[Ebook PDF] Chemical Dependency Counseling: A Practical Guide, 5th Edition

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Chemical Dependency Counseling: A Practical Guide, 5th Edition

Authors: Robert R. Perkinson (Author)

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.

Preface to the Fifth Edition
Things are changing in the addiction world, and the new health care parity and Affordable Care Act should make things better. As I travel around the country giving workshops on addictive disorders, I often have the privilege of listening to the leaders in the field speak, and I find they are all saying the same thing.
Addiction is a brain disease that needs long-term management. For decades, the field of addiction was living in the belief that treatment takes a few weeks. This is not true for any chronic disease, including hypertension, diabetes, asthma, or addiction. Addiction needs management for a lifetime. The gold standard in addiction treatment is found in programs designed for physicians and airline pilots. This starts off with 90 days in inpatient treatment, followed by a very aggressive relapse prevention plan that requires telephone contact with one random urine analysis (UA) a week for the first 6 months, then the successful
client can extend random UAs to every month and then finally every year. Random drug screens mean the client never knows when he or she will get called in for a urine drug screen. Sometimes counselors use hair drug testing that can tell if a client is using more often. The clients are monitored with weekly phone calls as long as it is necessary to stabilize recovery. One 12-step meeting is required every day for the first 90 days, and the client must acquire a sponsor. Once a year in continuing care the client attends a weekly return to the treatment center with the clients he or she went through the original program with, solidifying how they are doing in recovery and discussing what worked and what didn’t work to maintain their sobriety.
Clients who get well need to come into treatment for an individualized number of days, weeks, months, or even years and are then followed in continuing care for at least the next 5 years; that is when the relapse rate drops to around zero. Continuing care should include random drug screens, therapy, motivational enhancement, treatment for co-occurring disorders, mandatory attendance at 12- step meetings, sponsorship, spiritual direction, lifestyle management, enhanced recreation, support from the family, and finding new friends in recovery. There is no easy fix or magic bullet; recovery is hard work. However, it is incredibly rewarding. We are fortunate in addiction treatment to see our clients literally blossom into health before our eyes. Advancements in new treatments and medications will continue to change the field almost on a daily basis, so we must remain open to new treatments whenever possible. In any field, change occurs slowly in incremental steps.
Unfortunately, along with huge advancements in recovery, the field of addiction treatment is shrinking. This is a catastrophe because millions of our brothers and sisters will die, and millions will spend valuable time in prison. Most addiction programs today occur in outpatient settings with an average of 6 to 10 counselors working with 150 to 500 clients. This results in poor treatment outcomes.
Research says that approximately two-thirds of client’s relapse in the first year. Only 40% of these treatment programs offer individual sessions; they have no medical or medication support and are overwhelmed with paperwork. The turnover of staff is dismal—about 50% —which is as high as the fast-food industry. Because of managed care, we have been trying to make treatment cheaper and more effective. This has led to cost cutting and usually staff cutting, which leads to fewer professionals working with more clients. A few hospitals such as the Talbott Recovery Addiction Treatment Center are doing things differently.
They focus on the client first, believing that better care leads to a more stable system, better outcomes, and greater financial rewards. They concentrate on prevention, treatment, and continuing care.
It is possible to treat addiction the right way the first time. Most addicts come through treatment three or four times. Most addicts eventually stop using on their own by making a motivated, life-changing decision, usually made with the help of someone in recovery or a health care professional (McLellan, 2006). Still, many clients will not be able to recover without treatment. “I have spent my whole career looking at all of the kinds of things that have been tried—at least in the country—to reduce substance use problems, and treatment is by far the best” (McLellan, 2010, p. 26).
Because of third-party payers, thousands of treatment centers have closed. There are more than 23 million diagnosed addicts in the United States on any given day, and only 3 to 10% are in treatment. Worst of all, most professionals in the field are not using evidence-based treatments but treatments they learned in their own recovery or on-the-job training. These treatments do not work as well as evidence-based treatment programs. When we see a client, we want to know we are giving that person the best treatment in the world.
