Addiction Counseling Research Articles

Training Addiction Counselors to Implement an Evidence-Based Intervention: Strategies for Increasing Organizational and Provider Acceptance

One barrier to widespread public access to empirically supported treatments (ESTs) is the limited availability and high cost of professionals trained to deliver them. Our earlier work from 2 clinical trials demonstrated that front-line addiction counselors could be trained to deliver a manualized, group-based cognitive behavioral therapy (GCBT) for depression, a prototypic example of an EST, with a high level of adherence and competence. This follow-up article provides specific recommendations for the selection and initial training of counselors, and for the structure and process of their ongoing clinical supervision. We highlight unique challenges in working with counselors unaccustomed to traditional clinical supervision. The recommendations are based on comprehensive feedback derived from clinician notes taken throughout the clinical trials, a focus group with counselors conducted 1year following implementation, and interviews with key organization executives and administrators.

The Medicalization of Addiction Treatment Professionals

In a previous article, the authors described the changes initiated by recent health care legislation, and how those changes might affect the practice of medicine and the delivery of addiction services. This article reviews the same changes with respect to how they have the potential to change the practice activities of addiction physicians, addiction therapists, addiction counselors and addiction nurses, as well as the activities of administrators and service delivery financial personnel. Developments in delivery systems and the impact of those developments on professionals who work in addiction treatment are considered; current problems, potential solutions, and opportunities for clinicians under health reform are addressed. The goals envisioned for health system reform and the potential for realization of those goals via changes in addiction service delivery design and clinical practice are discussed.

Ethics and Accreditation in Addictions Counselor Training: Possible Field Placement Issues for CACREP‐Accredited Addictions Counseling Programs

The Council for Accreditation of Counseling and Related Educational Programs now recognizes addictions counseling as a specialized field of practice. Two case studies illustrate possible unintended violations of ethical and training standards.

Reaching out and reaching up - developing a low cost drug treatment system in Cambodia

Cambodia, confronted by the spread of drug misuse among young people, requested support from international agencies to develop a drug treatment programme in 2000. The initial plan developed by the United Nations Office on Drugs and Crime was to set up a number of conventional drug treatment centres in urban areas. During the planning phase, however, the project was redesigned as a community based outreach programme. Ten Community Counselling Teams have been formed and trained in pilot areas, and within the first year of operation 462 drug and alcohol users contacted. Comprising former drug users, family members affected by drug use and health care staff, they have drug scene credibility, local knowledge and connectivity, and a rudimentary level of medical competence. Crucially, they enjoy the support of village elders, who are involved in the planning and reporting stages. While the Community Counselling Teams with their basic training in addiction counselling are in no position as yet to either provide or refer clients to treatment, they can provide brief interventions, organise self help groups, and most importantly provide an alternative to law enforcement. By taking a development centred approach, with emphasis on community, empowerment and inclusion, it provides a constructive and inclusive alternative to medical approaches and the compulsory drug treatment centres. The paper is based on an evaluation involving interviews with a range of stakeholders and a review of project documents.

