Health & Medical Alcohol Use Disorder & Substance Use Disorder Essay

Addiction
Counseling
Competencies
The Knowledge, Skills, and
Attitudes of Professional Practice
21
TAP 21
Technical Assistance Publication Series
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ADDICTION COUNSELING
COMPETENCIES
The Knowledge, Skills, and
Attitudes of Professional Practice
Technical Assistance Publication (TAP) Series
21
U.S. Department of Health and Human Services
Substance Abuse and Mental Health Services Administration
Center for Substance Abuse Treatment
5600 Fishers Lane
Rockville, MD 20857
Acknowledgments
A number of people deserve recognition for their tireless and dedicated work on this document. The publication was originally conceived and written by the National Addiction Technology Transfer Center (ATTC)
Curriculum Committee. The Committee, one of six national committees designed to serve the ATTC Network,
comprises representatives from several ATTC Regional Centers and the ATTC National Office. This group was
responsible for the original 1998 publication and for the 2000 draft on which this updated edition is based
(see page v). A second Committee convened in 2005 to update and finalize the current document (see page
vi). Karl D. White, Ed.D., and Catherine D. Nugent, M.S., served as the Center for Substance Abuse Treatment
(CSAT) ATTC Project Officers. Christina Currier served as the CSAT Government Project Officer. This
publication was produced by JBS International, Inc. (JBS), under the Knowledge Application Program (KAP)
contract number 270-04-7049.
D
The views, opinions, and content of this publication are those of the authors and do not necessarily
reflect the views, opinions, or policies of SAMHSA or HHS.
Public domAin notice
All materials appearing in this volume except those taken directly from copyrighted sources are in the public
domain and may be reproduced or copied without permission from SAMHSA or the authors. Citation of the
source is appreciated. However, this publication may not be reproduced or distributed for a fee
without the specific, written authorization of the Office of Communications, SAMHSA, HHS.
E
This publication may be ordered or downloaded from SAMHSA’s Publications Ordering Web page at http://
store.samhsa.gov. Or, please call SAMHSA at 1-877-SAMHSA-7 (1-877-726-4727) (English and Español).
R
Center for Substance Abuse Treatment. Addiction Counseling Competencies: The Knowledge, Skills, and
Attitudes of Professional Practice. Technical Assistance Publication (TAP) Series 21. HHS Publication No.
(SMA) 15-4171. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2006.
O
Quality Improvement and Workforce Development Branch, Division of Services Improvement, Center for
Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, 5600 Fishers Lane,
Rockville, MD 20857.
HHS Publication No. (SMA) 15-4171
First Printed 2006
Revised 2007, 2008, 2009, 2011, 2012, 2013, 2014, 2015, and 2017
No substantive revisions have been made to this publication since its original printing.
C
Curriculum Committees. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v
1998 National ATTC Curriculum Committee. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v
2005 Update Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vi
Foreword. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Section 1: Transdisciplinary Foundations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
I. Understanding Addiction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
II. Treatment Knowledge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
III. Application to Practice. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
IV. Professional Readiness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Section 2: Practice Dimensions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
I. Clinical Evaluation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
II. Treatment Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
III. Referral. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
IV. Service Coordination. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
V. Counseling. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
VI. Client, Family, and Community Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
VII. Documentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
VIII. Professional and Ethical Responsibilities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Section 3: Additional Resources. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Cultural Competency. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
Internet Resources. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Attitudes Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
Recovery Bibliography. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
Section 4: Appendices. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
A. Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
B. The Competencies: A Complete List. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177
C. National Validation Study: Defining and Measuring the Competence
of Addiction Counselors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
D. Complete Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
E. Other Contributors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225
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1998 nAtionAl Attc curriculum committee
Affiliations indicated below are those at the time of the work.
David A. Deitch, Ph.D. (Chair)
Pacific Southwest ATTC
University of California San Diego
La Jolla, California
Alan M. Parsons, M.S.W., ACSW
Northeastern States ATTC
State University of New York at Albany
Albany, New York
G.E. Carrier, Ph.D.
Representing the Texas ATTC
Alvin Community College
Alvin, Texas
Nancy Roget, M.S., MFT, LADC
Mountain West ATTC
University of Nevada–Reno
Reno, Nevada
Steven L. Gallon, Ph.D.
Northwest Frontier ATTC
Oregon Health and Science University
Salem, Oregon
Susanne R. Rohrer, RN, M.B.A.
Center for Substance Abuse Treatment
Substance Abuse and Mental Health
Services Administration
Washington, D.C.
Paula K. Horvatich, Ph.D.
Mid-Atlantic ATTC
Virginia Commonwealth University
Richmond, Virginia
Mary Beth Johnson, M.S.W.
ATTC National Office
University of Missouri–Kansas City
Kansas City, Missouri
Hendi Crosby Kowal, M.P.H.
DC/Delaware ATTC
Danya International, Inc.
Silver Spring, Maryland
Linda Nicholas
Great Lakes ATTC
University of Illinois–Chicago
Jane Addams School of Social Work
Chicago, Illinois
Anne Helene Skinstad, Psy.D.
Prairielands ATTC
University of Iowa
Iowa City, Iowa
Patricia L. Stilen, LCSW, CADAC
Mid-America ATTC
University of Missouri–Kansas City
Kansas City, Missouri
Susan A. Storti, RN, M.A.
ATTC of New England
Brown University
Providence, Rhode Island
Elleen M. Yancey, Ph.D.
Southeast ATTC
Morehouse School of Medicine
Atlanta, Georgia
v
Addiction Counseling Competencies
2005 uPdAte committee
Paula K. Horvatich, Ph.D. (Chair)
Mid-Atlantic ATTC
Virginia Commonwealth University
Richmond, Virginia
Carol Davidson, M.S.W., CDP
Evergreen Treatment Services
Seattle, Washington
Steven L. Gallon, Ph.D.
Northwest Frontier ATTC
Office of Alcohol and Drug Abuse Programs
Salem, Oregon
Michael Hoge, Ph.D.
Annapolis Coalition
Yale University
New Haven, Connecticut
James Holder, M.A., LPC-S, MAC
National Association for Alcohol and
Drug Addiction Counselors
McLeod Behavioral Health
Florence, South Carolina
Mary Beth Johnson, M.S.W.
ATTC National Office
University of Missouri–Kansas City
Kansas City, Missouri
Linda Kaplan, M.A.
National Association for Children
of Alcoholics
Rockville, Maryland
Captain Florentino (Tino)
Merced-Galindez, M.S.N., RN
Center for Substance Abuse Prevention
Substance Abuse and Mental Health
Services Administration
Rockville, Maryland
Randolph Muck, M.Ed.
Center for Substance Abuse Treatment
Substance Abuse and Mental Health
Services Administration
Rockville, Maryland
Paul D. Nagy, M.S., LCAS, LPC, CCS
Duke Addictions Program
Duke University Medical Center
Durham, North Carolina
Nancy Roget, M.S., MFT, LADC
Mountain West ATTC
University of Nevada–Reno
Reno, Nevada
Gerard J. Schmidt, M.A., LPC, MAC
NAADAC–The Association for Addiction
Professionals
Valley HealthCare System
Morgantown, West Virginia
Michael Shafer, Ph.D.
Pacific Southwest ATTC
Tucson, Arizona
James L. Sorensen, Ph.D.
San Francisco General Hospital
University of California–San Francisco
San Francisco, California
Patricia L. Stilen, LCSW, CADAC
Mid-America ATTC
University of Missouri–Kansas City
Kansas City, Missouri
Deborah Stone, Ph.D.
Center for Mental Health Services
Substance Abuse and Mental Health
Services Administration
Rockville, Maryland
Pamela Waters, M.Ed., CAPP
Southern Coast ATTC
Florida Certification Board
Tallahassee, Florida
vi
F
Counselors who treat people with substance use disorders do life-changing work on a daily
basis, amid difficult circumstances that include staff shortages, high turnover, low salaries,
and scant program funding. Counselors come to this important work by various paths and
with vastly different skills and experience. The diversity of backgrounds and types of
preparation can be a strength, provided there is a common foundation from which counselors
work. This publication addresses the following questions: What professional standards should
guide substance abuse treatment counselors? What is an appropriate scope of practice for
the field? Which competencies are associated with positive outcomes? What knowledge,
skills, and attitudes (KSAs) should all substance abuse treatment professionals have in
common?
Workforce development is essential to the field of substance use disorder treatment.
The Substance Abuse and Mental Health Services Administration (SAMHSA) has included
workforce development in its Matrix of Priority Programs. A major focus of this workforce
development strategy is improving the competencies of professionals in the field. This updated
edition of Technical Assistance Publication (TAP) 21: Addiction Counseling Competencies:
The Knowledge, Skills, and Attitudes of Professional Practice (The Competencies) is a key
component of that strategy.
In 1998, in cooperation with its Addiction Technology Transfer Center (ATTC) Network,
SAMHSA published TAP 21, a comprehensive list of 123 competencies that substance abuse
treatment counselors should master to do their work effectively. TAP 21 has been used to
develop and evaluate addiction counseling curricula, advise students, and assess counseling
proficiencies.
