Addictions Counseling

Drug and Alcohol Counseling

Addictions counseling has changed so much since the emergence of AA in the mid-1930's.

Prior to AA, alcholism was viewed as a morality issue, a lack of will power issue, and according to Carl Jung, the sporadic recoveries in the psychoanalysis case histories always involved some kind of spontaneous spiritual conversion.

There was no hope for most chronic alcoholics, or their family. Now there is, and research is taking us into the cells of addiction, and we are finding that the brain can change itself. Once again though, there is no magic pill or potion. Work is involved.

If you read the history of AA, you will read the history of desperate folks looking for a way to stay alive, and addictions counseling often is about life or death choices.

But AA changed all that and AA is still a viable recovery model.

The key to AA though is doing the steps and growing in terms of a strong spiritual program so that you can continue one day at a time reprieves from active drinking.

Since AA began and all of the other 12 step approaches followed, research has given rise to other models of recovery, and the smart addictions counselor will familiarize him or herself with all of them.

Drug Abuse Counseling Models

Introduction and Overview John J. Boren, Lisa Simon Onken, and Kathleen M. Carroll

Dual Disorders Recovery Counseling Dennis C. Daley

The CENAPS® Model of Relapse Prevention Therapy (CMRPT®) Terence T. Gorski

The Living In Balance Counseling Approach Jeffrey A. Hoffman, Ben Jones, Barry D. Caudill, Dale W. Mayo, and Kathleen A. Mack

Treatment of Dually Diagnosed Adolescents: The Individual Therapeutic Alliance Within a Day Treatment Model Elizabeth Driscoll Jorgensen and Richard Salwen

Description of an Addiction Counseling Approach Delinda Mercer

Description of the Solution-Focused Brief Therapy Approach to Problem Drinking Scott D. Miller

Motivational Enhancement Therapy: Description of Counseling Approach William R. Miller

Twelve-Step Facilitation Joseph Nowinski

Minnesota Model: Description of Counseling Approach Patricia Owen

A Counseling Approach Fred Sipe

A Psychotherapeutic and Skills-Training Approach to the Treatment of Drug Addiction Arnold M. Washton

The National Institute on Drug Abuse (NIDA) is part of the National Institutes of Health (NIH) , a component of the U.S. Department of Health and Human Services.

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Finally a Tutorial for This Incredible Software!

Counselor Competencies

Addiction counseling is relatively young as professions go. Certification processes started in the late 1970’s and in 1981 three states in the Mid-west established a small consortium to develop some common standards for certification. A report by Birch and Davis (1984) delineated the first set of national competencies for alcoholism and drug abuse counselors, which laid the foundation for the twelve core functions that were then used as the basis for certification standards.