Addiction Counseling Licensure Issues for Licensed Professional Counselors

Go To DigestThis article addresses the obstacles of effectively integrating addiction counseling into a nationwide definition of professional counseling scope of practice. The article covers an overview of issues, specific licensure and credentialing frameworks in two U.S. states, and recommendations to effectively bridge the gap between professional and addiction counseling.The question of professional identity within the counseling profession, first considered during the founding of the American Personnel and Guidance Association (Sweeney, 1995), still exists today (Calley & Hawley, 2008; Cashwell, Kleist, & Schofield, 2009; Mellin, Hunt, & Nichols, 2011; Myers, Sweeney, & White, 2002; Nassar-McMillan & Niles, 2011; Remley & Herlihy, 2009). One possible reason for the continual debate around professional identity may lie in the multitude of specialty fields (e.g., addiction, career, and school) within counseling (Gale & Austin, 2003; Myers, 1995; O'Brien, 2010). Remley (1995) underscores that unlike psychology, psychiatry and social work, counseling is the only mental health profession that licenses specialty areas. Specialty areas such as career and school counseling only denote a practice area or population; whereas addiction counseling actually entails a DSM-IV-TR Axis I disorder (i.e., Substance Use Disorders; American Psychiatric Association, 2000). No other Axis I or Axis II disorder receives such attention.Addiction is considered a part of professional counseling as implied by the latest CACREP standards (2009). However, a separate licensure track exists for the profession of addiction counseling. If the practice of addiction counseling really is a part of counseling (as implied by the latest 2009 CACREP standards), then the time has come to recalibrate the rest of the counseling profession to better fit an inclusive and unifying professional counseling identity that includes addiction counseling. Thus, the purpose of this paper is to start the dialogue regarding the mixed-messages on the issue of counselor identity and specialization for addiction counseling (Morgen, Miller, Culbreth, & Juhnke, 2011; Tabor, Camisa, Yu, & Doncheski, 2011). The article is divided into an overview of issues, specific licensure and credentialing frameworks in two sample states (New Jersey and North Carolina), and recommendations in response to the concerns discussed.Overview of IssuesHenriksen, Nelson, and Watts (2010) criticize the counseling specialty system by arguing that counseling specialties do not define counseling, but merely denote a practice area and that counseling specialty licensure/credentialing implies that only a small proportion of the counseling profession is qualified to work with this population. The addiction area is one such area of specialization that comes with a separate licensure/credentialing process. The authors believe that in regard to addiction counseling, the additional supervisory and training hours required for addiction licensure/credentialing (in addition to the supervisory and training hours required for licensure as a professional counselor) implies that addiction content falls outside the professional counseling scope of practice.For instance, if the graduate counseling program does not possess an addiction track, a cursory review of curriculum at CACREP and non-C ACREP programs found the typical option of one addiction course as an elective. However, curricular reviews of numerous programs find few to no electives on other DSM-IV-TR disorders (e.g., mood, anxiety). Thus, the authors argue this produces a confusing mixed-message in that licensure as a professional counselor covers practice areas that typically receive minimal exclusive attention (e.g., one-week discussion on anxiety disorders in a maladaptive behavior course), yet an area where one (or more) electives are typically offered for in-depth study of a disorder (such as addiction) comes with an entirely unique and separate licensure process. …

Developing an evidence-based, multimedia group counseling curriculum toolkit

Training community-based addiction counselors in empirically supported treatments (ESTs) far exceeds the ever-decreasing resources of publicly funded treatment agencies. This feasibility study describes the development and pilot testing of a group counseling toolkit (an approach adapted from the education field) focused on relapse prevention (RP). When counselors (N = 17) used the RP toolkit after 3 hours of training, their content adherence scores on “coping with craving” and “drug refusal skills” showed significant improvement, as indicated by very large effect sizes (Cohen's d = 1.49 and 1.34, respectively). Counselor skillfulness, in the “adequate-to-average” range at baseline, did not change. Although this feasibility study indicates some benefit to counselor EST acquisition, it is important to note that the impact of the curriculum on client outcomes is unknown. Because a majority of addiction treatment is delivered in group format, a multimedia curriculum approach may assist counselors in applying ESTs in the context of actual service delivery.

Neuroscience exposure and perceptions of client responsibility among addictions counselors

Members of the National Association of Alcoholism and Drug Abuse Counselors (n = 231) participated in a survey concerning their view of the role of personal responsibility in addictions treatment and its relation to their exposure to neuroscience (i.e., the amount to which members considered themselves familiar with current neuroscience research). We used the two-dimensional model of responsibility (Responsible/not responsible for development × Responsible/not responsible for recovery) proposed by P. Brickman et al. (1982) to guide our assessment of responsibility, thus inquiring about counselors' views of clients' responsibility for both the development of a substance-related addiction and its resolution. Findings suggest that counselors rate biological factors as most influential in the development of an addiction and assign clients less personal responsibility for the development of an addiction than for recovery from an addiction. Counselors' level of neuroscience exposure was negatively correlated with their ratings of client responsibility for the development of an addiction but positively correlated to ratings of client responsibility for recovery. This suggests that counselors are integrating neuroscientific findings with what is learned from other modes of enquiry in a way that diminishes the view that clients are responsible for addiction development but accentuates the view that clients are responsible for recovery. We explore reasons for why this is and why this approach may be beneficial.

