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Posted: January 31st, 2023

Substance Use Disorders:

Substance Use Disorders:
Assessment and Intervention

Fall 2022

COURSE DESCRIPTION
This course is designed to teach methods for assessment, diagnosis, intervention, and treatment of the person with substance use disorders in social service, mental health, medical, rehabilitative, and specialized substance abuse settings. It is directed to clinicians who work with (1) individuals with early stage problems, (2) individuals with more serious problems who do not acknowledge the problem or its severity, (3) people with diagnosed substance use disorders, and (4) family members who seek assistance with loved ones with substance use problems..
The course provides guidelines for routine screening of clients, taking a detailed drinking/drug history, working through ambivalence about change and increasing motivation, examining family dynamics, and treatment planning and implementation. Teaching methods are varied and include lecture, discussion of readings, case consultation, classroom exercises, and video. The course will lean very heavily on Motivational Interviewing as the cornerstone of any SUD treatment.
The course builds on CP 770: Clinical Practice with Individuals and CP 772: Clinical Practice with Families, in teaching approaches such as, Stages of Readiness for Change (trans-theoretical model), Motivational Interviewing (based on Carl Rogers), relapse prevention (based on CBT), utilizing 12-Step Programs, and working with family systems dynamics. It also addresses the following social work competencies:
1 )Demonstrate ethical and professional behavior
2) Engage diversity and difference in practice
4) Engage in Practice-informed Research and Research-informed Practice
6) Engage with Individuals, Families and Groups
7) Assess Individuals, Families and Groups
8) Intervene with Individual, Families and Groups
Social Work Competencies

COURSE OBJECTIVES
By the end of the course, students will be able to:
1. Write a page paper – Describe a range of attitudinal barriers clinicians experience in themselves and their settings when they encounter AOD-involved clients.
2. Write a page paper – Describe the progression of Substance Use Disorders (SUD)from mild to severe and the symptoms that characterize the client’s thinking and behavior at different severity ratings..
3. Explain criteria and methods for assigning a DSM-5 diagnosis.
4. Explain the physical and behavioral effects of drugs in major drug categories including the effects of poly-drug use.
5. Conduct SUD assessments including: (a) brief, routine screening questions (e.g., quantity/frequency, CAGE); (b) a psychosocial history examining risk factors, (c) an intensive history of symptoms and progression of use, and (d) questions for the presence of co-occurring psychiatric disorders.
6. Provide feedback to clients on their pattern of use and the implications, and negotiate treatment goals (e.g., reduced use, abstinence, harm reduction).
7. Write a page paper – Describe the content of the Stages of Readiness for Change model and its relevance to working with people with an SUD..
8. Write a page paper – Describe the goals and methods of major treatment approaches highlighted in the course (e.g., Motivational Interviewing, Relapse Prevention, utilizing 12-Step Programs, and working with the family).
9. Explain the influence of culture on the client’s and family’s substance use, willingness to seek treatment, and preferred treatment methods, and ways clinicians can adapt treatment to meet the needs of racially/ethnically/culturally diverse clients.
10. Understand the role of discrimination and oppression as contributing to (a) the development of SUDs, (b) “resistance” to help seeking, and (c) over-representation of the poor and racial and ethnic minorities in the criminal justice and child welfare systems.
11. Demonstrate clinical skills from one or more of the assessment and treatment approaches highlighted in the course (e.g., Stages of Readiness for Change, Motivational Interviewing, reducing barriers to 12-step Program participation, Relapse Prevention, family education and intervention).
12. Name at least three evidence-based treatment practices commonly used in the treatment of SUDs (other than the major approaches taught in the course), describe their general characteristics, and provide examples of settings and populations with whom they are used.
13. Identify ways that urban environments may perpetuate the development of an SUD or may offer avenues for recovery not available in other environments.

TEXTS & READINGS
Required Text:
Washton, Arnold, & Zweben, Joan (2006). Treating alcohol and drug problems in psychotherapy practice: Doing what works. New York: The Guilford Press.

Required Readings:

Journal articles (approximately 30) are available through Mugar Library’s Electronic Reserve system. Book chapters and some articles (approximately 10) are available on Blackboard.

