The Addiction Counselors

Desk Reference

Robert Holman CoombsWilliam A. Howatt

John Wiley & Sons, Inc.

C1.jpg

The Addiction CounselorsDesk Reference

The Addiction Counselors

Desk Reference

Robert Holman CoombsWilliam A. Howatt

John Wiley & Sons, Inc.

This book is printed on acid-free paper.

Copyright 2005 by John Wiley & Sons. All rights reserved.

Published by John Wiley & Sons, Inc., Hoboken, New Jersey.Published simultaneously in Canada.

No part of this publication may be reproduced, stored in a retrieval system, ortransmitted in any form or by any means, electronic, mechanical, photocopying,recording, scanning, or otherwise, except as permitted under Section 107 or 108 ofthe 1976 United States Copyright Act, without either the prior written permission ofthe Publisher, or authorization through payment of the appropriate per-copy fee to theCopyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923,(978) 750-8400, fax (978) 646-8600, or on the web at www.copyright.com. Requests tothe Publisher for permission should be addressed to the Permissions Department,John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, (201) 748-6011,fax (201) 748-6008.

Limit of Liability/Disclaimer of Warranty: While the publisher and author have usedtheir best efforts in preparing this book, they make no representations or warrantieswith respect to the accuracy or completeness of the contents of this book andspecifically disclaim any implied warranties of merchantability or fitness for aparticular purpose. No warranty may be created or extended by sales representativesor written sales materials. The advice and strategies contained herein may not besuitable for your situation. You should consult with a professional where appropriate.Neither the publisher nor author shall be liable for any loss of profit or any othercommercial damages, including but not limited to special, incidental, consequential, orother damages.

This publication is designed to provide accurate and authoritative information in regardto the subject matter covered. It is sold with the understanding that the publisher is notengaged in rendering professional services. If legal, accounting, medical, psychological,or any other expert assistance is required, the services of a competent professionalperson should be sought.

Designations used by companies to distinguish their products are often claimed astrademarks. In all instances where John Wiley & Sons, Inc. is aware of a claim, theproduct names appear in initial capital or all capital letters. Readers, however, shouldcontact the appropriate companies for more complete information regarding trademarksand registration.

For general information on our other products and services please contact our CustomerCare Department within the United States at (800) 762-2974, outside the United Statesat (317) 572-3993 or fax (317) 572-4002.

Wiley also publishes its books in a variety of electronic formats. Some content thatappears in print may not be available in electronic books. For more information aboutWiley products, visit our web site at www.wiley.com.

ISBN 0-471-43245-8

Printed in the United States of America.

10 9 8 7 6 5 4 3 2 1

www.wiley.com

For CARLA CRONKHITE VERA,our esteemed associate at UCLA,

with appreciation for all you have contributed.

vii

CONTENTS

Preface xviiAcknowledgments xxi

PART I: ABUSED SUBSTANCES AND THEIR EFFECTS

Abused Drugs 2OP I AT E S 2

Heroin 2Prescription Opiates 3

DE P R E S SA N T S 4Alcohol 4Barbiturates/Sedative-Hypnotics 6Benzodiazepines such as Diazepam (Valium) Abuse 6

S T I M U L A N T S 7Cocaine 7Amphetamines and Methamphetamines 8

C A N N A B I S 9Marijuana and Hashish 9

H A L L U C I N O G E N S 10Lysergic Acid Diethylamide 10Psilocybin, Peyote, and Mescaline 11

I N H A L A N T S 12S T E R O I D S ( A NA B O L I C - A N DR O G E N I C ) 12DE S I G N E R DRU G S 13

3,4-Methylendioxymethamphetamine (MDMA) 14Ketamine 15Gamma Hydroxybutyrate (GHB) 15Rohypnol 15

Control Schedules for Abused Drugs 15P R E S C R I B I N G DRU G S 30T H E F I V E C O N T R O L S C H E DU L E S 30C O N T R O L L E D S U B S TA N C E A NA L O G U E S 32G OV E R N M E N T DE C I S I O N M A K I N G 3 2

viii CONTENTS

PART II: CONCEPTUAL TOOLS

Definitions of Addiction 35M O R A L M O DE L 35S E L F - M E D I C AT I O N M O DE L 35M E D I C A L / D I S E A S E M O DE L 36S P I R I T UA L I T Y M O DE L 36I M P U L S E - C O N T R O L D I S O R DE R 36R E WA R D DE F I C I E N C Y A N D