Reframing Recovery: Developmental Considerations for Maintaining Change

Lasting recovery for clients can be challenging to establish in addictions counseling. Through the combination of 2 approaches, motivational interviewing and developmental counseling and therapy, client treatment can be refined to promote transformative change and long‐lasting recovery.

A Randomized Controlled Trial Comparing Integrated Cognitive Behavioral Therapy Versus Individual Addiction Counseling for Co-occurring Substance Use and Posttraumatic Stress Disorders

Objective: Co-occurring posttraumatic stress (PTSD) and substance use disorders provide clinical challenges to addiction treatment providers. Interventions are needed that are effective, well-tolerated by patients, and capable of being delivered by typical clinicians in community settings. This is a randomized controlled trial of integrated cognitive behavioral therapy for co-occurring PTSD and substance use disorders. Methods: Fifty-three participants sampled from seven community addiction treatment programs were randomized to integrated cognitive behavioral therapy plus standard care or individual addiction counseling plus standard care. Fourteen community therapists employed by these programs delivered both manual-guided therapies. Primary outcomes were PTSD symptoms, substance use symptoms, and therapy retention. Participants were assessed at baseline, 3- and 6-month follow-up. Results: Integrated cognitive behavioral therapy was more effective than individual addiction counseling in reducing PTSD re-experiencing symptoms and PTSD diagnosis. Individual addiction counseling was comparably effective to integrated cognitive behavioral therapy in substance use outcomes and on other measures of psychiatric symptom severity. Participants assigned to individual addiction counseling with severe PTSD were less likely to initiate and engage in the therapy than those assigned to integrated cognitive behavioral therapy. In general, participants with severe PTSD were more likely to benefit from integrated cognitive behavioral therapy. Conclusions: The findings support the promise of efficacy of integrated cognitive behavioral therapy in improving outcomes for persons in addiction treatment with PTSD. Community counselors delivered both interventions with satisfactory adherence and competence. Despite several limitations to this research, a larger randomized controlled trial of integrated cognitive behavioral therapy appears to be warranted.

Interview & innovative practice with Merrill Norton, Pharm.D., NCAC II, CCS, CCDP-D

Interview & innovative practice with Merrill Norton, Pharm.D., NCAC II, CCS, CCDP-D

Counselor training in several evidence-based psychosocial addiction treatments in private US substance abuse treatment centers

Background Given that most addiction counselors enter the field unprepared to implement psychosocial evidence-based practices (EBPs), surprisingly little is known about the extent to which substance abuse treatment centers provide their counselors with formal training in these treatments. This study examines the extent of formal training that treatment centers provide their counselors in cognitive behavioral therapy (CBT), motivational interviewing (MI), contingency management (CM), and brief strategic family therapy (BSFT). Methods Face-to-face interviews with 340 directors of a nationally representative sample of privately funded US substance abuse treatment centers. Results Although a substantial number of treatment centers provide their counselors with formal training in EBPs that they use with their clients, coverage is far from complete. For example, of those centers that use CBT, 34% do not provide their counselors with any formal training in CBT (either initially or annually), and 61% do not provide training in CBT that includes supervised training cases. Sizable training gaps exist for MI, CM, and BSFT as well. Conclusions The large training gaps found in this study give rise to concerns regarding the integrity with which CBT, MI, CM, and BSFT are being delivered by counselors in private US substance abuse treatment centers. Future research should examine the generalizability of our findings to other types of treatment centers (e.g., public) and to the implementation of other EBPs.

