1 Graduate Program in Counseling COUN 6303 Substance Abuse Counseling Graduate Studies in Counseling Instructor: Fern Richie, DSN, APRN-BC Office Hours: Available by appointment Class Location: Ezell, Room 138 for all classes except 12/7 which meets in Room 109 Credit Hours: 3.0 Required Texts: Straussner, S. L. A. (2004). Clinical Work with Substance-Abusing Clients (2 nd ed.) New York: The Guilford Press. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, 5 th edition. Washington, DC. Supplemental Readings: Additional readings, including journal articles, book chapters, and first-person accounts of counseling and substance abuse are posted in the weekly Blackboard modules. These are listed below, and also noted in the Course Schedule. Where Does AA Fit In? book chapter from Clean: Overcoming Addiction and Ending America s Greatest Tragedy, Sheff, D. (2013), Boston: Houghton Mifflin. Me and My Girls, from The New York Times, July 20, 2008, by David Carr. The Compulsion to Repeat the Trauma, journal article from Psychiatric Clinics of North America, 1989, Bessel van der Kolk, 389-411. Grace: the Qualities of Mercy, book chapter from Addiction and Grace: Love and Spirituality in the Healing of Addictions, May, G. (1988), New York: HarperCollins. Course Description: This is a course for preparing students to work with substance abuse clients, and to be able to refer clients to appropriate treatment. Supervised exposure to a controlled inpatient substance abuse environment is required. Course Format: This course utilizes a hybrid format, including class meetings, online work, and community engagement.
Course Objectives: 2 GOALS OBJECTIVES LEARNING ACTIVITIES ASSESSMENT CMHC.C.4. Knows the disease concept and etiology of addiction and co-occurring disorders Q and A; Assigned Reading; PowerPoint Midterm Exam; Final Reflection Paper CMHC.A.6. Recognizes the potential for substance use disorders to mimic and coexist with a variety of medical and psychological disorders PowerPoint; Message Board Conversations; Case Analysis Midterm Exam; Message Board Conversations CMHC.K.3. CMHC.G.4. CMHC.H.4 CMHC.E.3. CORE 11.G.5.E. CMHC.D.2. Knows the impact of co-occurring disorders on medical and psychological disorders Identifies standard screening and assessment instruments for substance use disorders and process addictions Applies the assessment of a client s stage of change, dependence, or recovery to determine appropriate treatment modality and placement within the continuum of care Understands current literature that outlines theories, approaches, strategies, and techniques shown to be effective when working with specific populations of clients with mental and emotional disorders, i.e., clients who abuse substances A systems perspective that provides an understanding of family and other systems theories and major models of family and related interventions Applies multicultural competencies to clinical mental health counseling involving case conceptualization, diagnosis, treatment, referral, and prevention of mental and emotional disorders, i.e., substance abuse disorders Q and A; PowerPoint; Assigned Reading; Case Studies (small group format) PowerPoint; Assigned Reading; Case Studies (small group format) Guest Speaker; Assigned Reading; PowerPoint; Case Studies (small group format); 12-Step Meeting Attendance PowerPoint; Assigned Reading; Message Board Conversations Guest Speaker; Al-Anon, ACOA, or Alateen Meeting Attendance; Assigned Reading Case Studies (small group format); Assigned Readings Midterm Exam Case Analysis; Midterm Exam Case Analysis; 12- Step Meeting Reflection Papers; Midterm Exam Case Analysis; Message Board Conversations; Midterm Exam; Final Reflection Paper Al-Anon, ACOA, or Alateen Meeting Reflection Paper; Case Analysis Pre-Suppositions Exercise; Midterm Exam Class Expectations: Students are expected to: 1. Attend and be on time for all class sessions. Any student who misses more than 2 class sessions will be dropped from the course with a grade of F. 2. Complete all assignments by the due date. a. Assignments are to be submitted electronically as Word documents via email. b. The professor is very willing to negotiate delayed due dates for assignments when personal circumstances arise. It is the student s responsibility to contact the professor to arrange alternative due dates.
