Cas 454 final

What is AVE?

"abstinence violation effect" or AVE In simple language, it means that once a relapse has occurred, a client equates this with a feeling or belief of complete failure by telling themselves such things as, "Who was I fooling? This just proves I am nothing but an alcoholic" such that the relapse is deepened and/or lengthened, and/or never interrupted

What is the nevada 458 code?

(f) If the patient is no longer to receive services from the program for treatment: (1) Documentation verifying that a copy of the plan for continuing care of the patient, including, without limitation, any referrals given to the patient, was provided to the patient prior to discharge, if possible; and (2) A summary of services which were provided to the patient not more than five business days after the patient is discharged from the program for treatment, including, without limitation: (I) The diagnosis and condition of the patient at the time of admission or intake to the service; (II) The response of the patient to treatment; (III) The reason for discharge of the patient; (IV) The diagnosis and condition of the patient at the time of discharge and rating of the client on all 6 ASAM dimensions; (V) Referrals given to the patient for continuing care; (VI) Recommendations for any future treatment of the patient.

benefits of good, regular documentation?

-A therapist is able to review the work that has been done with a client to see what the client has responded to and what works. The therapist does not have to waste time or work against the client's progress by "guessing" or assuming what would be best; good documentation will help them to "follow the bread crumbs" so that they can continue supporting the treatment arc of the client. It will also minimize the therapist making unnecessary mistakes. -In the context of working as a member of a treatment team (i.e., caseworker, therapist, psychiatrist), each member of the team will be able to review how the client is progressing and responding to the different team members' interventions. They will be able to increase the likelihood of treatment success by utilizing those interventions to which the client is responding positively. -The likelihood of harm is minimized. -Resources are efficiently utilized. -Continuity of treatment is more easily sustained and supported.

Understand therapeutic benefits and reasons for treatment planning

-Clear goals and key objectives -well-researched strategies- optimize likely hood of success -Acquisition of needed materials and supplies: all materials -A clear definition of the overall goal core part: chart path of treatment and what is expected -each and every client is different from the next and require different care options

Guidelines to Consider when developing a continuing care/discharge plan

-Don't wait until the end of treatment to being discharge planning! Discharge planning should begin on Day 1 of a client's treatment. As with the relapse prevention plan, discharge planning is an evolving process. -Use the ASAM Criteria to help determine eligibility for discharge. -Include the client in all aspects of treatment planning including discharge planning. -As with treatment plan goals, the discharge plan must be reasonable, realistic, and straight-forward. -As with treatment plan goals, specific dates or timelines should be included for all activities and tasks. -The discharge plan might best be thought of as a clinical tool that addresses the required elements as previously discussed, and also includes the relapse prevention plan. In other words, the discharge plan is "bigger" than, but includes, the relapse prevention plan.

Review M.A.R.T.S. method

-Measurable: held accountable -Attainable: short time goals that are within client's control -Realistic: effective goals are achievable given available resources -Time-limited: effective goals are not open-ended -Specific: detailed goal stated

some of the repercussions of being arrested for drug offenses that have fallen heaviest on those of color

-Time spent in jail has been found to have criminogenic effects. This means that once someone has been to jail, he or she is more, not less, likely to reoffend and end up back in jail. -With a felony conviction, clients may be denied access to beneficial services such as welfare and housing, and have difficulty finding employment. -Families and neighborhoods are negatively impacted and suffer a higher degree of disruption and instability

Know what a case file is for

-a file which is established and maintained by an agency. The agency documents a family's or individual's application for and/or receipt of public assistance or public social services. A case file may include documents and computer records

what should be included in a file

-all intake paperwork including various forms signed by the client -assessment materials- counselor's initial impressions and summary of recommendations for treatment -treatment planning section that includes a problem list and the initial and updated treatment plans -all progress and other case notes relating to the treatment of the client -a discharge plan

characteristics of a culturally skilled counselor

-aware of culturally learned assumptions by themselves and their clients -comprehend culturally competent facts and info -awareness

Know basic therapies for relapse prevention and substance abuse treatment that were handled in class

-destigmatize the word "relapse" -enhance motivation for long-term change -develop feelings of self-efficacy -identity high-risk vulnerabilities -develop skills, strategies, and resources for addressing potential triggers -address all areas of life -treat the "relapse prevention plan" as a living and breathing document -practice, practice, practice

How is MI a communication style of therapy?

