People spend a lifetime searching for happiness; looking for peace. They chase idle dreams, addictions, religions, even other people, hoping to fill the emptiness that plagues them. The irony is the only place they ever needed to search was within.
—Ramona L. Anderson

As an educator, having taught college-level courses in addiction counseling since 1993, I am intrigued by acquired learning strategies and where ideas for improving educational programming originate. This interest found an unexpected conduit last month as I was buying a new Honda®. After filling out the paperwork, the sales person immediately began to discuss the importance of complying with the manufacturer’s maintenance schedule. Honda® has created a comprehensive checklist that sets the standards and criteria for maintenance, with the goal of ensuring the automobile is properly maintained and road worthy.

As I was driving home, I started to reflect on the similarities between the manufacturer’s maintenance schedule and the continuing education credits (CEUs) required to maintain certification as an addictions counselor. Master mechanics have exhaustive predetermined maintenance schedule checklists that include the mundane checking of the air valves on the tires to the more complicated testing of the engine’s timing. I thought to myself, why don’t addiction counselors have such a checklist for managing CEUs?

As professional counselors, we are obligated to take a certain amount of CEU hours to maintain certification. Beyond that, continuing education is at our discretion. Much like the master mechanic who has a checklist that captures the scope of his or her professional responsibility, how can we remember to program into our development paths core skills we may overlook? A potential solution lies in the addiction counselor tune-up checklist.
Intended for addiction counselors who work with clients daily, the purpose of this tune-up checklist is twofold: to provide you with an example of an addiction counselor program checklist while creating an opportunity to perform a self-diagnostic overview. The checklist facilitates an interactive opportunity to self-evaluate your core skill set — the goal is to present the intrinsic and professional value of an assessment tool that leads to improved clinical efficacy. Annually identifying, in detail, a list of core competencies is helpful in determining a professional development trajectory in terms of CEUs as well as heightening an addiction counselor’s ability to keep up with the continuous changes in the growing field of addiction studies.

ADDICTION COUNSELOR TUNE-UP CHECKLIST

As part of the tune-up checklist, you will be asked 18 questions that span the phases of addiction counseling. Please note that the list has no specific rationale for its order, as all listed competencies can play an important role in the treatment of persons with addictive disorders. I have developed this checklist from both my clinical and academic experiences; however, I will make no claims that this is an exhaustive list. You may invariably see the value of adding constructs and competencies that are relevant to your particular practice environment. Please take a blank piece of paper and answer the following 18 questions. It is important to write out your responses without using any kind of support or resource material so that you can accurately assess your level of competency.

1. Addiction Definitions and Treatment Model
What is your definition of addictive disorders, and what is your treatment model?

2. Addictive Disorders
Define the array of addictive disorders you will be faced with treating.

3. Understanding Motivation for Change
How do you conceptualize the motivation for change, and how does it impact treatment planning?

4. Referral Resources and Case Management
What are your referral procedures? How do you define case management and your typical role in the process?

5. Multicultural Considerations
How do you formally and informally screen for multicultural differences?

6. Counseling Theory
What are your two preferred counseling theories, and why have you chosen them?

7. Counseling Process
What are your counseling processes and/or therapies?

8. Counseling Techniques
What are your five standard counseling techniques, and why have you chosen them?

9. Counseling Micro Skills
What are the top five micro skills that you actively use in counseling?

10. Addiction Clinical Measures and Screening Tools
What are your three favored addiction measures, and what is your most useful screening tool?

11. Addiction Recovery Tools
What are five of your chosen addiction recovery tools?

12. Professional and Personal Ethics
How do you define your professional and personal ethics?

13. Crisis Intervention
What is your crisis intervention model? What types of crises are you prepared for?

14. Addictions Assessment Protocol
Describe your assessment process from beginning to end. Be specific as to how you assess physical, emotional, spiritual, and mental health.

15. Treatment Planning
What is your treatment planning process, and how do you develop treatment plans?

16. Relapse Prevention
What relapse prevention model are you currently using, and why have you chosen this one?

17. Aftercare Program
How do you design aftercare programs?

18. Addictive Disorder Prevention
What is your addictive disorder prevention model?

Please review those areas that you left blank or in which you provided a general response. They may be developmental areas that you could consider adding to next year’s development plan. Even areas in which you provided detailed responses merit additional investigation as you manage your career development and clinical efficacy.