Neuer Präventionsansatz zur Vermeidung und Reduzierung von Suchtmittelkonsum in Schwangerschaft und Stillzeit

The Sozialdienst Katholischer Frauen e. V. and Sozialdienst Katholischer Manner e. V. as well as the German Institute for Addiction and Prevention Research (Catholic University of Applied Sciences, NRW) cooperate within this pilot project to reduce the consumption of psychotropic substances – especially alcohol and tobacco – among women during pregnancy and the breast feeding period. To reach the objectives of this project the access to specific counselling and treatment services will be optimized by building up an innovative tandem structure of pregnancy and addiction counselling services and by using the existing resources and structures. Particularly the involvement of the counselling services for pregnant women with their low thresholds of access will be used to enable affected women the reachability of the addiction specific counselling and treatment services. Simultaneously the efficiency of the intervention methods Motivational Interviewing and SKOLL (self-control training for responsible dealing with addictive substances) on pregnant women will be investigated. Concerning the systemic perspective the offer of target group specific services will be widen by counselling services for relatives and post-natal courses for strengthening the mother and child relationship as well as their competences of education. Results of the process- and outcome-evaluation will be available in 2012.

Alcoholics and narcotics anonymous: A radical movement under threat

In recent decades, the considerable proliferation of the self-help groups (especially those of the Alcoholics Anonymous (AA) and Narcotics Anonymous (NA)) has attracted the interest of those engaged in the social sciences as well as of those responsible for mapping out health policies. This article is based on the 10-year involvement of the authors in a participatory action research project for the promotion of self-help groups in Greece as well as to an extensive literature review of the AA and NA movements. Based on this methodology, the objective of this article is twofold. First, it identifies the radical perspective of self-help groups, as the main source for their effectiveness, while it attempts an assessment of their effect on traditional professional attitudes. Second, it raises concerns over the radical perspective of these initiatives in the framework of their transition from an alternative stance towards their integration in formal Health Systems. This transition process is manifested in the following developments: (1) the constantly increasing number of old members who quit the role of the volunteer sponsor and undertake the financially beneficial role of (para-) professional addiction counselor; (2) the instrumentalization of 12 steps; (3) the increasing number of members who adopt the nosological perspective of addiction 4. The various adverse effects of dominant culture on the internal working of the groups are studied. Moreover, this article attempts a comparative assessment of the produced experience with the AA and NA movements in Greece and abroad.

Doctors and Medical Students Case Managed by an Australian Doctors Health Program: Characteristics and Outcomes

The aim of this paper is to describe the characteristics and outcomes of participants with an Australian physician health program, the Victorian Doctors Health Program (VDHP), for case management of substance use disorder (SUD) and/or significant mental illness. As part of quality assurance, processes data, including demographic information, care plan components and outcomes, were analysed. Between 2001 and 2008, 115 participants undertook case management plans with the VDHP. The majority (n = 71, 62%) had some involvement with the Medical Practitioners Board of Victoria (MPBV). Case management included facilitating referrals to addiction specialists, psychiatrists, counsellors and peer-based support. Ninety (78%) participants reported SUD, the remainder having mental illness (n = 25, 22%). Alcohol was the main drug reported by the SUD group (n = 44, 49%). Most of the SUD participants undertook biochemical monitoring. On commencement with the VDHP, 39 (34%) participants were on leave due to illness. The majority of participants case managed for 5 years were in medical work (n = 31, 84%). Case management by an independent physician health program may protect the health of the doctor and the community, and could be considered in other jurisdictions.

Training Addiction Counselors to Implement CBT for Depression

Many clients in publicly funded substance abuse treatment programs suffer from depression yet lack access to effective mental health treatment. This study sought to examine whether addiction counselors could be effectively trained to deliver group CBT for depression and to ascertain client perceptions of the treatment. Five counselors were trained in the therapy and treated 113 clients with depression symptoms. Counselors demonstrated high fidelity to the therapy and client perceptions of the therapy were positive. Our results suggest that training addiction counselors to deliver group CBT for depression is a promising integrated treatment approach for co-occurring depression and substance disorders.

