How is treatment delivered to the individual with a substance use disorder? This video includes an overview of assessment of substance use disorders, developing a substance use history, modalities and some of the issues that come up in treatment.
Alcohol #18. Treating alcohol use disorders
This video describes briefly some of the considerations when the client enters a drug or alcohol treatment program. How do people recover from alcoholism? What are the stages of change? Alcoholism is a chronic disease. How to screen for alcohol use disorders. Brief alcoholism interventions and when someone needs medical attention before entering a treatment program.
By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.
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 that 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.
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 a 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.
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.
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.
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.
If your motivation to become a drug counselor is because you feel sorry for people with a history of a 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
Seven David Joel Miller Books are available now!
My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.
Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.
Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.
As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.
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.
Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.
Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.
Planned Accidents The second Arthur Mitchell and Plutus mystery.
Letters from the Dead: The third in the Arthur Mitchell mystery series.
What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?
Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.
For these and my upcoming books; please visit my Author Page – David Joel Miller
Want the latest blog posts as they publish? Subscribe to this blog.
For videos, see: Counselorssoapbox YouTube Video Channel
By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.
What is a Standard Drink?
Photo courtesy of Pixabay.com
Only one kind of alcohol, ethanol, is drinkable. Ethanol or ethyl alcohol is made from fermenting a liquid made from fruit, grains, or similar vegetative products. Sometimes this chemical is called grain alcohol. While chemically similar, all the types of alcohol other than Ethanol can do significant harm, including cause blindness or death, when consumed. From here on, when I say alcohol, I am talking exclusively about the ethanol type.
The folk-lore of drinking contains lots of myths about what to drink and how to drink it. People may think that if they only drink beer or wine then they can’t become alcoholics. Some people give up “the hard stuff” thinking this will prevent them from having a problem with alcohol. Most of this belief that one alcoholic drink is better or worse than another is based on misconceptions about the content of alcoholic drinks.
No matter what we call an alcoholic beverage, what it is made from or what flavorings and additives are included, the pure alcohol part of alcoholic beverages is the same. All drinkable alcoholic beverages contain ethanol. Ethanol is the component that gets you drunk and withdrawal from ethanol, no matter the source, is what causes a hangover.
In order to compare the amount of pure alcohol contained in various beverages we use a concept called a “standard drink.” That standard drink is the amount of a beverage that contains one-half an ounce of pure ethanol.
In some places, the alcohol content is calculated by weight and in other places, it is calculated by volume. Depending on whether the alcohol is measured by weight or by volume and depending on who does the measuring we can get slightly different numbers here. Either way, the results of alcohol are pretty much the same.
Beers can vary between three and seven percent alcohol. Most of the major commercial beers in the U. S. are at the low end, close to 3 % and a twelve-ounce beer is considered a standard drink. Many people believe that because beer has a lower alcohol content it is safer and less likely to lead to problems. Unfortunately, that turns out to not be true. Because beer has a lower alcohol content per standard drink most people just drink more volume of beer than they would if drinking another alcoholic beverage. More than half the pure alcohol consumed every year here in the U. S. comes from beer.
Typical wines come in at eight to fourteen percent alcohol. The various textbooks I consulted gave between four and five oz. of wine as a standard drink. Wine can be fortified by adding alcohol distilled from some other alcoholic beverage. By fortifying a wine it can be pushed up to as much as twenty-two percent ethyl alcohol.
As the fermentation progresses the alcohol begins to prevent the yeast from working so the process of fermentation stops. To get stronger alcoholic beverages some manipulation is required. If the liquid is heated, the alcohol evaporates faster than the water and other components. Catch this steam which is largely alcohol, condense it, and you get a beverage with a higher concentration of alcohol. We call this product with the concentrated levels of alcohol, spirits, or hard liquor.
A standard drink containing spirits is about one “shot” of an 86 proof liquor. Proof numbers are twice the percentage numbers so this shot contains about half an ounce of pure alcohol.
In trying to compare the amount of alcohol in one drink with another it is important to keep in mind that a glass of wine is defined as a 4 to 5 ounce glass size. Pouring the wine into a 32-ounce tumbler does not mean a tumbler full is still one standard drink.
When the “proof” changes so should the size of the drink. Stronger spirits should be served in smaller glasses. In practice, people still pour more than one standard drink into their glass resulting in some drinks that contain way more than “one standard drink.” Even beer can become deceptively intoxicating if served in a mug that holds more than 12 ounces.
The whole idea of standard drinks was to predict the effects of drinking a glass of a particular alcoholic beverage. In practice, most people are taking in more alcohol than they realize and the heavy or binge drinkers are drinking way more drinks than they planned.
If you are having a problem with controlling your drinking the answer is not in measuring standard drinks. If when you drink you consume more than intended or bad things happen to you, there is a good chance that you have an Alcohol Use Disorder. Stop trying to find a way to beat the game and drink more but not get drunk and get some help from a support group like A. A. or a professional counselor.
For more on this topic see: Alcoholism Drug Use, Abuse, and Addiction
Terms and their meaning can differ with the profession using them. The literature from the Rehab or AOD (Alcohol and Other Drug) field may be very different from that in the mental health field. There is still a large gap between recovery programs and AOD professionals and the terms and descriptions used in the DSM.
FYI These “What is” sometimes “What are” posts are my efforts to explain terms commonly used in Mental Health, Clinical Counseling, Substance Use Disorder Counseling, Psychology, Life Coaching, and related disciplines in a plain language way. Many are based on the new DSM-5; some of the older posts were based on the DSM-IV-TR, both published by the APA. For the more technical versions please consult the DSM or other appropriate references.
See Recommended Books. More “What is” posts will be found at “What is.”
Staying connected with David Joel Miller
Seven David Joel Miller Books are available now!
My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.
Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.
Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.
As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.
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.
Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.
Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.
Planned Accidents The second Arthur Mitchell and Plutus mystery.
Letters from the Dead: The third in the Arthur Mitchell mystery series.
What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?
Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.
For these and my upcoming books; please visit my Author Page – David Joel Miller
Want the latest blog posts as they publish? Subscribe to this blog.
For videos, see: Counselorssoapbox YouTube Video Channel
counselorssoapbox 