Table of Contents. Chapter 1. Chapter 3. Chapter 2

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Preface, xiii

Acknowledgments, xiv

About the Authors/Contributors, xv

Chapter 1 Introduction to the Tap 21, 1

Lori Phelps

The TAP 21: Rationale for Higher Education, 1 What Is the TAP 21?, 2

History of the Competencies, 4

The Model: Knowledge, Skills, and Attitudes, 6 The Transdisciplinary Foundations, 6

The Professional Practice of Addiction Counseling, 7 The Science Behind the TAP 21, 7 National Validation Study: Defining

and Measuring the Competence of Addiction Counselors, 7

Higher Standards for the Profession of Addiction Counseling, 9

The National Addiction Studies Accreditation Commission (NASAC), 9

Standardized Curriculum Model in California, 9 History of Standardized Addiction Counselor

Curriculum in California, 10 References, 12 Suggested Reading, 13 Internet Resources, 17 Videos/Webcasts, 17 Exercises/Activities, 19

Chapter 2 Transdisciplinary Foundation I: Understanding

Addiction, 23

Barbara Lawrence, Lori Phelps

Competencies 1–4, 23

Understanding Addiction, 23

How Science Has Revolutionized the Understanding of Drug Addiction, 23 Competency 1, 23

What Is Drug Addiction?, 24 Competency 2, 25

Culture and the Criminal Justice System, 25 Competency 3, 27

The Effects of Psychoactive Substance Abuse, 27 Medical Consequences of Drug Abuse, 27 Competency 4, 28

Comorbidity/Co-Occurring Disorders, 28

What Is Comorbidity and What Are Its Causes?, 28 Why Do Drug Abuse and Mental Disorders

Commonly Co-occur?, 29

How Common Are Comorbid Drug Abuse and Mental Disorders?, 29

How Can Comorbidity Be Diagnosed and Treated?, 29 References, 31 Suggested Reading, 31 Internet Resources, 32 Videos/Webcasts, 33 Exercises/Activities, 35

Disease Model of Addiction, 35 Sample Intake Form, 35

Relapse Prevention Workbook, 39

Chapter 3 Transdisciplinary Foundation II: Treatment

Knowledge, 43

Lori Phelps

Competencies 5–8, 43 Compentency 5, 43

Scientifically Supported Models of Treatment, 43 Pharmacotherapies, 44

Opioid Addiction, 44 Tobacco Addiction, 45 Alcohol Addiction, 45 Behavioral Therapies, 46

Cognitive-Behavioral Therapy (alcohol, marijuana, cocaine, methamphetamine, nicotine), 46 Community Reinforcement Approach Plus

Vouchers (alcohol, cocaine), 46

Contingency Management Interventions/ Motivational Incentives (alcohol, stimulants, opioids, marijuana, nicotine), 47

Motivational Enhancement Therapy (alcohol, marijuana, nicotine), 47

The Matrix Model (stimulants), 47

12-Step Facilitation Tehrapy (alcohol, stimulants, opiates), 48

Behavioral Couples Therapy, 48

Behavioral Treatments for Adolescents, 48 Multisystemic Therapy, 48

Multidimensional Family Therapy for Adolescents, 48

Brief Strategic Family Therapy, 49 Approaches Used by Substance Abuse

Treatment Facilities, 49 Competency 6, 52

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vi Table of Contents

Introduction to the Family Education Group, 52 Overview, 52

Goals of Family Education Group, 54 Competency 7, 54

Evidence-Based Practices, 54 Why Emplement EBPs?, 54

Evidence-Based Practice (or Best Practice) Defined, 54

Competency 8, 55

Principles of Effective Treatment, 55 References, 56 Suggested Reading, 57 Internet Resources, 58 Videos/Webcasts, 59 Exercises/Activities, 61 Hypothetical Scenario, 63

Confidence In Clinical Skills Checklist, 61

Chapter 4 Transdisciplinary Foundation III: Application to

Practice, 65

Lori Phelps

Diagnostic Criteria Related to Substance Use Disorders, 66

Competency 9, 66 Competencies 10–11, 67 Stages of Change, 67 Competency 12, 69

Culturally Appropriate Treatment, 69 Competency 13, 70

Levels of Care, 70 Competency 14, 71

Psychotherapeutic Medications 2011, 71 Searchable Rx database online, 71 Medication-Assisted Treatment, 71 Competency 15, 74

