Illinois CADC Exam 2018

Culturally Responsive Teaching

The educator develops teaching approaches to address the cultural knowledge, prior experiences, and performance styles of diverse students to make learning more appropriate and effective for them. This is called culturally responsive teaching and acknowledges the legitimacy of cultural heritages, builds bridges between social and learning experiences, employs a wide variety of instructional strategies connected to different learning styles, teaches students to know and praise their own and each other's cultural heritages, incorporates multicultural information, resources and materials in the subjects and skills.

Withdrawal from Drugs of Abuse

Attempting to give up a benzodiazepine or alcohol dependency can result in seizures and worse if not carried out properly.

Withdrawal from Drugs of Abuse

Central to the role of nearly all drugs taht are commonly abused to prodeuce euphoria is the nucleus accumbens, the brain's "pleasure center".

Active Listening

Clear listening. New counselors tend to think while listening and is not accurately hearing what the person is saying. Important to listen without judging. Reflecting: summarizing and repeating client's thoughts and feelings in a simple and clear manner. Asking open-ended questions, requiring clients to explore the reasons they think, feel and act the way they do. Use effective body language (sit with legs and arms uncrossed, lean forward and make eye contact. Watch for non-verbal cues. Listen and watch carefully.

Other situations involving referral

Client is experiencing difficulty outside the counselor's knowledge base; the client has reached the limit of time for services but has not completed treatment goals,. The counselor or agency's therapeutic approach or philosophy is not the best match for the client. There is a safety concern for either the counselor or the client. The counselor feels unable to work effectively with the client due to personal values, cultural barriers or other issues. The client expresses discomfort or refuses to work with the counselor.

Utilize Adequate Consultation

Clinical supervision is often viewed merely as a legal requirement for program licensure or as a form of risk management and liability prevention.However good supervision can reduce burnout, creativity in resolving difficult cases, professional development and increased expertise, staff development, better clinical care of consumers and shared leadership between supervisors, staff members and co-workers.

Cannabis (Marijuana)

Contrary to popular belief, marijuana is addictive.

Ethical Situations for addiction Counselors

Counselor as a person must have self awareness to maintain a relationship grounded in respect, empathy and genuineness. Moral sense is having a personal understanding of the difference between right and wrong. If an action seems uncomfortable or does not "feel right', a counselor should seek supervision. Values reflect what we believe to be important in our lives. Counselors should be clear about their values.

Measuring Client Progress

Traditionally client progress in treatment was measured by the achievement of goals delineated in the client treatment plan In the era of evidence-based practices, many programs have prescribed pre-and post-test measures or specified indicators of progress which must be utilized to ensure implementation fidelity. Instruments such as GAIN are designed to measure the recency, breadth and frequency of problems.

Trauma-Specific Models

"Trauma Informed" and "Trauma-Specific Approaches" - knowledge about trauma, impact, interpersonal dynamics, paths to recovery and incorporate this knowledge thoroughly in all aspects of service delivery. The primary goals of trauma-specific services are focused to address directly the impact of trauma on people's lives and to facilitate trauma recovery and healing.

Goals of the Initial Interview

(1) Establish trust, rapport and effective communication with the client. (2)facilitating the client's UNDERSTANDING OF THE RATIONALE, PURPOSE, AND PROCEDURES ASSOCIATED WITH THE SCREENING AND ASSESSMENT PROCESS. (3) Exploring the client's problems and expectations; and (4) determining whether further assessment is needed.

The "spirit" of MI is based on 4 key elements:

(1)Partnership/Collaboration: Work in collaboration and avoid the "expert" role. (2)Acceptance/Autonomy:Respecting the client's autonomy, potentials, strengths and perspectives (3)Compassion: Keeping the client's best interests in mind. (4)Evocation: The best ideas come from the client: "You have what you needs and together we will find it".

Clinical Evaluation

Effectively assessing a person's alcohol and/or drug misuse is critical to preventing or early intervention in addiction - can be through outreach, screening, or assessment.

Client, Family and Community Education (Learning)

Learning is defined as change in behavior (knowledge, skills and attitudes). There are three basic learning styles: Auditory - hearing. (30% of the population is described as auditory learners). Visual 65% of the US population is primarily visual in learning. Kinesthetic. learners learn through touch, movement and space - only 5% of the population.

Five principles for MI

Open-ended questions; Listen reflectively; Summarize; Affirm; Elicit self-motivational statements.