The number of state credentialing boards for alcoholism and drug abuse counselors increased rapidly and by 1989 almost all states had voluntary certification boards. The National Certification Reciprocity Consortium (today Reciprocity Consortium/Alcohol and Other Drug Abuse [IC&RC]) had about 43 member states by the late 1980’s. Common standards were developed that included both written and oral exams, supervised work experience and a set number of education/training hours. In 1990 the National Association of Alcoholism and Drug Abuse Counselors (NAADAC), concerned about the lack of a national standard and the multitude of acronyms used by the many state certification boards, developed a national certification process that required applicants to be state certified, pass a national exam, and have an academic degree. This was the first time in the addiction treatment field that academic degrees were paired with competencies as a basis for certification. Traditionally, the addiction counseling field, which was developed by recovering counselors, had relied on assessing competencies as a basis for certification, rather than on academic preparation. In 1993 the Addiction Technology Transfer Center (ATTC) Network was created by the Center for Substance Abuse Treatment (CSAT) of the Substance Abuse and Mental Health Services Administration (SAMHSA) to improve the preparation of addiction treatment professionals. Soon the ATTC National Curriculum Committee (Curriculum Committee) was formed to evaluate curricula and establish priorities for curriculum development. The Curriculum Committee developed the Addiction Counseling Competencies (ATTC, 1995), which contained 121 competencies. A national study was conducted validating the competencies as necessary for addiction counseling (Adams & Gallon, 1997). These competencies were developed without regard to education level. The next step in the process was to articulate the knowledge, skills and attitudes (KSA) under each of the competencies. Input from many stakeholder groups in the field was sought and the competencies were sent to addiction experts for a field review. In 1996, a National Steering Committee was formed which cross-walked the Addiction Counseling Competencies: The known as the International Certification andKnowledge, Skills and Attitudes of Professional Practice (ACC) (ATTC, 1995) and the International Certification & Reciprocity Consortium (IC&RC) Role Delineation Study (IC&RC, 1996). This Steering Committee found that the ACC included the knowledge, skills and attitudes that were required for effective practice, and endorsed the ACC as the bases for education and training of staff that work with people with substance use disorders. In 1998 SAMHSA published the ACC as a Technical Assistance Publication (U.S. Department of Health and Human Services [DHHS], 1998). The ACC is divided into two sections. The first contains the Transdisciplinary Foundations organized in four dimensions, which cover the basic knowledge and attitudes for all disciplines working in the addiction field: • Understanding Addictions: Current models and theories; the context within which addiction exists; behavioral, psychological, physical health and social effects of psychoactive substances. • Treatment Knowledge: Continuum of care; importance of social, family and other support systems; understanding and application of research; interdisciplinary approach to treatment. • Application to Practice: Understanding of diagnostic and placement criteria; understanding of a variety of helping strategies. • Professional Readiness: Understanding diverse cultures and people with disabilities; importance of self-awareness; professional ethics and standards of behavior; the need for clinical supervision and ongoing education. There are eight dimensions in the second section, which focus on The Professional Practice of Addiction Counseling: • Clinical Evaluation: Screening - to determine the most appropriate initial course of action; and Assessment - the ongoing process of gathering and interpreting all necessary information to evaluate the client and make treatment recommendations. • Treatment Planning: A collaborative process whereby the counselor and client develop treatment outcomes and strategies. • Referral: A process that facilitates the client’s use of needed support systems and community resources.• Service Coordination: Encompasses case management, client advocacy and implementing the treatment plan. • Counseling: A collaborative process that facilitates the client’s progress toward mutually determined treatment goals and objectives through individual, group, couples, and family counseling. • Client, Family and Community Education: Process of providing clients, families and community groups information on the risks related to psychoactive substance use, as well as treatment, prevention and recovery resources. • Documentation: Recording intake, treatment and clinical reports, clinical progress notes and discharge notes in an acceptable, accurate manner. • Professional and Ethical Responsibilities: Includes responsibilities to adhere to accepted ethical standards and professional code of conduct and for continuing professional development; knowing and adhering to all federal and state confidentiality regulations, abiding by the Code of Ethics for addiction counselors, and obtaining clinical supervision and developing methods for personal wellness.

Drug Abuse Counseling Education

Drug Abuse Counseling Certification

Alternative Models-EEG Biofeedback, Yoga, Chi Gong, Self-Hypnosis

My partner, Jeremy Croyle, who owned FAIR TREATMENT, a DUI agency, and I began to do Alpha-Theta biofeedback with alcohol addicted folks, and had some incredible results. I believe the the Peniston Protocol, mentioned below by Siegried Othmer, is an incredible tool for addiction issues.

"Addiction is a brain-based problem, and it demands a brain-based solution. The will is over-rated when it comes to the addicted brain. Fortunately, a new era opened up at the outset of the “Decade of the Brain” with the publication in 1989 of Eugene Peniston’s epoch-making study of Viet Nam Veteran alcoholics. This breakthrough study on the application of neurofeedback to alcoholism was performed essentially independently by Eugene Peniston, staff psychologist at Fort Lyons Veterans Administration Hospital in Colorado, and Paul Kulkosky, a physiologist. The treatment outcome for alcohol addiction treatment for Viet Nam veteran pilots was abysmal at the time. Veterans were simply cycling periodically through the treatment program, only to resume their prior habits soon after."

"Peniston had personally experienced biofeedback and neurofeedback at the Menninger Clinic where an early research group in EEG biofeedback was continuing its work. The group was aware of the benefits of EEG biofeedback for alcoholism, but that was not their research interest."

"Peniston took the Menninger method back with him to Fort Lyons where he undertook a controlled study. The results were striking. Every veteran who did the neurofeedback (ten out of ten) no longer abused alcohol after the training, whereas everyone in the control group, which received the regular in-patient treatment, continued the pattern of addiction after release. There was no reason for them to do otherwise. The contrast could not have been more dramatic. If anything the results were too good to be believed, so critics simply didn’t believe them! Nobody wants to be taken for a fool."

"There were a number of small-scale replications subsequently which supported Peniston’s findings. But all involved small numbers of clients, and they did not provide for controls. Years later, our own research group participated in a replication of this work, and it included a variety of drugs of choice simply because at that time it was difficult to recruit a lot of alcoholics. Other drugs were more popular. The result was fortuitous: outcome was in no way dependent on the drug of preference, whether we were talking about heroin or crack cocaine or methamphetamine or alcohol."

