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The Addiction Counselor’s Desk Reference
- By Misc Author
- Published 11/16/2007
- Addiction Research
- Unrated
PSYCHOSOCIAL TOOLS
These treatment modalities focus on strengthening and reinforcing the network of a client’s social support network.
FAMILY STRENGTHENING
Family members typically enable the client’s addictive behaviors. This codependence, an adaptation paralleling addiction, needs to be identified and treated.
Brown and her colleagues (S. Brown, Lewis, & Liotta, 2000; Schmid & Brown, 2001) use a developmental model that consists of four addictive stages:
1. Active addiction: In this stabilizing phase, all family members are screened and treated for their own addictions or dual diagnosis issues.
2. Transition: Family members accept there is an addicted person in the family and come to terms with the need to take action.
3. Early recovery: Family members start to act differently and no longer act on impulse. The focus is on education and the development of new behavior that supports the family; the addictive family member no longer controls the family.
4. Ongoing recovery: The family is out of denial and is no longer emotionally, cognitively, and behaviorally trapped. This is a crucial stage for each family member in healing from the trauma of living with an addict.
Additional Resources -- For more on this subject, see Schmid, J., & Brown, S. (2001). Family treatment: Stage-appropriate psychotherapy for the addicted family. In R. H. Coombs (Ed.), Addiction recovery tools: A practical handbook. Thousand Oaks, CA: Sage.
GROUP THERAPY
Group therapy is an effective tool for two basic reasons: (1) Group interaction helps penetrate “the addict’s massive wall of denial,” (Washton, 2001, p. 240) and (2) recovering addicts need a strong social support system (Coombs, 2001).
When you group several addicts together in a therapeutic atmosphere, they call each other’s bluffs even as they provide an encouraging recovery environment.
Washton (2001) suggests arranging different types of groups for progressive stages of recovery:
(1) Self-evaluation groups for clients who are not yet ready to commit to abstinence and need motivational enhancement;
(2) Early recovery groups, lasting from several months to a year, where members work on acknowledging their addiction, achieve abstinence, and stabilize their lives; and
(3) Relapse prevention groups for those in advanced recovery who have maintained abstinence for some time and are ready to focus specifically on those issues that make them more vulnerable to relapse.
Additional Resources -- For an effective resource on group treatment planning, see Jongsma, A. E., Jr., & K. M. Paleg. (1999). Group therapy treatment planner. New York: Wiley.
PEER SUPPORT
Peer groups provide hope and give recovering addicts a much needed social support system in lieu of their network of drug-using friends. Social support groups, common in 12-step programs, help break down denial and encourage participants to change and take personal responsibility for their actions.
For high impact, Alcohol Anonymous (AA) suggests that newcomers attend 90 meetings in 90 days (Kurtz, 2001). At these meetings—whether 12-step oriented or a 12-step alternative—members share their recovery stories, discuss insights and concerns, or study pertinent literature.
Recovery is greatly enhanced when a group member working the program can call a sponsor—a senior member of the group who is assigned to assist addicted individuals outside meetings any time of day or night for help in resisting the urge to relapse.
Additional Resources -- See “Addiction Recovery Programs” later in Part V for detailed specifics.
LIFESTYLE PLANNING AND MONITORING
The two key features in the big-picture approach to addiction recovery are getting off drugs and creating a healthy, drug-free way of life (Zackon, McAuliffe, & Chien, 1993). Zackon (2001) identifies three common barriers to success: (1) the people problem (building a satisfying new social network); (2) the work problem (finding rewarding employment); and (3) the pleasure problem (acquiring new means of entertainment and excitement).
He points out that the drug lifestyle, with its immediate gratification and highs, is not easily replaced by a straight life, which may seem inherently dull and unsatisfying to drug users.
Howatt (1999) explains that clients who wish to gain a healthy lifestyle must balance five elements: money, career, relationships, self, and health. Zackon (2001), suggests that a recovery lifestyle needs eight vital elements:
(1) Participation in a community that supports abstinence and nourishes moral or spiritual values;
(2) productive work (or appropriate training or education) that yields sustenance and social approval;
(3) social activities with friends who offer drugfree recreation and support;
(4) a home setting that is comforting and relatively free of strong “triggers” (incitements to use);
(5) personal growth activities in any or all of the preceding;
(6) standard practices for avoiding high-risk (triggerladen) situations;
(7) standard practices for coping with unavoidable high-risk situations, and
(8) regularity in personal routines and schedules.
Additional Resources -- For resources on how to implement life management skills, see Kern, M., & Lenon, L. (1994). Take control now! Life Management Skills, Inc.
