HANDBOOK FOR CHRIST-CENTERED
SUBSTANCE ABUSE AND ADDICTION COUNSELORS
by
Michael Belzman, M.Ed., CDAAC
Association of Christian Alcohol &Drug Counselors
COPYRIGHT 2003
REDLANDS, CALIFORNIA
The Spirit of the Lord is upon me, because he has anointed me
to preach the gospel to the poor; he has sent me to heal the
brokenhearted, to preach deliverance to the captives, and
recovering of sight to the blind, to set at liberty them that are
bruised, (Luke 4:18 KJ2000)
ASSOCIATION OF CHRISTIAN ALCOHOL & DRUG COUNSELORS INSTITUTE
PO BOX 8604
REDLANDS, CA 92375
(909) 307-0183
DEDICATION
This handbook is dedicated to the five people who are most
responsible for its existence: My wife Bonnie, who loved me
during a time when no one else could; Pastor Rob Scribner, of
the Santa Monica Foursquare Church, who officiated at our
wedding and who kept telling the church to count it all joy
when we go through various trials (a lesson that I didn’t learn for
several years); Rob Hezeltine the founder of Victory Resource
Center who told me not to worry about getting a Ph.D. in
Psychology but to trust that God will make a way; my pastor
Wade Kyle, who prodded me to write this training manual for
Christian Alcohol & Drug Counselors; and Jerry Smithley, our
board member who kept asking me how the book was coming
along whenever he saw me.
3
ACKNOWLEDGEMENTS
I would like to thank Pastor Wade Kyle for his contribution of the
chapter on work environments that use human services
counselors who receive the kind of training provided through
the Association of Christian Alcohol & Drug Counselors Institute.
His support as administrator of one of our institute locations and
his "…in-your-corner…” support has been invaluable.
4
THE PURPOSE OF OUR COUNSELOR TRAINING COURSE
AND THIS HANDBOOK
The purpose of this course is to educate, train and equip
people who have been called to work in the field of Substance
Abuse Counseling in ways that do not stand in opposition to the
Bible, the inspired, inerrent, and infallible Word of God. The
Bible is rich and full of wisdom that has set people free for
centuries. Most homes in America have a half dozen or so lying
around collecting dust from disuse. But the most effective
interventions of healing and freedom from bondage are still
contained within those pages. This handbook aims to rekindle
the truths contained therein and dispel some of the myths
perpetuated by Humanistic Educators who somehow
overlooked them.
Counselors are in greater demand in a culture in which its
members have strayed away from spiritually healthy lifestyles
more than any other time in history. Everyone who has been
bruised by today’s world, everyone who has been victimized,
everyone who has been deceived and sought the emptiness of
fruitless lifestyles, needs quality counseling more than ever; the
type that a secular world trained to ignore God’s Word is not
equipped to give.
There is a large portion of our society that has turned to both
illegal and prescribed drugs in an effort to medicate away the
pain that life has brought them. These too need counselors
with a heart and skill to impact their lives and effectively
provide the truth they desperately need to be set free.
This course will give insight, skill, and confidence needed to be
competent to counsel. The honing of these skills, increased
wisdom and insight, along with greater opportunities for
employment and ministry, will come through experience, God’s
5
leading, and stretching that comes when you faithfully seek
and say “yes” to the Master of the universe and the lover of
your soul.
I wrote this handbook with the goal in mind to equip the
student with the fundamental knowledge and skills that will be
useful in any human services setting with an emphasis upon
substance abuse and addiction counseling. I have come to
see that good counseling skills will serve well in any form of
employment and in any role whether you are an employee,
supervisor, manager or owner. It will give the student
confidence to know what to do in situations that commonly
arise. It is also a reference manual that will always be available
for the student.
In addition to fundamental training tools, this course will impart
vital truths that will challenge many dysfunctional attitudes and
beliefs that commonly creep into our thinking while we are
unaware of them. Biblical truths that can impact your own
growth & development will be offered in exchange from some
of these dysfunctional attitudes that need discarding.
It is also the goal of this Handbook to impart to the student a
better understanding of God’s views on how to enter the world
of Human Service, both in the church and out in the world.
With just a little equipping and the attitudinal “tweaking” that
this handbook has to offer I hope you will gain a measure of
spiritual sensitivity and wisdom in all your affairs, and a true
ability to help people overcome their life’s challenges.
6
TABLE OF CONTENTS
Introduction: What Makes an Effective Counselor?
Chapter I: Facilities that Use Trained Counselors
Chapter II: Ethics
Chapter III: Documentation & Case Management
Chapter IV: Understanding 12 Step Therapeutic Approach
Chapter V: Addiction Intervention
Chapter VI: Pharmacology and the Effects of Drug Abuse
Chapter VII: The Major Pitfalls of Humanistic Psychology
Chapter VIII: Crisis Counseling
Appendix A: Professional Code of Ethics
Appendix B: Spiritual Gifts Inventory
Appendix C: Glossary of Neuroscience Words
Appendix D: California Code Of Regulations For Rehabilitation
Agencies Pertaining To Confidentiality / Data Collection
Appendix E: Government Resources And Web Sites
Appendix F: Addiction Severity Index
7
INTRODUCTION: WHAT MAKES AN EFFECTIVE COUNSELOR?
The material presented in this handbook is necessary
fundamental knowledge for anyone who hopes to be effective
in healing the broken hearted and setting the captive free from
a lifestyle of substance abuse or addiction of any kind. But by
itself it is not sufficient, it is only the beginning.
The making of an effective counselor goes beyond the
knowledge contained herein. It includes a heart that has been
formed by God. A heart that has known suffering and has
experienced God’s loving mercy and His healing power.
The making of an effective counselor includes the formation of
Godly character that has come about through a long series of
choices to do things God’s way when the choice could have
more easily been made to not.
The making of an effective counselor includes having learned
not to rely upon human knowledge and intellect, but to rely
upon the Holy Spirit for leading and guidance pertaining to all
things.
The making of an effective counselor includes the necessity of
entering in to a process of transformation out of carnal thinking
to a lifestyle of surrender.
It includes an understanding of the gifts of the spirit that have
been imparted by the Holy Spirit, and a willingness to apply
them.
An effective counselor is one who has nurtured a deep,
abiding, personal relationship with Jesus Christ and as a result
enjoys a rich communion and prayer life.
8
The effective counselor became effective because he first
remained still upon the potters wheel as the Master potter
molded him and made him what he is today.
We live in a microwave generation that believes it is possible to
make an effective counselor through education and the
granting of a Masters degree or a Ph.D. But of all the things it
takes to become a truly effective counselor, these are the
least.
9
FACILITIES THAT USE TRAINED COUNSELORS
10
CHAPTER 1
FACILITIES THAT USE TRAINED COUNSELORS
Course Objective: The student will understand the major
Human Services organizations, agencies and working
environments that will hire people who have training received
from this program. Students will receive an overview of
important core knowledge areas and know all necessary
certification requirements for entry level jobs into the human
services field including safety, CPR, first aid, and background
checks.
TYPES OF HUMAN SERVICES FACILITIES
Alcohol and Drug Treatment Programs have residential and
outpatient treatment facilities that provide medical and nonmedical alcoholism and drug abuse recovery, treatment, and
detoxification services for adult and youth populations. These
facilities must be licensed by the Department of Alcohol and
Drug Programs unless they are operated under the authority of
a non-profit organization. Health and safety concerns are the
primary focus of licensure. Licensing procedure is described in
The California Code of Regulations (CCR), Title 9, Division 4,
Chapter 5: Licensure of Residential Alcoholism or Drug Abuse
Recovery or Treatment Facilities. This regulation can be found
at http:// www.ca.gov.
The California State Department of Alcohol and Drug Programs
also certifies both residential and outpatient alcohol and drug
treatment programs. Certification is voluntary. It is considered
advantageous in gaining the confidence of both potential
program participants and third party payers.
11
Human Services workers are used at most facilities under the
supervision of managers, medical and paramedical personnel
in the administration and operations of program activities. The
types of jobs that are typically found in alcohol & drug
treatment facilities are intake interviewers, counselors,
administrative assistants, hotline counselors, referral desk
counselors, and recreation coordinators.
Group Homes
Group homes are 24 Hr. residential facilities designed for
people with limited living choices or disabilities that restrict
their ability to have control over their living arrangements.
Some are designated for children and teens who have
nowhere to go and come from families who did not have
the ability, desire or love to maintain a commitment to
raise them. These youth find a place to belong in a
licensed private group home. They have emotional,
behavioral or educational and spiritual problems, which
limited their options to live successful lives, unless they get
the right kind of help. Human Services workers who
receive the right kind of training and who have
compassion for this kind of population can offer them
support, care, affirmation, counseling and preparation for
independent living or adoption while they reside in the
group home.
Recipients of residential services live in large institutions,
medical or psychiatric facilities, group homes, adult foster
care arrangements, or in supervised apartments. The
human service care giver or counselor working in this field
has a major impact on the treatment and
accomplishment of goals for the resident and therefore
can be a major source of fulfillment for the worker as well.
12
Skilled Nursing Facilities
Skilled nursing facilities help adults of all ages recover from
surgery, injury, serious illness, or mental health disability. For
people who need long-term residential care, some facilities
also provide comfortable, safe homes and quality healthcare.
Many facilities also offer short-term respite care when family
caregivers are temporarily unable to provide care.
Skilled nursing facilities provide treatment, care and
rehabilitation therapy for patients after hospitalization for joint
replacement or other orthopedic surgery, traumatic injuries,
brain injuries, strokes, open heart surgery or a serious illness. For
patients who need complex medical treatments, Skilled Nursing
Facilities provide:






intravenous and enteral therapy
pain management
postsurgical stabilization
specialized skin and wound care
medication management
mental health disability behavioral therapy
Working with each patient and willing family members, a skilled
interdisciplinary team sets treatment goals and creates an
individualized plan of care. The team includes nurses,
rehabilitation therapists, medical directors, social workers,
recreation therapists, dietitians and other healthcare
professionals. They share a common goal: to help the patient
achieve his or her highest level of functioning and, when
possible, return home safely.
In these facilities there are some opportunities for
advancement to senior level, supervisory or administrative
overseer positions in your career without additional educational
training. But because the educational requirements and
13
standards are continuously being raised, it is more necessary in
these days to continue receiving training in your career than it
was just a decade ago.
Emergency Shelters
Victims of domestic violence, sudden job loss, medical
problems or disasters may all find themselves in need of
emergency shelters. Most of these service centers are open
seven days a week. Services include: meals, showers,
clothing, on-site and referral health screening, street/jail
outreach, follow-up, representative payee services/money
stewardship for SSI, laundry facilities, advocacy, case
management, medication management, specialized
HIV/AIDS and diabetes case management, mental health
screening, on-site psychiatric treatment, and a drug
recovery program.
14
Job opportunities include human services workers for the
following positions: Food & meal preparation and service,
laundry, on-site and referral health screening, advocacy,
case management, medication management, money
payee services and stewardship, specialized HIV/AIDS case
management, counseling, job and computer training, art /
literacy classes, and drug recovery programs.
While caring for the homeless, battered women, and other
emergencies you make it possible for frail and helpless
people unable to help themselves to get through their
immediate life crisis by the provision of food and shelter and
essential supportive services.
Then by linking them to
educational and employment opportunities they can
become able to build a more secure and self-sufficient life.
Mental Health Facilities
The California Department of Mental Health licenses facilities or
certifies programs engaged in the provision of care to
individuals with major mental disorders. The Department of
Mental Health licenses Psychiatric Health Facilities and Mental
Health Rehabilitation Centers and certifies the mental health
programs of Community Residential Treatment Systems and
Special Treatment Programs in Skilled Nursing Facilities.
Community Residential Treatment Systems (CRTS)
Community Residential Treatment Systems provide a social
rehabilitation program in a residential setting. They offer
programs that assist the client with self-help and social skills,
15
behavior adjustment, interpersonal relationships and vocational
preparation.
Mental Health Rehabilitation Center (MHRC)
Mental health rehabilitation centers provide intensive support
and rehabilitation to clients as an alternative to state hospital or
other 24-hour care facilities. MHRCs help clients develop the
skills to become self sufficient and capable of increasing levels
of independent functioning.
Psychiatric Health Facility (PHF)
Psychiatric health facilities provide acute psychiatric inpatient
care for patients who cannot be appropriately treated at any
other lower level of care. These facilities were established in
1978 as a low cost, high quality alternative to acute
hospitalization in a general acute care hospital or freestanding
psychiatric hospital.
Special Treatment Program (STP)
Special Treatment Programs, as certified by the Department of
Mental Health, exist within skilled nursing facilities for the benefit
of chronically and persistently mentally ill patients who require
24-hour supervision and care. Special treatment programs
provide mental health treatment, instruction on personal care
and medication management and the use of community and
personal resources. All of the above programs offer many entrylevel positions that will get you started on your human service
career path.
16
Elder Care Facilities
Elder care facilities are a type nursing home that provides
skilled nursing care and rehabilitation services to people with
illnesses, injuries or functional disabilities. Most facilities serve
the elderly. However, in some cases some facilities provide
services to younger individuals with special needs such as the
developmentally disabled, mentally ill, and those requiring drug
and alcohol rehabilitation. Elderly nursing homes are generally
stand-alone facilities, but some are operated within a hospital
or retirement community.
The level of care provided by elderly nursing homes has
increased significantly over the past decade. Many homes now
provide much of the nursing care that was previously provided
in a hospital setting. As a result, most nursing homes now focus
their attention on rehabilitation, so that their clients can return
to their own homes as soon as possible. Some of the services a
nursing home may provide include:
 Physical therapy
 Occupational therapy
 Speech therapy
 Respiratory therapy
 Pharmacy Services
 Equipment Rental
 Alzheimer's treatment
 Cancer treatment
 Cardiovascular disease
 Developmentally disabled
17
 Dementia
 Head trauma
 Hematologic conditions
 Mental disease
 Neurological diseases
 Neuromuscular diseases
 Orthopedic rehabilitation
 Pain therapy
 Pulmonary disease
 Para/quadriplegic impairments
 Stroke recovery
 Trauma
 Wound care
 Special Services
 Home health care
 Adult day care
 Respite care
Other Senior Care Options
The range of senior care options continues to expand to better
meet the care and financial needs of individuals. Some of the
alternatives that expand the care giver employment
opportunities include independent living, congregate care,
assisted living and home health care.
18
Independent Living
Independent living is for people who can take care of
themselves and includes residing in one's own home or
apartment, a retirement community, or independent living
apartments.
Congregate Care
Congregate care is similar to independent living, but features a
community environment, with one or more meals per day
prepared and served in a community dining room. Many other
services and amenities may be provided such as
transportation,
pools,
a
convenience
store,
bank,
barber/beauty shop, resident laundry, housekeeping, and
security.
Assisted Living
Assisted living provides apartment-style accommodations
where services focus on providing assistance with daily living
activities. These facilities are designed to bridge the gap
between independent living and nursing home care, and
provide a higher level of services for their residents including
meals, housekeeping, medication assistance, laundry, and
regular checks-ins.
Intermediate Care
Intermediate care is nursing home care for residents needing
assistance with activities of daily living, but without significant
nursing requirements.
19
Continuing Care Retirement Communities (CCRC) or Life Care
Communities (LCC)
These communities are planned and operated to provide a
continuum of care from independent living through skilled
nursing. The facilities allow individuals to live within the same
community as their needs progress through the spectrum of
care.
Sub-acute Care
Sub-acute care is intensive nursing care for patients recovering
from surgery or illness patients receive this care in a nursing
home setting.
Hospice Care
Hospice care is a combination of facility-based and home care
provided to benefit terminally ill patients and support their
families.
Hospitals
In addition to traditional services, many hospitals offer skilled or
sub-acute nursing services either in their facility or on their
campus.
Respite Care
20
Respite care is provided on a temporary basis to allow a
primary care provider or family member relief for a few hours or
days.
Adult Day Care
Adult day care programs provide meals and care services in a
community setting during the day while a caregiver needs time
off or must work.
Outpatient Therapy
Many facilities offer the same therapies provided in a nursing
home on an outpatient basis. For those choosing a homebased option, outpatient therapy may be a necessary
professional service.
Home Health Care
Home health care is provided in an individual's home by
outside providers and aims to keep the individual functioning at
the highest possible level. Services range from basic assistance
with household chores to skilled nursing services. As you can
see, the elder care human service worker has many career
paths to choose from with many opportunities available.
Honor your father and your mother as the Lord your God has
commanded you. Deuteronomy 5:16
Put your religion in
practice by caring for your own family and so repaying your
parents and grandparents, for this is pleasing to God. - 1
Timothy 5:4
Sober Living Homes
21
Sober living homes assist recovering persons by creating a
caring culture, instilling self-help learning activities and
promoting individual responsibility. The Network believes that
well-managed sober living homes can assist at least 80% of the
addicted population. The value of community recovery
housing is mostly unrecognized by health insurers, government
officials and State legislators. Most quality sober living homes
provide an outstanding service without government funding.
There are a few poorly operated homes that overcrowd and/or
create a nuisance in neighborhoods. Such problem homes exist
but are in the minority; over ninety percent of the homes
operate quietly and are good neighbors.
Board & Care Homes
Board and Care Homes (BCHs) are a type of shared housing
designed to serve a smaller number of residents, usually less
than 15. Often BCHs are large, private homes converted into
private or shared bedrooms; residents share common areas like
day rooms, living rooms, and dining rooms. Bathrooms may be
private or shared. BCHs usually feel less institutional and are
designed to provide 'family- style' care. However, these homes
may not have professional or skilled care. Residential Care
facilities operate under the supervision of Community Care
Licensing, a sub agency of the California Dept. of Public Social
Services. In California in the early 1970's the residential care
system was established to provide non institutional home based
services to dependent care groups such as the elderly,
developmentally disabled, mentally disordered and child care
centers under the supervision of the Department of Public
Social Services. At that time homes for the elderly were known
as Board and Care Homes and the name still persists as a
common term to describe a licensed residential care home. In
the vernacular of the State these homes are also known as
RCFE's (Residential Care Facilities for the Elderly).
Residential care facilities are not allowed to provide skilled
nursing services, such as give injections or maintain catheters
22
and do colostomy care, but they can provide assistance with
all daily living activities, such as bathing, dressing, toileting,
urinary or bowel incontinency care. Most elderly people find
that there needs fall beneath having to access skilled nursing
services and therefore don't need to be housed in a nursing
home. The small residential care home, licensed for 2 to 6
people provides a safe, comfortable and dignified
environment for those who need help intermittently throughout
the day and night.
23
ETHICS
24
CHAPTER 2
ETHICS
Course Objective: The student will know the professional code
of ethics intended to guide the ethical behavior and actions of
drug & alcohol counselors. The student will also know the
central biblical guidelines that influence counselor behavior,
actions, and choices of therapeutic approaches. The student
will become familiarized with the most common dilemmas
encountered in the field of drug & alcohol counseling.
MAN’S CODES OF ETHICS
What is a “Code of Ethics”?
“Code” is defined as a
systematically arranged, comprehensive collection of laws.
The American Heritage Dictionary defines the word “Ethics” as
the study of the general nature of morals and of the specific
moral choices to be made by the individual in his relationship
with others, the philosophy of morals. Therefore Man’s code of
ethics could be described as an agreed upon system of moral
standards or choices that a group or an individual has vowed
to live by in his or her relationship with others.
PROFESSIONAL CODES OF ETHICS
Most professions that involve interpersonal relationships with the
public or co-workers, have a written or implied professional
code of ethics. Physicians, Lawyers, Teachers, and Police
Officers are just a few examples of professions that operate
25
under the authority of a professional code of ethics. Matters
concerning the privacy and respect of clients, patients or
residents, their belongings, and their loved ones, are kept safe
and in strict confidence. A breech of these ethics could result
in a law suit, employment termination, or loss of professional
license.
BUSINESS CODES OF ETHICS
Every corporation or business that has employees publishes a
policy manual that clearly lays out the organizations internal
standards of behavior. These standards include descriptions of
behaviors and attitudes that will be expected of each
employee in order for the person to considered a valued and
productive employee. The standards described in the manual
also lay out behaviors and attitudes that, if violated, could be
cause for disciplinary action and even termination of
employment.
Each corporation or business is allowed by law to determine it’s
own policies and procedures and given a large amount of
latitude as to how strict or relaxed their internally set standards
shall be. In the arena of these ethics, the line is more blurred as
to the nature of how moral the policies are. This is so because
they are more closely related to the moral integrity (or lack
thereof) of the individuals who wrote them, then they are to
moral codes considered by the greater society to be of higher
and broader moral authority. Codes written at this level are
most often much more interested with legalities and the
intentions of the individual/s who devised them than with higher
moral codes such as professional ethics or the Word of God.
The State Department of Consumer Affairs
26
The Department of Consumer Affairs oversees and approves
licensing for businesses and organizations producing products
or services for the consumer. Its purpose is to protect the
consumer by setting standards for licensing. They also receive
complaints against businesses and organizations and have the
mandated power to investigate the complaint and if justified,
suspend and revoke licenses. Over time the standards that are
applied become more complex and the bar is being raised
ever higher.
Business Associations
Business Associations have a code for members usually spelled
out in their bylaws.
Organization or Agency Codes of Ethics
The written code for organizations and agencies are often
found embedded in their bylaws and in their policy manual.
Policies & Corporate Policy Manuals
When a new employee is hired, they are given a policy manual
containing the company’s code of ethics. This code often
contains such things as dress code, behavioral expectations,
and consequences for behavioral misconduct, i.e. sexual
harassment, missing work, or showing up late.
GOD’S CODE OF ETHICS
27
God’s Code of Ethics is the only code not written by Man. It is
found in the Holy Bible that Christians reverently call, “The Word
of God”. Though many disagree on this point, it is the belief of
every authentic Christian that the Holy Scripture is the inerrant,
indisputable, and infallible Word of God. It is the highest Truth
of truths. It is important to note, however, that it can only be
reliably interpreted and applied if done so prayerfully under the
illuminating light of the Holy Spirit.
CONFIDENTIALITY DILEMMAS
Our clients need to know that it is safe to share their thoughts,
feelings and behaviors with us. If they couldn’t we would not
be able to effectively help them by discussing with them their
thoughts, feelings and behaviors that have been getting them
into deeper trouble. But while it is important to keep our client’s
confidence in most cases, there are some rare occasions when
it would be more moral to divulge a confidence than to keep
it. The law requires us to divulge our client’s confidence to
appropriate authorities when someone’s life is endangered or
when there are threats of violence or abuse. There may also,
on occasion, be other revealed confidences not covered
under law that your conscience or the leading of the Holy Spirit
may dictate you, as a Christian counselor to divulge. Unlike the
humanistic psychology arena of counseling, the Christian
counselor is duty bound to the higher authority of God’s
leading or the leading of conscience in cases not covered by
law.
RELATIONSHIP BOUNDARY DILEMMAS
28
It is easy for role boundaries to become blurred between
counselor and client or resident. The relationship can not be
too casual. You can not be in a helping relationship where
there is no respect given. There must be lines of respect going
both ways. Respect must be given to the client or resident due
by virtue of the fact that that person is a beloved child of God
alone. But a line of respect must also be maintained by the
counselor who should discern when the helping relationship
borders of becoming too casual.
Familiarity does indeed
breed contempt. It is difficult to help some one who has lost
respect for you to receive from you. Your client or resident can
not be your close buddy.
The humanistic counselor view of ethics regarding this issue
approaches it legalistically. Embedded in some professional
codes are the rules that no gifts can be received or given, and
the counselor can not be involved in any outside activities with
the client. These stringent rules are a little more relaxed in the
view of ethics of the Christian human services worker or
counselor from the standpoint that the resident or client is not
viewed as only a professional appointment from whom we
must remain professionally detached.
The Christian human
services worker or counselor has the added burden of thinking
of the client or resident as a brother or sister and a person to
whom me must extend God’s love.
LEGAL & MORAL DILEMMAS
We live in an extremely law conscious generation. There are
hundreds of laws and regulations pertaining to the work of
human services workers and counselors. More laws become
instituted every year in our litigious society and as determined
as lawmakers are to lay out prescribed behavior as an exact
science, it can never really be. If we were no more than a
people whose behaviors were exacted by laws and
29
regulations, we would have no use of a conscience, or the
Word of God which transcends Man’s laws wherever there is a
conflict, or the Holy Spirit to lead us in certain situations.
As Christian human services workers and counselors, we are
duty bound to respect the laws governing us and not take
them lightly. We should also take the time to learn the laws
that pertain to our specific career field. So we must know that
there will come times when the laws can say one thing but our
conscience will say something else. These times are rare but as
a Christian human services workers or counselor, when we are
confronted with a legal & moral dilemma, we do not choose
action or inaction before we agonize and pray and seek God’s
will.
A clear example of such a dilemma is seen in the case of a
Psych Tech who was ordered to distribute medications to the
residents of mental health facility. The Psych Tech noticed that
the dosage the doctor had ordered was 10 times the
customary dose and believed that if the dosage was
administered it could kill the patient. The Psych Tech called the
doctor to inform him of the possibility of an error. But the doctor,
who was busy and irritable, stubbornly told the Psych Tech to
just follow his instructions, that he was right and didn’t have
time for discussion on how he prescribes medications. The
Psych Tech decided to follow her conscience, risking the loss of
her job, but the resident lived and ultimately the prescription
was changed.
BUSINESS DILEMMAS
A common business dilemma occurs whenever the owner of a
care center must choose between hiring a qualified supervisor
to oversee the staff and assure a high quality of patient or
resident care, or hire the most cost effective individual that
30
may meet the minimum standards provided by the law but is
not personally qualified to assure a high quality of care.
The human services care industry is lucrative for the owners of
the care facility. They are not always motivated by a desire to
provide good quality care. They may instead be motivated
solely by their desire to acquire wealth. Or they may be
conflicted between the two goals. This is truly a difficult
dilemma many facility owners must face.
ROLE CONFUSION DILEMMAS
Role confusion occurs when a counselor experiences multiple
roles in the relationship he has with the client or resident. This
dilemma shows up when the person receiving your help is also
a friend, relative or acquaintance in another area of life. For
example, if a client of your is also a person you used to work
with, that person already has a concept of you as the person
he knew. Maybe he sees you as someone he could be more
casual than you feel comfortable with in your role as counselor.
In such cases it might be wise to explain your situation to your
supervisor and ask that the case be transferred to someone
who would not have this dilemma.
WHEN THE LAW AND THE WORD OF GOD DISAGREE
Some human services workers and counselors find employment
in medical facilities and health clinics that do prenatal and
perinatal counseling. It is important that those who find
themselves in this field be well versed on certain landmark
Supreme Court decisions including Roe v. Wade, which is
without doubt the most controversial decision of the 20th
century.
Dr. Frank Beckwith, Associate Professor of Philosophy, Culture
and Law at Trinity International University Graduate School,
31
gives the following insight as to the current legal status of
abortion in America:
“It is important that the reader understand the current legal
status of abortion in America. There seems to be a widespread
perception that the Supreme Court decision Roe v. Wade
(1973) only permits abortions up to 24 weeks, and after that
time only to save the life of the mother. This false perception,
fueled in large part by groups supporting abortion rights, is
uncritically accepted by the media. The fact is that the current
law does not restrict a woman from getting an abortion for
practically any reason she deems fit during the entire nine
months of pregnancy. In order to understand why this is the
case, a brief history lesson is in order.”
“In Roe, Justice Harry Blackmun divided pregnancy into three
trimesters. He ruled that aside from normal procedural
guidelines (e.g., an abortion must be safely performed by a
licensed physician), a state has no right to restrict abortion in
the first six months of pregnancy. Thus a woman could have an
abortion during the first two trimesters for any reason she
deemed fit, whether it be an unplanned pregnancy, gender
selection, convenience, or rape. In the last trimester the state
has a right, although not an obligation, to restrict abortions to
only those cases in which the mother's health is jeopardized. In
sum, Roe v. Wade does not prevent a state from allowing
unrestricted abortion for the entire nine months of pregnancy if
it so chooses.”
“Like many other states, my state of Nevada has chosen to
restrict abortion in the last trimester by only permitting abortions
if "there is a substantial risk that the continuance of the
pregnancy would endanger the life of the patient or would
gravely impair the physical or mental health of the patient." [2]
But this restriction is a restriction in name only. For the Supreme
Court so broadly defined "health" in Roe's companion decision,
Doe v. Bolton (1973), that for all intents and purposes the
32
current law in every state except Missouri and Pennsylvania
(where the restrictions allowed by Webster have been enacted
into law) allows for abortion on demand.”
“In Bolton the court ruled that "health" must be taken in its
broadest possible medical context, and must be defined "in
light of all factors -- physical, emotional, psychological, familial,
and the woman's age -- relevant to the well being of the
patient. All these factors relate to health." [3] Since all
pregnancies have consequences for a woman's emotional
and family situation, the court's health provision has the
practical effect of legalizing abortion up until the time of birth -if a woman can convince her physician that she needs the
abortion to preserve her "emotional health." This is why the
Senate Judiciary Committee, after much critical evaluation of
the current law in light of the court's opinions, concluded that
"no significant legal barriers of any kind whatsoever exist today
in the United States for a woman to obtain an abortion for any
reason during any stage of her pregnancy." [4] ”
“A number of legal scholars have come to the same
conclusion, offering comments and observations such as the
following:
In actual effect, Roe v. Wade judicially created abortion on
demand in the United States. [5]
The concept of "health," as defined by the Supreme Court in
Doe v. Bolton, includes all medical, psychological, social,
familial, and economic factors which might potentially inspire a
decision to procure an abortion. As such, "health" abortion is
indistinguishable from elective abortion. Thus, until a more
narrow definition of "health" is obtained, it may not be possible
to limit effectively the number of abortions performed. [6]
After viability the mother's life or health (which presumably is to
be defined very broadly indeed, so as to include what many
might regard as the mother's convenience...) must, as a matter
of constitutional law, take precedence over...the fetus's life...
[7] It is safe to say, therefore, that in the first six months of
33
pregnancy a woman can have an abortion for no reason, but
in the last three months she can have it for any reason. This is
abortion on demand.”
“Those who defend abortion rights do not deny this disturbing
fact but often dismiss it by claiming that only one percent of all
abortions are done in the last trimester. There are several
problems with this statistical dismissal. First, the fact that thirdtrimester abortions are permitted for nearly any reason and that
unborn children are left unprotected is significant in itself
regardless of whether a small percentage of total abortions has
taken place during this time. Second, since there are about 1.5
million abortions per year in the U.S., it follows that 15,000 (or
one percent) of them are done in the third trimester. This means
that 1,250 of them are performed every month (about 40 a
day). This is no insignificant number.”
“Notes:
[1] Politically Correct Death: Answering the Arguments for
Abortion Rights
[2] Nevada Revised Statute, 442.250, subsection 3.
[3] Doe v. Bolton 410 U.S. 179, 192 (1973).
[4] Report, Committee on the Judiciary, U.S. Senate, on Senate
Resolution 3, 98th Congress, 98-149, 7 June 1983, 6.
[5] John Warwick Montgomery, "The Rights of Unborn Children,"
Simon Greenleaf Law Review 5 (1985-86):40.
[6] Victor G. Rosenblum and Thomas J. Marzen, "Strategies for
Reversing Roe v. Wade through the Courts," in Abortion and the
Constitution: Reversing Roe v. Wade through the Courts, ed.
Dennis Horan, Edward R. Grant, and Paige C. Cunningham
(Washington, D.C.: Georgetown University Press, 1987), 199-200.
[7] John Hart Ely, "The Wages of Crying Wolf: A comment on
Roe v. Wade," Yale Law Journal 82 (1973):921.”
If you find yourself in a prenatal or perinatal counseling setting,
you would not want to be a counselor who takes the life of the
unborn child lightly. Psalm 22:10 says, “I was cast on You from
34
the womb, from My mother's belly, You are My God. Psalm
139:13 reads, “For You have possessed my inward parts; You
wove me in the womb of my mother.” The Christian counselor
understands that God’s precious child is alive in the womb of
the mother.
There are many physicians and humanistic
counselors today who believe a child in the mother’s womb is
no more than a glob of fecal tissue or a gelatinous mass. They
are blind to the fact that a “fetus” is a child formed by God. It
is this irreverent attitude that has caused the death of millions of
children and has caused untold damage to the spiritual,
emotional and physical lives of millions of mothers. Perhaps the
greatest spiritual tragedy of our day is that humanistic
counseling organizations all across the nation, backed by the
Roe v. Wade and Doe v. Bolton Supreme Court decisions,
continue to counsel unsuspecting young mothers that abortion
is an acceptable option. Some organizations like, Planned
Parenthood, actively encourage it. So the killing of innocent
children in the mother’s womb goes on daily.
The Supreme Court decision of Roe v. Wade has brought
spiritual darkness to our nation. Asked to comment on this
decision, Mother Theresa was quoted in the Wall Street Journal
in its February 25th, 1994 edition and had this to say about the
decision:
"America needs no words from me to see how your decision in
Roe v. Wade has deformed a great nation. The so-called right
to abortion has pitted mothers against their children and
women against men. It has portrayed the greatest of gifts--a
child--as a competitor, an intrusion, and an inconvenience.”
THE HOLY SPIRIT HAS THE FINAL WORD
35
If one were to say, do whatever your heart tells you to do, that
would be bad advice. Our feelings often fool us. The Word of
God says in Jeremiah 17:9 that, “The heart is deceitful above all
things, and desperately wicked: who can know it?” Unless it
lines up with the infallible Word of God which never deceives
us, it shouldn’t be trusted.
If we are given the advice to pray and listen to whatever
voices you hear, don’t trust them unless they line up with the
Word of God. The Word of God says in Ephesians 6:12, that we
wrestle not against flesh and blood, but against principalities,
against powers, against the rulers of the darkness of this world,
against spiritual wickedness in high places. If we listen to voices
or “spiritual leadings” without knowing whether or not they
conform to the Word of God, we might be being led by one of
the evil spirits that Ephesians 6:12 refers to.
If we are given advice based upon the Word of God, but if the
advice, coming from the advice is misapplied, do not take it as
applying to you. Many well-meaning pastors will take scripture
out of context and misapply it in a counseling session because
they have not first prayed and interpreted the Word in the light
of the Holy Spirit. It takes the written Word of God, interpreted
in the light of the Holy Spirit, by one who prays, to apply
scripture accurately and incisively.
As a human services worker or counselor, you will have to know
the Word of God and have it living in your heart in order to be
effective. You must be a walking bible who prays without
ceasing, sensitive to the Holy Spirit and ever listening for His
leading. If you have the discernment which comes from
having the Word of God living in your spirit, then the Holy Spirit
will always have the final word and you will not be deceived.
Then you will be able to apply the Word of Truth accurately,
incisively and effectively.
36
37
DOCUMENTATION & CASE MANAGEMENT
CHAPTER 3
DOCUMENTATION & CASE MANAGEMENT
Course Objective: The student will know how to conduct an
intake interview and complete a typical intake form used by
most facilities. The student will know how to create, document,
and follow-up on a treatment plan. The student will know how
38
to write case notes appropriately and in an objective,
observational manner. The student will understand the laws of
confidentiality as they pertain to case files. The student will
become familiarized with the most common forms used in
recovery, group home, and skilled nursing center facilities. The
student will know how to prepare monthly and quarterly
reports.
THE TREATMENT PLAN
The Addiction Severity Index as a Diagnostic Tool
The ASI, Addiction Severity Index, is the most used diagnostic
tool in our field. One of its greatest strengths is to provide the
counselor with an accurate profile that describes the severity of
problems in the following areas:
 Medical Status
 Employment/Support Status
 Alcohol/Drug Abuse History
 Family/Social Relationships
 Legal Status
 Psychiatric Status
The Spiritual Life Index
Must humanistic counseling programs leave out the individual’s
spiritual life as a dimension that should also be measured. So
we use the SLI, Spiritual Life Index to give the counselor a profile
of the individual’s spiritual strengths and weaknesses. The SLI
gives a profile in the following areas:
 Belief in God
 Personal Theology and Belief System
 Devotional Life
 Prayer Life
 Personal Purpose & Direction
 Methods used to overcome spiritual adversity
 Behaviors & Actions resulting from spiritual life
39
The Problem Statement
Problem statements are determined by the counselor and
taken from the profiles found in the ASI and SLI. The best way to
formulate a problem statement is to go over the results of the
ASI and SLI with the client or resident present. Together you
can come to an agreement as to what areas and indicated as
being most paramount in receiving attention. These problem
areas are then cited in the treatment plan as focus areas each
of which will be assigned goals, an action plan, and will be
tracked through progress notes toward a problem resolution.
It is important to have both short term and long term goals.
Short term goals are necessary because the client or resident
need something to work towards that they can view as easily
achievable in not too long of time. This will give them
immediate hope and encouragement. The long term goals
are needed to provide a greater level of difficulty and
challenge. They also necessary to clarify areas of long term
direction and focus.
The goal statements are written into the treatment plan and
are periodically re-evaluated and adjusted when there is a
need. Sometimes due to quick progress or new information
providing a better understanding of what a more effective
goal should be, it needs to be updated and restated in the
treatment plan.
The Action Plan
The action plan is a declaration of behaviors and actions the
individual will agree to engage in to meet their short term and
long term goals. A certain amount of specificity is required in
order for the action plan to be effective. Fully described,
specific actions should be spelled out in detail with
expectations of dates, times and deadlines recorded.
40
The S-O-A-P method of progress tracking in case notes
Progress notes are important for the following reasons:
 They help keep both the client and counselor on track as
they progress toward the stated goals of the treatment plan.
 They help the counselor to maintain a strand of continuity
 They show periods of progress and regress
 They can serve as an important source of documentation for
legal matters and court cases.
Subjective Feelings of client during session
As part of the progress notes in every session, it is important to
annotate the perceived emotional state of the client during
that session. An example of this kind of entry would be, “John
appeared irritable when he arrived for the session, and during
the session he also appeared restless.
Avoid making a
diagnosis like, “John has a problem with anger.” It would be
better to say that, “John appeared tense and irritable, raising
his voice in what appeared to be anger at several points
during our session. It is much easier for a diagnostic statement
to be incorrect than an objective description of John’s
behaviors that serve as indicators of his subjective feelings.
Objective behaviors noted by counselor during session
Make note of significant objective behaviors that would be
helpful in shedding light on how the client is progressing, their
present attitudes, motivations, thoughts, desires and
commitments. An example of such a note might be, “John
arrived to his session on time. He told me about an interaction
he had with his father who he hasn’t seen in over a year. He
explained that he was able to have a good conversation with
him for the first time in his life. As he told his story, tears came to
his eyes.
41
Discussion Question: With a little more probing, what types of
useful information do you think can be gleaned from this
annotation of John’s objective behaviors?
Actions determined during session
During each session the counselor will want to note one of
three possible statements regarding what action to take. 1) A
statement of a specific action to be done by the client based
upon information that came out in the session (the counselor &
client must both agree that this action should be taken; 2) The
statement that the client is in the process of completed an
action that was begun during an earlier session stating what
has been accomplished so far and what remains to be
completed; 3) The statement that no action is required at this
time.
It is important to incorporate and track actions that the client
contracts to make with you in your documentation both in the
treatment plan and in your case notes. With out action
commitments and follow up tracking. A state of stagnation will
occur. The trick is to find the right kind of action which should
always be sought prayerfully. Many humanistic counselors
assign actions to their clients that just keep them jumping
through hoops but don’t really impact the client where the
need is the greatest. We want to avoid causing our clients to
jump through needless hoops, this will discourage them and
cause the therapeutic relationship to go nowhere. An example
of an action statement that you might want to annotate might
be, “John has agreed to spend quiet time every morning
consisting of prayer and bible meditations. He also agrees to
read a daily devotional from Oswald Chambers, “My Utmost for
His Highest”.
42
Plans added or changed during this session
Plans in the treatment are not made to be static. It is only
natural and even necessary that they change from time to
time as progress is made during the therapeutic relationship.
An example of an initial plan might be that, “John will gain an
understanding that there is a purpose for his life.” This is a good
start but you don’t want to stay there forever. When the
counselor is convinced that John is now aware of the fact that
there is a God intended purpose for his life, it will be necessary
to begin working on the next element of his therapeutic
journey. The next element to plan will vary from person to
person. It will become clear through our therapeutic dialogue.
As the new element of the treatment plan is becomes clear, it is
written both in the progress notes, and the treatment plan. An
example of what the counselor might put into the case notes
might be that, “John has been able for the first time been able
to express that he sees the purpose of his life to be a teacher
who is able to impart life-giving knowledge to students. He
stated that he wants to help people who have been stuck in
the same kind of addictions as he has experienced.” He stated
that that’s the only thing in life that is worth working hard for. I
believe that John is sincere in his desire and therefore we have
accomplished our first plan of finding and articulating John’s
purpose. I believe that now we should establish new goals
consisting of educational pursuits spelling out the specifics of
how to do what will be necessary for John to enter into his
stated avocation. During the next session we will agree on a
new plan statement and write down new goals and actions
that will correspond to it. John has agreed to prayerfully seek
after the specifics of his new plan and write down any ideas
that occur to him about the new plan during this week. We will
go over them together in the next session.
The Treatment Plan Face Sheet
43
The treatment plan face sheet contains the following
information:
 Name
 Permanent Address
 Telephone
 Date of Birth
 Date of Program Intake
 Statement of Problem Areas
 Long Term Goal Statements (stated under each problem
statement)
 Short Term Goal Statements (stated under each problem
statement)
 Action Plan (stated under each goal statement)
THE INTAKE INTERVIEW
Every counseling center, recovery center or home has its own
intake interview form that contains the client’s general
demographic information as well as the information needed by
the counselor and the organization to know how to start
providing services.
As part of your internship program you will be asked to visit a
human services organization and speak with their intake worker
about the questions they have chosen to ask on their intake
interview form. A good intake form will always have questions
pertaining to the following items:
 General Demographic Information
 Medical Status
 Employment Status
 Family Status
 Social Status
 Legal Status
44
 Financial Status
 Addiction Severity Rating
 Mental Health Status
CONFIDENTIALITY
In accordance with professional ethics and California state law,
any information shared in the context of professional
counseling is considered confidential, with the following
exceptions:
1. The counselor believes that a client is a danger to harm
him/herself or is gravely disabled.
2. The counselor believes that a client is a danger to harm
another person or the property of another person.
3. The counselor is informed of or suspects the abuse or
potential abuse of a child.
4. The counselor is informed of or suspects the abuse or
potential abuse of an elderly person or other dependent
adult.
5. In other legally defined situations, usually involving
litigation or the judicial system, client confidentiality may
be waived.
STANDARD FORMS
The forms that are typically used in a case file for outpatient
treatment facilities are:




Intake interview
Treatment plan
Case notes
Referral form
The forms that are used in residential facilities include the
above plus a large and varied number of other forms such as,
legal forms, county forms, medical forms, clothing form,
45
prescription drug from, financial status forms, and the number
and types of forms can go on and on depending upon the
facility and its requirements. Usually in government facilities, or
facilities subject to government accountability, there is much
redundancy and many more specialized forms that are
required to be filled out. This varies depending on the type of
facility.
CASE NOTES
Good case notes are crucial because of your need to track
the course of your client’s progress in order to keep you on
track with your treatment plan goals and action plans. They are
also crucial in order to accurately document important aspects
of the course of treatment that may later be needed for
medical or legal reasons.
In order to get a good understanding of the California state
requirements for case notes and documentation refer to Exhibit
E covering confidentiality and data collection.
Keep in mind that it is very possible that your case notes may
be subpoenaed someday by the justice system. This could
have serious repercussions on your client, therefore, it is
important to fully consider what you write down in a case file
and how it may be used against your client in the future.
S-O-A-P METHOD
The S-O-A-P method of taking case notes makes it easy for the
counselor to remember the type of information that should be
collected and noted in each counseling session. The four types
of information are:
 Subjective (Resident’s emotional state)
 Objective observations
46
 Attitudes
 Plan of action
Anything you might do in a counseling session may be reported
under one of these four categories and will make up the
complete progress notes for a particular interview or counseling
session.
LEGAL ISSUES OF DOCUMENTATION
We live in an age in which people seem to be much more
interested in making sure that all documentation is correctly
filled out and meets all legal requirements than interested in
people being healed and restored. If you work under the
authority of someone who needs the documentation done
meticulously, even though it may take so much of your time
that it robs your clients of their time with you, the
documentation still gets the higher priority.
If your employer is in a system that requires a lot of
documentation to be completed according to state
regulations governing it, it must be done in accordance with
those regulations in order for the organization you work for to
get paid. If the documentation is not complete and done
properly, your organization could be dropped from the
approved list of vendors that your county or state uses. This
means, no documentation … no job?
In this area we commiserate with all counselors, most of whom
have a resistance to all paperwork functions. The fact still
remains that rarely can we be purists in the sense that we
counsel and do nothing else. You can’t eat cake alone
without the balanced nutrition of a diet that includes spinach
and broccoli to keep the body in good health.
47
It is possible to diminish your paper work load in a setting like a
small, church counseling center. A small counseling center
with a far smaller documentation burden, that uses counselors
who are competent to counsel, is better able to do the job
than a secular counselor, who is living under the tyranny of the
paper work and documentation that seems so overwhelming
these days. This is not a problem limited to the field of
substance abuse counseling but the whole field of health care
has seen the quality of care diminish because of the ever
increasing demands for legal documentation that comes out
every year.
48
UNDERSTANDING THE 12-STEP THERAPEUTIC APPROACH
49
CHAPTER 4
UNDERSTANDING THE 12-STEP THERAPEUTIC APPROACH
Course Objective: The student will understand the biblical
intentions of the 12 steps of the anonymous programs, their
power to bring spiritual transformation, their uses, abuses and
limitations.
The field of Drug & Alcohol Counseling is philosophically divided
between those who believe in the Self-help method and those
who believe in the Surrender method of recovery. Most if not
all of the humanistic psychological models of counseling focus
on a variety of Self-help techniques that have come into vogue
in the past few decades. These techniques can be artistically
creative, and vary, as does the theories of the Psychologists
who have posited them. But no matter how different they may
appear, they all have one thing in common: The idea that the
individual can rebuild his own life.
Unlike humanistic self-help techniques, those Drug & Alcohol
Counselors who believe in the Surrender method, as does 12
step counselors and Christian Counselors, believe that the only
way to break a deep addiction of any kind is to surrender it to
God who alone has the power great enough to do the job. It is
believed by the “Surrender” group that all the self-help
techniques, though they may show superficial results for a
season, will ultimately fail, causing relapse and possibly worse.
The Word of God is filled with scripture explaining the process of
each of the 12 steps. The process of going through these steps
is necessary for every person to face in order to experience an
authentic spiritual transformation having the power to take one
out of even the deepest of addictions and restore their life.
50
There are many other approaches in use by substance abuse
counselors today that try to avoid these steps. Without going
through them, however, any other approach is superficial at
best and, though it may produce abstinence for a season, will
result in relapse, self-deception and the development of
attitudes and behaviors that may be worse than substance
abuse itself.
Below is a chart that contains the twelve steps with biblical
scripture that supports the central concept of each step. The
particular scripture cited is meant to be only representative of
the thousands of God’s Words that can be found laced richly
throughout His inspired word for each principle represented by
each of the steps. Though many profess to be Christians, only
those who know the Bible well enough to have God’s Inspired
Word is alive inside their spirit are mature enough as Christians
to have overcoming power in their lives. The twelve steps is no
more than an introductory passage toward understanding the
whole Bible. Authentic Christians have the whole Bible living
inside them and because they don’t just hear the Word of God
but live it and apply it in their daily lives, they automatically live
out the 12 steps also in their daily lives. The great advantage
that Bible study has over 12 step study is that with Bible study,
the believer has the advantage of nurturing a close, personal
relationship with Jesus Christ, from whom derives the highest
degree of overcoming power of all.
The Steps
1. We
admitted "I know that nothing
we
were good lives in me, that is,
powerless over in my sinful nature. For I
our
have the desire to do
addiction/afflict what is good, but I
ion ... that our cannot carry it out."
lives
had (Romans 7:18)
become
unmanageable
51
.
2. Came
to
believe that a
Power greater
than ourselves
could restore us
to sanity.
"... my grace is sufficient
for you, for my POWER is
made
perfect
in
weakness."
(2
Corinthians 12:9)
3. Made
a
decision to turn
our will and our
lives over to the
care of GOD as
we understood
Him.
“Come unto me, all ye
that labour and are
heavy laden, and I will
give you rest. Take my
yoke upon you, and
learn of me; for I am
meek and lowly in
heart: and ye shall find
rest unto your souls. For
my yoke is easy, and
my burden is light.
(Matthew 11:28-30)
4. Made
a "Let us examine our
searching and ways and test them,
fearless
moral and let us return to the
inventory
of Lord."
(Lamentations
ourselves.
3:40)
5. Admitted
to
GOD,
to
ourselves and
to
another
"…confess your faults to
one another and pray
for each other so that
you may be healed."
52
human
being (James 5:16)
the
exact
nature of our
wrongs.
6. Were
entirely
ready to have
GOD
remove
all
these
defects
of
character.
"The Lord in near to
those who have a
broken and contrite
spirit.” (Psalm 34:18)
7. Humbly asked
Him to remove
all
our
shortcomings.
"Humble
yourselves
before the Lord, and He
will lift you up." (James
4:10)
8. Made a list of
all persons we
had
harmed
and
became
willing to make
amends
to
them all.
"Therefore, if you are
offering your gift at the
alter
and
there
remember that your
brother has something
against you, leave your
gift there in front of the
alter. (Matthew 5:23)
9. Made
direct
amends to such
people
wherever
possible, except
when to do so
would
injure
them or others.
“…First go and be
reconciled
to
your
brother; then come
and offer your gift."
(Matthew 5:24)
10 Continued
to "For by the grace given
. take
personal me I say to every one of
53
inventory and
when we were
wrong,
promptly
admitted it.
you: Do not think of
yourself more highly
than you ought, but
rather think of yourself
with sober judgment, in
accordance with the
measure of faith GOD
has
given
you."
(Romans 12:3)
11 Sought through
. prayer
and
meditation
to
improve
our
conscious
contact
with
GOD as we
understood
Him,
praying
only
for
knowledge of
His will, and the
power to carry
that out.
"After
this
manner
therefore pray ye: Our
Father which art in
heaven, Hallowed be
thy name. Thy kingdom
come. Thy will be done
in earth, as it is in
heaven.”
12 Having had a
. spiritual
awakening as a
result of these
steps, we tried
to carry this
message
to
alcoholics, and
practice these
principles in all
our affairs.
"Brothers, if someone is
caught in a sin, you
who are spiritual should
restore him gently. But
watch yourself, or you
also may be tempted.
Carry
each
other's
burdens, and in this
way you will fulfill the
law
of
Christ."
(Galatians 6:1-2)
54
ADDICTION INTERVENTION
55
CHAPTER 5
ADDICTION INTERVENTION
Course Objective: The student will understand the principles of
addiction intervention using the social milieu of family and
friends. The student will know how to organize an intervention
and facilitate it as an advocate of the individual and the
family.
DEFINITION OF AN INTERVENTION
There are two kinds of interventions: 1) A counselor client
intervention in which the counselor challenges the system of
self-deception that upholds the drug or alcohol abusers lifestyle
in a one-on-one counseling session or group of sessions. 2) A
family intervention in which the substance abuser who desires
to gain freedom over the addiction and family members and
friends meet in order to discuss concerns and solutions and
together with the full involvement and agreement of the
individual develop a treatment plan consisting of periodic
family meetings and follow-up. The client must be willing to
attend these sessions in which he is aware that elements of his
thinking regarding his lifestyle will be lovingly challenged. The
client must be shown dignity and respect as a beloved child of
God on the one hand, and on the other be able to hear the
concerns presented that will challenge his or her deceptive
56
thinking patterns. Both Individual and Family Interventions are
helpful to lead an alcoholic to 12 step program involvement
that will be able to break the power of addiction in the
individual as he or she commits to working the steps in
submission to the power of God.
The power of a special group of loved ones and friends
The support of family and friends should never been
underestimated as to the role they play in the spiritual and
emotional health or illness of the individual. Most people who
have committed violent crimes against people and society
have one thing in common. They all grew up with absentee
fathers. Most people who have grown up without knowing the
nurture and love of a mother also have something in common:
a tendency to be sickly, frail and defeated by life. By the same
token we have seen that many sickly or angry children who are
removed from their families and put into a home with strong
and loving parental guidance, often grow to be healthy adults
with fruitful lives.
People most often turn to substance abuse when they have
not had love and guidance from family members. When the
fabric of a healthy family life unravels, people become
emotionally and spiritually disoriented. If they can not find love
in the home, they will turn to other sources such as gangs and
associations with people who will at best encourage a
mediocre lifestyle and, at worst, crime.
The only thing that could ever really overcome the damage
done by critical and unloving family members is found in the
nurturing of a personal relationship with Jesus Christ, of Whom it
is said, is a friend who faithfully sticks closer to us than a brother.
A family advocate and not a confronter
57
(except with the express leading of the Holy Spirit).
Many humanistic therapies prescribe heavy confrontation
techniques to deal with alcohol & drug abusers in denial. This
rarely works because of the tight defensive posture most
substance abusers have erected for themselves. Healthy family
relationships of trust and a feeling of the extension of unmerited
love must be established before confrontation could ever work,
and then it must be spoken in love as concerns, not
condemnations.
The Interventionist is, therefore, a family advocate, always
mindful of upholding and encouraging what is healthy and
loving in family communications and discouraging any and all
condemning statements. A large part of his role is to teach
and guide the family in healthy communication. His role is also
to help identify, uphold, and advocate for the God-given gifts
and goodness of each family member because only if
identified and activated can progress take place.
Worldly confrontation does not work and often makes the
problem worse
The biggest temptation that family members face during an
intervention is to read the riot act to the family member for
whom the family intervention is held. If this is allowed to
happen, family members will say things that later they will
regret ever having said.
Often, unfortunate words of
condemnation, criticism, and anger are let loose.
The
individual receiving the words experience them as a barrage of
hate and hostility. Such expressions have the effect of putting
the individual, who already has an unhealthy self-esteem, into
even a greater self-loathing. It also closes the door for healing
words to ever take place.
The best way to understand the effect that such words can
have is to put yourself in the hotseat for a moment. How would
you feel if a close relative said to you, “The problem with you is
58
that you are only concerned with only yourself. You only care
about getting high all the time and you haven’t done a single
thing to help the family.” Now contrast these words with,
“Whenever you’re high on drugs, it seems to keep you away
from us. We miss you. You are a member of our family and we
are not a complete family without you” In contrast to the first
statement, how does the second statement make you feel. In
the first statement, the focus is on the problem and on
condemning the family member. In the second statement, the
focus is on “concerns” and does not condemn the family
member but lets him know that he is needed.
The harm of humanistic confrontation
The confrontation techniques used in many humanistic
psychological approaches are not motivated by love but
human manipulation. It is experienced as empty, vacant and
distant by the hearer. Even though, because the therapist is
viewed as someone who must know what he or she is talking
about, or is viewed as an expert, the things they say may be
accepted and received as truth and deeply planted in the
psyche. Because humanistic therapists often tend to focus on
the problem rather than the true solution and only offer
superficial solutions, the individual might arrive at therapy with a
vaguely defined problem, and after many sessions end up with
a much more highly defined problem in a deeper state of
hopelessness and despair. Or what is worse, they will be given
a self-help program or techniques that may actually work in
stopping the surface behavior addiction but be deceptive to
the point of hindering and blocking the person from entering in
to the kind of surrender really required to bring deep and
lasting change.
Pulling out the props
59
Some of the more confrontational humanistic therapies focus
upon the removing of all defense mechanisms, self-deceptive
self-images, lifestyle justifications, and all other props that help
to define the persons identity before they are truly ready to
deal with the prospect of rebuilding a new life.
The
confrontation techniques used is some therapies can be
effective in removing these props of a false identity, but the
condition that people are left in when these props are
removed is both spiritually and emotionally devastating and
traumatic. The same therapists who remove these props, often
do not have a clue as to what can put in their place. When a
person’s whole system of meaning has been removed, even a
false and deceptive one, and nothingness remains, there are
few things in life more deviating than the stark reality of the
desolation that remains.
In order for a counselor to be able to adequately deal with this
kind of desolation, despair and hopelessness so prominent in a
person’s life, they must be able to offer the very real hope of
our loving God, who alone has the power to transform a
meaningless life into one of true purpose.
Humanistic
techniques can not work at this point because the individual
knows in his heart of hearts, that left to his own devices, he does
not have the energy, power, vision, or strength to overcome
mountain of despair standing before him. He knows in his heart
of hearts that if new life is possible, it has to come from a power
that is higher, wiser, more benevolent, and stronger than
himself.
The props can only be taken away if the counselor is confident
in the promise of God’s truth for the individual. That truth is
found in Jeremiah 29:11, “For I know the plans I have toward
you, says the Lord, Plans to prosper you and not to harm you,
plans that give you hope and a future.”
60
The transformation process
Humanistic therapists who believe that they can change
people by their sharp confrontational techniques deceive
themselves. It is the Holy Spirit who changes us. His spirit
convicts the heart of Man, but then we have the freedom to
choose whether to respond to the conviction power of His spirit
or to harden our heart against it.
A Christian counselor who has a deep and abiding relationship
with the Holy Spirit understands that the best he can do under
the leading of the Holy Spirit is to prayerfully impart the specific
truth that the person is ready to hear. He can not expect that
the person will change in any significant way unless there is a
spiritual transformation brought on by the conviction of the Holy
Spirit and the choice of surrender to God who alone can do it.
Why do an intervention?
An intervention is helpful when the idea is to reinstate the
individual into a context of family and/or friends who are able
and willing to relate to the person in spiritually and emotionally
edifying ways. Intervention will work where there is relational
commitment and accountability. Keep in mind that the
primary reason for the intervention is reinstatement into a
healing social milieu.
The secondary reason to conduct an intervention is to offer an
opportunity to the individual to recognize the harmful effects of
his past behavior and with contrition of heart given by the Holy
Spirit, admit his role and responsibility. The Christian counselor
offers the truth in love connected to the Word of God
pertaining to His redemptive and resurrection power.
61
A good intervention is the gateway to future recovery and a
new life full of peace, purpose, and joy.
Under what conditions is it possible to do a family intervention?
 The person with the problem is not forced, coerced,
intimidated, or pressured into participating.
(Must be
completely voluntary)
 Family members and friends are willing to make
accountability commitments
 All participants agree to abide by the rules pertaining to the
expression of “concerns”.
 The person identified as having the problem is willing to hear
from significant friends & family members with a humble,
teachable spirit.
In some cases a stranger such as a counselor, policeman,
pastor, or parole officer may be the only family a person has.
One of life’s greatest tragedies is when a person is either an
outcast from a hateful and mean dysfunctional family, or the
only remaining, living member of the family. The Bible says that
the Lord puts the orphan into families. Unfortunately the devil
does the same thing. If the person turns to the Lord for His
redemption, the Lord places him among the sheep of His
pasture.
Between such persons is found joy, love and
edification of mind and spirit. If the person turns to evil minded
people to be his companions and forsakes God, that person
finds himself among people who will influence him to do all evil
behaviors the result of which will be depression, despair, and
ultimately death.
Sometimes as a Christian counselor, we have the opportunity to
see someone who has lived a hermit like existence, alone in a
hostile world with nothing but the voices of his mind to guide
him. It’s possible that this person has suffered from loneliness for
62
so long that he might have suicidal tendencies. For such as
these who may be in despair, you as their counselor represent
their only hope. In you they must see an extension of the love
of God for them. You will only be able to give them this love if
you yourself have nurtured a deep personal relationship with
the Lord. Humanistic therapists often try to extend a humanistic
love to their clients, but it is not strong enough to last through
the course of therapy because it is only a counterfeit of God’s
love that ultimately fails. Instead, the Christian counselor should
have nurtured strong relationship with God that His love should
be seen shining through.
DEALING WITH DENIAL
Planting the seed that takes root at a later date
It is not easy to penetrate the defenses of one who is actively in
denial. The Bible tells us to not cast our pearls before swine.
The intended meaning of this guidance from the Lord is to be
careful who you share God’s precious wisdom and truth with.
The wisdom and truth that was given to you as a Christian
counselor is precious like pearls and would be received by
people inclined to God and His wisdom as the precious
commodity it is. But Proverbs 29:6 says, “Do not speak in the
ears of a fool, for he will despise the good sense of your words.
But there are those who are in transition from a foolish lifestyle
to the new life that only the Lord can provide. For these we
may plant seeds that can take root immediately or at a later
date depending upon the spiritual state of the client. The Bible
speaks of four possible spiritual states that will determine the
degree of receptivity of our client. 1) Seed fallen by the
roadside; 2) Seed fallen upon stony places; 3) Seed fallen in
thorn bushes; and 4) Seed fallen upon good ground.
It is
helpful to us as counselors to look at ourselves as seed sowers in
the context of the parable of the seed sower. Read the
63
parable and see if you can understand the 4 types of ground
that the seed fell upon. What understanding does this parable
give you in terms of which condition of your client will allow for
which responses. The parable goes like this:
“…Behold, the sower went out to sow. And in his sowing, some
fell by the roadside, and the birds came and ate them. And
other fell on the stony places where they did not have much
earth, and it immediately sprang up because it had no
deepness of earth. And the sun rising, it was scorched; and
because of having no root, it was dried up. And other fell on
the thorn-bushes, and the thorn-bushes grew up and choked
them. And other fell on the good ground and yielded fruit;
indeed, one a hundredfold, and one sixty, and one thirty. The
one having ears to hear, let him hear. Matthew 13:3-9
Everyone hearing the Word of the kingdom, and not
understanding, the evil one comes and catches away that
which was sown in his heart. This is that sown by the roadside.
And that sown on the stony places is this: the one hearing the
Word, and immediately receiving it with joy, but has no root in
himself, but is temporary, and tribulation, or persecution
occurring because of the Word, he is at once offended. And
that sown into the thorn bushes is this: the one hearing the
Word, and the anxiety of this age, and the deceit of riches,
choke the Word, and it becomes unfruitful. That sown on the
good ground is this: the one hearing the Word, and
understanding it, who indeed bears and yields fruit, one truly a
hundredfold, and one sixty, and one thirty. Matthew 13:19-23
Explain your understanding of the following imagery contained
in the parable of the seed sower:




Seed fallen on the Roadside – eaten by the birds
Seed fallen on Stony places – burnt up by the sun
Seed fallen into Thorn bushes – choked by deceitful riches
Seed fallen on good ground – bearing fruit
64
Communicating negative judgment (the evil eye)
As people of discernment, it is easy to see behaviors that are
less then healthy in the people we counsel. A common mistake
made by counselors, pastors and others who would intervene in
people’s lives is that during these behaviors the counselor will
give a look of disapproval or disgust, often without even
realizing it. It shows up to your client as a krinkle in the
forehead, a dip in the brow, a change in posture, or a dirty
look. But it conveys the message, “Your are despised!”, “Your
no good!”, “Your weird!”, “Boy do you really have a problem”.
That subconscious krinkle on the forehead that you carelessly
communicated to your client, may have just reinforced the
constellation of put-downs and lies that have been
propagated for decades by the enemy of your client’s soul,
reinforcing his problem. It also communicated the fact that
you can’t be trusted to be a person that can be trusted to not
pass judgement. You’ve just lost your opportunity to be a useful
influence in your client's life.
With maturity the Christian counselor learns not to react to their
clients less than edifying behaviors.
In fact, the mature
Christian counselor disciplines himself as an act of love. The
Bible says that, “Love covers a multitude of sin.” It is therefore
better to overlook many behaviors so you could impart the one
truth that your client most needs to hear. If the Lord’s leading
and your love are partnering together, your divine charge will
accept it. And by disciplining yourself to strain out the
destructive power of “the evil eye”, you will have developed a
Godly style that has filtered out many openings that Satan
once had available through you to do his destructive work.
If the individual is reprobate, there may be a leading to curtail
the intervention.
65
One of the devil’s wiles to the work we do is to send people to
us who really do not intend to change through the intervention.
They are there for any number of reasons all of which can meet
satan’s design to obstruct and hinder the valid and effective
work of the ministry. This is a chief reason why it is important for
all participants to be prayerful before and during an
intervention. With the spiritual discernment of a prayed up
counselor and their sensitivity to the Holy Spirit, the Lord may
give a definite leading to stop the intervention. If this happens,
the counselor should inform the individual of the Lord’s leading
to not continue. The Lord will take care of the rest.
When to avoid an intervention
When the individual:
 Is reprobate
 Does not want to change
 Insists upon having active substance abusing friends present
 Insists upon having family members who are active
substance abusers present at intervention
We don’t use force or intimidation to get someone to do an
intervention (bribery is okay).
Use of force and intimidation is unethical and never okay. In
order for the individual to be open to receiving anything from
the intervention he should be there by his own free will. Caring
family members, however, motivated by their love for the
individual, have used incentives to get the family member to
the first session of the intervention. Though some individuals
may not have arrived unless the incentive was given, after
attending the first session of the intervention, their ignoble
reasons for attending have been replaced by new knowledge
and desire to continue.
66
When it is clear that the individual does not want to change
It is clear that an individual does not want to change if they say
so. If that is the case there is not a lot we could do unless the
Holy Spirit gives us something to say at that point. There are
Biblical examples of incidents in which the Lord would have a
word thorough one of His servants to such an individual. The
Prophet Nathan delivered a word to King Saul, Daniel to
Nebuchadnezzar, to cite two examples. These kinds of things
happen frequently in today’s world through men and women
who enjoy a rich prayer life and have nurtured a strong
personal relationship with the Lord.
Outside of a direct word from the Lord about a person, an
intervention should be offered to individuals who express a
desire to change.
When it is not clear what a “friend’s” spirit is
Sometimes a person who is making a sincere lifestyle change
has been accompanied by a “friend” who has no intention of
really helping them. The Bible speaks of being aware of wolves
among the sheep. The counselor can know and try the way of
the people involved in the ministry or therapeutic process. In 1st
John 4:1 it says “…test the spirits whether they are of God.” In
Jeremiah 6:27-30 it says, “I have set thee for a tower and a
fortress among my people, that thou mayest know and try their
way. They are grievous revolters, walking with slanders …
Reprobate silver shall men call them, because the LORD hath
rejected them”. Our desire is to help everyone, but in wisdom
we must become aware of the existence of these kind of
people and their tendency to work themselves into the midst of
God’s people.
67
We should not try to help someone who God has given over to
a reprobate mind.
God has given us free choice and only He can see the choices
we ultimately make. The Bible says that He has predetermined
us to follow one course or another. This may seem like a
contradiction or a paradox, but because only God has the
ability to know what we shall ultimately choose, He knows best
how to predetermine our course. To those whom he knew
would choose evil, He gave them over to evil. “And even as
they did not like to retain God in their knowledge, God gave
them over to a reprobate mind, to do those things which are
not convenient…” Romans 1:28
What are the symptoms of a reprobate mind?
The Bible defines a reprobate as someone who is committed to
and practices all kinds of evil.
“Being filled with all
unrighteousness,
fornication,
wickedness,
covetousness,
maliciousness; full of envy, murder, debate, deceit, malignity;
whisperers, Backbiters, haters of God, despiteful, proud,
boasters, inventors of evil things, disobedient to parents,
Without understanding, covenant breakers, without natural
affection, implacable, unmerciful; Who knowing the judgment
of God, that they which commit such things are worthy of
death, not only do the same, but have pleasure in them that
do them.” Romans 1:28-32
“They profess that they know God; but in works they deny him,
being abominable, and disobedient, and unto every good
work reprobate.” Titus 1:16
DEALING WITH THE PROBLEM
The initial purpose
68
The primary purpose of an Intervention is to allow the individual
to admit there is a problem, to see how serious it is, and agree
to enter into a program of change.
At the beginning of the therapeutic relationship it is important
for the counselor to get an understanding of the problem, so
there must be a focus on the problem at first. But it’s not a
good idea to give too much emphasis to the problem. The
Christian counselor moves on to the solution and put the focus
there as soon as possible. Humanistic counselors often deal
with an ever deepening analysis of the “problem” all the way
through. This is not necessary and often does more harm than
good.
The secondary purpose
Our goal to help the person admit they have a problem, not by
heavy confrontation, but by allowing family members to
express their “concerns”. Once the individual has crossed this
threshold they are ready for the development of a treatment
plan which is the secondary purpose of a good intervention.
Take care of physical needs first
A hungry man or a man in pain can not easily receive freedom
giving truth into their life. Therefore, it is important to tend to first
things first.
If they are hungry, give them a hearty meal. Notice if there are
any indications of illness that must be treated by a physician.
We must be observant as whether or not the individual is in
need of medical care. If they are hurting, if their physical wellbeing is in jeopardy, this must be taken care of first. Seek the
Lord for what to tell the person on the way to the doctors, or
the emergency room if you can see that this is where they
need to go.
Use of the ASI as a guideline to learn of areas that need
attention
69
The Addiction Severity Index, best known as the ASI, is used in
recovery programs all around the country. Presently it is the
most widely used diagnostic, paper and pencil instrument in
use. It not only is used to get a profile understanding of the
person, but also has high utility as an interviewing tool and
treatment plan guidance tool. By using the ASI, the individual
has the opportunity to tell us something about the seven major
areas of life that are important for the counselor to know.
The tool also can be abused. It can easily be used to mislead
the counselor if the questions are answered untruthfully. We will
cover the ASI more thoroughly in the chapter that deals with it
in this book.
How much emphasis on the problem should there be?
There needs to be enough emphasis on the problem so that
the person understands that there is one, and that it has had
destructive consequences in his life. Sometimes there are also
glimpses of new insights that gives a new perspective that may
come after a while. But for the most part the intervention will
deal with “concerns” of loved ones so that the person can
better understand how his substance abusing behavior
effected those around him.
As soon as family members and friends had an opportunity to
express their concerns, the rest of the intervention needs to be
spent on the identification of the ministry gifts, skills and abilities
that each family member and friend possesses and what each
of their roles will be in the development and working out of the
treatment plan.
Avoid excessive diagnostic probing
70
After the first, or at most 2nd session, in most cases you have
completed all your diagnostic work …the rest of the
intervention should be spent focusing upon the solution. Many
Psychiatrists and Psychologists have been known to spend
years seeing their clients every week in sessions that delved
ever more deeply into their problems. Sometimes, after years
of such delving, at best you have only a high analyzed and
defined problem, but not much of a solution, at worst you have
a highly creative analysis of a false interpretation that offers no
utility in offering the client a solution.
Aptly apply the Word of God
Which scripture would you apply to someone who feels
crushed, beaten, and despairing?
Both of the following
scriptures are true but applicable to different people in
different stages of spiritual transformation:
“Let him turn aside from evil, and let him do good. Let him seek
peace, and pursue it; because the eyes of the Lord are on the
righteous, and His ears open to their prayer. But the face of the
Lord is against those who do evil things." 1 Peter 3:11-12
“Come to Me, all those laboring and being burdened, and I will
give you rest. Take My yoke upon you and learn from Me,
because I am meek and lowly in heart, "and you will find rest to
your souls. For My yoke is easy, and My burden is light. Matthew
11:28-30
The misapplication of scripture is something frequently done by
pastors and lay ministers who do not minister in the Love of the
Lord and through the leading of the Holy Spirit. The Church at
large is plagued by churches that minister “legalism”, but forget
about grace and love. By doing so they are like guilt factories
that minister death instead of life. Beware of churches that
focus upon your sin but fail to give the message of grace
71
accomplished by the work of Jesus Christ on the cross. Romans
8:2 says,
“ For the Law of the Spirit of life in Christ Jesus set me free from
the law of sin and of death.”
Jesus Christ came not only to comfort the afflicted but also to
afflict the comfortable. But in our role as counselors we need
to know which function we need to perform on any specific
occasion. If we give comfort to one who needs to be
prodded, we keep that person in bondage. On the other
hand, if we prod to good works a person who most needs to
hear about hope of new life, they may not be able to forebear
without having first received the message of hope, forgiveness,
and new life to encourage them.
IDENTIFYING THE ADDICTION STRONGHOLDS
(THE STEPS TO FREEDOM IN CHRIST)
Interventions in which the interventionist is able to gather
together a group of concerned family members are always
good opportunities to impact not only the individual, but the
whole family as well. The truth is that when one member of the
family has a problem, the whole family has a problem. It is also
true, but not usually seen at first by family members, that the
person for whom the intervention is called, the person with the
presenting problem, is not always the person with the worst
problem. It may be the most visible, but very often, other family
members have hidden problems that may even be more
severe than the problem belonging to the person for whom the
intervention is called.
Therefore, we look at the family
intervention as an opportunity to minister, counsel and teach
the whole family, not only one person.
One of the best uses of a family intervention is to go through
the Steps to Freedom in Christ found in Appendix A of this
manual.
72
The Steps to Freedom in Christ cover 7 significant areas that
people most commonly get stuck in and have the greatest
difficulties getting free from, in life. The 7 steps are:
 Discerning the Counterfeit from the Real and renouncing all
past counterfeit spiritual experiences and involvement
 Discerning Deceptive thinking patterns from the truth and
renouncing all past deception, self-deception, and selfdefense.
 Renouncing resentment and bitterness that we have
harbored in our hearts declaring God’s forgiveness of us and
our forgiveness of those who have sinned against us,
whether they deserve it or not.
 Renouncing rebel attitudes against the authority of God in
our lives and against the authorities he has put in our lives.
 Renouncing prideful attitudes that cause us to think more
highly or lowly of ourselves than we ought.
 Renouncing habitual sin.
 Renouncing Generational sin.
These 7 steps are powerful and effective in breaking down
strongholds (deeply entrenched areas of addiction). Included
in Dr. Neil Anderson’s discussion of the 7 steps located in
Appendix A at the end of this manual are checklists that can
help you identify areas that you may have not thought of
before. Go through each one diligently, with sincerity of heart,
and humbly before your God as you recite the prayers
associated with each one.
Spiritual Warfare Prayer
Hal Lindsey authored a book entitled, “Satan Is Alive And Well
On Planet Earth”. Though it is not pleasant to think about the
reality of the person known as “Satan” or the “Devil”, in order to
ever get free of the spiritual bondages that beset human
73
beings, we must accept the fact that he is real and he is the
one who has put human beings ignorant of his wiles in
bondage. People who do not believe in the existence of satan
are the ones who are most vulnerable to his traps. There are
even professing Christians who do not believe in the reality of
satan. They should ask themselves how is it that they can
believe in God, but not His antithesis. If God is real doesn’t it
reason out that satan is too? They should ask the question,
“Where does evil come from?”, “What is its origin”. Every
believer knows that a Holy God did not bring evil into this world,
yet we all know that evil exists. Where than did it come from?
Every Christian counselor must be able to answer this question
as it was answered in the title of Hal Linsey’s book by saying yes,
indeed, satan is alive and well and living on planet earth.
Equipped with this fundamental understanding, the Christian
counselor can then accomplish due diligence in spiritual
warfare, without which spiritual bondages are not easily
broken.
The necessity to conduct spiritual warfare is clearly stated in the
book of Ephesians chapter 6. “Finally, my brethren, be strong in
the Lord, and in the power of his might. Put on the whole
armour of God, that ye may be able to stand against the wiles
of the devil. For we wrestle not against flesh and blood, but
against principalities, against powers, against the rulers of the
darkness of this world, against spiritual wickedness in high
places. Wherefore take unto you the whole armour of God,
that ye may be able to withstand in the evil day, and having
done all, to stand. Stand therefore, having your loins girt about
with truth, and having on the breastplate of righteousness; And
your feet shod with the preparation of the gospel of peace;
Above all, taking the shield of faith, wherewith ye shall be able
to quench all the fiery darts of the wicked. And take the helmet
of salvation, and the sword of the Spirit, which is the word of
God: Praying always with all prayer and supplication in the
74
Spirit, and watching thereunto with all perseverance and
supplication for all saints.” Ephesians 6:10-18.
Spiritual Warfare Prayer is more effective, the more we
understand God’s Word. Unless we understand the hundreds
of promises contained in His word that apply to us as believers
and inheritors of His Kingdom authority and power we can not
with authority and conviction tell the devil to get his hands off
of whatever he tries to steal from us. The devil is a thief and a
liar, but until we know what he is trying to steal from us and the
lies he is telling us, we can not claim back from him the things
that belong to us. Some of the things we have to claim back
for ourselves as well as our clients are things like self-respect, joy,
peace, and self-determination. Also anything else that satan
has stolen like family members, friends, land, finances and the
power to accomplish God’s plan for your life.
Leading the individual to the threshold of their own surrender
In order to lead a person to surrender in a certain area of life, to
be effective, it is helpful if the counselor has first successfully
surrendered that aspect of his own life. It is difficult, not to
mention hypocritical, to attempt to counsel with spiritual
authority in an area the counselor has not obtained
overcoming victory brought on by his own surrender.
Teach the true meaning of “surrender”
The word “surrender”, in therapeutic and 12 step program
circles, is often used, but less often understood. Program jargon
such as, “Let go and let God!”, is held near and dear by most
program participants. This jingle is almost a sacred cow among
those to whom twelve step programs serve as a church. But
among those reverencing these words so highly exists a wide
difference of interpretation as to their meaning. To some, “Let
75
go and let God” means to, stop holding on so tight; to others,
these words mean to give up and cease your efforts; and still to
others it means to cease stubbornly doing things your own way
and begin seeking, trusting and obeying God’s way.
Biblical Christians believe that the latter interpretation of “Let
go and let God” or “Surrender” is the only one that is effective.
The other two interpretations can lead to a spiritual dead end.
It is only the third interpretation that requires a personal
relationship with God and it is only in a personal relationship
that true surrender can take place.
The second interpretation of giving up does not require a
personal relationship with God. It only leads to forfeit and
defeat and can be a self-destructive choice in a person’s life.
Giving up, leads nowhere because there is no creative power
from God to inspire and lift the individual up higher than his
own circular thoughts.
The first interpretation of holding on too tight is a bit more
insightful but still likes power greater than yourself.
We believe that the only concept of surrender that works, is
that you have finally arrived at your wits end, and realize that
the best of your human knowledge, ability and skill, can not do
for you, what you can do only in partnership with God,
submitted to Him, trusting in Him, and obedient to His Word and
His leading by the Holy Spirit. You now realize that without His
power and His input, you are hopeless and helpless.
Formulating God’s treatment plan
Once it is clear in an intervention that the individual is willing
and able to surrender his life to God, the second stage of the
intervention is ready to begin. The second stage is the
treatment plan. Every family member and friend present is
76
asked to help with the development of the plan. It should be
done prayerfully and thoughtfully, relying upon the data
obtained from the ASI, the intake interview, and any other
interviews held with the client and the one hand, and from
insights offered by family members on the other.
The areas addressed in treatment planning include (but are not
limited to) the following:
 Spiritual Condition
 Mental Health and Thought Life
 Emotional Life
 Health
 Family Life
 Social Life and Friendships
 Career
 Financial Life
 Legal Issues
Lets take the example of a parolee who has agreed to enter
into an intervention with his family members. Frequently in the
life of parolees, there is some unfinished legal and financial
issues hanging over their head. It could be in the form of
outstanding warrants, or fines that remain to be paid to the
court.
The counselor who deals with this population
understands that these things could be a cause for despair and
hopelessness to those who are under the bondage of them.
These debts seem to the parolee like a mountain that can
never be moved.
A good interventionist will guide the
individual and family to include these things in the treatment
plan which may include a plan to get a job and a budget plan
that sets aside an affordable percentage of the salary to
systematically take care of these outstanding fines. Alone, the
individual might feel that he could ever manage these things,
but with the loving accountability of a family member or friend
he can trust, it can be accomplished with much less confusion
and difficulty. This kind of family support is priceless. But in
77
cases where there is no family support, the interventionist or the
counselor may be a point of accountability to give this support.
In developing initial treatment plan statements for the parolee
example just discussed, the statement might read as follows:
1. John will seek a job in the area of his skill and training in
order to financially stabilize his life.
2. John will meet at least once a month with (a member of the
family skillful with financial management) to go over his
budget and discuss the most appropriate allocation and
distribution of his finances.
3. During the first meeting with (this family member) statements
of long term and short term financial goals will be
establishes and written into the treatment plan.
These three statements are just the beginning. In most cases
they will be amended or changed to meet financial changes
that take place to meet events such as the loss of a job or the
gaining of a pay raise. For these reasons and others, the
treatment plan statements and goals must be reexamined
periodically and especially whenever there is a change of
status.
The interventionist is not responsible for the treatment plan
content
The interventionist supplies the guidelines and acts as a referee
to keep the family on track. In doing so he may offer teachings
on topics that will help guide the individual and the family
members into making wise decisions and taking wise actions.
But in order for the treatment plan to be accepted by the
family and worked on by the individual, it must be understood
that they are the ones who are ultimately responsible for the
treatment plan content. In cases where the interventionist has
put together the treatment plan alone without the input and
78
agreement of the individual or family members, it is seen as an
outside imposition and is usually discarded at the first
opportunity. An important goal of a good intervention is to
impart to the family that the treatment plan is theirs and they
have ownership of it to do what they want. Our part as
interventionists and counselors is to train them and guide them
but not to live their lives for them. Getting the individual used to
a “compliancy” life-style will sooner or later end in failure. The
wisdom contained in a good treatment plan must be
surrendered to in the same way that one would surrender to
God’s truth, and then owned by the individual as his journey
out of darkness.
Facilitate family involvement in creating the treatment plan
The best way to facilitate family involvement in the creating of
the treatment plan is to find out what the gift and skill areas of
each family member are. This can be done by asking each
member to take the spiritual gift test, and through questions
asked during the interview conducted by the interventionist
prior to the intervention.
Having an influence on the treatment plan development of
social workers in government agencies
Most families don’t realize how overworked most social workers
are and how welcomed a treatment plan put together by a
concerned family would be. In many cases the social workers
will allow the family to write the treatment plan for them, or
have input into the treatment plan, because they are so
overworked and don’t have the time to develop a thoughtful
plan for each case in their huge caseloads. This is a good
opportunity to make sure that a good and biblical treatment
plan is executed. If the family does not get involved, the social
worker is free to send the individual to facilities, programs and
79
counselors using therapies and practices that may stand in
opposition to God’s word.
Involve the right kind of friends, family, and church members as
accountability partners.
The family members and friends desiring to participate in the
intervention should be carefully screened by the interventionist.
There are certain categories of people that would not be
helpful to the intervention if they were asked to be part of it.
These categories include family members and friends who:
 Are presently substance abusers and have no intention of
quitting
 Do not have the time or can not find the time needed to
commit to helping the family member in need
 Have a dislike, hatred or critical attitude toward the
individual
 Are not trusted by the individual
Intervention Rules
Rules are important because they 1) They give the participants
a sense of security and safety that is needed; 2) They provide
guidelines and boundaries for effectiveness; and 3) They
inhibit family members and friends from making destructive
statements or taking destructive actions. There must be rules
set that the participants can understand and agree to. While
no rules will lead to chaos and destruction of the process, too
many rules can be burdensome and lead to confusion. An
intervention typically works best when no less then one and no
more than 7 rules are applied. The following list of rules is an
example of a good set for a typical intervention:
80
1) All statements must be in the form of loving expressions of
care and concern.
2) Judgmental or critical statements are strictly forbidden. If a
participant makes such a statement they will be given one
warning to not make further judgmental or critical
statements. If they persist they will be excused from the
intervention.
(Some dysfunctional family members are
simply not able to abide by the rules and must be excused)
3) One person speaks at a time
4) There is no cross talk
5) Each participant must actively participate in the carrying
out of the treatment plan the best they can.
The number of sessions may be anywhere from 1 to 3 leading to
ongoing family meetings
A typical intervention is one, two, or three sessions of 2 to 3
hours each. But the hope is that if the intervention is successful,
it will lead to the restoration of family meetings that could be
ongoing indefinitely. The best possible outcome would be the
establishment of something like a weekly family bible study; a
time in which family members could draw closer to God and
one another, study God’s Word, pray, and heal. Over time this
will result in deep family intimacy, support and love that would
add great strength to the lives of all family members.
The Interventionist is not a member of the family or group of
friends, but a family advocate, referee, guide and leader
The interventionist is the person with the wisdom, skill and
expertise to conduct the intervention. He is not a family
member or friend though later, in a different role, he may
become considered as one by family and friends. But for the
purpose of conducting a successful intervention he must
maintain a professional detachment in order to be effective.
81
The interventionist’s role as family advocate requires that he
use great care that all of his statements uphold the family as a
supportive unit, and each member as a functional person. To
do this, the interventionist must actively look for and affirm
every good quality, spiritual gift, and skill that he could detect
in every family member, friend and especially the individual for
whom the intervention has been convened. It can’t be
emphasized enough how important it is to locate and publicly
affirm as many good qualities of the individual as possible. This
will protect him from a burden of shame and afford him the
freedom to receive and interact at optimum levels with family
members and friends.
The interventionist’s role as referee requires that at times he
must stop the beginnings of critical, judgmental or destructive
conversation from going any further before it does any harm.
In his role as referee he might have to issue a warning to one of
the family members not to proceed in the way he was going.
This warning may take the form of a friendly reminder of the rule
with a coaching on how to restate his concerns in a nonjudgmental, critical or destructive use of words and tone of
voice. Sometimes family members may also need to be
coached about the use of an angry look.
In his role as guide, the interventionist may need to redirect the
conversation to either avoid critical, destructive or judgmental
statements, or, encourage the identification of strengths, skills or
statements containing solutions.
The guide role of the
interventionist will also have to teach at times by shedding light
and giving wisdom and understand to areas of
misunderstanding.
The interventionist as a leader must be seen as one who is
confident in his level of knowledge, skill and expertise to earn
family trust. He must also be seen as a person of high moral
character, a man or woman who is able to be firm and
82
decisive at a time when there may be disagreement. There
should be no doubt that the interventionist is in overall control
of the direction of the intervention at any given time. (Be
careful to discern the difference between your true goal of
having control of the intervention, and having control of the
people, which would not be your goal).
Concerns must be stated as loving concerns … not angry
accusations
One of the reasons why secular interventions so often end up in
explosive anger with people walking out of the session, never
willing to try again, is because there is not a rule (or people are
not disciplined enough to obey the rule) to state their concerns
in love while avoiding using it as an opportunity to dump their
anger, rage and hostility.
Example of the effects of expression of concern degenerating
into an angry accusation:
Jim the brother of John: “John, when you stopped coming to
our family outings, it was a slap in the face to mom & dad.
You’re a selfish ignoramus who only thinks about himself!”
John’s likely response: “Listen, idiot! You don’t even have a
clue as to why I stopped coming! What do you care anyway!
I’m outa here!”
Notice that no loving concern is expressed; that no feelings are
owned by the first communicator; and an angry accusation
was made. These kind of remarks usually lead to a defensive
reaction and reactive anger. But let’s look at what could have
been said instead that would have put in motion a positive flow
of energy:
Jim the brother of John: “John, when you stopped coming to
our family outings, I missed my brother. I love you, John, and
there was something important missing when you weren’t
there.”
83
John’s response now might be: “Jim, I really didn’t know you
missed me all that much. Truth is, I missed you and the family as
well!”
Notice how this more positive response can lead the
interventionist to guide the intervention into writing treatment
plan goals to include periodic family meetings, which all family
members should make their best effort to attend. It’s okay for
the interventionist to suggest a goal but not to decide on one
without the permission and agreement of the family. It must be
owned by the family members, who are free to change the
wording to meet their specific needs. But one of the primary
goals of the intervention is to make a way for on-going family
gatherings for the purpose of practicing more positive family
communication skills and experiencing deeper and more
meaningful family intimacy.
Admitting the problem and preparedness to work on it
There is danger in focusing upon the problem too long. We’ve
mentioned it before because of the importance of this
understanding, and we will mention it again. Although it is
necessary to discuss the problem so the individual could
accept the fact that he has one, so often the focus is more on
analyzing and delineating the problem, without ever getting
involved in the solution. If by the end of the first session, the
individual isn’t ready to admit that he has a problem, he
probably won’t come back for the next session.
The process of facing the problem is best followed by
discerning the individual’s attitudes about a number of things.
Following is a list of things to do and to look for in order to
discern if the individual is ready for the intervention. Following is
a list of actions that will help the individual face their problem:
84
 Ask the individual to explain why he decided to come to the
intervention
 Discern his level of motivation for being their…anything less
than desperate, might need more time and prayer.
 Discern if there are people there that he feels uncomfortable
with.
 Teach and model the proper way of expressing concerns to
everyone participating in the intervention.
 Focus on expressing an appreciation for the good qualities
that the individual possesses. (must be truthful and not trivial)
 Expressions of concerns related to the individual’s behaviors
and family members feelings may then be expressed only if
the behaviors are not expressed with finger wagging, and
the feelings are owned by the family member expressing
their true feelings with vulnerability.
 Discern how the individual is responding:
defensive,
contemplative, receiving, or a combination of emotional
responses. Correct discernment at this stage will guide the
interventionist on what to do next.
 If the individual appears defensive, it would be wise to break
into a general teaching to all family members than to focus
upon the individual.
 Discern the spirit of the person: Is it rebellious, mocking,
angry, or prideful? If so, little ground would be gained at this
time by proceeding. If you proceed when the individual is
exhibiting these attitudes, it is easy to further damage
already tattered family relationships.
 If the person seems contemplative, stay in a teaching mode
for a while then ask probing and open ended questions so
the individual will reveal their thoughts, attitudes and
feelings.
 If the individual is receptive and admits to having a problem
that they want help with, you can go directly to the family
gift and skill learning mode followed by treatment planning.
Greater focus must be on the solution than on the problem
85
Enough of the intervention time should be focused upon
harnessing the family’s spiritual gifts and skills for the purpose of
developing and implementing the treatment plan. It would be
a good idea to administer the Spiritual Gifts Inventory prior to
the first session when that is possible. The last part of the
intervention time should be focused upon writing the treatment
plan and determining the specifics about what role each
person will play in implementing it.
A powerful exercise useful in pointing out the participant’s gifts
and strengths
Every family member and friend gets an opportunity to express
to the individual truthful observations that they have made
about the individual related to his positive areas of gifting and
strengths. This is especially powerful because all too often all
the individual has heard from anyone has been related to their
substance abusing behavior or something negative. This can
be an extremely edifying and uplifting experience for the
individual and prepare him for the harder work to come.
Everyone plays an accountability role acceptable to the
individual
During the actual treatment planning phase a list of ways that
family members and friends could help is drawn up by the
intervention participants. Such things as “drive John to job
interview”, “go with John to court”, “give John a call to see
how he is doing every other week”, “conduct a bible study with
John,” are drawn up based upon the gifts and skills of family
members that became apparent during the intervention.
Family members will make a commitment to following through,
though perfection is not expected.
86
For the post-intervention work to be effective the individual
should:
 Agree to commit to a church family
 Agree to pray with prayer partners
 Agree to abide by the treatment plan
CHAPTER 7
PHARMACOLOGY AND THE EFFECTS OF DRUG ABUSE
87
Course Objective: The student will know the structures and
functions of the brain and the central and peripheral nervous
systems. The student will also know the immediate and longterm effects of each drug on the brain and other tissues, organs
and systems of the human body.
THE BRAIN AND THE NERVOUS SYSTEM
Neurons
The human body is made up of trillions of cells. Cells of the
nervous system, called nerve cells or neurons, are specialized to
carry "messages" through an electrochemical process. The
human brain has about 100 billion neurons. The neurons carry
messages electrochemically through what is called action
potential.
Neurons come in many different shapes and sizes. Some of the
smallest neurons have cell bodies that are only 4 microns wide.
Some of the biggest neurons have cell bodies that are 100
microns wide. (1 micron is equal to one thousandth of a
millimeter).
Neurons are the oldest and longest cells in the body. You have
many of the same neurons for your whole life. Although other
cells die and are replaced, many neurons are never replaced
when they die. In fact, you have fewer neurons when you are
old compared to when you are young. Neurons can be quite
large - in some neurons, such as corticospinal neurons (from
motor cortex to spinal cord) or primary afferent neurons
(neurons that extend from the skin into the spinal cord and up
to the brain stem), can be several feet long.
Neurons are similar to other cells in the body because:
88
 Neurons are surrounded by a cell membrane.
 Neurons have a nucleus that contains genes.
 Neurons contain cytoplasm, mitochondria and other
"organelles".
 Neurons carry out the basic processes of protein synthesis
and energy production.
However, neurons differ from other cells in the body because:
 Neurons have specialized extensions called dendrites and
axons.
 Dendrites bring information to the cell body
 Axons take information away from the cell body.
 Neurons communicate with each other through an
electrochemical process.
 Neurons contain some specialized structures called synapses
and neurotransmitters.
Types of Neurons
One way to classify neurons is by the number of extensions that
extend from the neuron's cell body (soma).
 Bipolar neurons have two processes extending from the cell
body (examples: retinal cells, olfactory epithelium cells).
 Pseudounipolar cells (example: dorsal root ganglion cells).
Actually, these cells have 2 axons rather than an axon and
dendrite. One axon extends centrally toward the spinal cord,
the other axon extends toward the skin or muscle.
 Multipolar neurons, such as spinal motor neurons, have many
processes that extend from the cell body. However, each
neuron of this type has only one axon.
Axons and Dendrites
Axons take information away from the cell body and have the
following characteristics:
 Axons have a smooth surface
89