The classes of prescription drugs most commonly abused:

Opioid pain relievers such as Vicodin or Oxycontin; stimulants for treating ADHD such as Adderall, Concerta or Ritalin and Cental Nervous System depressants for relieving anxiety such as Valium and Xanax.

Continuum of cultural competence include five stages:

1. Cultural Destructiveness: myopic view of effective treatment, can project superiority and arrogance. 2. Cultural incapacity: counselors ignore the relevance of culture while using the dominant client population and/or culture as the norm for services. At this level, counselors can be aware of the need to approach treatment differently but likely believe they are powerless over circumstances or the organizational system. #. Cultural Blindness - the assumption that all cultural groups are alike and have similar experiences, there are no essential differences among individuals across cultural groups. 4. Cultural Pre-Competence: Counselors acknowledge a need for more training and recognize the importance of developing cultural competence and have taken small steps to improve their clinical knowledge. 5. Cultural Competence and Proficiency: Counselors adopt culturally responsive practices.

Taleff (2010) provides a list of seven criteria for defining ethics.

1.Ethics require other people as they are about relationships 2.Intent makes a difference 3.Ethics aim to resolve dilemmas 4.Thinking is necessary for ethics and morality. 5. Ethics ask you to be impartial 6. Ethics require us to care about the suffering of others 7. Ethics judge human behavior.

Residential Treatment

24 hour intensive medical, psychiatric, and/or psychosocial treatment and residential care. Therapeutic communities are highly structured residential programs that can last between 6 months and two years.

Contingency Management Therapy

A behavioral modification strategy using motivational incentives to facilitate behavior change e.g. substance abstinence, clinic attendance.

Motivational Enhancement Therapy

A client-centered counseling approach consisting of an initial assessment battery session, followed by two to four individual treatment sessions with a therapist (resolve ambivalence about engaging in treatment).

Case Management

A collaborative process. it's primary purpose is to help individuals identify needed services, select the most appropriate services available in a given geographical area, facilitate linkage with services and promote continued retention in services by monitoring the individual's participation, co-ordinate the activities of multiple services when present and when necessary and advocate for continued participation (NASW 2012). Objectives include continuity of care, accessibility, accountability and efficiency. The core agency for a specific geographic area is responsible for developing contracts with providers for the delivery of specified services for case-managed clients.

Counselor Self-Disclosure

A counselor should limit sharing personal information to circumstances when doing so is clearly relevant to the client's treatment goals - in order to maintain appropriate boundaries and clear roles. A general rule of thumb is that a counselor should only reveal information about a personal life problem well after it has been resolved and not while it is an ongoing issue.

Codes of Ethics

A set of principles that define our actions. Ethics are based on moral values - a sense of what is right and wrong.

Fulfilling public trust.

Use of public funds creates an obligation to fulfill the public trust. This results in higher standards than those required in private industry.

Therapeutic Alliance

A key component of successful counseling. Has three components: (1) The relationship or bond between therapist and client (2)Consensus between counselor and client regarding the techniques/methods employed in treatment (3) Consensus between therapist and client regarding the goals of treatment. THE PRIMARY RESPONSIBILITY FOR DEVELOPING AND MAINTAINING THE RELATIONSHIP RESTS WITH THE COUNSELOR. It has been found that over 80% of the positive outcomes of treatment may be due to the therapeutic relationship (warmth, empathy, respect for client).

Self-Administered Tests

A less threatening method of self-disclosure

Structured Interview

A prescribed interview structure but the interviewer is free to ask probing or clarifying questions when clinically appropriate.

Assessment

A process for defining that nature of the problem, determining a diagnosis, developing specific treatment recommendations. Entry level counselors perform screening while assessment is performed by more experienced and credentialed staff. Assessment is an in-depth evaluation.

Evidence of Cultural Competence

A process of learning about and becoming allies with people from other cultures, thereby broadening our own understand and ability to participate in a multicultural process. The key element to becoming more culturally competent is respect for the ways that others live in and organize the world and an openness to learn from them.

Counseling

A professional relationship that empowers diverse individuals, families and groups to accomplish mental health, wellness, education and career goals.

Applicable Laws and Regulations

A regulated industry. The state has laws that establish defined duties and minimum standards of practice.

