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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!

Reasons for Using Substances

Contributor: Yvette McBride Thomas

People like to feel good. Many experiences in our world are geared toward altered states of consciousness–natural highs. These “natural highs” are derived from many experiences: roller coaster rides, skydiving, white water rafting, dancing, or anything else that can produce an adrenaline rush. Our enjoyment of these sensations begins at an early age. Small children will spin around in circles or scare each other in order to feel this altered state of consciousness. Unfortunately, “artificial highs” from drugs or alcohol are easier to obtain than natural highs, and drugs are readily available to children at an early age. The following seem to be the most common reasons for drug use today.

Parental or Guardian Influence

As seen in the previous section, the “pill for every ill” attitude that is seen in the home has a major impact on children. Approximately 80% of children’s values, morals, work ethic and attitude are derived before age 8. A child is exposed to his/her parents for the majority of his/her life before age 8. Therefore, parents will have the greatest influence on their children. A child learns many lifelong habits and attitudes from his/her parents. Unfortunately, in about 80% of cases, a child’s first exposure to alcohol and drug use is in the home. Children may see a parent drinking alcohol, popping pills or doing other drugs. Parents may have a liquor cabinet, a steady supply of beer in the refrigerator, or other drugs in the home. The influence of a child’s parents cannot be emphasized enough. Parents need to understand this and be proper role models for their children. What is the subliminal programming that is occurring every time a child opens the refrigerator and sees beer? It becomes the norm. We are not saying that parents should never drink beer in the home, but rather that they must assess the role that alcohol plays in their home.

Unfortunately, too, some children are exposed to illegal drugs from the time of their birth. Worse, some are exposed even before birth, if the mother uses during pregnancy. Such babies may be born addicted to drugs (i.e., “crack babies”). Infants may be exposed to drugs in the mother’s breast milk or in the home environment. One client in drug treatment described a baby picture of himself, in which a bottle of beer and a marijuana “joint” were photographed with him in his crib. He grew up believing that drug and alcohol use was normal for everyone. He began using at age eight and was chemically dependent and involved in the courts by age 17. Another client in treatment, an adolescent, shared a story of being beaten by her father-for smoking his marijuana. She had the black eye to prove it.

Peer-Group Influence 

Most people are aware that during the adolescent years, a person’s most influential group is their peer group. When their peers are using substances, teens often feel a need to use them as well, in order to gain acceptance, to be “tight” with their friends. Using substances because “everyone else does” may not seem to be a valid reason to adults, but to high school and junior high students, it is compelling. Failure to join in can cause a teen to become an outcast from the group-the worst fate imaginable to many teenagers. So they will often do whatever it is that their friends are doing so that they can fit in.

Even “good” kids may submit to peer pressure. For many adolescents, using drugs or alcohol can make them feel rebellious, as if they are being independent and carving out their niche in the world. It may also make them feel “grown up”. As a person grows older, he/she may decide to continue using or to stop using for many different reasons. He/she may outgrow the peer group influence but may not outgrow the substance involvement.

To Get An Effect or To Get High (Pleasure)

The majority of people using substances do so to get the mood-altering effect or some type of pleasurable sensation. Many available substances will induce a feeling of euphoria. People who use substances for pleasure, who have few problems with their substance use, are often labeled “social” users. These individuals can drink or get high on weekends just to feel good and have no resulting problems. Other persons who get involved in this type of substance use will eventually develop major substance abuse problems. No one can predict before beginning use if he/she will become drug- or alcohol- dependent.

Curiosity and Boredom

Curiosity is the most familiar reason given for first trying a substance. Curiosity is quickly satisfied. Therefore, if the person chooses to continue using the drug, he/she does so for other reasons. With the current availability of many substances, people are aware that if they want to try substances, they can. Young people are naturally curious; they are attracted to new and exciting things. Adolescents want immediate gratification and often don’t look at the possible consequences. This also leads them into trying many different drugs, to experiment with the different highs. This need for immediate gratification also allows them to get bored very easily. Obtaining and using illegal drugs is often viewed as exciting or “cool” by adolescents and can take up a large amount of time, thus alleviating their boredom.