A user-friendly book on life coaching is provided by Curly, M. (2001). The life coaching handbook. London: Crown House.
For more information on coaching training, visit Coach U at www.coachinc.com.
HOLISTIC TOOLS
Traditionally used by nonmedical specialists, these treatment modalities address the health of the entire body, not just a specific body part or malady. Clinicians trained in Western medicine philosophy and techniques have been incorporating these elements of Eastern medicine into their treatment arsenals.
ACUPUNCTURE -- Some 1,000 treatment programs use acupuncture in treating addictions, both to ease withdrawal symptoms and to prepare clients for psychosocial recovery (M. O. Smith & White, 2001). Acupuncture has a calming effect and improves treatment retention; in addition, it is safe and cost-efficient (Brewington, Smith, & Lipton, 1994).
During treatment, needles are inserted smoothly and shallowly and other than a brief pinching sensation, pain or bleeding are rarely experienced. The technique generally produces an immediate sense of relaxation. Clients may also feel warmth, tingling, electrical movement, or heaviness either in the application area (usually the ears) or some other part of the body (M. O. Smith & White, 2001).
Touch, movement, heat, and electricity can also stimulate the points. Related acupuncture procedures include acupressure, shiatsu, reiki, and tai ji chaun. In addition to treating the obvious needs for relaxation and relief of withdrawal symptoms, acupuncture addresses the addict’s general state of physiological imbalance and ill health.
Holistic treatment can also support treatment of coexisting psychiatric disorders ranging from depression to paranoia. The Lincoln Recovery Center has found a group setting to be most successful, and has trained clinicians to administer this treatment.
The National Acupuncture Detoxification Association (NADA) assists programs interested in applying this treatment modality (www.acudetox.com).
Additional Resources -- For information on certified and licensed clinicians, visit the American Association of Oriental Medicine (www.aaom.org) and the National Certification Commission for Acupuncture and Oriental Medicine (www.nccaom.org). Also, see Knaster (1996). Discovering the body’s wisdom. NewYork: Bantam Books.
SPIRITUALITY ENHANCEMENT
Though spirituality has long been a central focus of 12-step programs, only recently has Western medicine acknowledged its importance. Spirituality cannot be measured scientifically, but its consequences can.
Research has documented that praying for strength has health-enhancing benefits (Dossey, 1997). Even atheist nations like the former USSR, turned to spirituality-based programs to deal with rampant alcoholism in their society. Efforts to develop spiritually can open doors of opportunity for clients who are willing to experiment. A large literature is developing on the relationship between spirituality and health.
Additional Resources -- To learn more about the application of spirituality and addiction counseling, visit the Centre for Spiritual Awareness (www.csa-davis.org) and read Kus, R. J. (Ed.). (1995). Spirituality and chemical dependency. New York: Harrington. This excellent resource provides a strategy for implementing spirituality into recovery.
See also Carl Jung’s classical writings described in Part IV of this book.
MEDITATION
Meditation, “a specific state of attending to a particular focus while withdrawing one’s attention from the outside world,” (Snarr, Norris, & Fahrion, 2001, p. 307), is used effectively to support recovery. An alternative to the addictive state, meditation slows the mind and body to achieve a restful state normally achieved by addicts only through their addictive elixir.
By slowing down the central nervous system, the client calms the mind and reduces stress. When the brain rhythms are slowed, the brain produces mind-altering and brain-healing substances, such as neuropeptides, enkephalins, and endogenous opiates that reduce craving and promote abstinence (Blum & Payne, 1991).
Through mastering a meditative state, clients are better able to connect their conscious and unconscious mind for the purpose of healing (Benson & Stark, 1997). Breathing and hand temperature training are two basic meditation techniques. Regulating breathing is the first skill learned by beginning students of meditation.
The goal is to replace shallow thoracic breathing with deeper diaphragmatic breathing, a calming practice. Hand temperature training, in which clients learn to adjust the warmth and blood flow in their hands, is an example of biofeedback which also integrates the mind/body connection.
Additional Resources -- For tools to learn more about meditation and its application to addiction, see Schaub, B., & Schaub, R. (1997). Healing addiction. New York: Delmar; Davis, M., Eshelman, E. R., & McKay, M. (1995). The relation and stress reduction workbook (4th ed.). Oakland, CA: New Harbinger; and Lohman, R. (1999). Yoga techniques applicable within drug and alcohol rehabilitation programmes. Therapeutic Communities: International Journal for Therapeutic and Supportive Organizations, 20(1), 61–72.
This Internet resource provides a user-friendly application for how to meditate: www.how-to-meditate.org.
