride Thomas

Diagnosis— the meaning or interpretation that is derived from assessment information and is usually translated in the form of some type of classification system.

A description of a person’s condition and not a judgment of a person’s worth
A common misconception is that a classification of mental disorders classifies people, when actually what are being classified are mental disorders that people have. For this reason, the text of DSM-IV…avoids the use of such expressions as ‘a schizophrenic’ or ‘an alcoholic’ and instead uses the more accurate, but admittedly more cumbersome, ‘an individual with schizophrenia’ or ‘an individual with alcohol dependence’” (DSM IV-TR, APA, p. xxxi).
Diagnoses are important for:
1. Insurance company reimbursement
2. Developing a proper treatment plan
3. To be able to communicate with other professionals, counselors must be able to speak about, understand, or report a client diagnosis
Diagnostic decisions are an evolving process and not a static event.
Diagnosis and treatment planning are now such standard components of counseling practice that a failure to diagnose on some level or a lack of professional diagnostic training may be construed as unethical (p. 335).

Nota bene:

Dual diagnosis—a substance abuse diagnosis with a co-occurring mental health diagnosis in the same individual.
Substance abuse counselors (e.g. LCDCs, ADCs) do not diagnose mental health disorders. We can only diagnose alcohol/drug addiction problems.

Resource: Gladding, S.T. (2011). Counseling: A comprehensive profession (7th ed.). Upper Saddle, NJ: Pearson-Merrill.

8. Professional and Ethical Responsibilities

December 11, 2012 8:00 am / 3 Comments on 8. Professional and Ethical Responsibilities

Professional and ethical responsibilities are the obligations of an addiction counselor to adopt ethical and behavioral standards of conduct and continuing professional development. Our competencies in this area, are:

1. To adhere to established professional codes of ethics that define the professional context within which the counselor works to maintain professional standards and protect the client.