Discussion Questions
Chapter 1: The First Contact
1. According to the Centers for Disease Control and Prevention (2010) “one in four Americans die as a
direct result of substance abuse.” Do you believe our health care system has adequately addressed the
issues of addiction? How can these numbers be improved? What do these statistics say about the
addictions as a national health care priority?
2. The author describes the need for healers to be honest with their clients. Describe an area of personal
difficulty you might struggle with as you engage your client in a “life or death battle with the truth.”
3. What is the difference between screening and assessment for substance abuse? What are some
things you might consider in assessing a client’s substance abuse?
4. Think of examples of your own experience with each of the motivational stages during at various
times your life. The example does not necessarily need to involve substance abuse. Think about times in
your life when you have tried to make a change. List one example for each stage: precontemplation,
contemplation, preparation, action, and maintenance. What barriers did you experience that made
moving from one stage to another difficult? What was helpful to you as you moved from one stage to
the next? What implications does this have for your counseling practice?
5. In this chapter, you were provided with an example of a motivational interview. Review the interview
and identify the specific skills used by the professional as he or she directed the motivational interview.
What qualities did the professional possess that allowed him or her to develop the therapeutic alliance?
What strategies did the professional employ that assisted the client in his or her move from
precontemplation to contemplation?
6. Treatment works for both individuals, their families, and even society as a whole. The book indicates
that an investment of $1 in addictions treatment will result in a savings of $7 in health care and other
societal costs. List some specific examples of where these societal savings would be. With such a large
cost-benefit ratio (1:7), why do we not invest more into addictions treatment?