Understanding Health Reform: The Federal Parity Law, 74 Understanding Health Reform:

Commonly Used Terms in Health Reform, 74 Competency 16, 75

Using Brief Interventions, 75

Brief Interventions Outside Substance Abuse Treatment Settings, 76

Essential Knowledge and Skills for Brief Interventions, 76

Steps in Active Listening, 76 Brief Intervention Workbooks, 77 Competency 17, 77

Improve Treatment Outcomes by Delivering Effective, Evidence-Based Substance Abuse Services, 77

What Are Evidence-Based Practices?, 77 13 Basic Principles of Effective Treatment, 78 Duration of Care, 78

Variety of Treatment Intensities, 78 Effective Treatment Strategies, 79 References, 80

Suggested Reading, 81 Internet Resources, 81 Videos/Webcasts, 82 Exercises/Activities, 83

Health Promotion Workbook, 83

University of Rhode Island Change Assessment Scale (URICA), 83

What I Want from Treatment, 86

Chapter 5 Transdisciplinary Foundation IV: Professional

Readiness, 89

Jack Kearney, Lori Phelps

What Is Professional Readiness?, 89 Competency 18, 89

Cultural Competence, 89 Competency 19, 91

Self-Care & Stress Management, 91 Common Stress Reactions, 92 Competency 20, 93

Ethical Standards for Addiction Counselors, 93 Variations in Ethical Codes, 93

Clinical Supervision and Professional Development of the Substance Abuse Counselor, 95

Rationale, 96

Functions of a Clinical Supervisor, 96 Competency 22, 96

Crises Have a Profound Impact on People with Serious Mental Health or

Emotional Problems, 97

What It Means to Be in a Mental Health Crisis, 98 References, 99

The Slippery Slope: Violating the Ultimate Therapeutic Taboo, 100

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Ethics Quiz, 100

Culture of Addiction Enmeshment Scale, 101

Chapter 6 Practice Dimension I— Clinical Evaluation, 103

Lori Phelps

Strategies for Establishing Rapport, 104 Raising the Topic, 105

Establish Rapport and Trust, 105

Five Principles of Motivational Interviewing, 105 Element: Screening, 106

Suicide Assessment, 108

GATE: Procedures for Substance Abuse Counselors 109

Quick Overview of GATE, 110 Element: Assessment, 111 Competencies 33–36, 111 Assessment, 112

Individualized Assessment and Treatment, 112 Basic Assessment, 112

The Role of Assessment Tools, 112 References, 114

Project CORK Clinical Tools, 117

Simple Screening Instrument for Substance Abuse (SSI-SA), 117

Scoring for the Simple Screening Instrument for Substance Abuse, 120

Mental Health Screening Form-III, 121

Chapter 7 Practice Dimension II—

Treatment Planning, 123

Ben Eiland Competencies 37–48, 123 Competency 37, 124 Treatment Planning, 124 Competencies 38–40, 125 Competency 41, 127 Competency 42, 128 Competency 43, 130

Client Involvement in the Development of the Treatment Plan, 130

Treatment Planning Coordination and Sharing Treatment Information, 132

Developing the Treatment Plan, 132

Competencies 44–45, 133 Competencies 46–48, 134 References, 136

Suggested Reading, 136 Internet Resources, 136

Screening and Assement Instruments, 137 The CAGE Questionnaire, 137

The Michigan Alcoholism Screening Test, 137 Assessment Instruments, 139

The Addiction Severity Index, 139

Chapter 8 Practice Dimension III— Referral, 141

Jack Kearney, Dennis Wade

Competencies 49–55, 141 Introduction, 141

Competency 49, 143 Competency 50, 145

Elements of Effective Referrals, 145

Mechanism for Information Dissemination, 145 Focus on Communitywide Outcomes, 145 Vision-Driven Service Provision, 145 Provider Credibility and Consistency, 145 Competency 51, 145

Competency 52, 146 Referral Skills, 146 Competency 53, 146

Try These Sensitive Interviewing Techniques When Recommending a Referral, 147

Competency 54, 147 Competency 55, 148

Assessment, Diagnosis, and Referral, 148 Guidelines for Referrals, 148

Making Effective Referrals, 149

Steps for Establishing an Authentically Connected Referral Network, 149

Characteristics of Authentically Connected Referral Networks, 149

Integrating Substance Abuse Treatment and Vocational Services, 149

References, 150

Suggested Reading, 150 Internet Resources, 150 Exercises/Activities, 151

Performance Assessment Rubric for Referral, 151 Permission to Disclose Information Under C.F.R.

