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Chemical Dependency Counseling


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Table of Contents

Preface to the Fifth Edition Acknowledgments 1. First Contact Treatment Works The Motivational Interview How to Develop the Therapeutic Alliance How to Do a Motivational Interview What to Do If There Are One or More Red Flags Natural History of Addiction How to Diagnose an Addiction Problem How to Intervene How to Assess Motivation The Stages of Motivation Motivating Strategies 2. First Hours of Treatment The First Hours How to Greet Clients Examples Beginning the Therapeutic Alliance The Importance of Trust Dealing With Early Denial Example of an Initial Contact How to Check for Organic Brain Dysfunction The Initial Assessment Referral How to Conduct a Crisis Intervention American Society of Addiction Medicine Patient Placement Criteria Diagnostic and Statistical Manual Criteria for Diagnosis Diagnosis: Substance Use Disorder Gambling Disorder How to Determine the Level of Care Needed Criteria for Outpatient Treatment (Adults) Criteria for Inpatient Treatment (Adults) Criteria for Outpatient Treatment (Adolescents) Criteria for Inpatient Treatment (Adolescents) The Client's Reaction to Intoxication What to Do With an Intoxicated Client Detoxification How Clients React in Detoxification The AMA Threat Example of an AMA Intervention How to Develop and Use the AMA Team How to Use the In-House Intervention How to Respond to Clients Who Leave AMA 3. Biopsychosocial Interview The Biopsychosocial Interview How to Conduct the Interview Summary and Impression Diagnosis Disposition and Treatment Plan A Sample Biopsychosocial Interview 4. Treatment Plan How to Build a Treatment Plan The Diagnostic Summary The Problem List How to Develop a Problem List Goals and Objectives How to Develop Goals Examples of Developing Goals Examples of Goals How to Develop Objectives Examples How to Develop Interventions Examples How to Evaluate the Effectiveness of Treatment How to Select Goals, Objectives, and Interventions Examples Treatment Plan Review Documentation How to Write Progress Notes Examples Formal Treatment Plan Review Discussion of Continuing Care 5. Individual Treatment The Therapeutic Alliance How to Develop a Therapeutic Alliance How to Be Reinforcing How to Use Empathy Transference and Countertransference Examples of Empathic Statements How to Be Confrontive Behavior Therapy How Clients Learn Habits Changing a Habit What Is Reinforcement? What Is Punishment? The Behavior Chain The Importance of Reinforcement How to Use Punishment When a Client Breaks a Rule Why We Concentrate on Behavior Therapy Cognitive Therapy How Chemically Dependent People Think Defense Mechanisms Applying Cognitive Therapy Automatic Thoughts How to Correct Inaccurate Thoughts Interpersonal Therapy How to Develop Healthy Relationships Building a Relationship With a Higher Power Developing a Relationship With Self Building Relationships With Others How Clients Use Feelings Inappropriately How Clients Learn Relationship Skills How to Change Relationships How to Handle Grief How to Choose the Therapeutic Modality 6. Group Therapy Benefits of the Group Process Preparation for the Group The Preparation Statement The Agenda Group How to Choose the Order of the Agenda How to Give Good Feedback How to Receive Feedback How to Run a Group How to Know Which Therapy to Use The Honesty Group Example of the Honesty Group Uncovering the Lies How to End Each Group The Euphoric Recall Group How to Uncover Euphoric Recall How to Help the Clients See the Truth The Reading Group The Relapse Prevention Group The Trigger Group How to Uncover the Triggers The Drug Refusal Skills The Inaccurate Thinking Group The Feelings and Action Group The Lapse Group The Spirituality Group How to Develop Healthy Relationships How to Develop a Healthy Relationship With a Higher Power The Eleventh Step Group