3 c. If an alternative due date has not been arranged with the professor prior to the date/time an assignment is due, 1.5 points/day may be deducted from the grade. d. The professor will insert comments in all assignments as part of the grading process. Assignments will be emailed back to the student with the grade and comments. The student must open the document to view the comments. 3. Have the Blackboard readings and case studies accessible during class, either electronically or hard copy. 4. Bring DSM-5 Manual to each class. 5. Check email and announcements on Blackboard on a regular basis to receive updates from the professor. 6. Utilize scientific and clinical language in writing assignments. Papers utilizing colloquial language will be returned for resubmission using appropriate, graduate-level language. 7. Complete online course evaluation at end of semester. Academic Integrity Policy: Students are expected to adhere to Lipscomb s Academic Integrity Policy. All answers on the midterm exam should come from your memory, not from the textbook or any other source. Sharing exam questions with other students, or taking the exam with another student s help is a serious integrity violation. All integrity violations are reported in writing to the Academic Integrity Counsel. For clarification, refer to the policy: http://academics.lipscomb.edu/content.asp?cid=5329&sid=12. Class Schedule Disruption Policy Except in the rarest of instances, Lipscomb University does not cancel classes or close offices. However, should an event (weather-related or otherwise) occur that requires disruption of the entire Lipscomb University class schedule, students will be notified via multiple venues including the Lipscomb homepage (www.lipscomb.edu), a text message sent through LU ALERT (http://lualert.lipscomb.edu), and the Lipscomb Weather Information Line (966-1836). For information on possible snow-related closures or late starts, students should consult local television stations (2-WKRN, 4-WSMV, 5-WTVF and 6-WZTV, and Channel 9 on campus). Students should look for information regarding Lipscomb University, not David Lipscomb Campus Schools. Student s Responsibility for Notification of Extended Absence In the case of individual absences, students should contact their professors directly. However, students who find themselves in circumstances which would cause them to miss classes for an extended period of time (e.g., missing a week or more of classes due to illness) should contact Steve Prewitt, Associate Provost for Student Academic Support, (steve.prewitt@lipscomb.edu; 615-966-5804). The Associate Provost for Student Academic Support will communicate the student s situation to the appropriate faculty members. Students are expected to provide timely notification to the Associate Provost for Student Academic Support regarding any extended absence and may be required to provide supporting documentation for their absences. Grades: There are a total of 215 points possible in the course. Grades will be stored on Blackboard where you will be able to keep track of them. Your final grade will be based on the number of points accumulated. All assignments must be submitted by the due date/time, and are to be submitted electronically. A = 90% of points or better (193.5 or greater) B = 80-89.9% of points or better (172-193 points) C = 70-79.9% of points or better (150.5 171.5 points) F = less than 70% of points (150 points or lower)
4 1. Self-Assessment This is an ungraded questionnaire to be completed at the beginning of the semester. The Self-Assessment gives the student the opportunity to explore his/her own perspectives on the issue of substance abuse and counseling, and prepares the student to write the Pre-Suppositions/Ethics paper. Due Friday, August 30 @ 5:00 pm 2. Presuppositions/Ethics Exercise (25 points) Identify and discuss your own presuppositions: the primary presuppositions that function as you approach the counseling encounter and the issue of substance abuse. In other words, what do you take for granted? What are the fundamental assumptions/perspectives regarding substance abuse that you accept as given and true and unnecessary to prove? What beliefs and biases do you bring to the counseling encounter and the issue of substance abuse? (4-5 pages) Due Saturday, September 7 @ 9:00 am 3. 