HANDBOOK FOR CHRIST-CENTERED SUBSTANCE ABUSE AND ADDICTION COUNSELORS. By Michael Belzman, PhD, CDAAC, RAS

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1 HANDBOOK FOR CHRIST-CENTERED SUBSTANCE ABUSE AND ADDICTION COUNSELORS By Michael Belzman, PhD, CDAAC, RAS Association of Christian Alcohol & Drug Counselors Copyright 2003

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3 The Spirit of the Lord is upon me, because he has anointed me to preach the gospel to the poor; he has sent me to heal the brokenhearted, to preach deliverance to the captives, and recovering of sight to the blind, to set at liberty them that are bruised, (Luke 4:18 KJ2000) ASSOCIATION OF CHRISTIAN ALCOHOL & DRUG COUNSELORS INSTITUTE PO BOX 8604 REDLANDS, CA (909)

4 DEDICATION This handbook is dedicated to the five people who are most responsible for its existence: My wife Bonnie, who loved me during a time when no one else could; Pastor Rob Scribner, of the Santa Monica Foursquare Church, who officiated at our wedding and who kept telling the church to count it all joy when we go through various trials (a lesson that I didn t learn for several years); Rob Hezeltine the founder of Victory Resource Center who told me not to worry about getting a Ph.D. in Psychology but to trust that God will make a way; my pastor Wade Kyle, who prodded me to write this training manual for Christian Alcohol & Drug Counselors; and Jerry Smithley, our board member who kept asking me how the book was coming along whenever he saw me. 4

5 ACKNOWLEDGEMENTS I would like to thank Pastor Wade Kyle for his contribution of the chapter on work environments that use human services counselors who receive the kind of training provided through the Association of Christian Alcohol & Drug Counselors Institute. His support as administrator of one of our institute locations and his " in-your-corner support has been invaluable. 5

6 THE PURPOSE OF OUR COUNSELOR TRAINING COURSE AND THIS HANDBOOK The purpose of this course is to educate, train and equip people who have been called to work in the field of Substance Abuse Counseling in ways that do not stand in opposition to the Bible, the inspired, inerrent, and infallible Word of God. The Bible is rich and full of wisdom that has set people free for centuries. Most homes in America have a half dozen or so lying around collecting dust from disuse. But the most effective interventions of healing and freedom from bondage are still contained within those pages. This handbook aims to rekindle the truths contained therein and dispel some of the myths perpetuated by Humanistic Educators who somehow overlooked them. Counselors are in greater demand in a culture in which its members have strayed away from spiritually healthy lifestyles more than any other time in history. Everyone who has been bruised by today s world, everyone who has been victimized, everyone who has been deceived and sought the emptiness of fruitless lifestyles, needs quality counseling more than ever; the type that a secular world trained to ignore God s Word is not equipped to give. There is a large portion of our society that has turned to both illegal and prescribed drugs in an effort to medicate away the pain that life has brought them. These too need counselors with a heart and skill to impact their lives and effectively provide the truth they desperately need to be set free. This course will give insight, skill, and confidence needed to be competent to counsel. The honing of these skills, increased wisdom and insight, along with greater opportunities for employment and ministry, will come through experience, God s 6

7 leading, and stretching that comes when you faithfully seek and say yes to the Master of the universe and the lover of your soul. I wrote this handbook with the goal in mind to equip the student with the fundamental knowledge and skills that will be useful in any human services setting with an emphasis upon substance abuse and addiction counseling. I have come to see that good counseling skills will serve well in any form of employment and in any role whether you are an employee, supervisor, manager or owner. It will give the student confidence to know what to do in situations that commonly arise. It is also a reference manual that will always be available for the student. In addition to fundamental training tools, this course will impart vital truths that will challenge many dysfunctional attitudes and beliefs that commonly creep into our thinking while we are unaware of them. Biblical truths that can impact your own growth & development will be offered in exchange from some of these dysfunctional attitudes that need discarding. It is also the goal of this Handbook to impart to the student a better understanding of God s views on how to enter the world of Human Service, both in the church and out in the world. With just a little equipping and the attitudinal tweaking that this handbook has to offer I hope you will gain a measure of spiritual sensitivity and wisdom in all your affairs, and a true ability to help people overcome their life s challenges. 7