The overarching competencies in this updated version of TAP 21 remain largely unchanged
from the original TAP 21. The KSAs have been changed from those in the 1998 edition when
necessary, in light of new thinking in the field. The competencies and the KSAs in practice dimensions that address clinical evaluation and treatment planning have been revised to reflect
changes in the field. The competencies are defined by sublists of the KSAs needed to master
each competency. Bibliographies have been supplemented with new publications through 2005.
The format has been improved to make the information more accessible and useful.
SAMHSA’s TAP series provides a flexible format for the timely transfer of important technical
information to the substance abuse treatment field. This updated version of TAP 21 exemplifies
the flexibility of the TAP format. We are grateful to the members of the ATTC Network and staff
and to all those who participated in the validation and updating of these competency lists.
Kana Enomoto, M.A.
Acting Deputy Assistant Secretary
Substance Abuse and Mental Health Services Administration
Kimberly A . Johnson, Ph.D.
Director
Center for Substance Abuse Treatment
Substance Abuse and Mental Health Services Administration
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I
In 1998, the Substance Abuse and Mental Health Services Administration (SAMHSA) and the
Center for Substance Abuse Treatment (CSAT) published Addiction Counseling Competencies:
The Knowledge, Skills, and Attitudes of Professional Practice (The Competencies) as Technical
Assistance Publication (TAP) 21. Developed by the National Curriculum Committee of the
Addiction Technology Transfer Center (ATTC) Network, TAP 21 identifies 123 competencies
that are essential to the effective practice of counseling for psychoactive substance use
disorders. TAP 21 also presents the knowledge, skills, and attitudes (KSAs) counselors need
to become fully proficient in each competency.
TAP 21 has been widely distributed by SAMHSA’s Public Engagement Platform (PEP) and the
ATTC Network. It has become a benchmark by which curricula are developed and educational
programs and professional standards are measured for the field of substance abuse treatment
in the United States. In addition, it has been translated into several languages.
Because the ATTC Network is committed to technology transfer, after the initial publication
of TAP 21, the National Curriculum Committee began exploring ways to enhance the document for future printings. Successful technology transfer requires more than presenting good
information. It entails transmitting scientific knowledge in a way that makes it understandable,
feasible to implement in a real-world setting, and supportable at a systematic level—in other
words, getting the right information across in a way that makes it useable. The National
Curriculum Committee examined how best to package and present TAP 21 to help people
learn key elements and adopt new strategies. The result was a revision of TAP 21—a process
that was begun in 2000, was completed in 2005, and resulted in the current publication.
History of The CompeTenCies
In 1993 CSAT created a multidisciplinary network of 11 ATTC Regional Centers geographically
dispersed across the United States and in Puerto Rico and the U.S. Virgin Islands. Since its
inception, the ATTC Network has collaborated with diverse international, national, State,
regional, and local partners from multiple disciplines to recruit qualified addiction treatment
practitioners and enhance academic preparation and professional development opportunities
in the substance abuse treatment field.
The National Curriculum Committee, composed of ATTC Directors, was established at the
Network’s inaugural meeting. The committee’s initial charge was to collect and evaluate
existing addiction educational and professional development curricula and establish future
priorities for ATTC curriculum development. This effort led to researching existing practice
and professional literature and defining an extensive list of addiction practice competencies
determined to be essential to effective counseling for substance use disorders. These initial
competencies would serve as benchmarks to guide future ATTC curriculum design, development, and evaluation.
1
Addiction Counseling Competencies
In addition to its own work, the National Curriculum Committee reviewed and incorporated
other publications on the work of addiction counselors.1 In 1995 the committee’s work
resulted in the ATTC publication Addiction Counselor Competencies. Subsequent to this
publication, the ATTCs conducted a national survey to validate the competencies (see appendix
C). Results supported virtually all of the competencies as being essential to the professional
practice of addiction counseling.
In 1996, the International Certification and Reciprocity Consortium (ICRC) convened a national
leadership group to evaluate the need for model addiction counselor training. After careful
deliberation, the group concluded that much of the work to define such a curriculum standard
had already been accomplished by the ATTC National Curriculum Committee and the ICRC in
the National Curriculum Committee’s Addiction Counselor Competencies and the ICRC’s 1996
Role Delineation Study,2 respectively.
Soon after, CSAT agreed to fund a collaborative effort to finalize a document that could be used
as a national standard. CSAT convened a panel—The National Steering Committee for Addiction
Counseling Standards (NSC)—that comprised representatives from five national educational,
certification, and professional associations. The NSC was successful in achieving unanimous
endorsement of the Addiction Counselor Competencies—a milestone in the addiction
counseling field.
Based on this foundation, the National Curriculum Committee began to delineate the KSAs
that undergird each competency statement. Input was solicited from a number of key national
organizations and selected field reviewers. In 1998 CSAT published the results of this groundbreaking work as TAP 21 (The Competencies).
After TAP 21 was published, the National Curriculum Committee systematically conducted
focus groups and a national survey to elicit feedback from the field about the impact of TAP 21.
Although feedback was uniformly positive and thousands of copies of TAP 21 were disseminated
through SAMHSA’s PEP and the ATTC Network, refinements were needed to improve the utility
of the publication and enhance its effect in both the addiction practice and educational systems.
Feedback obtained from the survey and the focus groups indicated a need for additional information to help the field incorporate the competencies into daily practice. Feedback also suggested
that there was no need to change the competencies. The most common suggestions were to
refine the 1998 publication by presenting the content in a more user-friendly fashion and linking
it to professional literature and specific applications. The National Curriculum Committee revised
TAP 21 in 2000 based on the feedback of dedicated addiction practice and education professionals;
however, this revision was never published.
A new Update Committee was convened in 2005 to update the revised 2000 edition with literature
published between 2000 and 2005. The Update Committee consisted of some of the original members from the National Curriculum Committee; representatives from NAADAC—The Association for
Addiction Professionals, CSAT, the Center for Mental Health Services, the Center for Substance
Abuse Prevention, the National Association for Children of Alcoholics, and the Annapolis Coalition;
treatment providers; and experts in addiction research. The current updated edition retains
all of the feedback-based improvements of the 2000 revised version and adds relevant literature
2
1
Birch and Davis Corporation (1986). Development of Model Professional Standards for Counselor Credentialing. Dubuque, IA:
Kendall/Hunt Publishing.
2
International Certification and Reciprocity Consortium (ICRC)/Alcohol and Other Drug Abuse (1991). Role Delineation Study for
Alcohol and Other Drug Abuse Counselors. Raleigh, NC: ICRC.
Introduction
published after 2000. In addition, the competencies and KSAs of several practice dimensions,
in particular those that address clinical evaluation and treatment planning, were rewritten to
reflect current best practices.
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The Model
When creating The Competencies, the National Curriculum Committee recognized a need to
emphasize three characteristics of competency: knowledge, skills, and attitudes. Many hours
were spent conceptualizing a differentiated model when designing TAP 21—a model that could
address general KSAs necessary for all practitioners dealing with substance use disorders while
explaining the more specific needs of professional substance abuse treatment counselors.
The first section of the model addresses the generic KSAs. This section contains the transdisciplinary foundations, comprising four discrete building blocks: understanding addiction,
treatment knowledge, application to practice, and professional readiness. The term “transdisciplinary” was selected to describe the knowledge and skills needed by all disciplines (e.g.,
medicine, social work, pastoral guidance, corrections, social welfare) that deal directly with
individuals with substance use disorders.
The second section of the model specifically addresses the professional practice needs, or
practice dimensions, of addiction counselors. Each practice dimension includes a set of competencies, and, within each competency, the KSAs necessary for effective addiction counseling
are outlined. Many additional competencies may be desirable for counselors in specific settings.
Education and experience affect the depth of the individual counselor’s knowledge and skills; not all
counselors will be experienced
and proficient in all the compeFigure 1. Components in the CompetenCies model
tencies discussed. The National
Curriculum Committee’s goal
for the future is to help ensure
that every addiction counselor
possesses, to an appropriate
degree, each competency listed,
regardless of setting or treatment model.
The relationship of the components in the competencies
model is conceptualized as
a hub with eight spokes (see
figure 1). The hub contains
the four transdisciplinary foundations that are central to the
work of all addiction professionals. The eight spokes are
the practice dimensions, each
containing the competencies
the addiction counselor should
attain to master each practice
dimension.
3
Addiction Counseling Competencies
Recommended Readings
Journal articles, book chapters, and other critical literature for each transdisciplinary foundation
and practice dimension have been reviewed and included in this document. Moreover, separate
bibliographies on attitudes and recovery have been added, as have lists of Internet and cultural
competency resources. These can be found in section 3.
Appendices
Appendices include a glossary (appendix A), a complete list of the competencies (appendix B),
a summary of the results of the Committee’s National Validation Study of The Competencies
(appendix C), a complete bibliography with a detailed overview of the methodology used for
literature searches (appendix D), and a list of people who acted as field reviewers or provided
research assistance (appendix E).
Companion Volume—TAP 21-A
As a companion to this volume on counselor competencies, CSAT is publishing TAP 21-A,
Competencies for Substance Abuse Treatment Clinical Supervisors, which discusses the qualities
and abilities integral to supervising substance abuse treatment clinicians.
