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Chemical Dependency Counseling
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Chemical Dependency Counseling
A Practical Guide

Fifth Edition
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October 2016 | 744 pages | SAGE Publications, Inc
The best-selling Chemical Dependency Counseling: A Practical Guide provides counselors and front-line mental health professionals with the information and skills they need to use evidence-based treatments, including motivational enhancement, cognitive behavioral therapy, skills training, medication, and 12-step facilitation. Guiding the counselor step by step through treatment, author Robert R. Perkinson presents state-of-the-art tools, forms, and tests necessary for client success while meeting the highest standards demanded by accrediting bodies.

The Fifth Edition of this landmark text has been updated to include coverage of current topics of concern for counselors, including full compliance with DSM-5, new coverage of steps 6 – 12 in 12-step facilitation, discussions on synthetic and designer drugs, new psychotherapeutic medications, new survey data on patterns of use and abuse, a list of online recovery support groups for clients, and a new section on Recommendations for a Successful First Year in Recovery.

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; and a nationally certified gambling counselor and supervisor. In addition to the best-selling Chemical Dependency Counseling: A Practical Guide, Fifth Edition, Dr. Perkinson is the author of The Alcoholism and Drug Abuse Client Workbook, Third Edition and The Gambling Addiction Client Workbook, Third Edition.
 
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

Supplements

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ISBN: 9781506307343
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