Category:

Drug Addiction Counseling

Course Outline

Chapter 1: Introduction

  • Introduction
  • Treatment Philosophy
  • Contributions of the 12-Step Approach
  • Role of Self-Help Groups
  • Role of Significant Others in Treatment

Chapter 2: Overview

  • Comparison of Addiction Counseling and Psychotherapy
  • Similar and Dissimilar Approaches
  • Compatibility With Other Treatments

Chapter 3: Logistics of the Model

  • Frequency and Duration of Sessions
  • Duration of Treatment
  • Target Population
  • Setting

Chapter 4: Assessment

  • Assessment
  • Addiction Severity Index
  • Biological Assays

Chapter 5: The Role of the Addiction Counselor

  • Patient-Counselor Relationship
  • Therapeutic Alliance
  • Behaviors That Should Not Be Done

Chapter 6: The Individual Drug Counseling Model

  • Goals and Objectives of Individual Drug Counseling
  • Stages of Treatment
  • In Each Session

Chapter 7: Treatment Initiation

  • Goals
  • Treatment Issues
  • Denial
  • Introductory Sessions

Chapter 8: Early Abstinence

  • Treatment Issues

Chapter 9: Maintaining Abstinence

  • Goals
  • Treatment Issues

Chapter 10: Advanced Recovery

  • Termination
  • Treatment Booster Sessions

Chapter 11: Dealing With Problems That Arise

  • Dealing With Lateness or Nonattendance
  • Denial, Resistance, or Poor Motivation
  • Strategies for Dealing With Crises
  • Dealing With Relapse
  • Levels of Severity of Relapse

Chapter 12: Counselor Characteristics and Training

  • Ideal Personal Characteristics of the Counselor
  • Educational Requirements
  • Credentials and Experience Required
  • Counselors in Recovery Themselves

Chapter 13: Supervision

  • Training and Supervision
  • Use of the Adherence Scale
  • Appendix -Adherence/Competence Scale for Individual Drug Counseling (IDC) for Cocaine Dependence
  • Exhibit 10: Problem List Form

Cognitive-Behavioral Therapy: An Overview

  • Why CBT?
  • Components of CBT
  • Parameters of CBT
  • Active Ingredients of CBT
  • CBT Compared to Other Treatments

Basic Principles of CBT

  • Learned Behavior
  • Functional Analysis
  • Skills Training

The Structure and Format of Sessions

  • 20/20/20 Rule
  • Exhibit 1: Session Flow in CBT, The 20/20/20 Rule
  • First Third of Session
    • Assess Patient Status
    • Urine Tests
    • Problemsolving
  • Listen for Current Concerns
  • Discuss the Practice Exercise
  • Second Third of Session
  • Final Third of Session
  • Assign a Practice Exercise
  • Anticipate High-Risk Situations
  • Topics

Integrating CBT and Medication

Session 1: Introduction to Treatment and CBT

  • Tasks for Session 1
  • Session Goals
  • Key Interventions
  • History and Relationship Building
  • Present the CBT Model
  • Establish Treatment Ground Rules
  • Introduce Functional Analysis
  • Practice Exercise
  • Exhibit 2: Functional Analysis

Topic 1: Coping With Craving

    • Tasks for Topic 1
  • Session Goals
  • Key Interventions
  • Practice Exercises
  • Exhibit 3: Coping With Cravings and Urges

Topic 2: Shoring Up Motivation and Commitment to Stop

  • Tasks for Topic 2
  • Session Goals
  • Key Interventions
  • Clarify Goals
  • Address Ambivalence About Abstinence
  • Identifying and Coping With Thoughts About Cocaine
  • Practice Exercises
  • Exhibit 4: Goals Worksheet
    • Exhibit 5: Coping With Thoughts About Cocaine
    • Topic 3: Refusal Skills/Assertiveness

Tasks for Topic 3

  • Session Goals
  • Key Interventions
  • Assess Cocaine Availability
  • Handling Suppliers
  • Cocaine Refusal Skills
  • Within-Session Role-Play
  • Passive, Aggressive, And Assertive Responding
  • Remind Patients of Termination
  • Practice Exercises
  • Exhibit 6: Managing Availability
  • Exhibit 7: Cocaine Refusal Skills