Internal Issues

Internal issues correlate with serious substance abuse problems. Internal pressures to use include: stress, low self-worth, depression, anxiety and nervousness. Low self-esteem has been found to be a major factor in an individual’s choice to begin using substances. Alcohol and drugs are called mood-altering substances for a reason. Drugs alter (change) the mood (emotions) of the individual. They may either exacerbate an existing problem or create a new one. Many drugs also contribute to additional internal issues, such as depression, anxiety, or low self-esteem. Once again, substances may provide an easy but temporary method of dealing with these internal issues but usually cause additional problems. Often, the user doesn’t realize that substance use does not solve problems. When the substance wears off, the problem is still present, and often there are additional problems resulting from the substance use.

External Pressures

An individual may use substances to escape external pressures. These external pressures–situations with which an individual may feel uncomfortable-may include school problems, work difficulties, family problems, peer pressure, relationship issues, etc. If an individual feels upset about a certain situation and gets drunk or high, he/she may feel relief from the problem. This escape, however, will only last for a limited period of time. When the individual is no longer high, the problem will return. Using drugs or alcohol as an escape is only temporarily effective–and very dangerous.

An individual may begin to regularly rely on the drug or alcohol as a coping mechanism. This leads to addiction and produces an individual who has no other coping skills for difficult situations. Often, the use of drugs creates additional external pressures and exacerbates the existing ones. A vicious cycle occurs: the individual uses drugs or alcohol to deal with existing problems and the use causes more problems. The individual then uses more drugs to deal with these new problems. This additional use then causes more problems, which leads to more use. It is a never-ending cycle of use and problems.


How Substance Abuse Starts

Contributor: Yvette McBride Thomas

There is a debate in this country about how substance abuse begins. In the past, it was believed to be a moral issue. At that time, alcoholics and addicts were seen as morally deficient. This is not the view of clinicians today. Today physicians, psychologists, and counselors identify chemical dependency as a disease. The question still remains, however: why can some people use alcohol or drugs safely while others become chemically dependent? The debate points to heredity or environment, or a combination of these. Many experts theorize that chemical dependency is hereditary. If we examine the background of someone who is alcohol- or drug-dependent, we often see a family history of the illness. One thing is certain: in order to become chemically dependent, an individual must first begin using alcohol or drugs. As mentioned previously, the United States, though comprising only 5-6% of the world’s population, consumes three-quarters of all illegal drugs produced in the world! Additionally, Americans are the leading abusers of alcohol and prescription drugs in the world. Why is this?

One environmental theory is based on the fact that American society today over-emphasizes the importance of “feeling good.” In our society, if a person doesn’t feel well, we

After alcohol, marijuana has the highest rate of dependence or abuse among all drugs.

reach for substances as a solution. As a result, our society has developed a “pill for every ill” attitude. These “ills,” regardless of type or severity, are often being treated with drugs or alcohol. Our “pill-for-every-ill” attitude influences many individuals in our society to believe that a chemical cure is the only solution for any societal problem. (We’re not referring here to the appropriate use of medication, as prescribed by a physician or other health care professional, for physical, mental, or emotional disorders, but rather to the abuse of alcohol and drugs.)

As adults, we demonstrate this “pill for every ill’ attitude to our children. We may take pills to get started in the morning, to get to sleep at night, to deal with mild pain, or to deal with situational sadness. This vicious cycle of chemical cures is paraded in front of our children on a daily basis. This behavior does not provide a proper example for our children. Today, the morals we teach our children have changed. Unfortunately, the breakdown in discipline of children and the many changes in family structure (such as families where both parents work, single-parenting situations, etc.) have eroded the traditional family structure. It is often replaced with a loose structure, in which children may doubt their parents’ authority and values.

Community is another area where society has weakened. Changes in the community have contributed to a breakdown, a lack of respect, in the general moral standards of the past. We live in a society where “anything goes.” Often, there are no repercussions when moral standards or laws are broken. Looking at our society, we see gang wars, prostitution, drug trafficking and theft. Many people do not know who their neighbors are and have little concern for them. Children are being taught (by the example of the adults in their lives) to “look the other way,” and to avoid confronting important issues.

