Graduate Program in Counseling COUN 6303 Substance Abuse Counseling

Transcription

1 1 Graduate Program in Counseling COUN 6303 Substance Abuse Counseling Graduate Studies in Counseling Instructor: Brooke Foxworthy, PhD, LPC-MHSP Office Hours: Available by appointment Class Location: Ezell, Room 205 Credit Hours: 3.0 Required Texts: Brooks, F. & McHenry, B. (2015). A Contemporary Approach to Substance Use Disorders and Addiction Counseling (2 nd ed.) Alexandria, VA: American Counseling Association. Supplemental Readings: Additional readings, including journal articles, book chapters, and first-person accounts of counseling and substance abuse are posted in the weekly Blackboard modules. These are listed below, and also noted in the Course Schedule. Me and My Girls, from The New York Times, July 20, 2008, by David Carr. The Compulsion to Repeat the Trauma, journal article from Psychiatric Clinics of North America, 1989, Bessel van der Kolk, Course Description: This is a course for preparing students to work with substance abuse clients, and to be able to refer clients to appropriate treatment. Theories of addiction counseling and application of these theories will comprise a significant part of this course, specifically with how they apply to work with individuals, couples, families, and groups. Co-occurring disorders, such as process addictions and mental illnesses will also be addressed. Students will develop conceptual knowledge, practical skills, and self-awareness concerning the etiology of addiction, assessment strategies, counselor self-care and preventing clinician burnout, and diagnosis and treatment planning. This will be accomplished through assigned readings, class discussions, videotapes, lectures, case presentations, guest speakers, and student assignments. Course Format: This course utilizes a hybrid format, including class meetings, online work, and community engagement. Course Objectives:

2 GOALS OBJECTIVES LEARNING ACTIVITIES ASSESSMENT CMHC.C.4. Knows the disease concept and etiology of addiction and co-occurring disorders Q and A; Assigned Reading; PowerPoint Midterm Exam; Final Exam CMHC.A.6. Recognizes the potential for substance use disorders to mimic and coexist with a variety of medical and psychological disorders PowerPoint; Message Board Conversations; Case Analysis Midterm Exam; Message Board Conversations; Final Exam CMHC.K.3. Knows the impact of co-occurring disorders on medical and psychological disorders CMHC.G.4. Identifies standard screening and assessment instruments for substance use disorders and process addictions CMHC.H.4 Applies the assessment of a client s stage of change, dependence, or recovery to determine appropriate treatment modality and placement within the continuum of care CMHC.E.3. CORE 11.G.5.E. Understands current literature that outlines theories, approaches, strategies, and techniques shown to be effective when working with specific populations of clients with mental and emotional disorders, i.e., clients who abuse substances A systems perspective that provides an understanding of family and other systems theories and major models of family and related interventions CMHC.D.2. Applies multicultural competencies to clinical mental health counseling involving case conceptualization, diagnosis, treatment, referral, and prevention of mental and emotional disorders, i.e., substance abuse disorders Q and A; PowerPoint; Assigned Reading; Case Studies (small group format) PowerPoint; Assigned Reading; Case Studies (small group format) Guest Speaker; Assigned Reading; PowerPoint; Case Studies (small group format); Abstinence Exercise; 12-Step Meeting Attendance PowerPoint; Assigned Reading; Message Board Conversations Guest Speaker; Al-Anon, ACOA, or Alateen Meeting Attendance; Assigned Reading Case Studies (small group format); Assigned Readings Midterm Exam; Final Exam 2 Case Analysis; Midterm Exam Case Analysis; 12-Step Meeting Reflection Paper; Abstinence Summary Paper; Midterm Exam; Final Exam Case Analysis; Message Board Conversations; Midterm Exam; Final Exam Al-Anon, ACOA, or Alateen Meeting Reflection Paper; Case Analysis Case Analysis; Interview Paper; Midterm Exam; Final Exam; Addiction Paper Class Expectations: Students are expected to: 1. Attend and be on time for all class sessions. Any student who misses more than 2 class sessions will be dropped from the course with a grade of F. 2. Complete all assignments by the due date. a. Assignments are to be submitted electronically as Word documents via . b. The professor is very willing to negotiate delayed due dates for assignments when personal circumstances arise. It is the student s responsibility to contact the professor to arrange alternative due dates. c. If an alternative due date has not been arranged with the professor prior to the date/time an assignment is due, 1.5 points/day may be deducted from the grade.

