The difference in mental health services for youth and adults.

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

One size does not fit all.

Children

Children.
Photo courtesy of Pixabay.com

When it comes to mental health services what’s needed and what’s actually provided can vary tremendously. Treatment for each client should be individualized.

Therapy for children needs to be appropriate for both their age and their developmental stage. There are also some differences in the way the counselor or therapist may need to approach treatment. In selecting a therapist, it’s important to find someone with both the training and experience required to work with the person receiving services. Here are some of the differences between mental health services for youth and adults.

The therapist needs to speak the same “language” as the child.

Children don’t have the vocabulary to describe feelings. Children often express themselves by actions rather than words. For very young children therapy is best done through speaking the language of “play.” How a child expresses themselves through action will change as they age.

What’s appropriate for a baby to say at age six months will be very different from what they should be saying at five years. The same is true of their behaviors and the way in which they play.

The therapist needs to consider “who is the client?”

Children are usually referred to therapy because an adult has either recognized the problem or is afraid the child may develop a problem. The counselor must consider whether the reason this child is in therapy is because the child is doing something an adult doesn’t want them to do or because they aren’t doing something the adult wants them to do.

More than one female single parent has brought their male offspring in for counseling because they did not want that child to “be just like their father.” In these cases, often the father was either physically abusive, drug-addicted, or engaged in criminal activity. Unfortunately, being told repeatedly that you are “just like your father” can be extremely damaging to the child’s development.

A similar problem happens when male parents are raising female children and, in their effort, to prevent their daughters developing sexuality, they continually accuse the daughter of promiscuity “just like your mother.”

In cases like these, where a parent is projecting their own issues and negative life experiences on to their children, the counselor tries to help the child develop the skills to make their own healthy choices. Frequently, what needs to happen is for the parent to get into therapy for their issues and for help in becoming a more effective parent.

The counselor will at most see the child for an hour a week, while the parent will provide the care for that child for 167 other hours each week.

Lifespan development issues are important.

If a child isn’t hitting their developmental milestones, walking, talking, learning schoolwork and appropriate behavior on time, this warrants a referral to medical or mental health professionals. Unfortunately, many parents have unrealistic expectations for their child. Parents often push their children to do things that they are not developmentally ready for. I’ve had parents request that their child be assessed for ADHD because the child was getting B grades instead of straight A’s.

Children may be afraid to tell the truth.

While the child is often the one identified as having the problem, it’s entirely possible the problem is with the home situation. Children who grow up in a home where parents have frequent violent fights may be awake all night. When they go to school, they can’t concentrate because of their lack of sleep and their fears about what is going on at home while they’re at school. If they witnessed domestic violence, they might learn to use hitting as a way to get what they want.

While the child is referred for assessment for attention problems the real issue may lie with the parents. Children are afraid to report problems at home for fear that their parents will punish them or that they may be taken away from their parents.

Many children are taught not to talk to strangers and to never talk about families “business” outside the family. Children from lower socioeconomic status homes may be embarrassed. Children may have been instructed not to talk about parents who are engaged in illegal activity, or they may be reluctant to talk about having a parent or caregiver who is incarcerated.

Many problems are not identified until the child gets older.

I see many files for teenagers in which they were treated in the early grades for developmental issues. Later they were treated for attention deficits. In middle school and high school, they may have been treated for bad behavior. It’s not until late high school or college that some of these clients are diagnosed with severe depression.

It’s important that anyone working with children not write off poor attention and behavioral problems as a result of “bad child” diagnoses. A specialist in child developmental issues should be looking for serious mental health issues such as anxiety disorders and depression.

Children may need help in developing life skills.

Counselors working the children must be careful not to think that it’s the child who has the problem. Sometimes what the child needs are the skills to cope with a dysfunctional family and a challenging world. Social skills are tough for some children to develop. The majority of adults who develop anxiety disorders had the symptoms by the end of middle school.

Counselors may need to normalize the challenges of growing up. Most children go through a stage of feeling insecure and worrying about whether they measure up. Helping the young client through the transition periods can reduce or possibly even prevent the development of anxiety disorders, eating disorders, and other mental health problems that are the result of judging themselves in overly negative ways.

These are some of the major differences between working with children and adults. The techniques and materials the counselor uses are also likely to be different. Please feel free to leave additional questions or comments.