N E U R OP H Y S I O L O G I C A L A DA P T I O N 37G E N E T I C M O DE L 37B I O M E D I C A L M O DE L 37S O C I A L L E A R N I N G M O DE L 38E R R O N E O U S T H O U G H T PAT T E R N S 38B I OP S YC H O S O C I A L M O DE L 38P U B L I C H E A LT H M O DE L 39

Characteristics of Addiction 39C O M P U L S I V E U S E 40L O S S O F C O N T R O L 40C O N T I N U E D U S E DE S P I T E A DV E R S E C O N S E Q U E N C E S 40T O L E R A N C E 40W I T H DR AWA L 41

Types of Addictive Disorders 41T H E B R A I N A N D P S YC H OAC T I V E DRU G S 41T H E B R A I N A N D A D D I C T I V E B E H AV I O R S 42A D D I C T I V E I N T E R AC T I O N D I S O R DE R 45

Drug-Use Stages 46I N I T I AT I O N 46E S C A L AT I O N 47M A I N T E NA N C E 47D I S C O N T I N UAT I O N A N D R E L A P S E 47R E C OV E RY 48

Early Stage Recovery 48Middle Stage Recovery 48Late State Recovery 49

Levels of Drug Use 49T Y P E 1 A B S TA I N E R S 50T Y P E 2 S O C I A L U S E R S 50T Y P E 3 DRU G A B U S E R S 51T Y P E 4 P H Y S I C A L LY B U T N O T P S YC H O L O G I C A L LY

DE P E N DE N T U S E R S 51T Y P E 5 P H Y S I C A L LY A N D P S YC H O L O G I C A L LY

DE P E N DE N T U S E R S 52

CONTENTS ix

Stages of Behavioral Change 53S TAG E 1 P R E C O N T E M P L AT I O N 53S TAG E 2 C O N T E M P L AT I O N 54S TAG E 3 P R E PA R AT I O N 54S TAG E 4 AC T I O N 55S TAG E 5 M A I N T E NA N C E A N D R E L A P S E P R E V E N T I O N 55S TAG E 6 T E R M I NAT I O N 55

Prevention Types and Principles 56T H E T R A D I T I O NA L C L A S S I F I C AT I O N 56

Primary Prevention 56Secondary Prevention 56Tertiary Prevention 56

T H E I N S T I T U T E O F M E D I C I N E C L A S S I F I C AT I O N 57Universal Prevention 57Selective Prevention 57Indicated Prevention 57

P R E V E N T I O N P R I N C I P L E S 57R E L A P S E P R E V E N T I O N 59

Marlatt and Gordons Relapse Prevention Model 60Gorski s CENAPS Relapse Model 61

PART III: TREATMENT PLANNING AND ASSESSMENT RESOURCES

Treatment Planning 64C O M P E T E N C I E S A N D G OA L S 64S C R E E N I N G A N D A S S E S S M E N T 65D I AG N O S T I C S U M M A RY 67T R E AT M E N T 68C L I E N T P L AC E M E N T C R I T E R I A 68W R I T I N G A T R E AT M E N T P L A N 69SA M P L E T R E AT M E N T P L A N 70L E V E L S O F C A R E 71

Level 0.5: Early Interventions 71Level I: Outpatient Treatment 71Level II: Intensive Outpatient/Partial Hospitalization 71Level III: Residential/ Inpatient Services 74Level IV: Medically Managed Intensive Inpatient Treatment 74

Assessment Resources 75A L C O H O L A S S E S S M E N T I N S T RU M E N T S 75

Adolescent Alcohol Involvement Scale (AAIS) 75Adolescent Drinking Index (ADI) 76Alcadd Test Revised (AT) 76Alcohol Abstinence Self-Ef f icacy Scale (AASES) 76Alcohol Clinical Index (ACI) 76Alcohol Dependence Scale (ADS) 76Alcohol Ef fects Questionnaire (AEQ) 77

x CONTENTS

Adolescent Expectancy Questionnaire (AEQ-A) 77Alcohol Use Disorders Identif ication Test (AUDIT) 77Alcohol Use Inventory (AUI) 77CAGE Questionnaire 78Drinking Refusal Self-Ef f icacy Questionnaire (DRSEQ) 78Drinking Related Locus of Control Scale (DRIE) 78Drinking Restraint Scale (DRS) 78Diagnostic and Statistical Manual of Mental Disorders, Text