Drugs are in our children’s lives at an early age. Often children face major decisions before they are twelve years old as to whether or not to smoke, drink or use drugs. Because of this, information about alcohol, drugs and appropriate decision making must be presented early by knowledgeable individuals in the school system. This education of our youth should not stop with the school system but should be reinforced in the home, in athletics, in the workplace and in the community.

Childhood and adolescence is a time of tremendous change in a child’s life. Teens, in particular, undergo rapid changes in emotions, coinciding with the numerous physiological changes taking place. This is also the age at which a child begins to create his/her own value system. It is very important for parents to understand that substance use by children and teens is a very critical issue. Substance abuse affects a young person’s emotional, physical, and moral development. It contributes to emotional immaturity, improper physical development, poor moral standards, an inability to learn and faulty decision making. But we must start setting the right example even before the teen years. For pre-school age children and toddlers, parents should reinforce the concept that medicine is taken only for illnesses or by direction of a physician. Drug education in primary schools is extremely important. Teachers, administrators and parents should all provide educational information to the children and reinforce the consequences associated with substance use.

Substance abuse is on the rise by our adolescents. During the teenage years, experimentation with alcohol and/or drugs is common; this is when most drug problems begin. Most people are unaware that alcohol is classified as a mood-altering drug. Use of alcohol by teenagers often leads to use of other drugs. Experimentation with substances may occur in the home, at school, in social situations or at a stressful time in youngsters’ lives. Alcohol and drugs are used on a regular basis by a large percentage of our teenagers, many of whom later become alcoholics or drug addicts. Sadly, we know that some will even die as a result of their substance use.

Today, an alarming number of adolescents are smoking cigarettes. Once they begin using tobacco, marijuana is the logical next step. Over half of adolescents admitted to drug treatment programs are seeking treatment for marijuana addiction. Adolescents who smoke marijuana are 85 times more likely to eventually turn to cocaine and other “hard” drugs, compared to those who have not smoked marijuana. Thus, tobacco, alcohol, and marijuana are known as “gateway” drugs. Use of these “gateway” substances may lead to “harder” drugs, especially for adolescents who are already chemically dependent upon alcohol or marijuana.

Once our children become adults, the cycle doesn’t end. As adults, they become part of our nation’s workforce. In our corporations today, we see many problems caused by substance abuse. The list is staggering: increased absenteeism and illness, lower productivity, theft, an increased number of accidents and fatalities, greater use of medical benefits, violence, altercations, and lower employee morale are all related to drug and alcohol abuse in the workplace.

To combat experimentation and substance abuse, all aspects of society must join together and provide educational information to our children on the dangers of substance use. We must be good role models. We must provide community support, and encourage effective law-enforcement programs. We must arm our youth with the knowledge they need to make important decisions about alcohol and drug use.

Reasons for Using Substances

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Thank you: Subscribers, Followers, and WordPress!! Happy 2013

Dear subscribers and followers,

Thank you for following my blog. When I started the LCDC Exam review blog, I only had one thing in mind: to share what I know and what I am learning. It has been a pleasure and  a lot of fun. Today, LCDC Exam Review is being read all over the world and I have subscribers from countries I didn’t even know existed!

I want to express my special gratitude to my main contributor, colleague, and friend, Yvette McBride Thomas, who has been a great support from the moment LCDC Exam Review started. In addition to being a full-time student and working full time, Yvette has made the time to submit valuable information on counseling, substance abuse treatment and prevention, and several other topics related to the substance abuse counseling field. She is very professional, highly reliable, and proactive, and I am very glad and honored to have her as part of this project. Thanks a lot Yvette, for all your support.

LCDC Exam Review wouldn’t be what it is today, without my subscribers and followers, and all the wonderful people behind WordPress. To all of you, wherever you are today (New Year’s Eve)……

Thank you!