PLEASE STOP HERE AND FINISH THE ABOVE QUESTIONNAIRE BEFORE READING ON

1. Addiction Definitions and Treatment Models

• While there is no universally accepted definition for addiction, it is essential to have a clear concept of both addiction disorders and treatment models (e.g., biopsychosocial). It is critical that definitions for addictive disorders be based in clinical research (e.g., the dopamine reward system is becoming recognized as a common link for many addictive disorders).
• An excellent resource is Concepts of Chemical Dependency (Brooks/Cole, 1996) by Harold E. Doweiko.

2. Addictive Disorder

• There are many different addictive disorders. Those most commonly covered in the literature are: alcohol, drugs, gambling, work, sex, interactive, buying, and food. John Wiley & Sons will soon release an exciting book in press: Addictive Disorder: A Practical Handbook edited by Robert H Coombs.
• It is critical that addiction counselors understand both drug classifications and the drugs that require supervised medical detoxification (e.g., alcohol).

3. Understanding Motivation for Change

• The Transtheoretical/Stages of Change model is widely accepted as a critical benchmark for determining a client’s motivation and planning treatment strategies. This six-step model has utility in all aspects of treatment from intake to aftercare planning.
• An effective resource that provides an overview of the Transtheoretical/Stages of Change model is the following journal article: Prochaska, J.O., & DiClemente, C.C. (1982). Transtheoretical therapy toward a more integrative model of change. Psychotherapy: Theory, Research and Practice, 19(3), 276-287.

4. Referral Resources and Case Management

• Each addiction counselor must have a current list of referral services for their region, which can be found in a number of trade periodicals, including Counselor. One helpful Web site is: www.soberrecovery.com/links/forprofessionals.html. Addiction counselors must be clear on the protocols for referral in their local area.
• A text that comprehensively reviews addictive disorder case management is Becoming an Addictions Counselor: A Comprehensive Text (Jones & Bartlett, 2000) by Peter L. Myers and Norman R. Salt.

5. Multicultural Considerations

• We live in a multicultural society, and it is paramount that each addiction counselor have a built-in process to screen for multicultural needs. Addiction counselors must challenge any potential prejudices or preconceived notions to be effective with a multicultural population.
• Addiction counselors cannot assume that one treatment or clinical model will fit all. An excellent resource that defines the value of learning a client’s frame of reference is Multicultural Counseling Competencies: Assessment, Education and Training, and Supervision, Vol. 7 (Sage Publications, 1995) edited by Hardin L.K. Coleman and Donald B. Pope-Davis.

6. Counseling Theory

• Counselors need a frame of reference that explains why people do what they do from a theoretical perspective. It is important that each addiction counselor develop his or her own unique counseling orientation that is grounded in accepted counseling theory. The most common counseling theories used today are cognitive-behavioral (e.g., theories of Aaron Beck, Albert Ellis, and William Glasser).
• One of the most detailed books on counseling theory is Current Psychotherapies, 5th Edition (F. E. Peacock, 1995) edited by Raymond J. Corsini and Danny Wedding.

7. Counseling Process

• Counseling process must have a clearly defined beginning, middle, and end. Counseling processes must be proven to work with persons with addictions, like William Glasser’s Choice Theory and Reality Therapy (http://www.wglasser.com/).
• An excellent comprehensive re-source is Substance Abuse Counseling: Theory and Practice, 2nd Edition (Prentice Hall, 2000) by Robert L. Smith and Patricia Stevens-Smith.

8. Counseling Techniques

• A well-developed set of proven counseling techniques is critical to the success of any addiction counselor. Typical addiction counseling techniques include journaling, magic wand, and the triple column technique, which represent merely a sampling of contemporary techniques.
• A user-friendly resource is The Human Services Counseling Toolbox (Brooks/Cole, 2000) by William A. Howatt.

9. Counseling Micro Skills

• In order to keep the counseling process moving in a positive direction, addiction counselors need to have an effective communication model that is supported by micro skills.
• There are many clinical measures and screening tools to choose from. A helpful resource is The Skilled Helper (Wadsworth, 1997) by Gerald Egan.

