Chapter 13: Addiction Counseling
Chapter Overview
The author summarize theoretical, clinical, and research perspectives in the treatment of substance abuse
problems from a practitioner’s point of view. Treatment approaches are discussed through the use of
theoretical models of addiction and screening, assessments, and diagnosis of substance abuse problems.
Relapse prevention and strategies are discussed for recovery maintenance.
Key Words
Substance Misuse – Using a drug in greater quantities or for reasons other than those prescribed by a
doctor.
Substance Abuse – Continued use of a substance in a manner, amount, or situations despite problems or
negative consequences of such use; using a drug in excess of accepted social standards.
Dependence – Compulsive substance use despite negative consequences.
Tolerance – Individuals are tolerant if they need increasing quantities of drug in order to create the same
effects as the original dose.
Withdrawal – Physiological and psychological symptoms when a dependent person ceases drug use.
Addiction – The out of control use of substances that results in numerous personal, social, occupational,
and familial consequences.
Multiple Choice Questions
1. How many Americans over the age of 12 have used illicit substances currently or in the past month?
a) 15 million.
b) 25 million.
c) 20.1 million.
d) 400 million.
2. Which of the following is NOT one of Nakken’s stages in the development of an addictive personality?
a) internal change.
b) life breakdown.
c) lifestyle change.
d) lifestyle acceptance.
3. Two major criticisms of the disease model include:
a) loss of control and that addiction is a progressive disease.
b) abstinence of one of many goals.
c) it conceptualizes addiction as secondary.
d) both b and c.
4. All of the following are assumptions of the psychological model EXCEPT:
a) it assumes addiction is secondary to psychological problems.
b) psychological problems are at the root of all addiction.
c) it proposes that abstinence is the only goal.
d) treating psychological problems first will help resolve the addiction.
5. The main difference between substance abuse and substance dependence is
a) abuse is long term, dependence is short term.
b) with dependence, people experience consequences and in abuse they do not.
c) dependence is less serious than abuse.
d) using at the level of dependence may include tolerance and withdrawal, whereas these are not
ever present in abuse.
6. Which of the following is NOT part of the CAGE assessment?
a) Have you ever tried to cut down . . .
b) Has anyone ever been annoyed . . .
c) Did you ever want to get back at anyone . . .
d) Have you ever used alcohol to get going in the morning . . .
7. Substance Use Disorders refer to ___________________ and Substance Induced Disorders refer to
___________________________.
a) abuse and dependence . . . intoxication and withdrawal.
b) intoxication and withdrawal . . . abuse and dependence.
c) abuse only . . . dependence only.
d) withdrawal only . . . dependence only.
8. The withdrawal syndrome typically occurs when:
a) A person who abuses substances suddenly stops the drug.
b) A dependent person suddenly stops taking a drug.
c) Only alcohol has been ingested.
d) A poly-substance abuser stops taking at least two out of three substances.
9. Critics of the disease model, including psychologists and philosophers, suggest that the idea of loss of
control in addiction is logically inconsistent. What is meant by this?
a) The intention to use is formed after actual consumption.
b) Cravings and desire, not behaviors, become out of control.
c) Because loss of control happens only after ingesting a substance, the person would have no
craving when sober (or clean).
d) Loss of control is not logically inconsistent.
10. An important advantage of the disease model is that it:
a) provides a complex explanation of addiction, which is needed in the field.
b) provides no commitment to any single goal, which provides clients with more options.
c) removes addiction from the moral realm.
d) removes the psychological variables as possible causes of addiction.
11. Which of the following is the correct sequence of Nakken’s conceptualization of the addictive cycle?
a) pain – feel the need to act out – act out, start to feel better – pain
b) feel the need to act out – act out, feel better — pain
c) act out – pleasure – act out – pleasure – act out – pain
d) there is no such thing as the addictive cycle.
12. According to Zimberg, what is considered the “hidden problem” in addiction?
a) the link between the addict and the self.
b) the link between psychopathology and addiction.
c) the link between the drug of abuse and cognitive states.
d) the link between reinforcement and unconscious wishes.
13. Part of the sociocultural model of addiction suggests that drug problems are the result of:
a) a backlash against the cultural “norm” to get ahead, produce, and be the best.
b) The more one achieves, the more he/she is likely to use substances.
c) The less one achieves, the more he/she is likely to use substances.
d) none of the above.
14. According to Nakken, the “Addict” side of the addictive personality:
a) wants to be alone and works against resolving emotional issues.
b) wants to be social and keep emotional issues to a minimum.
c) wants to emotionally heal, but doesn’t know how.
d) wants to smoke pot all day and play Guitar Hero.
15. What is the main difference between relapse prevention and relapse management?
a) relapse prevention involves planning for lapses, and relapse management involves teaching skills
when a lapse already occurs.
b) they are the same thing.
c) relapse prevention has less empirical support than relapse management.
d) none of the above.
Activities
1. Engage in an abstinence contract for a specified period of time (as outlined in the pedagogical activity
listed above), and attempt to work through the 12 steps of Alcoholics Anonymous (or Narcotics
Anonymous) related to your forbidden substance, food, behavior, etc. Document your experiences
through each of the 12 steps. That is, list the respective step you are working on, and the struggles,
successes, surprises, etc. that accompanied you while trying to successfully achieve each step. How far
did you get? What did you like/dislike about this process, and the 12 steps? Would you recommend self-
help groups to your clients?
2. A group of peers select a narrative (a movie) from the list below and discuss and debate (a) background
information on the client’s life and how the substance addiction began, (b) what a substance use
assessment of the presenting concern would look like, (c) the needs/defense mechanisms the client uses,
(d) a description of co-occurring disorders and how these impact the addiction, followed by likely
substance abuse diagnoses, and (g) what a relapse prevention plan would look like.
Films
• Requiem for a Dream
• Midnight Cowboy
• Blow
• Life with Judy Garland: Me & My Shadows
• Leaving Las Vegas
• When a Man Loves a Woman
• The Doors
• The Lost Weekend
• Pollock
• Written in the Wind
• Lenny
• Affliction
• 28 Days
• Clean & Sober
• Spun
• Another Day in Paradise
• Drunks
• Quitting
• Traffic
3. Interview a substance abuse counselor in your community, and then meet together as a group to share
your experiences. Questions to consider asking might be:
• What model of addiction do you “subscribe to”?
• What has been your most successful work with clients?
• What have you learned about being a substance abuse counselor? What wisdom would you share?
• What might happen in a “typical session” with a client?
Feel free to ask any other question that you feel important to ask. Process your experiences with a small
group of students. What surprised you? What disappointed you? What did you learn that you can take
with you?
Discussion Questions
1. Discuss the concept of the disease (or medical model). Do you agree that substance addiction is a
disease? Why or why not?
2. If you were to counsel someone in stage three of Nakken’s addictive personality model, what might be
some interventions you would use? What is the key problem in this stage?
3. Create three interventions that you could use to help a client manage a relapse, using Marlatt and
Gordon’s model as your guide. At what point would you intervene and what would you do?
Multiple Choice Questions – Answer Key