Staying connected with David Joel Miller

Three David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Books are now available on Amazon, Kobo, iBooks, and many other online stores.

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

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Assessment – a core drug counselor function.

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Assessment doesn’t mean the same thing to everyone.

Counseling

Counseling.
Photo courtesy of Pixabay.com

Anytime counselors get together you’re likely to hear the word assessment.

Unfortunately, it means so many different things to so many different counseling specialties it’s as if we are not speaking the same language.

There are two primary ways that the word assessment is used. One is to describe the form the counselor fills out during the initial part of treatment.

The other meaning of the word assessment is the ongoing process counselors use to try to identify the client’s problem and find ways to be helpful.

Assessment may mean the assessment form.

Often a form is completed either during the initial intake of very soon after that. The information is gathered on this form should be used to develop a treatment plan, part of the next core drug counselor function designing a comprehensive recovery plan. It’s common to hear counselors referred to filling out this form as “doing an assessment.” If you use an assessment form that should be thought of as a tool you use to gather the information you need to assess the client’s issues.

One danger of relying too heavily on a particular form is that the process of filling out the form can turn into an interrogation of the client rather than a conversation. One simple way to tell a good assessment from a poorly done one, especially in the drug counseling field, is to look at the bottom of the page for the comments. Anything the client says that’s out of the ordinary should call for follow-up questions to get more information. Under the pressure of a lot of work to do it’s easy for the staff member doing the initial intake and assessment to rush through the form and get only surface information.

Assessment in substance abuse counseling is very different from the type of assessment done in mental health settings. In a mental health setting, the goal is to collect enough information to rule in or out various diagnoses and then to design a treatment plan to treat that illness. The various license types are likely to have been trained in very different ways of doing an assessment. How the assessment is done also varies with the setting. Therapists working for a public agency are likely to have a specific form they must fill in. In private practice, they’re more likely to use a more conversational approach to assessment.

Clinical psychologists do a great deal of testing and often have the clients fill out a large quantity of paper and pencil “assessment instruments.” Clinical counselors are likely to use a very limited number of brief screening tools. In California licensed professional clinical counselors are limited by the licensing law to using only a couple of instruments and then only for diagnosing. Mental health counselors and therapists are generally not allowed to do testing and report the results to outside parties. Marriage and family therapists, of course, emphasize assessing the client’s relationships and the connections between their “presenting problem” and their relationships with family, friends, and the people they interact with in the work setting.

Drug counselors are assessing the client’s drug use and its consequences.

Drug counselor should limit their scope of practice to working on the client’s issues as they relate to substance use disorders. They can be some fuzziness around the edges of their scope of practice. The assessing drug counselor needs to develop a picture of the client’s drug use, both current and past. Many clients abused multiple substances at various times in their life. The drug counselor is assessing for what drugs the client has used recently and what drugs they used in the past that they may be at risk to resume using.

The drug counselor also assesses all the various aspects of the client’s life to see how problems in other areas may have influenced the client’s drug use and how that drug use may have affected all those other parts of the client’s life.

There are two primary assessment tools I’ve seen used in drug and alcohol counseling, although individual programs may design their own written tools drawing on either or both models.

Assessment using the biopsychosocial-spiritual model.

The biopsychosocial assessment understands the healthy, or recovered life as requiring balance in all the various aspects of the person’s life. Drug and alcohol use has probably bent the wheel of life completely out of balance. Assessing all these various areas of the client’s life helps to develop not only a treatment plan for the current substance use disorder but a recovery plan for the client putting their lives back in balance.

The Addiction Severity Index or ASI.

The ASI is a widely used assessment tool for drug and alcohol counseling. The ASI is a copyrighted instrument with both paper and electronic online versions available. Students can look at an online sample by searching for the Addiction Severity Index – training edition.

American Society of Addiction Medicine Patient Placement Criteria (ASAM.)

This is another assessment tool which may or may not be used during intake. The goal of the American Society of Addiction Medicine Patient Placement Criteria (ASAM) is to create objective criteria for how much and what kind of treatment a client might need.

These criteria have various levels ranging from a high of long-term residential treatment to a low of psychoeducation. Programs which plan to bill medical insurance are likely to need to complete this measure to justify the level and intensity of treatment for insurance reimbursement.

