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Chemical Dependency Counseling

Chemical Dependency Counseling
A Practical Guide

Fifth Edition

August 2016 | 744 pages | SAGE Publications, Inc
The best-selling Chemical Dependency Counseling: A Practical Guide provides counselors and front-line mental health professionals with the information and skills they need to use evidence-based treatments, including motivational enhancement, cognitive behavioral therapy, skills training, medication, and 12-step facilitation. Guiding the counselor step by step through treatment, author Robert R. Perkinson presents state-of-the-art tools, forms, and tests necessary for client success while meeting the highest standards demanded by accrediting bodies.

The Fifth Edition of this landmark text has been updated to include coverage of current topics of concern for counselors, including full compliance with DSM-5, new coverage of steps 6 – 12 in 12-step facilitation, discussions on synthetic and designer drugs, new psychotherapeutic medications, new survey data on patterns of use and abuse, a list of online recovery support groups for clients, and a new section on Recommendations for a Successful First Year in Recovery.

About the Author

Robert R. Perkinson is the clinical director of Keystone Treatment Center in Canton, South Dakota. He is a licensed psychologist; licensed marriage & family therapist; internationally certified alcohol and drug counselor; and a nationally certified gambling counselor and supervisor. In addition to the best-selling Chemical Dependency Counseling: A Practical Guide, Fifth Edition, Dr. Perkinson is the author of The Alcoholism and Drug Abuse Client Workbook, Third Edition and The Gambling Addiction Client Workbook, Third Edition.
Preface to the Fifth Edition
1. First Contact
Treatment Works

The Motivational Interview

How to Develop the Therapeutic Alliance

How to Do a Motivational Interview

What to Do If There Are One or More Red Flags

Natural History of Addiction

How to Diagnose an Addiction Problem

How to Intervene

How to Assess Motivation

The Stages of Motivation

Motivating Strategies

2. First Hours of Treatment
The First Hours

How to Greet Clients


Beginning the Therapeutic Alliance

The Importance of Trust

Dealing With Early Denial

Example of an Initial Contact

How to Check for Organic Brain Dysfunction

The Initial Assessment


How to Conduct a Crisis Intervention

American Society of Addiction Medicine Patient Placement Criteria

Diagnostic and Statistical Manual

Criteria for Diagnosis

Diagnosis: Substance Use Disorder

Gambling Disorder

How to Determine the Level of Care Needed

Criteria for Outpatient Treatment (Adults)

Criteria for Inpatient Treatment (Adults)

Criteria for Outpatient Treatment (Adolescents)

Criteria for Inpatient Treatment (Adolescents)

The Client’s Reaction to Intoxication

What to Do With an Intoxicated Client


How Clients React in Detoxification

The AMA Threat

Example of an AMA Intervention

How to Develop and Use the AMA Team

How to Use the In-House Intervention

How to Respond to Clients Who Leave AMA

3. Biopsychosocial Interview
The Biopsychosocial Interview

How to Conduct the Interview

Summary and Impression


Disposition and Treatment Plan

A Sample Biopsychosocial Interview

4. Treatment Plan
How to Build a Treatment Plan

The Diagnostic Summary

The Problem List

How to Develop a Problem List

Goals and Objectives

How to Develop Goals

Examples of Developing Goals

Examples of Goals

How to Develop Objectives


How to Develop Interventions


How to Evaluate the Effectiveness of Treatment

How to Select Goals, Objectives, and Interventions


Treatment Plan Review


How to Write Progress Notes


Formal Treatment Plan Review

Discussion of Continuing Care

5. Individual Treatment
The Therapeutic Alliance

How to Develop a Therapeutic Alliance

How to Be Reinforcing

How to Use Empathy

Transference and Countertransference

Examples of Empathic Statements

How to Be Confrontive

Behavior Therapy

How Clients Learn


Changing a Habit

What Is Reinforcement?

What Is Punishment?

