Foundations of Addictions Counseling, Fifth Edition by David Capuzzi and Mark D. Stauffer

By

Foundations of Addictions Counseling, Fifth Edition

David Capuzzi and Mark D. Stauffer

Foundations of Addictions Counseling

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

Internet Gaming Disorder 73

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

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