For more on the drug counselor domains and the core functions see John W. Herdman’s book Global Criteria; the 12 Core Functions of the Substance Abuse Counselor

Staying connected with David Joel Miller

Three David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Books are now available on Amazon, Kobo, iBooks, and many other online stores.

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Intake – a core drug counselor function.

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Intake involves a lot of paperwork.

Counseling

Counseling.
Photo courtesy of Pixabay.com

Getting a client signed up for a drug treatment program involves a lot of paperwork that needs to be completed before the counseling can begin. Drug counselors need to know how to do this function, although the exact paperwork they will have to do can vary a great deal from program to program. Many treatment agencies now use computerized systems. As the counseling field shifts towards more electronic records, more of the intake paperwork will end up on the computer. Some systems now include electronic signature pads that will capture the client signature onto the electronic file.

Some of this paperwork part can be done by office staff. Larger drug treatment programs may have one person assigned to do the intake paperwork. There are some advantages to having the primary counselor, the one the client will see the client throughout treatment, do the intake. When the client first comes into drug treatment, they are likely to be anxious and uncertain. Developing a relationship, establishing rapport, is an essential part of what staff at a drug treatment program must do. It’s easier to build up a rapport when the client sees the same person throughout treatment.

Informed consent is a required part of treatment.

Informed consent is not a separate specific drug counselor function, but it should be incorporated into all the intake paperwork as part of the legal and ethical responsibilities of a counselor. Fees need to be discussed during the first session the staff spends with the client.

Limits of confidentiality and the exceptions to them need to be explained to the client. What information will the program keep confidential and what information might be disclosed. Drug counseling has an extremely high requirement for confidentiality. Drug counselors should not even confirm or deny that someone is in their program.

Drug counselors are mandated reporters who must report clients who are a danger to themselves or others. They also are required to report abuse of the child, an elderly, or a disabled person. In some jurisdictions, they may be required to report clients who view child pornography. All these exceptions to confidentiality need to be explained to the client during the intake process.

Because so many clients are referred to drug treatment by the criminal justice system, parole probation, or the courts, more of the client’s information may be divulged than might happen in mental health counseling.

As part of the evidence that you did informed consent, the client will be required to sign a form called either a consent for treatment or a treatment agreement.

Consent to release information forms.

If any information about a client will be released to an outside party, a specific form called a consent for release of information should be filled out and signed by the client. These forms are often referred to by counselors as “releases.” Most releases can be revoked by the client, which must be done in writing if they decide they want the drug program stop releasing information. One exception to this right to revoke consent to release information is the “criminal justice consent form.”

If the criminal justice system has sent a client to your program, they will require information about that client. If the client does not wish to sign a release of information, you will not be able to admit that client to your program. Clients who attend a drug treatment program without signing a release for the criminal justice system will not have met their legal requirements for a court-mandated program.

Financial forms are part of drug counseling intakes.

For most programs, someone is paying for treatment. If it’s insurance, then there will be insurance forms to fill out. If the treatment is paid for by the criminal justice system or the child protective services, there will be other forms they will need to fill out. Clients who self-pay will still need to fill out a financial agreement.   Some programs have a sliding scale fee agreement for low-income clients. Providing financial information and filling out additional forms may be a part of qualifying for these reduced fees.

HIPPA notice of privacy practices.

Almost all programs nowadays are “covered entities” and must follow the HIPPA regulations. The counselor needs to give the client a notice of privacy practices and have the client sign a form saying they received this information.

Demographic information.

Clients need to provide the program with their demographic information. You need to know who it is you’re working with. It’s good practice to have an address and phone number for this client. This form might also next of kin.

Consent to follow-up.

Some programs do follow-up studies to see how effective their treatment is. Studying the results of treatment may be a condition of receiving funding from grants or contracts with governmental agencies. It’s a good practice to have written permission to follow-up, signed at the time of intake. You should also make sure you know how you are allowed to contact the client. If the phone number they gave you is a work phone, they may not want you calling there for follow-up.

Program rules or expectations.

During the intake, the counselor may give the client rules, a form about client rights and responsibilities and other information about the program. Some programs do this after the intake as part of a separate step referred to as the core function of orientation. More about orientation in an upcoming post.