The Meditation Group The Childhood Group How to Explore Early Parental Relationships How to Begin to Heal Early Childhood Pain Men's Group/Women's Group The Community Group The Personal Inventory Group Skills Training Group Assertiveness Skills Group Skills Problem-Solving Skills Group Skill Set 1 Skill Set 2 7. Drugs of Abuse Drugs of Abuse Central Nervous System Depressants Central Nervous System Stimulants The Hallucinogens The Reinforcing Properties of Drugs Tolerance and Dependence Cross-Tolerance Alcohol Alcohol-Induced Organic Mental Disorders Alcohol Intoxication Alcohol Amnesic Disorder (Blackout) Wernicke-Korsakoff Syndrome Alcohol Withdrawal Alcohol Withdrawal Seizures Alcohol Withdrawal Delirium (Delirium Tremens) Sedatives, Hypnotics, and Anxiolytics Opioids Cocaine and Amphetamines Phencyclidine Dissociative Anesthetics (Phencyclidine, Ketamine, Dextromethorphan, and FLAKKA) Hallucinogens The Psychedelic State Cannabis Synthetic Designer Drugs Inhalants Nicotine Club Drugs MDMA GHB Ketamine Rohypnol Polysubstances Treatment Outcome 8. Recovery Skills The Chemical Use History Honesty Love, Trust, and Commitment Feelings Relationship Skills Addictive Relationships Communication Skills Self-Discipline Impulse Control Relapse Prevention Stress Management 9. Steps The Committee Step One Step Two How to Help Clients Accept a Higher Power Step Three How to Help Clients Embrace Step Three Step Four Step Five Step Six Step Seven Step Eight Step Nine Step Ten Step Eleven Step Twelve 10. Lectures The Disease Concept Addiction Is Not a Moral Problem Addiction Is Not Due to a Weak Will Addiction Has Genetic Components Addiction Is a Social Problem Addiction Is a Psychological Problem Addiction Is a Physiological Problem The Obsession The Problems Defense Mechanisms Minimization Rationalization Denial How to Begin to Live in the Truth The Great Lie How the Great Lie Works We Never Feel Accepted The Promise of the Disease Truth A Program of Rigorous Honesty Normal Development The Primary Caregiver The Struggle for Independence The Fear of Abandonment Learning the Rules The Development of Insecurity The Peer Group Adolescence Adulthood Physical Addiction and Recovery How Drugs Affect the Cell How Drugs Affect Behavior Tolerance Cross-Tolerance Withdrawal How We Learn Alcoholics Anonymous A Spiritual Awakening Two Alcoholics Talking to Each Other The "Big Book" The 12 Steps Meetings Feelings All Feelings Are Adaptive Assertive Skills 11. Special Problems The Psychiatric/Psychological Assessment How to Develop the Treatment Plan The Depressed Client How to Assess Depression How to Treat Depression Psychopharmacology Behavior Therapy Cognitive Therapy Interpersonal Therapy Grief Suicide The Angry Client How to Handle a Violent Client How to Handle an Angry Client Assertiveness Skills The Importance of Forgiveness How to Teach the Client to Recognize Anger Disengagement Time-Out How to Keep Your Cool as a Counselor The Homicidal Client The Duty to Warn Personality What Is Personality? The Antisocial Personality A Disorder of Empathy How to Treat the Antisocial Personality How to Deal With a Rule Violation Moral Development How to Deal With the Family of an Antisocial Client The Borderline Client Interpersonal Relationships Emotional Regulation How to Treat the Borderline Client Setting Limits Dealing With Transference Stress Tolerance Dealing With the Family The Narcissistic Client The Anxious Client How to Measure Anxiety The Psychological Component of Anxiety How to Use Relaxation Techniques The Daily Log Cognitive Therapy Post-Traumatic Stress Disorder Panic Attacks The Psychotic Client Hallucinations and Delusions How to Treat the Psychotic Client The Family of the Psychotic Client Acquired Immune Deficiency Syndrome The High-Risk Client The Client With Low Intellectual Functioning How to Treat the Client With Low Intelligence The Client Who Cannot Read The Family of the Client With Low