Cognitive-Behavioral Therapy (CBT)

A short-term, focused approach to helping individuals with SUD become abstinent. The underlying assumption is that learning processes play an important role in the development and continuation of substance use and dependence. Same learning processes can be used to help individuals reduce their substance use. CBT is based on the idea that feelings and behaviors are caused by a person's thoughts, not on outside stimuli (people, situations, events). People may not be able to change their circumstances but they can change how they think about them and therefore change how they feel and behave. The goal of CBT is to teach people how to recognize situations in which they are most likely to drink or use substances, avoid these circumstances if possible, and cope with other problems and behaviors which may lead to their substance use.

Specific Cultural Groups

A stereotype is an ending point. No attempt is made to learn whether the individual in question fits the statement or assumption. A generalization is a beginning point.

Motivational Interviewing (MI)

A style of interaction to facilitate change, began in substance abuse treatment in the early 1980's. It contrasts with the traditional confrontational style. MI is a client-centered approach that seeks to enhance and individual's motivation to change by exploring and resolving ambivalence. It has been framed as a "guiding" style of communication as compared to a more directive style.

Communication Techniques (reflecting, clarifying, focusing, summarizing)

Active Listening is an intentional feedback loop wherein the counselor reflects, clarifies and summarizes what the client says in order to verify that they understand both the literal content and feelings being conveyed. Specific skills include: Reflecting (restating); Clarifying (rephrasing); Focusing (directing client's attention) and Summarizing.

Treatment Documentation

Activities and Strategies that are used to address substance use problems that have been diagnosed as moderate or severe, or mental disorders generally require the following documentation: Medical Documentation; Clinical Documentation.

Intervention Documentation

Activities and Strategies used to prevent further development or progression of substance use problems.

Drug Cultures and the Culture of Recovery

Addiction counselors must also be aware of the influence of drug cultures and the culture of recovery.

Engaging the Family

Addiction is a family disease. The person abusing substances is regarded as a subsystem within the family. Codependency refers to people who are in a close relationship with the addicted individual. The codependent person is typically over involved and takes on the role of caretaker. Enabling can result by putting out little fires. An intervention refers to a confrontation staged by a group of family or friends to convey the impact of the substance use and to urge entry into treatment.

Understanding Addiction and Recovery

Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors. Addiction is characterized by a diminished recognition of significant problems with one's behaviors. (ASAM: American Society of Addiction Medicine)

How duties are defined and ethical accountability is established.

Agencies must treat requirements in the following order of precedence: Law (federal, state, local); precedent by case law; reasonable person test (common sense); regulations or administrative rules; contracts.

Alcohol

Alcohol is classified as a sedative-hypnotic, thus a central nervous system depressant. Alcohol has eights stages of effect: sub-clinical, euphoria, excitement; excitement (2); excitement/confusion; confusion/stupor;coma and death Catholic University of America 2011)

Drugs of Abuse

Alcohol is the most frequently abused substance. Drugs obtained through prescriptions or stolen from pharmacies is a serious problem.

Risk Assessment

At both the screening and assessment stages, counselor must observe client to assess for signs of psychoactive substance toxicity, intoxication and withdrawal; aggression or danger to others; potential for self-inflicted harm or suicide; and coexisting mental health problems,

The Importance of Culture

An integrated pattern of human behavior that includes thoughts, communications, languages, practices, beliefs, values, customs,courtesies, rituals, manners of interacting and roles, relationships and expected behaviors of a racial, ethnic, religious or social group; and the ability to transmit the above to succeeding generations. Cultural identities are not static but develop, evolve and change across the life cycle.

Treatment Planning

An intentional carefully considered road map for treatment and recovery process. All of the information gathered throughout the assessment process is analyzed and interpreted in order to make decisions about client placement and approaches to treatment. Treatment planning is action-oriented and lays out a logical, goal-oriented strategy for making positive changes in a client's life. Treatment plans are developed once a diagnosis is confirmed, a placement recommendation has been made and the client has been admitted into an appropriate level of care. The level of care is determined based on the diagnosis of the problem and on the client's strengths and assets.

Elements of Informed Consent

An ongoing collaborative effort between client and counselor for establishing and monitoring goals and strategies of counseling as well as roles, rights, responsibilities of all parties.

Key Provisions of 42 CFR

Any person who violates any provision of the regulations may be fined up to $500 for the first offense and up to $5000 for each subsequent offense.

Alcoholics Anonymous

Began in 1935 as a fellowship for those who wanted to stop drinking. Bill W. a stockbroker and Dr. Bob, a surgeon were the original two members. The main purpose is to stay sober and help other alcoholics achieve sobriety. Abstinence is the only treatment. Three legacies are Recovery, Unity and Service.

