Addictions Counseling A CompetencyBased Approach Cynthia A Faulkner

Addictions Counseling: A Competency-Based Approach Cynthia A. Faulkner, Ph. D. , LCSW-S Samuel S. Faulkner, Ph. D. , LCSW

CHAPTER TWELVE: Diversity Issues Chapter Competencies and Standards • CSWE—Competencies 2 and 3 • IC&RC—Domain III: Tasks 4, 7; Domain IV: Task 2 • SAMHSA—Competencies 12, 18– 23, 99– 107

Working with LGBTQ The Centers for Disease Control (2011) reports that adolescents and young men who reported rejection from their families were: • 8. 4 times more likely to have tried to commit suicide • 5. 9 times more likely to report high levels of depression • 3. 4 times more likely to use illegal drugs • 3. 4 times more likely to have risky sex

Working with LGBTQ, Cont. The increased rate of psychological problems can be directly attributed to the increased rate of prejudice and stigma associated with being queer. LGBT persons of color cope with trying to fit into the gay and lesbian communities in the face of racism and discrimination. Some may be alienated by their culture.

Working with Adolescents SAMHSA (1999) reports that “the numerous adverse consequences associated with teenage drinking and substance use disorders include fatal and nonfatal injuries from alcohol- and drug-related motor vehicle accidents, suicides, homicides, violence, delinquency, psychiatric disorders, and risky sexual practices. ” Several researchers have found that adolescents can present with co-occurring disorders (Chan et al. , 2008; Wilens & Morrison, 2011; Wise et al. , 2001).

Treatment Considerations for Adolescents respond best to treatment when the following factors are considered: • the developmental stage of the individual adolescent, • the family • ethnicity • gender • co-existing disorders (including any medications the person may be taking) • environment (including any negative school, peer and community influences)

Working with Women who use drugs often suffer from other serious health problems, sexually transmitted diseases, and mental health problems, such as depression. Women who use drugs are at greater risk for unwanted pregnancy. The most serious effects on the baby can be HIV infection, AIDS, prematurity, low birth weight, sudden infant death syndrome, small head size, stunted growth, poor motor skills, and behavior problems.

Treatment Protocols for Women (SAMHSA, 2009) • Acknowledge the importance and role of socioeconomic issues and differences among women. • Promote cultural competence specific to women. • Recognize the role and significance of relationships in women’s lives. • Address women’s unique health concerns. • Endorse a developmental perspective. • Attend to the relevance and influence of various caregiver roles that women often assume throughout the course of their lives. • Recognize that ascribed roles and gender expectations across cultures affect societal attitudes toward women who abuse substances. • Adopt a trauma-informed perspective. • Utilize a strengths-based model for women’s treatment. • Incorporate an integrated and multidisciplinary approach to women’s treatment. • Maintain a gender-responsive treatment environment across settings. • Support the development of gender-competency specific to women’s issues.

Working with People of Color SAMSHSA (2006) defines cultural competence as: • The capacity for people to increase their knowledge and understanding of cultural differences • The ability to acknowledge cultural assumptions and biases • The willingness to make changes in thought and behavior to address those biases. Culturally competent program should demonstrate empathy and understanding of cultural differences in treatment design, implementation, and evaluation. A culturally competent treatment program is characterized by: • Staff knowledge of or sensitivity to the first language of clients • Staff understanding of the cultural nuances of the client population • Staff backgrounds similar to those of the client population • Treatment methods that reflect the culture-specific values and treatment needs of clients • Inclusion of the client population in program policymaking and decision making.

Working with Older Persons Schonfeld et al. (2010) reports that prescription medication was the most widely abused drug among this population, followed by alcohol. “People 65 and older consume more prescribed and over-the-counter medications than any other age group in the United States. Prescription drug misuse and abuse is prevalent among older adults not only because more drugs are prescribed to them but also because, as with alcohol, aging makes the body more vulnerable to drugs’ effects” (SAMHSA, 2008, p. xxii).

Factors Increasing a Person’s Likelihood of Illicit Drug Use Being male, being unmarried, initiating use at an early age, and having experienced depression, alcohol use, and tobacco use in the past year (Blank, 2009). The loss of loved ones, juggling of multiple roles, and retirement or other alterations in employment and income may cause some older people to use illicit drugs as selfmedication for anxiety or depression, especially if they have a history of taking drugs to cope. Slowing metabolism can increase sensitivity to the effects of drugs. Furthermore, the effects of drugs of abuse in older adults may be influenced by age-related health conditions and medications—contingencies that are more problematic when patients hide their drug abuse, (Volkow, 2011).

Working with Clients with Infectious Diseases People who abuse drugs are more likely to contract infectious diseases: • HIV/AIDS • sexually transmitted diseases • tuberculosis • Endocarditis • body lice/scabies • venereal warts (SAMHSA, 1993).

Prevention and Identification SAMHSA (2011) recommends that all counselors provide the following screening measures for clients (regarding hepatitis): • Consider screening to be more than just a blood test. It is an opportunity to educate the client about hepatitis its effects on health, and prevention strategies. It is an opportunity for clients to identify their risk factors and learn how they can reduce the risk of contracting or transmitting viruses. • Be aware that many clients may not know whether they have been screened for hepatitis in the past or they might not know the results. They might confuse HIV screening or any blood test with hepatitis screening, and they might erroneously believe that they are—or are not—infected. • Clearly explain that the hepatitis test is optional. Clients may not understand what disease the test will detect or that they have the option not to give consent; • Follow up with clients regardless of the results. Failure to follow up is a missed opportunity to deliver or reinforce prevention messages.

Working with Veterans, Active-Duty Military, and Their Dependents While the 2008 Department of Defense Health Behavior Survey reveals general reductions over time in tobacco use and illicit drug use, it reported increases in other areas, such as prescription drug abuse and heavy alcohol use. A study of Army soldiers screened 3– 4 months after returning from deployment to Iraq showed that 27% met criteria for alcohol abuse and were at increased risk for related harmful behaviors (e. g. , drinking and driving, using illicit drugs).

Children of Military Children with a parent deployed in the military suffer from greater anxiety and those with preexisting psychological conditions, such as anxiety and depression, may be particularly vulnerable, (Cohoon, 2011). Children with specific risk factors, such as child abuse, family violence, or parental substance abuse (Lincoln et al. , 2008).

Specific Prevention and Identification Strategies For Families Techniques include: • education • communication skills • helping families to recognize stress triggers • teaching emotional regulation skills • parenting classes (Beardslee, et. al. , 2011; Gewirtz et al. , 2011; Lester et al. , 2011; Murphy & Fairbank, 2013; Saltzman et al. , 2011). Ahmadi and Green (2011)