42, Part 2, 152

Referral Information, 153 Referral Evaluation Form, 154 Resource Identification Form #1, 155 Resource Identification Form #2, 156

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viii Table of Contents

Chapter 9 Practice Dimension IV—

Service Coordination, 157

Melinda Moneymaker, Angela Stocker

Element: Implementing the Treatment Plan 157 Competencies 56–61, 157

Service Coordination Defined 157 Definitions of Case Management, 158

Case Management and Service Coordination, 158 Element: Consulting, 160

Sharing Information With An Outside Service Agency, 160

Screening, Brief Intervention, and Referral to Treatment, 162

Element: Continuing Assessment and Treatment Planning, 162

Competencies 67–74, 162 Continuum of Services System

Re-Engineering: California, 163

Continuum of Services Task Force Core Principles for System Re-Engineering, 163

References, 164

Suggested Reading, 164 Internet Resources, 165 Videos/Webcasts, 165

Sample Intake Questions, 166 Service Coordination Form, 167

Chapter 10 Practice Dimension V— Counseling, 169

Element: Individual Counseling, 169

Robin Staton

Competencies 75–87, 169 Individual Counseling, 170 Competencies 75–76, 170 The Successful Counselor, 170

Congruence, Unconditional Positive Regard, Accurate Empathy, 170

Body Language, 171 Competencies 77–79, 171 Theoretical Foundations, 172 Competencies 80–81, 172 Motivation for Change, 172 Competencies 82–83, 172 Skills Enhancement, 173 Past, Present, and Future, 173 Sexually Transmitted Diseases, 173 Healthy Schedules, 173 Competency 84, 173 Cultural Awareness, 173 Competencies 85–87, 174 References, 175 Suggested Reading, 175 Internet Resources, 175 Videos/Webcasts, 175 Exercises/Activities, 177

Counseling Student Practice Triads, 177 Advanced Listening Worksheet, 179 Counselor Burnout Worksheet, 181 Counseling Case Studies, 183 Suicide Assessment Case Study, 185

Chapter 11 Practice Dimension V— Counseling, 187

Element: Group Counseling, 187

Greg Granderson, Dick Wilson, Lori Phelps

Competencies 88–93, 187 Executive Summary, 187

Groups and Substance Abuse Treatment, 188 Competencies 88–89, 188

Modifying Group Therapy to Treat Substance Abuse, 188

Types of Groups Commonly Used in Substance Abuse Treatment, 190

Specialized Groups in Substance Abuse Treatment, 191

Criteria for the Placement of Clients in Groups, 191

Matching Clients with Groups, 191

Placing Clients from Racial or Culturally Different Backgrounds, 191

Goals and Effectiveness of Treatment, 193 Competency 93, 194

Stages of Recovery, 194

Group Stages: An Alternate Model, 196 Forming, Storming, Norming, Performing,

Adjourning, 196

Group Leadership and Group Process: The Extensional Group, 196

A Letter to Students and Educators from Richard C. Wilson, Ph.D., 196

Lessons Learned, 196

Major Elements of Extensional Groups, 197 The Group Experience, 197

Self-Disclosure, 197 Authentic Behavior, 197 Personal Risk Taking, 197 Personal Privacy & Risk, 197

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References, 198

Johari Window Exercise #1, 203 Johari Window Exercise #2, 203 Johari Window Adjectives in

Alphabetical Order, 203

Johari Window Class Handout, 205

Chapter 12 Practice Dimension V— Counseling, 207

Element: Counseling Families, Couples, and Significant Others, 207

Lynn Delvaux, Lori Phelps

Impact of Substance Abuse on Families, 207 Competency 95, 209

Family Intervention, 209

Approaches to Engagement, 209

A Relational Intervention Sequence for rundown and indent, 210

A Relational Intervention Sequence for Engagement (ARISE), 210

Goals and Outcomes of Family Services, 210 Engaging the Family in Treatment, 211 Strategies to Engage the Family, 211

Overcoming Barriers to Engaging Family Members in Treatment, 213

Techniques to Help Families Attain Sobriety, 213 Multidimensional Family Therapy, 213