There are a wide variety of other forms used by various treatment programs. Most of these forms have been created by the individual treatment program.

Assessment may take place during intake.

Assessment means different things in different contexts. Assessment is considered a separate drug counselor function and it’s a skill that counselors need to learn and to practice. Assessment may take place during the initial intake. Some programs will schedule a separate appointment for the assessment. Assessment functions as the bridge between the first domain which involves getting clients into treatment, and the second domain which is the work the counselor will do in creating a comprehensive recovery plan.

In our next installment of this “what do drug counselors do and how do they do it” series we will look at the core counselor function of assessment.

For more on the drug counselor domains and the core functions see John W. Herdman’s book Global Criteria; the 12 Core Functions of the Substance Abuse Counselor

Staying connected with David Joel Miller

Three David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Books are now available on Amazon, Kobo, iBooks, and many other online stores.

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

What is the counselor function of screening?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Screening means two different things in drug counseling.

Counseling

Counseling.
Photo courtesy of Pixabay.com

Drug counselors are often required to “screen” clients.

That doesn’t mean they’re looking for reasons to turn people away, but sometimes screening can result in someone not being admitted to the program.

During their career counselors will be called upon to do two very different types of screening.

Both types of screening can be done in mental health systems though I have never heard these things called screening except in substance abuse counseling.

Screening can be used to detect a problem.

Counselors sometimes use “screens” to detect a problem. In medical settings, they might screen for high blood pressure. Drug counselors sometimes set up informational booths or attend public events and ask people a series of questions designed to find out whether that person has a problem with drugs or alcohol.

These kinds of screenings are mostly informational. One common screening tool is the “CAGE” instrument. The CAGE is a series of four questions that can be asked to detect a problem with alcohol. This screen can be administered by the counselor or could be a checklist given the person to be screened. In this screen, a yes to any one of these four questions indicates that the person needs further assessment for a possible alcohol problem.

Because of screenings, people may be referred to their primary care doctor, self-help program, or professional drug treatment.

The second type of screening happens when a drug program admits someone.

People don’t usually show up at the cancer center wanting to try chemotherapy even though they don’t have cancer. People do sometimes turn out for a drug treatment program that doesn’t meet their needs. People who are homeless may try to get into a residential drug program even though they don’t have a drug problem because they need a place to stay and food to eat.

Sometimes a lawyer has told the client they need to get into counseling. Maybe they’re going to court for a DUI or domestic violence charges. They want to sign up for a program, so they have something to show the judge when they go to court. Now if they really have a drug problem that would be appropriate. But if they need an anger management program or domestic violence program, the drug counselor should not be signing them up for drug treatment.

During intake, the counselor will be asking questions to find out if this person has a substance use disorder. Some programs specialize in a particular type of treatment. Someone with an opiate or methamphetamine use disorder would not be appropriate for a drunk driving program.

Some programs are residential; some are outpatient. You don’t want to put someone with a full-time job into a residential treatment program they won’t be able to attend. A man would not be admitted to a women’s only program. If the client does not speak English and you have no staff speaking their language, you either must be able to provide an interpreter or referred them to a program that provides services in their language. You shouldn’t put an adult in a program for adolescents or a teenager in an all adult program.

During intake, the question the counselor is asking themselves is: “Is this client appropriate for our program? Do they have the problem we treat? Are they part of the “population” our program is designed to serve?

If you get no is to any of those questions you won’t be able to admit this client. That does not mean you merely turn them away. Another one of the counselor’s essential functions is to be able to do a thing we call “referrals and linkages” in which you help them access services your agency does not provide. More on that function in another post.

Is this person acceptable to your program?

There might be some reasons why, even though the person has the problem you treat, like drug addiction, and they are part of the population you serve, for example, if this client is a man and your program has groups specifically for men, you may still have to turn them away. Why might someone who is appropriate for your program not be acceptable?

Sometimes this is the question of finances. If you take a specific medical insurance, but the client doesn’t have that kind of insurance, you can’t accept them. If your program is funded by criminal justice, parole or probation but this client was referred by their doctor for a medical problem you might not be able to accept them.