I look forward to sharing this project with all of you and new followers, in 2013.

Happy 2013!!

2012 Annual Report

WordPress prepared this for LCDC Exam Review!! Please, check it out..it’s so beautiful.

The WordPress.com stats helper monkeys prepared a 2012 annual report for this blog.

Here’s an excerpt:

600 people reached the top of Mt. Everest in 2012. This blog got about 2,000 views in 2012. If every person who reached the top of Mt. Everest viewed this blog, it would have taken 3 years to get that many views.

Click here to see the complete report.

15 Types of Distorted Thinking

Contributor: Yvette McBride Thomas

Thought Distortions

  1. Tunnel vision
  2. Awfulising
  3. Black & White Thinking
  4. Generalization
  5. Assumption
  6. Projection
  7. Negative Thinking
  8. Self-consciousness
  9. Blame
  10. Unfairness
  11. Emotional Reasoning
  12. Manipulation
  13. Shoulds
  14. Got To Be Right
  15. Heaven’s Reward

1. Tunnel vision :

Example: “I expect it’ll be another boring party”.

It is being stuck in a mental groove. In particular you look for that which confirms your fear or prejudice, remember it from the past and expect it in the future. You ignore other points of view or the possibility of alternative solutions.

2. Awfulising :

Example: “I can’t bear going on these awful buses”.

This attitude is saying that it’s unacceptable if things aren’t as you would prefer them to be. You take the negative aspect of a situation and magnify it. To handle this, recognize when you use words like terrible, awful, disgusting, etc. and in particular the phrase “I can’t stand it”. Examine their rationality.

3. Black & White Thinking :

Example: “You’re either for me or against me”.

Things are black or white, wonderful or terrible, a great success or a total failure, brilliantly clever or really stupid, a certainty or a complete mystery, friend or enemy, love or hate – there is no middle ground, no room for improvement, no room for mistakes. judgments on self and others swing from one emotional extreme to another and are easily triggered. It is important to remember that human beings are just too complex to be reduced to dichotomous judgments, and that all qualities fall somewhere along a continuum, containing elements of either extreme.

4. Generalization :

Example: “I’ll never be any good at tennis” (after one poor game).

In this distortion you make a broad, generalized conclusion, often couched in the form of absolute statements, based on a single piece of evidence. If something bad happens once, you expect it to happen over and over again. If someone shows evidence of a negative trait, this is picked up on and exaggerated into a global judgment. This inevitably leads to a more and more restricted life and your view of the world becomes stereotyped. Cue words that indicate you may be over-generalizing are: all, every, none, never, always, everybody and nobody. To become more flexible use words such as: may, sometimes and often, and be particularly sensitive to absolute statements about the future, such as “No one will ever love me”, because they may become self-fulfilling prophecies.

5. Assumption :

Example: “Nothing can change the way I feel”.

Making an assumption, presupposes knowledge that you do not have. Assumptions are often popular beliefs that have been adopted without examining their basis in fact, such as “I’m over the hill now that I’m forty”. Making decisions based on assumptions may lead to disaster, as when an executive assumes that a new product will sell well, having made no market research. Often, taking things for granted causes people to be blind to possible solutions – assuming no-one can help them, a couple’s marriage may go on the rocks, when they could seek counseling. Question: What leads you to believe this? Why do it this way? Who says? What alternatives are there? What would happen if you did? What would happen if you didn’t? As a practical matter, all of us must proceed with the business of living by relying on “maps” of the world which we have taken on trust and which we have not tested and often cannot test. To supplement personal experience, we absorb a constant stream of reports, descriptions, judgments, inferences and assumptions coming from a multitude of sources. From this abundance of stored information, you piece together a mental “model” of the world and its workings that literally becomes your world view. However, people do vary considerably in the extent of their misinformation and in the degree to which they actively seek out new information, take opportunities to correct or update their mental models, and expose themselves to new experiences.

6. Projection :

Example: “I know he doesn’t like me”.

