The most important tools a counselor can use to help a client struggling with addiction or substance abuse are genuine compassion and a deep understanding, say Ford Brooks and Bill McHenry, licensed professional counselors (LPCs) and co-authors of the second edition of A Contemporary Approach to Substance Use Disorders and Addiction Counseling, published by the American Counseling Association.
“The amount of shame, guilt, embarrassment and terror that drug-abusing and addicted clients feel can be beyond description,” McHenry and Brooks write in the book’s first chapter. “Therefore, clients need a sense of safety, understanding and compassionate care in the counseling relationship to change and grow. … A genuine, truthful and in-the-moment relationship allows clients to know, without question, that they are understood and cared for during their emotional pain and time of crisis. The connection that is forged between counselors and clients following a drug and alcohol crisis can be profound.”
A counselor’s empathy and compassion will benefit any client, certainly, but that is even more pronounced for those battling addiction, they write. This perspective comes from Brooks and McHenry’s combined experience of nearly a half-century of counseling clients with substance abuse issues in a variety of settings, from college counseling centers to hospital and rehabilitation programs.
The second edition of their book was published earlier this year; the first edition was published in 2009.
Q+A: A Contemporary Approach to Substance Use Disorders and Addiction Counseling
Responses by Ford Brooks
What is an important takeaway that you want counselors of all types and specialties to know about addictions and substance abuse?
Working with clients who are addicted is not as scary as most may think. Once a counselor is willing to enter the world of addiction through stories, attendance at open 12-step meetings, exploring the horrendous lives of clients and being educated and trained, it is like no other population to work with in counseling. Not only will counselors see fairly quick progress once recovery begins, counselors will see clients at their very worst. Walking with that person through their hell is an experience like nothing else. We walk the journey with them but not for them. It’s a humbling and powerful experience.
Mainly [we’d like counselors to realize that] addiction is treatable like any other disease, and people do get well.
The counselor-client relationship plays a key part in this work. What are some techniques you recommend to strengthen the therapeutic relationship?
Empathic listening is very important, as well as motivational interviewing techniques with the OARS acronym: open-ended questions to explore; affirming responses for support; reflective listening and comments; and accurate summaries. The core conditions outlined by Carl Rogers are so important with a population that needs empathy and support through their shame and embarrassment. A nonjudgmental approach is so important.
What prompted you to release a second edition of your book? What’s new and different in this edition?
There were three main areas that we found important to address:
- Changes in the Diagnostic and Statistical Manual of Mental Disorders (DSM), including updating diagnostic criteria. The DSM’s fifth edition, published in 2013, contained a major shift from abuse and dependence to a substance use disorder in the model of a continuum, plus the addition of cravings and gambling addiction.
- Neurobiology and addiction as well as treatment for opiates. We felt that both areas needed some updating, as both have grown in research since the last edition (2009).
- And finally, because of [the influx of] returning veterans and trauma throughout this country and in others, the treatment of trauma was included along with attention to suicide and depression.
In your opinion, what makes professional counselors a good fit for addictions work? What unique skills do they bring to the table?
Having taught an overview course in addiction since 1987, I have found few books to address the “good fit” aspect of counselors. A person makes a good addictions counselor if they are interested, hopeful, patient, willing to challenge in a therapeutic and caring way, and understanding of the internal process of recovery.
In the course I teach, I want students to experience as much as possible the [client’s] internal struggle to go without and the emotions, thoughts and behaviors that go along with this process. Those who are “good fits” will be open to that struggle, be willing to explore their own biases around addiction and immerse themselves in the journey.
The main area we emphasize in the book is a beginner’s mind — one that is open to dealing with the client anew despite multiple relapses, denial and defensiveness. Also, being patient and having a willingness for the client to make mistakes and also a willingness to confront choices throughout the therapy. If a counselor wants to work with this population in treatment, being able to facilitate groups is, in my mind, a must.
Besides your book, what are some resources counselors can turn to for more information — and to stay current — on different types of drugs and their effects?
The main association for alcohol and drug addiction is the National Association for Alcoholism and Drug Abuse Counselors (NAADAC). There is also an American Counseling Association division, the International Association of Addictions and Offender Counselors (IAAOC), and the National Institute on Drug Abuse (NIDA). All three organizations have substantial bodies of information, as well as research in the area of addiction.
You and your co-author have been doing counseling work in substance abuse and addictions for more than a decade. How have you seen the field change?
I watched treatment program after program close in the late 1980s due to managed care. With that was the departure of many counselors who were in long-term recovery [programs but] not licensed to provide services. Many of the counselors who were then charged with running programs were licensed but had limited knowledge about addiction. The days of inpatient treatment are now reserved for those with financial resources. Although there is availability for those without the money to enter inpatient treatment, the funding is becoming less and less. Intensive outpatient programs have moved into a significant place in providing services.
Medication-assisted treatment with opiates has continued since the inception of methadone in the 1960s. Properly assigned medication protocols along with structured treatment and tapering is a new area of exploration. As stated before, the increased scientific knowledge of how the brain holds the key to addiction determines and supports [the concept] that addiction happens in the brain.
We also can see that addiction is addiction is addiction. Ultimately, the understanding [needs to be] that to enter recovery, one needs to be in treatment and discontinue addictive, mood-altering chemicals.
Another area of continued growth has to be with addiction and returning veterans and the treatment of co-occurring disorders. Sadly, the gap between treatment services continues. Those who treat mental health only treat mental health [and] those who treat substance use disorders only treat those issues. It is the challenge of the next iteration of counselors to close that gap.
What made you personally interested in pursuing addictions and rehabilitation counseling as a specialty?
I have a family history of addiction that extends generations and have experienced the impact of addiction. When I was an undergraduate at the University of Richmond, a graduate student from Virginia Commonwealth University (VCU) came to my psychology class and talked about [VCU’s] alcohol and drug rehabilitation program. I applied after hearing how powerful her experience was in the program. The rest is history.
A Contemporary Approach to Substance Use Disorders and Addiction Counseling is available from the American Counseling Association bookstore at counseling.org/publications/bookstore or by calling 800-422-2648 x 222.
About the authors
Ford Brooks is a professor in the Department of Counseling and College Student Personnel at Shippensburg University of Pennsylvania. A licensed professional counselor, he has been a counselor for more than 30 years, working primarily with clients who suffer from addiction and co-occurring mental disorders.
Bill McHenry is a licensed professional counselor and dean of graduate studies and research at Texas A&M University in Texarkana. His more than 15 years of counseling experience includes working with groups and individuals with substance abuse and addiction issues in schools, universities, rehabilitation programs and mental health agencies.
Bethany Bray is a staff writer for Counseling Today. Contact her at firstname.lastname@example.org