If your program treats women and children, you may not be able to admit the client with a history of convictions for rape or child molestation. A residential drug treatment program may have things in their rules or their insurance requirements that prohibit them from admitting a person with a history of convictions for arson. You must be careful not to create so many rules that you screen out all people in need of treatment, but there may be certain people that you will not be able to admit to your program.

The screening part of intake boils down to two questions.

  1. Is this client appropriate for the kind of treatment you offer?
  2. Is this client acceptable under the rules of your program or is there some reason you can’t admit them.

Treatment begins with your first contact with the client.

Sometimes clients call, and sometimes they come in person. From the moment they make the first contact, the whole course of treatment takes shape. This is why it’s crucial for the people at your front desk or who answer the phone to be knowledgeable about your program and to be engaging.

Screening could happen during that first contact even if it’s on the phone or it may take place at your first face-to-face meeting in the office. It’s imperative that if you can’t provide the needed services, you can give them a referral. You may have potential legal liability if someone calls and is suicidal and you don’t refer them for appropriate treatment.

Once the screening is completed, whether it happened on the phone or in person, the next step in the process of getting someone into treatment is the intake. In our next post let’s look at all that paperwork that needs to be done during intake.

For more on the drug counselor domains and the core functions see John W. Herdman’s book Global Criteria; the 12 Core Functions of the Substance Abuse Counselor,

Staying connected with David Joel Miller

Three David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Books are now available on Amazon, Kobo, iBooks, and many other online stores.

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

What do drug counselors do?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Drug counselors have many job duties besides talking to clients.

Counseling

Counseling.
Photo courtesy of Pixabay.com

When you say counselor, most people envision a person who sits talking with the client. Many people who want to become counselors believe they would be good at it because friends have told them they’re good at giving advice. Professional counselors avoid giving advice. The stakes are just too high. It is the client’s life, and they need to make the decisions. What counselors may sometimes do is provide education, but that education needs to be objective not the counselor’s opinion.

Most drug counselors do not work in private practice but work for agencies. Because of this system, not every counselor does every one of these functions, but it is essential for them to know how to do each of these functions.

In the workplace, counselors perform many tasks other than counseling.

Peripheral tasks are probably true of all professions. There are lots of things that must be done by the professional beyond the function most people expect. One of those other things that the drug counselor needs to do is paperwork. The paperwork function, along with several other administrative tasks can take up a sizable chunk of the counselor’s day, but these other tasks need to be done to keep the program running so that it’s there when the client needs it.

There are different systems for classifying the drug counselor’s duties.

Defining what any profession does, and how they should do it, can be problematic. Many books have been written about how, in mental health counseling, the therapist or professional mental health counselor should do what they do. I have seen very few however which go into any detail about all the things they do each day other than counseling.

The what does the counselor do and how do they do it is especially problematic when it comes to drug counseling. Mental health counseling has its roots in medicine and psychology while substance use disorder counseling has its origins in self-help groups and recovery literature. As drug counseling has become more professional, it has become essential to define precisely what the job duties of the counselor may be or should be, in addition to the actual time spent “counseling” clients.

Here are the three primary sources in this area that I’m familiar with and have used in teaching substance abuse counseling classes. Along the way, there have been several workforce studies done which have informed these three sources.

John W. Herdman’s book Global Criteria; the 12 Core Functions of the Substance Abuse Counselor, first published in 1994 this book is now in its seventh edition just released in 2018. This book has been a standard text, especially among accredited programs, across the country as part of the introductory drug counseling training’s since it was first written.

Substance Abuse Mental Health Services Administration (SAMHSA) published TAP 21 Addiction Counseling Competencies: The Knowledge, Skills, and Attitudes of Professional Practice. This book was initially issued in 1998 and has been revised since. TAP21 has been incorporated into some of the tests used to license or certified drug counselors.

The International Certification and Reciprocity Consortium (ICRC.) The ICRC took all the various tasks a drug counselor might do and sorted them into four categories which they call performance domains.

While the three different systems use different labels, I see very little that is part of the tasks of the counselor that is not included in all three systems. So, what are the four domains that a drug counselor needs to know about to do their job?

Domain One: “Intake” or getting the client in the treatment.

This domain includes all the tasks that would be necessary to get the client to the point of the first counseling session. In Mental health treatment settings, some or all this work would be done by paraprofessionals or office staff. Some drug programs may have specialized intake counselors, but in many drug and alcohol counseling programs counselors would be doing this work themselves.