Behavioral Family Therapy, 214

Network and Family/Larger System, 214 Bowen Family System Therapy, 214 Techniques to Help Families Adjust

to Sobriety, 214

Structural/Strategic Systems, 214 Multidimensional Family Therapy, 214 Cognitive-Behavioral Family Therapy, 214 Network Interventions, 214

Solution-Focused Family Therapy, 215 Techniques to Help Families in Long-Term

Maintenance, 215 Family/Larger System, 215 Network Therapy, 215 References, 216 Suggested Reading, 218 Internet Resources, 218 Videos/Webcasts, 219 Exercises/Activities, 221

The Family Table, 223 Personal Coat of Arms, 224

Chapter 13 Practice Dimension VI— Client, Family, and

Community Education, 225

Carlton Blanton, Tandy Iles, Lori Phelps

Client, Family, and Community Education, 225 Competency 99, 226

Addressing Diverse Client Populations in Intensive Outpatient Treatment, 226 What it Means to Be a Culturally Competent

Clinician, 227 Competency 100, 227

Risk and Protective Factors for ATOD Problems, 227 What factors determine if a person will become

addicted?, 228

Which biological factors increase risk of addiction?, 228 Risk Factors, 228 Protective Factors, 229 Resilience, 230 Defining Resiliencies, 230 Competencies 101–104, 230 Diverse Client Populations, 231 Hispanics/Latinos, 231

African Americans, 231 Native Americans, 232

Asian Americans and Pacific Islanders, 232 Persons with HIV/AIDS, 233

Lesbian, Gay, Bisexual, and Transgender (LGBT) Clients, 233

Persons with Physical and Cognitive Disabilities, 233

Rural Populations, 234 Homeless Populations, 234 Older Adults, 235

Preventing Drug Abuse: The Best Strategy, 236 Why Is Adolescence a Critical Time for Preventing

Drug Addiction?, 236

Can Science-Validated Programs Prevent Drug Addiction in Youth?, 236

How Do Science-Validated Prevention Programs Work?, 236

Are All Prevention Programs Effective in Reducing Drug Abuse?, 237

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x Table of Contents

Health and Behavior Problems Related to Substance Use, 237

Overview, 237 Key Facts, 237

Resources for Current Data on Alcohol and Drug Use, 238

Illness Management and Recovery, 238 Practitioner Guides and Handouts, 238 References, 239

Prevention Program Research Project, 247 Reframe Your Own Life, 247

Prevention, Intervention, Treatment, 247

Chapter 14 Practice Dimension VII: Documentation, 251

Carlton Blanton, Lou Hughes, Patrick Hughes

Competencies 108–114, 251 Introduction, 251

Competencies 108–111, 252 Competencies 112–114, 253

Areas Requiring Documentation, 254 Treatment Planning, 254

Treatment Plan Documentation Notes, 255 Definitions of Treatment Plan Terms, 255 Progress Notes, 255

Sample Initial Treatment Plan, 256

Examples of Words to Introduce Progress Notes, 257

Response, 257

Progress Notes--Points to Remember, 257 Individual or Group Sessions, 259

Weekly Observations, 259

Useful Words/Phrases in Charting Staff Interventions, 259 Discharge/Summary Statement, 259 Correct Documentation, 260 Incorrect Documentation, 260 References, 261 Suggested Reading, 261 Internet Resources, 261 Videos/Webcasts, 261 Exercises/Activities, 263

Exercise: Strategies for Recovery, 263

Exercise: Satisfaction with Areas of My Life, 264 Which Goals Would You Like to Focus On?, 265 Exercise: Step-by-Step Problem-Solving and Goal

Achievement, 266

Sample Initial Treatment Plan, 268

Chapter 15 Practice Dimension VIII: Professional and Ethical

Responsibilities, 269

Jack Kearney, Lori Phelps

Professional and Ethical Responsibilities, 270 Competency 116, 270

CFR 42 Part 2, 270

Code of Federal Regulations: Confidentiality of Alcohol and Drug Abuse Patient Records, 270 Intent of 42 CFR Part 2, 270

The Health Insurance Portability and Accountability Act of 1996, 270 What is HIPAA?, 270

Overview of the Privacy Rule, 270

The Confidentiality of Alcohol and Drug Abuse Patient Records Regulation and the HIPAA Privacy Rule: Implications for Alcohol and Substance Abuse Programs, 271

Contacts for Filing Complaints Regarding Ethical Violations, 272

Licensing and Certification in California, 272 Competencies 117–118, 273

Medication-Assisted Treatment (MAT) for Opioid Addiction as a Model, 273

Ethical Considerations in MAT, 273 Fundammental Ethical Principles, 273 Competency 119, 274