Making false assumptions about what other people think depends on a process called projection. It is like mind-reading – putting words into peoples’ mouths. You imagine that people feel the same way you do and react to things the same way. If you get angry when someone is late, you assume that another will feel the same way about you or others, in that situation. If you don’t like yourself, you assume others also think that way. The answer is not to jump to conclusions about what other people think and feel.

 7. Negative thinking :

Example: “We haven’t seen each other for two days – I think the relationship is falling apart”.

You read a newspaper article about some misfortune and wonder if that could happen to you. Predicting negative consequences is a defense, to protect oneself from disappointment by expecting the worst. Consider, what are the realistic odds of that happening?

8. Self-consciousness :

Example: “Quite a few people here seem smarter than I am”.

This is the introverted tendency to relate everything around you to yourself, to think people must be judging you, or to think that everything they do or say is a reaction to something about you. It is the habit of continually comparing yourself to other people, based on the underlying assumption is that your worth is questionable. You are therefore continually forced to test your value as a person by measuring yourself against others. If you come out better you have a moment’s relief; if you come up short, you feel diminished. Your worth doesn’t depend on being better than others, so why start the comparison gamble?

9. Blame :

Example: “It’s your fault we’re in debt”.

If you see yourself as externally controlled, you see yourself as helpless, a victim of fate or “the system”. You don’t believe you can really affect the basic shape of your life, let alone make any difference in the world, so you try and manipulate others to take care of your interests. Someone else is to blame and is responsible for your pain, your loss, your failure. The truth is that we are constantly making decisions and every decision affects and steers our lives. It is your responsibility to assert your needs, to say no or go elsewhere for what you want. In some way we are responsible for nearly everything that happens to us, including our distress and unhappiness. Taking responsibility means accepting the consequences of your own choices. Ask yourself: What choices have I made that resulted in this situation? What decisions can I now make to change it? The opposite distortion is also very common – the fallacy that makes you responsible for the pain or happiness of everyone around you. You carry the world on your shoulders. You have to right all wrongs, fill every need and balm each hurt; if you don’t you feel guilty and turn the blame on yourself. Blaming yourself means labeling yourself inadequate if things go wrong. With this viewpoint you are very easily manipulated. The key to overcoming this fallacy is to recognize that each person is responsible for himself – taking responsibility doesn’t imply that you are also responsible for what happens to others. Remember, part of respecting others includes respecting their ability to overcome or accept their own pains, make their own decisions and be in control of their own lives.

10. Unfairness :

Example: “It’s not fair, he should take me out more often”.

The consideration of unfairness results from resentment that the other person does not want or prefer the same as you, or that events do not turn out in your favour. The person gets locked into his or her own point of view, with a feeling of ever-growing resentment. Be honest with yourself and the other person. Say what you want or prefer, without getting involved in the fallacy of unfairness: that people and situations shouldn’t be the way they are.

11. Emotional reasoning :

Example: “I feel depressed, life must be pointless”.

You believe that what you feel must be true – automatically. If you feel stupid then you must lack intelligence. If you feel guilty then you must have done something wrong. If you feel angry, someone must have taken advantage of you. However, there is nothing automatically true about what you feel – your feelings can lie to you, they can be based on misconceptions. If your feelings are based on distorted thoughts, then they won’t have any validity. So be skeptical about your feelings and examine them as you would a used car.

12. Manipulation :

Example: “If we had sex more often, I’d be more affectionate”.

The only person you can really control or have much hope of changing is yourself. When you pressure people to change, you are forcing them to be different for your own benefit. Strategies for manipulating others include blaming, demanding, withholding and trading – in order to make the other feel obliged. The usual result is that the other person feels attacked or pushed around and resists changing at all, or feels resentful if they do. The underlying fallacy of this thinking style is that your happiness depends on controlling the behavior of others. In fact your happiness depends on the many thousands of large and small decisions you make during your life.

13. Shoulds :

Example: “You should never ask people personal questions”.