Revision (DSM-IV-TR) 79FAST Screening 79F-SMAST/M-SMAST 79Inventory of Drinking Situations (IDS) 79MAST-G (Geriatric Version) 80Semi-Structured Assessment for the Genetics of Alcoholism (SSAGA-II) 80Situational Confidence Questionnaire (SCQ) 80Michigan Alcohol Screening Test (MAST) 80Yale-Brown Obsessive Compulsive Scale (YBOCS) 80

O T H E R DRU G A S S E S S M E N T S 81Addiction Severity Index (ASI) 81Adolescent Drug Abuse Diagnosis (ADAD) 81Adolescent Drug Involvement Scale (ADIS) 81Adolescent Problem Severity Index (APSI) 81American Drug and Alcohol Survey (ADAS) 82Drug and Alcohol Problem Quick Screen (DAPQS) 82Chemical Dependency Assessment Prof ile (CDAP) 82Drugs, Alcohol, and Gambling Screen (DAGS) 82Drug Abuse Screening Tool (DAST) 82Drug Use Screening Inventory (DUSI) 83Substance Abuse Problem Checklist 83Substance Abuse Subtle Screening Inventory-3 (SASSI-3) 83Substance Use Disorders Diagnostic Schedule (SUDDS) 83Teen-Addiction Severity Index (T-ASI) 84

N O N C H E M I C A L A D D I C T I O N S 8 4Gambling Attitudes Scale (GAS) 84Global Appraisal of Individual Needs (GAIN) 84Internet Addiction Test 84Online Cognition Scale (OCS) 84Sexual Addiction Screening Test (SAST) 85South Oaks Gambling Screen (SOGS) 85Eating Attitudes Test (EAT-26) 85Work Addiction Risk Test (WART) 85

M E N TA L H E A LT H ( DUA L D I AG N O S I S ) A S S E S S M E N T S 8 5Adult Suicidal Ideation Questionnaire (ASIQ) 85Beck Hopelessness Scale (BHS) 86Beck Depression Inventory (BDI) 86Childrens Depression Scale (CDS) 86Detailed Assessment of Posttraumatic Stress (DAPS) 86Millon Clinical Multiaxial Inventory-II (MCMI-II) 87Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-A) 87

CONTENTS xi

Minnesota Multiphasic Personality Inventory-2 (MMPI-2) 87Multidimensional Anxiety Questionnaire (MAQ) 88Novaco Anger Inventory-Short Form 88Obsessive-Compulsive Inventory (OCI) 88Psychiatric Research Intervention for Substance and Mental Disorders (PRISM) 88Psychopathy Checklist (PCL-R) 89Trauma Symptom Inventory (TSI) 89

R E C OV E RY P O T E N T I A L A S S E S S M E N T S 8 9Alcoholics Anonymous 20 Questions 89Alcohol Timeline Followback (TLFB) 89AWARE Questionnaire (Advance WArning of RElapse-Revised) 89Structured Addictions Assessment Interview for Selecting Treatment (ASIST) 90Beck Codependence Assessment Scale (BCAS) 90Brown-Peterson Recovery Progress Inventory (BPRPI) 90Circumstances, Motivation, and Readiness Scales (CMR SCALES) 90Clinical Institute Withdrawal Assessment (CIWA) 90Comprehensive Drinker Prof ile (CDP) 91Computerized Lifestyle Assessment (CLA) 91Coping Responses Inventory (CRI) 91Drinking Self-Monitoring Log (DSML) 91Follow-Up Drinker Prof ile (FDP) 91Individual Assessment Prof ile (IAP) 92Life Satisfaction Scale (LSS) 92Recovery Attitude and Treatment Evaluator Questionnaire (R AATE) 92Stages of Change Readiness and Treatment Eagerness Scale (SOCR ATES) 92Steps Questionnaire 92Readiness to Change Questionnaire (RTCQ) 93

M U LT I P L E M E A S U R E S R E S O U R C E S 9 3

Dual Diagnoses: Psychiatric Illness with Addiction 93T H E D I AG N O S T I C A N D S TAT I S T I C A L M A N UA L ( D S M - I V- T R ) 94P S YC H I AT R I C D I AG N O S T I C C AT E G O R I E S 94

Psychotic Thought Disorders 95Mood Disorders 95Disorders of Childhood and Adolescence 97Eating Disorders 98Personality Disorders 98Cognitive Disorders 99Substance-Induced Disorders 99

