A Contemporary Approach to Substance Use Disorders and Addiction Counseling

Ford Brooks, Bill McHenry

• Publisher: American Counseling Association
• Year: 2015
• ISBN:
  9781119098195
• Edition: 2
• Topic: Psychology
• Subtopic: Clinical Psychology
• Index: Psychology

Written as an introduction to the field of addiction counseling, this text covers the fundamental knowledge and skills necessary to counsel people who are struggling with addiction. Drs. Brooks and McHenry provide a straightforward and holistic approach to treatment and recovery, from the major theoretical underpinnings, to assessment and diagnosis, to relapse prevention and spirituality. With a focus on current clinical applications and how-tos, this book is ideal both for master's-level addictions courses and mental health clinicians.

Topics covered are cultural and gender issues, including work with LGBT clients; drug classifications and referral; assessment, diagnosis, and interview techniques; the continuum from nonuse to addiction; work in college/university, school, and community/mental health agency settings; developmental approaches in treatment; the role of the family; grief and loss in addiction; group counseling; relapse and recovery; spirituality and support groups; addictions training, certification, and ethics; and the importance of counselor self-care. Exploration questions and suggested activities are presented in each chapter.

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Chapter 1
Drug and Alcohol Counseling: An Introduction

To the Fish and the Owl
The Alpha and the Omega
Synchronicity at the Time of Death
Brought Forth Life and Spirit

—Ford Brooks

A client presents during his intake evaluation that he is using three grams of cocaine four times a week and is about to lose his job, his marriage, and all of his life’s savings because of his use. He is coming to you for help, yet he is resistant to inpatient drug and alcohol treatment.

A 16-year-old female student is referred to you for “behavioral problems” in the classroom and was just suspended for smoking cigarettes in the bathroom. During the session you suspect she is under the influence of drugs.

A 60-year-old male comes in for issues of depression, yet during the session you detect the faint smell of alcohol.

In each of these cases, what would you do and how might you proceed? Working with clients who suffer from substance abuse and addiction problems is very challenging and at the same time can be very rewarding. As clinicians who have worked with this client population and counselor educators who teach this subject, we wish to convey information, suggestions, and strategies to best work with this clinical issue and population.

Our Stories

When I (Ford) started as a counselor in the drug and alcohol field, I struggled because I was a novice with only a basic understanding of the requirements to work with drug- and alcohol-addicted clients. Despite being anointed a master’s-level alcohol and drug rehabilitation counselor, I toiled and labored to understand the use of “self” in effecting positive change, especially with clients experiencing significant emotional and physical pain. I could not fully envision the power of compassion; nor could I fully grasp the negative presence my frustration could have on clients. I struggled to grasp how spontaneity and hope could possibly be as important as confrontation, urine screens, and alcohol and drug education.

When I (Bill) started working with clients who had drug and alcohol issues, I struggled. My previous counseling experiences were with other types of clients exhibiting other types of problems. I labored to effectively connect and make meaning of the stories of drug and alcohol clients. As I saw clients relapse, I saw failure; as I saw clients using again, I framed it as wrong. My dichotomous thinking regarding alcohol and drug clients retarded my general nature of believing in and valuing the journey.

The Counseling Relationship

One of the main reasons we wrote this text is to encourage readers to more fully engage in the helping process with drug- and alcohol-addicted clients. In essence, we hope to help you avoid our mistakes and to provide you with informative and creative approaches to working with this unique population of clients. We consider genuine compassion and deep understanding to be the core values manifested by effective counselors. We cannot stress this enough. Although such values are appreciated by many types of clients, we suggest that they are crucial in counseling clients who use drugs and alcohol.

The amount of shame, guilt, embarrassment, and terror that drug-abusing and addicted clients feel can be beyond description. Therefore, clients need a sense of safety, understanding, and compassionate care in the counseling relationship to change and grow. My (Ford’s) first supervisor described it as “loving your clients to wellness.” I took her wisdom and found how clients responded and grew when I did just that, therapeutically loved them.

We want counselors reading this text to own this fact: Your way of being in the therapeutic relationship affects client growth. Counselors bring to the therapeutic relationship a self (e.g., compassion, genuineness, spontaneity, and creativity), which is used as an instrument of change in the counseling relationship.

Carl Rogers (1957) suggested that certain counselor characteristics were necessary in the therapeutic relationship for clients to feel supported and begin the change process. He believed the counselor’s ability to be genuine, express accurate empathy, and provide unconditional positive regard were significant in the foundation of counseling relationships. We agree with Rogers. Clients are well-served when counselors are authentic, can accurately empathize and understand their clients’ worldviews, and have compassion for their clients.

What helps maintain the helping attitude is for counselors to frame client anger, blame, and dishonesty as a function of survival in a chaotic chemically induced world. By so doing, counselors can understand their clients’ drug and alcohol use as an important relationship they will protect with whatever means possible. A genuine, truthful, and in-the-moment relationship allows clients to know, without question, that they are understood and cared for during their emotional pain and time of crisis. The connection that is forged between counselors and clients following a drug and alcohol crisis can be profound. In an effort to help empathize with drug- and alcohol-addicted clients, Gideon (1975) encouraged counselors to frame clients as disconnected, isolated (from self and others), and afraid. He emphasized the value of understanding clients’ experiences and creating an environment of trust and safety.

