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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You need to process those feelings.

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

Unexplored feelings are like unopened mail.

Emotional Regulation

Managing Feelings
Photo courtesy of Flickr ( istolethetv )

Imagine going into your email and randomly deleting as many emails as possible. That email from a friend – mark it delete.

The email from the electric company and the mortgage company delete those unopened. Can you imagine going along randomly clicking delete without knowing what was in the email?

Some people try to avoid bills by not opening the mail. While that may avoid having to deal with problems for a while, eventually the power gets shut off, or the home goes into foreclosure. Those and many other issues could have been solved just by paying attention to the notices you are getting.

Some people think feelings are to be avoided.

Somewhere along the line, I’m guessing back during the Victorian era; feelings got a bad reputation. In their effort not to be carried away and controlled by feelings, being rational and unemotional was elevated to a virtue. The problem that created was making feelings into our enemies rather than our friends.

Feelings can be valuable sources of information.

It turns out that emotions and feelings can be valuable sources of information. By some estimates, more than half of all your nerve cells are located outside your head. There are nerve cells surrounding your stomach and intestines. They can tell you when you’re hungry or when your intestines are in distress.

Those same nerve cells can also communicate information about dangerous or unpleasant situations. When you say that someone makes you sick to your stomach, there’s truth to that statement. Your nervous system is reacting to that person and preparing to ready you for the flight or fight response.

When we say that someone is a pain in the neck, this is a very tangible sensation. The nerve cells which connect your brain to the muscles in your neck have sent the message to tighten those muscles in preparation for an emergency.

Unpleasant feelings can also motivate you to act.

Loneliness can make you miserable. Loneliness can also tell you that you aren’t getting enough human contact. Humans are inherently social animals. Living in groups increases our chances of survival. Feeling lonely can motivate you to reach out to others and increase your social connections.

Feeling tired both physically and emotionally tired is one of the early signs of burnout. Feeling tired warns you that the energy you are expending exceeds the available resources. Rather than being an interference with what you’re trying to do that feeling of being tired is a warning that you need to attend to your bodies physical and emotional resources.

Trying to avoid feeling unpleasant emotions can harm you.

Many people get themselves into serious trouble by attempting to avoid experiencing unpleasant feelings. Using drugs and alcohol to cope with anger, loneliness, or feeling tired, may anesthetize those feelings in the short term but eventually, those efforts to escape dealing with those feelings results in creating an even larger problem, alcoholism or drug addiction.

You shouldn’t pretend that you don’t feel what you’re feeling.

Ignoring the messages from feelings is the emotional equivalent of taping over the gauges on your car’s dashboard. You can ignore the check engine light, disregard the oil light, and ignore the gas gauge, but if you do, eventually your car will stop running.

Feelings can be like little children clamoring for your attention.

The next time you experience a feeling you’d rather not feel, try treating it like a small child. Initially, you need to listen to that feeling. After you are sure you’ve heard the message, the feeling is giving you, decide what you want to do with it. Sometimes you must deal with it immediately, and other times you can defer action. What you shouldn’t do is try to ignore the message that feeling is trying to give you.

Learning to work cooperatively with your feelings rather than being controlled by them or completely ignoring their messages is a skill you need to develop to have a happy, productive, life.

For more on this topic, take a look at the post about the three processes for making friends with your feelings.

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.

Are you having an Emotional Affair?

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

Emotional affairs may be more common than we realized.

Emotional Affair

Emotional Affair.
Photo courtesy of Pixabay.com

Many couples who come for relationship or marriage counseling have been arguing about the nature of one of the partner’s interactions with another person. Almost every client I’ve worked with who was in a relationship would agree that engaging in sex with someone other than their partner qualifies as an affair. What they don’t always agree about is whether a relationship with a third party has crossed the line and become an emotional affair.

It’s probably more common for women to become concerned that their partner’s friendship with another woman has become an emotional affair. Men are likely to dismiss these relationships as simply friendships and not having been an affair, so long as actual intercourse has not taken place.

Developing an overly close friendship with someone other than your romantic partner can damage a relationship. Here are some of the signs that your friendship has turned into an emotional affair.

Do you sometimes think about the “other” when talking to your spouse?

Having become so close to another person that during conversations with your spouse you are imagining what that other person would say or feel. This is a strong indication that they have him become more important to you and your spouse.

Do you, even a bit, wish your mate was more like someone else?

If you come to idealize the “other.” If you are thinking they are preferable to your mate or that they would be a better partner, this is likely to damage your relationship with your mate. Comparing your partner to others and wishing they were more like someone else is an early sign of an emotional affair in the making.

Do you imagine what you’d do if free to pursue someone else?

Daydreaming about what it would be like to be with that “other” suggests you’re already establishing an emotional relationship with them. The more you fantasize about being with the other, romanticize the possibility of starting a new relationship, the more you’re likely to withdraw from your current relationship. Even if you don’t leave your partner, imagining being with somebody else distances you from your partner.

Does your present lover know the stranger exists?

