Substance Addictions and Abuse Counseling
Substance abuse and addictions counseling is a newer counseling field. Although it is fairly new, there is so much research and so many guidelines to help someone make it through as a substance abuse and addictions counselor. It holds a great importance and people should be aware of the severity of substance abuse and addiction. This field has several aspects and themes that help an addict or substance abuser gain a new lifestyle without substances. Reasons for use, assessment, diagnosis, treatment/recovery/rehabilitation, and sober living are extremely important topics in the substance abuse and addictions counseling field.
Each one leads to the next and provides answers for the next step in counseling an addict or substance abuser. Legal and ethical issues, as well as biblical values and insight, should be taken into great consideration when in this counseling field. Allowing God to help guide counselors and patients, should be a great influence in the betterment of your patients. Substance Abuse and Addictions Counseling Introduction Substance Abuse and Addictions Counseling is a relatively new counseling field. Miller (2005) describes that counseling has a theoretical framework that is built like a tree.
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The trunk of the tree is the base and the main way people heal; the branches are the natural factors that are grown from the trunk of the tree and the twigs/smaller branches are the counselors ways of counseling with their techniques to make their theoretical framework (Miller, 2005, p. 17). Understanding a client and their needs will allow a counselor to correctly assess, diagnose, and treat a client. Substance abuse and addictions counseling is very important to the counseling field, especially with it being a newer concentration. There are several themes relevant to substance abuse and addictions counseling as well.
Legal and ethical issues will be discussed in detail in the legal and ethical issues section. There are some biblical values and insights related to substance abuse and addictions counseling. Personal reflections are also going to be covered in the latter part of the paper. Importance of Substance Abuse and Addictions Counseling to the Field of Counseling Substance Abuse and Addictions Counseling is a very important addition to the counseling field. Substance abuse and addiction is a very prevalent issue and there are more people with these addictions through out the country, and even the world.
According to Feldman (2011), there are some signals that an adolescent is going through addiction: “Identification with the drug culture, signs of physical deterioration, dramatic changes in school performance, changes in behavior” (p. 373). Feldman says that forty-nine percent of college men are binge drinkers and forty-one percent of college women do the same (p. 373). Leukefeld, Gullotta, and Staton-Tindall (2009) said: In the year 2000, it was estimated that 85,000 deaths in the United States (3. % of all deaths) were attributed to alcohol consumption, among behavioral risk factors, the third-leading cause of death behind tobacco use and poor diet and exercise (Mokdad, Marks, Stroup, & Gerberding, 2004) Major Themes Relevant to Substance Abuse and Addictions Counseling Reasons for Using Substances There are numerous reasons for using and addiction. The reasons are different for everyone. Feldman (2011) describes that most adolescents try drugs and alcohol because of their peers. Peer pressure can be very overwhelming, especially during those highly influential years of the teenager’s life.
Other adolescents try drugs and alcohol because media portrays using as fun or enjoyable (Feldman, 2011). Finally some use because they are trying to escape from something, whether it is feelings, emotions, physical issues, or maybe even dissatisfaction with self (Feldman, 2011). Fazzio (2009) states that there are, “sociological, pyshological and biological” (p. 252), influences that affect substance abuse. Feldman (2011) says that some people make using a habit and it becomes out of control and the toleration for alcohol or drugs becomes so high that they ave to use more and more to feel the effects they once felt. A drug, “releases inhibitions and tension, and it reduces stress” (Feldman, 2011, p. 372-373). Feldman says that a lot of college students drink a lot because they think that everyone else is drinking a lot (“known as the false consensus effect” (p. 373)). Genetics can play a role in addictions as well. Prenatal care is very important. Leukefeld et al. (2009) suggests that there are several influences to a fetus that can affect them throughout their life. Leukefeld et al. tates that use of drugs and/or alcohol during pregnancy can influence addiction during the fetus’s life time. It is said to be difficult to determine the extreme influence of biological effects of using on the child. Leukefeld et al. does describe that the immense exposure to different substances, does have a major influence on a child and their likeliness to use or abuse as well. Substances include tobacco, caffeine, alcohol, drugs and other day-to-day things people use that we do not think about often (Leukfeld et al. , 2009). Assessment Correct assessment of addiction is very important.