Types of Treatment Programs: Withdrawal management:

Broad process with three essential components: Evaluation; Stabilization; Fostering client entry into treatment. Withdrawal management can be ambulatory (outpatient) methadone maintenance clinic - less expensive, less disruptive, allows client to remain in same environment where he/she will function when drug-free. Residential/inpatient programs can be provided in acute care hospital, residential addiction programs, psychiatric hospital or freestanding medical care. Outpatient treatment can range from highly structured to "drop-in" centers.

CSAT

Center for Substance Abuse Treatment

Minors and Families

Counselors must report situations hat present an imminent risk of harm to minors. An addiction counselor should not investigate the child's situation or determine how the child should be handled. This is the responsibility of specially trained child protective investigators. In the best of circumstances the counselor will obtain the client's consent to disclose important information to the parents. The therapeutic alliance between counselor and client may be damaged if a counselor who is unclear on the limits of confidentiality later provides information to parents.

Standardized Interview - more credible than the structured interview for referrals, legal actions DCFS etc.

Differs from the Structured Interview in that it limits the interviewer to a prescribed style and list of questions. The interviewer is restricted from freely probing beyond conflicting or superficial answers, which is sometimes a disadvantage of this technique. An advantage is that this interview may be more credible than the structured interview.

Disclosures without client consent

Disclosures without client consent may only be made under specific circumstances: Reports of suspected child abuse and neglect; Crimes on program premises or against program personnel; medical emergencies;Research activities conducted by qualified researchers; Audit and evaluation activities, including third party payers, Medicaid, Medicare and Peer review organizations; Qualified service organizations; court order.

Progress Notes

Document the client's progress in relation to treatment goals and objectives. Sometimes counselors use format called SO/AP that provide this structure: S/O Subjective Objective: What the client reports and what is observed. A/P - Assessment Plan: How the counselor assesses what was said and observed.

Setting Expectations

Educate the client regarding the structure, expectations and limitations of the counseling process.

Personal Dimensions that characterize facilitative relationships are:

Empathy: ability to understand how another person sees and interprets and experience, Genuineness: the ability to be fully oneself and express this to others, Respect, counselor believes that the client has the ability to make it in life, the right to make his or her own decisions, Self-Disclosure: the ability to disclose information about oneself (thoughts and feelings); Warmth: convey care; Immediacy: focus on the :here and now: relationship with another person; Concreteness: the ability to identify specific problems and steps necessary to correct them; Cultural Sensitivity: cultural competence requiring ongoing training and self-evaluation of counselor.

There is no universally accepted code of ethics for the addiction field

Ethical conflicts for addiction counselors arise in three basic contexts: 1. Failure to comply with the law, governing policies and ethical codes 2. Personal dilemmas where an individual knows what is right, but is tempted to do wrong 3. Moral dilemma when there are conflicting rights or conflicting wrongs.

Race and Ethnicity

Ethnicity refers to a common heritage of a particular group.

Special Circumstances

Exceptions to allow access to records in special circumstances: disclosure of law enforcement records; disclosure under health or safety emergency; disclosure under the adult criminal justice and juvenile justice systems.

Substance Use Disorders (SUDs)

Exist along a continuum.

The Interview Climate

Factors include Stigma, Expectations, Likableness, First Impression, Professional Manner, Environment.

Self-Help Approaches

Formal Treatment organizations incorporate 12-step groups into their treatment regimen and recommend them for ongoing recovery support following the conclusion of treatment. The key to recovery is turning one's life and will over to a personally meaningful "higher power" such as God or Spirit. An extremely valuable aid to recovery as a social support network outside of the treatment program, and teaches skills needed to recover and helps clients take responsibility for their recovery.

Factors that Influence Addiction

Genetic, Home & Family, Peer & School; Early Use; Method of Administration; Fundamental changes in the Brain.

Counseling strategies and individual progress

Good outcomes: Participation for less than 90 days is of limited or no effectiveness. For methadone maintenance, 12 months is the minimum. For opiate-addicted individuals, methadone maintenance treatment can last years. Many individuals have multiple episodes of treatment, often with a cumulative impact. Recovery support services are complementary to, and supportive of treatment rather than antithetical or a replacement for treatment.