One key characteristic of emotional affairs is the need to hide your relationship with this other person from your primary partner. If you must keep secrets, those secrets are reducing your emotional closeness with your current partner.

What do you imagine your mate would think if he/she overheard you talking with this special person or read your email?

Having secrets that you share with the “other” and then being concerned about what your partner would think if they knew about this conversation suggest your relationship with this other person is inappropriate. Having to keep secrets from your partner is damaging to a relationship.

Does the arrival of a new message give you a rush?

You remember the rush of excitement you used to feel when you were first starting your relationship with your current partner? If messages from your “friend” start to give you that same rush of excitement, you are moving dangerously close to turning that friendship into an affair.

Can you sense the “sex of things” even if you haven’t acted on it?

Have you ever felt a craving for something? Remember how hard it is to say no to that temptation? If you are starting to feel those sexual attractions when you’re around your friend you’ve moved into a high-risk area. Even if you never actually engage in physical sex your friendship has become a source of mental and sexual stimulation and is becoming an emotional affair.

Do you lie to disguise any aspect of the new relationship?

If you have to tell your partner lies to facilitate or maintain your relationship with the “other,” this is a clear sign that relationship is turning into an emotional affair.

Is the mental and emotional space devoted to the stranger enlarging?

The larger a role this stranger plays in your life, the riskier the relationship is becoming. When the mental and emotional space the “other” occupies begins to exceed the space in your life taken up by your current partner, you’ve arrived at an emotional affair.

Do you engage in secret phone calls with the other?

Engaging in secret communications, phone calls, texts or emails, which you don’t want your partner to find out about, says this is an affair.

Have you arranged meetings in a park, coffee shop, restaurant or the like?

Do you and this “friend” have to arrange secret meetings away from other people? Do you have to be dishonest with your partner about when and where you’re meeting this other? It sounds like your friend has become more than a friend.

Do you share confidences not offered to your spouse?

One of the most damaging aspects of an emotional affair is when you begin to share confidences with your friend which should have been reserved only for your partner. Lack of loyalty to your spouse or making your friend your primary loyalty, are incredibly damaging to your current relationship.

Is your sexual desire for your mate now smaller than before you became preoccupied?

If your relationship with your friend has resulted in less sexual desire for your mate, it’s damaging the relationship. If your new friend reduces your desire to be emotionally close to your partner, or if your interest in spending time with your partner has declined, then your friend is taking on an increasingly more significant role in your life.

Are photo exchanges part of your new, hidden life?

Exchanging photos, particularly those which make you look attractive, or sexually explicit photos is often the last stop on the trail which turns an emotional affair into an actual physical one.

So, what do you think? How many of the signs of an emotional affair do you see in your friendship? How many of these signs of an emotional affair do you see, or suspect, are part of your spouse’s relationship with a “friend?”

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.

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.

How do you get your child help for drug addiction?

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

Finding help for a child with a mental illness or drug addiction is difficult.

Drugs of addiction

Addiction.
Photo courtesy of Pixabay.com

The question of how you get help for a child with a drug addiction, mental illness or alcoholism comes up frequently. Parents contacted me asking this question. Other therapist and counselors contact me looking for a referral to give their clients. The answers to these questions depend on a lot of factors and are never easy. My answer to the question of how to get help for a child typically begins with me asking some questions to gather more information. No one answer is right for everyone.

How old is your child who has the addiction?

If your child is under 18, you theoretically have not only control over the child but also the responsibility to act. Getting help for a child under 18 often is a parenting question. How do you get your child to go to school? Or how do you get your child to go to bed at night or eat their broccoli? For young children, you use discipline, that mixture of reward and punishment that shapes children’s behavior. Send them for treatment and make sure they go.

What if the child with an addiction is over 18?

I know if you are a parent you never stop thinking of your offspring as your child. The reality of the situation is that once they turn 18, you have very limited options to control their behavior. You may not like the person they want to have children with, the job they choose or the chemicals they select to put into their bodies. Once they turn 18, you can only help them if they want to be helped, and even then, you need to be careful about the help you offer.

Does your addicted adult child want help with their addiction?

If the child says no to drug treatment than the only things you can do are hope, pray, and wait for the opportunity to be helpful. The only way adults are forced into drug treatment is by being arrested, and court-ordered into treatment. You can hope that your adult child with an addiction, encounters law enforcement or child protective services and is required to get drug treatment. Trying to force this by calling the police on your child is likely to backfire causing them to sever their relationship with you and maybe delaying them getting into treatment.

You should avoid enabling your adult addicted child to continue using.

A lot of parents offer their children with an addiction all kinds of help. You might let them live with you until they steal things to sell for drug money. You might feed them or pay their rent. Anything you do financially to help them carries the risk that it just frees up more money for them to use to support their drug habit.

Should you pay for your adult child to go into rehab?

Addiction is characterized by being a chronic, relapsing, and often fatal disease. One episode in rehab may not result in arresting the disease of addiction. I’ve seen families spend everything they have putting an adult addicted child into rehab only to have them walk out of treatment early or relapse shortly after the treatment episode. If you have lots of money, sending them to a month-long rehab at the beach may be an option. But think of how many famous people have gone through repeated expensive episodes of rehab.