There can often be multiple diagnoses of addiction and mental health disorders. It is imperative that a counselor or someone around the client is able to understand the signs and symptoms of substance abuse. It is also very important that the counselor be able to detect any other mental disorders that may be causing the use or enhancing the drug use. Butler et al. (2005) performed a self-assessment, called the ASAT, on several different patients, from different treatment facilities, that allowed the patients to answer in four different ways from “not true at all” to “very true”.
This test was administered to test and score symptoms and how a user was functioning (Butler et al. , 2005). However, the Drug Abuse Screening Test (DSAT) was mainly about symptoms of users (Butler et al. , 2005). The Recovery Attitude and Treatment Evaluation-Questionnaire I (RAATE-QI) was similar to the ASAT, in being multidimensional, but contained ninety-four questions, compared to the twenty-four in the ASAT; the RAATE-QI scored how ready a patient was to actually go through the treatment process (Butler et al. , 2005). Butler et al. escribes the Substance Abuse Subtle Screening Inventory (SASSI) and the Drug Use Screening Inventory (DUSI) are also multidimensional screening tests with the SASSI testing the likeliness of someone ending up with a substance addiction and the DUSI being very controversial and administering one hundred and fifty-nine questions. The most well known and researched assessment is actually an interview, Addiction Severity Index, which is that covers, “medical, employment, alcohol, drug, legal, family and social, and psychiatric” issues (Butler et al. , 2005).
With the interview taking so long, they made a computerized version that still has a forty-five minute face-to-face interview (Butler et al. , 2005). Diagnosis Diagnosis and assessment go hand-in-hand and a correct diagnosis cannot be made without an accurate assessment. “Diagnosis shapes treatment planning, gives credence to the symptoms under consideration, and documents that thoroughness and thoutfulness are shaping the clinical process” (Fazzio, 2009, p. 253). Fazzio (2009) explains that diagnosis should be taken very seriously and that clinicians should not try and guess.
Frail (2012) explains that a diagnosis, after careful assessment, should determine whether someone is an addict or an abuser. According to Webster (2003), an abuser is, “improper or excessive use or treatment”, and an addict is, “to devote or surrender (oneself) to something habitually or obsessively”. Assessment leads to a diagnosis. Sometimes an assessment may not catch something that may be caught in diagnosis, like a personality disorder. Delphin-Rittmon et al. , (2012) did a study that determined that, unlike Hispanics, African Americans are more likely to have a personality disorder on top of abuse or addiction.
Also, it was found that African Americans and Hispanics were more likely to have a ‘drug use disorder’ than white or non-Hispanic people (Delphin-Rittmon et al. , 2012). Treatment/Recovery/Rehabilitation There are several different types of treatment, recovery, and rehabilitation. Treatment is how someone is cared for during a process. Recovery is, “the process of combating a disorder (as alcoholism) or a real or perceived problem” (Webster, 2003). Rehabilitation is, “to restore or bring to a condition of health or useful and constructive activity” (Webster, 2003).
They all work together toward the same goal of bettering the patient and getting them to a sober and healthy lifestyle. Treatment of substance abuse and addiction can include vaccination. Although the goal is to get someone off of drugs or alcohol, sometimes the use of vaccines and other medication may be necessary to avoid other medical issues that can come from withdraw. Other forms of treatment include, “CBT, motivational interviewing, contingency management, psychodynamic psychotherapy, network therapy, group therapy, 12-step programmes and family therapy” (Ashraph, Galanter, Kleber, & Herbert, 2012, p. 80). CBT is cognitive behavioral therapy. Sober Life Ertos (2011) describes a sober living community in Las Vegas, Nevada. The community is ran by a man named Jeff Iverson. Jeff Iverson states that, “When you’re ready to recover, you’re ready” (Ertos, 2011, p. 40). Iverson’s community is an apartment community with recovering addicts. A person is always considered a recovering addict, even if that person has been sober for twenty years. During an initial stay in the Iverson community, a person still goes through treatment, recovery, and rehabilitation.