The Behavior Chain

The Importance of Reinforcement

How to Use Punishment

When a Client Breaks a Rule

Why We Concentrate on Behavior Therapy

Cognitive Therapy

How Chemically Dependent People Think

Defense Mechanisms

Applying Cognitive Therapy

Automatic Thoughts

How to Correct Inaccurate Thoughts

Interpersonal Therapy

How to Develop Healthy Relationships

Building a Relationship With a Higher Power

Developing a Relationship With Self

Building Relationships With Others

How Clients Use Feelings Inappropriately

How Clients Learn Relationship Skills

How to Change Relationships

How to Handle Grief

How to Choose the Therapeutic Modality

6. Group Therapy
Benefits of the Group Process

Preparation for the Group

The Preparation Statement

The Agenda Group

How to Choose the Order of the Agenda

How to Give Good Feedback

How to Receive Feedback

How to Run a Group

How to Know Which Therapy to Use

The Honesty Group

Example of the Honesty Group

Uncovering the Lies

How to End Each Group

The Euphoric Recall Group

How to Uncover Euphoric Recall

How to Help the Clients See the Truth

The Reading Group

The Relapse Prevention Group

The Trigger Group

How to Uncover the Triggers

The Drug Refusal Skills

The Inaccurate Thinking Group

The Feelings and Action Group

The Lapse Group

The Spirituality Group

How to Develop Healthy Relationships

How to Develop a Healthy Relationship With a Higher Power

The Eleventh Step Group

The Meditation Group

The Childhood Group

How to Explore Early Parental Relationships

How to Begin to Heal Early Childhood Pain

Men’s Group/Women’s Group

The Community Group

The Personal Inventory Group

Skills Training Group

Assertiveness Skills Group


Problem-Solving Skills Group

Skill Set 1

Skill Set 2

7. Drugs of Abuse
Drugs of Abuse

Central Nervous System Depressants

Central Nervous System Stimulants

The Hallucinogens

The Reinforcing Properties of Drugs

Tolerance and Dependence



Alcohol-Induced Organic Mental Disorders

Alcohol Intoxication

Alcohol Amnesic Disorder (Blackout)

Wernicke-Korsakoff Syndrome

Alcohol Withdrawal

Alcohol Withdrawal Seizures

Alcohol Withdrawal Delirium (Delirium Tremens)

Sedatives, Hypnotics, and Anxiolytics


Cocaine and Amphetamines


Dissociative Anesthetics (Phencyclidine, Ketamine, Dextromethorphan, and FLAKKA)


The Psychedelic State


Synthetic Designer Drugs



Club Drugs






Treatment Outcome

8. Recovery Skills
The Chemical Use History


Love, Trust, and Commitment


Relationship Skills

Addictive Relationships

Communication Skills


Impulse Control

Relapse Prevention

Stress Management

9. Steps
The Committee

Step One

Step Two

How to Help Clients Accept a Higher Power

Step Three

How to Help Clients Embrace Step Three

Step Four

Step Five

Step Six

Step Seven

Step Eight

Step Nine

Step Ten

Step Eleven

Step Twelve

10. Lectures
The Disease Concept

Addiction Is Not a Moral Problem

Addiction Is Not Due to a Weak Will

Addiction Has Genetic Components

Addiction Is a Social Problem

Addiction Is a Psychological Problem

Addiction Is a Physiological Problem

The Obsession

The Problems

Defense Mechanisms




How to Begin to Live in the Truth

The Great Lie

How the Great Lie Works

We Never Feel Accepted

The Promise of the Disease


A Program of Rigorous Honesty

Normal Development

The Primary Caregiver

The Struggle for Independence

The Fear of Abandonment

Learning the Rules

The Development of Insecurity

The Peer Group



Physical Addiction and Recovery

How Drugs Affect the Cell

How Drugs Affect Behavior




How We Learn

Alcoholics Anonymous

A Spiritual Awakening

Two Alcoholics Talking to Each Other

The “Big Book”

The 12 Steps



All Feelings Are Adaptive

Assertive Skills

11. Special Problems
The Psychiatric/Psychological Assessment

How to Develop the Treatment Plan

The Depressed Client

How to Assess Depression

How to Treat Depression


Behavior Therapy

Cognitive Therapy

Interpersonal Therapy



The Angry Client

How to Handle a Violent Client

How to Handle an Angry Client

Assertiveness Skills

The Importance of Forgiveness

How to Teach the Client to Recognize Anger



How to Keep Your Cool as a Counselor

The Homicidal Client

The Duty to Warn


What Is Personality?