NUTRITIONAL COUNSELING
Many addicts become malnourished and have a severe imbalance in their body’s biochemistry. Adding nutritional counseling to your repertoire will close what tends to be a glaring gap in the addict’s treatment needs (Gordis, 1993). Early animal studies showed that well-nourished subjects demonstrated “wisdom of the body” by rejecting alcohol in favor of water, while malnourished subjects were more likely to consume alcohol (Williams et al., 1955, cited in Beasley, 2001).
In another study, even bacterial cultures were better able to resist the toxic effects of alcohol when they were better nourished (Ravel et al., 1955, cited in Beasley, 2001). Three decades later, Guenther (1983) treated two groups of addicts, differentiating in her approach only by incorporating a nutritional component into one program.
A follow-up at 6 months found that 81% of the nutrition groups were not drinking, as opposed to 38% of the control group (Guenther, 1983). Patients in the nutrition group also claimed to experience fewer cravings.
Building on Guenther’s (1983) work in their program for 111 patients in New York, Beasley (2001, p. 294) found, “[All] had severe and chronic alcoholism. All had long and difficult histories of alcohol and drug abuse, with many failed treatment attempts. . . . All their diets were deficient; 80% were overtly clinically malnourished, almost two thirds had liver disease, and almost half were also addicted to other drugs.”
After 12 months in his treatment program that included a strong nutritional component, 91 patients were still participating, and 74% of these patients were sober (Beasley, 2001, p. 294). Addiction counselors should develop core competencies in nutritional counseling. Simple basics such as eating regular healthy meals and drinking lots of bottled water (2 liters a day) are only two examples.
Additional Resources -- To support your client’s nutritional needs while in recovery, an excellent guide is Beasley, J. D., & Knightly, S. (2001). Food for recovery: The complete nutrition companion for recovering from alcoholism, drug addiction, and eating disorders (2nd ed.). New York: Crown Books.
Center for Food Safety and Applied Nutrition, 5100 Paint Branch Parkway, College Park, MD 20740-3835, http://vm.cfsan.fda.gov/list.html. Clemens Library, Internet Resources for Nutrition: www.csbsju.edu/library/internet/nutrition.html.
Coombs, Robert H. (Ed.). (2001). Addiction recovery tools: A practical handbook. Thousand Oaks, CA: Sage. This edited book offers more extensive elaboration on each of the recovery tools briefly reviewed in this chapter. It also discusses ways to match clients with recovery tools.
These treatment modalities focus on strengthening and reinforcing the network of a client’s social support network.
FAMILY STRENGTHENING
Family members typically enable the client’s addictive behaviors. This codependence, an adaptation paralleling addiction, needs to be identified and treated.
Brown and her colleagues (S. Brown, Lewis, & Liotta, 2000; Schmid & Brown, 2001) use a developmental model that consists of four addictive stages:
1. Active addiction: In this stabilizing phase, all family members are screened and treated for their own addictions or dual diagnosis issues.
2. Transition: Family members accept there is an addicted person in the family and come to terms with the need to take action.
3. Early recovery: Family members start to act differently and no longer act on impulse. The focus is on education and the development of new behavior that supports the family; the addictive family member no longer controls the family.
4. Ongoing recovery: The family is out of denial and is no longer emotionally, cognitively, and behaviorally trapped. This is a crucial stage for each family member in healing from the trauma of living with an addict.
Additional Resources -- For more on this subject, see Schmid, J., & Brown, S. (2001). Family treatment: Stage-appropriate psychotherapy for the addicted family. In R. H. Coombs (Ed.), Addiction recovery tools: A practical handbook. Thousand Oaks, CA: Sage.
GROUP THERAPY
Group therapy is an effective tool for two basic reasons: (1) Group interaction helps penetrate “the addict’s massive wall of denial,” (Washton, 2001, p. 240) and (2) recovering addicts need a strong social support system (Coombs, 2001).
When you group several addicts together in a therapeutic atmosphere, they call each other’s bluffs even as they provide an encouraging recovery environment.
Washton (2001) suggests arranging different types of groups for progressive stages of recovery:
(1) Self-evaluation groups for clients who are not yet ready to commit to abstinence and need motivational enhancement;
(2) Early recovery groups, lasting from several months to a year, where members work on acknowledging their addiction, achieve abstinence, and stabilize their lives; and
(3) Relapse prevention groups for those in advanced recovery who have maintained abstinence for some time and are ready to focus specifically on those issues that make them more vulnerable to relapse.
Additional Resources -- For an effective resource on group treatment planning, see Jongsma, A. E., Jr., & K. M. Paleg. (1999). Group therapy treatment planner. New York: Wiley.