"This means that we may be witnessing here an underlying commonality in the problem of addiction that is independent of the drug of choice. It may also indicate that the remedy for drug addiction and alcoholism is not to be found in biology alone, but must involve the psyche as well. What may be needed here is not a cure in the usual sense, but a more comprehensive healing, and neurofeedback may be making that possible."

"The dramatic results obtained by Peniston and others, and replicated in our large-scale controlled study, invite the question about what may account for the high level of effectiveness while almost everything else fails so abysmally. The first thing to be said is that neurofeedback doesn’t just target the addiction narrowly. The objective is improved self-regulation in general, and with that we help with the conditions that sustain the addiction: anxiety and depression; cognitive deficits; poor emotional regulation; even attentional deficits. The training may even resolve the physiological dependency, so that craving for the drug subsides."

"It must be said, however, that remediation of the addiction is not built entirely upon the relief from craving, because indeed many who abandon their addiction with neurofeedback do so while the craving persists. Something else must be at work. There is a second stage to the neurofeedback work in which the person is encouraged to move toward a more interior focus, a state of disengagement from the “real” world—both outer and inner—for the duration of the session. This is an opportunity for an encounter with the essential self, where the defenses are stripped away. This can be called “soul work.” This is where the real healing takes place that allows the person to live more authentically, and to escape the hall of mirrors that is dependency. Addiction is simply no longer a part of such a rediscovered life."

"Successful recovery, then, is actually a rediscovery of one’s essential being. This must, of necessity, be a very private affair for which no therapist can have a road map. The therapist can guide, facilitate, and support the process, but ultimately this is a very personal journey. Given the fact that those caught in drug dependency will typically take this opportunity to abandon addiction when it is offered, we should perhaps alter our view that addiction merely represents a personal and moral failing. It may be a largely biological response to psychic trauma. Resolving the trauma allows the person to resume a drug-free life."

"In our study, the inclusion of neurofeedback in residential treatment tripled the favorable outcome in terms of relapse prevention over the best conventional treatment when looked at one year post-treatment. At three years, the ratio was even better."

"It is estimated that for every dollar spent in addictions treatment, the society saves $7. This appears to be the case even with the simply abominable outcome statistics in conventional treatment. Multiply this by a factor of three and we see that the society is better off by $21 for every dollar spent in treatment when that treatment includes neurofeedback. And the formerly addicted person is clearly better off as well. The implementation of neurofeedback-augmented treatment programs should be a priority for our society.

A Hopeful Perspective on Addictions Treatment

"Most of what is written about addictions comes from those who treat the condition. The result is commonly a very pessimistic picture. One of the more lamentable realities is that people are reluctant to seek the help that they need for this condition. And that state of affairs can exist for many years. The belief has been that people cannot bail out of addiction by themselves; on the other hand, they are unlikely to seek help until things are desperate. Treatment does not work, it is said, until the person is committed to change, and that is unlikely to occur until other alternatives are blocked."

"Now all of this can be framed very differently. It is coming to be realized that the decision to seek help is a very powerful step in the recovery process already, perhaps even the most important single step. And of course that fateful step will likely be taken well before a therapist is in the loop. It is the first stage in a process of self-recovery. Perhaps the significance of this has been missed precisely because the therapist can in no wise take credit, and there is no way for the therapist to influence the process."

"Perhaps the whole recovery process should be looked at as one of “self-recovery,” one in which the therapist plays only a minor, albeit essential, role. By the time the person acknowledges the state of brokenness that leads to seeking help, the resources of self-recovery are indeed diminished, but they are still powerfully present. What if the entire focus were to shift from the drama of brokenness that the therapist finds so appealing to one of mastery? We’ll pursue that thought in the following."

"If indeed it takes ten years on average before someone seeks the help they need for an addictions issue, and if only a quarter of those affected show up at all, and if at best only a quarter of those in treatment are truly successful in shedding their addiction, then we can’t really talk about having an effective treatment program. Among alcohol abusers whose lives are coming unglued, less than ten percent seek help, and no more than two percent are successful in any treatment program. The message is clear: What exists is irrelevant, as a practical matter, to nearly all candidates for drug and alcohol treatment in our society."