After graduation, people are allowed to stay in the community, get their own apartment, and their utility bills go into that person’s name to allow them to grasp life situations again. Enos (2011) provides another type of sober living perspective. The Turning Point of New Haven, Connecticut is a sober living community for ‘young men’ who are trying to recover from addictions (Enos, 2011). Enos explains that the ‘young men’ engage in several different activities including Mixed Martial Arts (MMA) and other physical activities to strengthen themselves and their minds.
Sober life is explained to the residents as allowing them to face their fears and anxieties, and allow them to find new ways to approach and handle those fears and anxieties (Enos, 2011). Legal and Ethical Issues Related to Substance Abuse and Addictions Counseling William Howatt’s The Addiction Counselor’s Desk Reference, includes an extensive amount of information on the major themes relevant to Substance Abuse and Addictions Counseling. Howatt (2005) explains that the counselors have a level of professionalism to uphold that include legal and ethical ssues. Record keeping is highly recommended to avoid any questions at a later time, or to answer them very quickly. Record keeping is actually required by law and could result in lawsuits if not done (Howatt, 2005). Howatt provides some example documentation on pages 190 and 191 that include intake forms, evaluations and assessments, treatment plan, correspondence, financial records and legal documents. Howatt explains different approaches to crises and how to exude crisis management.
Howatt also expresses that a counselor is legally, and ethically, required to seek authority if a client becomes threatening or violent to themselves and/or others. A counselor should always express their boundaries to their client. The following are the professional values that need to be met: “autonomy, obedience, conscientious refusal, beneficence, gratitutde, competence, justice, stewardship, honesty and candor, fidelity, loyalty, diligence, discretion, self-improvement, nonmalfeasance, restitution, self-interest, and other culture” (Howatt, 2005, p. 214-215).
The Assosciation of Addiction Professionals, as described by Howatt , includes the following ethical codes: “nondiscrimination, responsibility (for objectivity and integrity), competence, legal and moral standards, public statements, publication credit, client warfare, confidentiality, client relationships, interprofessional relationships, remuneration, and societal obligations” (p. 215-216). Malpractice, referral obligation and rights of minors need to all be taken seriously, as they can all end up getting a counselor in a lot of trouble if not followed properly (Howatt, 2005).
Biblical values and insight “We ought not to worry about faith in our society. We ought to welcome it into our programs. We ought to welcome it in the welfare system. We ought to recognize the healing power of faith in our society” (Broyles & Bush, 2003, p. 315). George W. Bush wanted Americans to bring faith into their homes and allow faith to guide families through everyday battles. Broyles and Bush (2003) brought a “faith-based initiative” into the public eye.
Broyles and Bush explain that there is a stigmitizm against religion in the public. Some people see religion as an overbearing and controlling organization, while other people base their lives off religious beliefs. Broyles and Bush express that many people have adopted a ‘holistic approach’ to taking care of and counseling social, mental, and psychological disorders. This approach is carried on to the be the primary ‘cure’ for these disorders.
The National Center on Addiction and Substance Abuse at Columbia University did a study to see the effects of religion and spirituality when it comes to treating and preventing substance abuse and addiction (Broyles and Bush, 2003). Spirtual and religious treatment has proven to have a great influence on the recovery, prevention, and treatment of substance abuse and addiction. A FBO is a faith based organization (Broyles and Bush, 2003, p. 317).