The intake domain would include such functions as screening, assessment, and engagement activities, as well as orienting the client to the program.

Domain Two: treatment planning, collaboration, and referral.

This domain includes developing a treatment plan, case management functions, referrals and linkages, and consultation.

Domain Three: counseling, both individual and group.

Most drug counseling is done in the group setting. These groups could include psychoeducational groups, “process” or discussion groups, feelings groups, or topical groups, often focused on the 12 steps or life skills.

There are many different theories and techniques for individual counseling.

Domain Four: professional, legal and ethical responsibilities.

This domain includes the requirement to complete paperwork, meeting your legal responsibilities and following the applicable code of ethics. Doing things professionally, legally, and ethically should be woven into everything the counselor does, but the counselor also needs to periodically review the decision-making model they’re using to be sure that they and the agency they work for are performing legally and ethically.

In future posts let’s look at the various tasks the drug counselor must do in each of these domains.

Staying connected with David Joel Miller

Three David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Books are now available on Amazon, Kobo, iBooks, and many other online stores.

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Do you want to be a drug counselor?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

The need for qualified drug counselors continues to grow.

Pill for that?

Drug Counseling?
Photo courtesy of Pixabay.com

The growing opioid epidemic has highlighted the need for more drug treatment. So has the use of other drugs, methamphetamine, the so-called bath salts, and a whole host of new substances which continue to grow. The need for treatment among the older generation is at an all-time high as many baby boomers have continued to use their drug of choice into their retirement years. While the increasing problem with hard drugs gets a lot of media attention, we can’t forget that the two legal drugs, nicotine and alcohol remain huge killers. In medical settings, most of the patients have illnesses caused by or made worse by the use and abuse of alcohol and drugs.

There are several reasons why you might want to become a drug and alcohol counselor. For over ten years now I’ve taught classes in counseling those with substance use disorders. This week another class is starting. Over the next few weeks, I’d like to talk to you about some of the things drug counselors learn. Let’s begin today with reasons you might want to become a drug counselor and why your reason might help or hinder you in becoming a good drug counselor.

The field of drug counseling continues to evolve. The laws and regulations vary from place to place, and so do the names given to drug counselors. Counselors in this field are sometimes called substance abuse counselors, substance use disorder counselors, drug and alcohol counselors, or AOD counselors which stands for alcohol and other drug counselors.

This field used to separate alcoholics from drug addicts and provide two different kinds of treatment. Today it’s rare to find treatment programs where the two issues are disconnected. People with alcohol only problems usually end up in a drunk driver program or self-help groups such as AA. People with drug problems go to drug programs even though they often also have alcohol problems.

If you are in recovery, you may want to become a drug counselor.

Today’s substance abuse counseling programs mainly grew out of the alumni from drug programs and people who had attended 12 step groups. If you’re in recovery yourself, you may want to give back. The good part about this is that you probably have a lot of knowledge about the process of addiction. Many of my students are former alcoholics or addicts now in recovery. I tell the class, only half-joking, that many of you have done “extensive field research” on drugs and alcohol.

If you’re a recovering person, you probably know a lot about the 12 steps. While a lot of research is being done about what works and doesn’t work in the substance use disorder field, working the 12 steps and attending self-help groups continues to be a significant component of most recovery programs.

The downside to being a recovering person is that you may struggle with the academic, professional part of the curriculum. People in recovery who rushed too rapidly into becoming drug counselors put themselves at risk for relapse. For recovering person to work in the treatment field, they need to not only know the disease of addiction, but they also need to understand the process of recovery. If you’re in early recovery give yourself plenty of time to get used to your new sobriety before beginning to work in the field, otherwise you can put yourself at risk of relapse.

You may have had a family member or friend with an addiction problem.

Many people come into the field because they lost a family member or close friend to the diseases of addiction. I’ve seen some very effective counselors who have not themselves been addicts but have grown up in a home with an addicted parent or partner. If you’ve lost a child to addiction, death, or incarceration, that can be an exceptionally strong motivation to work in the field.