1 axon per cell
Contains no ribosomes
Can have myelin
Branch further from the cell body
Dendrites bring information to the cell body and have the
following characteristics:





Rough Surface (dendritic spines)
Usually many dendrites per cell
Have ribosomes
No myelin insulation
Branch near the cell body
The inside of a neuron
A neuron has many of the same "organelles," such as
mitochondria, cytoplasm and a nucleus, as other cells in the
body.
 The Nucleus - The nucleus contains genetic material called
chromosomes which includes information for cell
development and synthesis of proteins necessary for cell
maintenance and survival. It is covered by a membrane.
 The Nucleolus - The nucleolus produces ribosomes necessary
for translation of genetic information into proteins
 Nissl Bodies - groups of ribosomes used for protein synthesis.
 Endoplasmic reticulum (ER) - system of tubes for transport of
materials within cytoplasm. Can have ribosomes (rough ER)
or no ribosomes (smooth ER). With ribosomes, the ER is
important for protein synthesis.
 Golgi Apparatus - membrane-bound structure important in
packaging
peptides
and
proteins
(including
neurotransmitters) into vesicles.
 Microfilaments/Neurotubules - system of transport for
materials within a neuron and may be used for structural
support.
 Mitochondria - produce energy to fuel cellular activities.
90
Neuroanatomy
Neuroanatomy: the structure of the nervous system. To learn
how the nervous system functions, you must learn how the
nervous system is put together.
The nervous system can be divided into several connected
systems that function together. Let's start with a simple division:
The Nervous System is divided into:
The Central Nervous System and the Peripheral Nervous System.
Central Nervous System
The central nervous system is divided into two parts: the brain
and the
spinal cord. The average adult human brain weighs 1.3 to 1.4
kg
(approximately 3 pounds). The brain contains about 100 billion
nerve cells called (neurons) and trillions of "support cells" called
glia. The spinal cord is about 43 cm long in adult women and 45
cm long in adult men and weighs about 35-40 grams. The
vertebral column, the collection of bones (back bone) that
houses the spinal cord, is about 70 cm long. Therefore, the
spinal cord is much shorter than the vertebral column. For brain
weights of other animals, see brain facts and figures.
Peripheral Nervous System
The peripheral nervous system is divided into two major parts:
the somatic
nervous system and the autonomic nervous system.
Somatic Nervous System
91
The somatic nervous system consists of peripheral nerve fibers
that send
sensory information to the central nervous system and motor
nerve fibers
that project to skeletal muscle. The cell body is located in
either the brain or spinal cord and projects directly to a skeletal
muscle.
Autonomic Nervous System
The autonomic nervous system is divided into three parts: the
sympathetic
nervous system, the parasympathetic nervous system and the
enteric nervous system. The autonomic nervous system controls
smooth muscle of the viscera (internal organs) and glands.
The preganglionic neuron is located in either the brain or the
spinal cord. This preganglionic neuron projects to an
autonomic ganglion. The postganglionic neuron then projects
to the target organ.
The somatic nervous system has only one neuron between the
central nervous system and the target organ while the
autonomic nervous system uses two neurons.
The enteric nervous system is a third division of the autonomic
nervous system that you do not hear much about. The enteric
nervous system is a meshwork of nerve fibers that innervate the
viscera (gastrointestinal tract, pancreas, and gall bladder).
Divisions of the Nervous System
92
The brain is divided into two halves, called hemispheres. Each
hemisphere communicates with the other through the corpus
callosum, a bundle of nerve fibers. (Another smaller fiber
bundle that connects the two hemispheres is called the
anterior commissure).
Central Nervous System and the Peripheral Nervous System
differences
Differences between the Peripheral Nervous System (PNS) and
the Central Nervous System (CNS):
In the CNS, collections of neurons are called nuclei. In the PNS,
collections of neurons are called ganglia. In the CNS,
collections of axons are called tracts. In the PNS, collections of
axons are called nerves.
In the Peripheral Nervous System, neurons can be functionally
divided in these ways:
 Sensory (afferent) - carry information into the central nervous
system from sense organs.
 Motor (efferent) - carry information away from the central
nervous system (for muscle control).
 Cranial - connects the brain with the periphery.
 Spinal - connects the spinal cord with the periphery.
 Somatic - connects the skin or muscle with the central
nervous system.
 Visceral - connects the internal organs with the central
nervous system.
BRAIN STRUCTURES AND FUNCTIONS
The Cerebral Cortex
93
The functions of the cerebral cortex part of the brain consist of
thought, voluntary movement, language, reasoning, and
perception. The word "cortex" comes from the Latin word for
"bark" (of a tree). This is because the cortex is a sheet of tissue
that makes up the outer layer of the brain. The thickness of the
cerebral cortex varies from 2 to 6 mm. The right and left sides of
the cerebral cortex are connected by a thick band of nerve
fibers called the "corpus callosum." In higher mammals such as
humans, the cerebral cortex looks like it has many bumps and
grooves. A bump or bulge on the cortex is called a gyrus (the
plural of the word gyrus is "gyri") and a groove is called a sulcus
(the plural of the word sulcus is "sulci").
The Cerebellum
The cerebellum governs the functions of movement, balance,
and posture.
The word "cerebellum" comes from the Latin word for "little
brain." The
cerebellum is located behind the brain stem and is similar to
the cerebral cortex as it too is divided into hemispheres and
has a cortex that surrounds these hemispheres.
Brain stem
The brain stem governs the functions of breathing, heart rate,
and blood pressure. The brain stem is a general term for the
area of the brain between the thalamus and spinal cord.
Structures within the brain stem include the medulla, pons,
tectum, reticular formation and tegmentum. Some of these
areas are responsible for the most basic functions of life such as
breathing, heart rate and blood pressure.
94
Hypothalamus
The hypothalamus governs the functions of body temperature,
emotions, hunger, thirst, and daily biological rhythms.
The hypothalamus is composed of several different areas and
is located at the base of the brain. Although it is the size of only
a pea (about 1/300 of the total brain weight), the
hypothalamus is responsible for some very important functions.
One important function of the hypothalamus is the control of
body temperature. The hypothalamus acts like a "thermostat"
by sensing changes in body temperature and then sending
signals to adjust the temperature. For example, if you are too
hot, the hypothalamus detects this and then sends a signal to
expand the capillaries in your skin. This causes blood to be
cooled faster. The hypothalamus also controls the pituitary.
Thalamus
The thalamus governs the functions of sensory processing and
movement.
The thalamus receives sensory information and relays this
information to the cerebral cortex. The cerebral cortex also
sends information to the thalamus, which then transmits this
information to other areas of the brain and spinal cord.
Limbic System
The limbic system governs our emotions. The limbic system (or
the limbic areas) is a group of structures that includes the
amygdala, the hippocampus, mammillary bodies and
cingulate gyrus. These areas are important for controlling the
95
emotional response to a given situation. The hippocampus is
also important for memory.
Hippocampus
The Hippocampus is the part of the limbic areas of the brain
that governs the functions of learning and memory.
Basal Ganglia
The basal ganglia are a group of structures, including the
globus pallidus, caudate nucleus, subthalamic nucleus,
putamen and substantia nigra, that are important in
coordinating movement.
Midbrain
The midbrain governs the functions of vision, auditory response,
eye movement, and body movement. The midbrain includes
structures such as the superior and inferior colliculi and red
nucleus. There are several other areas also in the midbrain.
Refer to the glossary in appendix D at the end of this book for
definitions of these and other brain areas.
BRAIN CHEMISTRY AND NEUROTRANSMITTERS
Communication of information between neurons is
accomplished by movement of chemicals across a small gap
called the synapse. Chemicals, called neurotransmitters, are
released from one neuron at the presynaptic nerve terminal.
Neurotransmitters then cross the synapse where they may be
accepted by the next neuron at a specialized site called a
receptor. The action that follows activation of a receptor site
96
may be either depolarization (an excitatory postsynaptic
potential) or hyperpolarization (an inhibitory postsynaptic
potential). A depolarization makes it MORE likely that an action
potential will fire; a hyperpolarization makes it LESS likely that an
action potential will fire.
Neurotransmitter Criteria
Neuroscientists have set up a few guidelines or criteria to prove
that a chemical is really a neurotransmitter. Not all of the
neurotransmitters that you have heard about may actually
meet every one of these criteria:
 The chemical must be produced within a neuron.
 The chemical must be found within a neuron.
 When a neuron is stimulated (depolarized), a neuron must
release the chemical.
 When a chemical is released, it must act on a post-synaptic
receptor and cause a biological effect.
 After a chemical is released, it must be inactivated.
Inactivation can be through a reuptake mechanism or by an
enzyme that stops the action of the chemical.
 If the chemical is applied on the post-synaptic membrane, it
should have the same effect as when it is released by a
neuron.
Neurotransmitter Types
There are many types of chemicals that act as neurotransmitter
substances. Following is a categorized list of some of the major
neurotransmitters:
Small Molecule Neurotransmitter Substances
 Acetylcholine (ACh)
97





Dopamine (DA)
Norepinephrine (NE)
Serotonin (5-HT)
Histamine
Epinephrine
Amino Acids




Gamma-aminobutyric acid (GABA)
Glycine
Glutamate
Aspartate
Neuroactive Peptides


















bradykininbeta-endorphin
bombesin
calcitonin
cholecystokininen
kephalin
dynorphin
insulin
gastrinsubstance P
neurotensing
lucagon
secretin
somatostatin
motilin
vasopressin
oxytocin
prolactin
thyrotropin
angiotensin
98
Synthesis of Neurotransmitters
Acetylcholine is found in both the central and peripheral
nervous systems.
Choline is taken up by the neuron. When the enzyme called
"choline acetyltransferase" is present, choline combines with
acetyl coenzyme A
(CoA) to produce acetylcholine.
Catecholamines
Dopamine, norepinephrine and epinephrine are a group of
neurotransmitters called "catecholamines". Norepinephrine is
also called "noradrenalin" and epinephrine is also called
"adrenalin". Each of these neurotransmitters is produced in a
step-by-step fashion by a different enzyme.
Transport and Release of Neurotransmitters
Neurotransmitters are made in the cell body of the neuron and
then transported down the axon to the axon terminal.
Molecules of neurotransmitters are stored in small "packages"
called vesicles. Neurotransmitters are released from the axon
terminal when their vesicles "fuse" with another cell where it
activates enzymes for the production of "second messengers."
Neurotransmitters will bind only to specific receptors on the
postsynaptic that recognize them.
The 4 mechanisms that stop the action of neurotransmitters:
1. Diffusion: the neurotransmitter drifts away, out of the synaptic
cleft where it can no longer act on a receptor.
99
2. Enzymatic degradation (deactivation): a specific enzyme
changes the structure of the neurotransmitter so it is not
recognized by the receptor. For example, acetylcholinesterase
is the enzyme that breaks acetylcholine into choline and
acetate.
3. Glial cells called astrocytes remove neurotransmitters from
the synaptic cleft.
4. Reuptake: the whole neurotransmitter molecule is taken
back into the axon terminal that released it. This is a common
way the action of norepinephrine, dopamine and serotonin is
stopped.
These neurotransmitters are removed from the
synaptic cleft so they cannot bind
to receptors.
MAJOR DRUGS OF ABUSE
Acid (LSD)
Lysergic acid diethylamide, better known as LSD, is a chemical
that alters a user's mood, thoughts or perceptions. For this
reason, LSD is grouped a class of drugs known as hallucinogens
or psychedelics. These drugs cause auditory, visual or
somatosensory hallucinations, paranoia or paranoia-like states.
LSD Pills
LSD was first synthesized from a fungus that grows on rye and
other grains. In 1938, Albert Hofmann working in the Swiss
pharmaceutical called Sandoz, produced LSD for the first time.
He was hoping that this new drug could be used to stimulate
circulation and respiration. However, the tests he conducted
were all failures and he forgot about LSD for 5 years. In 1943,
100
Hofmann accidentally ingested (or somehow absorbed) a bit
of LSD and experienced some of the psychedelic effects of this
chemical: dizziness, visual distortions and restlessness. A few
days later he prepared 0.25 mg of LSD in water and drank it. He
again experienced the mood and thought altering effects of
LSD.
Effects of LSD on the Nervous System
LSD is water soluble, odorless, colorless and tasteless. It is a very
powerful drug; a dose as small as a single grain of salt (about
.01 mg) can produce some effects. Psychedelic effects are
produced at higher doses of from .05 - .1 mg.
The effects of LSD depend on a user's mood and expectations
of what the drug will do and last several hours. The behavioral
effects that LSD can produce include:
Feelings of
"strangeness", vivid colors, hallucinations, confusion, panic,
psychosis, anxiety, fear, happiness, sadness
Physical Effects include increases in heart rate and blood
pressure, chills, and muscle weakness.
Distortion of the senses and of time and space "Flashback"
reactions are the effects of LSD that occur even after the user
has not taken LSD for months or even years.
Tolerance to the effects of LSD develops quickly and users must
increase their intake of LSD to get the same effects. The exact
neural pathways that are affected by LSD are not completely
known. LSD has a chemical structure that is very similar to the
neurotransmitter called serotonin.
It is thought that the effects of LSD are caused by stimulation of
serotonin receptors on neurons, perhaps in the brain area
101
called the raphe nuclei. However, it is still not clear what
produces all the effects of LSD.
Alcohol
The structure of Ethanol Alcohol may be the world's oldest
known drug. Fermented grain, fruit juice and honey have been
used to make alcohol (ethyl alcohol or ethanol) for thousands
of years. The production of products containing alcohol has
become big business in today's society and the consumption
and abuse of alcohol has become a major public health
problem. On this page, only the effects of alcohol on the brain
and behavior will be discussed. For further information about
other effects of alcohol, see the links at the bottom of this
page.
Alcohol is a central nervous system depressant. There are
several factors that influence how alcohol will affect a person.
These include: age, gender, physical condition, amount of
food eaten, and other drugs or medicines taken.
The Path of Alcohol in the Body
 Mouth: alcohol enters the body.
 Stomach: some alcohol gets into the bloodstream in the
stomach, but most goes on to the small intestine.
 Small Intestine: alcohol enters the bloodstream through the
walls of the small intestine.
 Heart: pumps alcohol throughout the body.
 Brain: alcohol reaches the brain.
 Liver: alcohol is oxidized by the liver at a rate of about 0.5 oz
per hour. Alcohol is converted into water, carbon dioxide
and energy.
102
Effects of low, medium, and high doses
In low doses, alcohol produces a relaxing effect, reduces
tension, lowers inhibitions, impairs concentration, slows reflexes,
impairs reaction time, and reduces coordination.
In medium doses, alcohol produces slurred speech, drowsiness,
and alters emotions.
In high doses, alcohol produces vomiting, breathing difficulties,
unconsciousness, and coma.
Effects of Alcohol on the Nervous System
As mentioned above, alcohol is a central nervous system
depressant. It acts at many sites, including the reticular
formation, spinal cord, cerebellum and cerebral cortex, and on
many neurotransmitter systems. Alcohol is a very small molecule
and is soluble in "lipid" and water solutions. Because of these
properties, alcohol gets into the bloodstream very easily and
also crosses the blood brain barrier. Some of the
neurochemical effects of alcohol are:




Increased turnover of norepinephrine and dopamine
Decreased transmission in acetylcholine systems
Increased transmission in GABA systems
Increased production of beta-endorphin in the
hypothalamus
Chronic drinking can lead to dependence and addiction to
alcohol and to additional neurological problems. Typical
symptoms of withholding alcohol from someone who is
addicted to it are shaking (tremors), sleep problems and
nausea. More severe withdrawal symptoms include
hallucinations and even seizures.
103
Brain Damage
Chronic alcohol use can damage the frontal lobes of the brain,
cause an overall reduction in brain size and increase in the size
of the ventricles, lead to alcoholism (addiction to alcohol) and
result in tolerance to the effects of alcohol and avariety of
other health problems. It can also cause a vitamin deficiency.
Because the digestion system of alcoholics is unable to absorb
vitamin B-1 (thiamine), a syndrome known as "Wernicke's
Encephalopathy" may develop. This syndrome is characterized
by impaired memory, confusion and lack of coordination.
Further deficiencies of thiamine can lead to "Korsakoff's
Syndrome". This disorder is characterized by amnesia, apathy
and disorientation. Widespread disease of the brain is a feature
of both Wernicke's and Korsakoff's Syndromes.
Fetal Alcohol Syndrome
Another consequence of alcohol use is Fetal Alcohol Syndrome
(FAS). Inside the mother, a fetus is fed through the placenta.
Because alcohol passes easily through the placenta, every
time the mother drinks alcohol, the developing fetus gets a
dose of alcohol. The alcohol disrupts normal brain
development. Fetal exposure to alcohol can impair the
development of the corpus callosum (the main connection
between the right and left hemispheres of the brain) and
reduce the size of the basal
ganglia. Compared to normal babies, babies born with FAS
have:
smaller heads and brains, some degree of mental retardation,
poor coordination, hyperactivity, abnormal facial features.
Moderate alcohol drinking by a mother during pregnancy may
also lower the child's IQ.
104
How alcohol causes these effects is not known. Perhaps alcohol
affects the placenta in some way to alter the blood flow to the
fetus. It is also unclear how much alcohol is necessary to cause
these effects. Many pregnant women avoid alcohol
completely...this seems to be the safest choice.
Cirrhosis of the Liver
In cirrhosis of the liver, scar tissue replaces normal, healthy
tissue, blocking the flow of blood through the organ and
preventing it from working as it should. Cirrhosis is the eighth
leading cause of death by disease in the United States, killing
about 25,000 people each year.
Cirrhosis can be caused by most of the risk factors for liver
damage, with alcohol abuse and chronic hepatitis C being the
most common causes in the United States. Severe reactions to
prescription drugs, prolonged exposure to environmental toxins,
and various infections can each lead to cirrhosis. Cirrhosis is a
progressive condition that normally develops after years or
even decades of abuse to the liver, at which point the liver's
regenerative capacity has been diminished if not exhausted.
Symptoms




exhaustion, fatigue and weakness
loss of appetite
nausea
weight loss.
Complications of cirrhosis of the liver




edema and ascites
accumulation of fluid in the legs and abdomen
Bruising and bleeding
spider-like veins appearing in the skin
105
 Redness of the palms (palmar erythema) and/or curling up
of the fingers (Dupuytren's contracture of the palms)
 Jaundice, or the yellowing of the skin and eyes caused by
the restriction of bile flow
 Itching caused by bile products deposited in the skin
 Gallstones, when bile is prevented from reaching the
gallbladder
 Toxins in the blood or brain, which can dull mental
functioning and cause personality changes, coma, and
even death. Signs of the buildup of toxins in the brain include
neglect of personal appearance, unresponsiveness,
forgetfulness, trouble concentrating, or changes in sleep
habits
 Sensitivity to medication. As the liver fails to adequately filter
medications from the blood, they can accumulate in the
body
 Portal hypertension, or increased pressure in the portal vein,
which flows into the liver
 Vomiting or coughing up blood. Varices, or enlarged blood
vessels in the stomach and esophagus, can result from the
backup in blood flow. The resulting strain on these vessels
can cause them to burst and create a serious bleeding
problem in the upper stomach or esophagus
 Feminization in men, including breast enlargement and
shrinking of the testes
 Immune system dysfunction, leading to infection
 Muscle wasting
 Abnormal nerve function
 Hair loss
 Kidney dysfunction and failure
As with most progressive conditions, the prognosis with cirrhosis
worsens with the advancement of the disease and the
development of serious complications (such as vomiting of
blood or abnormal brain functioning). Liver cancer is always a
concern.
106
There is no cure for cirrhosis. Scarring, once it has occurred,
cannot be reversed. Treatment begins with the withdrawal of
the cause of damage whenever possible in order to arrest the
process of scarring. For example, a patient with alcoholic
cirrhosis must stop drinking. Beyond this treatment will normally
involve proper nutrition, including supplemental vitamins, and
treating complications as they arise.
With advanced cirrhosis, a liver transplant may be required.
Amphetamines and Methamphetamines
Amphetamines are drugs such as dextroamphetamine,
benzedrine, and
Ritalin. Amphetamines were originally developed to treat
asthma, sleep
disorders (narcolepsy) and hyperactivity. In 1920, a drug called
"ephedrine" was used to treat asthma. In China, the ma huang
plant
(Ephedra vulgaris) had been used for centuries to treat people
with
asthma. It is no wonder that the plant worked...the ma huang
plant
contains ephedrine. In 1932, synthetic ephedrine was sold
"over-the-counter" and was available without a prescription
until 1954.
During World War II, amphetamines were given to soldiers and
pilots to
keep them alert and to fight off fatigue.
107
Amphetamine Effects on the Nervous System
Amphetamines are stimulants of the central nervous system
and sympathetic division of the peripheral nervous system. It
appears that the main action of amphetamines is to increase
the synaptic activity of the dopamine and norepinephrine
neurotransmitter systems. Amphetamine action can:




cause the release of dopamine from axon terminals
block dopamine reuptake
inhibit the storage of dopamine in vesicles
inhibit the destruction of dopamine by enzymes.
All of these actions result in more dopamine in the synaptic
cleft where it can act on receptors.
Many of the effects of amphetamines are similar to cocaine.
Addiction to
and withdrawal from amphetamines are both possible.
Amphetamine use also causes tolerance to its effects. This
means that more and more amphetamines must be used to
get "high." Amphetamine withdrawal is characterized by severe
depression and fatigue. Users will go to extreme measures to
avoid the "downer" that comes when the effect of
amphetamines wears off.
Short-term effects of amphetamine




Increased heart rate
Increased blood pressure
Reduced appetite
Dilation of the pupils
108
 Feelings of happiness and power
 Reduced fatigue
Long-term effects of amphetamines
 Insomnia, restlessness
 Paranoid psychosis
 Hallucinations
 Violent and aggressive behavior
 Weight loss
 Tremors
Cocaine
The Coca Leaf is from the plant called Erythroxylon coca,
which is chemically transformed into cocaine and used in
medicine as a local anesthetic and central nervous system
stimulant.
Cocaine can be taken by chewing on coca leaves, smoked,
inhaled ("snorted") or injected.
History of Cocaine
Early Spanish explorers noticed how the native people of South
America were able to fight off fatigue by chewing on coca
leaves. A medical account of the coca plant was published in
1569. In 1860, Albert Neiman isolated cocaine from the coca
leaf and described the anesthetic action of the drug when it
was put on his tongue. Angelo Mariani, in the early 1880s
produced a "medicinal" wine, called Vin Mariani, that
contained 11% alcohol and 6.5 mg of cocaine in every ounce.
The famous psychotherapist, Sigmund Freud, in 1884,
recommended cocaine for a variety of illnesses and for alcohol
and morphine addictions. Unfortunately, many of his patients
went on to become addicted to cocaine! In 1886, John
109
Pemberton developed Coca Cola, a drink that contained
cocaine and caffeine. The cocaine was removed from Coca
Cola in 1906.
The Harrison Narcotic Act of1914 made cocaine illegal. But in
1985, crack cocaine was introduced and rapidly became a
major drug problem.
Effects of Cocaine on the Nervous System
A dose of between 25 to 150 mg of cocaine is taken when it is
inhaled (within a few seconds to a few minutes after it is taken)
can cause:




a feeling of euphoria
excitement
reduced hunger
a feeling of strength
After this "high" which lasts about one hour, users of cocaine
may "crash" into a period of depression. This crash causes
cocaine users to seek more cocaine to get out of this
depression and results in addiction. Withdrawal from cocaine
can cause the addict to feel depressed, anxious, and
paranoid. The addict may then go into a period of exhaustion
and they may sleep for a very long time.
Large doses or prolonged use produce neurological problems
like:






dizziness
headache
movement problems
anxiety
insomnia
depression
110
 hallucinations
Death caused by too much cocaine (an overdose) is not
uncommon. Cocaine can cause large increases in blood
pressure that may result in bleeding within the brain.
Constriction of brain blood vessels can also cause a stroke. An
overdose of cocaine can cause breathing and heart problems
that could result in death. This is what killed the University of
Maryland basketball player, Len Bias, in 1986. Comedian John
Belushi also died from a cocaine/heroin overdose in 1982.
Cocaine is highly "reinforcing": when it is given to animals, they
will give it to themselves. In fact, if animals are given the
choice, they will put up with electrical shocks and give up food
and water if they can get cocaine.
Cocaine acts by blocking the reuptake of the neurotransmitters
dopamine, norepinephrine and serotonin in the brain.
Therefore, these neurotransmitters stay in the synaptic cleft for a
longer time. Research has also shown that cocaine can also
cause the release of dopamine from neurons in the brain.
Cocaine can also affect the peripheral nervous system. These
effects include constriction of blood vessels, dilation of the pupil
and irregular heart beat. The brain of the cocaine user also
does not use glucose as effectively as the brain of the normal
person.
Inhalants
Inhaling (also called "huffing" or "sniffing") chemicals is a
problem for many people including teenagers. Inhalants are
cheap and can be found everywhere - in kitchens, garages
and schools. There are hundreds of different materials that can
be abused by people who inhale these dangerous chemicals.
Inhalants not only damage the nervous system, but other
111
organs such as the lungs, liver, heart and kidney can be injured
permanently.
Common inhalants used in huffing













Hairspray - Fluorinated hydrocarbons
Propane – isobutane
Nitrous Oxide
Cleaning Fluids - Chlorinated hydrocarbons
Naphtha - Typewriter Correction
Paint remover – Trichloroethane
Nail Polish – Acetone
Gasoline – Hydrocarbons and tetraethyl lead
Glue - Toluene; acetone, benzene; xylene; ethanol;
chloroform
Paint/Paint Thinner - Toluene; methylene chloride; benzene,
ethanol
Lighter Fluid - Hydrocarbons
Room Deodorizers - Amyl, butyl and isobutyl nitrite
Marker pens - Toluene; xylene
Effects of Inhalants on the Nervous System
When vapors are inhaled (1), they are absorbed through the
lungs (2) and enter the bloodstream (3). Once in the
bloodstream, the chemicals travel to the brain (4) and other
tissues throughout the body. Most inhalants that are abused
depress the functioning of the nervous system. However, the
effects of each inhalant are difficult to determine because
each product in made up many different chemicals and each
person may breathe in different amounts of each chemical.
Nevertheless, these chemicals do have significant effects on
the nervous system. Some of the effects of inhalants are simliar
to those of alcohol.
112
The immediate effects of inhalants









relaxation
slurred speech
euphoria
hallucinations
drowsiness
dizziness
nausea
vomiting
DEATH - from heart failure or suffocation
Long term effects of inhalants





memory loss
concentration problems
visual disturbances; blindness
motor problems
peripheral nerve damage
Effects on the Nervous System
Inhalants may affect different parts the brain and nervous
system and may cause a variety of sensory, motor,
psychological and emotional problems.
One major effect of inhalants is the destruction of the myelin
sheath that surrounds neurons. This can result in problems in the
normal transmission of impulses through neurons and cell
death.
Specific areas of the brain targeted by inhalants
113
 Cerebral cortex: damage can cause changes in personality,
memory loss, hallucinations and learning problems.
 Cerebellum: damage can cause problems in balance and
movement.
 Hippocampus: damage may result in the memory problems.
 Visual System: damage to the peripheral nerves may cause
visual disturbances.
Heroin
Street names: horse - jive - smack - junk - shag - dope
Chemical name: diacetylmorphine
Heroin is an illegal opiate drug made from the opium poppy,
Papaver somniferum. The opium poppy is a plant found in the
Middle East, Southeast
Asia and parts of Central and South America. To harvest opium,
the seed pod of the poppy is cut and a juice flows out. The
main ingredient that is extracted from raw opium is morphine.
Morphine is easily converted to heroin by a chemical process.
In 1973, scientists discovered that the brain had receptors for
opiates. In other words, there are places on neurons that
recognize opiates. These receptors were located in parts of the
brain important for breathing, pain and emotions. The
discovery of opiate receptors in the brain raised the question as
to why neurons would have such receptors. Two years later,
scientists found the answer: the brain manufactures its own
opiates known as "endorphins." Endorphins are always in the
brain, but they are released in greater amounts when people
and animals are in pain or under stress.
History of the Opiates
114
Records indicate that opium was used by the ancient
Egyptians, Greeks and Romans. The poppy even appears on
Egyptian art dating back 6,000 years.
Opium was imported to China around 800 A.D. By the 1600s,
opium smoking was widespread throughout China. In 1680, a
famous English physician named Thomas Syndenham
introduced opium to the medical field.
In the 17th century, many people in Europe were treated for a
variety of health problems with opium. In 1729, opium smoking
was made illegal in China and soon the importation of opium
was banned. This ban upset the British who were in charge of
trading this valuable product. Opium was still smuggled into
China and this caused the "Opium Wars" (1839-1842 and 18561860) between the British and the Chinese.
In the US, opium was used to treat soldiers during the Civil War
(1861-1865). During the late 1800s, doctors prescribed "tonics"
containing opiates for many conditions. Rarely did these
medicines list opiates as one of the ingredients. In fact, heroin
was marketed as a cough medicine and a cure for morphine
addiction. However, many physicians had concerns about
possible addiction to these medicines.
Important Dates in the History of Opiates
 1803 - morphine was isolated from opium by Frederick
Serturner.
 1832 - codeine was extracted from opium.
 1853 - the hypodermic needle was invented.
 1874 - heroin was first produced from morphine.
 1898 - The Bayer Company introduced heroin as a substitute
for morphine.
 1906 - Pure Food and Drugs Act - required medicines to be
labeled with the materials that they contained.
115
 1914 - Harrison Narcotic Act - added a tax on opiate
distribution.
 1922 - Narcotic Import and Export Act - restricted the
importation of crude opium except for medical use.
 1924 - Heroin Act - made manufacture and possession of
heroin illegal.
 1930 - Federal Bureau of Narcotics was created.
 1970 - Controlled Substances Act was passed - divided drugs
into categories, set regulations and penalties for narcotics
How Heroin is Used
The purity of heroin can vary greatly. Heroin can be mixed with
powdered milk, sugar, baking soda, procaine and lidocaine
(local anesthetics) or even laundry detergent, talc, starch, curry
powder, Ajax cleaner or strychinine. All of these "additives" are
dangerous if they are injected into the bloodstream.
Heroin is smoked or inhaled as a powder or it can be mixed in
water, heated, then injected. Heroin crosses through the blood
brain barrier 100 times faster than morphine because it is highly
soluble lipids.
Injecting heroin into a vein (intravenous use) produces effects
in 7 to 8 seconds. Injecting heroin into a muscle (intramuscular
use) or under the (subcutaneous use) can produce effects in 5
to 8 minutes. Addicts inject themselves up to 4 times in one
day.
Effects of Heroin
116
The overall effect of heroin is a depression of the central
nervous system.
Short Term Effects