3 3 d. The professor will insert comments in all assignments as part of the grading process. Assignments will be ed back to the student with the grade and comments. The student must open the document to view the comments. 3. Have the Blackboard readings and case studies accessible during class, either electronically or hard copy. 4. Check and announcements on Blackboard on a regular basis to receive updates from the professor. 5. Utilize scientific and clinical language in writing assignments. Papers utilizing colloquial language will be returned for resubmission using appropriate, graduate-level language. Academic Integrity Policy: Students are expected to adhere to Lipscomb s Academic Integrity Policy. All integrity violations are reported in writing to the Academic Integrity Counsel. For clarification, refer to the policy: Class Schedule Disruption Policy Except in the rarest of instances, Lipscomb University does not cancel classes or close offices. However, should an event (weather-related or otherwise) occur that requires disruption of the entire Lipscomb University class schedule, students will be notified via multiple venues including the Lipscomb homepage ( a text message sent through LU ALERT ( and the Lipscomb Weather Information Line ( ). For information on possible snow-related closures or late starts, students should consult local television stations (2-WKRN, 4-WSMV, 5- WTVF and 6-WZTV, and Channel 9 on campus). Students should look for information regarding Lipscomb University, not David Lipscomb Campus Schools. Student s Responsibility for Notification of Extended Absence In the case of individual absences, students should contact their professors directly. However, students who find themselves in circumstances which would cause them to miss classes for an extended period of time (e.g., missing a week or more of classes due to illness) should contact Steve Prewitt, Associate Provost for Student Academic Support, (steve.prewitt@lipscomb.edu; ). The Associate Provost for Student Academic Support will communicate the student s situation to the appropriate faculty members. Students are expected to provide timely notification to the Associate Provost for Student Academic Support regarding any extended absence and may be required to provide supporting documentation for their absences. Grades: There are a total of 500 points possible in the course. Grades will be stored on Blackboard where you will be able to keep track of them. Your final grade will be based on the number of points accumulated. All assignments must be submitted by the due date/time, and are to be submitted electronically. Following is a breakdown of points and the grading scale: Abstinence Exercise Case Analysis Message Board Conversations Midterm Interview Reflection Paper Group Project Final Exam 150 points 60 points 20 points 80 points 70 points 40 points 80 points A = 90% of points or better (450pts or greater) B = % of points or better ( pts)

4 C = % of points or better ( pts) F = less than 70% of points (350pts or lower) 4 1. Abstinence Exercise and Paper (150pts. Total) This exercise is designed to help you experience some of the feelings/thoughts that addicted individuals experience when they quit their drug or behavior of choice. You will be asked to enter into an abstinence contract with yourself wherein you will be asked to abstain from a particular food, substance, behavior, activity, etc. of your choosing, one of which has some value to you (i.e., it would be difficult to give up). This exercise requires that you give up a substance (e.g., nicotine, caffeine, or alcohol) or a behavior (e.g., Internet use, eating sweets, social media, playing video/computer games, watching television, cell-phone usage) for a period of 12 weeks (see dates at the end of this syllabus). A written contract containing your name and the item from which you have chosen to abstain (form will be provided during the first class) is due to the instructor by the second week of the semester. Students will meet periodically in small in-class groups to process their experiences honoring (or not honoring) their abstinence contracts. As part of this assignment, each student will choose a sponsor from class who he/she can confide in should he/she should have difficulties remaining abstinent. Sponsors can be available outside of class; however, it is up to the sponsor to make the determination of providing contact information. During this assignment you will (a) write an introductory letter to your substance/behavior, (b) attend two support group meetings, and (c) write a summary paper, which will serve as the conclusion to the 8-week exercise. This assignment will have the following components: (a) A Letter to my Substance/Behavior written in the first person to the substance/behavior from which you are abstaining, will be due before the abstinence period begins (the content for this letter can be found toward the end of the syllabus) Due May 25 (b) Support Group Meetings - As part of your class experience, you are required to attend two different Open and live support group meetings. You may attend any of the below groups or any other support group approved by the professor. Note: All meetings are "closed meetings" (exclusively for those that are addicted) unless O (open) is indicated next to the meeting location found in the directory. Only attend Open meetings unless you meet the necessary criteria (if you are in recovery it is preferred that you attend meetings outside of your normal area. Ex: if you normally attend AA then attend CA, NA or Alanon.) (c) A summary paper This is to be a minimum 3-4 page paper describing the abstinence experience (e.g., did you succeed or fail, what influenced you, what was the process like for you, etc.) and will serve as the conclusion to your overall experience. The paper should include, but is not limited to the following: 1. Physiological, cognitive & emotional experiences during the 8 weeks 2. Behavioral, cognitive and emotional triggers for cravings 3. Defense mechanisms that arose such as denial, minimization, projection & rationalization 4. Your experience of slips or relapse 5. The stage of change you were in at the beginning of your abstinence & the one you were in at the end of the 8 weeks 6. Your experiences in attending support group meetings 7. Overall thoughts & feelings about support group meetings 8. How this experience affects your views of individuals struggling with substance abuse & chemical dependency Due July 2

