The primary course I teach at the University of Massachusetts-Boston is ‘Addiction & Co-Occurring Disorders.’ This is in the Addiction Counselor Education Program which leads one to being eligible to become a certified and/or licensed addiction counselor. One of the first videos they see features Kim Mueser from Boston University (https://www.youtube.com/watch?v=cnUv-869AS8) discussing, ‘Sequential, Parallel, and Integrated Treatment.’
Many (if not most) of the addiction counseling students I encounter these days want to learn more about: CBT, DBT, EMDR, Affective Disorders, Personality Disorders, Trauma & Relapse, Smart Recovery, etc. They are more open to critical thinking and empirical studies (which either confirms or repudiates their views).
If they are in recovery themselves many understand now that what works for them may not work for someone else. Treatment should be based on the patient/client’s ‘story’ not on theirs. Do you really want to set-up an expectation based on what works for you? Then if they fail what do you say, ‘Ah, you didn’t work it the way I laid it out for you.’
When I began in the field some twenty-five years ago Twelve Step was the “Answer.” Considered by many to be the “only” answer. While Twelve Step can always be the base of a person’s recovery or at least part of the answer (if counselor and client decide together it is a good fit) it may not be enough in and of itself.
Try telling someone with a severe trauma history that well, you should get some clean time before you address those issues. Oh that should work out well. Let’s see, they are not self-medicating the flashbacks, they are in agony, and you think a meeting in and of itself will be enough? (check the NIDA studies on this topic)
Please note I am not attacking Twelve Step Programs. Many of us that are dual-diagnosed utilize Twelve Step as our base but we are also involved with other types of groups (guess I am out of the closet now, huh? lol).
Over the years the other disciplines would look at us as a ‘para-profession’ (many still do). You know, those addiction counselors think that Twelve Step is the answer to everything and conversely many in the addiction field looked at psych and felt all they wanted to do is get everyone on medications.
Maybe the attitude was also the result of the early days of addiction counseling; “Oh, you have six months sober, we’ll make you a counselor now.” While the times have changed with the establishment of addiction counseling education programs the attitude about us is still pervasive.
Addiction Counseling Education Programs such as the one I am involved in offer my course as an elective, not a requirement. Conversely, the other disciplines offer maybe one or two addiction courses (if that) and those are electives as well.
Something is wrong with this picture. I suggest to my students that if they really want to learn about addiction and mental health they should work for a year or two with the street people and/or inpatient psych/addiction. Get your clinical from the ground up.
Willy is available for Presentations on Substance Abuse & Co-Occurring Disorders. He presents from an academic, clinical, and personal perspective. For more information you can email him at: william.drinkwater@umb.edu.