Recommended Texts for Future Reading:

Brown, Stephanie. (Ed.)(1995). Treating alcoholism. San Francisco: Jossey Bass.
(Now more than 15 years’ old, but continues to have practical advice for working with SUD clients.)

Doweiko, Harold E. (2009). Concepts of chemical dependency, Seventh Edition, Australia: Brooks/Cole. (A resource book with scientific evidence that supports major SUD treatment methods.)

Frances, R. J. J., Miller, S. I., & Mack, AH. (Eds.) (2005). Clinical textbook of addictive disorders, Third Edition, New York: The Guilford Press. (Very good chapters on treatment methods, e.g., CBT, DBT, Family-based treatment).

Marlatt, G. A., Larimer, M.E., & Witkiewitz, K. (2012). Harm reduction: Pragmatic strategies for managing high risk behaviors. New York: The Guilford Press. (Covers harm reduction approaches for a range of drugs and a range of racial/ethnic populations.)

Miller, W. R., Florcehimes, A. A., & Zweben, A. (2011). Treating addiction: A guide for professionals. New York: The Guilford Press. (A good general coverage of a range of SUD issues.)

Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change. Third Edition, New York: The Guilford Press. (Most recent publication on Motivational Interviewing theory and practice. From my experience, this is an important book to own.)

Wallace, B. C. (2005). Making mandated addiction treatment work. Lanham: Jason Aronson. (Excellent resource on mandated SUD clients.)

Link to e-reserves:

Course Materials (Reserves)


then type in “CP 809”

COURSE OUTLINE
September 9, 2022: Session 1
o Introduction to course, review of syllabus, overview of text and readings.
o Discuss the process of learning including expectations and responsibilities of instructor and students.
o Student introductions—influences on your views of alcohol and drug issues.
o Introduction to SBIRT requirement
o Why SUD skills are essential
o DSM V (mild, moderate, severe).
o Parameters for examination in assessment:
o Quantity, Frequency, Duration, Consequences, Control.
o Washton & Zweben continuum (p. 24-26)
o Low risk vs. High risk; no risk

o

**Note that first assignment (written report on attending meeting of 12-Step Program) is due in session 4. We’ll talk next week about the assignment..

REQUIRED READING:
o Washton & Zweben, Two chapters: Preface and Introduction–Chapter 1.

September 16, 2022: Session 2
Nature and Course of an SUD; Bio-psycho-social Condition; Spectrum Disorder; Dealing with the here and now in treating SUD clients who are actively using alcohol and other drugs. Controversies and differences of opinions regarding SUDs. Medical disease – brain disease controversy, is the brain disease model racist

o Discuss Assignment 1
o Johann Hari: Everything you think you know about addiction is wrong | TED Talk

REQUIRED READING:
o Washton & Zweben, Chapter 2 (Nature, course and diagnosis)
Volkow, N.D., Koob, G., & McLellan, A.T. (2016). Neurobiologic advances from the brain disease model of addiction. The New England Journal of Medicine, 374(4), 363- 371).
https://doi.org/10.1056/NEJMra151148

o Hart C. Exaggerating Harmful Drug Effects on the Brain is Killing Black People. Neuron. 2020 July 22: 107(2): 215-218
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7328574/

READING HELPFUL FOR 12-Step PROGRAM ASSIGNMENT DUE SESSION 4
o Washton & Zweben, Chapter 13 (self-help participation)
o Washton & Zweben, Chapter 4 (section on self-help involvement)
o Tonigan & Hiller-Sturmhofel (Alcoholics Anonymous: Who Benefits?) Mugar Library
o Caldwell (Fostering client connections with AA: Framework for SW) Mugar
o AA Video for Healthcare professionals (www.AlcoholicsAnonymous.org)
o Any other articles you feel help you to understand the dynamics of the program

September 23, 2022: Session 3
Learning Objectives: Write a page paper – Describe the importance of language in working with individuals who use substances to minimize stigma. Develop an understanding of one’s own feelings and attitudes around substance use and how they may influence your work in the field. View the

SAMHSA video series, Language matters: Talking about addiction and recovery (Parts 1-4). Retrieved from https://www.youtube.com/watch?v=f5e2s8iVRDM


September 30, 2022: Session 4
Assessment: Initiating the discussion of Alcohol/Other Drug Use: questions to ask. Screening –gross measure assessing “Should we be concerned or not?—yes/no”.