-facilitates a client's progress through treatment. -Resistance is viewed as a natural and welcome part of a client's progress through treatment and the stages of change. -The counselor's responsibility is to utilize the necessary MI tools depending on in which stage of change the client is currently.

proper handling of a file

-faithful representation of a client's record of treatment episode from admission to discharge

What is in a good continuing care plan?

-identify what treatment needs a client may still have; -highlight additional community resources a client may still need; -help with referral between providers; -ensure problems from transition between levels of care and to home are minimized; and -address areas in a client's life needing ongoing support such as transportation, employment, and so on.

Understand discharge planning

-should begin when client is admitted (with the exception of LTC) -assess if the client will be able to return home and/or if they will need assistance at home -assess residence to see if adaptations or specific equipment will be necessary -make referral to social worker if needed -communicate client health status and needs to community service providers -if client chooses to leave before discharged, notify provider and have pt sign off

What is Relapse Autopsy?

-we would instead ask "How is it that we ended up with a relapse?" We could then review all the different factors that contributed to the relapse. -The reasons for doing this are many but this is the primary one: to strengthen a client's relapse prevention strategies such that future relapse is minimized

What are some examples of CM?

-wherein clients are rewarded for things such as turning in clean urine tests. Because things like clean UA's are something that clients "should" be doing, strong feelings against contingency management strategies are often experienced and vocalized by some. -initiating the first phone call -Another example would be whether substance abuse counselors should be the ones doing urine tests (UAs). I had held to the belief that UAs were the responsibility of the courts and its probation and parole officers, and long resisted implementing UAs at our treatment facility. When research clearly showed superior treatment outcomes for those facilities and practitioners that incorporated UAs as part of their treatment approach, I changed what I was doing.

Using the ASAM to Determine when to Discharge

1. Treatment goals have been met. 2. Treatment goals unmet. 3. Patient has lack of capacity to resolve his or her problems. 4.Problems have intensified.

Review NIDA's 13 principles of drug addiction treatment.

1. individualized 2. timely 3. multidimensional 4. flexible 5. appropriate duration 6. include counseling 7. proper use medication 8. attend to coexisting problems 9. multistage process 10. not necessarily voluntary 11. include continuous monitoring 12. provide assessment for health-related problems 13. long term recovery and persistent

Steps for Intern Licensure

1. Become familiar with your state's statutes and regulations that apply to the particular license(s) you are seeking. These will often be posted on the website of the particular board tasked with licensing its professionals (i.e., as but one example, in Nevada there are separate boards for psychology, drug and alcohol counseling, social workers, and marriage and family therapists and clinical professional counselors). Within these statutes and regulations will be the list of minimum requirements you must meet in order to receive a particular license. 2. Request an application from the board. These applications can also be helpful for helping to figure out what the requirements may be. In submitting the application, you will likely be asked to also submit some combination of official school transcripts, letters of reference, and fingerprint cards and other background checks. There will also likely be an application fee. 3. Take and pass an exam. If you are first licensed as an intern, you will have time to earn experience and receive additional training before taking an exam. 4. If licensed as an intern, you will also need to secure supervision. Oftentimes, this will mean making phone calls to several potential supervisors to find one who is available and is a good fit. It is a good idea to have more than one supervisor in case one of them is otherwise unavailable when you might need to reach them (i.e., during a crisis). 5. Complete any additional or needed trainings. 6. Complete the required experience hours.