In this distortion, you operate from a list of inflexible rules about how you and other people should act. The rules are right and indisputable. Any particular deviation from your particular values or standards is bad. As a result you are often in the position of judging and finding fault. People irritate you, they don’t act properly or think correctly. They have unacceptable traits, habits and opinions that make them hard to tolerate. They should know the rules and they should follow them. Of course, the answer is to focus on each person’s uniqueness: his or her particular needs, limitations, fears and pleasures, and consequently different values. Personal values are just that – personal. You are also making yourself suffer with shoulds, oughts and musts (or their negatives). You feel compelled to do something or be a certain way and feel guilty if you don’t, but you never bother to ask objectively if it really makes sense. Some people beat themselves up constantly for being incompetent, insensitive, stupid, too emotional, etc. They are always ready to be wrong. The psychiatrist Karen Horney called this the “tyranny of the shoulds”.

14. Got to be right :

Example: “I’ve been doing this longer than you, so I know what I’m talking about”.

In this very common distortion you are usually on the defensive, needing to prove to yourself and others that your views, assumptions and actions are all correct. You never make mistakes! If you’ve got to be right, you don’t listen. You can’t afford to – listening might reveal that you are wrong sometimes. Your opinions rarely change because if the facts don’t fit what you already believe you ignore them. This makes you lonely, because being right seems more important than an honest, caring relationship. The key to overcoming being right, is active listening – making sure you really understand what’s been said to you, to appreciate the other’s point of view and what you can learn from it, which is effort better spent than in devising rebuttals and attacks. Remember that other people believe what they are saying as strongly as you do, and there is not always just the one right answer.

15. Heaven’s reward :

Example: “I worked and raised these kids and look what thanks I get”.

This distorted thinking style accepts pain and unhappiness because “those who do good are rewarded in the end”. You expect all your sacrifice and self-denial to pay off, as if there was someone keeping score. You feel hostile and bitter when the reward doesn’t come. In reality the reward is now. Your relationship, your progress toward your goals, and the care you give to those you love, should be intrinsically rewarding. If not, you need to rearrange your activities to provide some here-and-now reward, dropping or sharing the activities that chronically drain you – Heaven is a long way off and you can get very tired waiting.


The best way to practice identifying Thought Distortions in everyday life is to take particular notice of one of the distortions for one day, and notice whenever it is used – by others or by yourself! Frequently, several Distortions are combined in a statement, or a statement fits into several categories of Distortion. These are commonly rationalizations – i.e. seemingly plausible explanations, excuses or justifications, which in fact are ignoring or fudging the real issue. For example. “I don’t need to work hard on this job because no one else will,” is an assumption, a generalization, negative thinking, tunnel vision, projection, and so on.

Unclear Thinking

Without us being aware of it, the way we usually think serves to riddle our minds with inconsistencies and irrationalities. This unclear thinking then leads to the Thought Distortions listed above. This occurs because language is a representation of human experience and not the experience itself. Language is an abstraction and in many cases a person will delete, distort or generalize in his verbal thoughts or statements about the actual experience. We can’t speak all of the meaning underlying our thoughts or every statement would be too long and pedantic but there is a danger in simplifying our thoughts too much. This is usually done to avoid confronting the whole truth about a situation. A situation can be seen as final and fixed rather than ongoing and changeable, so that responsibility is avoided and nothing can be done about it. For example:

I’m angry“. About whom? About what?

That’s not right“. What specifically is not right?

I realize I’m stupid“. How specifically do you realize you’re stupid?

I want love“. Who do you want loving from?

Nobody loves me“. Who specifically does not love you?

I have to clean the house before my husband gets home“. What would happen if you didn’t?

It’s impossible to talk to my boss“. What stops you?

My wife makes me angry“. How specifically does your wife make you angry?

I handled that meeting badly“. Badly compared with what?

I know he dislikes me“. How do you know he dislikes you?

It’s wrong to love two people at the same time“. It’s wrong for whom to love two people at the same time?

“I have a bad memory“. What do you have trouble memorizing and how do you go about it?

I can’t relax“. What prevents you? What would happen if you did?

I can’t cry“. Is that can’t or won’t?