The Antisocial Personality

A Disorder of Empathy

How to Treat the Antisocial Personality

How to Deal With a Rule Violation

Moral Development

How to Deal With the Family of an Antisocial Client

The Borderline Client

Interpersonal Relationships

Emotional Regulation

How to Treat the Borderline Client

Setting Limits

Dealing With Transference

Stress Tolerance

Dealing With the Family

The Narcissistic Client

The Anxious Client

How to Measure Anxiety

The Psychological Component of Anxiety

How to Use Relaxation Techniques

The Daily Log

Cognitive Therapy

Post-Traumatic Stress Disorder

Panic Attacks

The Psychotic Client

Hallucinations and Delusions

How to Treat the Psychotic Client

The Family of the Psychotic Client

Acquired Immune Deficiency Syndrome

The High-Risk Client

The Client With Low Intellectual Functioning

How to Treat the Client With Low Intelligence

The Client Who Cannot Read

The Family of the Client With Low Intelligence

The Elderly Client

The Client With Early Childhood Trauma

How to Deal With Sexual Abuse

Cognitive Therapy

How to Learn Forgiveness

Love in the Treatment Center

The Importance of the Unit Rules

How to Deal With Clients in Love

The Pathological Gambler


Gambling Step One

Gambling Step Two

Gambling Step Three

Gambling Step Four

Gambling Step Five

Gambling Step Six

Gambling Step Seven

Gambling Step Eight

Gambling Step Nine

Gambling Step Ten

Gambling Step Eleven

Gambling Step Twelve

Gambling Relapse Prevention

12. Adolescent Treatment
The Normal Adolescent


Ages 13 to 16

Ages 16 to 19

Interesting Adolescent Facts

The Chemically Dependent Adolescent

The Adolescent Chemical Dependency Counselor

The Point System

The Primary Elements in Adolescent Treatment

The Rules

Communication Skills



Fun in Sobriety

The Reinforcers


Group Therapy

Peer Pressure

Continuing Education

Continuing Care

The Parents Support Group

The Behavioral Contract

Phases of Adolescent Treatment

13. The Family Program
The First Family Contact

How to Handle the Early Against Medical Advice Risk

Common Family Problems



Loss of Control




Inability to Know Feelings

Inability to Know Wants

Lack of Trust

People Pleasing

Feelings of Worthlessness


Poor Communication Skills

How to Treat Family Members

The Family Program Schedule

How to Work With the Family in Group

The Conjoint Session

14. The Clinical Staff
The Physician/Addictionologist

The Psychologist/Psychiatrist

The Social Worker/Mental Health Counselor

The Nurse

The Clinical Director

The Clinical Supervisor

The Chemical Dependency Counselor

The Rehabilitation Technician or Aide

The Recreational Therapist

Clinical Staffing

How to Present a Client

Team Building

Commitment to Coworkers


Staff–Client Problems

What to Do When a Client Does Not Like a Counselor

What to Do When a Client Complains About a Rule

The Work Environment

15. Discharge and Continuing Care
Outpatient Discharge Criteria

Inpatient Discharge Criteria

How to Develop a Discharge Summary

The Discharge Summary

Saying Good-Bye

16. The Good Counselor
Good Counselors Are Caring

Good Counselors Love Their Work

Good Counselors Do Not Become Overly Involved

Good Counselors Do Not Lie

Good Counselors Are Gentle

Good Counselors Like Themselves

Good Counselors Are Supersensitive

Good Counselors Have a Sixth Sense

Good Counselors Do Not Become Overly Emotional

Good Counselors Are Active Listeners

Good Counselors Do Not Talk Too Much

Good Counselors Maintain Boundaries

Good Counselors Are Client Centered

Good Counselors Have Effective Relationship Skills

Good Counselors Have a Sound Code of Ethics

Appendix 1- Cognitive Capacity Screening