8 TABLE OF CONTENTS Introduction: What Makes an Effective Counselor? Chapter I: Facilities that Use Trained Counselors Chapter II: Ethics Chapter III: Documentation & Case Management Chapter IV: Understanding 12 Step Therapeutic Approach Chapter V: Addiction Intervention Chapter VI: Pharmacology and the Effects of Drug Abuse Chapter VII: The Major Pitfalls of Humanistic Psychology Chapter VIII: Crisis Counseling Appendix A: Professional Code of Ethics Appendix B: Spiritual Gifts Inventory Appendix C: Glossary of Neuroscience Words Appendix D: California Code Of Regulations For Rehabilitation Agencies Pertaining To Confidentiality / Data Collection Appendix E: Government Resources And Web Sites Appendix F: Addiction Severity Index 8

9 INTRODUCTION: WHAT MAKES AN EFFECTIVE COUNSELOR? The material presented in this handbook is necessary fundamental knowledge for anyone who hopes to be effective in healing the broken hearted and setting the captive free from a lifestyle of substance abuse or addiction of any kind. But by itself it is not sufficient, it is only the beginning. The making of an effective counselor goes beyond the knowledge contained herein. It includes a heart that has been formed by God. A heart that has known suffering and has experienced God s loving mercy and His healing power. The making of an effective counselor includes the formation of Godly character that has come about through a long series of choices to do things God s way when the choice could have more easily been made to not. The making of an effective counselor includes having learned not to rely upon human knowledge and intellect, but to rely upon the Holy Spirit for leading and guidance pertaining to all things. The making of an effective counselor includes the necessity of entering in to a process of transformation out of carnal thinking to a lifestyle of surrender. It includes an understanding of the gifts of the spirit that have been imparted by the Holy Spirit, and a willingness to apply them. An effective counselor is one who has nurtured a deep, abiding, personal relationship with Jesus Christ and as a result enjoys a rich communion and prayer life. 9

10 The effective counselor became effective because he first remained still upon the potters wheel as the Master potter molded him and made him what he is today. We live in a microwave generation that believes it is possible to make an effective counselor through education and the granting of a Masters degree or a Ph.D. But of all the things it takes to become a truly effective counselor, these are the least. 10

11 FACILITIES THAT USE TRAINED COUNSELORS 11

12 CHAPTER 1 FACILITIES THAT USE TRAINED COUNSELORS Course Objective: The student will understand the major Human Services organizations, agencies and working environments that will hire people who have training received from this program. Students will receive an overview of important core knowledge areas and know all necessary certification requirements for entry level jobs into the human services field including safety, CPR, first aid, and background checks. TYPES OF HUMAN SERVICES FACILITIES Alcohol and Drug Treatment Programs have residential and outpatient treatment facilities that provide medical and nonmedical alcoholism and drug abuse recovery, treatment, and detoxification services for adult and youth populations. These facilities must be licensed by the Department of Alcohol and Drug Programs unless they are operated under the authority of a non-profit organization. Health and safety concerns are the primary focus of licensure. Licensing procedure is described in The California Code of Regulations (CCR), Title 9, Division 4, Chapter 5: Licensure of Residential Alcoholism or Drug Abuse Recovery or Treatment Facilities. This regulation can be found at The California State Department of Alcohol and Drug Programs also certifies both residential and outpatient alcohol and drug treatment programs. Certification is voluntary. It is considered advantageous in gaining the confidence of both potential program participants and third party payers. 12