SBIRT

Pharmacology and Substances—tolerance, cross-tolerance, dependence. Medical, cognitive, behavioral effects for various drug categories

o Alcohol—“Helping Patients who Drink Too Much”
o Screening, Brief Intervention and Referral to Treatment (SBIRT)
o Drug Categories
• Benzodiazepines and other Sedatives
• Stimulants (e.g., cocaine, methamphetamine)
• Opioids (e.g., heroin, codeine, oxycontin)
• Marijuana
• Hallucinogens
• Club Drugs (e.g., ecstasy, Ketamine, PCP)
• Other

REQUIRED READING:
o Washton & Zweben, Chapter 3 (Pharmacology and psychoactive substances)

READ at least ONE OF THE FOLLOWING:
o Senreich & Vairo (gay, lesbian, bisexual substance abusers) Mugar
o Martell et al. (gay, lesbian, transgender & bisexual) on Blackboard and Mugar
o LGBT Guide, SAMHSA/CSAT: A Provider’s Introduction to SA Treatment for Lesbian, Gay, Bisexual & Transgender Individuals on Blackboard and Mugar

October 7, 2022: Session 5
Assessing Alcohol and Drug Use during Psycho-social Interview
o Conducting an assessment interview: (a) choose a strategy; (b) explore past and current risk factors; (c) take a focused drinking/drug history.
o Review assessment tasks and interviewing guidelines –HANDOUT
o Reviewing examples of standardized questionnaires.

Reports on visits to 12-Step Programs: Therapeutic elements; methods for linking clients to 12-step programs.

REQUIRED READING:
o Barbara Wallace, Chapter 1 (Mandated addiction treatment) Mugar (pp. 3-16).
o Brown, Chapter 2 by Joseph Liftik (Assessment) on Blackboard and Mugar

October 14, 2022: Session 6
Assessment Continued: co-occurring substance use and psychiatric disorders

o Co-occurring disorders—process for verifying whether separate disorders exist
o Examine cases
o Role of medications

REQUIRED READING:
o Washton & Zweben, Chapter 7 (Assessment) (NOTE—THIS IS 35 PAGES)
o Miller, Forcehimes, & Zweben, Chapter 18 (treating co-occurring disorders) Mugar
o Washton & Zweben, Chapter 6 (role of medications)
o Washton & Zweben, Chapter 5 (concurrent psychiatric and substance use disorders)

RECOMMENDED
o Drake & Mueser (Psychosocial approaches to dual diagnosis) OR
o Riggs (Treating adolescents for substance abuse and co-morbid psych disorders) Mugar Reserves

October 21, 2022: Session 7

Influence of culture on view of SUDs, treatment, & recovery–cultural framework; questions for assessing and responding to cultural influences–vignettes

REQUIRED READING
o Amodeo & Jones (Cultural Framework), Mugar Reserves
o Barbara Wallace, Chapter 2 (Multi-problem clients: Characteristics, needs and diversity) Mugar Reserves
o Miller, Forcehimes, & Zweben, Chapter 13 (involving and working with family) Mugar
READ AT LEAST ONE
o O’Dwyer (The Irish and substance abuse) Mugar Library
o Mora (Latinas and alcohol use)
o Gil, Tubman & Wagner (Latino adolescents) Mugar Library

RECOMMENDED READING:
o Wright (African American substance abusers) Mugar Reserves
o Brown, Chapter 9 (Treating the alcoholic couple) Blackboard
 Amodeo, Robb, Peou, Tran (adapting mainstream treatments for Southeast Asians) Mugar Library
o O’Hare & Tran (Southeast Asians)

October 28, 2022: Session 8
Ingredients of Integrated Treatment Approach (assessing Stage of Readiness for Change; Motivational Interviewing, disease model; self-medication, therapeutic traps).