“Without us being aware of it, the way we usually think serves to riddle our minds with inconsistencies and irrationalities.” The idea is to shift one’s state of being to at least acknowledge the possibility of choice, and to revise one’s fixed ideas. This is not to say one should question one’s every word, but if you find yourself feeling dissatisfied, look out for what you are deleting, distorting or generalizing about your experience, and how are you reducing your choices.

Each day, take one of the above Thought Distortions and spot when you find yourself or a person you are talking to using the Distortion. Also note on TV when this occurs. Just recognizing it as such – i.e. that it is an irrational thought – will enable you to be free of the Distortion or will enable you to better understand your fellow man.

10 Signs of Alcoholism

Contributor: Yvette McBride Thomas

10 Signs of Alcoholism

An addiction is defined as a maladaptive behavior that one engages in repeatedly, without the ability to quit, despite enduring serious and significant consequences as a result of that behavior.

Alcoholism is a biological disorder that impacts a person’s physiology as well as their psyche. Addiction is a highly genetic disorder such that over 90 percent of addicts have a relative or relatives who are addicts within 1 to 2 generations. Thus, those who come from families with a high incidence of addiction need to be careful, and monitor their own potential to abuse substances. Of course, if one who is genetically predisposed to be an alcoholic chooses to simply stay away from alcohol, this genetic disorder will never have an opportunity to be expressed. Unfortunately, many do not know that they are predisposed toward alcoholism until they are already embroiled in an unproductive cycle of self medicating their negative mood states with drugs or alcohol.

Denial goes hand in hand with addiction, so most addicts, especially in the early stages of using, will deny that drugs or alcohol are impacting their life in a negative manner. They may continue to deny this reality, even as they begin to lose friendships, have trouble with the law, or perform poorly at work or school. Such is the power of denial. Below are 10 symptoms indicating a drinking problem. They should be used as a guideline to help an alcoholic or problem drinker admit that they do not have control over their alcohol use:

DYI! Get ready with me.Samantha DeLint - Youtube Channel

DYI! Get ready with me.
Samantha DeLint – Youtube Channel

  1. Drinking alone
  2. Making excuses to drink
  3. Daily or frequent drinking needed to function
  4. Inability to reduce or stop alcohol intake
  5. Violent episodes associated with drinking
  6. Drinking secretly
  7. Becoming angry when confronted about drinking
  8. Poor eating habits
  9. Failure to care for physical appearance
  10. Trembling in the morning

These symptoms are all indicative of problem drinking. Not all problem drinkers are addicts however. Some people may not be addicted to alcohol, but may drink to excess primarily as a coping tool to deal with negative feelings. These types of drinkers, who DO NOT have ANY family history of addiction, who have NOT suffered extreme consequences as a result of their drinking, and who WANT to stop drinking, may be excellent candidates for individual therapy. Those who DO have a family history of addiction, who CANNOT stop drinking on their own and who have suffered severe consequences such as social difficulties, legal trouble and work or school problems may be excellent candidates for Alcoholics Anonymous and group therapy in order to promote sobriety. Alcoholism and problem drinking are serious physical and mental health issues and need to be treated as such. If YOU believe that you may be an alcoholic or a problem drinker please consult your physician in addition to contacting a mental health professional who specializes in substance abuse in order to coordinate your treatment.

Dr. Maloff specializes in the outpatient treatment of substance abuse and addiction disorders. jared on October 9th, 2007

ASAM Dimension 3 – Emotional/Behavioral Conditions

Contributor: Yvette McBride Thomas

Dimension 3:  Emotional/Behavioral Conditions

Problem (need)

  • Patient reports evidences of possible depressive symptoms
  • Patient reports unresolved loss/grief issues due to deaths in immediate family
  • Patient has a history of poor anger management
  • Patient has a history of illicit behavior which has led to legal problems
  • Patient reports difficulty coping with loss of child custody
  • Patient exhibits very low frustration tolerance
  • Patient’s current functioning affected by history of verbal/sexual/physical abuse
  • Patient experiencing grief due to divorce/desperation
  • Patient experiencing difficulty coping with loss of significant relationship
  • Patient seems unable to keep schedule of structured recovery activities, showing erratic or irresponsible behavior.