steps for developing a relapse prevention plan

1. Destigmatize the word "relapse." Because there is so much shame associated with the word, it is helpful to address these beliefs and attitudes up-front. In some cultures and circles, for example, relapsing is seen as a sign of weakness. If not addressed, such a belief can erode the confidence of our clients. 2. Enhance motivation for long-term change. To the degree that clients remain uncertain or uncommitted to continued positive long-term changes, we will want to work on utilizing our motivational enhancement skills to increase motivation. 3. Develop feelings of self-efficacy. As described in more detail in the textbook, those who hold beliefs that they will be successful are more likely to be so. 4. Identify high-risk vulnerabilities (aka "triggers"). This would include identifying any and all thoughts, emotions, cravings, urges, times of the day, days of the week, situations, places, people, and so forth that could be potential triggers for our clients. Previous relapses can be good sources of information in this regard. 5. Develop skills, strategies, and resources for addressing potential triggers. Examples include role-playing refusal skills and assertive communication, active identification of negative self-talk and replacing it with positive self-talk, scheduling of daily activities so as to reduce "down" time, and identification of helpful resources including support groups and people. 6. Address all areas of life. A well-rounded relapse prevention plan would include specific sections believed to be important for a well-balanced life. These could include: physical health, emotional health, sexual health, spiritual health, recreation, personal hobbies, employment/schooling, and more. Vulnerabilities would be identified in each area, as well as specific skills, strategies, and resources. 7. Treat the "relapse prevention plan" as a living and breathing document. It is never completed. It is always being refined as strengths are developed and other triggers are identified. 8. Practice, practice, practice! This cannot be overemphasized enough. It is not simply a matter of reading something and being able to do it (this class is a good example!), clients must familiarize themselves with their relapse prevention plans over-and-over. Continuing practice being assertive in high-risk situations will ensure that clients' skills for relapse prevention stay sharp.

There are four primary principles of motivational interviewing

1. Express empathy. This means what it suggests. It is important for counselors to communicate verbally and nonverbally that they understand the implications and realities of their clients' situations including their perspectives and emotions. This helps clients to understand that their experiences of ambivalence are normal. 2. Develop discrepancy. The point of this principle is to amplify the discomfort a client is feeling (in fact, this is sometimes referred to as amplifying ambivalence) such that their cognitive dissonance becomes unbearable enough that it provides the necessary motivation to make more healthful decisions vis-à-vis the use of substances. Counselors intentionally reflect what clients are saying in this regard such that it directs the client to directly consider their ambivalence and not avoid it. 3. Roll with resistance. Essentially, this means that a counselor is always willing to consider giving up a current approach with a client when resistance is experiences so that the client isn't put in a spot of defending why they can't make a change. Rather than arguing for why change is needed, a counselor will simply "change channels" and go in a different direction. 4. Support self-efficacy. A client's likelihood of succeeding is directly related to how confident they feel. Thus, a counselor will support the development of a client's internal attitudes, abilities, and beliefs that s/he is capable of making the changes needed.

Understand basic concepts of ethics

1. Identify the problem or dilemma 2. Identify the potential issues involved 3. Review the relevant ethics codes 4. Know the applicable laws and regulations 5. obtain consultation 6. consider possible and probable courses of action 7. Enumerate the consequences of various decisions 8. Choose what appears to be the best course of action

What are the 8 helpful steps of ethical dilemmas?

1. Identify the problem or dilemma 2. Identify the potential issues involved 3. Review the relevant ethics codes 4. Know the applicable laws and regulations 5. obtain consultation 6. consider possible and probable courses of action 7. Enumerate the consequences of various decisions 8. Choose what appears to be the best course of action

What are the 3 steps of case management?