12-Step Meeting Reflection Paper #1 (25 points) Students are required to observe/participate in an OPEN 12-Step Recovery Meeting, and to submit a reflection paper describing the experience. Topics that can be addressed include reason for attending the particular meeting selected, analysis of group process, identification of healing dynamics observed, and what the students found most helpful from the meeting that can be used in his/her counseling practice. The student will also pose any questions that are left unanswered, and any concerns that s/he has regarding the 12-Step approach. (4-5 pages) Due Saturday, October 12 @ 9:00 am 4. Case Analysis (35 points) A case study will be presented via Blackboard. The case is also available on page 10 of this Syllabus. Students will submit a written analysis of the case, to include the following Discussion of assessment data provided Identification of additional data needed by the counselor to plan treatment for the client, including use of any standardized screening measures that will be used Discussion of differential diagnosis: identify the diagnoses that are confirmed and the diagnoses that must be ruled out Identification of stage of change and defenses used by the client, with rationale provided Identification of 3 short-term goals for the client Identification of 3 long-term goals for the client Detailed and specific treatment plan for the client Discussion of ethical and cultural issues that may influence counseling of the client Discussion of potential countertransference issues that might arise if the student were to counsel this client Material from class discussions, readings, guest speakers, and handouts should be utilized to support the analysis. A reference list must be included. (5 pages) Due Wednesday, November 13 @ 5:00 pm 5. Message Board Conversations (2 at 20 points each = 40 points) For two supplementary readings posted on Blackboard, discussion threads are posted. One student will begin the online conversation by writing a short response (length 250-300 words) responding to the Professor s question/statement. All other students should read the thread and all posts that have been written previously and submit their comments via a 250-300 word post to contribute to the conversation. Posts should not represent a disconnected essay, but rather should reflect a thoughtful and engaged
5 reflection on the thread and subsequent posts. Grades are based on comments being the appropriate length of words, comments making contributions to the conversation, and showing critical thinking/synthesis of the material. Scores on late posts will be reduced by 1 point so that 90% is the highest score that can be received. Conversation # 1 o Initial post due by Friday, September 20 @ midnight o Second post due by Monday, October 7 @ midnight Conversation # 2 o Initial post due by Monday, November 4 @ midnight o Second post due by Monday, November 11 @ midnight 6. Midterm examination (35 points) The midterm examination will consist of short answer and essay questions. Items will be developed from class discussion, material from the texts, guest speakers, and handouts. The exam will be administered via Blackboard during the week of October 22. Students will have 3 hours to complete the exam, and can take the exam at a time of their own choosing. The exam is not an open-book exam. Exam to be taken during week of October 22 7. 12-Step Meeting Reflection Paper #2 (25 points) Students are required to observe/participate in a family/friend 12-Step Recovery Meeting, and to submit a reflection paper describing the experience. Students may attend an Al-Anon, ACOA, or Alateen meeting for this assignment. The paper should address what the student learned about the family experience of substance abuse, and how the 12-step groups function to support family members/friends, as well as help them look at their own behaviors in relation to the addiction. The student will pose any questions that are left unanswered about the family experience of addiction. (4-5 pages) Due Monday, December 2 @ 5:00 p.m. 8. Final Reflection Paper (15 points) Identify an a-ha moment that you have had this semester. This may be a new way of looking at an issue concerning substance abuse, or a concept that is new to you. It could be an approach to counseling the client/family with substance abuse that you now understand, or something that you have learned that will help you to be a more empathetic counselor. Develop a 2-page essay that describes how you will incorporate this learning into your work as a counselor, and how the insight will inform your practice. You will have the opportunity to share your reflections during the last class meeting. (2 pages) Due Saturday, December 7 @ 9:00 a.m. 9. Online Participation (15 points) Students are to check Blackboard frequently and respond to posts made by those who submitted comments after original submissions, especially those that address your comments specifically. The participation grade will be assigned at the end of the semester based on the degree to which the student was an active presence and substantive contributor in all conversations. Schedule of Events: August 21 - Class Meeting, 4:00 6:40 pm Topics: Introductions Course overview True/False Exercise Self-Assessment exercise