13 Human Services workers are used at most facilities under the supervision of managers, medical and paramedical personnel in the administration and operations of program activities. The types of jobs that are typically found in alcohol & drug treatment facilities are intake interviewers, counselors, administrative assistants, hotline counselors, referral desk counselors, and recreation coordinators. Group Homes Group homes are 24 Hr. residential facilities designed for people with limited living choices or disabilities that restrict their ability to have control over their living arrangements. Some are designated for children and teens who have nowhere to go and come from families who did not have the ability, desire or love to maintain a commitment to raise them. These youth find a place to belong in a licensed private group home. They have emotional, behavioral or educational and spiritual problems, which limited their options to live successful lives, unless they get the right kind of help. Human Services workers who receive the right kind of training and who have compassion for this kind of population can offer them support, care, affirmation, counseling and preparation for independent living or adoption while they reside in the group home. Recipients of residential services live in large institutions, medical or psychiatric facilities, group homes, adult foster care arrangements, or in supervised apartments. The human service care giver or counselor working in this field has a major impact on the treatment and accomplishment of goals for the resident and therefore can be a major source of fulfillment for the worker as well. 13

14 Skilled Nursing Facilities Skilled nursing facilities help adults of all ages recover from surgery, injury, serious illness, or mental health disability. For people who need long-term residential care, some facilities also provide comfortable, safe homes and quality healthcare. Many facilities also offer short-term respite care when family caregivers are temporarily unable to provide care. Skilled nursing facilities provide treatment, care and rehabilitation therapy for patients after hospitalization for joint replacement or other orthopedic surgery, traumatic injuries, brain injuries, strokes, open heart surgery or a serious illness. For patients who need complex medical treatments, Skilled Nursing Facilities provide: intravenous and enteral therapy pain management postsurgical stabilization specialized skin and wound care medication management mental health disability behavioral therapy Working with each patient and willing family members, a skilled interdisciplinary team sets treatment goals and creates an individualized plan of care. The team includes nurses, rehabilitation therapists, medical directors, social workers, recreation therapists, dietitians and other healthcare professionals. They share a common goal: to help the patient achieve his or her highest level of functioning and, when possible, return home safely. In these facilities there are some opportunities for advancement to senior level, supervisory or administrative overseer positions in your career without additional educational training. But because the educational requirements and 14

15 standards are continuously being raised, it is more necessary in these days to continue receiving training in your career than it was just a decade ago. Emergency Shelters Victims of domestic violence, sudden job loss, medical problems or disasters may all find themselves in need of emergency shelters. Most of these service centers are open seven days a week. Services include: meals, showers, clothing, on-site and referral health screening, street/jail outreach, follow-up, representative payee services/money stewardship for SSI, laundry facilities, advocacy, case management, medication management, specialized HIV/AIDS and diabetes case management, mental health screening, on-site psychiatric treatment, and a drug recovery program. 15

16 Job opportunities include human services workers for the following positions: Food & meal preparation and service, laundry, on-site and referral health screening, advocacy, case management, medication management, money payee services and stewardship, specialized HIV/AIDS case management, counseling, job and computer training, art / literacy classes, and drug recovery programs. While caring for the homeless, battered women, and other emergencies you make it possible for frail and helpless people unable to help themselves to get through their immediate life crisis by the provision of food and shelter and essential supportive services. Then by linking them to educational and employment opportunities they can become able to build a more secure and self-sufficient life. Mental Health Facilities The California Department of Mental Health licenses facilities or certifies programs engaged in the provision of care to individuals with major mental disorders. The Department of Mental Health licenses Psychiatric Health Facilities and Mental Health Rehabilitation Centers and certifies the mental health programs of Community Residential Treatment Systems and Special Treatment Programs in Skilled Nursing Facilities. Community Residential Treatment Systems (CRTS) Community Residential Treatment Systems provide a social rehabilitation program in a residential setting. They offer programs that assist the client with self-help and social skills, 16