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Since its inception, The Competencies has been improving addiction counseling and addiction
counselor education across the country in a number of ways. The most common reported
applications have been in curriculum/course evaluation and design for higher education;
personal professional development; student advising, supervision, and assessment; assessment
of competent practices; design of professional development and continuing education programs; and certification standards/exams. Examples of how The Competencies is being used
are given on the following pages:
Montana. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Illinois . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Nebraska. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
New York . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Missouri. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Texas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Puerto Rico. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
International Applications. . . . . . . . . . . . . . . . . . . . . . 59
New England . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
Idaho, Oregon, and Washington. . . . . . . . . . . . . . . . . . 74
Nevada. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Texas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
Florida . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Virginia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Northeast. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Idaho . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Washington. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
California. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
Oregon and Wisconsin. . . . . . . . . . . . . . . . . . . . . . . . . 135
Iowa. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
Georgia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
Alaska, Hawaii, Idaho, Oregon, and Washington. . . . . 155
4
Section 1:
introduction to tHe trAnsdisciPlinAry foundAtions
T
Addiction professionals work in a broad variety of disciplines but share
an understanding of the addictive process that goes beyond the narrow
confines of any one specialty. Specific proficiencies, skills, levels of involvement with clients, and scope of practice vary widely among specializations. At their base, however, all addiction-focused disciplines are built
on four common foundations.
This section focuses on four sets of competencies that are transdisciplinary in that they underlie the work not just of counselors but of all
addiction professionals. The four areas of knowledge identified here
serve as prerequisites to the development of competency in any of the
addiction-focused disciplines.
T
Understanding Addiction
Treatment Knowledge
Application to Practice
Professional Readiness
Regardless of professional identity or discipline, each treatment provider
must have a basic understanding of addiction that includes knowledge of
current models and theories, appreciation of the multiple contexts within
which substance use occurs, and awareness of the effects of psychoactive
drug use. Each professional must be knowledgeable about the continuum
of care and the social contexts affecting the treatment and recovery
process.
Each addiction specialist must be able to identify a variety of helping strategies
that can be tailored to meet the needs of individual clients. Each professional
must be prepared to adapt to an ever-changing set of challenges and
constraints.
Although specific skills and applications vary across disciplines, the attitudinal components tend to remain constant. The development of effective
practice in addiction counseling depends on the presence of attitudes
reflecting openness to alternative approaches, appreciation of diversity,
and willingness to change.
The following knowledge and attitudes are prerequisite to the development of competency in the professional treatment of substance use
disorders. Such knowledge and attitudes form the basis of understanding on which discipline-specific proficiencies are built.
5
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UNDERSTANDING ADDICTION
7
Transdisciplinary Foundation I
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uuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuu
TF understAnding Addiction
C
Understand a variety of models and theories of addiction and other problems
related to substance use.
Knowledge
Attitudes
● Terms and concepts related to theory,
● Openness to information that may differ
● Scientific and theoretical basis of model
● Appreciation of the complexity inherent
etiology, research, and practice.
from medicine, psychology, sociology,
religious studies, and other disciplines.
● Criteria and methods for evaluating
models and theories.
● Appropriate applications of models.
● How to access addiction-related literature
from personally held views.
in understanding addiction.
● Valuing of diverse concepts, models,
and theories.
● Willingness to form personal concepts
through critical thinking.
from multiple disciplines.
C
Recognize the social, political, economic, and cultural context within which
addiction and substance abuse exist, including risk and resiliency factors that
characterize individuals and groups and their living environments.
Knowledge
Attitudes
● Basic concepts of social, political,
● Recognition of the importance of
economic, and cultural systems and their
impact on drug-taking activity.
● The history of licit and illicit drug use.
● Research reports and other literature
contextual variables.
● Appreciation for differences between
and within cultures.
identifying risk and resiliency factors for
substance use.
● Statistical information regarding the
incidence and prevalence of substance
use disorders in the general population
and major demographic groups.
9
Addiction Counseling Competencies
C
Describe the behavioral, psychological, physical health, and social effects of
psychoactive substances on the person using and significant others.
Knowledge
Attitudes
● Fundamental concepts of pharmacological
● Sensitivity to multiple influences in the
properties and effects of all psychoactive
substances.
● The continuum of drug use, such as
developmental course of addiction.
● Interest in scientific research findings.
initiation, intoxication, harmful use,
abuse, dependence, withdrawal, craving,
relapse, and recovery.
● Behavioral, psychological, social, and
health effects of psychoactive substances.
● The effects of chronic substance use
on clients, significant others, and
communities within a social, political,
cultural, and economic context.
● The varying courses of addiction.
● The relationship between infectious
diseases and substance use.
C
Recognize the potential for substance use disorders to mimic a variety of
medical and mental health conditions and the potential for medical and
mental health conditions to coexist with addiction and substance abuse.
Knowledge
Attitudes
● Normal human growth and development.
● Symptoms of substance use disorders that
● Willingness to reserve judgment until
are similar to those of other medical and/
or mental health conditions and how
these disorders interact.
● The medical and mental health conditions
that most commonly exist with addiction
and substance use disorders.
● Methods for differentiating substance use
disorders from other medical or mental
health conditions.
10
completion of a thorough clinical
evaluation.
● Willingness to work with people who
might display and/or have mental health
conditions.
● Willingness to refer for treating conditions
outside one’s expertise.
● Appreciation of the contribution of
multiple disciplines to the evaluation
process.
TF 1. Understanding Addiction
B
Members of the National ATTC Curriculum Committee reviewed the bibliography from the
first printing of The Competencies. Following previously established guidelines, the Committee reviewed and linked each reference with a specific transdisciplinary foundation. Primarily
textbooks are referenced in this section; however, such texts are not mutually exclusive of the
practice dimensions.
TF I. Understanding Addiction
Akers, R.L. (1992). Drugs, Alcohol, and Society: Social Structure, Process, and Policy.
Monterey, CA: Brooks/Cole.
Baer, J.S., Marlatt, G.A., & McMahon, R.J. (Eds.) (1993). Addictive Behaviors Across the
Life Span. Newbury Park, CA: Sage Publications.
Bennett, L.A., Reiss, D., et al. (1987). The Alcoholic Family. New York: Basic Books.
Blevins, G.A., Dana, R.Q., & Lewis, J.A. (1994). Substance Abuse Counseling: An Individual
Approach (2nd ed.). Pacific Grove, CA: Brooks/Cole.
Cohen, W.E., Holstein, M.E., & Inaba, D.S. (1997). Uppers, Downers, All Arounders: Physical
and Mental Effects of Psychoactive Drugs (3rd ed.). Ashland, OR: CNS Publications.
Collins, R.L., Leonard, K.E., & Searles, J.S. (Eds.) (1990). Alcohol and the Family: Research
and Clinical Perspectives. New York: Guilford Press.
Curtis, O. (1998). Chemical Dependency: A Family Affair. Pacific Grove, CA: Brooks/Cole.
Epstein, E.E., & McCrady, B.S. (Eds.) (1999). Addictions: A Comprehensive Guidebook.
New York: Oxford University Press.
Fisher, G.L., & Harrison, T.C. (2004). Substance Abuse: Information for School Counselors,
Social Workers, Therapists, and Counselors. Boston: Allyn & Bacon.
Gullotta, T.P., Adams, G.R., & Montemayor, R. (Eds.) (1994). Substance Misuse in Adolescence.
Thousand Oaks, CA: Sage Publications.
Jaffe, J. (Ed.) (1995). Encyclopedia of Drugs and Alcohol. New York: Macmillan.
Jonnes, J. (1999). Hep-Cats, Narcs, and Pipe Dreams: A History of America’s Romance With
Illegal Drugs. Baltimore: Johns Hopkins University Press.
Kinney, J. (2003). Loosening the Grip: A Handbook of Alcohol Information (7th ed.). New York:
McGraw-Hill.
Lawson, A.W., Lawson, G.W., & Rivers, P.C. (1996). Essentials of Chemical Dependency
Counseling (2nd ed.). Gaithersburg, MD: Aspen Publishers.
Lawson, G.W., & Lawson, A.W. (1992). Adolescent Substance Abuse: Etiology, Treatment,
and Prevention. Gaithersburg, MD: Aspen Publishers.
Lewis, J.A., Dana, R.Q., & Blevins, G.A. (2001). Substance Abuse Counseling (3rd ed.).
Pacific Grove, CA: Brooks/Cole.
Lowinson, J.H., Ruiz, P., et al. (Eds.) (1997). Substance Abuse: A Comprehensive Textbook
(3rd ed.). Baltimore: Lippincott Williams & Wilkins.
11
Addiction Counseling Competencies
McKim, W.A. (2002). Drugs and Behavior: An Introduction to Behavioral Pharmacology
(5th ed.). Upper Saddle River, NJ: Prentice Hall.
Miller, G. (2004). Learning the Language of Addiction Counseling (2nd ed.). Hoboken, NJ:
John Wiley & Sons.
Musto, D.F. (1999). The American Disease: Origins of Narcotic Control (3rd ed.). New York:
Oxford University Press.
Nathan, P.E., & Gorman, J.M. (Eds.) (2002). A Guide to Treatments That Work (2nd ed.).
New York: Oxford University Press.
Pita, D.D. (2004). Addictions Counseling: A Practical and Comprehensive Guide to Counseling
People With Addictions. New York: Crossroad Publishing.
Rutzky, J. (1998). Coyote Speaks: Creative Strategies for Psychotherapists Treating Alcoholics
and Addicts. Northvale, NJ: Jason Aronson.