o Discuss final assignment—Need APPROVED topic by Session 11—Nov. 12
o Stages of Readiness for Change Model
– identifying stages and assessing client readiness–quiz
– clinician tasks at each stage to enhance motivation
– Using the Decisional Balance exercise in the Contemplation Stage
– Using “Importance” and “Confidence” Rulers

o Providing feedback to clients; negotiating a plan

REQUIRED READING:
o Washton & Zweben, Chapter 4 (integrated approach)

RECOMMENDED
o Miller & Rollnick, Chapter 1, 2, 3, 4 (what is change) on Blackboard (This is easy reading)
o Miller & Rollnick, Chapter 15 (stages of change) on Blackboard
o McMaster (harm reduction) Mugar Reserves
o Amodeo, Peou, Grigg-Saito et al. (refugees & immigrants) Mugar

November 4, 2022: Session 9
Goal Setting and Treatment Planning: Issues requiring immediate attention; involving significant others: Moderation and Harm Reduction; Managing cravings & urges; Use of “substitute” substances and behaviors.
o Quik Course Evaluation
o Motivational interviewing
– As a philosophy (mindset); comparison with abstinence/disease model and CBT
– Core MI counseling methods: open-questions; affirmations, reflections and Summaries
– 4 principles—express empathy, develop discrepancy, roll with resistance, support self-efficacy (skill practice)
– Video demonstrating MI
o Reminder: decide on final paper topic–communicate it to me by next week.

REQUIRED READING
o Washton & Zweben, Chapter 8: (goal setting and treatment planning)
o Miller, Forcehimes, & Zweben, Chapter 10 (enhancing motivation for change)
o Harm Reduction handouts (Documents will be emailed to you.)

Video: https://www.bing.com/videos/search?q=youtube+Motivational+interviewing++rounder&docid=608012350993562509&mid=B5D4D6DE8D824DF33C37B5D4D6DE8D824DF33C37&view=detail&FORM=VIRE

RECOMMENDED
o Washton & Zweben, Chapter 9 (taking action)
o Andrasik, Michelle Peake; Briana Woods (Harm reduction for African Americans) OR
o Blume, A. W., Michelle R. Resor (harm reduction among Hispanic/Latino

November 11, 2022: Session 10
Preventing Relapse: psycho-education, cognitive and behavioral methods, family issues;
o Quik course evaluation
o Relapse prevention methods: what is a relapse? identifying triggers, refusal skills, handling Post-acute Withdrawal, maintaining coping logs

Trauma-informed substance abuse treatment; integrating trauma treatment

REQUIRED READING:
o Washton & Zweben, Chapter 10 (preventing relapse)
o Najavits (Managing trauma reactions) on Blackboard or Mugar
o Finklestein (Integrating trauma treatment) on Blackboard or Mugar

RECOMMENDED READING:
o Amaro et al. (integrated trauma treatment with diverse clients) on Blackboard

ASSIGNMENTS
Assignment #3, you will again demonstrate your competency in critical thinking and professional role and identity in researching an evidence-based treatment method, critiquing the science behind it, and applying the method with a client, and reflecting on how you would adapt the method based on client needs.

COURSE GRADING CRITERIA & REQUIREMENTS
For 3 Credits: 4 grades on the following (See detailed description of each assignment on the following pages):
(1) Class participation demonstrating mastery of major concepts and skills from readings and class sessions and ability to apply them to clinical situations. [10% of final grade]
(2) Written report on visit to 12-Step Program {25%]
(3) Psychosocial assessment with drinking/drug questions [25%]
(4) Final Paper: Application of treatment method [25%]
(5) SBIRT Statement of Completion forwarded by email to the instructor by Class 9. [15%]

Assignment #3:
Group Presentation – Evidence-based Treatment Method:
Description of Method, Quality of Evidence for Effectiveness,
and Application to Client Situation

Choose a topic with your group and discuss it with me. This is an opportunity to learn about an approach of specific interest to the group, or one that could help the kinds of clients seen in internship settings, or those clients you expect to encounter in your professional career.