Analgesia (reduced pain)
Brief euphoria (the "rush" or feeling of well-being)
Nausea
Sedation, drowsiness
Reduced anxiety
Hypothermia
Reduced respiration; breathing difficulties
Reduced coughing
Death due to overdose - often the exact purity and content
of the drug is not known to the user. An overdose can cause
respiration problems and coma.
Long Term Effects
Tolerance: more and more drug is needed to produce the
euphoria and other effects on behavior.
Addiction: psychological and physiological need for heroin.
People are driven to get more heroin and feel bad if they do
not get it. People begin to crave heroin 4 to 6 hours after their
last injection.
Withdrawal: About 8-12 hours after their last heroin dose,
addicts' eyes tear, they yawn and feel anxious and irritable.
Excessive sweating, fever, stomach and muscle cramps,
diarrhea and chills can follow several hours later. These
withdrawal symptoms can continue for 1 to 3 days after the last
dose and can last 7 to 10 days. In some cases, full physical
recovery can take even longer. Lifestyle recovery takes quite a
while longer.
117
Other Effects
In addition to the direct dangers of heroin, this powerful drug
also carries the risk of:








HIV/AIDS - due to sharing of needles
Poisoning - from the addition of toxin to the drug
Hepatitis - liver damage
Skin infections - from repeated intravenous injections
Other bacterial and viral infections
Increase risk of stroke
Collapsed veins
Lung infections
How Heroin Affects the Brain
Not all of the mechanisms by which heroin and other opiates
affect the brain are known. Likewise, the exact brain
mechanisms that cause tolerance and addiction are not
completely understood. Opiates stimulate a "pleasure system"
in the brain. This system involves neurons in the midbrain that
releases the neurotransmitter called "dopamine." These
midbrain dopamine neurons project to another structure called
the nucleus accumbens which then projects to the cerebral
cortex. This system is responsible for the pleasurable effects of
heroin and for the addictive power of the drug.
Other neurotransmitter systems, such as those related to
endorphins, are also likely to be involved with withdrawal from
and tolerance to heroin.
Common Treatments for Heroin Overdose and Addiction
118
 Behavioral Methods
 Heroin addiction is usually treated with both medical and
behavioral methods. Behavioral treatment might give
rewards to people for negative drug tests. Other treatments
may attempt to change the drug-seeking behavior of
addicts.
 Naloxone – Used for people who overdose on heroin, it acts
as an opiate receptor blocker that binds to neurons so
opiates cannot work.
 Methadone - a drug that blocks the effects of heroin and
has been used for several decades to treat heroin addiction.
Methadone can be
swallowed (rather than injected) and it blocks heroin
withdrawal symptoms and does not have euphoric or
sedative effects.
 LAAM (levo-alpha-acetyl-methadol) is a drug like
methadone, but its effects last longer. LAAM was approved
by the US Food and Drug Administration for treating heroin
addiction in 1993.
Marijuana
Marijuana is one of the world's most commonly used illegal
drugs. There are approximately 300 million users worldwide and
28 million users in the States (Diaz, 1997). Marijuana comes from
a plant called "Cannabis sativa." The chemical in this plant that
produces the altered states of consciousness is called "delta-9
tetrahydrocannabinol" or "THC." Marijuana is usually smoked
like a cigarette, but it can also be cooked into baked goods
like brownies or cookies or brewed like a tea. THC is also
contained in "hashish" (hash) which is the resin from the
marijuana plants. Hash is usually smoked in a pipe. Other
names for marijuana include: grass, pot, reefer and weed.
119
Effects of Marijuana on the Nervous System
THC acts on "cannabinoid" receptors which are found on
neurons in many places in the brain. These brain areas are
involved in memory (the hippocampus), concentration
(cerebral cortex), perception (sensory portions of the cerebral
cortex) and movement (the cerebellum, substantia nigra,
globus pallidus). When THC activates cannabinoid receptors, it
interfers with the normal functioning of these brain areas.
In low to medium doses marijuana causes:






relaxation
reduced coordination
reduced blood pressure
sleepiness
disruption in attention
an altered sense of time and space
In high doses marijuana causes:




hallucinations
delusions
impaired memory
disorientation
Long-term use




Apathy
Diminished capacity for alertness when needed
Confusion and unclear thinking
Build up of tar and cancer-causing chemical derivatives in
the brain, reproductive system, and respiratory system
120
 Lowers the body’s immune system making the body
susceptible to disease
Amotivational Syndrome
Perhaps the most devastating mental health danger from
marijuana is “Amotivational Syndrome”, a mental illness in
which the individual becomes apathetic, loses all desire to do
anything and can not find a motivating purpose in life.
Recent discoveries about the drug interaction of marijuana
In the mid 60’s a pseudo-intellectual book was published
praising all the healing properties of marijuana discovered in
research conducted since 1942. This book managed to make
its way to most the major university campuses throughout the
U.S. and sparked a movement
Scientists have known for a long time that THC interacted with
cannabinoid receptors in the brain, but did not know why the
brain would have such receptors. They thought that the brain
must make some kind of substance that naturally acted on
these receptors. In 1992 Anandamide was discovered.
Anandamide is the brain's own THC (just like "endorphin" is the
brain's own morphine). Still, scientists are not sure what the
function of anandamide is in the normal brain.
The effects of marijuana start as soon as 1-10 minutes after it is
taken and can last 3 to 4 hours or even longer. Experiments
have shown that THC can affect two neurotransmitters:
norepinephrine and dopamine. Serotonin and GABA levels
may also be altered.
Because there is a high level of tar and other chemicals in
marijuana, smoking it has many of the same destructive
characteristics as smoking cigarettes. The lungs get a big dose
121
of chemicals that increase the chances of lung problems and
cancer later in life. Studies have also shown that because tar
and other chemical deposits are permanently deposited in the
male sex organs, that it is a cause of damage to the
reproductive organs and has rendered many men sterile and
unable to father children.
MDMA (Ecstasy)
The American Heritage Dictionary defines ecstasy as "intense
joy or delight." Despite its peppy name, the illegal drug Ecstasy
can damage nerve cells in the brain. Ecstasy, also known as 3,4
or "MDMA" for short, is a stimulant related to the drugs
mescaline and amphetamine. Other names for MDMA are
"Adam," "XTC," "Doves" or just "E."
MDMA was first synthesized and patented in 1914 by the
German drug company called Merck. Scientists thought that
this drug could be used as an appetite suppressant. In the
1970s, MDMA was given to psychotherapy patients because it
helped them open up and talk about their feelings. This
practice was stopped in 1986 when animal studies showed that
Ecstasy caused brain damage.
Behavioral Effects of MDMA
Some users say they take Ecstasy because it lowers their
inhibitions and relaxes them. MDMA is also said to increase
awareness and feelings of pleasure and to give people energy.
However, some people report side effects after taking MDMA
such as headaches, chills, eye twitching, jaw clenching, blurred
vision and nausea. Some doses of MDMA can cause
dehydration, hyperthermia and seizures.
122
The effects of MDMA send some people to the emergency
room. Unlike the drug LSD, MDMA in low doses does not cause
people to hallucinate. Ecstasy gained national attention when
it was the drug of choice at club parties, called "raves." In a
survey taken in 2001, 9.2% of 12th graders, 6.2% of 10th graders
and 3.5% of 8th graders reported that they had used MDMA at
least once within the year.
Effects of MDMA on the Brain
MDMA appears to have several effects on the brain. MDMA
can:
 cause the release of the neurotransmitter called serotonin.
 block the reuptake of serotonin by the synaptic terminal that
releases it.
 deplete the amount of serotonin in the brain.
 decrease the amount of the neurotransmitter called
dopamine.
Recent data suggest that MDMA may be toxic to the brain. Dr.
George Ricaurte, an associate professor of neurology at Johns
Hopkins University, brain scans of people who had used Ecstasy.
The study included people who had used Ecstasy an average
of 200 times over five years. Although the behavior of these
people appeared normal, brain scans showed that the drug
had damaged their brains. In fact, those who used the drug
more often had more brain damage than less frequent users.
Moreover, memory tests of people who have taken Ecstasy as
compared to non-drug users have shown that the Ecstasy users
had lower scores. Specifically, the drug damaged cells that
release the neurotransmitter called serotonin. Using an imaging
technique called positron emission tomography (PET), Ricaurte
noted a 20-60% reduction in healthy serotonin cells in the drug
users. Damage to these cells could affect a person's abilities to
remember and to learn. At this point, scientists do not know if
123
this damage is permanent, or if those damaged cells will
replace themselves. Also, it is not known if this loss of cells
affects behavior or the ability to think. Studies are not being
conducted to gauge Ecstasy's effect on mood, memory,
cognition, and behaviors such as eating and sleeping.
In an article published in The Journal of Neuroscience (June 15,
1999), Ricaurte compared the data from monkeys who were
given Ecstasy dissolved in a liquid twice a day for four days to
other monkeys who received the same liquid WITHOUT the
Ecstasy twice a day for four days. The study showed that the
monkeys who were given Ecstasy had damage to the
serotonin-containing nerve cells. This damage was still visible
seven years later! Areas that were especially affected were the
frontal lobe of the cerebral cortex, an area in the front part of
the brain that is used in thinking, and the hippocampus, an
area deep in the brain that helps with memory.
MDMA has also been found to damage neurons that use
dopamine. Monkeys and baboons were given three doses of
MDMA to simulate the dosage that people take during all-night
raves. When the brains of these animals were observed a few
weeks later, the researcher observed "profound dopaminergic
neurotoxicity" which points to loss of memory and cognitive
ability among Ecstasy users. Damage to neurons that use
dopamine may also put Ecstasy users at a higher risk for
developing Parkinson's disease.
Nicotine (Cigarette Smoking)
Tobacco use remains the leading preventable cause of death
in the United States, causing more than 440,000 deaths each
year and resulting in an annual cost of more than $75 billion in
direct medical costs. Nationally, smoking results in more than
5.6 million years of potential life lost each year.
124
Approximately 80% of adult smokers started smoking before the
age of 18. Every day, nearly 4,000 young people under the age
of 18 try their first cigarette.
More than 6.4 million children living today will die prematurely
because of a decision they will make as adolescents — the
decision to smoke cigarettes.
About 62 million people in the United States ages 12 and older,
or 29 percent of the population, are current cigarette smokers,
according to the 1996 National Household Survey on Drug
Abuse. This makes nicotine, the addictive component of
tobacco, one of the most heavily used addictive drugs in the
United States.
Effects of Nicotine
When a person inhales cigarette smoke, the nicotine in the
smoke is rapidly absorbed into the blood and starts affecting
the brain within 7 seconds. In the brain, nicotine activates the
same reward system as do other drugs of abuse such as
cocaine or amphetamine, although to a lesser degree.
Nicotine's action on this reward system is believed to be
responsible for drug-induced feelings of pleasure and, over
time, addiction. Nicotine also has the effect of increasing
alertness and enhancing mental performance. In the
cardiovascular system, nicotine increases heart rate and blood
pressure and restricts blood flow to the heart muscle. The drug
stimulates the release of the hormone epinephrine, which
further stimulates the nervous system and is responsible for part
of the "kick" from nicotine. It also promotes the release of the
hormone beta-endorphin, which inhibits pain.
People addicted to nicotine experience withdrawal when they
stop smoking. This withdrawal involves symptoms such as anger,
anxiety, depressed mood, difficulty concentrating, increased
125
appetite, and craving for nicotine. Most of these symptoms
subside within 3 to 4 weeks, except for the craving and hunger,
which may persist for months.
Health Effects of Tobacco Products
Besides nicotine, cigarette smoke contains more than 4,000
substances, many of which may cause cancer or damage the
lungs. Cigarette smoking is associated with coronary heart
disease, stroke, ulcers, and an increased incidence of
respiratory infections.
Smoking is the major cause of lung cancer and is also
associated with cancers of the larynx, esophagus, bladder,
kidney, pancreas, stomach, and uterine cervix. Smoking is also
the major cause of chronic bronchitis and emphysema.
Women who smoke cigarettes have earlier menopause.
Pregnant women who smoke run an increased risk of having
stillborn or premature infants or infants with low birthweight.
Children of women who smoked while pregnant have an
increased risk for developing conduct disorders.
Cigar and pipe smokers and users of chewing tobacco and
snuff can also become addicted to nicotine. Although cigar
and pipe smokers have lower death rates than cigarette
smokers do, they are still susceptible to cancers of the oral
cavity, larynx, and esophagus. Users of chewing tobacco and
snuff have an elevated risk for oral cancer.
PCP (Phencyclidine)
"Angel Dust," "Hog," "Rocket Fuel," "DOA," "Peace Pill" - these are
other names for the illegal drug phencyclidine (PCP). PCP was
developed in the 1950s as an anesthetic. However, the use of
126
PCP as an anesthetic was stopped after some people
experienced psychotic reactions after using the drug. PCP is
now made illegally and has found its way onto the street, often
contaminating other street drugs. In fact, PCP is often sold in
place of drugs such as LSD and mescaline. According to the
Monitoring the Future survey of drug trends, 2.3% of 12th
graders in the United States used PCP sometime during the year
2000. PCP is classified as a dissociative anesthetic because
users appear to be "disconnected" from their environment: they
know where they are, but they do not feel as if they are part of
it. The drug has different effects on different people. It can act
as a stimulant, a depressant, an analgesic (decreasing pain) or
a hallucinogen depending on the dose and route of
administration. The effects produced by PCP are different from
those caused by hallucinogens such as LSD. Rather than
producing visual hallucinations, PCP causes changes in body
image. In addition to these distortions of reality, PCP can cause
frightening side effects such as feelings of terror and confusion.
Behavioral Effects of PCP
PCP can be eaten, snorted, injected or smoked. Depending on
how a person the drug, the effects are felt within a few minutes
(2-5 minutes when smoked) to an hour. PCP can stay in a
person's body for a long time; the half-life of PCP ranges from
11 to 51 hours. Furthermore, because PCP is made illegally
under uncontrolled conditions, users have no way of knowing
how much PCP they are taking. This makes PCP especially
dangerous.
People under the influence of PCP may not feel pain and their
perception of sensory stimuli may be altered, possibly causing
police officers to use stronger methods to control such
individuals
The low dose effect includes feelings of euphoria (well-being),
127
relaxation, numbness, sensory distortions, feelings of
detachment from one's own body, anxiety, confusion,
amnesia, illogical speech, blurred vision, and a blank stare.
The medium dose effect includes confusion, agitation,
analgesia, fever, excessive salivation, and "schizophrenic-type"
behavior.
The high dose effect includes seizures, respiratory failure, coma,
fever, stroke, and death.
Tolerance and dependence on PCP are possible. Withdrawal
symptoms include diarrhea, chills, tremors.
Effects of PCP on the Brain
PCP affects multiple neurotransmitter systems in the brain. For
example, PCP inhibits the reuptake of dopamine,
norepinephrine and serotonin and also inhibits the action of
glutamate by blocking NMDA receptors. Some types of opioid
receptors in the brain are also affected by PCP. These complex
effects on multiple chemical systems in the brain most likely
underlie the behavioral effects of PCP.
PRESCRIPTION DRUGS
Several indicators suggest that prescription drug abuse is on the
rise in the United States. According to the 1999 National
Household Survey on Drug Abuse, in 1998, an estimated 1.6
million Americans used prescription pain relievers nonmedically
for the first time. This represents a significant increase since the
1980s, when there were generally fewer than 500,000 first-time
users per year. From 1990 to 1998, the number of new users of
pain relievers increased by 181 per-cent; the number of
128
individuals who initiated tranquilizer use increased by 132
percent; the number of new sedative users increased by 90
percent; and the number of people initiating stimulant use
increased by 165 percent. In 1999, an estimated 4 million
people, almost 2 percent of the population aged 12 and older,
were currently (use in past month) using certain prescription
drugs nonmedically: pain relievers (2.6 million users), sedatives
and tranquilizers
(1.3 million users), and stimulants (0.9 million users).
Approximately 4 Million Americans reported current use of
prescription drugs for nonmedical purposes in 1999. (Source:
Office of Applied Studies, Substance Abuse and Mental Health
Services Administration. National Household Survey on Drug
Abuse, 1999.)
An estimated 9 million people aged 12 and older used
prescription drugs for nonmedical reasons in 1999; more than a
quarter of that number reported using prescription drugs
nonmedically for the first time in the previous year.
According to a recent national survey of primary care
physicians and patients regarding substance abuse, 46.6
percent of physicians find it difficult to discuss prescription drug
abuse with their patients. Prescription drug abuse is not a new
problem, but one that deserves renewed attention.
Prescription drug abuse affects many Americans. Some trends
of concern can be seen among older adults, adolescents, and
women. In addition, health care professionals, including
physicians, nurses, pharmacists, dentists, anesthesiologists, and
veterinarians are at increased risk of prescription drug abuse
because of ease of access, as well as their ability to selfprescribe drugs. In spite of this increased risk, recent surveys
and research in the early 1990s indicate that health care
providers probably suffer
129
Although many prescription drugs can be abused or misused,
there are three classes of prescription drugs that are most
commonly abused: Opioids, which are most often prescribed
to treat pain; CNS depressants, which are used to treat anxiety
and sleep disorders; Stimulants, which are
prescribed to treat the sleep disorder narcolepsy, attentiondeficit hyper-activity disorder (ADHD), and obesity.
Opioids
Opioids are commonly prescribed because of their effective
analgesic, or pain-relieving, properties. Medications that fall
within this class, sometimes referred to as narcotics, include
morphine, codeine, and related drugs. Morphine, for example,
is often used before or after surgery to alleviate severe pain.
Codeine, because it is less efficacious than morphine, is used
for milder pain, as well as meperidine (Demerol), which is used
less often because of its side effects. In addition to their painrelieving properties, some of these drugs, for example, codeine
and diphenoxylate (Lomotil), can be used to relieve coughs
and diarrhea.
Other examples of opioids that can be prescribed to alleviate
pain include oxycodone (OxyContin), propoxyphene (Darvon),
hydrocodone (Vicodin), and hydromorphone (Dilaudid), Most
people who take prescription medications take them
responsibly; however, the nonmedical use or abuse of
prescription drugs remains a serious public health concern.
Prescription drugs like opioids, central nervous system (CNS)
depressants, and stimulants, when abused, can alter the brain’s
activity and lead to dependence and addiction.
Opioids act by attaching to specific proteins called opioid
receptors, which are found in the brain, spinal cord, and
gastrointestinal tract. When
130
these drugs attach to certain opioid receptors, they can block
the transmission of pain messages to the brain. In addition,
opioids can produce drowsiness, cause constipation, and,
depending upon the amount of drug taken, depress
respiration. Opioid drugs also can cause euphoria by
stimulating the brain regions that affect what we perceive as
pleasure.
Chronic use of opioids can result in tolerance for the drugs,
which means that users must take higher doses to achieve the
same initial effects. Long-term use also can lead to physical
dependence and addiction. The body adapts to the presence
of the drug, and withdrawal symptoms occur if use is reduced
or stopped. Symptoms of withdrawal include restlessness,
muscle and bone pain, insomnia, diarrhea, vomiting, cold
flashes with goose bumps (“cold turkey”), and involuntary leg
movements. Finally, taking a large single dose of an opioid
could cause severe respiratory depression that can lead to
death. Many studies have shown, however, that properly
managed medical use of opioid analgesic drugs is safe and
rarely causes clinical addiction, defined as compulsive, often
uncontrollable use of drugs.
Opioids should not be used with other substances that depress
the central
nervous system, such as alcohol, antihistamines, barbiturates,
benzodiazepines, or general anesthetics, as such a
combination increases
the risk of life-threatening respiratory depression.CNS
depressants
CNS depressants
CNS depressants are substances that can slow normal brain
function. Because of this property, some CNS depressants are
useful in the treatment of anxiety and sleep disorders.
131
Barbiturates, which are among the medications that are
commonly prescribed for these purposes, such as
mephobarbital
(Mebaral)
and
pentobarbital
sodium
(Nembutal), are used to treat anxiety, tension, and sleep
disorders. Benzodiazepines, such as diazepam (Valium),
chlordiazepoxide HCl (Librium), and alprazolam (Xanax), which
can be prescribed to treat anxiety, acute stress reactions, and
panic attacks; the more sedating benzodiazepines, such as
triazolam (Halcion) and estazolam (ProSom) can be prescribed
for short-term treatment of sleep disorders. In higher doses,
some CNS depressants can be used as general anesthetics.
There are numerous CNS depressants; most act on the brain by
affecting the neurotransmitter gamma-aminobutyric acid
(GABA). Neurotransmitters are brain chemicals that facilitate
communication between brain cells. GABA works by
decreasing brain activity. Although the different classes of CNS
depressants work in unique ways, ultimately it
is through their ability to increase GABA activity that they
produce a drowsy or calming effect that is beneficial to those
suffering from anxiety or sleep disorders.
During the first few days of taking a prescribed CNS depressant,
a person usually feels sleepy and uncoordinated, but as the
body becomes accustomed to the effects of the drug, these
feelings begin to disappear. If one uses these drugs long term,
the body will develop tolerance for the drugs, and larger doses
will be needed to achieve the same initial effects.
Continued use can lead to physical dependence and, when
use is reduced or stopped, withdrawal. Because all CNS
depressants work by slowing the brain’s activity, when an
individual stops taking them, the brain’s activity can rebound
and race out of control, possibly leading to seizures and other
harmful consequences.
132
Withdrawal from prolonged use of CNS depressants can have
life-threatening complications. Therefore, someone who is
thinking about discontinuing CNS-depressant therapy or who is
suffering withdrawal from a CNS depressant should speak with
a physician or seek medical treatment.
CNS depressants should be used with other medications only
under a physician’s supervision. Typically, they should not be
combined with any other medication or substance that causes
CNS depression, including prescription pain medicines, some
over-the-counter cold and allergy medications, or alcohol.
Using CNS depressants with these other substances, particularly
alcohol, can slow breathing, or slow both the heart and
respiration, and possibly lead to death.
Stimulants
As the name suggests, stimulants are a class of drugs that
enhance brain
Activity. They cause an increase in alertness, attention,
andenergy that is accompanied by elevated blood pressure
and increased heart rate and respiration.
Stimulants were used historically to treat asthma and other
respiratory problems, obesity, neurological disorders, and a
variety of other ailments.
But as their potential for abuse and addiction became
apparent, the medical use of stimulants began to wane. Now,
stimulants are prescribed for the treatment of only a few health
conditions, including narcolepsy, attention-deficit hyperactivity
disorder, and depression that has not responded to other
treatments. In recent years, stimulants that have been sold over
the counter as appetite suppressants have been taken off the
133
shelves due to findings of wide-spread abuse and other related
side-effects such as heart attack and stroke.
Stimulants, such as dextroamphetamine (Dexedrine) and
methylphenidate (Ritalin), have chemical structures that are
similar to a family of key brain neurotransmitters called
monoamines, which include norepinephrine and dopamine.
Stimulants increase the amount of these chemicals in the brain.
This, in turn, increases blood pressure and heart rate, constricts
blood vessels, increases blood glucose, and opens up the
pathways of the respiratory system. In addition, the increase in
dopamine is associated with a sense of euphoria that can
accompany the use of these drugs.
The consequences of stimulant abuse can be dangerous.
Although their use may not lead to physical dependence and
risk of withdrawal, stimu-lants can be addictive in that
individuals begin to use them compulsively. Taking high doses
of some stimulants repeatedly over a short time can lead to
feelings of hostility or paranoia. Additionally, taking high doses
of a stimulant may result in dangerously high body
temperatures and an irregular heartbeat. There is also the
potential for cardiovascular failure or lethal seizures.
Stimulants should be used with other medications only when
the patient is under a physician’s supervision. For example, a
stimulant may be prescribed to a patient taking an
antidepressant. However, health care providers and patients
should be mindful that antidepressants enhance the effects of
a stimulant.
Patients also should be aware that stimulants should not be
mixed with over-the-counter cold medicines that contain
decongestants, as this com-bination may cause blood pressure
to become dangerously high or lead to irregular heart rhythms.
134
Role of health care providers
About 70 percent of Americans, approximately 191 million
people, visit a health care provider, such as a primary care
physician, at least once every 2 years. Thus, health care
providers are in a unique position not only to prescribe needed
medications, but also to identify prescription drug abuse when
it exists and help the patient recognize the problem, set goals
for recovery, and seek appropriate treatment when necessary.
Screening for any type of substance abuse can be
incorporated into routine history taking with questions about
what prescriptions and over-the-counter medicines the patient
is taking and why. Screening also can be performed if a
patient presents with specific symptoms associated with
problem use of a substance. Over time, doctors should note
any rapid increases in the amount of a medication needed,
which may indicate the development of tolerance, or frequent
requests for refills before the quantity prescribed should have
been used. They should also be alert to the fact that those
addicted to prescription medications may engage in “doctor
shopping,” moving from provider to provider in an effort to get
multiple prescriptions for the drug they abuse. Preventing or
stopping prescription drug abuse is an important part of patient
care. However, health care providers should not avoid
prescribing or administering strong CNS depressants and
painkillers, if they are needed.
It is the responsibility of the doctor who reviews the patients
charts to catch any indications that may show discrepancies
between amounts needed and amounts prescribed. Too
often, because of an over stressed health system, the doctor
does not take the time to review charts and many prescriptions
and dosages that should be changed are overlooked.
Assessing Prescription Drug Abuse
135
Four questions to ask:
 Have you ever felt the need to Cut down on your use of
prescription drugs?
 Have you ever felt Annoyed by remarks your friends or loved
ones made about your use of prescription drugs?
 Have you ever felt Guilty or remorseful about your use of
prescription drugs?
 Have you Ever used prescription drugs as a way to “get
going” or to “calm down?”
The role of pharmacists
Pharmacists can play a key role in preventing prescription drug
misuse and abuse by providing clear information and advice
about how to take a medication appropriately, about the
effects the medication may have, and about any possible drug
interactions.
Pharmacists can help prevent prescription fraud or diversion by
looking for false or altered prescription forms. Many pharmacies
have developed “hotlines” to alert other pharmacies in the
region when a fraud is detected. Alert pharmacists have also,
on multitudes of occasions, caught prescriptions that have
been misprescribed by physicians, or in which a clerical error
had been made.
Commonly Prescribed Medications: Use and Consequences
Opioids
 Oxycodone (OxyContin)
 Propoxyphene (Darvon)
 Hydrocodone (Vicodin)
136
 Hydromorphone (Dilaudid)
 Meperidine (Demerol)
 Diphenoxylate (Lomotil)
Generally prescribed for
 Postsurgical pain relief
 Management of acute or chronic pain
 Relief of coughs and diarrhea
Effects of short-term use




Blocked pain messages
Drowsiness
Constipation
Depressed respiration
Effects of long-term use
 Tolerance
 Physical dependence
 Withdrawal symptoms, or addiction
Possible negative effects
 Severe respiratory depression or death following a large
single dose
Dangerous if used with
 Alcohol
 Antihistamines
137




Barbiturates
Benzodiazepines
General anesthetics
Any substance causing CNS depression
CNS DEPRESSANTS
Barbiturates
 Mephobarbital (Mebaral)
 Pentobarbital sodium (Nembutal)
Benzodiazepines





Diazepam (Valium)
Chlordiazepoxide hydrochloride (Librium)
Alprazolam (Xanax)
Triazolam (Halcion)
Estazolam (ProSom)
Generally prescribed for






Anxiety
Tension
Panic attacks
Acute stress reactions
Sleep disorders
Anesthesia (at high doses)
Effects of short-term use
138
A “sleepy” and uncoordinated feeling during the first few days,
as the body becomes accustomed—tolerant—to the effects,
these feelings diminish.
Effects of long-term use
Potential for tolerance, physical dependence, withdrawal,
and/or addiction
Possible negative effects
Seizures following a rebound in brain activity after reducing or
discontinuing use
Benzodiazapines should not be used with:
 Alcohol
 Prescription opioid pain medicines
 Some over-the-counter cold and allergy medications
Stimulants
 Dextroamphetamine (Dexedrine)
 Methylphenidate (Ritalin)
 Sibutramine hydrochloride monohydrate (Meridia)
Generally prescribed for:
 Narcolepsy
 Attention-deficit hyperactivity disorder (ADHD)
 Depression that does not respond to other treatment
 Short-term treatment of obesity
139
 Asthma
Effects of short-term use