17 behavior adjustment, interpersonal relationships and vocational preparation. Mental Health Rehabilitation Center (MHRC) Mental health rehabilitation centers provide intensive support and rehabilitation to clients as an alternative to state hospital or other 24-hour care facilities. MHRCs help clients develop the skills to become self sufficient and capable of increasing levels of independent functioning. Psychiatric Health Facility (PHF) Psychiatric health facilities provide acute psychiatric inpatient care for patients who cannot be appropriately treated at any other lower level of care. These facilities were established in 1978 as a low cost, high quality alternative to acute hospitalization in a general acute care hospital or freestanding psychiatric hospital. Special Treatment Program (STP) Special Treatment Programs, as certified by the Department of Mental Health, exist within skilled nursing facilities for the benefit of chronically and persistently mentally ill patients who require 24-hour supervision and care. Special treatment programs provide mental health treatment, instruction on personal care and medication management and the use of community and personal resources. All of the above programs offer many entrylevel positions that will get you started on your human service career path. 17

18 Elder Care Facilities Elder care facilities are a type nursing home that provides skilled nursing care and rehabilitation services to people with illnesses, injuries or functional disabilities. Most facilities serve the elderly. However, in some cases some facilities provide services to younger individuals with special needs such as the developmentally disabled, mentally ill, and those requiring drug and alcohol rehabilitation. Elderly nursing homes are generally stand-alone facilities, but some are operated within a hospital or retirement community. The level of care provided by elderly nursing homes has increased significantly over the past decade. Many homes now provide much of the nursing care that was previously provided in a hospital setting. As a result, most nursing homes now focus their attention on rehabilitation, so that their clients can return to their own homes as soon as possible. Some of the services a nursing home may provide include: Physical therapy Occupational therapy Speech therapy Respiratory therapy Pharmacy Services Equipment Rental Alzheimer's treatment Cancer treatment Cardiovascular disease Developmentally disabled 18

19 Dementia Head trauma Hematologic conditions Mental disease Neurological diseases Neuromuscular diseases Orthopedic rehabilitation Pain therapy Pulmonary disease Para/quadriplegic impairments Stroke recovery Trauma Wound care Special Services Home health care Adult day care Respite care Other Senior Care Options The range of senior care options continues to expand to better meet the care and financial needs of individuals. Some of the alternatives that expand the care giver employment opportunities include independent living, congregate care, assisted living and home health care. 19

20 Independent Living Independent living is for people who can take care of themselves and includes residing in one's own home or apartment, a retirement community, or independent living apartments. Congregate Care Congregate care is similar to independent living, but features a community environment, with one or more meals per day prepared and served in a community dining room. Many other services and amenities may be provided such as transportation, pools, a convenience store, bank, barber/beauty shop, resident laundry, housekeeping, and security. Assisted Living Assisted living provides apartment-style accommodations where services focus on providing assistance with daily living activities. These facilities are designed to bridge the gap between independent living and nursing home care, and provide a higher level of services for their residents including meals, housekeeping, medication assistance, laundry, and regular checks-ins. Intermediate Care Intermediate care is nursing home care for residents needing assistance with activities of daily living, but without significant nursing requirements. 20

21 Continuing Care Retirement Communities (CCRC) or Life Care Communities (LCC) These communities are planned and operated to provide a continuum of care from independent living through skilled nursing. The facilities allow individuals to live within the same community as their needs progress through the spectrum of care. Sub-acute Care Sub-acute care is intensive nursing care for patients recovering from surgery or illness patients receive this care in a nursing home setting. Hospice Care Hospice care is a combination of facility-based and home care provided to benefit terminally ill patients and support their families. Hospitals In addition to traditional services, many hospitals offer skilled or sub-acute nursing services either in their facility or on their campus. Respite Care 21

