COUN 570 Final Prep combined

Ch 8 - 15

Addiction

Represents a pathological relationship between an individual and a substance, or a process.

Physiological dependence

Involves a physical reaction within the body in which the body begins to crave, or require, a substance in order to maintain a certain level of homeostatic functioning.

Substance Use Disorders (SUDs)

Characterized by a loss of control over consumption, obsessive thoughts about the substance, and continued use despite negative consequences.

DSM-5 Severity Specifiers: Mild

Two to three diagnostic criteria met.

DSM-5 Severity Specifiers: Moderate

Four to five diagnostic criteria met.

DSM-5 Severity Specifiers: Severe

Six or more diagnostic criteria met.

Cravings

An intense desire for the substance.

Biopsychosocial model

Takes into consideration the genetic predisposition for substance use along with sociocultural and psychological risk factor explanations.

Process addictions

Behavioral conditions that do not involve ingestion of substances, yet they share similarities to substance-related disorders.

Level 0.5: Early Intervention

Clients have not yet demonstrated any substance use issues but may be at risk. The focus is on prevention.

Level I: Outpatient Services

Clients generally meet on a weekly basis for one-on-one or group counseling sessions.

Level II: Intensive Outpatient/Partial Hospitalization Services

Services that occur during the day, before or after work/school, in the evenings, and on the weekends, generally ranging from 9 to 12 hours per week.

Level III: Residential/Inpatient Services

Clients receive 24-hour-a-day services in a residential setting with a mixture of individual, group, and case management services.

Level IV: Medically Managed Intensive Inpatient Services

Used when the client requires a medically supervised evaluation, care, and treatment of mental and substance-related disorders in an acute care inpatient setting, typically including medical detoxification.

Medical detoxification

Supervised withdrawal from substances, in some cases using medication.

Half-life

How long it takes for half of the substance to be eliminated from the bloodstream.

Relapse

A return to substance use after a period of abstinence from use.

Ethics consideration related to SUDs

Counselors who work with those who have SUDs are legally obligated to follow an additional confidentiality restriction under the federal law (i.e., Code of Federal Regulations [CFR] 42, Part 2.

42 CFR

Prohibit any unauthorized disclosure of the records of any client in a federally funded program that provides screening or treatment for SUDs. The intent is to encourage people to seek substance use treatment without fear of negative consequences.

Alcohol withdrawal

Characterized by a pattern of symptoms that develop approximately 4 to 12 hours after the reduction of intake following prolonged, heavy alcohol ingestion.

Countertransference

Unconscious needs, feelings, and wishes that the counselor projects onto the client.

4 phases of alcoholism (Jellinek)

The prealcoholic phase, the prodromal phase, the crucial phase, and the chronic phase.

Medical Detoxification (alcohol)

Usually takes place over the course of 3 to 7 days and involves a combination of medications designed to help alleviate some of the withdrawal symptoms associated with discontinuing alcohol use.

Residential Treatment

Programs usually begin after the point of detoxification, can range from 28 to 90 days in length, and usually incorporate some combination of individual, group, and family counseling.

Outpatient-Based Treatments

Include intensive outpatient programs (IOP) and outpatient (OP) services.

Motivational Enhancement Therapy (MET)

Relies on Motivational Interviewing (MI) as a foundation, effective when working with those who abuse substances.

Cognitive Behavioral Therapy (CBT)

Structured, goal-oriented approach that focuses on addressing the immediate problems associated with alcohol use.

Functional analysis

Counselor and client identify the client’s thoughts, feelings, and circumstances before and after substance use.

Social skills training

Teaching clients prosocial techniques for everyday living.

Twelve-Step Facilitation

Manual-guided treatment that was developed for use in the treatment of SUDs to promote abstinence.

Family Therapy

Generally involves those most affected by the individual’s substance use and can result in significant relational difficulties.

Behavioral Self-Control Training (BSCT)

A controversial behavior therapy approach that has been used in treating alcohol use disorders.

Psychopharmacotherapy

Withdrawal, abstinence, and cravings can be treated through the use of pharmacological approaches.