If you do decide to pay for your child’s rehab, spend the smallest amount possible because you’re likely to have to do it more than once. If your adult child has medical insurance, have them contact their insurance carrier.

Remember that even if you write the check to the rehab facility your child is an adult child, and that facility can’t tell you anything without your child’s permission. It can be very frustrating to parents whose child has an addiction to find that because of confidentiality the treatment provider can’t tell you anything even after you paid for treatment. Even if you get your child to sign a consent to release information form, at any moment they can revoke that release.

What resources are available if your adult addicted child says they want help?

The simplest resource to use is self-help groups, Alcoholics Anonymous or Narcotics Anonymous. There are meetings in almost every town, and there is no charge for their services.

You can also suggest you adult addicted child contact the local county behavioral health services. They can refer you to agencies which treat addiction in your county. Some of these agencies are low-cost or are funded by the County; others may accept medical insurance or have sliding fee scales.

Some private therapists and counselors specialize in treating clients with co-occurring disorders, both a mental illness and substance use disorder. Individual therapy is likely to be expensive. The therapist must pay for the office, and you’re buying an hour of their time. Going once a week to see a therapist will not result in an end to their addiction if they continue to use drugs between sessions.

Treating addiction is not a short-term process. Because of their using drugs over a long period the brain appears to change its default setting and the brain of the addict will continue to demand drugs long after the substances are out of the body. For most people, recovery from addiction is a long-term process requiring both treatment and the development of a support system which encourages the addict in recovery to stay sober.

What about interventions?

There used to be a lot of interventions. You still see TV shows about interventions. My experience has been that doing interventions has been a lot less effective than we would have hoped. Many people who are addicted refused to go into treatment. This can often lead to angry confrontations and an end to the relationship. For an intervention to work you also need to be able to get the addict into treatment immediately. Even a one-day delay can result in them changing the mind and not going into treatment. Unless you can pay for the treatment privately or are paying for their medical insurance you may not be able to reserve a bed in a rehab facility for an adult child.

So, what is your best option for getting an adult addicted child into treatment? Have an honest talk with them. Offer to be emotionally supportive but don’t enable their continued drug use. Expect to have to be patient until they are ready to go for treatment. A first step in the direction of recovery may be to agree to go with them to a 12-step self-help group.

I hope that it answered some of the questions. Feel free to leave a comment or use the contact me form if you’d like more information.

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.

The wounds of war last long after the soldiers return.

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

Military parades don’t tell the whole story.

Veterans Day

Veterans Day.
Photo courtesy of Pixabay.com

Today is Veterans Day in the United States. Various countries will celebrate their military veterans on other days.

On each of those veteran’s day’s, there will be parades and speeches and sometimes a lot of saber-rattling on the part of politicians.

It’s appropriate for people who served in the military to be honored today. Some will march in parades, and some will be honored with flags placed on their graves.

What we shouldn’t do is forget about these veterans the other 364 days of the year.

The physical wounds of war have become more pervasive.

The list of wars America has fought continues to grow. They used to be periods of peace between our wars, and we tried to believe that future generations wouldn’t have to fight. Unfortunately, across my lifespan, the periods of peace have grown shorter. We have reached the point where Americans have been fighting somewhere in the world continuously for the longest time in American history.

Many of the physical wounds of war today’s soldiers endure, traumatic brain injury, for example, are much more common today than they were in the past. It’s fashionable to spend money and manpower to win a war. It is a much lower priority to spend money and effort caring for the wounded warriors of America’s many conflicts across the remainder of these veteran’s lifespan.

The invisible wounds of war appear more common now than before.

PTSD and other psychological injuries are more common among today’s veterans than they were in past generations. At least that’s what the statistics tell us. It’s very likely that many cases of PTSD went unrecognized or underrecognized among veterans of World War II and Vietnam. It’s also probable that the more protracted wars, more frequent deployments, and the changing nature of warfare has made PTSD more common than it was before.

Homelessness among veterans remains much higher than it should be.

Politicians are far too willing to appropriate funds for new weapon systems to fight wars then they are to provide adequate resources for treatment and housing of those who have made the sacrifices to fight those wars.

Alcoholism and addiction are an occupational hazard among military veterans.

Medical facilities, particularly the VA, see many patients who are former military and whose medical issues have been caused by or made worse by, untreated alcoholism or drug abuse.

Substance abuse treatment facilities encounter a significant number of former military personnel who has struggled with alcoholism and drug addiction during and after the military service. For some former military personnel, drugs and alcohol have been their way of coping with the traumatic experiences they encounter during their military career.

However you celebrate Veterans Day, I hope during the day of parades, speeches, and ceremonies you don’t lose sight of the long-term personal costs borne by those who served their country, their families and friends, and the rest of our society.

Next week’s post will pick up where we left off in the series of posts about what drug counselors do on the job and the core functions of substance use disorder 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.