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Chemical Dependency Counseling
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Chemical Dependency Counseling
A Practical Guide

Fifth Edition


© 2017 | 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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