Collaboration

Good treatment is a collaborative process, both within the interdisciplinary team in a treatment program and with others outside the agency. The concept of the "warm referral" has been developed to assure that there is continuity of care between providers and to ensure that clients follow through with referrals to collaborative partners. The "warm referral" involves the counselor or case manager making the first contact on behalf of the client, and explaining to the referral organization or team the client's circumstances and the reason they believe the client would benefit from the referral. Warm referrals refer to ancillary support services and with other professionals (medical, dental, psychological).

HIPPA

HIPAA Privacy Rule gives clients rights over their own health information: Receive a copy of their record, request that mistakes be corrected, receive a notice about how their health information is used and shared, specify how and where they want to be contacted by the service provider, file a complaint if they think any of these rights have been violated. Rights are spelled out in the Notice of Privacy Practices that is given to clients when they receive services. The HIPAA Security Rule requires that health care providers set up physical, administrative and technical safeguards to protect electronic health information/records (EHR).

Four Major Dimensions in an effective ROSC

Health (disease management);Home;Purpose; Community.

Recovery and Recovery-Oriented Systems of Care

Important to make the destiction between Recovery and ROSC.

Assessment Instruments

Include Standardized interviews, Structured Interviews, Self-administered tests.

Levels of Treatment

Includes Group counseling: a group culture that focuses on the "here and now" behavior. Active and dynamic approach, empathic style. A common mistake is for a beginning counselor to focus an entire group meeting on one client, while others simply look on. Groups work well because they engage therapeutic forces - like affiliation, support, peer confrontation - enables clients to bond with a culture of recovery. Also effective in treating problems that accompany addiction such as depression, isolation and shame.

Specialized Outpatient Programs:

Intensive Outpatient Treatment: Highly structured and consists of 9 to 70 hours of treatment weekly. services may include group therapy, pharmacotherapy, relapse prevention training, individual counseling, family therapy and vocational training. Outpatient Treatment for Opioid Dependence: Methadone Maintenance Treatment is the familiar term but Medication Assisted Treatment (MAT) is the current term. MAT includes medication e.g. methadone, naltrexone etc.

Assessment Interview (Biopsychosocial)

Interviews with the person being assessed are more comprehensive than the brief interviews used for screening. In screening, information is focused on the self-report of the person seeking services, while in assessment interviews, a more thorough and systematic method of gathering information is used.

Community Education

Involves: Reviewing background information to define the problem; setting education objectives;analyzing and segmenting target audiences, Developing and pre-testing message concepts, selecting communication and education channels, select and create pretest messages and products, develop promotion plan and production, implement education strategies, impact evaluating.

Ethical Issues in Confidentiality

Laws protecting Substance Abuse clients are more stringent than laws regarding confidentiality of client records in other fields. Most people believe that counselors have an obligation to warn or protect people if they believe their client is placing those people in danger.

Memoranda of Understanding (MOU)

MOUs are a means to structure a relationship among agencies. More formal than "social service bartering".

Engaging the client in treatment

Making a respectful, non-judgmental connection with client is key to engagement.

Culturally appropriate strategies

Many EBT practices and programs were developed by Caucasian researchers. Modifications take two forms: Cultural Accommodation and Cultural Adaptation.

Process of SUD Treatment: Models of Treatment

Medical model: Views addiction as a chronic and progressive disease. Emphasis on physical causes and genetic factors. Spiritual Model: Largely because of AA and 12 step fellowships - Cocaine Anonymous, Narcotics Anonymous and Al-Anon. Spiritual models give less weight to causation and emphasize the importance of the spiritual path to recovery. Recognizing a higher power beyond one-self, asking for healing of character, maintaining communication withe the Higher Power through prayer and meditation and seeking to conform one's life to its will. Twelve step programs are not "wholly self-help but rather "Higer Power-help" programs. Psychological model - psycopathology can be treated behaviorally or psychoanalytically oriented dynamic therapies. Change process shifts from internal (intrapsychic) to external (behavioral, interpersonal). Sociocultural model: substance related problems are seen as occurring in interactive relations with families, groups, and communities, alterations in policie

Theories of Causation

Moral Model; Disease Model (E.M. Jellinek 1960); Genetic Model; Cultural Model; Blended Model.

Prescription Drugs

More people die from overdoses of prescription opioids than from all other drugs combined, including heroine and cocaine (Centers for Disease Control, 2011).