Thombs, D.L. (1999). Introduction to Addictive Behaviors (2nd ed.). New York: Guilford Press.
Venturelli, P. (Ed.) (1994). Drug Use in America: Social, Cultural, and Political Perspectives.
Boston: Jones and Bartlett Publishers.
Wallen, J. (1993). Addiction in Human Development: Developmental Perspectives on Addiction
and Recovery. New York: Haworth Press.
White, W.L. (1998). Slaying the Dragon: The History of Addiction Treatment and Recovery in
America. Bloomington, IL: Chestnut Health Systems.
12
TREATMENT KNOWLEDGE
13
Transdisciplinary Foundation II
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tf ii.TF
C
Describe the philosophies, practices, policies, and outcomes of the most
generally accepted and scientifically supported models of treatment,
recovery, relapse prevention, and continuing care for addiction and other
substance-related problems.
Knowledge
Attitudes
● Generally accepted models, such as
● Acceptance of the validity of a variety
but not limited to:
of approaches and models.
● Openness to new, evidence-based
– pharmacotherapy
– mutual help and self-help
– behavioral self-control training
– mental health
– self-regulating community
– psychotherapeutic
– relapse prevention.
treatment approaches, including
pharmacological interventions.
● The philosophy, practices, policies, and
outcomes of the most generally accepted
therapeutic models.
● Alternative therapeutic models that
demonstrate potential.
C
Recognize the importance of family, social networks, and community systems
in the treatment and recovery process.
Knowledge
Attitudes
● The role of family, social networks, and
● Appreciation for the significance and
community systems as assets or obstacles
in treatment and recovery processes.
●
complementary nature of various systems
in facilitating treatment and recovery.
 ethods for incorporating family and
M
social dynamics in treatment and recovery
processes.
15
Addiction Counseling Competencies
C
Understand the importance of research and outcome data and their
application in clinical practice.
Knowledge
Attitudes
● Research methods in the social and
● Recognition of the importance of scientific
behavioral sciences.
● Sources of research literature relevant to
the prevention and treatment of addiction.
● Specific research on epidemiology,
research to the delivery of addiction
treatment.
● Openness to new information.
etiology, and treatment efficacy.
● Benefits and limitations of research.
C
Understand the value of an interdisciplinary approach to addiction
treatment.
Knowledge
Attitudes
● Roles and contributions of multiple
● Desire to collaborate.
● Respect for the contribution of multiple
disciplines to treatment efficacy.
● Terms and concepts necessary to communicate effectively across disciplines.
● The importance of communication with
other disciplines.
16
disciplines to the recovery process.
● Commitment to professionalism.
TF II. Treatment Knowledge
B
Members of the National ATTC Curriculum Committee reviewed the bibliography from the
first printing of The Competencies. Following previously established guidelines, the Committee reviewed and linked each reference with a specific transdisciplinary foundation. Primarily
textbooks are referenced in this section; however, such texts are not mutually exclusive of the
practice dimensions.
TF II. Treatment Knowledge
Benshoff, J.J., & Janikowski, T.P. (2000). The Rehabilitation Model of Substance Abuse
Counseling. Pacific Grove, CA: Brooks/Cole.
Berg, I.K., & Miller, S.D. (1992). Working With the Problem Drinker: A Solution-Focused
Approach. New York: W.W. Norton.
Brown, S. (Ed.) (1995). Treating Alcoholism. San Francisco: Jossey-Bass.
Donigian, J., & Malnati, R. (1996). Systemic Group Therapy: A Triadic Model. Pacific Grove, CA:
Brooks/Cole.
Greenlick, M., Lamb, S., & McCarty, D. (Eds.) (1998). Bridging the Gap Between Practice and
Research: Forging Partnerships With Community-Based Drug and Alcohol Treatment.
Washington, DC: National Academy Press.
Heather, N., & Miller, W.R. (Eds.) (1998). Treating Addictive Behaviors (2nd ed.). New York:
Plenum Press.
Institute of Medicine (1990). Broadening the Base of Treatment for Alcohol Problems.
Washington, DC: National Academy Press.
L’Abate, L., Farrar, J.L., & Serritella, D. (1991). Handbook of Differential Treatments for
Addictions. Boston: Allyn & Bacon.
Lawson, A.W., & Lawson, G.W. (1998). Alcoholism and the Family: A Guide to Treatment and
Prevention (2nd ed.). Gaithersburg, MD: Aspen Publishers.
Miller, W.R., & Rollnick, S. (1991). Motivational Interviewing: Preparing People To Change
Addictive Behavior. New York: Guilford Press.
Nowinski, J. (1990). Substance Abuse in Adolescents and Young Adults: A Guide to Treatment.
New York: W.W. Norton.
Stevens, P., & Smith, R.L. (2004). Substance Abuse Counseling: Theory and Practice (3rd ed.).
Old Tappan, NJ: Prentice Hall.
17
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APPLICATION TO PRACTICE
19
Transdisciplinary Foundation III
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TFApplication to Practice
Competency 9:
Understand the established diagnostic criteria for substance use disorders,
and describe treatment modalities and placement criteria within the
continuum of care.
Knowledge
Attitudes
● Established diagnostic criteria,
● Openness to a variety of treatment services
including but not limited to current
Diagnostic and Statistical Manual of
Mental Disorders (DSM) standards and
current International Classification of
Diseases (ICD) standards.
based on client need.
● Recognition of the value of research
findings.
● Established placement criteria developed
by various States and professional
organizations.
● Strengths and limitations of various
diagnostic and placement criteria.
● Continuum of treatment services and
activities.
C
Describe a variety of helping strategies for reducing the negative effects of
substance use, abuse, and dependence.
Knowledge
Attitudes
● A variety of helping strategies, including
● Openness to various approaches to
but not limited to:
– evaluation methods and tools
– stage-appropriate interventions
– motivational interviewing
– involvement of family and
significant others
– mutual-help and self-help programs
– coerced and voluntary care models
– brief and longer term interventions.
recovery.
● Appreciation that different approaches
work for different people.
21
Addiction Counseling Competencies
C
Tailor helping strategies and treatment modalities to the client’s stage of
dependence, change, or recovery.
Knowledge
Attitudes
● Strategies appropriate to the various
● Flexibility in choice of treatment
stages of dependence, change,
and recovery.
modalities.
● Respect for the client’s racial, cultural,
economic, and sociopolitical backgrounds.
C
Provide treatment services appropriate to the personal and cultural identity
and language of the client.
Knowledge
Attitudes
● Various cultural norms, values, beliefs,
● Respect for individual differences
● Cultural differences in verbal and
● Respect for differences between cultures.
and behaviors.
nonverbal communication.
within cultures.
● Resources to develop individualized
treatment plans.
C
Adapt practice to the range of treatment settings and modalities.
Knowledge
Attitudes
● The strengths and limitations of
● Flexibility and creativity in practice
available treatment settings and
modalities.
● How to access and make referrals to
available treatment settings and
modalities.
22
application.
TF III. Application to Practice
C
Be familiar with medical and pharmacological resources in the treatment of
substance use disorders.
Knowledge
Attitudes
● Current literature regarding medical
● Open and flexible with respect to
and pharmacological interventions.
● Assets and liabilities of medical and
pharmacological interventions.
the potential risks and benefits of
pharmacotherapies to the treatment
and recovery process.
● Health practitioners in the community
who are knowledgeable about addiction
and addiction treatment.
● The role that medical problems and
complications can play in the intervention
and treatment of addiction.
C
Understand the variety of insurance and health maintenance options
available and the importance of helping clients access those benefits.
Knowledge
Attitudes
● Existing public and private payment plans
● Willingness to cooperate with
including treatment orientation and
coverage options.
● Methods for gaining access to available
payment plans.
● Policies and procedures used by available
payment providers.
● Willingness to explore treatment
alternatives.
● Interest in promoting the most
cost-effective, high-quality care.
payment plans.
● Key personnel, roles, and positions
within plans used by the client
population.
23
Addiction Counseling Competencies
C
Recognize that crisis may indicate an underlying substance use disorder and
may be a window of opportunity for change.
Knowledge
Attitudes
● The features of crisis, which may
● Willingness to respond and follow through
include but are not limited to:
in crisis situations.
● Willingness to consult when necessary.
– family disruption
– social and legal consequences
– physical and psychological
– panic states
– physical dysfunction.
● Substance use screening and assessment
methods.
● Prevention and intervention principles
and methods.
●
●
●
●
Principles of crisis case management.
Posttraumatic stress characteristics.
Critical incident debriefing methods.
Available resources for assistance in the
management of crisis situations.
C
Understand the need for and the use of methods for measuring treatment
outcome.
Knowledge
Attitudes
●
●
●
●
● Recognition of the importance of
Treatment outcome research literature.
Scientific process in applied research.
Appropriate measures of outcome.
Methods for measuring the multiple
variables of treatment outcome.
collecting and reporting on outcome data.
● Interest in integrating research findings
into ongoing treatment design.
U
The Competencies has been used in a number of different ways in Montana. It was incorporated
into the Montana certification and oral exam process. In higher education settings at colleges and
universities, The Competencies has been used to define behavioral expectations and objectives for
addiction counseling courses. Clinically, it has been used to establish “employment competencies”
for counselors working in a hospital-based setting with clients who abuse substances. These employment competencies were also modified for use by substance abuse counseling programs on the
Crow Indian Reservation and the Rocky Boy Indian Reservation.