Intelligence The Elderly Client The Client With Early Childhood Trauma How to Deal With Sexual Abuse Cognitive Therapy How to Learn Forgiveness Love in the Treatment Center The Importance of the Unit Rules How to Deal With Clients in Love The Pathological Gambler Honesty Gambling Step One Gambling Step Two Gambling Step Three Gambling Step Four Gambling Step Five Gambling Step Six Gambling Step Seven Gambling Step Eight Gambling Step Nine Gambling Step Ten Gambling Step Eleven Gambling Step Twelve Gambling Relapse Prevention 12. Adolescent Treatment The Normal Adolescent Puberty Ages 13 to 16 Ages 16 to 19 Interesting Adolescent Facts The Chemically Dependent Adolescent The Adolescent Chemical Dependency Counselor The Point System The Primary Elements in Adolescent Treatment The Rules Communication Skills Honesty Exercise Fun in Sobriety The Reinforcers Spirituality Group Therapy Peer Pressure Continuing Education Continuing Care The Parents Support Group The Behavioral Contract Phases of Adolescent Treatment 13. The Family Program The First Family Contact How to Handle the Early Against Medical Advice Risk Common Family Problems Codependency Guilt Loss of Control Shame Caretaking Enabling Inability to Know Feelings Inability to Know Wants Lack of Trust People Pleasing Feelings of Worthlessness Dependency Poor Communication Skills How to Treat Family Members The Family Program Schedule How to Work With the Family in Group The Conjoint Session 14. The Clinical Staff The Physician/Addictionologist The Psychologist/Psychiatrist The Social Worker/Mental Health Counselor The Nurse The Clinical Director The Clinical Supervisor The Chemical Dependency Counselor The Rehabilitation Technician or Aide The Recreational Therapist Clinical Staffing How to Present a Client Team Building Commitment to Coworkers Boundaries Staff-Client Problems What to Do When a Client Does Not Like a Counselor What to Do When a Client Complains About a Rule The Work Environment 15. Discharge and Continuing Care Outpatient Discharge Criteria Inpatient Discharge Criteria How to Develop a Discharge Summary The Discharge Summary Saying Good-Bye 16. The Good Counselor Good Counselors Are Caring Good Counselors Love Their Work Good Counselors Do Not Become Overly Involved Good Counselors Do Not Lie Good Counselors Are Gentle Good Counselors Like Themselves Good Counselors Are Supersensitive Good Counselors Have a Sixth Sense Good Counselors Do Not Become Overly Emotional Good Counselors Are Active Listeners Good Counselors Do Not Talk Too Much Good Counselors Maintain Boundaries Good Counselors Are Client Centered Good Counselors Have Effective Relationship Skills Good Counselors Have a Sound Code of Ethics Appendix 1- Cognitive Capacity Screening Appendix 2- Short Michigan Alcoholism Screening Test Appendix 3- DSM-5 Psychoactive Substance Use Disorder Appendix 4- Alcohol Withdrawal Scale Appendix 5- Narcotic Withdrawal Scale Appendix 6- Sample Biopsychosocial Interview Appendix 7- Chemical Use History Appendix 8- Honesty Appendix 9- Love, Trust, and Commitment Appendix 10- Feelings Appendix 11- Relationship Skills Appendix 12- Addictive Relationships Appendix 13- Communication Skills Appendix 14- Self-Discipline Appendix 15- Impulse Control Appendix 16- Relapse Prevention Appendix 17- Step One Appendix 18- Step Two Appendix 19- Step Three Appendix 20- Step Four Appendix 21- Step Five Appendix 22- Adolescent Unit Level System Appendix 23- Peer Pressure Appendix 24- The Behavioral Contract Appendix 25- Family Questionnaire Appendix 26- Codependency Appendix 27- Personal Recovery Plan Appendix 28- Sample Discharge Summary Appendix 29- Stress Management Appendix 30- Hamilton Depression Rating Scale Appendix 31- Biopsychosocial Assessment Appendix 32- Anger Management Appendix 33- Narcissism Appendix 34- Honesty for Gamblers Appendix 35- Step One for Gamblers Appendix 36- Step Two for Gamblers Appendix 37- Step Three for Gamblers