One way such a relationship can transcend technique is as follows: Clients, who for years have been isolated in addiction and reveal for the first time how sad and depressed they have felt, can immediately begin to experience a sense of relief and connection after sharing their torment with an understanding human being. Genuine and authentic counselors increase the likelihood of engaging with their clients in a trusting, therapeutic relationship, which can result in clients attempting change with new behaviors (W. R. Miller & Rollnick, 2013).

Counselors who are truly with clients during these low points (perhaps to depths that many people will never approach) are privileged to hear such astonishing stories. Therefore, we suggest counselors need to both realize and appreciate the courage it takes to share such pain after so much isolation. Please pause for a moment and consider the previous message. We encourage you to reflect on the strength, bravery, and perhaps enormous pain clients go through as they share their stories. Recognize this: You are uniquely qualified to provide your distinct gifts, talents, and compassion for the human spirit.

Mistaken Images of Drug- and Alcohol-Addicted Clients

We suggest counselors assess for and then address those biases they might have with clients who use, abuse, and are addicted to alcohol and drugs. For some counselors, the terms substance abuser, alcoholic, or addict may conjure strong negative images of individuals nursing inexpensive bottles of liquor wrapped in a brown paper bag; gaunt, unkempt folks with needle marks wearing bloody clothing; or maybe young students struggling in school because of their marijuana use. It should be noted, however, that the majority of drug- and alcohol-addicted individuals hide their use, are indistinguishable from nonusers most of the time, and function in society, albeit at times under the influence.

For many counselors, the field of drug and alcohol counseling harbors a challenging and perplexing population. Such a frame on the part of a counselor can mitigate the development of both a helping attitude and an open, compassionate heart. Remaining open and compassionate can be particularly difficult when clients become angry, minimize their alcohol and drug use, or seemingly lack motivation in treatment–goal follow-through. Without counselors developing a well-thoughtout helping attitude, clients are many times blamed and labeled as resistant. Paradoxically, such reactions by counselors typically yield an increased defensiveness from the client, where the resistance is in response to both the counselor and the counseling approach (here we suggest to the reader that this is similar to a self-fulfilling prophecy by the counselor). What counselors want to create is a helping attitude, which includes the following seemingly paradoxical attitudes: to be supportive yet questioning, to be unconditionally present yet at times direct, and to possess an overall attitude of realistic optimism.

Establishing a Genuine Helping Relationship

A starting point may be for counselors to foster a helping attitude when working with clients who use and are addicted to alcohol and drugs. This is evident when the counselor’s personal exploration of bias has entered the therapeutic process. One example is a counselor who is angry and disgusted by a heroin-using client. This counselor, with all the desire to be helpful and effective, will have substantial difficulty in developing a helping attitude. However, if this same counselor comes to understand and respect the nature of abuse and addiction and can empathize with the client’s emotional suffering, a helping attitude is possible. Counselors need to maintain this respectful and helpful attitude. One way to do this is to continue to develop knowledge and understanding in the area of use of drugs and alcohol. For example, as counselors realize the powerful effects of narcotics coupled with an understanding of the client’s life in relation to heroin, empathy and ongoing support on behalf of the counselor is possible (through both the good times and bad moments).

Another effective procedure is to unlearn previous lessons, notions, and knowledge. Start fresh with Zen Mind, Beginner’s Mind (Suzuki, 2006). This approach views each client interaction as new and interesting. For counselors to see with fresh eyes each day, the mental approach of the beginner’s mind can also be effective in maintaining a helping attitude and demonstrating empathy. How many times are counselors handed a case file 3 inches thick only to be told sarcastically by the staff, “Good luck”? Counselors want to approach clients as if it were their first time in counseling, otherwise counselor bias and prejudice ensure this assuming failure. The beginner’s mind is curious and open to all client messages and pieces of the story yet to be told. This curiosity and open-minded attitude staves off counselor apathy or fatigue while facilitating the development of new strategies to increase therapeutic effectiveness.

First, we hope you find our writing style comfortable and that you benefit from the book’s construction. We’ve approached writing this text the way in which we work with clients: as genuine and as clear as possible. We’ve found that counselors in training and counselors tend to be intimidated and fearful of working with clients who abuse and are addicted to alcohol and drugs. Counselors in training sometimes discount their own skills and assets in effecting change when they are not recovering themselves. This finding is very unfortunate. In response to such concerns, we believe we’ve created a body of information that will increase awareness and knowledge while reducing the amount of apprehension in working with this population.

Significant Aspects of This Book

Relapse prevention, developmental issues, spirituality, and ecological aspects of life are significant aspects of this book. Because addiction is relapse prone, we have devoted an entire chapter to relapse prevention. Included are m...