24
TF III. Application to Practice
B
Members of the National ATTC Curriculum Committee reviewed the bibliography from the
first printing of The Competencies. Following previously established guidelines, the Committee reviewed and linked each reference with a specific transdisciplinary foundation. Primarily
textbooks are referenced in this section; however, such texts are not mutually exclusive of the
practice dimensions.
TF III. Application to Practice
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental
Disorders (4th ed.). Washington, DC: American Psychiatric Association.
Bennett, L.A., Reiss, D., et al. (1987). The Alcoholic Family. New York: Basic Books.
Berg, I.K., & Miller, S.D. (1992). Working With the Problem Drinker: A Solution-Focused
Approach. New York: W.W. Norton.
Brown, S. (Ed.) (1995). Treating Alcoholism. San Francisco: Jossey-Bass.
Cavanaugh, E.R., Ginzburg, H.M., et al. (1989). Drug Abuse Treatment: A National Study of
Effectiveness. Chapel Hill, NC: University of North Carolina Press.
Chiauzzi, E.J. (1991). Preventing Relapse in the Addictions: A Biopsychosocial Approach.
New York: Pergamon.
Deitch, D., & Solit, R. (1993). Training of drug abuse treatment personnel in therapeutic
community methodology. Psychotherapy, 30(2):305-316.
Donigian, J., & Malnati, R. (1997). Systemic Group Therapy: A Triadic Model. Pacific Cove, CA:
Brooks/Cole.
Ettore, E. (1992). Women and Substance Use. New Brunswick, NJ: Rutgers University Press.
Evans, K., & Sullivan, J.M. (2001). Dual Diagnosis: Counseling the Mentally Ill Substance
Abuser (2nd ed.). New York: Guilford Press.
Flores, P.J. (1997). Group Psychotherapy With Addicted Populations: An Integration of
Twelve-Step and Psychodynamic Theory (2nd ed.). New York: Haworth Press.
Galanter, M. (1993). Network Therapy for Alcohol and Drug Abuse. New York: Guilford Press.
Institute of Medicine (1990). Treating Drug Problems, Volume 1: The Report. Washington, DC:
National Academy Press.
Levin, J.D. (1995). Introduction to Alcoholism Counseling: A Bio-Psycho-Social Approach
(2nd ed.). New York: Taylor & Francis.
Lewis, J.A. (Ed.) (1994). Addictions: Concepts and Strategies for Treatment. Gaithersburg, MD:
Aspen Publishers.
McCrady, B.S., & Miller, W.R. (Eds.) (1993). Research on Alcoholics Anonymous:
Opportunities and Alternatives. New Brunswick, NJ: Rutgers Center of Alcohol Studies.
McLellan, A.T., Woody, G.E., et al. (1988). Is the counselor an “active ingredient” in substance
abuse rehabilitation? An examination of treatment success among four counselors.
Journal of Nervous and Mental Disease, 176:430-432.
25
Addiction Counseling Competencies
Meyers, R.J., & Smith, J.E. (1995). Clinical Guide to Alcohol Treatment: The Community
Reinforcement Approach. New York: Guilford Press.
Miller, N.S., Gold, M.S., & Smith, D.E. (Eds.) (1997). Manual of Therapeutics for Addictions.
New York: Wiley-Liss.
Miller, W.R., & Heather, N. (Eds.) (1998). Treating Addictive Behaviors: Processes of Change
(2nd ed.). New York: Plenum Press.
Moos, R.H., Finney, J.W., & Cronkite, R.C. (1990). Alcoholism Treatment: Context, Process,
and Outcome. New York: Oxford University Press.
Murphy, L.L., & Impara, J.C. (Eds.) (1996). Buros Desk Reference: Assessment of Substance
Abuse. Lincoln, NE: Buros Institute of Mental Measurements.
Najavits, L.M., & Weiss, R.D. (1994). Variations in therapist effectiveness in the treatment of
patients with substance use disorder: An empirical review. Addictions, 89:679-688.
Prochaska, J.O., DiClemente, C.C., & Norcross, J.C. (1992). In search of how people change:
Applications to addictive behaviors. American Psychologist, 47:1102-1114.
Rutzky, J. (1998). Coyote Speaks: Creative Strategies for Psychotherapists Treating Alcoholics
and Addicts. Northvale, NJ: Jason Aronson.
Vannicelli, M. (1992). Removing the Roadblocks: Group Psychotherapy With Substance Abusers
and Family Members. New York: Guilford Press.
Washton, A.M. (1995). Psychotherapy and Substance Abuse: A Practitioner’s Handbook.
New York: Guilford Press.
Zweben, J.E. (Ed.) (1990). Understanding and preventing relapse. Journal of Psychoactive
Drugs, 22(2).
26
PROFESSIONAL READINESS
27
Transdisciplinary Foundation IV
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TFProfessional Readiness
C
Understand diverse cultures, and incorporate the relevant needs of culturally
diverse groups, as well as people with disabilities, into clinical practice.
Knowledge
Attitudes
● Information and resources regarding
● Willingness to explore and identify one’s
racial and ethnic cultures, lifestyles,
gender, and age as well as relevant needs
of people with disabilities.
● The unique influence the client’s culture,
own cultural values.
● Acceptance of other cultural values as valid
for other individuals.
lifestyle, gender, and other relevant factors
may have on behavior.
● The relationship between substance use
and diverse cultures, values, and lifestyles.
● Assessment and intervention methods that
are appropriate to culture and gender.
● Counseling methods relevant to the needs
of culturally diverse groups and people
with disabilities.
● The Americans with Disabilities Act and
other legislation related to human, civil,
and clients’ rights.
C
Understand the importance of self-awareness in one’s personal, professional,
and cultural life.
Knowledge
Attitudes
● Personal and professional strengths
● Openness to constructive supervision.
● Willingness to grow and change personally
and limitations.
● Cultural, ethnic, or gender biases.
and professionally.
29
Addiction Counseling Competencies
C
Understand the addiction professional’s obligations to adhere to ethical and
behavioral standards of conduct in the helping relationship.
Knowledge
Attitudes
● The features of crisis, which may include
● Willingness to conduct oneself in
but are not limited to:
– family disruption
– social and legal consequences
– physical and psychological
panic states
– physical dysfunction.
accordance with the highest ethical
standards.
●
Willingness to comply with regulatory and
professional expectations.
● Substance use screening and assessment
methods.
●
●
●
●
●
Intervention principles and methods.
Principles of crisis case management.
Posttraumatic stress characteristics.
Critical incident debriefing methods.
Available resources for assistance in the
management of crisis situations.
C
Understand the importance of ongoing supervision and continuing education
in the delivery of client services.
Knowledge
Attitudes
● Benefits of self-assessment and clinical
● Commitment to continuing professional
supervision to professional growth and
development.
● The value of consultation to enhance
personal and professional growth.
● Resources available for continuing
education.
● Supervision principles and methods.
30
education.
● Willingness to engage in a supervisory
relationship.
TF IV. Professional Readiness
C
Understand the obligation of the addiction professional to participate in
prevention and treatment activities.
Knowledge
Attitudes
● Research-based prevention models and
● Appreciation of the inherent value of
● The relationship between prevention and
● Openness to research-based prevention
strategies.
treatment.
prevention.
strategies.
● Environmental strategies and prevention
campaigns.
● Benefits of working with community
coalitions.
C
Understand and apply setting-specific policies and procedures for handling
crisis or dangerous situations, including safety measures for clients and staff.
Knowledge
Attitudes
● Setting-specific policies and procedures.
● What constitutes a crisis or danger to the
● Understanding of the potential seriousness
● The range of appropriate responses to a
self-control in the face of crisis or danger.
client and/or others.
crisis or dangerous situation.
● Universal precautions.
● Legal implications of crisis response.
● Exceptions to confidentiality rules in
of crisis situations.
● Awareness for the need for caution and
● Willingness to request help in potentially
dangerous situations.
crisis or dangerous situations.
U
The Board of Directors of the Illinois Alcohol and Other Drug Abuse Professional Certification
Association has endorsed and will be incorporating the knowledge, skills, and attitudes provided
in The Competencies into all of its models for Certified Alcohol and Other Drug Abuse Counselors.
The 22 training programs in Illinois that will be implementing these models are supportive of
this change.
A recently developed certificate for people who are employed in support positions for alcohol and
drug abuse treatment programs is based on The Competencies. This credential completes a career
path for alcohol and drug abuse treatment professionals in Illinois that will take them from support
staff to master’s level.
31
Addiction Counseling Competencies
B
Members of the National ATTC Curriculum Committee reviewed the bibliography from the
first printing of The Competencies. Following previously established guidelines, the Committee reviewed and linked each reference with a specific transdisciplinary foundation. Primarily
textbooks are referenced in this section; however, such texts are not mutually exclusive of the
practice dimensions.
TF IV. Professional Readiness
Atkinson, D.R., Morten, G., & Sue, D.W. (1997). Counseling American Minorities. New York:
McGraw-Hill.
Bell, P. (2002). Chemical Dependency and the African American: Counseling and Prevention
Strategies (2nd ed.). Center City, MN: Hazelden.
