The Addiction Counselor’s Desk Reference TEAM LinG - Live, Informative, Non-cost and Genuine ! TEAM LinG - Live, Informative, Non-cost and Genuine ! The Addiction Counselor’s Desk Reference Robert Holman Coombs William A. Howatt John Wiley & Sons, Inc. TEAM LinG - Live, Informative, Non-cost and Genuine ! This book is printed on acid-free paper. ➇ Copyright © 2005 by John Wiley & Sons. All rights reserved. Published by John Wiley & Sons, Inc., Hoboken, New Jersey. Published simultaneously in Canada. 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ISBN 0-471-43245-8 Printed in the United States of America. 10 9 8 7 6 5 4 3 2 1 TEAM LinG - Live, Informative, Non-cost and Genuine ! For CARLA CRONKHITE VERA, our esteemed associate at UCLA, with appreciation for all you have contributed. TEAM LinG - Live, Informative, Non-cost and Genuine ! TEAM LinG - Live, Informative, Non-cost and Genuine ! CONTENTS Preface xvii Acknowledgments xxi PART I: ABUSED SUBSTANCES AND THEIR EFFECTS Abused Drugs 2 OPIATES 2 Heroin 2 Prescription Opiates 3 DEPRESSANTS 4 Alcohol 4 Barbiturates/Sedative-Hypnotics 6 Benzodiazepines such as Diazepam (Valium) Abuse 6 STIMULANTS 7 Cocaine 7 Amphetamines and Methamphetamines 8 CANNABIS 9 Marijuana and Hashish 9 HALLUCINOGENS 10 Lysergic Acid Diethylamide 10 Psilocybin, Peyote, and Mescaline 11 INHALANTS 12 STEROIDS (ANABOLIC-ANDROGENIC) 12 DESIGNER DRUGS 13 3,4-Methylendioxymethamphetamine (MDMA) 14 Ketamine 15 Gamma Hydroxybutyrate (GHB) 15 Rohypnol 15 Control Schedules for Abused Drugs 15 PRESCRIBING DRUGS 30 THE FIVE CONTROL SCHEDULES 30 CONTROLLED SUBSTANCE ANALOGUES 32 GOVERNMENT DECISION MAKING 32 vii TEAM LinG - Live, Informative, Non-cost and Genuine ! viii CONTENTS PART II: CONCEPTUAL TOOLS Definitions of Addiction 35 MORAL MODEL 35 SELF-MEDICATION MODEL 35 MEDICAL/DISEASE MODEL 36 SPIRITUALITY MODEL 36 IMPULSE-CONTROL DISORDER 36 REWARD DEFICIENCY AND NEUROPHYSIOLOGICAL ADAPTION 37 GENETIC MODEL 37 BIOMEDICAL MODEL 37 SOCIAL LEARNING MODEL 38 ERRONEOUS THOUGHT PATTERNS 38 BIOPSYCHOSOCIAL MODEL 38 PUBLIC HEALTH MODEL 39 Characteristics of Addiction 39 COMPULSIVE USE 40 LOSS OF CONTROL 40 CONTINUED USE DESPITE ADVERSE CONSEQUENCES 40 TOLERANCE 40 WITHDRAWAL 41 Types of Addictive Disorders 41 THE BRAIN AND PSYCHOACTIVE DRUGS 41 THE BRAIN AND ADDICTIVE BEHAVIORS 42 ADDICTIVE INTERACTION DISORDER 45 Drug-Use Stages 46 INITIATION 46 ESCALATION 47 MAINTENANCE 47 DISCONTINUATION AND RELAPSE 47 RECOVERY 48 Early Stage Recovery 48 Middle Stage Recovery 48 Late State Recovery 49 Levels of Drug Use 49 TYPE 1—ABSTAINERS 50 TYPE 2—SOCIAL USERS 50 TYPE 3—DRUG ABUSERS 51 TYPE 4—PHYSICALLY BUT NOT PSYCHOLOGICALLY DEPENDENT USERS 51 TYPE 5—PHYSICALLY AND PSYCHOLOGICALLY DEPENDENT USERS 52 TEAM LinG - Live, Informative, Non-cost and Genuine ! CONTENTS ix Stages of Behavioral Change 53 STAGE 1—PRECONTEMPLATION 53 STAGE 2—CONTEMPLATION 54 STAGE 3—PREPARATION 54 STAGE 4—ACTION 55 STAGE 5—MAINTENANCE AND RELAPSE PREVENTION 55 STAGE 6—TERMINATION 55 Prevention Types and Principles 56 THE TRADITIONAL CLASSIFICATION 56 Primary Prevention 56 Secondary Prevention 56 Tertiary Prevention 56 THE INSTITUTE OF MEDICINE CLASSIFICATION 57 Universal Prevention 57 Selective Prevention 57 Indicated Prevention 57 PREVENTION PRINCIPLES 57 RELAPSE PREVENTION 59 Marlatt and Gordon’s Relapse Prevention Model 60 Gorski’s CENAPS Relapse Model 61 PART III: TREATMENT PLANNING AND ASSESSMENT RESOURCES Treatment Planning 64 COMPETENCIES AND GOALS 64 SCREENING AND ASSESSMENT 65 DIAGNOSTIC SUMMARY 67 TREATMENT 68 CLIENT PLACEMENT CRITERIA 68 WRITING A TREATMENT PLAN 69 SAMPLE TREATMENT PLAN 70 LEVELS OF CARE 71 Level 0.5: Early Interventions 71 Level I: Outpatient Treatment 71 Level II: Intensive Outpatient/Partial Hospitalization 71 Level III: Residential/Inpatient Services 74 Level IV: Medically Managed Intensive Inpatient Treatment 74 Assessment Resources 75 ALCOHOL ASSESSMENT INSTRUMENTS 75 Adolescent Alcohol Involvement Scale (AAIS) 75 Adolescent Drinking Index (ADI) 76 Alcadd Test Revised (AT) 76 Alcohol Abstinence Self-Efficacy Scale (AASES) 76 Alcohol Clinical Index (ACI) 76 Alcohol Dependence Scale (ADS) 76 Alcohol Effects Questionnaire (AEQ) 77 TEAM LinG - Live, Informative, Non-cost and Genuine !