Drug Addiction Counseling

Contents 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