Foundations of Addictions Counseling, Fifth Edition
David Capuzzi and Mark D. Stauffer
CONTENTS
PREFACE iii
ACKNOWLEDGMENTS vii
CONTRIBUTORS viii
PART 1 INTRODUCTION TO ADDICTIONS COUNSELING
Chapter 1 History and Etiological Models of Addiction 1
David Capuzzi, and Mark D. Stauffer
Substance Use in the United States:
The Temperance Movement and Prohibition 3
Current Policies Influencing Prevention 10
Models for Explaining the Etiology of Addiction 12
The Moral Model 13
Psychological Models 14
Family Models 16
The Disease Model 17
The Public Health Model 18
The Developmental Model 19
Biological Models 19
Multicausal Models 22
Summary and Some Final Notations 24 • Useful
Websites 24 • References 25
Chapter 2 Substance Addictions 30
Elizabeth H. Shilling, Laura J. Veach, Jennifer L. Rogers,
Regina R. Moro, and Hope Peterson-Sockwell
Substances of Addiction 31
Depressants 31
Opioids 39
Stimulants 42
Cannabinoids 47
Hallucinogens and Other Psychedelics 49
Neurobiology and the Physiology of Addiction 49
Neurobiological Components of Addiction:
Understanding the Reward Pathway 50
Neurobiological Components: The Addiction Cycle
and Understanding Loss of Control 53
Physiological Components of Addiction 56
Summary and Some Final Notations 58
Useful Websites 59 • References 59
Chapter 3 Process Addictions 65
Regina R. Moro, Laura J. Veach, Jennifer L. Rogers,
and Elizabeth H. Shilling
Introduction 65
Gambling Addiction 68
Technology Addiction 72
Sexual Addiction 75
Work Addiction 78
Compulsive Buying 83
Food Addiction and Disordered Eating 84
Exercise Addiction 86
Summary and Some Final Notations 89
Useful Websites 89 • References 89
Chapter 4 Professional Issues in Addictions Counseling 94
Melinda Haley, Deena Shelton, and Elom Togbi-Wonyo
Counselor Competence 95
Comorbidity 95
Clinical Knowledge of Polysubstance Use 96
Specific Populations 96
Knowledge of Theory, Treatment, and Recovery Models 98
Boundary Violation Issues 99
Multiculturalism 100
Education 102
Counselors in Recovery 103
Counselors Who Have Never Been Users 105
Self-Care 105
Continuing Education 106
Credentialing 106
Certification 106
Licensure 108
Accreditation 109
Treatment and Research Issues 109
Managed Care and Treatment Funding 109
Measuring Outcomes and Efficacy of Treatment 110
Professional Identity 110
Future Trends 111
Unity Among Addiction Professionals 111
Changes in U.S. Drug Laws 111
COVID-19 111
Summary and Some Final Notations 112 • Useful
Websites 112 • References 113
Chapter 5 Introduction to Assessment 118
Mark D. Stauffer, David Capuzzi, and Megan A. Flinn
Philosophical Foundations of Addictions Counseling 119
Hope 120
Strengths-Based Approaches 121
Holistic Approaches: Assessing the Whole Person 122
Client Collaboration in Addictions Counseling 127
Multidisciplinary Approach 128
The Role and Objectives of an Addictions Assessor 128
Assessment Across the Treatment Process 129
Empathic Connection and Rapport 129
Original Instrument Design and Purpose 130
Communicating Procedures and Results Clearly 130
Addictions Assessment Process 131
Structured, Semi-structured, and Unstructured Interviews 131
Gathering Background and Contextual Information 132
Client Presentation and Functioning 133
Key Points Related to Addiction Assessment 135
Motivation 135
Internal and External Triggers 136
Internal Consequences of Addiction 136
External Consequences of Addiction 137
Negative and Positive Consequences of Addiction 137
Expectancy 137
Current and Past Use of Addictive Behaviors 138
Onset and Historical Exposure 139
Prior Addiction and Mental Health Treatments 139
Ease of Access and Risky Sources 140
Family Systems and Peer Relationships 140
Summary and Some Final Notations 141 • Useful
Websites 142 • References 142
Chapter 6 Assessment and Diagnosis of
Substance-Related and Addictive Disorders 147
John M. Laux, Dilani M. Perera, Malvika Behl,
Jennifer Rio, Gwendolyn Hooks, and Paul T. Sundman
Diagnosing Using Dsm-5-TR 150
Substance-Related Disorders 150
Gambling Disorder (GD) 152
Why Use Standardized Assessments? 152
Philosophical Underpinning of Instrument Construction 154
How to Know Which Screen to Use 154
Sensitivity and Specificity 154
