Counseling the Alcohol and Drug Dependent Client

Transcription

1 Instructor s Manual and Test Items for Counseling the Alcohol and Drug Dependent Client Robert J. Craig West Side VA Medical Center, Chicago And Illinois School of Professional Psychology Boston New York San Francisco Mexico City Montreal Toronto London Madrid Munich Paris Hong Kong Singapore Tokyo Cape Town Sydney

2 Copyright 2004 Pearson Education, Inc. All rights reserved. The contents, or parts thereof, may be reproduced with Counseling the Alcohol and Drug Dependent Client, by Robert J. Craig, provided such reproductions bear copyright notice, but may not be reproduced in any form for any other purpose without written permission from the copyright owner. To obtain permission(s) to use the material from this work, please submit a written request to Allyn and Bacon, Permissions Department, 75 Arlington Street, Boston, MA or fax your request to ISBN Printed in the United States of America

3 Instructor s Manual for Counseling the Alcohol and Drug Dependent Client (Please note that the transcription to PDF can result in unintended reformatting. Page numbers in the table of contents may not correspond to the book s interior. The publisher regrets any inconvenience caused by this error.) Table of Contents Preface Chapter 1 The Cost of Substance Abuse in Society 1 Chapter 2 Etiology of Substance Abuse 6 Chapter 3 Drugs and Their Effects 13 Chapter 4 Assessment and Diagnosis 23 Chapter 5 Treatment: Principles and Modalities 29 Chapter 6 Counseling Techniques: Group 36 Chapter 7 Counseling the Family of Substance Abuse 40 Chapter 8 Working with Special Populations 48 Chapter 9 Public Policy 56

4 Instructor s Manual for Counseling the Alcohol and Drug Dependent Client Preface This book that accompanies this Instructor s manual was written for use by students in training to become substance abuse counselors, or for use by students taking a course on substance abuse. Throughout its chapters, there is a basic philosophy that can be elucidated by the following principles: (1) students need the best and most useful information available to help substance abusers, (2) both empirical findings and consensual experience of substance abuse professionals represent a codified body of knowledge that can be drawn upon to help the abuser, (3) attitudes of providers are an important determinant of care and students should become sensitive to those attitudes and how they influence the counseling process. It is up to the Instructor to help students uncover and/or reveal those attitudes for discussion and debate. Chapter 1 presents some basic concepts in epidemiology and then applies those concepts to the fields of alcoholism and drug abuse. Sources of statistics to estimate prevalence is presented, followed by the most recent data available (at the time this book was written) on use and abuse of the various drugs of abuse (including alcohol). This section is followed by both the costs of substance abuse to society as well as the costeffectiveness of treatment for these disorders. The instructor will need to acquire the latest statistics on these topics and this is an assignment suggested as a student classroom activity. Chapter 2 is a very theoretical chapter and presents major theories extant in the literature that are used to explain why someone uses and abuses drugs. Addressed are psychological, social/environmental and biological/genetic models. Evidence pertaining to the disease model is presented. Since the disease model continues to be a source of contention among many people, the Instructor should prepare for a substantial debate on this issue. This section is preceded by empirical findings on risk factors for beginning to use substance and risk factors for developing a substance abuse problem. An important point of this chapter is that the variables and risk factors for onset of drug use and different from those that can account for drug or alcohol abuse and dependence. The chapter concludes with three case histories which can be used in class or as an assignment to apply theories presented in the text to these cases. In doping so, students will learn that some theories are able to fit the facts of a case much better than others. However, in applying that same theory to another case, that particular theory may not do as well as others, since the facts have changed. Chapter 3 is a very long chapter and presents the drugs of abuse, using a drug class by drug class basis. This is preceded by some main concepts in pharmacology and pharmacokinetics. Besides dose, other variables are considered that may affect a patient s subjective experience to the effects of a drug. Starting with Alcohol, and continuing through all of the major drugs of abuse, the chapter presents the effects of these drugs, along with associated with medical, psychological, social, and public health problems that often accompany abuse.

5 Instructor s Manual for Counseling the Alcohol and Drug Dependent Client Chapter 4 may be thought of as a foundational chapter, since information learned in this chapter should be used when implementing the concepts and understandings presented in the remaining chapters. We discuss problems and issues in assessing substance abusers, the major methods used in this process, present the main domains and content of a good clinical interview with substance abusers, and present laboratory methods and psychological tests that are often used as ancillary tools in the assessment process. Chapter 5 presents both principles and modalities of treatment in a generic sense. We start the chapter with guidelines published by the National Institute on Drug Abuse that should be highlighted to help develop attitudes towards treatment. This is followed by sections on problems in counseling patients with acting out disorders (i.e, substance abuse), suggestions on how to prepare for counseling, and introduce the concept of treatment plans. Basic counseling techniques are presented in alphabetical order, along with examples. This section is followed by an overview of the major treatment approaches, beginning with AA/NA, behavioral approaches, and adjunctive medical therapies. There is a special emphasis on understanding relapse and relapse prevention strategies. Treatment matching is also considered. The chapter concludes with a presentation on strategies patients use to resist treatment, even while they are in treatment. The chapter has an appendix which presents a sample relapse prevent plan and sample treatment plans. Chapter 6 emphasizes group counseling techniques, since this modality is often the mainstream approach in treating addictive behavior. Presented are the factors that are responsible for behavior change when using group counseling called curative factors followed by the types of groups most often developed for the addictive disorders along with different models of group counseling. Selecting members for group counseling and special problems seen with the substance abusing population is also considered. The principles and ideas contained in Chapter 5 can be used in individual counseling but also in group or family treatment approaches. Chapter 6 concentrates on group counseling models and skills. Chapter 7 concludes the generic treatment chapters by focusing on family intervention methods. Covered in the chapter are research findings about the families of substance abusers, (preceded by an explanation of family systems theory), enabling behaviors, co-dependence origins, traits and treatment, and sections on Children of Alcoholics and Adult Children of Alcoholics. Chapter 8 rounds out this text by addressing the issues of special substance abusing populations. These include adolescent drug use, women, minority substance abuse, (African-American, Hispanic-American, Gay and Lesbians, elderly substance abuse, Native Americans and Military personnel), and concludes with a section on the Dually Diagnosed abuser. In some ways Chapter 9 may be the most important chapter in the book. It presents a large number of social policy issues for discussion and debate. These issues should grab the students and encourage interactive learning. It should help formulate

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