Appendix 2- Short Michigan Alcoholism Screening Test
Appendix 3- DSM–5 Psychoactive Substance Use Disorder
Appendix 4- Alcohol Withdrawal Scale
Appendix 5- Narcotic Withdrawal Scale
Appendix 6- Sample Biopsychosocial Interview
Appendix 7- Chemical Use History
Appendix 8- Honesty
Appendix 9- Love, Trust, and Commitment
Appendix 10- Feelings
Appendix 11- Relationship Skills
Appendix 12- Addictive Relationships
Appendix 13- Communication Skills
Appendix 14- Self-Discipline
Appendix 15- Impulse Control
Appendix 16- Relapse Prevention
Appendix 17- Step One
Appendix 18- Step Two
Appendix 19- Step Three
Appendix 20- Step Four
Appendix 21- Step Five
Appendix 22- Adolescent Unit Level System
Appendix 23- Peer Pressure
Appendix 24- The Behavioral Contract
Appendix 25- Family Questionnaire
Appendix 26- Codependency
Appendix 27- Personal Recovery Plan
Appendix 28- Sample Discharge Summary
Appendix 29- Stress Management
Appendix 30- Hamilton Depression Rating Scale
Appendix 31- Biopsychosocial Assessment
Appendix 32- Anger Management
Appendix 33- Narcissism
Appendix 34- Honesty for Gamblers
Appendix 35- Step One for Gamblers
Appendix 36- Step Two for Gamblers
Appendix 37- Step Three for Gamblers
Appendix 38- Step Four for Gamblers
Appendix 39- Step Five for Gamblers
Appendix 40- Relapse Prevention for Gamblers
Appendix 41- Adolescent Unit Point System
Appendix 42- Results From the 2013 National Survey on Drug Use and Health: Summary of National Findings
Appendix 43- Drug Categories for Substances of Abuse
Appendix 44- Adult Inpatient Program Schedule
Appendix 45- Adolescent Inpatient Program Schedule
Appendix 46- Adult Outpatient Program Schedule
Appendix 47- Adolescent Outpatient Program Schedule
Appendix 48- Gambling Inpatient Program Schedule
Appendix 49- Gambling Outpatient Program Schedule
Appendix 50- Day Treatment Program Schedule
Appendix 51- Pressure Relief Group Meeting and Budget Form
Appendix 52- Heroin
Appendix 53- South Oaks Gambling Screen
Appendix 54- Barriers in Thinking
Appendix 55- Psychotherapeutic Medications 2011
Appendix 56- Drug Abuse Screening Test
Appendix 57- Clinical Opiate Withdrawal Scale
Appendix 58- Adult Nurses Intake
Appendix 59- Adolescent Nurses Intake
Appendix 60- National Cancer Institute Guide to Quitting Smoking
Appendix 61- Post-Traumatic Stress Disorder (PTSD) Checklist Civilian Version
Appendix 62- Post-Traumatic Stress Disorder (PTSD) Checklist Military Version
Appendix 63- Alcohol Abstinence Self-Efficacy Scale
Appendix 64- Hamilton Anxiety Rating Scale
Appendix 65- Strengths, Needs, Abilities, and Preferences
Appendix 66- Daily Craving Record
Appendix 67- National Association of Alcohol and Drug Abuse Counselors (NAADAC) Code of Ethics
Appendix 68- Gambling History
Appendix 69- Diagnostic/Integrated Summary
Appendix 70- Mental Health Screening
Appendix 71- Fagerstrom Test for Nicotine Dependence
About the Author


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Robert R. Perkinson

Robert R. Perkinson is the clinical director of Keystone Treatment Center in Canton, South Dakota. He is a licensed psychologist; licensed marriage & family therapist; internationally certified alcohol and drug counselor; South Dakota certified chemical dependency counselor, Level III; and a nationally certified gambling counselor and supervisor. His specialty areas focus on treating alcoholics, addicts, and pathological gamblers. He is the author of Chemical Dependency Counseling: A Practical Guide (2nd ed.) (2003a), which is the leading treatment manual in the world for chemical dependency counselors. With Dr. Arthur E. Jongsma Jr. ... More About Author

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ISBN: 9781506307343