Addictions counseling has changed so much since the emergence of AA in the mid-1930's.
Prior to AA, alcholism was viewed as a morality issue, a lack of will power issue, and according to Carl Jung, the sporadic recoveries in the psychoanalysis case histories always involved some kind of spontaneous spiritual conversion.
There was no hope for most chronic alcoholics, or their family. Now there is, and research is taking us into the cells of addiction, and we are finding that the brain can change itself. Once again though, there is no magic pill or potion. Work is involved.
If you read the history of AA, you will read the history of desperate folks looking for a way to stay alive, and addictions counseling often is about life or death choices.
But AA changed all that and AA is still a viable recovery model.
The key to AA though is doing the steps and growing in terms of a strong spiritual program so that you can continue one day at a time reprieves from active drinking.
Since AA began and all of the other 12 step approaches followed, research has given rise to other models of recovery, and the smart addictions counselor will familiarize him or herself with all of them.
Introduction and Overview John J. Boren, Lisa Simon Onken, and Kathleen M. Carroll
Dual Disorders Recovery Counseling Dennis C. Daley
The CENAPS® Model of Relapse Prevention Therapy (CMRPT®) Terence T. Gorski
The Living In Balance Counseling Approach Jeffrey A. Hoffman, Ben Jones, Barry D. Caudill, Dale W. Mayo, and Kathleen A. Mack
Treatment of Dually Diagnosed Adolescents: The Individual Therapeutic Alliance Within a Day Treatment Model Elizabeth Driscoll Jorgensen and Richard Salwen
Description of an Addiction Counseling Approach Delinda Mercer
Description of the Solution-Focused Brief Therapy Approach to Problem Drinking Scott D. Miller
Motivational Enhancement Therapy: Description of Counseling Approach William R. Miller
Twelve-Step Facilitation Joseph Nowinski
Minnesota Model: Description of Counseling Approach Patricia Owen
A Counseling Approach Fred Sipe
A Psychotherapeutic and Skills-Training Approach to the Treatment of Drug Addiction Arnold M. Washton
The National Institute on Drug Abuse (NIDA) is part of the National Institutes of Health (NIH) , a component of the U.S. Department of Health and Human Services.
Linda Kaplan-Annapolis Coalition on Behavioral Health:
Addiction counseling is relatively young as professions go. Certification processes started in the late 1970’s and in 1981 three states in the Mid-west established a small consortium to develop some common standards for certification.
A report by Birch and Davis (1984) delineated the first set of national competencies for alcoholism and drug abuse counselors, which laid the foundation for the twelve core functions that were then used as the basis for certification standards.
The number of state credentialing boards for alcoholism and drug abuse counselors increased rapidly and by 1989 almost all states had voluntary certification boards.
The National Certification Reciprocity Consortium (today Reciprocity Consortium/Alcohol and Other Drug Abuse [IC&RC]) had about 43 member states by the late 1980’s. Common standards were developed that included both written and oral exams, supervised work experience and a set number of education/training hours.
In 1990 the National Association of Alcoholism and Drug Abuse Counselors (NAADAC), concerned about the lack of a national standard and the multitude of acronyms used by the many state certification boards, developed a national certification process that required applicants to be state certified, pass a national exam, and have an academic degree.
This was the first time in the addiction treatment field that academic degrees were paired with competencies as a basis for certification. Traditionally, the addiction counseling field, which was developed by recovering counselors, had relied on assessing competencies as a basis for certification, rather than on academic preparation.
In 1993 the Addiction Technology Transfer Center (ATTC) Network was created by the Center for Substance Abuse Treatment (CSAT) of the Substance Abuse and Mental Health Services Administration (SAMHSA) to improve the preparation of addiction treatment professionals.
Soon the ATTC National Curriculum Committee (Curriculum Committee) was formed to evaluate curricula and establish priorities for curriculum development. The Curriculum Committee developed the Addiction Counseling Competencies (ATTC, 1995), which contained 121 competencies.
A national study was conducted validating the competencies as necessary for addiction counseling (Adams & Gallon, 1997). These competencies were developed without regard to education level.
The next step in the process was to articulate the knowledge, skills and attitudes (KSA) under each of the competencies.
Input from many stakeholder groups in the field was sought and the competencies were sent to addiction experts for a field review.
In 1996, a National Steering Committee was formed which cross-walked the Addiction Counseling Competencies: The known as the International Certification and Knowledge, Skills and Attitudes of Professional Practice (ACC) (ATTC, 1995) and the International Certification & Reciprocity Consortium (IC&RC) Role Delineation Study (IC&RC, 1996).
This Steering Committee found that the ACC included the knowledge, skills and attitudes that were required for effective practice, and endorsed the ACC as the bases for education and training of staff that work with people with substance use disorders.
In 1998 SAMHSA published the ACC as a Technical Assistance Publication (U.S. Department of Health and Human Services [DHHS], 1998). The ACC is divided into two sections. The first contains the Transdisciplinary Foundations organized in four dimensions, which cover the basic knowledge and attitudes for all disciplines working in the addiction field:
• Understanding Addictions: Current models and theories; the context within which addiction exists; behavioral, psychological, physical health and social effects of psychoactive substances.
• Treatment Knowledge: Continuum of care; importance of social, family and other support systems; understanding and application of research; interdisciplinary approach to treatment.
• Application to Practice: Understanding of diagnostic and placement criteria; understanding of a variety of helping strategies.
• Professional Readiness: Understanding diverse cultures and people with disabilities; importance of self-awareness; professional ethics and standards of behavior; the need for clinical supervision and ongoing education.
There are eight dimensions in the second section, which focus on The Professional Practice of Addiction Counseling:
• Clinical Evaluation: Screening - to determine the most appropriate initial course of action; and Assessment - the ongoing process of gathering and interpreting all necessary information to evaluate the client and make treatment recommendations.
• Treatment Planning: A collaborative process whereby the counselor and client develop treatment outcomes and strategies.
• Referral: A process that facilitates the client’s use of needed support systems and community resources.• Service Coordination: Encompasses case management, client advocacy and implementing the treatment plan.
• Counseling: A collaborative process that facilitates the client’s progress toward mutually determined treatment goals and objectives through individual, group, couples, and family counseling.
• Client, Family and Community Education: Process of providing clients, families and community groups information on the risks related to psychoactive substance use, as well as treatment, prevention and recovery resources.
• Documentation: Recording intake, treatment and clinical reports, clinical progress notes and discharge notes in an acceptable, accurate manner.
• Professional and Ethical Responsibilities: Includes responsibilities to adhere to accepted ethical standards and professional code of conduct and for continuing professional development; knowing and adhering to all federal and state confidentiality regulations, abiding by the Code of Ethics for addiction counselors, and obtaining clinical supervision and developing methods for personal wellness.
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