Bepko, C. (Ed.) (1992). Feminism and Addiction. New York: Haworth Press.
Berg, I.K., & Miller, S.D. (1992). Working With the Problem Drinker: A Solution-Focused
Approach. New York: W.W. Norton.
Bissell, L., & Royce, J.E. (1994). Ethics for Addiction Professionals (2nd ed.). Center City, MN:
Hazelden.
Cushner, K., & Brislin, R.W. (1997). Improving Intercultural Interactions—Modules for
Cross-Cultural Training Programs. Thousand Oaks, CA: Sage Publications.
Delgado, M. (Ed.) (1998). Alcohol Use/Abuse Among Latinos: Issues and Examples of Culturally
Competent Services. New York: Haworth Press.
Delgado, M., Segal, B., & Lopex, R. (Eds.) (1999). Conducting Drug Abuse Research With
Minority Populations: Advances and Issues. New York: Haworth Press.
Ettore, E. (1992). Women and Substance Use. New Brunswick, NJ: Rutgers University Press.
Feld, B.C. (1999). Bad Kids: Race and the Transformation of the Juvenile Court. New York:
Oxford University Press.
Gardenswartz, L., & Rowe, A. (1994). The Managing Diversity Survival Guide: A Complete
Collection of Checklists, Activities, and Tips (book and disk). Chicago: Irwin Professional
Publishing.
Gomberg, E.S.L., & Nirenberg, T.D. (Eds.) (1993). Women and Substance Abuse. Norwood, NJ:
Ablex Publishing.
Gordon, J.U. (Ed.) (1994). Managing Multiculturalism in Substance Abuse Services. Thousand
Oaks, CA: Sage Publications.
Hawkins, J.D., & Catalano, R.F. (1992). Communities That Care: Action for Drug Abuse
Prevention. San Francisco: Jossey-Bass.
Heinemann, A. (Ed.) (1993). Substance Abuse and Physical Disability. New York:
Haworth Press.
Herring, R.D. (1999). Counseling Native American Indians and Alaska Natives: Strategies for
Helping Professionals. Thousand Oaks, CA: Sage Publications.
Hogan, J.A., Gabrielson, K.R., et al. (2003). Substance Abuse Prevention: The Intersection of
Science and Practice. Boston: Allyn & Bacon.
32
TF IV. Professional Readiness
Imhof, J. (1991). Countertransference issues in alcoholism and drug addiction. Psychiatric
Annals, 21:292-306.
Ivey, A.E., Simek-Morgan, L., et al. (2001). Theories of Counseling and Psychotherapy:
A Multicultural Perspective (5th ed.). Boston: Allyn & Bacon.
Ja, D., & Aoki, B. (1993). Substance abuse treatment: Cultural barriers in the Asian-American
community. Journal of Psychoactive Drugs, 25(1):61-71.
Jandt, F.E. (Ed.) (2003). Intercultural Communication: A Global Reader. Thousand Oaks, CA:
Sage Publications.
Lipton, H., & Lee, P. (1998). Drugs and the Elderly: Clinical, Social, and Policy Perspectives.
Stanford, CA: Stanford University Press.
Lowinson, J.H., Ruiz, P., et al. (Eds.) (1997). Substance Abuse: A Comprehensive Textbook
(3rd ed.). Baltimore: Lippincott Williams & Wilkins.
Maracle, B. (1994). Crazywater: Native Voices on Addiction and Recovery. New York:
Penguin Books.
Miller, G. (2004). Learning the Language of Addiction Counseling (2nd ed.). Hoboken, NJ:
John Wiley & Sons.
Pagani-Tousignant, C. (1992). Breaking the Rules: Counseling Ethnic Minorities.
Minneapolis, MN: Johnson Institute.
Paniagua, F.A. (2005). Assessing and Treating Culturally Diverse Clients: A Practical Guide
(3rd ed.). Thousand Oaks, CA: Sage Publications.
Paul, J.P., Stall, R., & Bloomfield, K.A. (1991). Gay and alcoholic: Epidemiologic and clinical
issues. Alcohol Health and Research World, 15:151-160.
Pedersen, P.B. (1997). Culture-Centered Counseling Interventions: Striving for Accuracy.
Thousand Oaks, CA: Sage Publications.
Pedersen, P.B. (1997). Decisional Dialogues in a Cultural Context: Structured Exercises.
Thousand Oaks, CA: Sage Publications.
Pedersen, P.B., Draguns, J.G., et al. (Eds.) (2002). Counseling Across Cultures (5th ed.).
Thousand Oaks: Sage Publications.
Perkinson, R.R. (1997). Chemical Dependency Counseling: A Practical Guide. Thousand Oaks,
CA: Sage Publications.
Pope-Davis, D.B., & Coleman, H.L.K. (1997). Multicultural Counseling Competencies,
Assessment, Education and Training, and Supervision. Thousand Oaks, CA: Sage
Publications.
Singelis, T.M. (Ed.) (1998). Teaching About Culture, Ethnicity, and Diversity: Exercises and
Planned Activities. Thousand Oaks, CA: Sage Publications.
Storti, S.A. (1997). Alcohol, Disabilities, and Rehabilitation. San Diego, CA: Singular
Publishing Group.
Sue, D.W., & Sue, D. (2002). Counseling the Culturally Different: Theory and Practice (4th ed.).
New York: John Wiley & Sons.
33
Addiction Counseling Competencies
Trimble, J.E., Bolek, C.S., & Niemcryk, S.J. (Eds.) (1992). Ethnic and Multicultural Drug Abuse:
Perspectives on Current Research. New York: Harrington Park Press.
Weinstein, D.L. (Ed.) (1993). Lesbians and Gay Men: Chemical Dependency Treatment Issues.
New York: Haworth Press.
Williams, R., & Gorski, T.T. (1997). Relapse Prevention Counseling for African Americans:
A Culturally Specific Model. Independence, MO: Herald House/Independence Press.
Williams, R., & Gorski, T.T. (1997). Relapse Warning Signs for African Americans: A Culturally
Specific Model. Independence, MO: Herald House/Independence Press.
34
Section 2:
introduction to tHe PrActice dimensions
T
Professional practice for addiction counselors is based on eight practice
dimensions, each of which is necessary for effective performance of the
counseling role. Several of the practice dimensions are subdivided into
elements. The dimensions identified, along with the competencies that
support them, form the heart of this section of The Competencies.
T
I. Clinical Evaluation
– Screening
– Assessment
Treatment Planning
Referral
IV. Service Coordination
– Implementing the Treatment Plan
– Consulting
– Continuing Assessment and Treatment Planning
V. Counseling
– Individual Counseling
– Group Counseling
– Counseling Families, Couples, and Significant Others
VI. Client, Family, and Community Education
VII. Documentation
VIII. Professional and Ethical Responsibilities
A counselor’s success in carrying out a practice dimension depends on
his or her ability to attain the competencies underlying that component.
Each competency, in turn, depends on its own set of knowledge, skills,
and attitudes. For an addiction counselor to be truly effective, he or she
should possess the knowledge, skills, and attitudes associated with each
competency that are consistent with the counselor’s training and
professional responsibilities.
35
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Practice Dimension I
CLINICAL EVALUATION
37
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uuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuu
Pd i. clinicAl eVAluAtion
E
● Screening
● Assessment
Definition: The systematic approach to screening and assessment of individuals thought to
have a substance use disorder, being considered for admission to addiction-related services,
or presenting in a crisis situation.
Element: Screening
Screening is the process by which the counselor, the client, and available significant others
review the current situation, symptoms, and other available information to determine the most
appropriate initial course of action, given the client’s needs and characteristics and the available
resources within the community.
C
Establish rapport, including management of a crisis situation and
determination of need for additional professional assistance.
Knowledge
S
● Importance and purpose of rapport
● Demonstrating effective verbal and
building.
● Rapport-building methods and issues.
● The range of human emotions and
feelings.
● What constitutes a crisis.
● Steps in crisis prevention and
management.
● Situations and conditions for which
additional professional assistance may
be necessary.
● Available sources of assistance.
nonverbal communication in establishing
rapport.
● Accurately identifying the client’s beliefs
and frame of reference.
● Reflecting the client’s feelings and
message.
● Recognizing and defusing volatile or
dangerous situations.
● Demonstrating empathy, respect,
and genuineness.
Attitudes
● Recognition of personal biases, values,
and beliefs and their effect on communication and the treatment process.
● Willingness to establish rapport.
39
Addiction Counseling Competencies
C
Gather data systematically from the client and other available collateral
sources, using screening instruments and other methods that are sensitive
to age, developmental level, culture, and gender. At a minimum, data
should include current and historic substance use; health, mental health,
and substance-related treatment histories; mental and functional statuses;
and current social, environmental, and/or economic constraints.
Knowledge
S
● Validated screening instruments for
● Administering and scoring screening
substance use and mental status,
including their purpose, application,
and limitations.
● Concepts of reliability and validity as they
apply to screening instruments.
● How to interpret the results of screening.
● How to gather and use information from
collateral sources.
● How age, developmental level, culture,
and gender affect patterns and history of
use.
● How age, developmental level, culture,
and gender affect communication.
instruments.
● Screening for physical and mental health
status.
● Facilitating information sharing and data
collection from a variety of sources.