Building Motivation for Treatment

Motivational Interviewing as a style of interaction to facilitate change, began in SUD treatment in the early 1980's. MI was truly an innovation in SUD because it created a shift in the underlying philosophy of care and used a set of specific techniques to engender engagement and empowerment of the persons seeking help for substance use problems. Earlier style used confrontation as an intervention.

Moral Dilemmas

Occur when there are conflicting values or rights. (lesser of two evils)

Recovery Boundaries

One area of concern is that counselors in recovery may be overly focused on replicating their own journey to recovery in their work with their clients e.g. clients who are strongly 12-step oriented may reject treatment approaches that are not abstinence -based.

Informed Consent

One of the most basic and important concepts in ethical practice. Includes "client-centered or client-directed treatment". The client has the right to choose or refuse treatment, to set goals for treatment outcomes and to define his/her recovery.

ROSC

Partnering with people in recovery from mental health and SUD to guide the behavioral health system and promote individual, program and system-level approaches that foster health and resilience; increase permanent housing, employment, education and other necessary supports; and reduce barriers to social inclusion.

Prescription Drugs

Past year abuse of prescription pain killers now ranks second-only behind marijuana- as the nations's most prevalent drug problem.

Three other specialized groups common in SUD Treatment

Prevent relapse, bring a specific culture's healing practices to bear on substance abuse, use art to express thoughts that are difficult to communicate or groups that target specific problems such as anger or shyness that contributes to substance abuse.

Recovery

Process of change whereby individuals improve their health and wellness.

Readiness to Change

Proschka and Diclemente 1984: Stages of Change Model. The five stages of change are pre-contemplation, contemplation, preparation, action and maintenance.

Six general guidelines for daily ethical conduct (Corey)

Provide informed consent; operate in a competent and theoretically sound manner; Ensure confidentiality of client information; maintain appropriate relationship boundaries; utilize adequate consultation; honor diverse personal and cultural values.

Single State Authority (SSA)

Providers that contract with the SSA to provide treatment services are governed by conditions of these contracts.

Psychoeducation

Psycho-education is health education combined with behavioral counseling. The counseling component deals with emotions, perceptions, coping, relaxation and self-care. Psycho-education is the education of a person in subject areas that serve the goals of treatment and rehabilitation - teaching people about their problem, how to treat it and how to recognize signs of relapse. The core psycho-educational principle is education has a role in emotional and behavioral change. Self-efficacy is the person believing that he/she is able to manage the situation. Psycho-educational groups are good options for clients for whom group therapy does not work e.g. clients who are unable to maintain confidentiality or who engage in anti-social behaviors or clients who are not motivated to participate in treatment. It is a highly structured format in one or two hour time-limited groups. Presents an opportunity to discuss presented material but very little processing of personal issues. Has been found to b

Groups commonly used in Substance Abuse Treatment

Psycho-educational which educate clients about substance abuse, Skills development groups to attain and sustain abstinence (anger and coping skills); Cognitive-behavioral groups which alter thoughts and actions that lead to substance abuse and support groups for maintaining abstinence and managing day-to-day healthy living. Interpersonal process groups delve into major developmental issues that contribute to addiction or interfere with recovery.

Recovery-Oriented Systems of Care

ROSCs are a model of sustained recovery management (RM). The RM model wraps traditional interventions in a continuum of recovery support services spanning the pre-recovery, recovery initiation and stabilization, and recovery maintenance stages of problem resolution. Distinctive is the model's emphasis on post-treatment monitoring and support; long term, stage-appropriate recovery education; peer- based recovery coaching; assertive linkage to communities of recovery; and when needed, early re-intervention (White, 2006).

Recovery

Recovery is a process of change whereby individual's improve their health and wellness, to live a self-directed life, and strive to reach their full potential (SAMHSA, 2014)

Perspectives on SUD Treatment

Scientifically based approaches to SUD treatment can include behavioral therapy (counseling, cognitive, psychotherapy), medications or their combination. Behavioral therapies offer people strategies for coping with their drug cravings, teaching them ways to avoid drugs and prevent relapse, help them deal with relapse if it occurs. Case management and referral to other medical, psychological and social services are crucial components of treatment for many clients. No single treatment is appropriate for all individuals.

Documentation: Screening Documentation

Screening occurs in the initial contact with the client and includes the following elements: Referral Source; Presenting problems; Background Information; Emotional/mental status; Clients strengths and preferences; Recommendation for assessment or other referral.