1. Implementing the Treatment Plan 2. Consulting 3. Continuing Assessment and Treatment Planning

CBT addresses several critical tasks that are essential to successful substance abuse treatment:

1. It fosters the motivation for abstinence by having the client decide what he or she has to gain from continued use or by stopping. 2. It teaches coping skills by helping clients recognize the high-risk situations in which they are most likely to use substances and to develop other, more effective means of coping with them. 3. It changes reinforcement contingencies by focusing on identifying and reducing habits associated with a drug-using lifestyle and substituting more enduring, positive activities and rewards. 4. It fosters management of painful or negative emotions by focusing on techniques to recognize and cope with urges to use substances. 5. It improves interpersonal functioning and enhances social supports by teaching the client how to expand their social support networks and build enduring, drug-free relationships.

Example of Soap

3/18/17 S—Client discussed issues she was having with wanting to quit drinking. Stated that she wasn't sure why she should quit as she felt it added many benefits to her life including keeping it interesting and exciting. On the other hand, she also expressed a need to "get her life under control" and "take a break" as she wasn't sure her life was headed where she wanted it to go. Reported that she went out twice in the past week and drank until she blacked out. O—Client appeared appropriately dressed and made good eye contact with the counselor and actively participated. A—Client appears to be in the contemplation stage of change as evidenced by her engaging in weighing the pros and cons of continued use. P—Counselor will continue to utilize motivational interviewing techniques to help facilitate client's movement to the preparation stage of change. Counselor left client with homework regarding probing her likes/dislikes of continued drinking to consider before next week's session. Erik E. Schoen, LADC #869

What are some warning signs of relapse?

59% Negative emotions: Negative emotions include both that are experienced in reaction to relationships (called interpersonal emotions) from conflict and included not feeling appreciated, feeling guilty, and feelings of being wronged.* 11% Cravings and Urges: Many, if not all, clients with substance use disorders will report having experienced a craving or urge to again use drugs or alcohol. 11% Personal "Tests" of Will: This is as it suggests: relapses preceded by a certain amount of planning to see whether one can control or limit their use of drugs or alcohol. 3% Feeling Bad Physically: This includes feeling tired, sick, pain, etc. 3% Positive Emotions: Perhaps surprisingly, perhaps not, positive emotions such as those associated with celebrating major milestones and holidays were found to play a role in a small sub-set of relapses.

Step 3: Continuing Assessment and Treatment Planning

A good case manager or counselor will circle back around to the referral sources and check in with their clients to find out how things are going, and problem-solve any potential barriers to treatment. Oftentimes, the clients we serve need their case manager or counselor to be their advocates so that they receive the respect they deserve from other professionals, and at other times it may be necessary to adjust the treatment plan.

What are advantages of using CBT with a group?

An advantage to groups however, is that the clients have the opportunity to brainstorm various coping mechanisms and role play their coping strategies in a safe environment.

What is case management?

Case management is defined as the administrative, clinical, and evaluative activities that bring the client, treatment services, community agencies, and other resources together to focus on the issues and needs that were identified in the treatment plan. Case management establishes a framework of action for the achievement of specified goals. It involves collaboration with the client, coordination of treatment and referral services, liaison activities with community resources and managed care systems, and ongoing evaluation of treatment progress and client needs

What is CBT?

Cognitive-Behavioral Therapy an approach that teaches people how to unlearn old habits and relearn (or learn) healthier means of coping. The client is encouraged to identify high-risk situations and taught how to cope with thoughts of using. This strategy is used for immediate cessation of drug and alcohol use and future use. (The G. Marlatt approach to relapse prevention and Community Reinforcement Approach (CRA) are both forms of cognitive-behavioral therapy.

What is CM?

Contingency Management As indicated, clients are in effect rewarded—oftentimes by earning small prizes or affirmations—when they do things that are known to be supportive of their continued treatment success.

AVE means experiencing a relapse so satisfying and complete that abstinence is easily achievable henceforth.

False

Licensure and certification are the same thing.

False

Once a problem is listed in the treatment plan, a counselor can treat it as it is now considered to be within their "scope of practice."