● Communicating effectively in emotionally
charged situations.
● Writing accurately, concisely, and legibly.
Attitudes
● Appreciation of the value of the datagathering process.
● Client mental status—presenting features
and relationship to substance use
disorders and psychiatric conditions.
● How to apply confidentiality rules and
regulations.
U
In Nebraska, The Competencies is used as a resource for instructors teaching core classes preparing students for State certification. It also is used as supplemental reading for students in these
courses and other continuing education programs sponsored by the Prairielands ATTC.
40
PD I. Clinical Evaluation
C
Screen for psychoactive substance toxicity, intoxication, and withdrawal
symptoms; aggression or danger to others; potential for self-inflicted harm
or suicide; and co-occurring mental disorders.
Knowledge
S
● Symptoms of intoxication, withdrawal,
● Eliciting pertinent information from the
and toxicity for all psychoactive
substances, alone and in interaction with
one another.
● Physical, pharmacological, and
psychological implications of psychoactive
substance use.
● Effects of chronic psychoactive substance
use or intoxication on cognitive abilities.
● Available resources for help with drug
reactions, withdrawal, and violent
behavior.
● When to refer for toxicity screening or
additional professional help.
● Basic concepts of toxicity screening
options, limitations, and legal
implications.
● Toxicology reporting language and the
meaning of toxicology reports.
● Relationship between psychoactive
substance use and violence.
● Basic diagnostic criteria for suicide risk,
client and relevant others.
● Intervening appropriately with a client
who may be intoxicated.
● Assessing suicide and/or violence potential
using an approved risk-assessment tool.
● Assessing risks of abuse and neglect of
children and others.
● Preventing and managing crises in
collaboration with health, mental health,
and public safety professionals.
Attitudes
● Willingness to be respectful toward the
client in his or her presenting state.
● Appreciation of the importance of empathy
in the face of feelings of anger,
hopelessness, or suicidal or violent
thoughts and feelings.
● Appreciation of the importance of legal
and administrative obligations.
danger to others, withdrawal syndromes,
and major psychiatric conditions.
● Mental and physical conditions that mimic
drug intoxication, toxicity, and withdrawal.
● Legal requirements concerning suicide
and violence potential and mandatory
reporting for abuse and neglect.
41
Addiction Counseling Competencies
C
Assist the client in identifying the effect of substance use on his or her
current life problems and the effects of continued harmful use or abuse.
Knowledge
S
● The progression and characteristics of
● Establishing a therapeutic relationship.
● Demonstrating effective communication
substance use disorders.
● The effects of psychoactive substances on
behavior, thinking, feelings, health status,
and relationships.
● Denial and other defense mechanisms in
client resistance.
and interviewing skills.
● Determining and confirming with the
client the effects of substance use on life
problems.
● Assessing client readiness to address
substance use issues.
● Interpreting the client’s perception of his
or her experiences.
Attitudes
● Respect for the client’s perception of his
or her experiences.
C
Determine the client’s readiness for treatment and change as well as the
needs of others involved in the current situation.
Knowledge
S
● Current validated instruments for
● Assessing client readiness for treatment.
● Assessing extrinsic and intrinsic
assessing readiness to change.
●
●
●
●
Treatment options.
Stages of readiness.
Stages-of-change models.
The role of family and significant others
in supporting or hindering change.
motivators.
● Assessing the needs of family members
including children for appropriate levels
of care and providing support;
recommending followup services.
Attitudes
Acceptance of nonreadiness as a stage
of change.
● Appreciation that motivation is not a
prerequisite for treatment.
● Recognition of the importance of the
client’s self-assessment.
42
PD I. Clinical Evaluation
C
Review the treatment options that are appropriate for the client’s needs,
characteristics, goals, and financial resources.
Knowledge
S
● Treatment options and their philosophies
● Eliciting and determining relevant client
● Relationship among client needs, available
● Making appropriate recommendations
and characteristics.
treatment options, and other community
resources.
characteristics, needs, and goals.
for treatment and use of other available
community resources.
● Collaborating with the client to determine
the best course of action.
Attitudes
● Recognition of one’s own treatment biases.
● Appreciation of various treatment
approaches.
● Willingness to link client with a variety
of helping resources.
C
Apply accepted criteria for diagnosis of substance use disorders in making
treatment recommendations.
Knowledge
S
● The continuum of care and the available
● Using current DSM or other accepted
● Current Diagnostic and Statistical
● Using appropriate placement criteria.
● Obtaining information necessary to
range of treatment modalities.
Manual of Mental Disorders (DSM) or
other accepted criteria for substance use
disorders, including strengths and
limitations of such criteria.
● Use of commonly accepted criteria for
client placement into levels of care.
● Multiaxis diagnostic criteria.
diagnostic standards.
develop a diagnostic impression.
Attitudes
● Recognition of personal and professional
limitations of practice, based on
knowledge and training.
● Willingness to base treatment
recommendations on the client’s best
interest and preferences.
43
Addiction Counseling Competencies
U
The Office of Alcoholism and Substance Abuse Services uses the International Certification and Reciprocity Consortium/Alcohol and Other Drug Abuse, Inc.’s examination for Alcohol and Other Drug
Abuse Counselors as the standard of minimum competence for counselors seeking a credential in
New York State. This examination is based on the 12 Core Functions of alcoholism and substance
abuse counselors, which are consistent with the practice dimensions and competencies outlined in
The Competencies.
C
Construct with the client and appropriate others an initial action plan based
on client needs, client preferences, and resources available.
Knowledge
S
● Appropriate content and format of the
● Developing the action plan in collabora-
initial action plan.
● The client’s needs and preferences.
● Available resources for admission or
referral.
tion with the client and appropriate
others.
● Documenting the action plan.
● Contracting with the client concerning
the initial action plan.
Attitudes
● Willingness to work collaboratively with
the client and others.
C
Based on the initial action plan, take specific steps to initiate an admission or
referral and ensure followthrough.
Knowledge
S
●
●
●
●
●
● Communicating clearly and appropriately.
● Networking and advocating with service
Admission and referral protocols.
Resources for referral.
Ethical standards regarding referrals.
Appropriate documentation.
How to apply confidentiality rules and
regulations.
● Clients’ rights to privacy.
providers.
● Negotiating and advocating client admis-
sions to appropriate treatment resources.
● Facilitating client followthrough.
● Documenting accurately and appropriately.
Attitudes
● Willingness to renegotiate.
44
PD I. Clinical Evaluation
U
The Competencies is being used in a series of scale validation studies by Alicia Wendler of the
Mid-America ATTC and Tamera Murdock and Johanna Nilsson of the University of Missouri–Kansas
City to develop the Addiction Counseling Self-Efficacy Scale (ACSES). The 32-item ACSES assesses
addiction counselors’ perceptions of their self-efficacy for addiction counseling skills and includes
five subscales:
● Executing specific addiction counseling skills
● Assessment, treatment planning, and referral skills
● Working with various co-occurring mental disorders
● Group counseling skills
● Basic counseling microskills.
The researchers reported adequate internal consistency of the scale with a sample of 451 addiction
counselors. Preliminary validity evidence for the scale was determined through two exploratory
factor analyses, and the scale was found to be sensitive to counselor experience and degree levels.
45
Addiction Counseling Competencies
Element: Assessment
Assessment is an ongoing process through which the counselor collaborates with the client and
others to gather and interpret information necessary for planning treatment and evaluating
client progress.
C
Select and use a comprehensive assessment process that is sensitive to age,
gender, racial and ethnic culture, and disabilities that includes but is not
limited to:
● History of alcohol and drug use
● Physical health, mental health, and addiction treatment histories
● Family issues
● Work history and career issues
● History of criminality
● Psychological, emotional, and worldview concerns
● Current status of physical health, mental health, and substance use
● Spiritual concerns of the client
● Education and basic life skills
● Socioeconomic characteristics, lifestyle, and current legal status
● Use of community resources
● Treatment readiness
● Level of cognitive and behavioral functioning.
Knowledge
S
● Basic concepts of test validity and
● Selecting and administering appropriate
reliability.
● Current validated assessment instruments
and protocols.
● Appropriate use and limitations of
standardized instruments.
● The range of life areas to be assessed in a
comprehensive assessment.
● How age, developmental level, cognitive
and behavioral functioning, racial and
ethnic culture, gender, and disabilities can
influence the validity and appropriateness
of assessment instruments and interview
protocols.
assessment instruments and protocols
within the counselor’s scope of practice.
● Introducing and explaining the purpose of
assessment.
● Addressing client perceptions and providing appropriate explanations of issues
being discussed.
● Conducting comprehensive assessment
interviews and collecting information from
collateral sources.
Attitudes
● Respect for the limits of assessment
instruments and one’s ability to
interpret them.
● Willingness to refer for additional
specialized assessment.
46
PD I. Clinical Evaluation
C
Analyze and interpret the data to determine treatment recommendations.
Knowledge
S
● Appropriate scoring methodology for
● Scoring assessment tools.
● Interpreting data relevant to the client.
● Using results to identify client needs and
assessment instruments.
● How to analyze and interpret assessment
results.
● The range of available treatment options.
appropriate treatment options.
● Communicating recommendations to the
client and appropriate service providers.
Attitudes
● Respect for the value of assessment in
determining appropriate treatment plans.
C
Seek appropriate supervision and consultation.