Reliability and Validity 155
Time and Cost Efficiency 155
Substance Use Disorder Instruments 156
Self-Administered Screening Instruments 156
Counselor-Initiated Comprehensive Substance
Abuse Assessment 161
Instruments Designed to Assess Alcohol Misuse
During Pregnancy 162
T-ACE 162
Tweak 163
Summary of Substance Use Disorder Screens 163
Process Addictions 163
Gambling Disorder Instruments 165
Brief Biosocial Gambling Screen 165
Early Intervention Gambling Health Test (EIGHT) Screen 165
Gamblers Anonymous Twenty Questions 166
National Opinion Research Center DSM Screen for
Gambling Problems 166
Problem Gambling Severity Index 167
South Oaks Gambling Screen 167
Other Process Addiction Instruments 168
Summary and Some Final Notations 172 • Useful
Websites 172 • References 172
PART 2 THE TREATMENT OF ADDICTIONS
Chapter 7 Motivational Interviewing 177
Lisa R. Langfuss Aasheim
Overview: Motivational Interviewing 177
The Stages-of-Change Model 178
Change and Resistance 183
Change 183
Resistance 183
Motivational Interviewing: Helping Clients Achieve Change 184
The Spirit of Collaboration in Motivational Interviewing 186
The Primary Principles of Motivational Interviewing 186
Motivational Interviewing Techniques: Early in
the Change Process 187
Five Techniques to Use Early and Often 187
The Role of Resistance in the Change Process 192
The Many Forms of Resistance 192
Reducing Resistance 193
Guiding the Change Process: More Motivational
Interviewing Techniques 196
Enhancing Confidence 196
Strengthening Commitment 197
Advantages and Disadvantages of Motivational Interviewing 197
Summary and Some Final Notations 198
Useful Websites 199 • References 199
Chapter 8 Psychotherapeutic Approaches 202
Cynthia J. Osborn, and Victoria Giegerich
Counselor Beliefs and Behaviors 203
Evidence-Based Approaches 204
Behavioral and Cognitive-Behavioral Assumptions
and Practices 206
Functional Analysis 207
Cognitive-Behavioral Interventions That Target
Triggers 209
Contingency Management and Behavior Contracting 211
Community Reinforcement Approach 212
Mindfulness-Based Approaches 213
Brief Interventions 215
Solution-Focused Counseling 217
SFC Research and Application to Addictions Treatment 217
Solution-Focused Integration 218
Solution-Focused Assumptions and Practices Useful in
Addictions Counseling 218
Harm Reduction 223
Trauma-Informed Approaches 226
Summary and Some Final Notations 228 • Useful
Websites 228 • References 229
Chapter 9 Treatment of Comorbid Disorders 235
Anthony Zazzarino, Crystal V. Socha, Scott E. Gillig,
and Pamela A. Cingel
Comorbidity vs. Co-Occurring 236
History and Prevalence of Comorbid Disorders 236
Screening and Assessment 237
Treatment and Care Needs 240
Counseling 240
Psychopharmacology 241
Social Support 241
Vocational Rehabilitation 241
Models of Treatment for Comorbid Disorders 242
Integrated Care 242
Assertive Community Treatment 243
Integrated Case Management 243
Dual Recovery Mutual Support Groups 244
A Brief Description of the Counseling Process That
Leads to Treatment Planning 245
Cultural Considerations Related to Treatment of
Comorbid Disorders 246
Racial and Ethnic Identity 247
Gender and Sexual/Affectional Identity 247
Use of Technology 248
Summary and Some Final Notations 249
Useful Websites 251 • References 251
Chapter 10 Group Counseling for Treatment of Addictions 254
Laura E. Rogers and Donna S. Sheperis
Theory Behind Group Work 255
Group Treatment of Substance Use Disorders 255
An Overview of Types of Groups 256
Psychoeducational Groups 257
Psychotherapeutic Groups 258
Self-Help Groups 260
Online Versus In-Person Groups 262
Ethical and Legal Issues with Groups 262
Competence of the Leader 262
Screening of Participants 263
Informed Consent 264
Confidentiality 264
Voluntary Versus Involuntary Participation 265
Group Stages 266
Managing Diversity in Group Settings 266
Race/Ethnicity 267
Gender 267
Sexuality 268
Type of Addiction 269
Group Counseling for Family Members of Clients
with Substance Use Disorders 270
Considerations for Psychoeducation Group Leaders 272
Issues Commonly Addressed in Group Counseling 273
Diversity Considerations for Group Leaders 275