Topic 4: Seemingly Irrelevant Decisions

  • Tasks for Topic 4
  • Session Goals
  • Key Interventions
  • Understand Seemingly Irrelevant Decisions
  • Identify Personal Examples
  • Practice Safe Decisionmaking
  • Practice Exercise
  • Exhibit 8: Seemingly Irrelevant Decisions

Topic 5: An All-Purpose Coping Plan

  • Tasks for Topic 5
  • Session Goals
  • Key Interventions
  • Practice Exercise
  • Exhibit 9: All-Purpose Coping Plan

Topic 6: Problems Solving

  • Tasks for Topic 6
  • Session Goals
  • Key Interventions
  • Practice Exercise
  • Exhibit 10: Reminder Sheet For Problemsolving

Topic 7: Case Management

  • Tasks for Topic 7
  • Session Goals
  • Key Interventions
  • Problem Identification
  • Goal Setting
  • Resource Identification
  • Specifying a Plan
  • Monitoring Progress
  • Practice Exercise
  • Exhibit 11: Support Plan

Topic 8: HIV Risk Reduction

  • Tasks for Topic 8
  • Session Goals
  • Key Interventions
  • Build Motivation To Change
  • Set Goals
  • Problemsolve Barriers
  • Provide Specific Guidelines
  • Practice Exercise
  • Significant Other Session
  • Tasks for Significant Other Session
  • Session Goals
  • Key Interventions
  • Plan Ahead
  • Identify Strategies
  • Practice Exercise

Final Session: Termination

  • Tasks for the Termination Session
  • Session Goals

Appendix A: Therapist Selection, Training, and Supervision

  • Therapist Training
  • Didactic Seminar
  • Supervised Training Cases
  • Rating of Therapists
  • Therapist Checklist
  • Certification of Therapists
  • Ongoing Supervision
  • Common Problems Encountered in Supervision
  • Speeding Through Material
  • Overwhelming The Patient
  • Unclear Strategies
  • No Specific Examples
  • Downplaying Practice Exercises
  • Abandoning The Manual With Difficult Patients
  • Exhibit 13: CBT Therapist Checklist

Appendix B: Clinical Research Supporting CBT

  • CBT and Interpersonal Therapy
  • CBT and Clinical Management
  • CBT and Depressive Symptoms
  • CBT and Alexithymia
  • One-Year Follow-up
  • CBT and Alcoholic Cocaine Abusers

References

Background

  • Psychosocial Interventions
  • Supporting Research
  • Use With Other Populations
  • Concurrent Alcohol Dependence

Program Overview

  • Lifestyle Changes
  • Vouchers
  • Other Drug Abuse
  • Treatment Parameters Schedule
  • Schedule
  • Components
  • Structure
  • Exhibit 1: Sample Schedule

Clinical Approach

  • Counseling Style
  • Flexibility
  • Empathy
  • Active Involvement
  • Directive But Collaborative
  • Social Reinforcement
  • Counseling Techniques
  • Behavioral Techniques
  • Additional Resources
  • Progress Graphs
  • Counseling Structure
  • Preparation
  • Session Protocol
  • Recent Problems or Crises
  • Special Issues
  • Absences
  • Tardiness
  • Extra Sessions
  • Drug and Alcohol Use
  • Concurrent Treatment
  • Premature Termination
  • Documentation of Patient Contact
  • Clinical Supervision
  • Exhibit 2: Therapy Session Checklist
  • Exhibit 3: Progress Note
  • Exhibit 4: Brief Contact Forms

The Voucher Program

  • Objective Monitoring
  • Exhibit 5: Recommended Reinforcement Schedule
  • Urinalysis Schedule
  • Specimen Collection
  • Laboratory Analysis
  • Presenting the Results

Intake

  • Initial Contact
  • Screen Applicants
  • Schedule Intake
  • Intake Procedures
  • Assessment
  • Self-Administered Questionnaires
  • Program Description
  • Structured Interviews
  • Initial Treatment Session
  • Get to Know the Patient
  • Provide Overview and Rationale
  • Introduce the Voucher Program
  • Describe Abstinence Contract
  • Explain Urinalysis Monitoring
  • Explain Voucher Program
  • Review Abstinence Contract
  • Priming
  • Problem List
  • Practical Needs Assessment
  • Appointment Book
  • Significant Others
  • Disulfiram Procedures (if applicable)
  • Collect Urine
  • Schedule the Next Session
  • Exhibit 7: Intake Worker Summary
  • Exhibit 9: Sample Abstinence Contract
  • Exhibit 10: Problem List Form
  • Exhibit 11: Sample Problem List