Goal (I will)

  • Patient to address unresolved loss issues
  • Patient to increase frustration management skills
  • Patient to increase anger management skills
  • Patient to cease illegal behaviors
  • Patient to develop alternative to illegal behavior
  • Patient to increase communication skills
  • Patent to address emotional needs of family
  • Patient to increase responsible time/task  management skills

Intervention (Objective)

  • Patient to complete mental health symptoms questionnaire with counselor within ___ weeks
  • Patient to examine situations precipitating frustration and anger and discuss nonaggressive responses to address and discuss in counseling sessions and monitor  progress on anger/frustration.
  • Patient to contact anger management group with in _______weeks and attend as scheduled, following up with primary counselor (pc)
  • Patient to process the loss of loved one in counseling sessions and progress on grief management to be monitored with with grief support group within ______ of referral
  • Patient to process feelings over possible loss of child custody
  • Patient to explore  ways to cope with emotional affects of serious illness
  • Patient is to discuss progress on avoiding arrest and illicit activities


Behavioral Definitions

  • History of explosive aggressive outburst out of proportion to any precipitating stressors leading to assaultive acts or destruction of property
  • Overreaction of hostility to insignificant irritants
  • Body language of tense muscles (clenched fist/jaw, glaring looks, or refusal to make eye contact)
  • Consistent pattern of challenging or disrespectful treatment of authority figures using verbally abusive language

Long term goals

  • Decrease overall intensity and frequency of angry feelings and increase ability to recognize and appropriately express angry feelings as they occur.
  • Develop an awareness of current anger behaviors, clarifying origins of and alternatives to aggressive anger
  • Come to an awareness and acceptance of angry feelings while developing better control and more serenity.
  • Become capable of handling angry feelings in constructive ways that enhance daily functioning.

Therapeutic Interventions

  • Identify targets of and causes of anger
  • Verbalize increased awareness of anger expression patterns
  • Verbalize how influential people in growing up have modeled anger expressions
  • Identify pain and hurt of past or current life that fuels anger
  • Utilize relaxation techniques to cope with angry feelings
  • Verbalize increased awareness of how past ways of handling angry feelings have had a negative impact
  • Verbalize increased awareness of and ability to react to hot buttons or anger triggers in a nonaggressive manner
  • Write  an angry letter to target and process this letter with counselor/therapist
  • Write a letter of forgiveness to perpetrator of past or present pain and process letter with therapist/counselor
  • Assist patient in identifying ways key life figures have expressed angry feelings and how positively  or negatively these experiences have influenced the way patient handles anger
  • Assign patient to list the experiences of life that have hurt and led to anger
  • Ask patient to list ways anger has negatively impacted his/her daily life. Process list in counseling  session
  • Ask patient to write an angry letter to parents, spouse, or whomever, focusing on the reason for his/her anger toward that person. Process letter in counseling session
  • Ask patient to write a forgiveness letter to target anger as a step toward letting go of anger. Process letter in session.
DYI! Get ready with me.Samantha DeLint - Youtube Channel

DYI! Get ready with me.
Samantha DeLint – Youtube Channel

Reference used: Jongsma, A.E. Jr and Peterson, L. Mark The Complete Adult Psychotherapy Treatment Planner 2nd edition
Suggested readings
 Roselline, G., and Worden, M (1986) Of Course You’re Angry. San Francisco: Harper Hazelden
Runin, T. I. (1969) The Angry Book. New York: Macmillan
Weisinger, H. (1985) Dr. Weisinger’s Anger Workout Book. New York: Quill.
Smedes, L. (1991). Forgive and Forget: Healing the Hurts We Don’t Deserve. San Franciso: Harper
Lerner, H. (1985) The Dance of Anger: a Woman’s guide to Changing the Patterns of Intimate Relationships. New York: harper Perennial
Other Resources
http://www.kap.samhsa.gov/products/manuals/pdfs/angermanagement_manual_0508.pdf – 2012-09-10
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