False

The best progress notes are those written the following week because it gives the counselor time to really make sense of what happened in the counseling session.

False

The need for regular ethics training doesn't really apply to chemical dependency counselors since data has shown that they are least likely to commit ethics violations.

False

The reason the drug and alcohol field uses the term "relapse" is because it is a neutral term without a lot of societal baggage.

False

The term "case management" means making sure all of the needed sections—intake paperwork, treatment plans, progress notes—of a client's treatment are completed and included in their file.

False

Step 1: Implementing the Treatment Plan

If there was one function around which all case management activities orbit, it is this: ensuring the treatment plan is implemented and that the needed steps are taken and resources identified so that clients have every expectation of successfully reaching their treatment plan goals. The case management activities that support this function are elaborated upon in the textbook and introduced here. -Initiating Collaboration with Referral Sources -Obtain and Interpret all Relevant Screening, Assessment, and Initial Treatment Planning Information -Confirm the Client's Eligibility for Admission and Continued Readiness for Treatment and Change -Complete Necessary Administrative Procedures for Admission to Treatment -Establish Accurate Client Expectations for Treatment

There are eight helpful steps when working through an ethical issue. Which is NOT one of them?

Immediately go to the authorities whenever a legal issue might be identified. This is so counselors will know they are covered in case they have to go to court.

What is the ethical dilemma? A client comes in to an outpatient session with alcohol on his breath. When asked, the client states that he drove himself to the counseling session. What should the counselor do, if anything, when it comes time for the client to leave?

In the case of a client with alcohol on his breath, the ethical dilemma arises out of the tension from our duty to protect (both the client and others) versus our obligation to keep confidential the client's information and identity.

What is the ethical dilemma? A client reveals to her counselor that she had a sexual relationship with a counselor at a previous treatment facility. She does not want this information shared as she just wants to put it behind her. What, if anything, should the new counselor do with this information?

In the last case, the ethical dilemma is likely clear: our duty to report other license holders doing harm to clients versus respecting the client's confidentiality

A Note on Alcoholics Anonymous

It is not a formal level of care or treatment but is, instead, what is known as a peer led support group. Is it effective? yes and no

Step 2: Consulting

It is not uncommon to have several different professionals from different fields involved in the care of one particular client. A physician might be tending to a client's diabetes and high blood pressure; a dietician might be working with a client to learn how to shop and prepare high nutrient and healthy meals; a GED prep program might be working with a client so that he or she can earn his or her GED; and, another agency might be providing childcare for the client's children. Consulting means that case managers and counselors will actively seek out and coordinate treatment with such external resources, oftentimes working with professionals from other fields.

What is the ethical dilemma? A client living in a rural town with only a few hundred people has an intake session with a counselor. In taking the client's history, the counselor recalls that he used to date her sister when they were both in high school. The counselor is confident he can help her. Should the counselor continue counseling the client or refer her?

It is one thing to suggest that clients only be seen by those without any previous relationships or connections (i.e., dual relationship), but how do we weigh this against providing needed helpful therapeutic services that might not otherwise be readily available.

Why is MAT considered controversial?

MAT is considered somewhat controversial, but it shouldn't be; the success rates accomplished through such approaches often far out-distance those from other approaches. As but one illustration, the success rates when using methadone and suboxone can exceed 70 percent when done thoughtfully and with appropriate ancillary supports such as active case management, available outpatient groups, recreation and music therapy, etc. (Firestone).

Which of the following IS a best practice for writing progress notes?

Make sure to write the client's name or identifying number on every page of a clinical file so that if a page ever becomes separated, it will be easy to return to the appropriate file.

What is MI?

Motivational Interviewing "A counseling approach which acknowledges that many people experience ambivalence when deciding to make changes. The operational assumption in MI is that ambivalent attitudes or lack of resolve is the primary obstacle to behavioral change, so examining and resolving ambivalence is its key goal. Its aim is not to immediately focus on changing behavior, but rather enhancing motivation to change."