Early Counseling Sessions

  • Outline a Treatment Plan
  • Sessions One and Two
  • Urinalysis Results
  • Complete Intake and Treatment Orientation
  • Introduce Functional Analysis and Stimulus Control
  • Assist With Practical Needs
  • Use the Appointment Book
  • Start To Develop the Treatment Plan
  • Discuss Areas for Change
  • Prioritize Problems
  • Set Specific Target Goals
  • Follow Through

Drug Avoidance Skills

  • Functional Analysis
  • Components of Functional Analysis
  • Triggers
  • Behavior
  • Positive Consequences
  • Negative Consequences
  • Conduct a Functional Analysis
  • Self-Management Planning
  • Rationale
  • Initiate Training
  • Make the Plan
  • Drug Refusal Training
  • Rationale
  • Refusing Cocaine and Other Drugs
  • Components of Effective Refusal
  • Practice Refusal Skills
  • Homework
  • Exhibit 13: Discovering Triggers of Your Cocaine Use
  • Exhibit 14: Functional Analysis – Cocaine Behavior Form
  • Exhibit 15: Functional Analysis – Cocaine Behavior Form (example)
  • Exhibit 16: Components of Effective Refusal

Lifestyle Change Components

  • Time Management
  • Develop Time-Management Skills
  • Apply Time Management
  • Social/Recreational Counseling
  • Rationale
  • List Activities and People
  • Set Goals and Assess Progress
  • Facilitate Change
  • Problem-solving
  • Rationale
  • Steps for Problem-solving
  • Recognize the Problem
  • Identify the Problem
  • Brainstorm
  • Select Approach
  • Evaluate Effectiveness
  • Practice
  • Vocational Counseling
  • Rationale
  • Set Goals
  • Treatment Components
  • Social-Skills Training
  • Assertiveness Training
  • Rationale
  • Assertiveness Skills
  • Practice
  • Set Goals and Assess Progress
  • HIV/AIDS Prevention
  • Rationale
  • AIDS Knowledge Pretest
  • Video and Discussion
  • Pamphlets and Condoms
  • AIDS Knowledge Posttest
  • HIV Antibody and Hepatitis B Testing
  • Provide Information
  • Discuss Results
  • Exhibit 17: Problem-solving Worksheet
  • Procedure
  • Practice Exercise
  • Exhibit 18: Being Assertive
  • Exhibit 19: AIDS Risk Knowledge Test
  • Exhibit 19a: AIDS Risk Knowledge Test (Answers)
  • Exhibit 20: Recommendations to Prevent HIV Transmission Through Shared Drug Injection Equipment

Relationship Counseling

  • Session 1
  • Introduce Relationship Counseling
  • Introduction Exercise
  • Relationship Happiness Scale
  • Daily Reminder To Be Nice
  • Session 2
  • Perfect Relationship Form
  • Positive Requests
  • Session 3
  • Communications Training
  • Session 4
  • Communications Training
  • Sessions 5-8
  • Exhibit 21: Relationship Happiness Scale
  • Exhibit 22: Examples of Relationship-Related Activities
  • Exhibit 23: Daily Reminder to be Nice
  • Exhibit 24: Perfect Relationship Form
  • Exhibit 25: Positive Requests
  • Exhibit 26: Reciprocal Contract for Behavior Change
  • Disagreements
  • Conflicts

Other Substance Abuse

  • General Approach
  • Treatment Goals
  • Abstinence
  • Reduced Use
  • No Intervention
  • Concurrent Alcohol Use
  • Abstinence
  • What Is Disulfiram?
  • Medical Oversight
  • Disulfiram Protocol
  • Exhibit 29: Disulfiram Consent Form
  • Exhibit 30: Disulfiram Contract
  • Exhibit 31: Therapist’s Disulfiram Checklist
  • Exhibit 32: Backup Disulfiram Contract
  • Introduce Disulfiram
  • Limited Alcohol Use/Safe Drinking
  • Patients Who Hesitate or Refuse
  • Backup Agreement
  • Marijuana Use