PEER SUPPORT
Peer groups provide hope and give recovering addicts a much needed social support system in lieu of their network of drug-using friends. Social support groups, common in 12-step programs, help break down denial and encourage participants to change and take personal responsibility for their actions.
For high impact, Alcohol Anonymous (AA) suggests that newcomers attend 90 meetings in 90 days (Kurtz, 2001). At these meetings—whether 12-step oriented or a 12-step alternative—members share their recovery stories, discuss insights and concerns, or study pertinent literature.
Recovery is greatly enhanced when a group member working the program can call a sponsor—a senior member of the group who is assigned to assist addicted individuals outside meetings any time of day or night for help in resisting the urge to relapse.
Additional Resources -- See “Addiction Recovery Programs” later in Part V for detailed specifics.
LIFESTYLE PLANNING AND MONITORING
The two key features in the big-picture approach to addiction recovery are getting off drugs and creating a healthy, drug-free way of life (Zackon, McAuliffe, & Chien, 1993). Zackon (2001) identifies three common barriers to success: (1) the people problem (building a satisfying new social network); (2) the work problem (finding rewarding employment); and (3) the pleasure problem (acquiring new means of entertainment and excitement).
He points out that the drug lifestyle, with its immediate gratification and highs, is not easily replaced by a straight life, which may seem inherently dull and unsatisfying to drug users.
Howatt (1999) explains that clients who wish to gain a healthy lifestyle must balance five elements: money, career, relationships, self, and health. Zackon (2001), suggests that a recovery lifestyle needs eight vital elements:
(1) Participation in a community that supports abstinence and nourishes moral or spiritual values;
(2) productive work (or appropriate training or education) that yields sustenance and social approval;
(3) social activities with friends who offer drugfree recreation and support;
(4) a home setting that is comforting and relatively free of strong “triggers” (incitements to use);
(5) personal growth activities in any or all of the preceding;
(6) standard practices for avoiding high-risk (triggerladen) situations;
(7) standard practices for coping with unavoidable high-risk situations, and
(8) regularity in personal routines and schedules.
Additional Resources -- For resources on how to implement life management skills, see Kern, M., & Lenon, L. (1994). Take control now! Life Management Skills, Inc.
A user-friendly book on life coaching is provided by Curly, M. (2001). The life coaching handbook. London: Crown House.
For more information on coaching training, visit Coach U at www.coachinc.com.
HOLISTIC TOOLS
Traditionally used by nonmedical specialists, these treatment modalities address the health of the entire body, not just a specific body part or malady. Clinicians trained in Western medicine philosophy and techniques have been incorporating these elements of Eastern medicine into their treatment arsenals.
ACUPUNCTURE -- Some 1,000 treatment programs use acupuncture in treating addictions, both to ease withdrawal symptoms and to prepare clients for psychosocial recovery (M. O. Smith & White, 2001). Acupuncture has a calming effect and improves treatment retention; in addition, it is safe and cost-efficient (Brewington, Smith, & Lipton, 1994).
During treatment, needles are inserted smoothly and shallowly and other than a brief pinching sensation, pain or bleeding are rarely experienced. The technique generally produces an immediate sense of relaxation. Clients may also feel warmth, tingling, electrical movement, or heaviness either in the application area (usually the ears) or some other part of the body (M. O. Smith & White, 2001).
Touch, movement, heat, and electricity can also stimulate the points. Related acupuncture procedures include acupressure, shiatsu, reiki, and tai ji chaun. In addition to treating the obvious needs for relaxation and relief of withdrawal symptoms, acupuncture addresses the addict’s general state of physiological imbalance and ill health.
Holistic treatment can also support treatment of coexisting psychiatric disorders ranging from depression to paranoia. The Lincoln Recovery Center has found a group setting to be most successful, and has trained clinicians to administer this treatment.
The National Acupuncture Detoxification Association (NADA) assists programs interested in applying this treatment modality (www.acudetox.com).
Additional Resources -- For information on certified and licensed clinicians, visit the American Association of Oriental Medicine (www.aaom.org) and the National Certification Commission for Acupuncture and Oriental Medicine (www.nccaom.org). Also, see Knaster (1996). Discovering the body’s wisdom. NewYork: Bantam Books.
SPIRITUALITY ENHANCEMENT
Though spirituality has long been a central focus of 12-step programs, only recently has Western medicine acknowledged its importance. Spirituality cannot be measured scientifically, but its consequences can.
Research has documented that praying for strength has health-enhancing benefits (Dossey, 1997). Even atheist nations like the former USSR, turned to spirituality-based programs to deal with rampant alcoholism in their society. Efforts to develop spiritually can open doors of opportunity for clients who are willing to experiment. A large literature is developing on the relationship between spirituality and health.