Elevated blood pressure
Increased heart rate
Increased respiration
Suppressed appetite
Sleep deprivation
Effects of long-term use
 Potential for addiction
Possible negative effects
 Dangerously high body temperatures or an irregular
heartbeat after taking high doses
 Cardiovascular failure or lethal seizures
 Hostility or feelings of paranoia after taking high doses
repeatedly over a short period of time
Should not be used with
 Over-the-counter cold medicines containing decongestants
 Antidepression medications
 Asthma medications
Steroids (Anabolic)
Anabolic steroids" is the familiar name for synthetic substances
related to the male sex hormones (androgens). They promote
140
the growth of skeletal muscle (anabolic effects) and the
development of male sexual characteristics (androgenic
effects), and also have some other effects. The term "anabolic
steroids" will be used through-out this report because of its
familiarity, although the proper term for these compounds is
"anabolic-androgenic" steroids.
Anabolic steroids were developed in the late 1930s primarily to
treat hypogonadism, a condition in which the testes do not
produce
sufficient
testosterone
for
normal
growth,
development, and sexual functioning. The primary medical
uses of these compounds are to treat delayed puberty, some
types of impotence, and wasting of the body caused by HIV
infection or other diseases.
During the 1930s, scientists discovered that anabolic steroids
could facilitate the growth of skeletal muscle in laboratory
animals, which led to use of the compounds first by
bodybuilders and weightlifters and then by athletes in other
sports. Steroid abuse has become so widespread in athletics
that it affects the outcome of sports contests.
Recent evidence suggests that steroid abuse among
adolescents is on the rise. The 1999 Monitoring the Future study,
a NIDA-funded survey of drug abuse among adolescents in
middle and high schools across the United States, estimated
that 2.7 percent of 8th- and 10th-graders and 2.9 percent of
12th-graders had taken anabolic steroids at least once in their
lives. For 10th-graders, that is a significant increase from 1998,
when 2.0 percent of 10th-graders said they had taken anabolic
steroids at least once. For all three grades, the 1999 levels
represent a significant increase from 1991, the first year that
data on steroid abuse were collected from the younger
students. In that year, 1.9 percent of 8th-graders, 1.8 percent of
10th-graders, and 2.1 percent of 12th-graders reported that
they had taken anabolic steroids at least once.
141
Few data exist on the extent of steroid abuse by adults. It has
been estimated that hundreds of thousands of people aged 18
and older abuse anabolic steroids at least once a year.
Among both adolescents and adults, steroid abuse is higher
among males than females. However, steroid abuse is growing
most rapidly among young women.
Affects of steroid abuse
Anabolic steroid abuse has been associated with a wide range
of adverse side effects ranging from some that are physically
unattractive, such as acne and breast development in men, to
others that are life threatening, such as heart attacks and liver
cancer. Most are reversible if the abuser stops taking the drugs,
but some are permanent.
Most data on the long-term effects of anabolic steroids on
humans come from case reports rather than formal
epidemiological studies. From the case reports, the incidence
of life-threatening effects appears to be low, but serious
adverse effects may be under-recognized or under-reported.
Data from animal studies seem to support this possibility. One
study found that exposing male mice for one-fifth of their
lifespan to steroid doses comparable to those taken by human
athletes caused a high percentage of premature deaths.
Hormonal system
Steroid abuse disrupts the normal production of hormones in
the body, causing both reversible and irreversible changes.
Changes that can be reversed include reduced sperm
production and shrinking of the testicles (testicular atrophy).
Irreversible changes include male-pattern baldness and breast
development (gynecomastia). In one study of male
bodybuilders, more than half had testicular atrophy, and more
than half had gynecomastia. Gynecomastia is thought to
occur due to the disruption of normal hormone balance. In the
142
female body, anabolic steroids cause masculinization. Breast
size and body fat decrease, the skin becomes coarse, the
clitoris enlarges, and the voice deepens. Women may
experience excessive growth of body hair but lose scalp hair.
With continued administration of steroids, some of these effects
are irreversible.
Musculoskeletal system
Rising levels of testosterone and other sex hormones normally
trigger the growth spurt that occurs during puberty and
adolescence. Subsequently, when these hormones reach
certain levels, they signal the bones to stop growing, locking a
person into his or her maximum height.
When a child or adolescent takes anabolic steroids, the
resulting artificially high sex hormone levels can signal the
bones to stop growing sooner than they normally would have
done.
Cardiovascular system
Steroid abuse has been associated with cardiovascular
diseases (CVD), including heart attacks and strokes, even in
athletes younger than 30. Steroids contribute to the
development of CVD, partly by changing the levels of
lipoproteins that carry cholesterol in the blood. Steroids,
particularly the oral types, increase the level of low-density
lipoprotein (LDL) and decrease the level of high-density
lipoprotein (HDL). High LDL and low HDL levels increase the risk
of atherosclerosis, a condition in which fatty substances are
deposited inside arteries and disrupt blood flow. If blood is
prevented from reaching the heart, the result can be a heart
attack. If blood is prevented from reaching the brain, the result
can be a stroke.
143
Steroids also increase the risk that blood clots will form in blood
vessels, potentially disrupting blood flow and damaging the
heart muscle so that it does not pump blood effectively.
Liver
Steroid abuse has been associated with liver tumors and a rare
condition called peliosis hepatis, in which blood-filled cysts form
in the liver. Both the tumors and the cysts sometimes rupture,
causing internal bleeding.
Skin
Steroid abuse can cause acne, cysts, and oily hair and skin.
Infection
Many abusers who inject anabolic steroids use nonsterile
injection techniques or share contaminated needles with other
abusers. In addition, some steroid preparations are
manufactured illegally under non-sterile conditions. These
factors put abusers at risk for acquiring life-threatening viral
infections, such as HIV and hepatitis B and C. Abusers also can
develop infective endocarditis, a bacterial illness that causes a
potentially fatal inflammation of the inner lining of the heart.
Bacterial infections also can cause pain and abscess formation
at injection sites.
Behavior
144
Case reports and small studies indicate that anabolic steroids,
particularly in high doses, increase irritability and aggression.
Some steroid abusers report that they have committed
aggressive acts, such as physical fighting, committing armed
robbery, or using force to obtain something. Some abusers also
report that they have committed property crimes, such as
stealing from a store, damaging or destroying others' property,
or breaking into a house or a building. Abusers who have
committed aggressive acts or property crimes generally report
that they engage in these behaviors more often when they
take steroids than when they are drug-free.
HEALTH EFFECTS OF A WIDE VARIETY OF STREET DRUGS
Acute and or Chronic Paranoid & Schizophrenic Reactions
A paranoid reaction is characterized by a feeling of fear, that
people are watching you, or that people are out to do you
harm. This feeling may be either acute, temporary, or chronic,
long-term.
A schizophrenic reaction is characterized by dissociative and
highly confused thinking and mental processes. In this state,
the individual is detached from reality and appears to have a
change of personality. The new personality may express a
wide variety of disjointed ideas ranging from claiming to be
Jesus Christ, having the power to touch someone and do things
to them, to a stream of consciousness of non-understandable
thoughts, to complete staring with a blank stare unable to
communicate at all.
Overt Symptoms
Overt, "psychotic" symptoms, include delusions, hallucinations
and disorganized thinking because the patient has lost touch
145
with reality in certain important ways. Delusions cause the
patient to believe that people are reading their minds or
plotting against them, that others are secretly monitoring and
threatening them, or that they can control other people’s
thoughts. Hallucinations cause people to hear or see things
that are not there. Approximately three-fourths of individuals
with schizophrenia will hear voices (auditory hallucinations) at
some time during their illness. Disorganized thinking, speech,
and behavior affect most people with this illness. For example,
people
with
schizophrenia
sometimes
have
trouble
communicating in coherent sentences or carrying on
conversations with others; move more slowly, repeat rhythmic
gestures or make movements such as walking in circles or
pacing; and have difficulty making sense of everyday sights,
sounds and feelings.
Is Schizophrenia Associated With A Chemical Defect In The
Brain?
According to the National Institute of Mental Health, “basic
knowledge about brain chemistry and its link to schizophrenia is
expanding rapidly. Neurotransmitters, substances that allow
communication between nerve cells, have long been thought
to be involved in the development of schizophrenia. It is likely,
although not yet certain, that the disorder is associated with
some imbalance of the complex, interrelated chemical systems
of the brain, perhaps involving the neurotransmitters dopamine
and glutamate.”
Many drugs affect the flow of neurotransmitters in the brain.
Researchers can not tell exactly to what extent, street drugs
are responsible for psychotic breakdowns and both acute and
long term reactions. These reactions are frequently brought on
by high dose drug abuse or long term drug abuse and can be
short term or long term. The major drugs of abuse that are
known for producing these effects with long term use are
146
methamphetamines, cocaine, and psychedelics. Marijuana,
long believed to be less harmful than other street drugs, has a
psychedelic affect as has been shown in many cases to have
more devastating long term psychotic effects than previously
believed.
Male Sterilization
This award goes to the drug Marijuana. Cases of permanent
damage to the reproductive system in males is attributed to this
drug more than any other.
Genetic Damage
All drugs are believed to be capable of corrupting the genetic
code of DNA. Among the drugs that have most been shown to
have this effect are street drugs that contain impurities or are
augmented with another chemical. But many believe that
even prescription drugs given under the care of physicians are
capable of corrupting the genetic code of DNA.
Pharmacology is a new science. The widespread use of
prescribed drugs is barely a few decades old. But the problem
is that it often takes decades to see what the genetic effects of
the drug might be through longitudinal studies that may take
several decades. The FDA has released many drugs onto the
market that have later been found to corrupt genetic material.
It is believed by many that the FDA is in serious crisis and is
making mistakes that are causing the lives of staggering
numbers of people nationwide. Read the following article
adapted from the Boston Globe of April 2, 2000 to get a feel for
what recent problems have been.
The biblical truth that
comes through this newspaper story loud and clear is that no
amount of science and no amount of research can foretell
what only God can know.
147
FDA in Crisis
By Thomas J. Moore
Adapted from the Boston Globe Sunday Focus Section of April 2, 2000.
The Food and Drug Administration's back-to-back withdrawal of two drugs in three days hints at a deeper
crisis in the agency.
In March, the FDA withdrew Rezulin after it was implicated in 63 reported deaths, and 27 cases of lifethreatening disability caused by liver damage. Two days later, the agency withdrew the heartburn drug
Propulsid after 80 reported deaths from cardiac arrest and 347 life-threatening cardiac emergencies.
These facts, taken directly from FDA press statements, might suggest a drug safety system operating
reasonably well. Some would argue that despite the unfortunate death toll - the rough equivalent of, say, an
airplane crash- millions of people have benefited from such innovative new drugs. But a closer look
reveals an FDA in crisis, clinging to its historical reputation for vigilance even as it exposes an
unprecedented number of consumers to new risks, and stifles concerns raised among its own ranks.
The casualty toll from the two FDA-approved drugs recently withdrawn is far higher, perhaps 100 times
higher, than that acknowledged by the agency and the two manufacturers involved (who privately
negotiate with the FDA and then give out the same numbers).
Because the system relies on voluntary reports, it captures only a small percentage - anywhere from 1 out
of 10 to 1 in 10,000 - of drug adverse events, including deaths. That small number is reduced even further
to arrive at official totals, because many additional reports are excluded on technicalities - such as
insufficient information on the form, or because a patient has another problem complicating the picture.
With Rezulin, for example, at the point the manufacturer, Warner-Lambert, and the FDA had publicly
disclosed only 33 deaths or liver transplant cases linked to the drug, voluntary reports indicated at least
155 deaths overall, and hundreds more serious injuries.
Just Two Drugs Seriously Injure Thousands
It is reasonable to estimate that Propulsid and Rezulin each caused thousands of serious injuries and
hundreds of preventable deaths. And they are but two of the nine drugs, each with its own casualty
toll,withdrawn for safety reasons since September 1997.
The pharmaceutical industry and the FDA have gambled with the public's health at a time when mistakes
can be deadlier than ever. In recent years, as a flood of new drugs has entered the market, the industry has
perfected aggressive marketing techniques that often result in literally millions of people taking a new
drug within months of its approval. If a dangerous new drug does reach the market, the consequences are
far more devastating than a decade ago, when new drugs made a far slower entry into the marketplace,
affecting far fewer people.
FDA Response to Rising Risks
The response of the FDA's senior drug regulators to these rising risks has been troubling. Since 1994, the
FDA's drug approval unit has been led by Janet Woodcock, a rheumatologist who has been with the
agency since 1986. Many key decisions have been publicly attributed to her senior deputy, Murray
Lumpkin, another career FDA physician. So far, these two appear to have shaped current drug approval
policy more than Jane Henney, the commissioner who has been in office less than 18 months.
In medical journal articles, special reports, and press statements, Woodcock and others have repeatedly
claimed that safety standards have not been lowered. Whether true or not, the agency could hardly say
otherwise. But with each additional drug withdrawal, that claim became steadily less credible.
148
The next line of defense has been the kind of spin-control usually employed by embattled politicians. For
example, when the antibiotic Raxar was Withdrawn last October for safety reasons, the agency made no
public statement whatever, and as a result got minimal media attention.
Spin Control in Action
The FDA timed its announcement on Rezulin and Propulsid so late in the day that the story was not
included on network television evening news, and print reporters' ability to get any perspective other than
the FDA's was limited. Meanwhile, safety concerns have been rising among FDA staff. When the Public
Citizen Health Research Group anonymously polled FDA medical officers who perform the hands-on
review of new drug applications, 34 said the pressure to approve new drugs had increased since 1995, and
19 officers named specific drugs they believed should not have been approved.
By early this year, the staff concern had boiled over into rebellion. Staff members leaked agency e-mails
documenting that a growing number of FDA specialists were urging the immediate withdrawal of Rezulin.
But Warner-Lambert strongly resisted, and Woodcock and Lumpkin sided with the company.
The FDA Investigates Its Own
The agency's response to the controversy was to investigate - and threaten with dismissal - Robert Misbin,
the medical officer who had initially backed approval of Rezulin, but later sought its immediate removal
from the market.
Investigators wanted to know whether Misbin had leaked agency e-mails voicing concerns about Rezulin
safety. And, in what may be the low point in this agency's history, heavy-handed FDA investigators
showed up in the office of Leo Lutwak, a medical officer and supervisor in the office that reviewed
Rezulin, according to several press accounts. They threatened Lutwak, who is 72, with five years in jail
unless he confessed that he was the one leaking e-mails from FDA specialists concerned about Rezulin. He
told them they were wrong.
This intimidation is a radical change from the agency's long and Honorable tradition of openness, in which
its experts were free to discuss concerns with the press and public.
Episodes Illustrate Policy of Accomodating Industry
Two pivotal moments illustrate how the FDA's new tilt toward industry has put consumers at risk:
The first involves Duract, a painkiller similar to ibuprofen, aspirin, and Aleve. Early testing revealed that
Duract could damage the liver, and this did not escape the attention of veteran FDA medical reviewer
Rudolph Widmark. He noted that some other drugs in this family had also shown liver toxicity, but
concluded Duract was the worst he had seen. It looked like an easy call.
Does the world need an alternative to aspirin and ibuprofen noted mainly for its higher liver toxicity? But
would the agency say no to the manufacturer, Wyeth-Ayerst, which had invested millions of dollars to
develop what must once have seemed a promising new drug? The issue was appealed to Lumpkin, who
tried to compromise. Duract was approved, but with a warning to doctors about its liver toxicity, and a
recommendation limiting its use to only 10 days. But millions of people with long-term pain routinely take
similar drugs for weeks or months. It was like unveiling a new car with a stern warning not to drive it over
35 miles per hour.
Selling an Expensive Alternative to Aspirin
And, then, could Wyeth-Ayerst actually sell an expensive alternative to aspirin with a liver toxicity
warning that it could only be used for 10 days? So effective is the industry at marketing, and so uncritical
are prescribing physicians, that more than 2.5 million prescriptions were written in the 10 months before
Duract was withdrawn because of the expected, predictable, and entirely preventable liver deaths.
Companies can now rack up sales with extraordinary speed if the FDA opens a window of opportunity.
Before its withdrawal, Propulsid had reached nearly $1 billion in sales each year. Warner-Lambert
captured about $1.8 billion in additional sales from the time Rezulin was withdrawn in Britain in late 1997
until its withdrawal here this month.
149
Rezulin is at the center of the second example illustrating the FDA's tilt toward industry, according to an
account first published in the Los Angeles Times.
The Orginial Evaluation of Rezulin
If it had been up to the original medical officer, John Gueriguian, Rezulin would never have reached the
market in the first place. He believed that its benefits were minimal and poorly documented, and noted its
potential toxicity both to the liver and the heart. He had written his preliminary findings in a draft report
that was circulating among colleagues at the FDA and may have reached the company.
But before he could finalize his review, Gueriguian was summarily removed from the Rezulin case. In a
meeting with Mary Taylor, a senior Warner-Lambert executive, Gueriguian had used vulgar language to
describe his negative view of the drug. After Warner-Lambert complained, Lumpkin reprimanded
Gueriguian and banned him from further work on Rezulin.
More mysteriously, his point-by-point critique was never filed and made part of the official Rezulin
record. With the most experienced reviewer out of the way, and Rezulin still rolling forward on the fast
track to approval, the liver toxicity of Rezulin was largely overlooked for many months - until the death
reports started flooding in. Even then, it was 2 1/2 more years and thousands of additional liver cases later
before the FDA finally took Rezulin off the market.
A Tilt Towards Industry by Two Measures
Whether one looks at the big picture - nine drugs withdrawn in four years -or inspects individual episodes,
the story is largely the same: The agency has accommodated industry by accepting risky drugs, and when
these drugs triggered concerns, simply issued warnings to doctors, rather than promptly removing the
drugs from the market.
Industry marketing has portrayed each of these risky new drugs as a breakthrough with unique mechanism
of action. In fact, the withdrawn drugs were largely "me-too" drugs, ones that offered consumers few new
benefits, compared to safer alternatives already on the market. Rezulin was the 11th drug to treat adultonset diabetes. There are at least five safer alternatives to Propulsid for heartburn. Duract was one among
18 similar painkillers; Posicor was the 104th drug for high blood pressure, and Raxar was the 13th
fluoroquinolone antibiotic to reach the market.
Industry View: The System Works Well
The pharmaceutical industry insists the current system is working well, and from its perspective, it may
well be. Profits have reached recordlevels. But, in a push for quick approval for new drugs, the tilt to
industry has gone too far.
The nation needs a strong and independent FDA. Just as we have the nonpartisan National Transportation
Safety Board as a watchdog over airline safety and the Federal Aviation Administration, we also need an
independent panel to monitor the FDA and prevent further deterioration of the vital drug safety system.
Until then, perhaps we should heed the suggestion of US Representative Henry Waxman, a California
Democrat, who has called for an outside investigation into what is happening at this troubled agency.
150
THE MAJOR PITFALLS OF PSYCHOTHERAPEUTIC APPROACHES
151
CHAPTER 7
THE MAJOR PITFALLS OF PSYCHOTHERAPEUTIC APPROACHES
Typical abuses and effects of humanistic therapeutic
approaches
 False interpretation of the client’s problems (Often found in Psychoanalytical
approaches).
 The manufacturing and perpetuation of victims (Self-Awareness Approaches).
 Traumatization (Gestalt Therapy and Confrontational Therapies).
 Instilling “Bellybuttonitis”: The practice of constantly becoming self-conscience
 Instilling a false sense of security – Transactional Analysis: “I’m Okay, You’re Okay.
 Instilling a false pride through the use of inappropriate praise.
 Instilling the idea that it’s okay to live out whatever you believe your “destiny” to be,
even if it is evil and destructive in nature – Gestalt and Existential, and Rogerian
therapeutic approaches.
 Building a false belief system leading to eternal disaster – Cognitive Mapping.
 Removing all props and masks before a person is given the only viable alternative
that can comfort and integrate them after all else is lost – Confrontational Therapies.
 Instilling a sense of rebuilding your own personality – The Human Potential
Movement and Maslow’s Theory of Self-Actualization.
 Attempting to discipline the flesh or soulish realm without seeking fundamental
spiritual transformation.
152
Major Counseling Theories and the spirit behind them
Psychoanalytic Therapy
Sigmond Freud is the developer of psycholanalytic theory and
considered by many to be the father of psychology.
The belief system behind the approach is that behaviors are
determined by sub-conscious, sexual motivations that can be
understood by analysis and changed by the reshaping of the
personality over time.
The therapeutic goal of this approach is to bring subconscious
motivations to awareness and strengthen the human ego so
the client is no longer determined by them.
The therapeutic techniques used in psychoanalytic therapy
include free association, the discussion of thoughts that come
to mind that have been stimulated by the showing of a picture
or mention of a word, journaling, and free discussion of
thoughts that come to mind while relaxing on a couch or
comfortable chair. These techniques allow clients to do most
of the talking in order to reveal information about their
personality and unconscious motivations. The therapist is then
free to make interpretations of the voluminous material given
and come up with a theory of what the cause of the client’s
troubles are.
The fallacy of this theory is that it assumes that unconscious
motivation determines our troubled thoughts and behaviors
and that by becoming aware of our subconscious motivations
the problem will be solved. But as Christians who are aware of
Biblical truth, we understand that we are not determined and
motivated by unconscious thoughts, but by what we believe,
and that it is the truth and belief in God’s promises that will set
us free, even from unconscious thoughts and feelings.
153
The pitfalls of this approach is that it often wastes time
analyzing and searching for subconscious motives which may
not exist, resulting in faulty interpretations which may actually
do damage to the individual and add further confusion to the
understanding of their life. Freud’s theory also denies the
existence of sin and willful choices motivated by sin.
Furthermore, because the approach believes in a broad base
of underlying sexual motivations for behavior, it supports
destructive sexual behavior as a way to healing and
wholeness.
Adlerian Therapy
Alfred Adler created this theory which says that Man’s view of
the first 6 years of life influences his perceptions in later life and
consciousness rather than unconsciousness is the center of
personality. Man suffers from feelings of inferiority overcome by
mastery and achievement.
The therapeutic goal of this therapy is to uncover areas of
inferiority established in the first 6 years of life and re-educate
the client toward behavior patterns that the counselor believes
will achieve superior goals.
The therapeutic technique used in this approach creates a
new cognitive map that helps client to develop social interest,
overcome feelings of discouragement and inferiority, modify
views, goals & lifestyle, change faulty motives, feel a sense of
equality with others, and become contributing members of
society.
The fallacy of this approach is that it assumes that the cognitive
mapping provided by the therapist is valid and helpful. If it
comes from the Word of God, applied by the leading of the
Holy Spirit it would be. But the problem is that most Adlerian
154
Therapists are “rationalists” relying upon their human intellect
alone. We know, however, that the word of God tells us not to
rely upon our human understanding but to rely upon God’s
Word which comes to us and through us by God’s Word (the
holy scriptures) interpreted by the Holy Spirit. This truth, which is
the highest truth, may or may not be consistent with our
understanding.
The major pitfall of this approach is that the values of the
therapist determine which goals of the client are mistaken and
how the client should be re-educated. Since in the vast
majority of cases, the new cognitive map that is internalized by
the client is not the Word of God interpreted by the Holy Spirit, it
will lead to further and perhaps more permanent confusion
and ill-fated behavior.
Since Adlerian Therapists belong to a group of highly “rational”
theorists they tend to be stuck in their intellect. This means that
they will rely more upon their biased and flawed intellect, than
Holy Spirit led instincts or conscience. Humanists believe in
relative truth and reject the absolute truth of God as applying
to all mankind. Because of their relativistic views, they do not
see their intellect as being flawed even though they may be
aware that their values may be different from what’s stated in
the bible or spoken of by other men.
In addition the other pitfalls mentioned, like other humanistic
theories of counseling and behavior, the outcome is reliant
upon self-effort without the advantage of the enabling power
of God.
Existential Therapy
Viktor Frankel and Rollo May created this theory which says that
Man must create meaning in a world that lacks intrinsic
meaning.
This therapeutic approach focuses upon self-
155
awareness, freedom of choice, identity, relationship to others,
search for meaning, dealing with anxiety as the human
condition, and awareness of death and non-being as routes to
health and wholeness.
The therapeutic goals of this therapeutic approach is to
increase client awareness and encourage them to take
responsibility for their lives and to help them confront the
“existential” anxieties of life (mainly the idea of death and
dying and that we are finite beings).
The therapeutic techniques used in this approach are the
encouraging of clients to focus upon the current subjective
world in order to help them understand alternative options.
Desensitization, free association, cognitive restructuring, and
self-awareness mirroring are often used but the focus is upon
confronting clients with the ways they are living a restricted
existence.
The fallacy of Existential Theory is that it completely denies the
reality of eternal life and the existence of God who can
intervene in their clients life. Instead it focuses upon feelings of
anxiety and tries to cover them up using techniques of
desensitization. As Christians, we know that the only permanent
way to deal with these anxieties is to surrender the burden of
them to God.
The major pitfall of this approach includes teaching the client
that there is no after life; that there is no God to help them
cope with existential anxiety, and that there is no God to give
them strength to make lifestyle changes. Since this is the belief
system that is internalized by the individual, they are effectively
blocked from being able to receive the supernatural help of
God. They are also further confused and set up for relapse at
some point, maybe even years, into the future when they may
experience a relapse of the surfacing of other behaviors that
156
have not been able to be resolved because they were stuck in
the deception of this theory.
Person-centered Therapy
Carl Rogers is the developer of this theory, also known as
“Chient-centered Therapy.”
The underlying belief behind this theory is that the core of the
human being is good and if provided with appropriate
conditions, will automatically grow in a positive way. The
emphasis is upon creating a non-judgemental, nonthreatening, non-directive growth producing climate.
The therapeutic goals of Roger’s theory is to encourage an
openness to experience, a trust in themselves and their internal
source of evaluation, and a willingness to continue growing.
The therapeutic techniques used are non-judgmental
unconditional positive regard and paraphrasing for
understanding. The role of the therapist is to reflect who the
client is back to the client without being directive in any way.
Paraphrasing and non-directive mirroring are the therapist’s
major techniques.
Carl Rogers held and posited the theory that there was no such
thing as what the Christian world calls “sin”. In fact, he denied
the doctrine of “Original Sin” which is central to the biblical
Christian faith. Rogers declared that the problem with human
beings is that they are born in innocence but as they grow up
through their childhood, they develop “neurotic” tendencies
put on them by the world. Roger’s personal belief influenced
his therapeutic approach to teach clients that there is no sin
and that the highest expectation from counseling is to see who
the client really is and accept whatever he sees. The fallacy of
157
this therapeutic approach is the sin is real and must be
confronted at some point if people are to change.
Gestalt Therapy
Fritz Perls is credited with the development of Gestalt Therapy.
The belief system behind this approach is based upon “Selfawareness”. Basically it says that as a person gets more selfawareness, they grow and are better able to find their own
way in life.
Gestalt Therapy’s therapeutic goals are to help the client gain
awareness of what they are feeling, thinking, believing, and
doing in the here and now, the therapist devises experiments to
help the client uncover truths about themself and decide how
they want to live.
The therapeutic technique employed by the Gestalt therapist is
that the therapist observes the client’s body and verbal
language and confronts the client’s habits and attempts to
hide, cover up or wear a mask.
The Gestalt therapist teaches that any behavior is okay so long
as the client believes that the behavior is really their true self.
The only thing that is wrong is when you try to mask it. The
fallacy of this approach is that like other humanistic theories, it
denies the concept of sin and evil. This approach teaches that
whatever your tendencies are, are okay if you want that to be
your true self. You choose. Even a choice to be evil is okay.
Reality Therapy
William Glasser is the developer of Reality Therapy.
158
The belief system behind Reality Therapy says that we are
internally motivated by 5 basic needs: Belonging, power,
freedom, fun, and survival.
We are not victims of
circumstances outside of ourselves nor are we at the mercy of
unconscious motivations. The capacity to change is within us.
The therapeutic goal of this approach is to help the client find
more effective ways of meeting their needs for belonging,
power, freedom, fun, and survival.
The therapeutic technique used by the Reality Therapist is to
establish a warm therapeutic relationship, and in that
relationship the therapist explores the client’s behaviors and
allows client to decide if they are effective in meeting his wants
and desires. The therapist then offers other behavioral choices.
No choices are based upon right or wrong, but only upon what
the client wants.
The great fallacy of this approach is that it posits the idea that
people are always able to choose whatever lifestyle and
behaviors are they desire to live out (even if what they choose
might be harmful to them or to society). For instance if one
desired to live out his life as a hermit, even if it was a pattern of
isolation and loneliness that stimulated his drug use, the reality
therapist might put his stamp of approval on life as a hermit (so
long as the drug use was successfully curtailed). There is no
such thing as good or bad or right or wrong with this theory. It
also teaches that strength to change comes from self alone
and supporting a humanistic “Get-A-Grip” philosophy while
overlooking the spiritual concept of “Surrender”.
Behavior Therapy
Ivan Pavlov, B. F. Skinner, and Albert Bandura are most well
known for the development of the theories of Behaviorism and
Behavior Therapy.
159
The belief system behind this theory posits that the person is
both the producer and the product of his environment and
that scientifically modifying the behavior of the client, changes
them internally as well.
The Behaviorists therapeutic goals are to set specific goals that
can become owned by the client for making specified
behavior changes, and to set new conditions for learning new
behaviors that can take the place of dysfunctional ones.
The therapeutic techniques used by the Behaviorist are as
follows: The counselor explains the purpose of goals and allows
the client to specify behavior changes they want to make.
Together they determine if the goals are “owned” by the client,
realistic, and advantageous. They then seek ways to measure
effects of new behaviors and explore possible goal revisions as
needed.
The developers of Behaviorism taught that human reason and
natural science reigns supreme in the universe and that there is
no God that could be appealed to intervene in a person’s life.
They believed that man could successfully psychologically
engineer people by conditioning their behavior. This view does
not take into account other important factors like the
individual’s relationship with God, family, and other human
beings. But it is true that as a person’s behavior is changed
feelings and attitudes do line up with these behaviors.
The failure of this kind of therapy is that unless the individual has
a personal relationship with God as the basis of his or her life, it
is possible to establish a false and unhealthy lifestyle from the
very conditioning techniques that are used to stop drug or
alcohol abusing behaviors. The bible tells us to, “Keep thy heart
with all diligence; for out of it are the issues of life.” (Proverbs
4:23 KJV) What we must realize is that by the use of behaviorist
conditioning we can change the surface behaviors of alcohol
160
use, but unless the heart, out of which the issues of life proceed
is also touched, no substantial and lasting change should be
expected. For this reason, many people who have been
through drug & alcohol rehab programs that use this
approach, will tend to suffer more relapses than those who
have been through a program in which surrender to God is a
central part of the program.
Rational-Emotive Therapy
Albert Ellis is the person credited most with the development of
Rational-Emotive Therapy.
The belief system behind this approach posits that Man is
capable of having both rational and irrational thought
processes and has inborn tendencies toward growth and selfactualization as well as tendencies toward crooked thinking.
The therapeutic goals is to help the client minimize emotional
disturbances and self-defeating behaviors by acquiring a more
realistic and workable philosophy of life offered by the rational
thinking of the therapist and by teaching the client to apply
discipline instead of avoiding life’s difficulties.
The therapeutic technique that is applied is that the therapist
helps the client to discover basic irrational ideas that motivate
disturbed behavior and challenges them to validate their ideas
while the therapist demonstrates the illogical nature of their
thinking and how they lead to emotional disturbances. The
therapist shows the client how to use scientific method to
replace old thinking with more rational ideas that are
empirically grounded.
One great fallacy of this approach is the idea that everything
can be worked out through rational means. The problem is
that one therapist’s rationality is another’s absurdity. Men’s
161
minds are not consistent. The only consistent mind is the mind
of God that we could have privy to through His inspired Word.
With regard to the idea of “rational thinking” as being the goal
of therapy, this approach teaches the humanistic idea of
freedom of thought and the methods of natural science as the
bedrock of therapy thereby encouraging the therapist to
impose atheist views or “science as religion” views of what
constitutes rational thinking.
CRISIS COUNSELING
162
CHAPTER 8
CRISIS COUNSELING
Course Objective: The Student will feel confident and will be
able to effectively conduct crisis counseling whenever the
need arises.
The meaning and purpose of crisis
The meaning of the word “Crisis” comes from the Greek word
Ananke meaning distress, hardship, compelled, or forced.
People go through crisis in a number of ways. It could be
through some kind of loss like the loss of a job, the loss of a
friend, or the death of a loved one. The crisis could be through
an emergency that has created great hardship for you or your