Burnout among the addiction counseling workforce: The differential roles of mindfulness and values-based processes and work-site factors

Although work-site factors have been shown to be a consistent predictor of burnout, the importance of mindfulness and values-based processes among addiction counselors has been little examined. In this study, we explored how strongly experiential avoidance, cognitive fusion, and values commitment related to burnout after controlling for well-established work-site factors (job control, coworker support, supervisor support, salary, workload, and tenure). We conducted a cross-sectional survey among 699 addiction counselors working for urban substance abuse treatment providers in six states of the United States. Results corroborated the importance of work-site factors for burnout reduction in this specific population, but we found that mindfulness and values-based processes had a stronger and more consistent relationship with burnout as compared with work-site factors. We conclude that interventions that target experiential avoidance, cognitive fusion, and values commitment may provide a possible new direction for the reduction of burnout among addiction counselors.

Addiction Counselors in Recovery: Perceived Barriers in the Workplace

In the 1970’s when the substance abuse treatment field was still developing as a discipline, there was a great deal of workers needed to help with the large amount of substance abusers wanting help. And since specific credentials were not yet established for the field of addictions, individuals with sobriety were hired on and given on the job training. The literature has described many barriers that the counselor in recovery has been faced with over the decades. A common theme throughout the literature is that these individuals usually enter the field at an older age and have less formal education than the non-recovering counsellor. The role of the counsellor in recovery is often distorted within the field by the second-class citizen status to which they are sometimes subjected. By writing this paper we hope to resurrect topics that might be perceived as barriers by counsellors in recovery that were briefly discussed in the literature decades ago. To begin this process of reform, this paper reviews the literature in an attempt to examine the perceived barriers associated with the recovering addict working in the addiction field. It also addresses the limitations of the studies conducted to date, provides recommendations for further research and proposes that this topic be explored using a qualitative approach, so that this unique group of counsellors can construct their own narratives.

Recovered Addicts Working in the Addiction Field: How do Substance Abuse Treatment Agencies Work with Substance Abuse Relapse among Addiction Counsellors who are in Recovery?

The potential for relapse among recovered counsellors if one accepts that substance abuse is a chronic illness, which often entails relapse, is a topic that has been neglected by the scientific community. The lack of research in this area needs to be addressed especially when bearing in mind the possible unresolved issues motivating some “ex-addicts” seeking employment in the field. Given that relapse among recovered counsellors is not a rare phenomena, the research posed certain questions with regards to how agencies work with employees who have had a substance abuse relapse. Using a case study design, the authors reviewed two diverse urban substance abuse treatment agencies with very distinctively different ways of working with recovered counsellors who have relapsed.

Problematic Internet use: Perceptions of addiction counsellors

Despite a growing number of publications on problematic Internet use (PIU), there is no consensus on the nature of the phenomenon, its constituent criteria, and its clinical threshold. This qualitative study examines the perceptions of addiction counsellors who have managed individuals with PIU in Québec (Canada). Four focus groups were conducted with 21 addictions counsellors working in public addiction rehabilitation centres. Discussion groups were digitally recorded, transcribed using a word processor, and analyzed using N’vivo 8.0 software. The results present the perceptions of counsellors regarding case management issues, including problematic applications, clinical picture, number of hours of Internet use for assessment, and for treatment.

Social Work Clinical Supervision in the Addictions: Importance of Understanding Professional Cultures

Over the past 30 years, increasing numbers of social workers have entered the field of alcohol and other drug addiction treatment. Many of them have assumed supervisory roles. Social workers who supervise addiction counselors are supervising across an often unrecognized cultural divide between the professions of social work and addictions counseling. This article compares the social work and addiction counseling cultures to enable social work clinical supervisors to recognize and bridge the divide between these 2 professions. Those supervisors who can bridge this divide can better support their supervisees' professional growth; they are also more likely to experience performance satisfaction.