For the first time, science has shown us how to keep most addicts clean after only one treatment. If you read articles or hear speeches by the leaders in the field, you will read about this new revolution: treatment that works developed in the programs where the cost of treatment was irrelevant because the cost of relapse was deadly to the public. This initially came from the work with physicians and
then branched out to other professionals such as airline pilots. No one wants a pilot flying a plane or a physician doing surgery while intoxicated. No price was too high to pay these professionals to stay clean and sober. These people had to stay clean to protect all of our lives. These programs developed markedly higher recovery rates hovering around 90%. If we develop similar programs for all substance abusers, most of our clients will stay clean and sober. It is obvious that this will be more effective and cheaper in the long run. Until now, third-party payers were reluctant to pay for treatment because it rarely worked. However, the treatment success rate in addiction is similar to the treatment of other chronic diseases. Third-party payers should be willing to pay for treatment that restores a client to health (Marlatt & Donovan, 2008; McKay, 2005; Skipper & DuPont, 2010; White, 2009).
There are many treatments for addiction, and most of them work, but it is important to note that when physicians treat their own, all these successful programs focus on 12-step facilitation and sponsorship as the core of treatment (Skipper, 1997; Skipper & DuPont, 2010). Studies show that if abstinence is the desired outcome, consistent involvement with 12-step meetings produces the best results. About 76% of treatment programs use the 12 steps as their basis (Florentine & Hillhouse, 2000).
Robert L. DuPont, MD, the founding director of the National Institute on Drug Abuse (NIDA), said the following: Today, I see these fellowships as a modern miracle and the key to sustained recovery for most, but not all, addicts. . .. In fact, these programs created the entirely new concept of “recovery,” which is much more than mere abstinence. The 12-step fellowships support a new and better way of life. (White, 2010, p. 43) These programs for professionals also use evidence-based therapies such as motivational enhancement, cognitive behavioral therapy, and medication including disulfiram, naltrexone, acamprosate, buprenorphine, and topiramate. The change required is an emotional, interpersonal, and spiritual shift (Earley, 2009). This same treatment should be available for all clients. This manual will concentrate on five evidence-based treatments:
1. Cognitive behavioral therapy
2. Motivational enhancement
3. Pharmacology
4. Skills training
5. 12-step facilitation
The Minnesota Model is the gold standard for alcohol and drug treatment. The research evidence for this treatment says that it is a good start, but continuing care in most programs is lacking. Two-thirds of clients going through these programs relapse in the first year after treatment. This is exactly like the treatment of other chronic relapsing diseases such as hypertension, asthma, and diabetes. These
chronic diseases have almost identical genetic concordance rates, about 50 to 60%; treatment compliance rates, about 50 to 60%; and relapse rates, about 50 to 60%. Health care has become an acute care business, but many chronic diseases need lifelong management. In acute medicine, clients learn what they need to do to stay healthy, but about half of them do not comply with treatment. Only half of
substance abuse clients are encouraged to go to 12-step meetings, and we know that these meetings help addicts recover. Clients may be encouraged to get a sponsor, go to some kind of counseling, and take their medications, but most of them are not followed up, do not comply, drop out, and relapse. This book outlines the best treatment in the world. The leading treatment centers and addiction professionals have contributed to and approved of this text. You might not work at a large treatment center that has all of these services available, but the more of these components you add, the better your treatment will become.
The best treatment centers have a large, multidisciplined staff, but even these treatment centers fail miserably when it comes to continuing care. They fail because they are not paid for the continuing care that works. It must become a part of your mission to change this policy. Recovery does not take a set number of days, weeks, months, or years but usually takes a lifetime of vigilance and hard work.
You are reading this book because you are interested in working with addicts. Congratulations! You can be proud of yourself because addiction treatment is effective and fun. You belong in one of the most rewarding professions in the world. In addition, with counseling you will watch your clients change from being at death’s door to being happy, joyous, and free. Treating alcoholics and addicts, you will be working with some of the most caring and dedicated professionals in the world. You will save lives, change the world, and have loads of fun. Because of whom you are and what you do, you have my greatest respect. I hope this manual, developed by thousands of treatment programs and professionals, will benefit you in your work.
—Robert R. Perkinson
brought to my attention.
WDN
Greeley, Colorado