5 Al-Anon: Alcoholics Anonymous: Celebrate Recovery: Codependents Anonymous: Emotions Anonymous Gamblers Anonymous: Nar-Anon: Narcotics Anonymous: Overeaters Anonymous: Rational Recovery: Sex Addicts Anonymous: Sexaholics Anonymous: SMART Recovery: Case Analysis (60pts.) A case study will be presented via Blackboard. The case is also available on page 10 of this Syllabus. Students will submit a written analysis of the case, to include the following Discussion of assessment data provided Identification of additional data needed by the counselor to plan treatment for the client, including use of any standardized screening measures that will be used Discussion of differential diagnosis: identify the diagnoses that are confirmed and the diagnoses that must be ruled out Identification of stage of change and defenses used by the client, with rationale provided Identification of 3 short-term goals for the client Identification of 3 long-term goals for the client Detailed and specific treatment plan for the client Discussion of ethical and cultural issues that may influence counseling of the client Discussion of potential countertransference issues that might arise if the student were to counsel this client Material from class discussions, readings, guest speakers, and handouts should be utilized to support the analysis. A reference list must be included. (3-5 pages) Due June Message Board Conversations (2 at 10 points each = 20 points) For two supplementary readings posted on Blackboard, discussion threads are posted. One student will begin the online conversation by writing a short response (length words) responding to the Professor s question/statement. All other students should read the thread and all posts that have been written previously and submit their comments via a word post to contribute to the conversation. Posts should not represent a disconnected essay, but rather should reflect a thoughtful and engaged reflection on the thread and subsequent posts. Grades are based on comments being the appropriate length of words, comments making contributions to the conversation, and showing critical thinking/synthesis of the material. Scores on late posts will be reduced by 1 point so that 90% is the highest score that can be received. Conversation # 1 o o Initial post due by Friday, June midnight Second post due by Friday, June midnight Conversation # 2 o o Initial post due by Friday, July midnight Second post due by Friday, July midnight 5. Midterm examination (80pts.)