"But we can look at the average eight to ten years before treatment is sought as a slow slide into progressive addiction. The brain learns addiction along the way. Can we bring influences to bear that help the brain unlearn addiction along the way, to counter the development of dependency? Indeed we can, and we call this the mastery model. Those who feel that they do not have a comfortable grip on their alcohol consumption can simply train their brains to compensate. They will likely still derive the usual pleasure from a drink, but one drink will not necessarily lead to another. With brain training, we are not sabotaged by our own brains. It is also possible, however, that they will give up alcohol altogether, and simply no longer feel drawn to it."

"It is actually quite silly to think that we, using our brains, can rise above the physiological drive for the drug on which the brain has become dependent. If the brain wants the drug badly enough, it will have its way. We have depended on will power when we had nothing else. But now we do. We can train the brain to shed its own addictions. This allows us to adopt the model that addiction is fundamentally brain-based, and that we need a brain-based remedy. We have of course tried all kinds of drug-based remedies along the way, and the results have not been encouraging. But as we are beginning to understand how the brain actually functions, new recovery possibilities open up."

"It is important to realize that brain training does not just “fill in the potholes” in brain function. It doesn’t just relieve the craving and the physiological dependency. It supports better brain function in some generality. And that means the person can have access to positive states of well-being for which drugs may have been sought at the outset. As addiction treatment specialists know, addiction is not merely a problem of the brain, it is also a kind of “suffering of the soul.” But here again, we should not speak of brokenness, but rather of suffering. Through brain training, there is the prospect of positive outcome."

"This is possible because brain training works at the body-mind nexus, our neuronal networks. It does not simply address our biology without also affecting our psychological states. Quite simply, successful brain training allows the “soul to sing.” This is where you need a poet to describe what happens, not a scientist. But even as scientists we can observe as bystanders that recovery from addictions is nothing less than a process of transformation, one in which the person finds himself or herself. This has nothing to do any more with brokenness, with dopamine deficits, with methadone or naltrexone. This has much more to do with persons unfolding into their full humanity."

"This is the path of mastery. At this point we should at least acknowledge the many people who have been successful in achieving mastery over their condition by the mere force of will. Some of them are so proud of their success that they will not take advantage of brain training. “I’ve gotten here by myself; I don’t want you to make it easy for me now!” Mastery over their demons is perhaps the central story of their lives. One must genuinely honor and appreciate their achievement. Either way, however, we are talking about self-recovery. Some people can do this entirely on their own; most could use some help. In brain training, everything happens inside the skin. Nothing is added or taken away. We are simply building upon the brain’s natural abilities."

"Another significant observation is that the problem of alcohol intolerance in our society is not an isolated one. More than four out of ten males are affected at some point in their lives, and about two out of ten women. Those of Irish descent and native Americans have a particular genetic burden with regard to alcohol tolerance. These relationships testify to the fact that we have biological tendencies to deal with here rather than merely moral failings. In fact, the problem of alcohol dependency is worse for the higher socio-economic groups, and worse for white folks!"

"So the message is this: We are not dealing with broken people and we are not dealing with isolated cases. We have a huge, society-wide issue with tolerance to alcohol, and with the ready availability of drugs that can beguile our nervous systems into dependency. With the availability of brain-training, the answer then is obvious. At any time when one feels uncomfortable about alcohol or drug overuse, a course of brain training should be undertaken to begin to steer the other way."

"This strategy is most effective early in the scheme of things, just when you begin to realize that your brain is making decisions for you that you don’t necessarily approve of. It is best undertaken while you are still successful in school or job, while the marriage is still holding together, and while your financial affairs are still healthy. And if the drug or alcohol use is escalating because of a personal crisis, then that is all the more reason to undertake brain training to give yourself the best shot at mastering your challenges."

"Finally, the above is applicable to any drug, legal or illegal, medical or recreational, that has a dependency risk. Thus, it is relevant to nicotine addiction as well as to dependency on sleep medications, anti-anxiety drugs, and prescription pain medications. For obvious reasons, we have put alcohol at the center of our considerations. Copyright © 2006 EEG Info. All Rights Reserved.

Addictions and the Brain

Principles of Addiction Treatment

From EEG Spectrum.

Drug Addiction Counseling by Terry Gorski

Dual Addictions

Living in Balance Drug and Alcohol Counseling Program

E-books, Online Counseling-Audio Tapes

My brand new site is already getting searches that tell me there is a need for specific information on counseling topics. Would you tell me yours? Mike Logan, Logan Counseling, Inc. 2917 N. Main St. Rockford, Il. 61103 815-484-0946