loved-ones; a natural disaster like a tornado or earthquake or
flood that destroyed your home. There are many scenarios
that would meet the requirements of creating a crisis in
someone’s life and making them feel overwhelmed by
circumstances beyond their control.
The Bible tells us that God puts us through the fires of affliction
by use of various trials and tribulations in our life. “How can a
loving God do that to us?” We might ask. He allows affliction
to come into our lives because He knows that only by them
163
can we get the needed conditions in life to turn to him in our
hour of desperation, with a mind prepared with the
hopelessness of our situation, and a heart prepared in humility,
so that we could cry out to Him with our prayers and see Him
be our redeemer and deliver us out of the situation and put us
in a safe place in His love.
Three kinds of crisis
There are three kinds of crises that take place in peoples lives:
Predictable, unexpected, and traumatic.
Predictable Crises
A predictable crisis often takes place when a beloved family
member passes on due to old age.
Often in such
circumstances it has been know for a quite some time that this
day would come. If the person was a member of the family
was crucial to the well-being of the family in one way or
another, the loss is deeply felt even though it was known that it
would come for some time.
Because it was known that it would come, the members of the
family had time to prepare both emotionally and with regard
to practical matters such as the distribution of an estate among
the remaining family members. The degree to which the family
knew how to prepare, and actually made preparations might
play a part in the ability of the family members to be more
ready for the event. Often times because it is known that the
event will take place, a period of grieving that needs to be
accomplished is often done prior to the event, so that when
the event takes place, it can be experienced as more of a
settling or a relief that it is finished and in God’s hands.
It
should be noted, however, that it is possible that even though
the crisis was predictable, because people respond differently
164
in their emotions, it could be experienced just as severely as it
was an unpredictable or traumatic crisis. Therefore, we should
not assume how someone in particular will respond on the basis
of what kind of crisis it is.
Unpredictable Crises
During the tornado season in America’s heartland, people are
aware of the possibility that the tornado may visit their home,
but few really believe that their home will not last through the
tornado season. Natural disasters may strike our homes at any
time. Fire, flood, earthquake, hurricane, tornado, landslide.
Locusts may pick clean someone’s farmland, or an epidemic
like SARS may visit a family. All of these types of crises are
unpredictable. There may have been the usual amount of
preparation for such events that we are all warned by the fire
department to prepare for, but virtually no time to prepare
emotionally.
With unpredictable crises there is an added dimension of
shock, in many cases, that is experienced by the person going
through the it. This should be expected as a possibility and we
should try to discern how severe there emotional response is in
actuality. This can be done mostly through observation of their
movements and their conversation.
Traumatic Crises
Traumatic crises can be either predictable or unpredictable,
but no one really believes or is prepared for it happening to
them. During the Vietnam war, our nation first became aware
of a condition experienced by many who have been in the
heat of combat. Many who saw their best friends being
brutally killed around them with blood splattering everywhere,
but somehow survived themselves, report a condition of
165
flashbacks to those combat images and night-terrors
containing these combat images. This condition has been
named Post-Traumatic Stress Syndrome by the Psychiatric
establishment. This is just one example of the effects of trauma.
Initial responses and spiritual outcomes
A person’s initial responses and spiritual outcome depends
upon their spiritual resources and their understanding of really
took place. As Christian counselors, we understand that the
emotional impact of crisis shakes up a person’s life. It disorients
them and often puts them into a place of emotional and
spiritual paralysis. Unless their spiritual resources and their
personal relationship with Jesus Christ was strong enough going
into the crisis, they will remain disoriented for some time.
No one comes out of a crisis the same as they came in. If the
individual did not have the resources of a rich spiritual life and
intimacy with Jesus Christ to begin with, the shock or trauma of
the event will have left them emotionally and spiritually
impaired. For such people, the aftermath of a crisis may cause
deep fear, anxiety and emotional paralysis. Initial physical
symptoms such as nausea, tremors and shaking, hypertension,
hives or skin rash, and digestive disorders followed by more
long-term ailments usually emerge.
On the other hand, the individual with spiritual resources, a
personal relationship with Jesus Christ, and a developed sense
of faith and trust in God to carry them through the deepest of
troubles is often observed to have an exact opposite response
of what might be expected. This individual instead will be seen
to have an inner strength that keeps them from being
overwhelmed by their troubles. An inner peace can be
observed because that person has taken refuge in God.
166
Three stages of counselor intervention
Stage one: Acceptance and comfort
When the person in crisis first comes to you they need to know
that you accept them and the reality and depth of their pain.
The first stage of counseling needs to contain the
communication of compassion, and acceptance. This is the
burden bearing stage. “Bear you one another's burdens, and
so fulfill the law of Christ.” (Galatians 6:2 KJ2000). This stage
must also be characterized by active listening.
Let the
individual know that you are hanging on every single word and
completely understand what they are saying. Allow the person
to pour out their emotions with as much abandon as they can.
Pray with them and together give those emotions to the Lord.
Show great empathy and give as much emotional support as
possible during this crucial stage.
Stage Two: Sort & Sift
In this stage, the main objective is to boil down the problem to
its essentials. The initial shock wave has passed but now the
individual is stuck in confusion about where to go from here.
Help the person to explore their present life situation and
determine their potential threats and most pressing needs that
must be met in order to regain their equilibrium.
Stage Three: Continue support and offer resources
After you are sure that the person understands their present
condition and has developed an immediate plan to work
toward reconstruction, continue to give insight as the Holy Spirit
gives it to you and give physical help if possible along with
referrals to community resources that can help the individual in
167
their present situation. “If a brother or sister be naked, and
destitute of daily food, And one of you say unto them, Depart
in peace, be warmed and filled; yet you give them not those
things which are needful to the body; what does it profit? Even
so faith, if it has not works, is dead, being alone.” (James 2:1517 KJ2000)
Four stages of the crisis-to-healing process
As Christian counselors, we earn the right to speak into people’s
lives by walking the process.
Stage One: Initial response to the crisis
The individual’s initial response to the crisis is typically
immediate to a matter of hours. The response can take the
forms of fight, flight or paralysis.
Thought processes are
characterized by numbness, disorientation or fear.
The
counseling intervention most needed during this stage should
be characterized by acceptance of feelings and compassion.
Stage Two: Confusion / emotional and spiritual turbulence
Typically it takes days after the event to get to this stage. The
individual’s emotional responses at this time may consist of
anger, fear, guilt, and rage. Their though process consists of
unbelief, ambiguity, and uncertainty. During this period the
individual may move between bargaining with God and
detachment. They involve themselves with the confused
scanning of the wreckage. Due to the prevalent confusion
experienced by the individual during this stage it is best for the
counselor to give simple task oriented direction.
168
Stage Three: Transition and sorting out
This stage may begin weeks after the crisis event. In this stage
positive thoughts begin with thoughts of problem solving and
the search for a better life. The individual begins seeking a
closer relationship with God and the leading of the Holy Spirit to
guide them.
During this stage there is more focused
exploration.
Counseling during this stage should be
characterized by support and spiritual insight.
Stage Four: Reconstruction
Typically it takes months to get to this stage of the process. This
stage is characterized by feelings of hope and new purpose.
The individual’s thought processes are more clear with new
direction. Intimacy with God has been established. During this
period the individual continues to seek a closer relationship with
God and the leading of the Holy Spirit with a more focused
exploration. The counseling guidance to give throughout this
stage is spiritual insight, support, and examination of new
purpose.
Prior to this last stage throughout the earlier stages of the
process, the counselor should discern what is too heavy a
burden for the individual to carry alone. Discern what should
be done for them and what they should do for themselves.
During the counseling there is the temptation on the part of the
counselor to try and figure out what God is trying to produce in
them just as Job’s friends did with Job. It is not our task to do
that. If we embark upon this expedition it will be a burden to
the reconstructive part of their process.
169
Giving help and identifying resources
Meet physical needs where you can. In the secular world of
counseling, there is a “professional” boundary that will not
allow the counselor to be of any help at all beyond the
confines of the counseling office. But as Christian counselors
we realize that we are also brothers and sisters in the lord to the
person we are counseling. We also hold the attitude that,
“There but by the grace of God go I.” This attitude does not
allow the detachment of non-involvement in wholesome and
edifying ways. As counselors there are certain boundaries we
can not cross, but we can give them a ride to church, we can
take them to a shelter or food pantry, or we can buy them a
bus pass, and we can pray for them and with them. “What
does it profit, my brethren, though a man says he has faith, and
has not works? Can faith save him? If a brother or sister be
naked, and destitute of daily food, and one of you say unto
them, Depart in peace, be warmed and filled; yet you give
them not those things which are needful to the body; what
does it profit? Even so faith, if it has not works, is dead, being
alone. (James 2:14-17 KJ2000)
Gather other people and other resources – you can’t do it
alone. It is important to be aware of ministries and resources in
the community that you can call upon to help in areas that
your client needs help in. If we remain unaware of what
resources there are in the community and what other Christian
ministries exist, we will not be able to bring them all the help we
could have.
Be realistic in your expectations during this time. On the one
hand, it is good to encourage your client to get back into a
certain routine of life as soon as is practical, but on the other
hand, each person requires a different amount of “rebound
time” to get back on their feet the length of which is only
known by God. We should not push too soon, too quickly.
170
Never judge one’s attitudes or behavior in the early phases of
the crisis-to-healing process. This will be experienced as a
burden to the recovery process. However, once your client is in
the reconstruction phase, certain words spoken fitly and in due
season regarding attitudes and behaviors may be needed in
order to make further progress. These brief interventions should
always be given after acknowledging the good qualities you
have noticed and the progress that has been made, couched
in a lot of encouragement.
Do not give “pat” answers. People need more than answers
from a cookbook formula. People are unique from one
another. They need time and understanding. They may be
hurting, but they can detect flippancy in a counselor who will
not take the time nor see them with eyes of understanding.
Jumping to quick conclusions based upon superficial
information gathering will be experienced by the client as salt
being poured into their wounds.
Keep expressing hope. Your client is surrounded with the
wreckage of their crisis as an ever-present reminder. They need
your frequent reminder concerning the truth of hope for their
future, a future that can and will turn out even better than they
can now conceive. Keep the focus upon God’s plan for their
lives. “For I know the plans I have for you, says the Lord, a plan
for good and not for evil, to give you hope and a future.”
Jeremiah 29:11.
Keep expressing God’s love and affirmation. Show to your
client through your patience and understanding, God’s love
through you. As you prayerfully ask God to show His love
through you to your client, He will.
Be very sensitive to the Holy Spirit about when to speak and
when to listen; when to help and when to let one help him or
herself. We can only be a tool of God for our clients, we can’t
be God for them. So we need to stay in prayer always seeking
171
God as to what we can and must not do. If we do too much
we might be short circuiting God’s plan.
Appendix A
Professional Code of Ethics for Drug & Alcohol Counselors
Ethical Standards for counselors by the NAADAC, The
Association for Addiction Professionals
NAADAC, The Association for Addiction Professionals is
comprised of alcoholism and drug abuse counselors who, as
responsible health care professionals, believe in the dignity and
worth of human beings. In the practice of their profession they
assert that the ethical principles of autonomy, beneficence
and justice must guide their professional conduct. As
professionals dedicated to the treatment of alcohol and drug
dependent clients and their families, they believe that they can
effectively treat its individual and familial manifestations.
NAADAC members dedicate themselves to promote the best
interests of their society, of their clients, of their profession and
of their colleagues.
SPECIFIC PRINCIPLES
Principle 1: Non-Discrimination
The NAADAC member shall not discriminate against clients or
professionals based on race, religion, age, gender, disability,
172
national ancestry, sexual orientation or economic condition.
a. The NAADAC member shall avoid bringing personal or
professional issues into the counseling relationship. Through an
awareness of the impact of stereotyping and discrimination,
the member guards the individual rights and personal dignity of
clients.
b. The NAADAC member shall be knowledgeable about
disabling conditions, demonstrate empathy and personal
emotional comfort in interactions with clients with disabilities,
and make available physical, sensory and cognitive
accommodations that allow clients with disabilities to receive
services.
Principle 2: Responsibility
The NAADAC member shall espouse objectivity and integrity,
and maintain the highest standards in the services the member
offers.
a. The NAADAC member shall maintain respect for institutional
policies and management functions of the agencies and
institutions within which the services are being performed, but
will take initiative toward improving such policies when it will
better serve the interest of the client.
b. The NAADAC member, as educator, has a primary
obligation to help others acquire knowledge and skills in
dealing with the disease of alcoholism and drug abuse.
c. The NAADAC member who supervises others accepts the
obligation to facilitate further professional development of
these individuals by providing accurate and current
information, timely evaluations and constructive consultation.
d. The NAADAC member who is aware of unethical conduct or
of unprofessional modes of practice shall report such
inappropriate behavior to the appropriate authority.
Principle 3: Competence
173
The NAADAC member shall recognize that the profession is
founded on national standards of competency which promote
the best interests of society, of the client, of the member and of
the profession as a whole. The NAADAC member shall
recognize the need for ongoing education as a component of
professional competency.
a. The NAADAC member shall recognize boundaries and
limitations of the member's competencies and not offer
services or use techniques outside of these professional
competencies.
b. The NAADAC member shall recognize the effect of
impairment on professional performance and shall be willing to
seek appropriate treatment for oneself or for a colleague. The
member shall support peer assistance programs in this respect.
Principle 4: Legal and Moral Standards
The NAADAC member shall uphold the legal and accepted
moral codes which pertain to professional conduct.
a. The NAADAC member shall be fully cognizant of all federal
laws and laws of the member's respective state governing the
practice of alcoholism and drug abuse counseling.
b. The NAADAC member shall not claim either directly or by
implication, professional qualifications/affiliations that the
member does not possess.
c. The NAADAC member shall ensure that products or services
associated with or provided by the member by means of
teaching, demonstration, publications or other types of media
meet the ethical standards of this code.
Principle 5: Public Statements
The NAADAC member shall honestly respect the limits of
present knowledge in public statements concerning alcoholism
and drug abuse.
174
a. The NAADAC member, in making statements to clients, other
professionals, and the general public shall state as fact only
those matters which have been empirically validated as fact.
All other opinions, speculations, and conjecture concerning the
nature of alcoholism and drug abuse, its natural history, its
treatment or any other matters which touch on the subject of
alcoholism and drug abuse shall be represented as less than
scientifically validated.
b. The NAADAC member shall acknowledge and accurately
report the substantiation and support for statements made
concerning the nature of alcoholism and drug abuse, its
natural history, and its treatment. Such acknowledgment
should extend to the source of the information and reliability of
the method by which it was derived.
Principle 6: Publication Credit
The NAADAC member shall assign credit to all who have
contributed to the published material and for the work upon
which the publication is based.
a. The NAADAC member shall recognize joint authorship and
major contributions of a professional nature made by one or
more persons to a common project. The author who has made
the principal contribution to a publication must be identified as
first author.
b. The NAADAC member shall acknowledge in footnotes or in
an introductory statement minor contributions of a professional
nature, extensive clerical or similar assistance and other minor
contributions.
c. The NAADAC member shall in no way violate the copyright
of anyone by reproducing material in any form whatsoever,
except in those ways which are allowed under the copyright
laws. This involves direct violation of copyright as well as the
passive assent to the violation of copyright by others.
175
Principle 7: Client Welfare
The NAADAC member shall promote the protection of the
public health, safety and welfare and the best interest of the
client as a primary guide in determining the conduct of all
NAADAC members.
a. The NAADAC member shall disclose the member's code of
ethics, professional loyalties and responsibilities to all clients.
b. The NAADAC member shall terminate a counseling or
consulting relationship when it is reasonably clear to the
member that the client is not benefiting from the relationship.
c. The NAADAC member shall hold the welfare of the client
paramount when making any decisions or recommendations
concerning referral, treatment procedures or termination of
treatment.
d. The NAADAC member shall not use or encourage a client's
participation in any demonstration, research or other nontreatment activities when such participation would have
potential harmful consequences for the client or when the
client is not fully informed. (See Principle 9)
e. The NAADAC member shall take care to provide services in
an environment which will ensure the privacy and safety of the
client at all times and ensure the appropriateness of service
delivery.
Principle 8: Confidentiality
The NAADAC member working in the best interest of the client
shall embrace, as a primary obligation, the duty of protecting
client's rights under confidentiality and shall not disclose
confidential information acquired in teaching, practice or
investigation without appropriately executed consent.
a. The NAADAC member shall provide the client his/her rights
regarding confidentiality, in writing, as part of informing the
client in any areas likely to affect the client's confidentiality. This
includes the recording of the clinical interview, the use of
176
material for insurance purposes, the use of material for training
or observation by another party.
b. The NAADAC member shall make appropriate provisions for
the maintenance of confidentiality and the ultimate disposition
of confidential records. The member shall ensure that data
obtained, including any form of electronic communication, are
secured by the available security methodology. Data shall be
limited to information that is necessary and appropriate to the
services being provided and be accessible only to appropriate
personnel.
c. The NAADAC member shall adhere to all federal and state
laws regarding confidentiality and the member's responsibility
to report clinical information in specific circumstances to the
appropriate authorities.
d. The NAADAC member shall discuss the information obtained
in clinical, consulting, or observational relationships only in the
appropriate settings for professional purposes that are in the
client's best interest. Written and oral reports must present only
data germane and pursuant to the purpose of evaluation,
diagnosis, progress, and compliance. Every effort shall be
made to avoid undue invasion of privacy.
e. The NAADAC member shall use clinical and other material in
teaching and/or writing only when there is no identifying
information used about the parties involved.
Principle 9: Client Relationships
It is the responsibility of the NAADAC member to safeguard the
integrity of the counseling relationship and to ensure that the
client has reasonable access to effective treatment. The
NAADAC member shall provide the client and/or guardian with
accurate and complete information regarding the extent of
the potential professional relationship.
a. The NAADAC member shall inform the client and obtain the
client's agreement in areas likely to affect the client's
participation including the recording of an interview, the use of
177
interview material for training purposes, and/or observation of
an interview by another person.
b. The NAADAC member shall not engage in professional
relationships or commitments that conflict with family members,
friends, close associates, or others whose welfare might be
jeopardized by such a dual relationship.
c. The NAADAC member shall not exploit relationships with
current or former clients for personal gain, including social or
business relationships.
d. The NAADAC member shall not under any circumstances
engage in sexual behavior with current or former clients.
e. The NAADAC member shall not accept as clients anyone
with whom they have engaged in sexual behavior.
Principle 10: Interprofessional Relationships
The NAADAC member shall treat colleagues with respect,
courtesy, fairness, and good faith and shall afford the same to
other professionals.
a. The NAADAC member shall refrain from offering professional
services to a client in counseling with another professional
except with the knowledge of the other professional or after
the termination of the client's relationship with the other
professional.
b. The NAADAC member shall cooperate with duly constituted
professional ethics committees and promptly supply necessary
information unless constrained by the demands of
confidentiality.
c. The NAADAC member shall not in any way exploit
relationships with supervisees, employees, students, research
participants or volunteers.
Principle 11: Remuneration
The NAADAC member shall establish financial arrangements in
178
professional practice and in accord with the professional
standards that safeguard the best interests of the client first,
and then of the counselor, the agency, and the profession.
a. The NAADAC member shall inform the client of all financial
policies. In circumstances where an agency dictates explicit
provisions with its staff for private consultations, clients shall be
made fully aware of these policies.
b. The NAADAC member shall consider the ability of a client to
meet the financial cost in establishing rates for professional
services.
c. The NAADAC member shall not engage in fee splitting. The
member shall not send or receive any commission or rebate or
any other form of remuneration for referral of clients for
professional services.
d. The NAADAC member ,in the practice of counseling ,shall
not at any time use one's relationship with clients for personal
gain or for the profit of an agency or any commercial
enterprise of any kind.
e. The NAADAC member shall not accept a private fee for
professional work with a person who is entitled to such services
through an institution or agency unless the client is informed of
such services and still requests private services.
Principle 12: Societal Obligations
The NAADAC member shall to the best of his/her ability actively
engage the legislative processes, educational institutions, and
the general public to change public policy and legislation to
make possible opportunities and choice of service for all
human beings of any ethnic or social background whose lives
are impaired by alcoholism and drug abuse.
Revised: May 20, 1995
NAADAC is comprised of members who, as responsible health
179
care professionals, believe in the dignity and worth of human
beings. In the practice of their profession they assert that the
ethical principles of autonomy, beneficence and justice must
guide their professional conduct. As professionals dedicated to
the treatment of alcohol and drug dependent clients and their
families, they believe that they can effectively treat its
individual and familiar manifestations. NAADAC members
dedicate themselves to promote the best interests of their
society, of their clients, of their profession, and of their
colleagues.
NAADAC grants permission for other professionals, associations
and certifying bodies to use this code of ethics. NAADAC shall
be referenced in writing as the source when using any or all
parts of this code. Any changes from NAADAC's original code
must be noted.
Appendix B
Spiritual Gifts Discovery Inventory
There are a total of 110 statements below. Indicate whether
you Strongly Agree, Agree Somewhat, are Undecided,
Disagree Somewhat or Completely Disagree with each
question. Transfer your answers to the profile sheet at the end of
the inventory. Total your scores for each of the gifts. Each gift
will have a score between ZERO and TWENTY. Order the gifts in
descending order of score. Higher scores indicate your more
dominant gifts. Use the List of Gifts For further study.
1) People seem to be willing to follow my leadership without
much resistance.
4 - Strongly Agree
3 - Agree Somewhat
180
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
2) I like to proclaim God's Word to fellow Christians.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
3) It is a joy for me to proclaim God's plan of salvation to
unchurched people.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
4) It is enjoyable to have the responsibility of leading other
people in their
spiritual life.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
5) I'm excited in helping people to discover important truths in
the scriptures.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
181
1 - Disagree Somewhat
0 - Completely Disagree
6) I have special joy singing praises to God either alone or with
other people.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
7) It is enjoyable to motivate people to a higher spiritual
commitment.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
8) People with spiritual problems seem to come to me for
advice and counsel.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
9) I received excellent grades in school.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
182
10) There is great joy in doing little jobs around the church.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
11) I look for opportunities to assist people in their work.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
12) There is great joy in leading people to accomplish group
goals.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
13) I like to organize people for more effective ministry.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
14) There is great satisfaction in giving large amounts of money
for the Lord's
work.
183
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
15) I feel great compassion for the problems of others.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
16) It seems easy to perceive whether a person is honest or
dishonest.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
17) I am ready to try the impossible because I have a great
trust in God.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
18) There is great joy in having people in my home.
4 - Strongly Agree
184
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
19) I find that the repair and maintenance of things in my
environment come
easily to me.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
20) I seem to recognize prayer needs before others.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
21) I enjoy the opportunity to pray with and for a person who is
physically ill
that they may be made well.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
22) I adapt easily in a culture different from mine.
4 - Strongly Agree
3 - Agree Somewhat
185
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
23) I feel a sense of authority in my relationship to the group.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
24) I like to proclaim the Word of God to comfort others.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
25) I seem able to determine when the Spirit has prepared a
person to received
Jesus Christ.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
26) It is exciting to provide spiritual leadership for a
congregation.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
186
0 - Completely Disagree
27) Teaching a Bible Class is one of the most enjoyable things I
do (or could
do) in the Church.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
28) God has given me the ability to play a musical instrument
and I enjoy it.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
29) It is a joy to give encouragement to people who are
discouraged.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
30) I enjoy providing solutions to difficult problems in life.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
187
31) It seems easy to learn difficult truths.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
32) I enjoy doing routine tasks for the glory of God.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
33) I enjoy helping with the emergency tasks around the
Church.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
34) People seem to enjoy following me in doing an important
task.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
35) There is joy in making important decisions.
188
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
36) I find real joy in giving a generous portion of my money to
the Lord.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
37) Visiting people in retirement homes gives me a great
satisfaction.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
38) I seem to know very quickly whether something is right or
wrong.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
39) When things seem impossible, I'm ready to move forward.
4 - Strongly Agree
3 - Agree Somewhat
189
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
40) I do not feel uncomfortable when people drop in
unexpectedly.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
41) I have enjoyed creating various kinds of arts and/or crafts.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
42) Prayer is one of my favorite spiritual exercises.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
43) I have prayed for an emotionally ill person and seen the
person get better.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
190
44) It is easy for me to move into a new community and make
friends.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
45) I have little fear in leading people where God wants them
to go.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
46) I enjoy relating and sharing God's Word to the issues of the
day.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
47) I feel a burden to share the Gospel with people.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
48) I like to assist people with their spiritual problems.
191
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
49) It seems that people learn when I teach them.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
50) I have enjoyed being involved with Church, school and/or
local musical
productions.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
51) I like to encourage inactive church members to become
involved Christians
again.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
52) It seems that people generally follow my advice.
192
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
53) I am able to understand difficult portions of God's word.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
54) I receive great satisfaction in doing small or trivial tasks in
church.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
55) I desire to do the tasks which will free others for important
ministry.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
56) It is more effective to delegate a task to someone else
rather than to do it
myself.
4 - Strongly Agree
193
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
57) I enjoy the responsibility for the achievement of group
goals.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
58) I appreciate the opportunity to financially support a critical
situation.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
59) I sense joy in comforting people in difficult situations.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
60) The difference between truth and error is easily perceived
by me.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
194
1 - Disagree Somewhat
0 - Completely Disagree
61) I am often ready to believe God will lead us through a
situation when others
feel it is impossible.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
62) People seem to feel very comfortable in my home.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
63) I like to create things with my hands.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
64) God consistently answers my prayers in tangible ways.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
195
65) I have visited a person who was sick, prayed that God
would make them
physically whole, and the person got better.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
66) I am able to relate well to Christians of different locations or
cultures.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
67) I appreciate the opportunity to proclaim God's word to
others.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
68) It is important for me to speak God's Word of warning and
judgment in the
world today.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
196
69) It is a joy to share what Jesus means to me with an
unchurched neighbor.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
70) People like to bring their troubles & concerns to me
because they feel I
care.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
71) One of the joys of my ministry is training people to be more
effective
Christians.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
72) I feel secure in the fact that my musical ability will be of
benefit to
other people with whom I come in contact.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
197
1 - Disagree Somewhat
0 - Completely Disagree
73) People who are feeling perplexed often come to me for
encouragement and
comfort.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
74) I feel that I have a special insight in selecting the best
alternative in a
difficult situation.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
75) I have a clear understanding of Biblical doctrines.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
76) I find more satisfaction in doing a job than finding someone
else to do it.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
198
1 - Disagree Somewhat
0 - Completely Disagree
77) I appreciate a ministry of helping other peoples to bear
their burdens.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
78) It is a thrill to inspire others to greater involvement in church
work.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
79) The development of effective plans for church ministry gives
me great
satisfaction.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
80) It is a joy to see how much money I can give to the Lord.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
199
0 - Completely Disagree
81) I enjoy ministering to a person who is sick in the hospital.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
82) I can judge well between the truthfulness and error of a
given theological
statement.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
83) People seem to view me as one who believes everything is
possible.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
84) When missionaries come to our church I (would) like to have
them come to my
home.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
200
0 - Completely Disagree
85) I see that the results of my working with various objects in
God's creation
help to improve and beautify that which other people have
not seen nor
developed.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
86) I faithfully pray for others recognizing that their effectiveness
and total
well-being depends on God's answer to prayers.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
87) I like to participate in ministry to the physically or emotionally ill and
pray for their recovery.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
88) The thought of beginning a new church in a new community is exciting
to me.
4 - Strongly Agree
3 - Agree Somewhat
201
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
89) I enjoy training workers in the congregation.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
90) In a Bible class it seems essential to share God's word even if it irritates
others.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
91) I feel a deep concern for the unreached people in my community.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
92) I Enjoy a close relationship with people in a one to one situation.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