Strategies for Effective Group Treatment 276
Summary and Some Final Notations 276 • Useful
Websites 276 • References 277
Chapter 11 Addiction Pharmacotherapy 280
Cass Dykeman, and Arien K. Muzacz
Rationale for a Chapter on Pharmacotherapy of Addiction 280
Terms and Concepts 282
Key Pharmacotherapy Terms 282
Key Concepts of Neurology in Pharmacotherapy 282
Diversity and Pharmacotherapy 283
Key Concepts of Neurotransmitters in Pharmacotherapy 286
Key Concepts of Pharmacokinetics in Pharmacotherapy 286
Key Concepts of Pharmacodynamics in
Pharmacotherapy 286
A Biological Theory of Craving 287
The Professional Counselor’s Role in Addiction
Pharmacotherapy 289
Application Example I: Pharmacotherapy of Alcohol
Use Disorder 291
Alcohol Withdrawal Pharmacotherapy 291
Alcohol Use Disorder: First-Line Pharmacotherapy 293
Alcohol Use Disorder: Comparative Efficacy of
Pharmacotherapies 293
Alcohol Use Disorder: Alternative Health Pharmacotherapy 294
Application Example II: Pharmacotherapy of Opioid
Use Disorder 294
First-Line Treatments 294
Opioid Use Disorder: Alternative Health Pharmacotherapy 295
Important Pharmacotherapy Terms 295
Summary and Some Final Notations 297 • Useful
Websites 297 • References 297
Chapter 12 Twelve-Step Facilitation of Treatment 303
Adrianne L. Johnson
History: Development of 12-Step Groups 304
Alcoholics Anonymous 304
Other Groups 305
The Group Process: How 12-Step Groups Work 307
Goals 307
The Twelve Steps and Twelve Traditions 308
Group Dynamics as Applied to 12-Step Groups 309
The Role of Sponsors in Recovery 309
Advantages, Disadvantages, and Efficacy of 12-Step
Groups 310
Disadvantages 311
Addressing Spirituality in 12-Step Groups 313
Using the 12-Step Group as Part of Treatment 315
The Role of the Counselor 316
How Can I Learn More About Groups? 320
Consult 320
Research 320
Get Involved 321
Summary and Some Final Notations 321 • Useful
Websites 322 • References 322
Chapter 13 Maintenance and Reoccurrences 325
Mita M. Johnson
Introduction 325
Recovery 326
Cravings 328
Continuum of Care 328
Goals of the Early Recovery Stage 329
Goals of the Maintenance Stage 330
Reoccurrences 331
Conceptualization of Reoccurrence 333
Stages of Reoccurrence 337
Reoccurrence Prevention 338
Identifying High-Risk Situations 341
Triggers 343
Fun 343
Building on Resiliency 344
Developing a Maintenance and RP Management Plan 345
Evidence-Based Therapies That Support
Maintenance and RP 346
Mindfulness Training 347
Peer Recovery Support Specialists 347
Technology-Assisted Recovery and RP 348
Summary and Some Final Notations 348 • Useful
Websites 349 • References 349
PART 3 ADDICTIONS IN FAMILY THERAPY,
REHABILITATION, AND SCHOOL SETTINGS
Chapter 14 Substance Use and Families 352
Krista D. Speicher, and Kristin A. Vincenzes
Substance Use and the Family 353
Family Systems 353
Stages in Family Systems with Substance Use 358
Parenting in a Family System with Substance Use 358
Substance Use and the Couple 359
The Impact of Substance Use on Couple Relationships 360
Impact of Parental Substance Use on Children 364
Behavioral Outcomes 366
Psychosocial Outcomes 366
Counseling Families with Substance Use Disorder 369
Efficacy of Couples and Family Counseling 369
Assessment of Family Systems with Substance Use 370
Treatment Approaches for Family Systems with
Substance Use 372
Summary and Some Final Notations 375 • Useful
Websites 375 • References 376
Chapter 15 Persons with Disabilities and Substance
Use Disorders 381
Debra A. Harley, and Hyun-Ju Ju
Introduction 381
Impact of Substance Use Disorder on People with Disabilities 383
Characteristics and Status of People with
Disabilities and SUD 387
Risk Factors for Persons with Disabilities 392
Health and Medical Risk Factors 393
Psychological Risk Factors 393
Interpersonal and Social Risk Factors 394
Economic and Employment Risk Factors 394
Access Risk Factors 395
Sociocultural Factors 396
Exposure to Trauma 397
Treatment Utilization and Outcomes 398
Summary and Some Final Notations 402 • Useful
Websites 402 • Summary of Key Points of People with
Disabilities 403 • References 403
Chapter 16 Substance Use Disorder Prevention Programs
Across the Lifespan 407
Abbé A. Finn, Ph.D.