6 The midterm examination will consist of multiple choice, short answer and essay questions. Items will be developed from class discussion, material from the texts, guest speakers, and handouts. The exam will be provided via Blackboard during the week of June 13. Exam will due by Wednesday, June midnight 6 6. Interview Reflection Paper: (70 points) Choose one of the following: Interview with substance abuse counselor/director: Visit one community agency/clinic that offers substance abuse counseling & interview a counselor or director. Document the interview with a 2-3 page reflection paper including your experience as well as the information you gathered during the interview. The following questions may be used as a guide: 1. What type (model) of substance abuse counseling services do you offer/use? 2. Who is served by the agency (primary population)? 3. How are clients referred to the agency? 4. What is the average length of stay at the agency? 5. How is the agency organized, funded, managed, etc.? 6. In what ways do the clients serve as client advocates? (referrals, legal issues, etc.) 7. What are the ethical issues that you are most concerned with? 8. What, if any, legal issues are you most concerned with? OR Interview with individual in recovery: Students will select an individual who is in recovery from substance abuse or chemical dependency. Document the interview with a 2-3 page reflection paper including your experience as well as the information you gathered during the interview. For confidentiality & anonymity purposes please do not use the real name of this individual. The following questions may be used as a guide: 1. What was your use history (drugs of choice, length of use, etc.) 2. How many times have you attempted to stop using in the past? 3. How did your previous attempts impact future attempts? 4. What steps did you take to become sober? (inpatient treatment, outpatient treatment, etc.) 5. Have you relapsed & if so how did you deal with this? 6. What seems most helpful to you now as a means of staying sober? 7. What type of support system do you have now compared to when you were using? 8. How were you impacted by your abuse? What areas were most affected? (work, relationships, legal, financial, spirituality, self-esteem, etc.) 9. What was most helpful in recognizing you needed outside assistance to help you stop using? Due July 6 7. Audio/Visual Collage / Mix Group Project (40pts.) As a group, students will present a minute visual collage of ads, articles, and images pertaining to alcoholism and other drug abuse. Alternatively, students may record (on an audiotape or CD) clips of popular songs in their chosen format (country, metal, classic rock, hiphop, top 40, etc.) containing lyrics that refer to alcohol and other drug use and present to the class. The songs may be limited to current or recent recordings. Or, students may choose to record an anthology of tunes within a category. In class, we will discuss the accuracies and inaccuracies of these messages or recordings. We will also examine how the music industry and other media sources promote and glamorize AODA in various ways. Presentations will be on August 3 8. Final Exam (80 points) Due Aug 3 by midnight (NO LATE SUBMISSIONS FOR THIS ASSIGNMENT) o Exam will be posted 2 weeks prior to due date Schedule of Events:

7 7 May 18 - Class Meeting, 4:00 6:40 pm Topics: Introductions Course Overview Discussion of Assignments Chapter 1: Intro to Substance Abuse May 25 - Class Meeting, 4:00 6:40 pm Chapter 2: Diversity Issues in Substance Abuse Treatment Abstinence Contracts Due Letter to Substance due June 1- Class Meeting, 4:00 6:40 pm Chapter 3: Types of Drugs & Their Effects Read Me and My Girls (posted on Bb) o Read and respond online to Professor s thread on this article (Conversation # 1) Initial post must be made by Friday, June midnight June 8 - Class Meeting, 4:00 6:40 pm Chapter 4: Assessment, diagnosis & Interview Techniques Chapter 5: Continuum of Nonuse to Addiction June 15 - Class Meeting, 4:00 6:40 pm Chapter 6: Treatment & Treatment Settings Chapter 7: Developmental Approaches in Treating Addiction Second post to Conversation #1 due Friday, June midnight Case Analysis Due June 22 Class Meeting 4:00 6:40 pm Chapter 8: Family Issues in Addiction Midterm due next Wednesday, June midnight June 29 - Class Meeting, 4:00 6:40 pm Chapter 9: Grief & Loss in Addiction o Guest Speaker Midterm midnight July 6 - Class Meeting, 4:00 6:40 pm Chapter 10: Group Counseling & Addiction Interview Reflection Paper Due July 13 - Class Meeting, 4:00 6:40 pm Chapter 11: Relapse Prevention & Recovery o Guest Speaker Read The Compulsion to Repeat the Trauma o Read and respond online to Professor s thread on this article (Conversation # 2) Initial post must be made by Friday, July midnight July 20 - Class Meeting, 4:00 6:40 pm Chapter 12: Spirituality & Support Groups in Recovery