22 Respite care is provided on a temporary basis to allow a primary care provider or family member relief for a few hours or days. Adult Day Care Adult day care programs provide meals and care services in a community setting during the day while a caregiver needs time off or must work. Outpatient Therapy Many facilities offer the same therapies provided in a nursing home on an outpatient basis. For those choosing a homebased option, outpatient therapy may be a necessary professional service. Home Health Care Home health care is provided in an individual's home by outside providers and aims to keep the individual functioning at the highest possible level. Services range from basic assistance with household chores to skilled nursing services. As you can see, the elder care human service worker has many career paths to choose from with many opportunities available. Honor your father and your mother as the Lord your God has commanded you. Deuteronomy 5:16 Put your religion in practice by caring for your own family and so repaying your parents and grandparents, for this is pleasing to God. - 1 Timothy 5:4 Sober Living Homes 22

23 Sober living homes assist recovering persons by creating a caring culture, instilling self-help learning activities and promoting individual responsibility. The Network believes that well-managed sober living homes can assist at least 80% of the addicted population. The value of community recovery housing is mostly unrecognized by health insurers, government officials and State legislators. Most quality sober living homes provide an outstanding service without government funding. There are a few poorly operated homes that overcrowd and/or create a nuisance in neighborhoods. Such problem homes exist but are in the minority; over ninety percent of the homes operate quietly and are good neighbors. Board & Care Homes Board and Care Homes (BCHs) are a type of shared housing designed to serve a smaller number of residents, usually less than 15. Often BCHs are large, private homes converted into private or shared bedrooms; residents share common areas like day rooms, living rooms, and dining rooms. Bathrooms may be private or shared. BCHs usually feel less institutional and are designed to provide 'family- style' care. However, these homes may not have professional or skilled care. Residential Care facilities operate under the supervision of Community Care Licensing, a sub agency of the California Dept. of Public Social Services. In California in the early 1970's the residential care system was established to provide non institutional home based services to dependent care groups such as the elderly, developmentally disabled, mentally disordered and child care centers under the supervision of the Department of Public Social Services. At that time homes for the elderly were known as Board and Care Homes and the name still persists as a common term to describe a licensed residential care home. In the vernacular of the State these homes are also known as RCFE's (Residential Care Facilities for the Elderly). Residential care facilities are not allowed to provide skilled nursing services, such as give injections or maintain catheters 23

24 and do colostomy care, but they can provide assistance with all daily living activities, such as bathing, dressing, toileting, urinary or bowel incontinency care. Most elderly people find that there needs fall beneath having to access skilled nursing services and therefore don't need to be housed in a nursing home. The small residential care home, licensed for 2 to 6 people provides a safe, comfortable and dignified environment for those who need help intermittently throughout the day and night. 24

25 ETHICS 25

26 CHAPTER 2 ETHICS Course Objective: The student will know the professional code of ethics intended to guide the ethical behavior and actions of drug & alcohol counselors. The student will also know the central biblical guidelines that influence counselor behavior, actions, and choices of therapeutic approaches. The student will become familiarized with the most common dilemmas encountered in the field of drug & alcohol counseling. MAN S CODES OF ETHICS What is a Code of Ethics? Code is defined as a systematically arranged, comprehensive collection of laws. The American Heritage Dictionary defines the word Ethics as the study of the general nature of morals and of the specific moral choices to be made by the individual in his relationship with others, the philosophy of morals. Therefore Man s code of ethics could be described as an agreed upon system of moral standards or choices that a group or an individual has vowed to live by in his or her relationship with others. PROFESSIONAL CODES OF ETHICS Most professions that involve interpersonal relationships with the public or co-workers, have a written or implied professional code of ethics. Physicians, Lawyers, Teachers, and Police Officers are just a few examples of professions that operate 26

27 under the authority of a professional code of ethics. Matters concerning the privacy and respect of clients, patients or residents, their belongings, and their loved ones, are kept safe and in strict confidence. A breech of these ethics could result in a law suit, employment termination, or loss of professional license. BUSINESS CODES OF ETHICS Every corporation or business that has employees publishes a policy manual that clearly lays out the organizations internal standards of behavior. These standards include descriptions of behaviors and attitudes that will be expected of each employee in order for the person to considered a valued and productive employee. The standards described in the manual also lay out behaviors and attitudes that, if violated, could be cause for disciplinary action and even termination of employment. Each corporation or business is allowed by law to determine it s own policies and procedures and given a large amount of latitude as to how strict or relaxed their internally set standards shall be. In the arena of these ethics, the line is more blurred as to the nature of how moral the policies are. This is so because they are more closely related to the moral integrity (or lack thereof) of the individuals who wrote them, then they are to moral codes considered by the greater society to be of higher and broader moral authority. Codes written at this level are most often much more interested with legalities and the intentions of the individual/s who devised them than with higher moral codes such as professional ethics or the Word of God. The State Department of Consumer Affairs 27