Other Psychiatric Problems

  • Depressive Symptomatology
  • Evaluate Suicide Risk
  • Monitor Symptoms
  • Treatment
  • Anxiety
  • Relaxation Protocol
  • Relaxation Exercise and Practice
  • Applications
  • Insomnia Protocol
  • Rationale
  • Sleep Diary
  • Sleep-Hygiene Rules
  • Sleep Restriction and Stimulus Control
  • Practice
  • Exhibit 34: Sleep Hygiene Rules
  • Exhibit 35: Sleep-Restriction and Stimulus-Control Instructions

Clinical Supervision

  • Weekly Clinical Staff Supervision
  • New Cases
  • Active Cases
  • Counselor Treatment Team Meetings
  • Exhibit 36: Supervisor Checklist by Case

References

Student Course Evaluation Form

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  • Category: Drug Addiction Counseling
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Evaluation of Individual Objectives

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Learning Objectives

Upon completing the course, you will able to:

An Individual Drug Counseling Approach to Treat Cocaine Addiction

Chapter 1: Introduction

  1. Describe the beliefs and philosophy of 12-step approach to recovery.

Chapter 2: Overview

  1. Distinguish between addiction counseling and psychotherapy.

Chapter 3: Logistics of the Model

  1. Discuss the logistics of the individual drug counseling model to treat cocaine addiction, such as frequency, duration, target population and setting of sessions.

Chapter 4: Assessment

  1. Describe the application of Addiction Severity Index in the assessment of drug addiction.

Chapter 5: The Role of the Addiction Counselor

  1.  Describe the patient-counselor relationship and list behaviors that the counselor should not indulge in.
  2.  List behaviors that a counselor should not indulge in.

Chapter 6: The Individual Drug Counseling Model

  1. List 12 objectives of individual drug counseling.
  2. Describe 4 stages of addiction treatment: Treatment initiation, Early abstinence, Maintenance of abstinence, Advanced recovery.

Chapter 7: Treatment Initiation

  1.  List some of the erroneous beliefs that a patient experiencing denial may exhibit.
  2.  Outline 3 goals of the treatment plan and make detailed plans for introductory sessions.

Chapter 8: Early Abstinence

  1. List 5 goals of the second stage in the treatment of addiction, i.e., abstinence, and discuss 10 treatment issues with the patient.

Chapter 9: Maintaining Abstinence

  1. Establish goals for maintaining abstinence and discuss various treatment issues with the patient as part of the ongoing recovery program.
  2. Identify 11 steps that will carry a patient toward relapse. 
  3. Define codependency and enabling behavior and explain how they can contribute to a person’s continued abuse of drugs.
  4. Identify “character defects” that are obstacles to further recovery and outline the process for working on changing defects.

Chapter 10: Advanced Recovery

  1. Discuss with the patient patient’s thoughts and feelings about ending treatment in the final active treatment session. 
  2. Explain the purpose and goals of treatment booster sessions.

Chapter 11: Dealing With Problems That Arise

  1. Identify 3 levels of severity of relapse and list appropriate interventions to be used in each case. 
  2. Discuss strategies for dealing with crises and relapses.

Chapter 12: Counselor Characteristics and Training

  1. List ideal personal characteristics of an addiction counselor.

Chapter 13: Supervision

  1. Explain the purpose and application of adherence scale in the IDC model.

Cognitive-Behavioral Therapy: An Overview

  1. Identify 6 important features of cognitive-behavioral therapy that make it particularly promising as a treatment for cocaine abuse and dependence.
  2. Distinguish between cognitive-behavioral therapy (CBT) and 12-step or disease-model approach.
  3. Compare CBT to other psychosocial treatments for substance abuse, such as cognitive therapy, community reinforcement approach, motivational enhancement therapy, 12-step facilitation and interpersonal psychotherapy.
  4. Discuss two critical components of CBT: functional analysis and skills training.
  5. Define various parameters of CBT such as format, length, setting, patients and compatibility with other adjunctive treatments.
  6. List essential and unique interventions of CBT, interventions that are recommended but not unique, acceptable interventions and interventions that are not part of CBT.
  7. Describe 7 strategies a counselor would use to help the patient master new skills.

Basic Principles of CBT

  1. Enunciate the basic principles of cognitive-behavioral therapy and describe how functional analysis and skills training are used to treat cocaine addiction.
  2. Describe the CBT principle that holds forth the three ways individuals learn to use drugs: modeling, operant conditioning, and classical conditioning.