Medication-Assisted Treatment (MAT)

In a highly controlled circumstance, clients use a different substance to change their patterns of use and break their addiction patterns (e.g., a client who takes methadone to aid in getting off heroin).

U.S. population age 12 and older report using marijuana in the previous 30 days

about 8%

Legal charges and SUDs

almost two-thirds of prison inmates meeting the diagnostic criteria for SUDs

Commonly Abused Substances

Cannabis, Opioids, Stimulants, and Tobacco.

Personality

People’s traits, coping styles, and ways of interacting with others and the world around them.

Egosyntonic

Their behaviors, values, and feelings are acceptable to the needs and goals of their ego; they are consistent with their ideal self-image

Cluster A

Includes paranoid, schizotypal, and schizoid personality disorders. These individuals all have in common odd and eccentric behaviors.

Cluster B

Includes antisocial, borderline, histrionic, and narcissistic personality disorders. Those who have these disorders are dramatic, emotional, and erratic.

Cluster C

Includes avoidant, dependent, and obsessive compulsive personality disorders. Individuals with cluster C disorders are anxious and fearful.

Antisocial Personality Disorder

Blatant disregard and violation of the rights of others.

Avoidant Personality Disorder

Inhibited; feelings of inferiority.

Borderline Personality Disorder

Unstable relationships; poor self-image; lack of emotion regulation.

Dependent Personality Disorder

Enmeshment; desires/requires external guidance and support from others.

Histrionic Personality Disorder

Attention seeking; self-dramatization.

Narcissistic Personality Disorder

Requires excessive admiration; overvaluation of others’ opinions and reactions.

Obsessive-Compulsive Personality Disorder

Inflexible; perfectionistic; values order and rules.

Paranoid Personality Disorder

Suspicious; a general mistrust of others.

Schizoid Personality Disorder

Inability and lack of desire to form social relationships.

Schizotypal Personality Disorder

Interpersonal deficits; odd, eccentric behaviors; perceptual disturbances.

Dialectical Behavior Therapy (DBT)

A cognitive behavioral therapy approach–specifically developed to treat BPD–that has been found to reduce anxiety, anger, and self-harming behaviors in those who have BPD.

Schema Therapy (ST)

Has some evidence to suggest its effectiveness in treating BPD, integrative psychotherapy (integrates psychodynamic theory tenets along with CBT principles

Psychodynamic Theories for Personality Disorders

Theories, psychoanalysts hold that people carry these childhood images and representations as objects within their subconscious and that these object representations are then carried or projected into adult relationships.

Mentalization-Based Psychotherapy

Based on attachment theory and holds that those with BPD suffer from disorganized attachments and have failed to develop a mentalization capacity within the context of a healthy attachment relationship.

Transference-Focused Psychotherapy

A modified psychodynamic therapy approach developed specifically to treat BPD. Those who have BPD are perceived to be holding onto affectively charged, unresolved, and contradictory internalized representations of themselves and significant others.

Cognitive Analytic Therapy

A brief, collaborative therapy that is based on cognitive therapy, elements of cognitive psychology, and psychodynamic psychotherapy.

STEPPS Group Therapy

Is a group treatment model that has demonstrated success in randomized controlled trials and integrates CBT and a systems model into a 20-week, manualized, outpatient group treatment format.

Antisocial Personality Disorder (ASPD) or dyssocial personality disorder

Identified by persistent disregard for and violation of the rights of others

Schema Therapy (ASPD)

This is an innovative approach that integrates cognitive therapy, behavior therapy, object relations therapy, and Gestalt therapy into a unified approach to treatment

Cognitive Behavioral Therapy (ASPD)

It involves treating morality indirectly by improving the patient's cognitive functioning

Narcissistic Personality Disorder (NPD)

Has at least five symptoms of Grandiose sense of importance, occupied with fantasies, Believing in 'special' status

Psychodynamic theory of Narcissistic Personality Disorder

The most effective treament will be to make that real relationship between counselor and patient to show the patient where his actions went south.

Histrionic Personality Disorder

To meet the diagnostic criteria for having histrionic personality disorder (HPD), one must have a pervasive pattern of excessive emotionality and attention seeking.