10. Addiction Clinical Measures and Screening Tools

• Addiction counselors must be current in addiction measures, e.g., Substance Abuse Subtle Screening (SASSI) (see www.sassi.com/sassi/index.shtml) and screening tools (e.g., the portable breath alcohol tester, see www.columbialab.com) that are indigenous to their clinical environment.
• Addiction counselors need to be familiar with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision (DSM-IV-TR) (American Psychiatric Association, 2000) as well as with psychological measures that are commonly used by their multi-disciplinary teams (e.g., dual diagnosis clients who are depressed are often monitored by the Beck Depression Inventory®).

11. Addiction Recovery Tools

• Addictions counselors must have an understanding of how addiction recovery tools work. These tools will support the counseling process and treatment planning. Some common recovery tools are motivational interviewing, peer support groups, group counseling, psychoeducational programs (e.g., anger management), recovery contracts, and computer-assisted programs that are congruent with the addiction counselor’s treatment environment (inpatient or outpatient).
• One of the best resources on the market today is Addiction Recovery Tools (Sage Publications, 2001) by Robert H. Coombs (Ed.). See also “Psychosocial Recovery Tools for Addictive Disorders” in the August 2003 issue of Counselor.

12. Professional and Personal Ethics

• Addiction counselors are accountable to both a professional and personal code of ethics. Professional ethics are set by state licensing boards and national trade organizations, while personal codes of ethics are defined by the counselor. An excellent resource is Ethics for Addiction Professionals (Hazelden Information Education, 1994) by Leclair Bissell and James E. Royce.
• Addiction counselors must be aware of organizational policies and procedures, standing orders, local and national laws, and changes in legislation.

13. Crisis Intervention

• Addiction counselors should have an understanding of a crisis intervention model, such as The Six-Step Crisis Inter-vention Model, in Crisis Intervention Strategies, 4th Edition (Brooks/Cole, 2001) by Burl Gilliland and Richard James.
• Addiction counselors are advised to have basic skills in first aid, suicide intervention, and self-protection. The wrong time to prepare for a crisis situation is when a crisis occurs.

14. Addictions Assessment Protocol

• Structural assessments are service guides to assess clients that never replace sound clinical judgment. Formal assessments often involve multidisciplinary teams. All assessments of addictive disorders must take into consideration the potential for dual diagnosis. A useful resource is http://www.dualdiagnosis.%20org/.
• A useful tool is Assessment Handbook for Addiction Treatment Programs (Centre for Addiction Studies and Mental Health, 1990) by Linda Palanek, Christine Bois, Darryl Upfold, Robert Murray, and Michael Gavin.

15. Treatment Planning

• Treatment planning can be facilitated with structured tools described in The Addiction Treatment Planner, 2nd Edition (John Wiley & Sons, 2001) by Robert R. Perkinson and Arthur E. Jongsma, Jr. Treatment planning must include a sound termination strategy that will ensure a smooth transition to aftercare programs.
• Treatment planning also requires effective note taking. A useful tool is The Addiction Progress Notes Planner (John Wiley & Sons, 2001) by David J. Berghuis and Arthur E. Jongsma, Jr.

16. Relapse Prevention
• Relapse prevention must be incorporated into any treatment planning. It is important that relapse prevention be discussed throughout treatment.
• Addiction counselors need to have a proven relapse prevention model such as Gorski’s Center for Applied Sciences (CENAPS®) clinical relapse prevention model (http://www.cenaps.com/).

17. Aftercare Program

• When a client exits counseling, it is paramount to help the client develop a well thought out aftercare program to assist in relapse prevention. An aftercare plan, to be effective, needs to be a natural extension of the client’s treatment plan.
• One effective tool for aftercare programming is The Journey: 52 Weeks in Recovery (Abbott-Sterling Publishing, 1995) by Jack Reid.