PART IV: CLINICAL SKILLS AND RESOURCES

Clinical Models 102S I G M U N D F R E U D S P S YC H OA NA LY T I C T H E R A PY 102

Therapeutic Approach 102C A R L G . J U N G S A NA LY T I C P S YC H OA NA LY S I S 103

Therapeutic Approach 103A L F R E D A D L E R S I N D I V I DUA L P S YC H O L O G Y 103

Therapeutic Approach 104

xii CONTENTS

C A R L R O G E R S S P E R S O N - C E N T E R E D T H E R A PY 104Therapeutic Approach 104

F R I T Z P E R L S S G E S TA LT T H E R A PY 104Therapeutic Approach 105

I RV I N YA L O M S E X I S T E N T I A L P S YC H O T H E R A PY 105Therapeutic Approach 105

V I K T O R F R A N K L S L O G O T H E R A PY 106Therapeutic Approach 106

A L B E R T E L L I S S R AT I O NA L - E M O T I V EB E H AV I O R T H E R A PY 106Therapeutic Approach 106

W I L L I A M G L A S S E R S C H O I C E T H E O RY A N DR E A L I T Y T H E R A PY 107Therapeutic Approach 107

A A R O N B E C K S C O G N I T I V E B E H AV I O R A L T H E R A PY 108Therapeutic Approach 108

E R I C B E R N E S T R A N SAC T I O NA L A NA LY S I S 108Therapeutic Approach 108

O T H E R B E H AV I O R A L A P P R OAC H E S 109Therapeutic Approach 109

Counseling Techniques 109

Clinical Microskills 115

Client Homework Exercises 117

Client Health and Stress Management 131N U T R I T I O NA L C O U N S E L I N G 131E X E R C I S E C O U N S E L I N G 132A F F E C T- R E G U L AT I O N C OP I N G S K I L L S C O U N S E L I N G 132S T R E S S - M A NAG E M E N T T R A I N I N G 134S H A F F E R C OP I N G M O DE L S 135

Option 1: Alter the Stressor 136Option 2: Adapt to the Stressor 136Option 3: Avoid the Stressor 137

C O M M O N S T Y L E S O F N E G AT I V E S E L F - TA L K 137R E W R I T I N G O L D B E L I E F S 138R E W R I T I N G I R R AT I O N A L B E L I E F S 139

PART V: TREATMENT RESOURCES

Addiction Recovery Tools 142M O T I VAT I O NA L T O O L S 142

Motivational Intervention 142Motivational Interviewing 143

M E D I C A L A N D P H A R M AC E U T I C A L T O O L S 143Detoxif ication 143Medications 144

CONTENTS xiii

Disease Orientation 145Drug Testing 145

C O G N I T I V E - B E H AV I O R A L T O O L S 146Contingency Management 146Cue Exposure 146Affect-Regulation Coping Skills Training 147Recovery Contracts 147

P S YC H O S O C I A L T O O L S 148Family Strengthening 148Group Therapy 149Peer Support 149Lifestyle Planning and Monitoring 149

H O L I S T I C T O O L S 150Acupuncture 150Spirituality Enhancement 151Meditation 151Nutritional Counseling 152

Addiction Recovery Programs 153R E S I DE N T I A L A N D O U T PAT I E N T T R E AT M E N T P R O G R A M S 153

Therapeutic Communities 153Short-Term Residential Treatment 153Treatment Facilities Directories 154Outpatient Programs 155

S U P P O R T G R O U P S 15512-Step Support Groups 15512-Step Alternatives 164

R E C OV E RY P R O G R A M S F O R S E L E C T E D P OP U L AT I O N S 167Women 167Adolescents 169Family Members 173Dual Diagnosis Clients 175HIV/AIDS-Af f licted Persons 177Gays and Lesbians 178

Harm Reduction Programs 181C H A R AC T E R I S T I C S O F H A R M R E DU C T I O N P R O G R A M S 183H A R M R E DU C T I O N G OA L S 183H A R M R E DU C T I O N T E C H N I Q U E S 184

Needle Exchange 184Drug Substitution Therapies 184Controlled Drinking 185Skills Training 185Computerized Interventions 186Condom Distribution 186Bleach Kits 186

O T H E R H A R M R E DU C T I O N T E C H N I Q U E S 186Psychotropic Medications 186Substance Use Management 187