Evidence-Based Prevention Programs 409
Prevention Research 409
Program Needs Assessment 410
Diversity, Equity, and Inclusion 412
Capacity 413
Planning 413
Implementation 413
Evaluation 414
Substance Use Disorders by the Numbers 414
Prevention Programs Targeting Children and Adolescents 418
Opioid Prevention 418
Early Treatment for Adolescents with a Co-occurring
Psychiatric Disorder 418
Juvenile Court Diversionary Programs 419
Prevention Programs Targeting Schools 420
Prevention Programs Targeting Students in
Higher Education 424
Brief Alcohol Screening and Intervention
for College Students 427
Prevention Programs Focused on Mass-Media
Campaigns Targeting Young Adult Populations 427
Collegiate Recovery Community 428
Prevention and Treatment Programs for
Pregnant Adolescents and Adults 428
Maternal, Infant, and Young Children
Home Visitation (MIYCHV) Programs 430
Prevention Programs Targeting the Military and
Their Families 432
Military Personnel 432
Veterans and Their Families 433
Prevention Programs Targeting Older Adults 433
Summary and Some Final Notations 435 • Useful
Websites 435 • References 436
PART 4 CROSS-CULTURAL COUNSELING IN ADDICTIONS
Chapter 17 Cross-Cultural Counseling: Engaging
Ethnic Diversity 441
Ashley L. Keaton, Jane E. Rheineck, and Amy L. Barth
Substance Use Demographic Trends in the United States 441
Why does Culture Matter in Substance Use Treatment? 442
Definitions 443
How Did We Get to This Point? 443
Treatment Needs and Issues for Racial and Ethnic Minorities 445
Disparities in Use and Access to Treatment 446
Racial and Ethnic Minorities 446
Theoretical Frameworks 452
Racial and Cultural Identity Models 452
Anti-Racist Framework for Substance Use Treatment 453
Multicultural and Social Justice Competencies 456
Application of Culturally Sensitive Treatment 457
Summary and Some Final Notations 463 • Useful
Websites 463 • References 463
Chapter 18 Gender, Sex, and Addictions 467
Cynthia A. Briggs, and Jill M. Lee-Hubble
Gender and Addiction in the United States 468
Prenatal Exposure 471
Women and Addiction 472
Biological Considerations 472
Psychological Considerations 474
Social Considerations 475
Special Considerations for Addicted Women 475
Men and Addiction 477
Biological Considerations 477
Psychological Considerations 478
Social Considerations 479
Treatment Considerations 480
Treatment Overview and History 480
Gender-Specific Treatment Needs: Women 481
Mix-Gendered Treatment: Women 481
Evidence-Based Practices: Women 482
Gender-Specific Treatment Needs: Men 483
Gender-Specific Treatment Needs: Transgender Clients 485
Gender-Specific Treatment Needs: Intersex Clients/
Clients with Difference of Sex Development 486
Treatment Outcomes and Relapse Prevention 487
Behavioral Addiction and Gender 487
Summary and Some Final Notations 488 • Useful
Websites 489 • References 489
Chapter 19 Lesbian, Gay, Bisexual, Trans, and Queer
Affirmative Addictions Treatment 494
Anneliese A. Singh, Joshua D. Smith, Frank B. Gorritz
FitzSimons, and Taryne M. Mingo
Common Terms for and Myths About LGBTQ+ People 497
Coming Out, Cultural Differences, and Addiction 499
LGBTQ+ Affirmative Addictions Treatment and Assessment 501
LGBTQ+ Specific Assessment of Addiction 503
LGBTQ+ -Specific Treatment of Addiction 507
Modality Issues 507
Relapse Prevention 509
Role of Addictions Counselors Working with
LGBTQ+ Clients 509
Creating a Safe Environment for LGBTQ+ People 511
How to Be an Advocate for LGBTQ-Affirmative Treatment 512
Summary and Some Final Notations 514 • Useful
Websites 515 • References 516
EPILOGUE SOME ADDITIONAL PERSPECTIVES
Chapter 20 Inpatient and Outpatient Addiction Treatment 521
Richard J. Cicchetti, G. Michael Szirony, and Craig R. Blum
Assessment and Types or Levels of Care 523
Assessment Dimensions 523
Outpatient Treatment: Asam Levels of Care 0.5, 1, and 2 527
Types of Outpatient Drug Treatment 527
Inpatient and Residential Services 532
Outreach Services 534
What to Expect in Practice 535
Drug and Alcohol Legislation Affecting Treatment 537
Federal Bureau of Prison Treatment Programs 540
Drug Courts 541
Cost to Society 541
Advocating for Social Change 542
Summary and Some Final Notations 543 • Useful
Websites 544 • References 544
Index 548