28 The Department of Consumer Affairs oversees and approves licensing for businesses and organizations producing products or services for the consumer. Its purpose is to protect the consumer by setting standards for licensing. They also receive complaints against businesses and organizations and have the mandated power to investigate the complaint and if justified, suspend and revoke licenses. Over time the standards that are applied become more complex and the bar is being raised ever higher. Business Associations Business Associations have a code for members usually spelled out in their bylaws. Organization or Agency Codes of Ethics The written code for organizations and agencies are often found embedded in their bylaws and in their policy manual. Policies & Corporate Policy Manuals When a new employee is hired, they are given a policy manual containing the company s code of ethics. This code often contains such things as dress code, behavioral expectations, and consequences for behavioral misconduct, i.e. sexual harassment, missing work, or showing up late. GOD S CODE OF ETHICS 28

29 God s Code of Ethics is the only code not written by Man. It is found in the Holy Bible that Christians reverently call, The Word of God. Though many disagree on this point, it is the belief of every authentic Christian that the Holy Scripture is the inerrant, indisputable, and infallible Word of God. It is the highest Truth of truths. It is important to note, however, that it can only be reliably interpreted and applied if done so prayerfully under the illuminating light of the Holy Spirit. CONFIDENTIALITY DILEMMAS Our clients need to know that it is safe to share their thoughts, feelings and behaviors with us. If they couldn t we would not be able to effectively help them by discussing with them their thoughts, feelings and behaviors that have been getting them into deeper trouble. But while it is important to keep our client s confidence in most cases, there are some rare occasions when it would be more moral to divulge a confidence than to keep it. The law requires us to divulge our client s confidence to appropriate authorities when someone s life is endangered or when there are threats of violence or abuse. There may also, on occasion, be other revealed confidences not covered under law that your conscience or the leading of the Holy Spirit may dictate you, as a Christian counselor to divulge. Unlike the humanistic psychology arena of counseling, the Christian counselor is duty bound to the higher authority of God s leading or the leading of conscience in cases not covered by law. RELATIONSHIP BOUNDARY DILEMMAS 29

30 It is easy for role boundaries to become blurred between counselor and client or resident. The relationship can not be too casual. You can not be in a helping relationship where there is no respect given. There must be lines of respect going both ways. Respect must be given to the client or resident due by virtue of the fact that that person is a beloved child of God alone. But a line of respect must also be maintained by the counselor who should discern when the helping relationship borders of becoming too casual. Familiarity does indeed breed contempt. It is difficult to help some one who has lost respect for you to receive from you. Your client or resident can not be your close buddy. The humanistic counselor view of ethics regarding this issue approaches it legalistically. Embedded in some professional codes are the rules that no gifts can be received or given, and the counselor can not be involved in any outside activities with the client. These stringent rules are a little more relaxed in the view of ethics of the Christian human services worker or counselor from the standpoint that the resident or client is not viewed as only a professional appointment from whom we must remain professionally detached. The Christian human services worker or counselor has the added burden of thinking of the client or resident as a brother or sister and a person to whom me must extend God s love. LEGAL & MORAL DILEMMAS We live in an extremely law conscious generation. There are hundreds of laws and regulations pertaining to the work of human services workers and counselors. More laws become instituted every year in our litigious society and as determined as lawmakers are to lay out prescribed behavior as an exact science, it can never really be. If we were no more than a people whose behaviors were exacted by laws and 30