Appendix 38- Step Four for Gamblers Appendix 39- Step Five for Gamblers Appendix 40- Relapse Prevention for Gamblers Appendix 41- Adolescent Unit Point System Appendix 42- Results From the 2013 National Survey on Drug Use and Health: Summary of National Findings Appendix 43- Drug Categories for Substances of Abuse Appendix 44- Adult Inpatient Program Schedule Appendix 45- Adolescent Inpatient Program Schedule Appendix 46- Adult Outpatient Program Schedule Appendix 47- Adolescent Outpatient Program Schedule Appendix 48- Gambling Inpatient Program Schedule Appendix 49- Gambling Outpatient Program Schedule Appendix 50- Day Treatment Program Schedule Appendix 51- Pressure Relief Group Meeting and Budget Form Appendix 52- Heroin Appendix 53- South Oaks Gambling Screen Appendix 54- Barriers in Thinking Appendix 55- Psychotherapeutic Medications 2011 Appendix 56- Drug Abuse Screening Test Appendix 57- Clinical Opiate Withdrawal Scale Appendix 58- Adult Nurses Intake Appendix 59- Adolescent Nurses Intake Appendix 60- National Cancer Institute Guide to Quitting Smoking Appendix 61- Post-Traumatic Stress Disorder (PTSD) Checklist Civilian Version Appendix 62- Post-Traumatic Stress Disorder (PTSD) Checklist Military Version Appendix 63- Alcohol Abstinence Self-Efficacy Scale Appendix 64- Hamilton Anxiety Rating Scale Appendix 65- Strengths, Needs, Abilities, and Preferences Appendix 66- Daily Craving Record Appendix 67- National Association of Alcohol and Drug Abuse Counselors (NAADAC) Code of Ethics Appendix 68- Gambling History Appendix 69- Diagnostic/Integrated Summary Appendix 70- Mental Health Screening Appendix 71- Fagerstrom Test for Nicotine Dependence References Index About the Author

About the Author

Robert R. Perkinson is the clinical director of Keystone Treatment Center in Canton, South Dakota. He is a licensed psychologist; licensed marriage & family therapist; internationally certified alcohol and drug counselor; South Dakota certified chemical dependency counselor, Level III; and a nationally certified gambling counselor and supervisor. His specialty areas focus on treating alcoholics, addicts, and pathological gamblers. He is the author of Chemical Dependency Counseling: A Practical Guide (2nd ed.) (2003a), which is the leading treatment manual in the world for chemical dependency counselors. With Dr. Arthur E. Jongsma Jr. (2001) he is the coauthor of The Addiction Treatment Planner, which is the best-selling treatment planner and computer software program for mental health and addiction professionals. He has also written The Alcoholism and Drug Abuse Patient Workbook (2003c) and the Gambling Addiction Patient Workbook (2003b). These workbooks have all of the exercises patients need to enter a stable recovery. His book entitled Treating Alcoholism: How to Help Your Clients Enter Recovery (2004) trains professionals how to treat patients with alcohol problems. He is the author of the book God Talks to You (2000) and the meditation tape A Communication from God (2008) by cdbaby, which help addicts make their first conscious contact with a Higher Power of their own understanding. He is a composer and has completed his second CD, Peace Will Come, music that helps addicts learn the essentials of a spiritual journey. With Dr. Jean LaCour (2004), he wrote the Faith-Based Addiction Curriculum to teach professionals of faith how to treat addiction. Dr. Perkinson is an international motivational speaker and regular contributor to numerous professional journals. He is the webmaster of several web pages, including www.robertperkinson.com, www.alcoholismtreatment.org, and www.godtalkstoyou.com, where he gets over 2.6 million hits a year and answers questions on addiction for free. His biographies can be found in Who's Who in America, Who's Who in Medicine and Healthcare, Who's Who in Science and Engineering, and Who's Who in the World.

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