Functional Analytic Psychotherapy

The role of the counselor is bringing attention to the problematic actions that they are doing right in the counseling session.

Cognitive Analytic Therapy

This is a form of time based therapy as the time the sessions will be taking place are known at the start.

Obsessive - Compulsive Personality

Characterized by people who are so into keeping detail

Dialectical Behavior Therapy (OCPD)

This type of therapy increases flexibility by being exposed to new experinces and to reduce compulsive behavior so people can improve their life.

Avoidant Personality Disorder

Is having a pervasive pattern by social inhabitation

Behavior Therapy (AVPD)

The use of gradual exposure, social skills training, and guided imagery.

Schizotypical Personality Disorder (STPD)

One having mild delusions related to schitzophrenia and cognitive distortions.

Cognitive behavioral therapy (STPD)

One must use CBT to alter negative thoughts from the patient.

Schizoid Personality Disorder (SPD)

A long standing pattern of detachment on relationships

Behavior Therapy (SPD)

Will often respond well while being treated with this behavioral interventions.

Paranoid personality disorder (PPD)

This is having a pervaisive distrust of the motivations from others.

Cognitive Behaviorial Therapy (PPD)

There must be a cognitive therapy to work with a clients paranoia and create new and or altered thoughts.

Dependent Personality Disorder (DPD)

Need to be taken care of that leads to submit and clinging behaviors

The overall goals for someone with DPD

Is to help people increase self reliance and independence.

Psychotic disorders defined

The abnormalities in one or more of the following five domains: delusions, hallucinations, disorganized thinking, grossly disorganized or abnormal motor behavior, and negative symptoms.

Examples of primary psychotic disorders

Schizophrenia, schizophreniform disorder, brief psychotic disorder, delusional disorder, and schizoaffective disorder

The DSM-5

includes a Clinician-Rated Dimensions of Psychosis Symptom Severity assessment tool, which provides scales for the dimensional assessment of the primary symptoms of psychosis.

accurate assessment

to determine appropriate levels of care, treatment plan considerations, and medication needs.

People with BPD are one of the largest populations

Found in inpatient acute care settings, residential treatment, and partial hospitalization programs with rapid shifts in their required level of care.

What is the function of counselor with clients who have BPD

Is for regular, updated training on abuse and its treatment,

What must counselors must be prepared to assess, diagnose, and intervene

in situations involving drug, alcohol, and/or process addictions.

It is best for Counselors with this complex presentation

seek supervision in situations involving substance-using clients.

Alcohol tends to be

the most abused substance in the United States

How to assess the severity of a client’s alcohol use

as clients who are physiologically dependent on the substance might require inpatient detoxification.

It is important to rule out intoxication or withdrawal effects

before diagnosing a co-occurring mental health condition in a client with alcohol use disorder.

It strains the most objective counselor

not to experience emotional reactions to these processes, and countertransference reactions are not uncommon among counselors who work with clients who have SUDs.

Treatment Models and Interventions for use with SUDs

cognitive behavioral therapy, twelve-step facilitation, motivational enhancement therapy, and medication-assisted treatments

Description of the Substance Use and Addictive Disorders

Addiction is a complex concept that represents a pathological relationship between an individual and a substance, or a process

Legal and criminal considerations are also important

when working with those who abuse substances. Research estimates have suggested a strong relationship between criminal activity and substance use.

Although twelve-step support is widely used

as an adjunct to treatment, it is not appropriate for all clients and It is important to note that those who feel coerced into twelve-step participation may be unlikely to receive a therapeutic involvement from their participation.

Clients who have experienced multiple adverse events during childhood

including physical, emotional, or sexual abuse, or family-based stressors such as addiction, incarceration, and interpersonal violence, are at an increased risk of misusing substances later in life

Clients who have SUDs are especially vulnerable

to developing new addictions to medicines that have an addictive potential and clients’ use of these medications should be monitored closely.

Specific diagnoses in the

Alcohol-Related Disorders

The critical ingredient in alcohol

is ethanol

The goal of substance abuse treatment

Is to decrease risk