August 22-30 Work on Self-Assessment Prepare for 09/07/2013 class by reading chapters 1, 2, and 6 in textbook Submit Self-Assessment by 5:00 p.m. Friday, August 30 (submit as Word document to fernrichie@gmail.com) September 1 6 Prepare for 09/07/2013 class by reading chapters 8, 9, and 10 in textbook Read Case Study # 1 (posted on Bb) Review Case Study Discussion questions (posted on Bb) Read pages 481-503 in DSM-5 Manual Work on Pre-Suppositions/Ethics exercise September 7 Class Meeting, 9:00 am 4:00 pm Submit Pre-Suppositions/Ethics Exercise by 9:00 a.m. (submit as Word document to fernrichie@gmail.com) Topics for discussion: o Theories of Addiction o Assessment and Diagnosis o Treatment Approaches o Understanding Denial and Resistance o Motivational Interviewing w/role play o Case Study # 1 o Guest Speaker September 8 October 11 Attend an open 12-step recovery meeting in the community. Meeting times and locations can be found at http://www.aanashville.org/meetings.html, http://www.nanashville.org/pdf-meeting-list, or http://www.celebraterecovery.com/finda-group/usa-tennessee/#city3260 (this is a Christian-based fellowship). OD (open discussion) meetings are preferable; do not attend a Closed meeting unless you are in recovery yourself Work on 12-Step Meeting Reflection Paper #1 Read Me and My Girls (posted on Bb) o Read and respond online to Professor s thread on this article (Conversation # 1) Initial post must be made by Friday, September 20 @ midnight A second post, which responds to other class members posts, must be made by Monday, October 7 @ midnight You are encouraged to read and respond frequently to all posts Prepare for 10/12/2013 class by reading Chapters 5, 7, 11, 12, and 13 in textbook, and Case Studies # 2 and # 3 (posted on Bb) Read a supplementary article The Compulsion to Repeat the Trauma (posted on Bb) Review Case Study Discussion Questions (posted on Bb) October 12 Class Meeting 9:00 am 4:00 pm Submit 12-Step Meeting Reflection Paper #1 by 9:00 a.m. (submit as a Word document to fernrichie@gmail.com) Topics for discussion: o Family Issues 6
o Understanding Relapse o Co-Occurring Disorders o Trauma and Addiction o Case Studies # 2 and # 3 o Counselor skill rehearsal o Guest Speaker o Midterm Review 7 October 13 20 Review week Study guide for Midterm Exam posted on Bb October 22 October 28 Take Midterm Exam via Bb (exam is located in Bb under Assessments) Exam is NOT open book You will have 3 hours to complete the exam, start to finish Save your work often Exam is open on Bb for you to take from Monday, October 21 @ 8:00 am until Sunday, October 27 @ 9:00 pm. October 28 November 12 Work on Case Analysis (posted in Bb under Assignments and attached to the end of this syllabus) Attend an open 12-step family/friend meeting in the community. Meeting times and locations can be found at http://www.middletnalanon.org/meetingdirectories/nashvillemeetings.h tml. OD (open discussion) meetings are preferable; do not attend a Closed meeting unless you are in recovery yourself. Read Grace: The Qualities of Mercy from Addiction and Grace by Gerald May (posted on Bb) Read and respond online to Professor s thread on this book chapter (Conversation # 2) Initial post must be made by Monday, November 4 @ midnight A second post, which responds to other class members posts, must be made by Monday, November 11 @ midnight You are encouraged to read and respond frequently to all posts Prepare for 11/13/2013 class by reading chapter 3, 14, 16, and 18 in textbook and Case Study # 4 (posted on Bb) Review Case Study Discussion Questions (posted on Bb) November 13 Class Meeting, 4:00 6:40 pm Submit Case Analysis by 5:00 p.m. today (submit as Word document to fernrichie@gmail.com) Topics for discussion: o Harm reduction o Counseling relationship o Exercises and resources for the counselor o Guest speaker o Case Study # 4
8 November 14 December 6 Prepare for 12/07/2013 class by reading Chapter 21 in textbook, and Where Does AA Fit In? (book chapter posted on Bb) Review all course materials Monday, December 2 Submit 12-Step Reflection Paper #2 by 5:00 p.m. today (submit as Word document to fernrichie@gmail.com) December 7 Class Meeting, 9:00 am 12 noon Submit Final Reflection Paper by 9:00 a.m. today (submit as Word document to fernrichie@gmail.com) Topics for discussion: o Ethical issues o Future directions o Countertransference Helpful Websites: Substance Abuse and Mental Health Services Administration This is the federal agency that provides clinical and research information on substance abuse and mental illness. There are many publications that can be downloaded (or ordered) for free. Many of these are also available in Spanish. www.samhsa.gov Mental Health America This