Professional and Ethical Standards for Supervisors, 274

Introduction, 275

The Competencies for Clinical Supervisors, 275 Competency 120, 276

Counselor Competency Assessment, 276 Competency 121, 276

Continuing Education and Training, 276 Continuing Education, 276

Sample Plan for Staff Education and Training, 277 Competencies 122–123, 278

Therapeutic Issues for Counselors, 278

Transference, Countertransference, and Secondary Traumatization, 279

Burnout, 280

Establishing the Treatment Frame and Special Issues, 281

Establishing and Enforcing a Clear Policy in Regard to Payment, 281

Building Trust, 281

When the Client ‘Falls in Love’ with the Counselor, 282

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The Counselor’s Reaction to Attemps at Seduction, 283

Dealing with Disruptive or Dangerous Behavior, 283

Avoiding the ‘Rescuer’ Role, 284

Recognizing Professional Limitations, 284 Responsibility of the Agency to Support

the Counselor, 285 References, 286 Suggested Reading, 287 Internet Resources, 287 Videos/Webcasts, 287 Activities/Exercises, 288

Ethics Discussion Questions, 288

What If Law Enforcement Shows Up at My Agency with a Court Order, Search Warrant, or

Arrest Warrant?, 289 Exercises/Activities, 290

Sample Letter to Law Enforcement, 290 Counselor Competency Assessment Form, 291

Appendices

Appendix A: CAADE, 269

Appendix B: Transdisciplinary Foundations Bibliography, 305

Appendix C: Practice Dimensions Bibliography, 311

List of Figures

1.1: CAADE CATC Tiered System, 3

1.2: Comparing the 8 Practice Dimentions (Knowledge, Skills, Attitudes) and the 12 Core Functions 5

1.3: Components in the Competencies Model, 6 2.1: Brain Scans of Drug Abuser and Heart

Disease Patient, 25

2.2: Total Population in Adult Correctional Systems 1980–2010, 26

3.1: Frequency with Which Substance Abuse Treatment Facilities Used Specified Clinical/ Therapeutic Approaches: 2009, 51

3.2: Evidence-Based Thinking, 55 4.1: Stages of Change, 68

4.2: Level of Care Quadrants, 70

4.3: Commonly Abused Prescription Drugs, 72 4.4: Facts About Prescription Drug Abuse, 73 5.1: Percent of Persons 12 or Older Who Met

Criteria for Substance Abuse or Dependence by Race/Ethnicity: 2009, 90

5.2: Percent of Admissions to Specialty Substance Abuse Treatment Facilities by Race/Ethnicity, 91 5.3: Updated California AOD Counselor Uniform

Code of Conduct, with UCC Attached, 95 5.4: Roles of the Clinical Supervisor, 96 6.1: Decision Tree: How to Address Suicidal

Thoughts and Behaviors in Substance Abuse Treatment, 109

6.2: What To Do If You Think a Person Is Having Suicidal Thoughts, 110

6.3: Key Definitions, 113

7.1: Maslow’s Hierarchy of Needs, 129

7.2: Maslow’s Hierarchy of Needs (with detail), 129 7.3: Client’s Recovery Plan (CRP), 131

7.4: ASI Master Problem List, 132 7.5: Treatment Plan Format, 133 9.1: Sample Consent Form, 159 9.2: Qualified Service Organization

Agreement, 161

11.1: What Is Culture?, 192

11.2: When Group Norms and Cultural Values Conflict, 193

11.3: Client Placement by Stage of Recovery, 195 11.4: Client Placement Based on Readiness

for Change, 195

11.5: Stages of Group Development, 196 11.6: Johari Window, 202

12.1: Suggestions for Engaging Family Members at Intake, 212

13.1: Risk Factors, 228

14.1: Areas Requiring Documentation, 254

List of Tables

2.1: Theories of Addiction, 24

3.1: Frequency with Which Substance Abuse Treatment Facilities Used Specified Clinical/ Therapeutic Approaches: 2009, 52

4.1: Criteria for a Diagnosis of Substance Abuse, 66

6.1: Advice to the Counselor: Do’s and Don’ts of Assessment for COD, 107

7.1: Stages-of-Change, 127

7.2: Screening, Brief Intervention, Referral, Treatment, xxx