The caution for family members is like the one for recovering people. Make sure you are fully recovered from your experiences of living with an addicted person. Don’t expect to work out your own problems by working with addicts. Living with an addicted person can cause severe emotional trauma. You need to be fully recovered from that trauma if you plan to do this kind of work. A number of my drug counseling students were family members of addicts. They pretty much all told me they benefited by taking the classes. Many however decided they needed to work on themselves rather than trying to fix themselves by fixing addicts.

You have discovered a lot of the people you work with have drug problems.

No matter where you work there’s a strong possibility that many of the people you see each day have a drug problem. One survey estimated that 80% of the people in prison were drunk or high in the 24 hours before the committed the crime that led to their incarceration. VA Hospital estimated half of their hospital beds on the results of patients whose condition was caused by or made worse by alcohol. People who work in the criminal justice system or the medical field need to know about addiction and recovery.

People who work in the welfare system need to be knowledgeable about drugs, alcohol, addiction, and recovery. Many people who are unemployed have substance use issues. Among the homeless population, one drug is almost universal. It’s probably not the drug you are thinking of, the drug of choice among the homeless – is tobacco.

If you’re working in education, you need to know about drugs, alcohol and the problems they’re creating for your students. Surveys tell us that at the college level F students consume twice as much alcohol as A students. Many elementary school students begin experimenting with drugs and drinking around the third or fourth grade. They start by smoking their parent’s cigarettes or drinking their alcohol. With the shift towards legalized marijuana more and more elementary and middle school students are using marijuana. If you work with kids in any capacity part of what you should be doing will be drug prevention and early interventions.

You work in mental health and clients want to talk to you about drug problems.

There’s a substantial overlap between mental health issues and substance use disorders. If you work in a program or facility that treats mental health problems you’re seeing people with substance use disorders whether you know it or not. Please don’t say “I don’t want to work with those people.” You are. If you give off the attitude you don’t want to talk to them about their drug problems, their sex problems, or their gambling problems; they just won’t tell you the truth about those issues.

Roughly half the people with a diagnosed mental illness, abuse substances and many go on to develop substance use disorders. About 60% of the people with substance use disorders also have a mental illness. The area of working with clients with both problems, now called “dual diagnosis” used to be called “co-occurring disorders.” The most effective treatment for people with both disorders is to get them both treated at the same time and either at the same place or with two different providers who work together to coordinate care.

You would like to help “those people.”

If your motivation to become a drug counselor is because you feel sorry for people with a history of substance use disorder, I’m going to suggest, please don’t become a drug counselor. You’re likely to come across as feeling superior and looking down on them. If you want to be helpful, work with them on their other needs, housing, meals, job training, or basic literacy. Leave the drug counseling to people who will put in the time to develop the needed skills.

Stay tuned for more posts on what drug counselors do on the job and how someone would go about becoming a drug counselor. If you have questions as I move through this series of posts, please leave a comment or use the “contact me” form. I will get back to you just as quickly as my schedule allows.

Staying connected with David Joel Miller

Three David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Books are now available on Amazon, Kobo, iBooks, and many other online stores.

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

2018 First-Foot.

2018 First-Foot.

By David Joel Miller.

The first-foot through the door each year sets the tone for the rest of the year.

First foot in the door.

First Foot.
Photo courtesy of Pixabay.com

There’s an old tradition; they say it comes from Scotland, that the first person through the door each new year’s sets the tone for the rest of that year.  Because of that, I wanted this to be my first post for the new year.

If this is your first time reading counselorssoapbox.com, I hope this post will start off your year in a good direction.  Longtime readers will know that this blog’s premise is having a happy life.

Life can have it struggles.  At some point in their life, everyone is likely to experience a mental, emotional or behavioral issue.  Because of this, I write a lot about mental health, mental illness, substance use disorders and overcoming the bumps on the road of life.  Here is hoping that this new year will bring happiness to you and yours.

Throughout this year on counselorssoapbox.com I plan to bring you tips about having a happy life, coping with emotional and mental issues and the impact that using and abusing substances might have on your mental and emotional health.

We will also present posts to help you with being a success. However, you define that success.  With over 1100 posts on counselorssoapbox.com so far, you’ll find plenty of tips in the past posts with more to come this year.  You might even want to consider subscribing to counselorssoapbox.com.

Thanks for being my lucky first-foot this year.

P.S.  If it takes you a while to get around to reading this post I will understand.  Whenever you get to it, please drop me a line.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.