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.

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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.