is a national non-profit dedicated to helping live mentally healthy lives. They have a 24-hour confidential Crisis Line and a free email. They also have downloadable client and family education pamphlets. www.nmha.org Alcoholics Anonymous This is the client-based self-help group that has been in operation for over 75 years for persons struggling with alcoholism or other chemical addictions. www.aa.org Narcotics Anonymous This is the client-based self-help group that has been in operation for over 60 years for persons struggling with chemical addictions. www.na.org 16-Step Empowerment Model This is a model based on the work of Charlotte Kasl and provides a holistic approach to overcoming addiction. This model views persons with a substance abuse disorder in their wholeness mind, body, spirit, and is thought to be more flexible than traditional 12-step models. http://www.charlottekasl.com/site/16-step-program/
Celebrate Recovery This is the client-based self-help group for persons struggling with any addiction. This organization uses principles similar to traditional 12-step approaches, but is a Christ-centered group. www.celebraterecovery.org How far you go in life depends on your being tender with the young, compassionate with the aged, sympathetic with the striving, and tolerant of the weak and the strong. Because some time in your life you will have been all of these. George Washington Carver 9
Case Analysis 10 Instructions Address the following points as you analyze the following case: Discussion of assessment data provided Identification of additional data needed by the counselor to plan treatment for the client, including use of any standardized screening measures that will be used Discussion of differential diagnosis: identify the diagnoses that are confirmed and the diagnoses that must be ruled out Identification of stage of change and defenses used by the client, with rationale provided Identification of 3 short-term goals for the client Identification of 3 long-term goals for the client Detailed and specific treatment plan for the client Discussion of ethical and cultural issues that may influence counseling of the client Discussion of potential countertransference issues that might arise if the student were to counsel this client Material from class discussions, readings, guest speakers, and handouts should be utilized to support the analysis. A reference list must be included. (5 pages) Due Wednesday, November 13 @ 5:00 pm Presenting Information John is a 55-yeara old Caucasian accountant who made an appointment with you for a second opinion. He appears severely depressed to you (neurovegetative symptoms, disheveled appearance, tearful), but minimizes any distress related to depression. My big problem, he says, is that I m in danger of losing my job at the accounting firm. John says that he has been drinking heavily for years, but that prior to this time it has gone unnoticed by his employer. He says that his employer has given him an ultimatum: either get help from the firm s employee assistance program (EAP), or get out. John says that he has dried out several times and returned to drinking; therefore he feels it may be pointless to try again. He also states that the Alcoholics Anonymous model has been beneficial to him in the past in maintaining his sobriety, but that as he has become more hopeless over the past several months, he ha also begun to doubt God s existence. So, the 12-step guys would probably turn me away. He goes on to say that he would like for you to write his employer a note saying that you don t believe he is an alcoholic, and thus does not need treatment at the EAP. He promises to cut down on his drinking, and to stop drinking completely when his divorce is finalized. John appears sober at today s session with you. Social History John is currently involved is a mediated divorce proceeding from his wife of 33 years. He says that he doesn t blame his wife for wanting the divorce, but that he still loves her. He is very tearful when he recounts the pain he has put his family through because of his drinking. John reports that he doesn t have any close friends: the bottle is all I can depend on, John says. Family History John and his wife have no children. He reports that his father was a heavy drinker. John says that he wished he could hold his liquor like a man. I can t even drink like a man. John says that his sister has also given up on him, and says that she would like to have a relationship with him, but only if he gets treatment for the drinking.
Physical/Medical Considerations John is thin in appearance, and says it is worthless to have a medical workup. All the doctors do is lecture you on why drinking is bad for your health. They don t understand what it s like to not be able to stop. 11