Knowledge
S
● The counselor’s role, responsibilities,
● Recognizing the need for review by or
● The limits of the counselor’s training and
● Recognizing when consultation is
● The supervisor’s role and how supervision
● Providing appropriate documentation.
● Communicating oral and written
and scope of practice.
education.
can contribute to quality assurance and
improvement of clinical skills.
● Available consultation services and roles
of consultants.
● The multidisciplinary assessment
assistance from a supervisor.
appropriate.
information clearly.
● Incorporating information from supervision and consultation into assessment
findings.
approach.
Attitudes
● Commitment to professionalism.
● Acceptance of one’s own personal and
professional limitations.
● Willingness to continue learning and
improving clinical skills.
47
Addiction Counseling Competencies
C
Document assessment findings and treatment recommendations.
Knowledge
S
● Agency-specific protocols and procedures.
● Appropriate terminology and
● Providing clear, concise, and legible
abbreviations.
● Legal implications of actions and
documentation.
● How to apply confidentiality rules and
regulations and clients’ rights to privacy.
documentation.
● Incorporating information from various
sources.
● Preparing and clearly presenting, in oral
and written form, assessment findings to
the client and other professionals within
the bounds of confidentiality rules and
regulations.
Attitudes
● Recognition of the value of accurate
documentation.
U
The Competencies has been used as a training standard for the Licensed Chemical Dependency
Counselor credential in Texas. The competencies were infused not only into academic course work,
but also into three levels of supervised work experience. A companion evaluation tool was
developed to monitor mastery of the competencies.
In addition, a number of colleges and universities across Texas have infused the knowledge, skills,
and attitudes from The Competencies into their addiction counseling coursework and curricula.
Many have changed course descriptions, learning outcomes, and course objectives.
48
PD I. Clinical Evaluation
B
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TREATMENT PLANNING
53
Practice Dimension II
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Pd ii. Treatment Planning
Definition: A collaborative process in which professionals and the client develop a written
document that identifies important treatment goals; describes measurable, time-sensitive
action steps toward achieving those goals with expected outcomes; and reflects a verbal
agreement between a counselor and client.
At a minimum an individualized treatment plan addresses the identified substance use
disorder(s), as well as issues related to treatment progress, including relationships with
family and significant others, potential mental conditions, employment, education,
spirituality, health concerns, and social and legal needs.
C
Use relevant assessment information to guide the treatment planning
process.
Knowledge
S
● The role assessment plays in identifying
● Establishing treatment priorities based on
client problems, resources, and barriers
to treatment.
● Stages of change and readiness for
treatment.
● The impact that the client and family
systems have on treatment decisions and
outcomes.
● Other sources of assessment information.
all available assessment data.
● Interpreting assessment information considering the client’s age, developmental
level, treatment readiness, gender, and
racial and ethnic culture.
● Using assessment information to individualize the client’s treatment goals.
Attitudes
● Appreciation of the strengths and limitations
of the assessment data.
● Recognition that assessment is an ongoing
process throughout treatment.
55
Addiction Counseling Competencies
C
Explain assessment findings to the client and significant others.
Knowledge
S
● How to apply confidentiality rules and
● Summarizing and synthesizing assessment
● How to communicate assessment data in
● Translating assessment information into
● Factors affecting the client’s
● Evaluating the client’s comprehension of
● Roles and expectations of significant
● Communicating with the client in a man-
regulations.
understandable terms.
comprehension of assessment data.
others involved in treatment.
results.
treatment goals and objectives.
assessment feedback.
ner that is sensitive to the client’s age,
developmental level, gender, and racial
and ethnic culture.
● Communicating assessment findings to
interested parties within the bounds of
confidentiality rules and regulations and
practice standards.
Attitudes
● Recognition of how biases influence com-
munication of assessment data and results.
● Recognition of the client’s right and need
to understand assessment results.
● Respect for the roles of others.
U
The former Caribbean Basin and Hispanic ATTC in Puerto Rico translated The Competencies into
Spanish and had widely distributed it in Puerto Rico and the mainland. (The translation is posted on the
CBHATTC Web site, http://www.attcnetwork.org/regcenters/productDocs/1/productpdf/Manuales/
TAP21/TAP21.pdf.)
The curriculum of the Substance Abuse Graduate Program of the Universidad Central del Caribe was
based on The Competencies.
The Competencies has been used as a resource for trainers teaching workshops such as Clinical
Skills in Supervision, S.M.A.R.T., Treatment Planning, and Levels of Care in Substance Abuse.
Some community-based organizations have incorporated The Competencies into their inservice
trainings.
The Comisión Certificadora de Profesionales en Substancias Sicoactivas of Puerto Rico (certification
board) incorporated The Competencies into its certifications standards.
The Puerto Rico Drug Control Office used The Competencies to develop the Addiction Prevention
Specialist Licensure standards in Puerto Rico.
56
PD II. Treatment Planning
C
Provide the client and significant others with clarification and additional
information as needed.
Knowledge
S
● Verbal and nonverbal communication
● Eliciting and integrating feedback during
● Methods to elicit feedback from the client
● Working collaboratively with the client and
styles.
and significant others.
the planning process.
significant others.
● Establishing a trusting relationship with
the client and significant others.
Attitudes
● Willingness to communicate interactively
with the client and significant others.
● Openness to client questions and input.
C
Examine treatment options in collaboration with the client and significant
others.
Knowledge
S
● Treatment interventions, client placement
● Presenting the range of treatment options
● Current research findings on various
● Using assessment data to make treatment
● Alternatives to treatment, including no
● Considering the client’s needs and prefer-
criteria, and outside referral options.
treatment models.
treatment.
and settings available.
recommendations.
ences when selecting treatment settings.
● Using the treatment planning process to
foster collaborative relationships with the
client and significant others.
Attitudes
● Willingness to negotiate treatment options
with the client.
● Openness to a variety of approaches.
● Respect for the input of the client and
significant others.
57
Addiction Counseling Competencies
C
Consider the readiness of the client and significant others to participate
in treatment.
Knowledge
S
● Stages-of-change process.
● Methods of tailoring treatment strategies
● Assessing the client’s stage of change.
● Developing strategies to address
to match the client’s motivational level.
ambivalence.
● Eliciting the client’s preferences.
● Promoting the client’s readiness to engage
in treatment.
Attitudes
● Respect for the client’s values, goals, and
readiness to change.
● Recognition and acceptance of behavioral
change as a multistep process.
C
Prioritize the client’s needs in the order they will be addressed in treatment.
Knowledge
S
● Treatment sequencing and the continuum
● Accessing referral resources necessary to
● Hierarchy-of-needs models.
● Holistic view of the client’s biological,
● Using clinical judgment in prioritizing
of care.
psychological, social, and spiritual needs
and resources.
address the client’s needs.
client problems.
● Assessing severity of client problems and
prioritizing appropriately.
Attitudes
● Recognition and acceptance of the client as
an active participant in prioritizing needs.
● Willingness to make referrals to address
the client’s needs.
58
PD II. Treatment Planning
C
Formulate mutually agreed-on and measurable treatment goals and
objectives.
Knowledge
S
● Use of goals and objectives to
● Translating assessment information into
● Treatment needs of diverse populations.
● How to write specific and measurable
● Collaborating with the client to develop
individualize treatment planning.
goal and objective statements.
measurable treatment goal and objective
statements.
specific, measurable, and realistic goals
and objectives.
● Engaging, contracting, and negotiating
mutually agreeable goals with the client.
● Writing goal and objective statements in
terms understandable to the client and
significant others.
Attitudes
● Respect for the client’s choice of treatment
goals.
● Respect for the client’s individual pace
toward achieving goals.
● Acceptance of the client’s readiness to
change.
● Appreciation for incremental achievements
in completing goals.
I
International applications of The Competencies are noteworthy. It was translated for use in the
Czech Republic, Greece, Hungary, and Slovakia. A Spanish translation has been completed.
Committee members have provided consultation on The Competencies in American Samoa,
Bulgaria, the Commonwealth of the Northern Mariana Islands, the Federated States of Micronesia,
Poland, the Republic of the Marshall Islands, the Republic of Palau, Italy, Slovenia, and the Territory
of Guam. The Competencies also is being considered for trainings in Thailand by a Thai delegation
through CSAT. In addition, the Web site created for the original version of The Competencies has
been visited by individuals from 34 countries.
59
Addiction Counseling Competencies
C
Identify appropriate strategies for each treatment goal.
Knowledge
S
● Intervention strategies, onsite services,
● Matching interventions to the client’s
● Client’s interest in various treatment
● Explaining strategies in terms understand-
● Treatment strategies sensitive to diverse
● Identifying and making referrals to outside
and outside referral options.
service options.
populations.
needs and resources.
able to the client and significant others.
resources.
Attitudes
● Recognition that client retention improves
when services are matched to the client’s
needs and resources.
● Appreciation for various treatment
strategies.
C
Coordinate treatment activities and community resources in a manner
consistent with the client’s diagnosis and existing placement criteria.
Knowledge
S
● Treatment strategies and community
● Coordinating treatment activities and
resources.
● Contributions of other professionals and
mutual- or self-help support groups.
● Levels of care and existing placement
criteria.
● The importance of the client’s age,
developmental and educational level,
gender, and racial and ethnic cu…

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