Understanding that a FBO is a faith based organization, it will be easier to understand the following recommendation from Broyles and Bush (2003): Agency guidelines must clarify existing charitable choice provisions and amend existing agency restrictions, charitable choice expansion legislation in Congress should be amended, a separate 501(c)(3) should be created to receive direct public funds, essential parameters of government programs that directly fund FBOs, ensuring that participation in faith-based programs is voluntary, and categorizing FBOs based on their use of religious speech should be avoided. p. 347-352) The African-American communities have always had a strong influence from church. Packer (2004) explains how church and God has brought many people together and has connected many communities in a very strong way. African-Americans have sought God to help with ‘soul saving’ and counseling (Packer, 2004). Part one of Counseling in African-American Communities: Biblical Perspectives on Tough Issues explains different methodology of how to deal with, confront, and treat substance abuse, including a Godly influenced twelve-step program.
Part two gives advice of how to deal with substance abuse while still having Godly influences (Packer, 2004). Part four shows how to solve any ethical issues with a Godly perspective (Packer, 2004). Research has shown that the bible, faith, and God have had positive influences in the process to recovery. A biblical verse that conveys strength, exudes encouragement of faith, and brings spiritual guidance through the process of becoming sober is: No temptation has overtaken you that is not common to man.
God is faithful, and he will not let you be tempted beyond your ability, but with the temptation he will also provide the way of escape, that you may be able to endure it. 1 Corinthians 10:13 Personal Reflections Substance Abuse and Addictions Counseling is the field that I would really like to go into. I have been around addicts and abusers all my life. My uncle was a heroin addict and my mother’s ex-husband was a drug addict and dealer. My son’s father was addicted to prescription pills and a totally different person when he was on them. My grandfather was also an alcoholic.
They gave me a new outlook and have helped me realize I want to help people like them to better themselves and provide them with a clean and healthy life to go forward with. I want to counsel people and help them learn new ways to live. I also want to help them close chapters in their lives that may have led them to use. Knowing the importance of Substance Abuse and Addictions Counseling, I want to spread the word and influence others to want to help these people obtain their goals of sober living, I want to understand their reasons for using and be able to accurately assess and diagnose a patient.
Creating a treatment plan, seeing someone through recovery, rehabilitation, and the beginning of their sober life is something I truly look forward to. I want to be well aware of the legal and ethical issues that I may face in my career and the biblical values and insight I will use as a Christian counselor. I will remain biblically grounded and keep God as my guiding light. God is, in essence, my counselor and who I keep in my heart and mind. God will guide me through my sessions and allow me to have strength to guide my patients and help them accept God into their lives as well.
God will also guide me ethically. As a future American Christian counselor, I follow the guildelines of the American Association of Christian Counselors Codes of Ethics (2004). Ethically, I will make sure that the most important thing is health and safety. I will make sure that I abide by the American Counseling Association’s Code of Ethics (2005) and allow them to be my outline for counseling. Conclusion Substance Abuse and Addictions counseling is one of the newest concentrations to the counseling field. It has been researched, explored and explained in so many different levels.
The ‘theoretical framework’, Miller (2005) described, has allowed counseling professionals to explore different ways to counsel and assist substance abusers and addicts. As described in the Importance of Substance Abuse and Addictions Counseling section, substance abuse and addictions counseling is extremely important to help someone gain a sober and healthy life. The major themes of substance abuse and addictions counseling are reasons for using, assessment, diagnosis, treatment/recovery/rehabilitation, and sober life. Each theme leads into the other and helps to accomplish the next theme.
A counselor needs to understand someone’s reasons for using to make an assessment. An accurate assessment leads to a diagnosis. Diagnosis needs to be made to begin a treatment plan for recovery and rehabilitation. After treatment, recovery and rehabilitation, a person begins a sober life. Sober life can be expanded through biblical values and insight. Understanding the above will definitely help when it comes to legal and ethical issues. There are some legal and ethical issues that should be considered while trying to counsel someone that is an addict or an abuser.
These legal and ethical issues will allow you to stay on the right track and keep the patient on the right track as well. The biblical values and insight are all self-interpreted. Each person reads the Bible differently but the overall values and insight provide a strength to many addicts and abuses and deflect them from the unhealthy lifestyle they have entered. The Bible and the other aspects of this research has lead to personal reflections that include the want and need to help substance abusers and addicts reach a healthy and sober life.