What are the 8 spokes of the wheel (schematic structures)

Physical Health—Includes consideration of all things related to physical health including sleep and dietary patterns, dental health, regular exercise, relationship(s) with doctors and other health providers, etc. Emotional Health—Includes consideration of whether someone acknowledges and validates their feelings and emotions, if they are able to express emotions appropriately, engagement with mental health professionals if needed, and more. Spiritual Health—To what degree does someone nurture their own self-defined sense of spirituality? Do they regularly attend church, go on hikes to commune with nature, meditate or do yoga, or??? Economic Health—How well is the person doing with respect to meeting their financial needs? Do they have an inordinate amount of debt? Are they utilizing pay-day lenders? Do they have savings in the bank? Are they thinking and planning for retirement? Work/Occupational Health—To what degree does someone enjoy the work they are doing? If not currently in work they enjoy, are they making plans and/or going to schooling to do so? Are they working too many or too few hours? Leisure Health—Includes consideration of whether someone has healthy and variable leisure pursuits in which they regularly engage and spend time. Relational Health—How many positive friends and acquaintances does someone have? How many of these positive friends are considered "deep" relationships? Intellectual Health—To what degree does someone "keep their brain alive" through regular intellectual stimulation?

MAT So integral role is medication thought to be in the successful treatment of addictions, that one of the 13 Principles of Effective Treatment is this:

Principle 7: Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies.

What is relapse?

Relapse is not an isolated event. Rather, it is a process of becoming unable to cope with life in sobriety. The process may lead to renewed alcohol or drug use, physical or emotional collapse, or suicide.

The most common type of formatting used for progress notes is

SOAP—Subjective, Objective, Response, (Treatment) Plan

A in Soap

The A in SOAP stands for assessment and is the portion of the note where the counselor provides an analysis of the data, both subjective and objective, that has been provided. This section could also include notes on a client's current state of mind including any suicidality or homicidality, diagnoses (especially if changed and/or added/refined). In the example, we can see that the therapist clearly noted the client's ambivalence and cited the data that led to that conclusion.

O in Soap

The O in SOAP stands for objective data and is essentially a record of data and observations that has been directly noted by the counselor or others. This could include notes on a client's appearance, body language, behavior, mood, and more. In the example, we can see that the client seems to be appropriately and actively engaged in the counseling process.

P in Soap

The P in SOAP stands for plan and is essentially the part of the note where the counselor lays out their plans for helping the client move forward with treatment. This section would include such things as goals, homework, specific recommendations, and more. In the example, we can see that the counselor continues to utilize motivational interviewing to help the client address their current stage of change, and that the counselor assigned homework specifically designed to help increase the client's cognitive dissonance, a likely motivator for prompting movement to the next stage of change.

S in soap

The S in SOAP stands for subjective data and refers essentially to what the client tells the counselor or therapist. This includes their thoughts, feelings, and perceptions about whatever they may choose to share; direct quotes may be used to better communicate a client's frame of mind or point-of-view. In the example, we can deduce that the client is experiencing ambivalence about her drinking—we can clearly see the benefits and consequences to which the client is oriented. As well, we can see that the client has not been able to completely quit drinking as of yet.

why it matters that we act ethically?

To begin, it is important to acknowledge that a power differential exists in any counseling relationship. That is, a client is not on equal footing as the therapist he or she is seeing.

A situation where a counselor's duty to protect is pitted against a counselor's obligation to keep a client's information confidential is an example of a true ethical dilemma.

True

A treatment plan should never be considered be "written in stone" as it is an always-evolving document responsive to a client's emerging needs.

True

And, finally, though "everyone" knows that confidential information can only be provided under certain circumstances, nearly 13 percent of all claims were due to the inappropriate sharing of such information.

True

Counseling files are essentially modeled after medical records and include all relevant sections.

True

In seeking licensure as an intern, it is helpful for counselors to be familiar with their states' statues and regulations that apply to the particular license(s) being sought.

