Individual Drug Counseling - National Institute on Drug Abuse

Therapy Manuals for Drug Addiction Series

Individual Drug Counseling

Delinda E. Mercer, Ph.D. George E. Woody, M.D. University of Pennsylvania and Veterans Affairs Medical Center

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Institute on Drug Abuse Division of Clinical and Services Research 6001 Executive Boulevard Rockville, Maryland 20892

ACKNOWLEDGMENTS

The development of this manual was supported, in part, by research grants for the Collaborative Cocaine Treatment Study (CCTS) and for the Drug Dependence Behavioral Treatment Research Center from the National Institute on Drug Abuse (NIDA). This manual was written by Drs. Delinda E. Mercer and George E. Woody under contracts with NIDA. Debra Grossman, the NIDA project officer, offered valuable guidance and comments throughout the preparation of this manual.

The material presented in this manual is the result of extensive research and clinical experience under the direction of Dr. Woody and colleagues at the University of Pennsylvania (Penn) and Veterans Affairs (VA) Medical Center. The University of Pennsylvania Center for Psychotherapy Research and the Penn-VA Center for Studies of Addiction were both instrumental in the development of this manual and in the Collaborative Cocaine Treatment Study for which this manual was originally prepared. This drug counseling model is based on the clinical work of Nina Chychula, Ph.D., John McGinnis, M.S.W., and Debra Wiles, M.S.W., in the Addiction Recovery Unit of the Veterans Affairs Medical Center under the direction of Iradj Maany, M.D. The work of many others was also quite valuable and is acknowledged in the relevant portions of this manual.

The assistance of many dedicated therapists, counselors, and research assistants who participated in the clinical trial of this therapy protocol is gratefully acknowledged and appreciated.

DISCLAIMER

The opinions expressed herein are the views of the authors and do not necessarily reflect the official policy or position of the National Institute on Drug Abuse or any other part of the U.S. Department of Health and Human Services. The U.S. Government does not endorse or favor any specific commercial product.

PUBLIC DOMAIN NOTICE

All material appearing in this report, except the appendix, is in the public domain and may be reproduced without permission from the Institute or the authors. Citation of the source is appreciated.

NIH Pub. No. 99?4380 Printed September 1999

Foreword

More than 20 years of research has shown that addiction is clearly treatable. Addiction treatment has been effective in reducing drug use and HIV infection, diminishing the health and social costs that result from addiction, and decreasing criminal behavior. The National Institute on Drug Abuse (NIDA), which supports more than 85 percent of the world's research on drug abuse and addiction, has found that behavioral approaches can be very effective in treating cocaine addiction.

To ensure that treatment providers apply the most current scientifically supported approaches to their patients, NIDA has supported the development of the "Therapy Manuals for Drug Addiction" series. This series reflects NIDA's commitment to rapidly applying basic findings in real-life settings. The manuals are derived from those used efficaciously in NIDA-supported drug abuse treatment studies. They are intended for use by drug abuse treatment practitioners, mental health professionals, and all others concerned with the treatment of drug addiction.

The manuals present clear, helpful information to aid drug treatment practitioners in providing the best possible care that science has to offer. They describe scientifically supported therapies for addiction and give guidance on session content and how to implement specific techniques. Of course, there is no substitute for training and supervision, and these manuals may not be applicable to all types of patients nor compatible with all clinical programs or treatment approaches. These manuals should be viewed as a supplement to, but not a replacement for, careful assessment of each patient, appropriate case formulation, ongoing monitoring of clinical status, and clinical judgment.

The therapies presented in this series exemplify the best of what we currently know about treating drug addiction. As our knowledge evolves, new and improved therapies are certain to emerge. We look forward to continuously bringing you the latest scientific findings through manuals and other science-based publications. We welcome your feedback about the usefulness of this manual series and any ideas you have on how it might be improved.

Alan I. Leshner, Ph.D. Director National Institute on Drug Abuse

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Contents

Page

Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii Chapter 1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Research Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Treatment Philosophy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Contributions of the 12-Step Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Role of Self-Help Groups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Role of Significant Others in Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Chapter 2 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Overview of This Counseling Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Comparison of Addiction Counseling and Psychotherapy. . . . . . . . . . . . . . . . . 7 Similar and Dissimilar Approaches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Compatibility With Other Treatments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Chapter 3 Logistics of the Model. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Frequency and Duration of Sessions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Duration of Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Target Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Setting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Chapter 4 Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Addiction Severity Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Biological Assays . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Chapter 5 The Role of the Addiction Counselor . . . . . . . . . . . . . . . . . 17 Patient-Counselor Relationship . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Therapeutic Alliance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

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