Examples of EBP Programs

Seeking Safety, Motivational Interviewing, twelve Step Facilitation Therapy, Behavioral Couples Therapy, Cognitive-Behavioral Therapy, Solution Focused Brief Therapy (SFBT); Community Reinforcement Approach (CRA) with vouchers, Dialectical Behavior Therapy (DBT). Fidelity is the degree to which a program or practice is delivered so that it remains true to the treatment as originally developed and evaluated in a research study. Fidelity can be lost when clinicians fail to apply the techniques of the EBT as they were trained. There can be significant failure is programs and practices are not delivered with fidelity.

Characteristics of Culture

Shared attributes of a group of people.

Challenges to learning and The Matrix Model

Some clients may have learning and memory deficits attributable to their substance use e.g. short-term memory impairment from methamphetamine use. The matrix model of outpatient treatment recognizes impairment and delivers information accordingly. Dales' cone of experience illustrates the effectiveness of various teaching strategies.

Documenting the Treatment Process

The client file is the official legal record of the treatment process and is subject to numerous legal and administrative requirements as well as clinical practice standards.

Advocacy

Speaking up or standing up for someone else in a : representative role (speaking for people); an accompanying role (speaking with people); an empowering role (enabling people to speak for themselves); a mediating role (facilitating communication between people); a modelling role (demonstrating practice to people and policy makers); a negotiating role (bargaining with those in power); a networking role (building coalitions)

GAIN

Standardized Screening tool to obtain information about substance use.

Professional and Ethical Responsibility

Standards are developed for the protection of four groups: Client;clinician; profession; community. Primary responsibility for ethical practice and for identifying ethical breaches rests withe the addiction counselor and the clinical supervisor.

SAMHSA

Substance Abuse and Mental Health Services

Treatment Approaches and Evidence-Based Practice (EBP)

The goal of EBP is to integrate clinical expertise, external scientific evidence and client/patient/caregiver values to provide high quality services reflecting the interests, values, needs and choices of the individuals we serve. EBP are the only ones that are supported by scientific evidence that proves they work to produce specific outcomes when used to treat the disorders for which they were developed and with people who are similar to the service recipients in the clinical trials.

Professional Ethics

The integrity of the substance abuse profession depends upon the ethical behavior of its practitioners. In most states candidates for IC and RC certification are required to sign the code of ethics as part of the application of the certification process. Training in professional ethics is also required.

Delivering Psycho-education

The leader of these groups has to be extensively prepared with information, skills and a deep understanding of the group topics and the intended audience. Leaders do not just present information but foster further goals such as information transfer, emotional discharge, support of a medication or other treatment, assistance toward self-help.

A New Recovery Paradigm

There has been a shift in traditional clinical practice toward new priorities of supporting the client in working toward self-defined goals and taking responsibility for their own life. The new recovery movement affirms the very real potential for permanent, personal resolution of behavioral health problems.

Code of Ethics for NAADAC

There may be great variation in how codes are interpreted, monitored and enforced. Often more attention is paid to ethical breaches that deal with prohibited behaviors (confidentiality, inappropriate touch) than to the prescribed behaviors such as respect for diversity, cultural competence and ongoing professional development. Ongoing education is expected to improve skills and keep updated with field developments. Counselors are expected to be knowledgeable about the laws, regulations and policies that govern their area of practice.

Family Psycho-educational Groups

This helps family members prevent the individual with substance use and/or co-occurring mental health disorders from relapsing and promoting their re-entry into their home communities. Families are provided wit the information they needs and the coping skills that will help them deal with their loved one's disorder(s). An associated goal is support for the clients' families.

Failure to comply

When compliance with a law or policy is mandatory, failure to comply becomes an ethical issue e.g. child abuse. professionals who become aware of child abuse are required by law to report it and failure to do so can result in fines and other disciplinary actions.

Alcohol

While it is trues that men are more likely to drink alcohol and in greater amounts, women have a higher risk of developing problems from alcohol consumption. This is because women generally have less water than men's bodies. Because alcohol mixes with body water, a given amount of alcohol is less diluted in a woman's body than in a man's. Women become more impaired by alcohol's effects and are more susceptible to alcohol-related organ damage.

Personal Dilemma

Within an ethical context: An example is when a professional engages in a dual relationship with a client counselor/client: landlord/tenant - can lead to confusion and blurred boundaries between the two parties.

Clinical and Recovery Support Services

advocacy, housing support, linkage to legal and child welfare services, employment readiness, education support and remediation, family programs, child development education, parenting education, life skills, community and recovery support services.