8 Abstinence Experience Summary Paper Due Final Exam posted (not due until August 3) 8 July 27 - Class Meeting, 4:00 6:40 pm Chapter 13: Addictions Training, Certification & Ethics Chapter 14: The Importance of Self Care Second post to Conversation #2 due Friday, July midnight August 3 - Class Meeting, 4:00 6:40 pm Group Presentations Final Exam Due by midnight (no late submissions allowed) Helpful Websites: Substance Abuse and Mental Health Services Administration This is the federal agency that provides clinical and research information on substance abuse and mental illness. There are many publications that can be downloaded (or ordered) for free. Many of these are also available in Spanish. Mental Health America This is a national non-profit dedicated to helping live mentally healthy lives. They have a 24-hour confidential Crisis Line and a free . They also have downloadable client and family education pamphlets. Alcoholics Anonymous This is the client-based self-help group that has been in operation for over 75 years for persons struggling with alcoholism or other chemical addictions. Narcotics Anonymous This is the client-based self-help group that has been in operation for over 60 years for persons struggling with chemical addictions Step Empowerment Model This is a model based on the work of Charlotte Kasl and provides a holistic approach to overcoming addiction. This model views persons with a substance abuse disorder in their wholeness mind, body, spirit, and is thought to be more flexible than traditional 12-step models. Celebrate Recovery This is the client-based self-help group for persons struggling with any addiction. This organization uses principles similar to traditional 12-step approaches, but is a Christ-centered group.

9 9 Letter to my Substance/Behavior This 1 2 page (minimum) paper is to be written to the substance or behavior from which you are abstaining. This is to be written in the first person (e.g., caffeine, you have always been there for me in the morning ) and should cover the following 5 areas: 1) How my addictive substance/behavior is loved and is considered a friend 2) How my addictive substance/behavior is sensual (appeals to my senses) 3) How my addictive substance/behavior provides healing or is a balm to my emotional wounds 4) How my addictive substance/behavior controls and promotes my feelings of helplessness and entrapment 5) Why my addictive substance/behavior is hated what consequences have a I faced as a result of this substance/behavior

10 Case Analysis 10 Instructions Address the following points as you analyze the following case: Discussion of assessment data provided Identification of additional data needed by the counselor to plan treatment for the client, including use of any standardized screening measures that will be used Discussion of differential diagnosis: identify the diagnoses that are confirmed and the diagnoses that must be ruled out Identification of stage of change and defenses used by the client, with rationale provided Identification of 3 short-term goals for the client Identification of 3 long-term goals for the client Detailed and specific treatment plan for the client Discussion of ethical and cultural issues that may influence counseling of the client Discussion of potential countertransference issues that might arise if the student were to counsel this client Material from class discussions, readings, guest speakers, and handouts should be utilized to support the analysis. A reference list must be included. (5 pages) Due Wednesday, June 5:00 pm Presenting Information John is a 55-year old Caucasian accountant who made an appointment with you for a second opinion. He appears severely depressed to you (neurovegetative symptoms, disheveled appearance, tearful), but minimizes any distress related to depression. My big problem, he says, is that I m in danger of losing my job at the accounting firm. John says that he has been drinking heavily for years, but that prior to this time it has gone unnoticed by his employer. He says that his employer has given him an ultimatum: either get help from the firm s employee assistance program (EAP), or get out. John says that he has dried out several times and returned to drinking; therefore he feels it may be pointless to try again. He also states that the Alcoholics Anonymous model has been beneficial to him in the past in maintaining his sobriety, but that as he has become more hopeless over the past several months, he has also begun to doubt God s existence. So, the 12-step guys would probably turn me away. He goes on to say that he would like for you to write his employer a note saying that you don t believe he is an alcoholic, and thus does not need treatment at the EAP. He promises to cut down on his drinking, and to stop drinking completely when his divorce is finalized. John appears sober at today s session with you. Social History John is currently involved is a mediated divorce proceeding from his wife of 33 years. He says that he doesn t blame his wife for wanting the divorce, but that he still loves her. He is very tearful when he recounts the pain he has put his family through because of his drinking. John reports that he doesn t have any close friends: the bottle is all I can depend on, John says. Family History John and his wife have no children. He reports that his father was a heavy drinker. John says that he wished he could hold his liquor like a man. I can t even drink like a man. John says that his sister has also given up on him, and says that she would like to have a relationship with him, but only if he gets treatment for the drinking. Physical/Medical Considerations John is thin in appearance, and says it is worthless to have a medical workup. All the doctors do is lecture you on why drinking is bad for your health. They don t understand what it s like to not be able to stop.