The Structure and Format of Sessions

  1. Describe the structure and format of a typical CBT session using the “20/20/20 Rule” and list tasks to be completed during each part of the session.
  2. List 8 skill topics covered in CBT for cocaine dependence.

Integrating CBT and Medication

  1. Outline the pharmacotherapy approach as used in cognitive-behavioral therapy.

Session 1: Introduction to Treatment of CBT

  1. Explain the treatment goal of cognitive-behavioral therapy.
  2. List six strategies a counselor can use during a treatment session to enhance motivation and avoid resistance.
  3. Outline the CBT model providing an explanation and rationale for the treatment.

Topic 1: Coping With Craving

  1. Help the patient understand craving.
  2. Elicit from the patient the experience of craving.
  3. List 5 strategies to cope with craving.

Topic 2: Shoring Up Motivation and Commitment to Stop

  1. Provide key interventions to shore up motivation and commitment to stop.

Topic 3: Refusal Skills/Assertiveness

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  • List three basic principles in effective refusal of cocaine and other substances.

Topic 4: Seemingly Irrelevant Decisions

  1. Identify examples of Seemingly Irrelevant Decisions and their relationship to high-risk situations.

Topic 5: An All-Purpose Coping Plan

  1. Help the patient identify high-risk situations and develop a coping plan.

Topic 6: Problemsolving

  1. Help the patient practice problemsolving skills within the session by listing 5 basic steps.

Topic 7: Case Management

  1. Develop a concrete support plan for addressing psychosocial problems that present a barrier to treatment.

Topic 8: HIV Risk Reduction

  1. Assess the patient’s risk for HIV infection and build motivation to change risk behaviors.
  2. Set behavior change goals.
  3. Formulate specific HIV risk-reduction guidelines

Significant Other Session

  1. Involve significant others so that they can help patients become and remain abstinent.
  2. Identify 6 strategies in which the significant other can offer support to the patient in his or her recovery.
  3. Explore strategies through which significant others in the patient’s life can help the patient become and remain abstinent.

Appendix A: Therapist Selection, Training and Supervision

  1. List guidelines for effective supervision.
  2. Identify some of the common problems encountered in supervision.

Appendix B: Clinical Research Supporting CBT

  1. Review clinical research supporting CBT and compare its effectiveness against Interpersonal Therapy and Clinical Management.

A Community Reinforcement Approach: Treating Cocaine Addiction

  1. Relate the efficacy of CRA+Vouchers approach over standard drug counseling and cite research studies to support this conclusion.

Clinical Approach

  1. Adopt a counseling style and techniques consistent with the CRA+Vouchers treatment program.

Intake

  1. List 3 categories of patients generally acceptable for the CRA+Vouchers program.
  2. Outline the intake process listing various self-administered questionnaires.
  3. Conduct the initial treatment session taking the patient through several steps.

Early Counseling Sessions

  1. List the tasks a therapist should complete in Sessions One and Two of the program.

Drug Avoidance Skills

  1. Explain the concepts and procedures concerning functional analysis as the first step of CRA+Vouchers treatment plan.
  2. Instruct the patient on the four components of the functional analysis.
  3. Help the patient develop self-management plans for handling triggers to reduce the risk of cocaine use.
  4. Instruct the patient in five components of effective refusal.

Lifestyle Change Components

  1. List at least 6 lifestyle change components for cocaine abusers in treatment.
  2. Explain the importance of time management in achieving and maintaining abstinence from cocaine, and help the patient develop time-management skills.
  3. Provide a rationale for working on lifestyle changes in social and recreational areas.
  4. List 5 basic steps for problem-solving.
  5. Help patients develop assertiveness skills, and distinguish between passive, aggressive and assertive behaviors.

Relationship Counseling

  1. Describe the purpose of relationship counseling and take the patient through various steps to improve the quality of his or her relationship.

Other Substance Abuse

  1. Outline the general strategy for dealing with concurrent alcohol and cocaine use.
  2. Introduce disulfiram protocol and develop compliance procedures.
  3. Outline the general strategy for dealing with marijuana use concurrent with cocaine.

Other Psychiatric Problems

  1. Describe the treatment protocol for dealing with depressive symptomatology and anxiety
  2. following abstinence from cocaine.

Clinical Supervision

  1. Describe the function of clinical supervision of therapists in the CRA+Vouchers program.

Behavioral Change Through Treatment

  1. Describe the behavioral treatment in drug abuse treatment as contingency management.

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