The presentations will be 30 minutes long. Be sure that the work necessary for the assignment is broken up equally among members. The grade will be for the quality of the group presentation.

This modality should be an evidence-based practice (EBP) (see the website established by the Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Registry of Evidence-based Programs and Practices (NREPP), or The Cochrane Collaboration or any other sites such as APA that have approved lists of EBPs). All new federal funding for substance abuse services requires that the programs and practices have strong research evidence for efficacy. Choose a topic below or one that is not here but is suitable for substance-abusing clients of interest: adolescents, a particular cultural group, dually or multiply-diagnosed clients, special populations (e.g., injection drug users, homeless).
Treatments/Interventions (I’m glad to consider other topics as well—see me if your area of interest is not on this list)
 Cognitive- behavioral therapy
 Dialectical behavioral therapy
 Interventions for mandated clients/Treatments for criminal justice populations
 Family intervention—choose a specific model (not taught in CP 772) (e.g., Behavioral Couples Therapy; Adolescent Community Reinforcement Approach A-CRA)
 Motivational interviewing (move beyond basic material discussed in class; choose specific aspect to cover in depth)
 Relapse prevention –choose a specific model or author
 Trauma work –choose a specific model or author (e.g., Seeking Safety)
 Working with dually diagnosed clients using an “integrated” model such as Integrated Dual Diagnosis Treatment, or Assertive Community Treatment (ACT).
 Integration of a cultural focus in using a clinical method (above) with a client–application of cultural framework as well as other readings.
 Harm Reduction —clinical interventions that YOU would apply as the clinician.
 Moderation Get research paper samples and course-specific study resources under   homework for you course hero writing service – Manage ment (for earlier stage problems).
 Psychodynamic approaches in ongoing recovery
 Developmental model of recovery (Stephanie Brown’s work)
 Parent-child interventions or parent-adolescent interventions
 Contingency management
(1) Write a page paper – Describe Treatment Method
The group will provide a detailed understanding of a treatment approach that can be used with an individual, couple or family with a substance-use disorder. Write a page paper – Describe the intervention/treatment method in terms of its theoretical components and key techniques. If relevant, name the groups or problems for which it is most often used. Best paper writer websites, Custom term paper writing service and Research papers owl essays – Professional help in research projects for students – Cite the research evidence for using this method with this type of client/group/family and the strengths and weaknesses of the research methodology (e.g., sample size, control group, use of standardized instruments, replication in other studies). Use at 10 scholarly articles/books that give clinical detail (to present the rationale for using this particular method with a particular type of client) as well as research evidence.
Demonstrate that you have integrated learning from the lectures, class activities, readings and discussion; use and cite assigned chapters and readings when relevant. Avoid use of internet resources since they are often superficial. biased and without the academic documentation necessary for good scholarship.
All members of the group will provide the instructor with his/her list of references used for the part of the presentation for which they were responsible.
(2) Apply the Treatment Method with a Client/ Scripted Role Play
Demonstrate this model would be applied in working with a client in a typical human service setting. Give only one or two sentences to describe the client initially. Show step-by-step, how you would apply this with the client, couple, or family in your vignette. (Include some sample dialogue so I can see that you understand how the method can be applied. Use continuous dialogue or smaller portions of dialogue (interspersed with your comments) to illustrate different issues and what might occur in early vs. later sessions.) Use citations from clinical and/or research literature to show why these specific “micro” techniques or interventions would be likely to work. Explain how you took into consideration factors such as race/ethnicity, cultural background, gender, etc.
Explain what you would do, using this method, if the client regresses psychologically, relapses to substance use, or does not fully cooperate with your application of the method. (Can you use some MI strategies to engage?) Give examples of these situations and how you would handle them.
Considerations in grading the final assignment:
 Specificity of description of clinical method
 Scientific evidence for effectiveness—quality of evidence
 Quality of scholarly references and extent to which they were used to inform the content of the paper.
 Integration of material from course texts, handouts and additional readings
 A scripted role play that clearly demonstrates the approach and what the differences might be with other approaches.

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