True

Licensed chemical dependency counselors commit one ethical violation for every 200 professionals—a rate five times higher than any other human services provider.

True

Relapse rates for alcoholism are similar to those of other chronic diseases like high blood pressure and asthma.

True

The "Spoked Wheel" exercise is a way for clients to self-assess important life areas so that they have a graphic representation of which areas are strengths and which would benefit from attention.

True

The relapse process is marked by predictable and identifiable warning signs that begin long before a return to use or collapse occurs

True

Though "everyone" knows that it is not appropriate to have sex or romantic relationships with clients or their family members, nearly 40 percent of one insurer's closed claims were for just this reason.

True

Though "everyone" knows they can only provide services for which they were educated and trained, nearly 16 percent of all closed claims were due to counselors practicing outside their scopes of competence.

True

When writing progress notes, counselors should always remember to be charting to the goals identified in the treatment plan.

True

it is important for counselors to educate themselves on the similarities and differences when working with different client populations.

True

relapse rates for these conditions are similar to those for alcoholism

True During the course of a year, 30-50 percent of adults with diabetes and 50-70 percent of adults with high blood pressure or asthma will suffer a re-occurrence of their symptoms severe enough to require medical intervention, sometimes including hospitalization.

What are advantages of using CBT alone?

When a client sees their counselor alone, that process can make for a stronger bond and obviously, the client has more individual attention.

When a counselor is working with a client on case management issues, it is NOT advised that

a summary of the client's assessment be sent out to all possible referral sources as soon as the assessment is completed. This is the most efficient way to "alert" other agencies that might be able to help the client.

What is an ethical dilemma?

at least one ethical principle is pitted against another.

CARE charting

condition of the client (C), before and after the session, the action taken (A), the response of the client (R), and an evaluation (E) or plan for the next session.

DAP

data (D), assessment (A), and plan (P)

When working with clients on their relapse prevention plans, counselors SHOULD

identify triggers—any and all kinds—so that plans can be developed for each trigger identified. A good source of information in this regard is previous relapses.

"Intrapersonal emotions," on the other hand

included feelings of loneliness, sadness, free-floating anger, and more accounted for 38 percent of relapses versus 18 percent from relationship reactions.

Why is CBT considered a brief therapy?

is frequently offered in twelve to sixteen sessions, usually over twelve weeks, which is intended to produce initial abstinence and stabilization. In many cases, this is sufficient to bring about sustained improvement for as long as a year after treatment ends. For some clients, this brief treatment is not sufficient to produce lasting improvement. Further treatment is recommended when the client requests it or when the client has not been able to achieve three or more weeks of continuous abstinence during the initial treatment.

Sexual orientation discrimination

less access to needed medical and dental services; high rates of depression, suicidal ideation, anxiety, and PTSD; lack of access to many needed mental health services; high rates of being victimized sexually, physically, and emotionally; high degree of stigmatization and exclusion from mainstream society; high rates of drug and alcohol use.

In what other forms of therapy is CBT embedded?

longer courses of counseling and other interventions such as pharmacotherapy, self-help groups, family and couples therapy, vocational counseling, parenting skills, and so on. When utilized in its "brief therapy" form it is often utilized to target specific issues that have come up for clients and/or to develop specific micro-skills that will help clients as they progress through counseling.

What is MAT

medication assisted treatment

What are examples of MAT?

methadone and suboxone for opiate-dependence, nicotine-replacement patches for nicotine- dependence, and Antabuse for alcohol

What does continuing care/discharge planning focus on?

the evolving treatment needs a client may have and/or need to be addressed while in care and/or for discharge to lower levels of treatment or out of treatment altogether. Because the continuing care plan is a core clinical document, it will likely be the responsibility of the primary counselor to develop it

What does MAT do?

utilizes medication(s) to assist clients achieve their goals to be drug- and alcohol-free.