Additional Resources -- To learn more about the application of spirituality and addiction counseling, visit the Centre for Spiritual Awareness (www.csa-davis.org) and read Kus, R. J. (Ed.). (1995). Spirituality and chemical dependency. New York: Harrington. This excellent resource provides a strategy for implementing spirituality into recovery.
See also Carl Jung’s classical writings described in Part IV of this book.
MEDITATION
Meditation, “a specific state of attending to a particular focus while withdrawing one’s attention from the outside world,” (Snarr, Norris, & Fahrion, 2001, p. 307), is used effectively to support recovery. An alternative to the addictive state, meditation slows the mind and body to achieve a restful state normally achieved by addicts only through their addictive elixir.
By slowing down the central nervous system, the client calms the mind and reduces stress. When the brain rhythms are slowed, the brain produces mind-altering and brain-healing substances, such as neuropeptides, enkephalins, and endogenous opiates that reduce craving and promote abstinence (Blum & Payne, 1991).
Through mastering a meditative state, clients are better able to connect their conscious and unconscious mind for the purpose of healing (Benson & Stark, 1997). Breathing and hand temperature training are two basic meditation techniques. Regulating breathing is the first skill learned by beginning students of meditation.
The goal is to replace shallow thoracic breathing with deeper diaphragmatic breathing, a calming practice. Hand temperature training, in which clients learn to adjust the warmth and blood flow in their hands, is an example of biofeedback which also integrates the mind/body connection.
Additional Resources -- For tools to learn more about meditation and its application to addiction, see Schaub, B., & Schaub, R. (1997). Healing addiction. New York: Delmar; Davis, M., Eshelman, E. R., & McKay, M. (1995). The relation and stress reduction workbook (4th ed.). Oakland, CA: New Harbinger; and Lohman, R. (1999). Yoga techniques applicable within drug and alcohol rehabilitation programmes. Therapeutic Communities: International Journal for Therapeutic and Supportive Organizations, 20(1), 61–72.
This Internet resource provides a user-friendly application for how to meditate: www.how-to-meditate.org.
NUTRITIONAL COUNSELING
Many addicts become malnourished and have a severe imbalance in their body’s biochemistry. Adding nutritional counseling to your repertoire will close what tends to be a glaring gap in the addict’s treatment needs (Gordis, 1993). Early animal studies showed that well-nourished subjects demonstrated “wisdom of the body” by rejecting alcohol in favor of water, while malnourished subjects were more likely to consume alcohol (Williams et al., 1955, cited in Beasley, 2001).
In another study, even bacterial cultures were better able to resist the toxic effects of alcohol when they were better nourished (Ravel et al., 1955, cited in Beasley, 2001). Three decades later, Guenther (1983) treated two groups of addicts, differentiating in her approach only by incorporating a nutritional component into one program.
A follow-up at 6 months found that 81% of the nutrition groups were not drinking, as opposed to 38% of the control group (Guenther, 1983). Patients in the nutrition group also claimed to experience fewer cravings.
Building on Guenther’s (1983) work in their program for 111 patients in New York, Beasley (2001, p. 294) found, “[All] had severe and chronic alcoholism. All had long and difficult histories of alcohol and drug abuse, with many failed treatment attempts. . . . All their diets were deficient; 80% were overtly clinically malnourished, almost two thirds had liver disease, and almost half were also addicted to other drugs.”
After 12 months in his treatment program that included a strong nutritional component, 91 patients were still participating, and 74% of these patients were sober (Beasley, 2001, p. 294). Addiction counselors should develop core competencies in nutritional counseling. Simple basics such as eating regular healthy meals and drinking lots of bottled water (2 liters a day) are only two examples.
Additional Resources -- To support your client’s nutritional needs while in recovery, an excellent guide is Beasley, J. D., & Knightly, S. (2001). Food for recovery: The complete nutrition companion for recovering from alcoholism, drug addiction, and eating disorders (2nd ed.). New York: Crown Books.
Center for Food Safety and Applied Nutrition, 5100 Paint Branch Parkway, College Park, MD 20740-3835, http://vm.cfsan.fda.gov/list.html. Clemens Library, Internet Resources for Nutrition: www.csbsju.edu/library/internet/nutrition.html.
Coombs, Robert H. (Ed.). (2001). Addiction recovery tools: A practical handbook. Thousand Oaks, CA: Sage. This edited book offers more extensive elaboration on each of the recovery tools briefly reviewed in this chapter. It also discusses ways to match clients with recovery tools.