18. Addictive Disorder Prevention

• Addiction counselors must have a clear understanding of addictive disorder prevention target areas. The three main target areas are Person (e.g., prior drug use, skills, physiological reactions, and perceptions), Situation (e.g., peer influence, family influence, opportunity, and social norms), and Environment (e.g., access, media impact, schools, and community policies and financial factors).
• Addiction counselors need to be aware of the current thinking around primary prevention models. An excellent source is the Institute of Medicine (http://www.iom.edu/). Another excellent resource on prevention is Substance Abuse and Mental Health Services Administration Center for Substance Abuse Prevention (SAMHSA/CSAP) (http://prevention.samhsa.gov/).

Now, plan your future
Addiction counseling is an exciting profession that is constantly changing as both a result of innovations in the discipline and the introduction of new addictions into an ever-fluid culture. It is up to each addiction counselor to ensure that he or she stays current and is prepared to offer services of the highest quality. The tune-up checklist provides an excellent baseline against which to assess current skill sets and plan future professional development.

William A. Howatt, PhD, EdD, ICADC, a Post Doc at the UCLA School of Medicine, serves on the faculty at Nova Scotia Community College and is Co-editor (with Robert H. Coombs) of the Wiley Book Series on Treating Addictions. He can be reached via e-mail at This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

References
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th Ed., text revision). Washington, DC: Author.
Berghuis, D. J. & Jongsma, Jr., A. E. (2001). The addiction progress notes planner. New York, NY: John Wiley & Sons.
Bissell, L. & Royce, J. E. (1994). Ethics for addiction professionals. Center City, MN: Hazelden.
Coleman, H. L. K. & Pope-Davis, D. B. (Eds.) (1995). Multicultural counseling competencies: Assessment, education and training, and supervision, Vol. 7. Sage Publications.
Coombs, R.H. (Ed.). (2001). Addiction recovery tools: A practical handbook. Thousand Oaks, CA: Sage.
Coombs, R. H. (in press). Addictive disorder: A practical handbook. New York, NY: John Wiley & Sons.
Corsini, R.J. & Wedding, D. (1995). Current psychotherapies (5th edition). Itasca, IL: F. E. Peacock.
Doweiko, H. E. (1996). Concepts of chemical dependency. Pacific Grove, CA: Brooks/Cole.
Egan, G. (1997). The skilled helper. Belmont, CA: Wadsworth Publishing Co.
Gilliland, B. & James, R. (2001). Crisis intervention strategies (4th edition). Pacific grove, CA: Brooks/Cole.
Howatt, B. (2000). The human services counseling toolbox. Pacific Grove, CA: Brooks/Cole.
Meyers, P.L. & Salt, N.R. (2000). Becoming an addictions counselor: A comprehensive text. Boston, MA: Jones & Bartlett.
Palanek, L., Bois, C., Upfold, D., Murray, R., & Gavin, M. (1990). Assessment handbook for addiction treatment programs. Toronto, Ontario: Centre for Addiction Studies and Mental Health.
Perkinson, R. R. & Jongsma, Jr., A. E. (2001). The addiction treatment planner (2nd Edition). New York, NY: John Wiley & Sons.
Prochaska, J.O., & DiClemente, C.C. (1982). Transtheoretical therapy toward a more integrative model of change. Psychotherapy: Theory, Research and Practice, 19(3), 276-287.
Reid, J. (1995). The journey: 52 weeks in recovery. Fort Lauderdale, FL: Abbott-Sterling Publishing.
Smith, R.L. & Stevens-Smith, P. (2000). Substance abuse counseling: Theory and practice (2nd edition). Englewood Cliffs, NJ: Prentice Hall.

Web Site References
Dual Diagnosis Recovery Network, http://www.dualdiagnosis.%20org/
William Glasser’s Choice Theory and Reality Therapy, http://www.wglasser.com/
Gorski-CENAPS®, http://www.cenaps.com/
Institute of Medicine, http://www.iom.edu/
Portable breath alcohol tester, http://www.columbialab.com/
Sober Recovery, www.soberrecovery.com/links/forprofessionals.html
Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Prevention (CSAP), www.samhsa.gov/csap
Substance Abuse Subtle Screening Institute (SASSI), www.sassi.com/sassi/index.shtml

This article is published in Counselor,The Magazine for Addiction Professionals, October 2003, v.4, n.4, pp. 16-20.

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alfred francois   |71.191.171.xxx |2008-01-13 14:53:44 This article was very informative,especially multicultural considerations. Reply | Quote 0   0

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