93) It is easy to organize materials for teaching a Bible class.
4 - Strongly Agree
202
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
94) Leading others in singing songs of praise to God or for pure enjoyment
is
personally satisfying.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
95) I would rather call on a delinquent family in my Church than an
unchurched
family.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
96) I have a strong sense of confidence in my solutions to problems.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
97) It is an exciting challenge to read and study a difficult book of the Bible.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
203
98) I like to do things without attracting much attention.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
99) If a family is facing a serious crisis, I enjoy the opportunity to help
them.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
100) There is great satisfaction in having others follow me in performing a
task.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
101) I would rather make decisions for the group than persuade them to
reach the
same decision.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
102) I can give sacrificially because I know that God will meet my
needs.
204
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
103) It is a special satisfaction to visit people who are confined to their
homes.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
104) I often seek the motives of a person and look beneath the words.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
105) When people are discouraged I enjoy giving them a positive vision.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
106) People seem to enjoy coming to my house.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
107) There is pleasure in drawing, designing and/or painting various objects.
205
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
108) I find myself praying when I possibly should be doing other things.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
109) I feel strongly that my prayers for a sick person effect wholeness for
that
person.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
110) More than most, I have a strong desire to see all people of other
communities and countries won to the Lord.
4 - Strongly Agree
3 - Agree Somewhat
2 - Undecided
1 - Disagree Somewhat
0 - Completely Disagree
Discovery Tool Profile Sheet
Transfer your scores for each question into the following table, then
compute the sum of each row. This provides your score for each gift.
206
1.
Apostle 1____ 23____ 45____ 67____ 89____
= ____
2.
Prophet 2____ 24____ 46____ 68____ 90____
= ____
3.
Evangelist 3____ 25____ 47____ 69____ 91____
= ____
4.
Pastor 4____ 26____ 48____ 70____ 92____
= ____
5.
Teacher 5____ 27____ 49____ 71____ 93____
= ____
6.
Music 6____ 28____ 50____ 72____ 94____
= ____
7.
Exhortation 7____ 29____ 51____ 73____ 95____ = ____
8.
Wisdom 8____ 30____ 52____ 74____ 96____
9.
Knowledge 9____ 31____ 53____ 75____ 97____ = ____
10.
Serving 10____ 32____ 54____ 76____ 98____
= ____
11.
Helps 11____ 33____ 55____ 77____ 99____
= ____
12.
Leadership 12____ 34____ 56____ 78____ 100____ = ____
13.
Administration 13____ 35____ 57____ 79____ 101____ = ____
= ____
14. Giving 14____ 36____ 58____ 80____ 102____ = ____
15.
Mercy 15____ 37____ 59____ 81____ 103____ = ____
16.
Discernment 16____ 38____ 60____ 82____ 104____ = ____
17. Faith 17____ 39____ 61____ 83____ 105____
= ____
18.
Hospitality 18____ 40____ 62____ 84____ 106____ = ____
19.
Craftsmanship 19____ 41____ 63____ 85____ 107____ = ____
20.
Intercession 20____ 42____ 64____ 86____ 108____ = ____
207
21.
Healing 21____ 43____ 65____ 87____ 109____
= ____
22.
Missionary 22____ 44____ 66____ 88____ 110____ = ____
In the spaces below, list your gifts in descending order of score. Use the List
of Gifts for further understanding of what they entail.
DOMINANT
___________________________
___________________________
___________________________
___________________________
___________________________
___________________________
___________________________
___________________________
___________________________
___________________________
___________________________
SUB-DOMINANT
___________________________
___________________________
208
___________________________
___________________________
___________________________
___________________________
___________________________
___________________________
___________________________
___________________________
___________________________
Appendix D
209
Spiritual Gifts Profile Sheet
Missionary
It is the special gift given by the Holy Spirit to certain members
of the body of Christ (local church) to minister whatever other
spiritual gifts they have in a second culture or second
community. See 1 Corinthians 9:19-23.
Healing
It is the special gift whereby the Spirit employs certain Christians
to restore health to the sick. See James 5:13-16, Luke 9:1-2.
Intercession
It is the special gift whereby the Spirit enables certain Christians
to pray for extended periods of time with great positive effect
for the building of the Kingdom. See 1 Thessalonians 3:10-13, 1
Timothy 2:1-2.
Craftsmanship
It is the special gift whereby the Spirit endows certain Christians
to use
hands and minds to build up the Kingdom through artistic,
creative means. See Exodus 28:3-4.
Hospitality
It is the special gift whereby the Spirit enables certain Christians
to open
their homes willingly and offer lodging, food, and fellowship
cheerfully to
other people. See Genesis 18:1-15.
Faith
It is the special gift whereby the Spirit provides Christians with
210
extraordinary confidence in God’s promises, power, and
presence so that they can take heroic stands for their future of
God’s work in the church. See Hebrews 11.
Discernment
It is the special gift whereby the Spirit certain Christians to know
with assurance whether some behavior is of God or of Satan.
See Acts 5:3-6, Acts 16:16-18.
Mercy
It is the special gift whereby the Spirit enables certain Christians
to feel exceptional empathy and compassion for those who
are suffering so that they devote large amounts of time and
energy to alleviate it. See Luke 10:30-37.
Giving
It is the special gift whereby the Spirit enables certain Christians
to offer their material blessings for the work of the church with
exceptional willingness, cheerfulness and liberality. See 2
Corinthians 8:1-5.
Administration
It is the special gift whereby the Spirit enables certain Christians
to
understand the goals of a given segment of the Church’s
ministry and to direct that area effectively, keeping the Church
on course. See Acts 15:12-21.
Leadership
It is the special gift whereby the Spirit enables certain Christians
to motivate, direct and inspire God’s people in such a way that
they voluntarily and harmoniously work together to do the
Church’s work effectively. See Hebrews 13:7, Judges 3:10,
Exodus 18:13-16.
Helps
211
It is the spiritual gift whereby the Spirit empowers certain
Christians to willingly bear the burdens of other Christians and
help them in such a way that they can do their tasks more
effectively. See Acts 6:2-4.
Serving
It is the special gift whereby the Spirit empowers certain
Christians to identify unmet needs of people and implement
plans to meet those needs. Serving one another, like witnessing,
is a calling of all Christians, but there are some who have a
special desire to find ways to serve, and get great blessing from
it. There seems to be a special desire to meet physical needs in
the people who have this gift. See Galatians 6:1-2.
Knowledge
It is the special gift whereby the Spirit enables certain Christians
to
understand in an exceptional way the great truths of God’s
Word and to make them relevant to specific situations in the
church. See Ephesians 3:14-19.
Wisdom
It is the special gift whereby the Spirit endows particular
Christians with an understanding of God’s will and work as it
relates to the living of life. See James 3:13-17
Exhortation
It is the special gift whereby the Spirit enables certain Christians
to bring comfort, counsel and encouragement, and on certain
occasions the hard truth. See Acts 11:23-24, Acts 14:21-22.
Music
It is the special gift whereby the Spirit enables certain Christians
to praise God through various forms of music and enhance the
worship experience of the local congregation. See 1
Corinthians 14:26, Mark 14:26.
212
Teacher
It is the special gift whereby the Spirit enables particular
Christians to communicate the truths of God’s Word so that
others can learn. See Hebrews 5:12-14.
Pastor
It is the special gift whereby the Spirit enables certain Christians
to assume responsibility for the spiritual welfare of a group of
believers. See 1 Peter 5:1-11.
Evangelist
It is the special gift whereby the Spirit enables particular
Christians to share the Gospel to unbelievers in such a way that
the unbeliever becomes a disciple of the Lord Jesus. See Acts
8:26-40.
Prophet
It is the special gift whereby the Spirit empowers certain
Christians to interpret and apply God’s revelation in a given
situation. It is the gift whereby the Spirit appoints certain
Christians to lead, inspire and develop the churches of God by
the proclamation and the teaching of true doctrine. See 1
Corinthians 14:1-5, 1 Corinthians 14:30-33, 1 Corinthians 14:37-40.
Apostle
It is the gift whereby the Spirit appoints certain Christians to
lead, inspire and develop the churches of God by the
proclamation and the teaching of true doctrine. See Acts 12:15, Acts 14:21-23.
213
Appendix E
Glossary of Neuroscience Words
A
Abducens nerve
Cranial nerve VI - innervates the lateral rectus muscle of the
eye. It is the only cranial nerve that originates from the dorsal
surface of the brainstem.
Ablation
Removal or destruction of tissue.
Acetylcholine (ACh)
A neurotransmitter found in the brain, spinal cord,
neuromuscular junction and autonomic nervous system.
Acetylcholinesterase (AChE)
214
Enzyme that terminates the action of acetylcholine.
Action Potential
Electrical "all-or-none" impulse that transmits information
within the nervous system.
Adrenergic
Associated with catecholamines.
Afferent
Neural information flowing from the periphery to more
central areas of the nervous system.
Aging and the brain
Agonist
Chemical that acts like a neurotransmitter; increases the
effect of a neurotransmitter.
Alzheimer's disease
A degenerative brain disease. Characterized by memory
loss and disorientation.
Amnesia
Partial or complete loss of memory. "Anterograde" amnesia is
when people cannot form new memories.
Amphetamine
A synthetic central nervous system stimulant.
Amplitude
The size or magnitude of a signal or response.
Amygdala
Brain structure that is part of the limbic system. Implicated in
emotion.
215
Analgesia
Insensitivity to pain.
Antagonist
Chemical that blocks the action of a neurotransmitter
Anterior
A directional term meaning toward the front.
Anterior Commissure
A small fiber tract that connects the right and left cerebral
hemispheres (like the corpus callosum).
Aphasia
Inability to speak or understand language.
Aqueous humor
Fluid in the space between the cornea and lens of the eye.
Arachnoid
Middle layer of the meninges.
Astrocyte (astroglia)
A glial cell that supports neurons.
Attention Deficit Hyperactivity Disorder
Autonomic Nervous System
Autoradiography
Neuroanatomical method using radioactivity that is
incorporated into neurons.
Axon
The part of the neuron that takes information AWAY from the
cell body.
216
Axodendritic (synapse)
A synapse formed by contact between a presynaptic axon
and a postsynaptic dendrite.
B
Basal Ganglia
Areas of the brain that are important from movement. These
areas include the putamen, caudate nucleus, globus
pallidus, subthalamic nucleus and substantia nigra.
Bipolar neuron
Neuron with only two processes extending from the cell
body.
Blood Brain Barrier
A system of astrocytes and capillaries in the brain that
prevents the passage of specific substances.
Brainstem
The central core of the brain.
C
Cauda equina
The "horse's tail" made up of a bundle of spinal nerves at the
base of the spinal cord.
Caudal
A directional term meaning toward the tail end.
Cell Body
Also called the soma; the part of the cell that contains the
nucleus.
Central Nervous System
217
The brain and spinal cord.
Central Sulcus
Large groove in the brain that separates the frontal and
parietal lobes.
Cerebellum
Area of the brain above the pons and medulla that is
important for balance and posture.
Cerebral Aqueduct
Part of the ventricular system that connects the third and
fourth ventricles.
Cerebral Cortex
Outermost layer (the gray matter) of the cerebral
hemisphere.
Cerebrospinal Fluid (CSF)
Clear fluid in the ventricular system.
Chimeric Figure
Figure using two separate faces on each half. These figures
are used in split brain experiments.
Choroid Plexus
Vascular structures in the ventricular system that produce
cerebrospinal fluid.
Cingulate Cortex
Part of the limbic system. Located directly above the corpus
callosum. Important for emotional behavior.
Circadian
About one day; used to describe some body rhythms.
218
Cochlea
Inner ear structure important for hearing.
Cone
Receptor found in the retina important for color vision and
detailed sight.
Cornea
Transparent front coat of the eye.
Corpus Callosum
Large collection of axons that connect the left and right
hemispheres of the brain.
Cranial Nerves
12 pairs of nerves that exit from the brain.
Cranium
The part of the skull that contains the brain.
D
Dendrite
Extensions from the neuron cell body that take information
TO the cell body.
Depolarization
Movement of the membrane potential toward 0 mV; a
decrease in polarization.
Dopamine
A neurotransmitter found in many areas of the brain.
Important for movement and other behavior.
Dorsal Root
Bundle of nerve fibers taking information into the spinal cord.
219
Drug Effects on the Brain
Dura
Outermost layer of the meninges.
E
Electroencephalogram (EEG)
Record of electrical activity of the brain obtained from scalp
electrodes.
Endorphin
Neurotransmitter with similar properties as opiates. Important
for pain reduction.
Excitatory Postsynaptic Potential (EPSP)
A graded depolarization of the postsynaptic cell.
F
Fetal Alcohol Syndrome
Fornix
Pathway that connects the hippocampus with the mamillary
bodies.
Fovea
Central part of retina; area of retina with most accurate
vision.
G
Glia
Non-neural support cells of the nervous system.
Gyrus (plural is gyri)
"Hills" or "bumps" on the brain that are separated by fissures.
220
H
Hippocampus
Area of the limbic system important for memory.
Hormones
Chemicals used by endocrine system to transmit messages.
Hypothalamus
Brain structure that monitors internal environment and
attempts to maintain balance of these systems. Controls the
pituitary.
I
Inferior Colliculus
Midbrain structure important for hearing.
Iris
Muscles of eye that control the size of the pupil. Gives color
to the eye.
J
K
L
Lens
Transparent structure in the eye that focuses light on the
retina.
Lesion
Injury caused by destruction of tissue.
Limbic System (or Limbic Areas)
Interconnected areas of the brain important for emotional
and other behaviors.
221
M
Medulla
Part of the brain stem important for breathing, respiration
and other behaviors.
Meninges
Series of 3 membranes (dura mater, arachnoid, pia mater)
that cover the brain and spinal cord.
Myelin Sheath
Fatty substance that surrounds some axons.
N
Neurotransmitters
Chemicals that transmit information across the synapse to
communicate from one neuron to another.
Node of Ranvier
Short unmyelinated segment of an axon.
O
Occipital Lobe
Area of the brain located behind the parietal lobe and
temporal lobe and responsible for vision.
Optic Chiasm
Crossing of the fibers from each retina.
Ossicles
Bones in the middle ear.
P
Parkinson's disease
222
Neurological disorder caused by damage to the dopamine
system of the brain; symptoms include tremor, rigidity, slow
movement.
Pia
Inner most layer of the meninges. Adjacent to the surface of
the brain.
Pituitary
"Master" gland attached to the base of the brain that
secretes hormones.
Pons
Area of the brainstem between the medulla and the
midbrain.
Proprioceptor
Sensory receptor providing information related to body
position, mainly in muscles and tendons.
Q
R
Retina
Innermost layer of the eye; contains receptors responsive to
light.
Rod
Receptor found in the retina important for in low light
conditions.
S
Soma
The neuron cell body. Contains the nucleus.
Sulcus (plural is sulci)
223
Groove located on the surface of the brain.
Synapse
Functional connection between a terminal of one neuron
with a membrane of another neuron.
T
Tectum
"Roof" of the midbrain.
Tegmentum
"Floor" of the midbrain.
Thalamus
Group of nuclei in the diencephalon of the brain. The
different nuclei have sensory and motor functions.
U
V
Ventricles
Hollow spaces within the brain that are filled with
cerebrospinal fluid.
224
Appendix F
CALIFORNIA CODE OF REGULATIONS FOR REHABILITATION
AGENCIES
PERTAINING
TO
CONFIDENTIALITY
/
DATA
COLLECTION
TITLE 9. Rehabilitative And Developmental Services
Division 3. Department of Rehabilitation*
Chapter 2. Application Process and Eligibility
Vocational Rehabilitation
Article 6. Confidentiality
§7140.5. Collection of Information.
for
(a) The case record shall contain only information which is
relevant and necessary to carry out the programs of the
Department.
(b) A Client Information Booklet which describes the kinds of
information that may be requested from the applicant/client
shall be provided and explained to all applicants at the initial
interview and shall be annually reviewed with the client or
his/her representative thereafter. The applicant's signature on
the Application for Services (DR 222 dated January, 1991)
acknowledges receipt of the booklet. The Client Information
Booklet shall contain:
(1) The title, address, and telephone number of the Department
employee who maintains the case record.
(2) The name of the Division or individual within the
Department who is requesting the information.
(3) A statement as to whether the provision of each item of
information requested is mandatory or voluntary.
225
(4) An explanation of the consequences of not providing all or
part of the requested information.
(5) An explanation of the purpose or purposes for which the
information is to be used.
(6) The legal authority which authorizes the maintenance of
the information.
(7) A statement as to the applicant's or client's right to review
the case record.
(8)
Any
known
or
foreseeable
interagency
or
intergovernmental transfer of the information which may be
made.
(c) To the greatest extent practicable, information shall be
collected directly from the applicant or client who is the
subject of the information rather than from another source.
(d) A completed form DR 264 (dated 1/90) Consent for
Release of Personal/Confidential Information, and form DR
264A (dated July, 1993) Consent to Release Medical
Information, which are incorporated by reference herein, shall
as appropriate be required for each request to a third party to
obtain the following personal information about an
applicant/client:
(1) Employment reports from former employers.
(2) School transcripts.
(3) Drug and alcohol abuse information of record.
(4) Public assistance information.
(5) Criminal justice cumulative summaries.
226
(6) Psychological resting information of record.
(7) Veteran's Administration information.
(8) Medical information of record.
e) During the initial interview and whenever necessary, the
Counselor shall complete form DR 264 (dated 1/90) or form DR
264A (dated July, 1993) to obtain applicant/client consent to
contact each source of information about the applicant/client.
Each release form shall:
(1) Specifically state the information requested and to whom
the request for information is directed.
(2) Be signed and dated by the applicant/client authorizing
each release. The signed release is used to verify that consent
was obtained from the applicant/client or his/her authorized
representative.
(3) Be prepared in triplicate. The original of each signed
release shall be attached to the appropriate request for
information, a copy shall be given to the applicant/client, and
a copy shall be filed in the case record with relevant
correspondence.
(4) Expire thirty (30) days from the date signed by the
applicant/client unless the release specifies another expiration
date.
(f) In addition to the above, the DR 264A (dated July, 1993)
Consent to Release Medical Information must include a
specific authorization from the applicant/client to the provider
of health care (see Civil Code section 56.05(d) for definition) to
allow the release of the information to the Department. The
227
consent for the Department to obtain medical information shall
specifically state:
“I authorize the above listed physician/facility to furnish to the
Department of Rehabilitation my records containing medical
history, treatment, and diagnosed mental and physical
condition, including disabilities such as drug, alcohol, and
psychiatric, or the result of any HIV test performed.
This information will be included in my case record and used to
assist in the determination of eligibility and, if eligible,
subsequent vocational rehabilitation services. The Department
of Rehabilitation may not disclose the information received
without my signed consent for each disclosure unless the
disclosure is specifically required or permitted by law.“
“This consent, shall remain valid for 30 days unless otherwise
specified.
(Applicant/client's signature and date)”
The applicant/client's signature must immediately follow the
statement. The applicant/client shall be provided a copy of the
authorization for each request.
(g) Medical, psychological, and work evaluation examinations
and information created by the provider at the request and
expense of the Department do not require a consent signed by
the applicant/client to release such information to the
Department except medical information that would disclose
the results of any HIV test performed.
(h) The source of any information shall be identified in the case
record unless the source is the applicant or client. If the source
is an entity such as a governmental agency, a corporation, an
association, or an individual, this requirement can be met by
maintaining the name of the entity so long as the smallest
responsible unit of that entity is reasonably identified.
228
(i) Except as provided in section 7141.5, information in the case
file shall remain in the file until the case is destroyed. No
information in the case record shall be removed, destroyed, or
altered for purposes of avoiding compliance with these
regulations. The following information may be purged from the
case record and destroyed:
(1) Information in the case file that is irrelevant and
unnecessary for carrying out the Rehabilitation program.
(2) Handwritten notes when the notes have been transcribed
into the case record.
(3) Duplicative information.
Authority cited: Sections 19006 and 19016, Welfare and
Institutions Code; and Section 1798.30, Civil Code. Reference:
Sections 56.10, 56.11, 56.13, 56.15 and 1798.14-1798.23, Civil
Code; and 34 CFR Section 361.49.
1. Renumbering of section 7281 to section 7140.5 filed 6-21-90;
operative 7-21-90 (Register 90, No. 35).
2. Amendment of subsection (b), new subsections (d), (e), (f)
and (g) and relettering of former subsections (d) and (e) to
subsections (h) and (i) filed 5-2-91; operative 6-1-91 (Register 91,
No. 25).
3. Change without regulatory effect amending subsections (b),
(d), (e) and (f) filed 3-28-94 pursuant to title 1, section 100,
California Code of Regulations (Register 94, No. 13).
§7141. Disclosure to the Applicant or Client.
(a) Except as limited by (c), all information in the case record
shall, upon request and proper identification, be disclosed to
the applicant or client.
229
(b) The Counselor shall translate or arrange for translation of
documents in the case record when requested, in a language
that is understood by the client. It is not required that the case
record be translated into other languages.
(c) In cases where the applicant or client requests access to
the case record and where the Department has reason to
believe that the disclosure of some portion of the case record
may be harmful to the applicant or client, the Department shall
notify the applicant or client in writing that direct disclosure is
not authorized by law. The notification shall include the way in
which the Department will release the information using the
following options.
(1) Disclose, and if requested or needed, interpret the
information directly to the authorized representative, guardian
or conservator of the applicant or client.
(2) Disclose and interpret the information to the applicant or
client through the District Medical Consultant, the District
Psychologist, a panel physician, or panel psychiatrist.
(3) Upon written authorization, disclose such information to a
physician, psychiatrist, or licensed or certified psychologist or
other representative designated by the applicant or client.
(d) Information in the case record shall upon request be
disclosed to a duly appointed guardian or conservator of the
applicant or client provided that it can be proved, with
reasonable certainty, that such person is the duly appointed
guardian or
(e) A request by an applicant or client to examine his/her case
record shall be processed as expeditiously as possible and shall
not take longer than 30 days for an active case record or 60
days for a closed case record.
230
(f) Examination of the case record shall be permitted only in a
departmental office. During the examination, the Counselor or
other designated employee shall be present while the case is
being reviewed. Case records may not be removed from a
departmental office except by an employee of the
Department for official business.
(g) The Department shall provide copies of any document or
item of information which the applicant or client is entitled to
obtain at a charge not to exceed 10 cents per page. If fewer
than ten pages are requested, no charge shall be made. The
Department may waive the charge at its discretion.
(h) The Counselor shall record in the case record the pertinent
details of each disclosure including the date disclosed.
Authority cited: Sections 19006 and 19016, Welfare and
Institutions Code and Section 1798.30, Civil Code. Reference:
Sections 1798.25-1798.34 and 1798.40, Civil Code, and 34 CFR
Section 361.49.
1. Renumbering of section 7282 to section 7141 filed 6-21-90;
operative 7-21-90 (Register 90, No. 35).
2. Amendment of subsection (a); new subsections (b), (f) and
(h); relettering and amendment of former subsection (e) to
subsection (c); relettering of former subsections (b), (c), (d) and
(e) to subsections (d), (e), (g) and (c); filed 5-1-91; operative 61-91 (Register 91, No. 25).
§7141.5. Amending the Case Record.
(a)
When a Counselor determines that information that
he/she originated for the case record is inaccurate or
incomplete, the Counselor shall correct that portion of
the case record. Copies of the corrected information
231
shall be provided to all individuals who obtained
incorrect information.
(b) An applicant or client may submit a written request to add,
delete, or amend information contained in the case record.
The Department, within 30 days of the receipt of such request,
shall make a decision whether to amend the record.
(c) If the client requests a change to information that was
originated by a source outside the Department, the client shall
be informed that departmental staff cannot change
information in the case record not originated by departmental
staff and that the request should be made to the source of the
information.
(d) If the record is to be amended, the Department shall:
(1) Amend any portion of the record which is not accurate,
relevant, timely, or complete.
(2) Destroy the original material.
(3) Provide the individual with a copy of the amended
material.
(e) If the record is not to be amended, the Department shall
inform the applicant or client in writing of the decision not to
amend the record, the reason for such decision, and the
procedures for requesting an administrative review and fair
hearing of such decision.
(f) If the applicant or client disagrees with the decision of the
Department not to amend the case record, the individual may
appeal that decision through the administrative review and fair
hearing process.
232
APPENDIX G
GOVERNMENT RESOURCES AND WEB SITES
233
 National Institute on Alcohol Abuse and Alcoholism (NIAAA)
niaaa.nih.gov
 National Institute on Drug Abuse (NIDA)
 National Institute of Mental Health (NIMH)
 United States Information Service's Substance Abuse
 National Institute on Drug Abuse (NIDA) The mission of the
NIDA is to lead the Nation in bringing the power of science
to bear on drug abuse and addiction.
 Search of the NIH Guide for Funding Opportunities This
system will provide you with any National Institute on Drug
Abuse (NIDA) or National Institute on Alcohol Abuse and
Alcoholism (NIAAA) grant announcements. The full text of
the announcements is also available.
 CRISP (Computer Retrieval of Information on Scientific
Projects) System is a major biomedical database containing
information on research ventures supported by the United
States Public Health Service (US-PHS), including the National
Institute on Alcohol Abuse and Alcoholism and the National
Institute on Drug Abuse. CRISP also contains information on
intramural research programs of the NIH and FDA. . Retrieval
of scientific information for each project in CRISP is made
available by project title, principal investigator's abstract,
and term descriptors.
 The Substance Abuse and Mental Health Services
Administration (SAMHSA) SAMHSA's mission is to assure that
quality substance abuse and mental health services are
available to the people who need them and to ensure that
prevention and treatment knowledge is used more
effectively in the general health care system.
 SAMHSA’s principal components are:
 Center for Substance Abuse Prevention (CSAP) was
established to lead the Federal efforts in prevention and
intervention of alcohol, tobacco, and other drug abuse
(ATOD) among the Nation's citizens.
234
 The National Clearinghouse for Alcohol and Drug
Information (NCADI) is the world's largest resource for current
information and materials concerning substance abuse
prevention.
 Center for Substance Abuse Treatment (CSAT) mission is to
expand the availability of effective treatment and recovery
services for alcohol and drug problems.
 The Office of National Drug Control Policy is authorized to
develop and coordinate the policies, goals, and objectives
of the Nation's drug control program for reducing the use of
illicit drugs. The 1997 National Drug Control Strategy is
available on the web.
 The Drug Enforcement Administration (DEA) is the lead
Federal agency responsible for the development of overall
Federal drug enforcement strategy, programs, planning, and
evaluation. These pages contain information about the
DEA's Demand reduction program and current statistics and
trends on use of various drugs.
 California Department of Alcohol & Drug Programs
adp.cahwnet.gov
235
APPENDIX F
Addiction Severity Index Lite - CF
Clinical/Training Version
Thomas McLellan, Ph.D.
John Cacciola, Ph.D.
Deni Carise, Ph.D.
Thomas H. Coyne, MSW
Remember: This is an interview, not a test
Item numbers circled are to be asked at follow-up.
Items with an asterisk* are cumulative and should be
rephrased at follow-up.
Items in a double border gray box are questions for the interviewer.
Do not ask these questions of the client.
HALF TIME RULE:
If a question asks the number of months,
round up periods of 14 days or more to 1
month. Round up 6 months or more to 1
year.
CONFIDENCE RATINGS: Last two items in each section.
 Do not over interpret.
 Denial does not warrant
misrepresentation.
 Misrepresentation = overt contradiction in
information.
Probe and make plenty of comments!
INTRODUCING THE ASI: Seven potential problem areas: Medical,
Employment/Support Status, Alcohol, Drug, Legal, Family/Social, and
Psychological. All clients receive this same standard interview. All
information gathered is confidential.
There are two time periods we will discuss:
1. The past 30 days
2. Lifetime Data
Patient Rating Scale: Patient input is important. For each area, I will ask
you to use this scale to let me know how bothered you have been by any
problems in each section. I will also ask you how important treatment is for
you for the area being discussed.
The scale is:
0 - Not at all
1 - Slightly
2 - Moderately
3 - Considerably
4 - Extremely
If you are uncomfortable giving an answer, then don't answer.
Please do not give inaccurate information!
INTERVIEWER INSTRUCTIONS:
1. Leave no blanks.
2. Make plenty of Comments (if another person reads this ASI, they should
have a relatively complete picture of the client's perceptions of his/her
problems).
3. X = Question not answered.
N = Question not applicable.
4. Terminate interview if client misrepresents two or more sections.
5. When noting comments, please write the question number.
6. Tutorial/clarification notes are preceded with "".
Revised- 06/02/99 DC/TRJ
HOLLINGSHEAD CATEGORIES:
1. Higher execs, major professionals, owners of large businesses.
2. Business managers if medium sized businesses, lesser professions, i.e.,
nurses, opticians, pharmacists, social workers, teachers.
3. Administrative personnel, managers, minor professionals,
owners/proprietors of small businesses, i.e., bakery, car dealership,
engraving business, plumbing business, florist, decorator, actor, reporter,
travel agent.
4. Clerical and sales, technicians, small businesses (bank teller, bookkeeper,
clerk, draftsman, timekeeper, secretary).
5. Skilled manual - usually having had training (baker, barber, brakeman,
chef, electrician, fireman, lineman, machinist, mechanic, paperhanger,
painter, repairman, tailor, welder, policeman, plumber).
6. Semi-skilled (hospital aide, painter, bartender, bus driver, cutter, cook,
drill press, garage guard, checker, waiter, spot welder, machine operator).
7. Unskilled (attendant, janitor, construction helper, unspecified labor,
porter, including unemployed).
8. Homemaker.
9. Student, disabled, no occupation.
LIST OF COMMONLY USED DRUGS:
Alcohol:
Methadone:
Opiates:
236
Beer, wine, liquor
Dolophine, LAAM
Pain killers = Morphine, Diluaudid, Demerol,
Percocet, Darvon, Talwin, Codeine, Tylenol 2,3,4,
Barbiturates:
Sed/Hyp/Tranq:
Cocaine:
Amphetamines:
Cannabis:
Hallucinogens:
Green,
Inhalants:
Syrups = Robitussin, Fentanyl
Nembutal, Seconal, Tuinol, Amytal, Pentobarbital,
Secobarbital, Phenobarbital, Fiorinol
Benzodiazepines = Valium, Librium, Ativan, Serax
Tranxene, Dalmane, Halcion, Xanax, Miltown,
Other = ChloralHydrate (Noctex), Quaaludes
Cocaine Crystal, Free-Base Cocaine or "Crack, and
"Rock Cocaine"
Monster, Crank, Benzedrine, Dexedrine, Ritalin,
Preludin, Methamphetamine, Speed, Ice, Crystal
Marijuana, Hashish
LSD (Acid), Mescaline, Mushrooms (Psilocybin), Peyote,
PCP (Phencyclidine), Angel Dust, Ecstacy
Nitrous Oxide, Amyl Nitrate (Whippits, Poppers),
Glue, Solvents, Gasoline, Toluene, Etc.
Just note if these are used:
Antidepressants,
Ulcer Meds = Zantac, Tagamet
Asthma Meds = Ventoline Inhaler, Theodur
Other Meds = Antipsychotics, Lithium
ALCOHOL/DRUG USE INSTRUCTIONS:
The following questions look at two time periods: the past 30 days and lifetime.
Lifetime refers to the time prior to the last 30 days. However if the client has been
incarcerated for more than 1 year, you would only gather lifetime information, unless
the client admits to significant alcohol /drug use during incarceration. This guideline
only applies to the Alcohol/Drug Section.
30 day questions only require the number of days used.
Lifetime use is asked to determine extended periods of use.
Regular use = 3+ times per week, binges, or problematic irregular use
in which normal activities are compromised.
Alcohol to intoxication does not necessarily mean "drunk", use the
words felt the effects", “got a buzz”, “high”, etc. instead of intoxication.
As a rule of thumb, 5+ drinks in one setting, or within a brief period of
time defines “intoxication".
 “How to ask these questions:
 "How many days in the past 30 have you used....?
 "How many years in your life have you regularly used....?"
237
Addiction Severity Index Lite - Training Version
GENERAL INFORMATION
G1.ID No.:
-
G2. SS No. :
G3. Program No:
-
___ ____ ____
G4. Date of Admission:
G5. Date of Interview:
G8. Class:
1. Intake
G9. Contact Code:
G10. Gender:
2. Follow-up
1. In person
2. Telephone (Intake ASI must be in person)
3. Mail
1. Male
2. Female
G11. Interviewer Code No.:
G12. Special:
1. Patient terminated
2. Patient refused
3. Patient unable to respond
__________________________________________________
Name
__________________________________________________
Address 1
__________________________________________________
Address 2
______________________________________(____)______
City
State
Zip Code
G14. How long have you lived at this
address?
Tel. No.
Years
Months
G16. Date of birth:
(Month/Day/Year)
G17. Of what race do you consider yourself?
1. White (not Hisp)
2. Black (not Hisp)
3. American Indian
4. Alaskan Native
5. Asian/Pacific 9. Other Hispanic
6. Hispanic-Mexican
7. Hispanic-Puerto Rican
8. Hispanic-Cuban
G18. Do you have a religious preference?
1. Protestant
2. Catholic
3. Jewish
4. Islamic
5. Other
6. None
G19. Have you been in a controlled environment in
the past 30 days?
1. No
4. Medical Treatment
2. Jail
5. Psychiatric Treatment
3. Alcohol/Drug Treat.
6. Other: ______________
A place, theoretically, without access to drugs/alcohol.
G20. How many days?
"NN" if Question G19 is No. Refers to total
number of days detained in the past 30 days.
(Clinical/Training Version)
239
MEDICAL STATUS
M1. How many times in your life have you been
hospitalized for medical problems?
 Include O.D.'s and D.T.'s. Exclude detox, alcohol/drug,
psychiatric treatment and childbirth (if no complications). Enter the
number of overnight hospitalizations for medical problems.
M3. Do you have any chronic medical
problems which continue to interfere
with your life?
0 -No 1 - Yes
 If "Yes", specify in comments.
 A chronic medical condition is a serious physical
condition that requires regular care, (i.e., medication, dietary
restriction) preventing full advantage of their abilities.
M4. Are you taking any prescribed
medication on a regular basis
for a physical problem?
0 - No 1 - Yes
 If Yes, specify in comments.
 Medication prescribed by a MD for medical conditions; not
psychiatric medicines. Include medicines prescribed whether or not
the patient is currently taking them. The intent is to verify chronic
medical problems.
M5. Do you receive a pension for a
physical disability?
0 - No 1 - Yes
 If Yes, specify in comments.
 Include Workers' compensation, exclude psychiatric disability.
M6. How many days have you experienced
medical problems in the past 30 days?
 Do not include ailments directly caused by drugs/alcohol.
 Include flu, colds, etc. Include serious ailments related to
were abstinent
(e.g., cirrhosis of liver, abscesses from needles, etc.).
drugs/alcohol, which would continue even if the patient
For Questions M7 & M8, ask the patient to use the Patient Rating scale.
M7. How troubled or bothered have you been by
these medical problems in the past 30 days?
 Restrict response to problem days of Question M6.
M8. How important to you now is treatment for
these medical problems?
 Refers to the need for new or additional medical treatment by the patient.
CONFIDENCE RATINGS
Is the above information significantly distorted by:
M10. Patient's misrepresentation?
M11. Patient's inability to understand?
0 - No 1 - Yes
0 - No 1 - Yes
240
MEDICAL COMMENTS
(Include question number with your notes)
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
page 2
241
EMPLOYMENT/SUPPORT STATUS
E1. Education completed:
 GED = 12 years, note in comments.
 Include formal education only.
Years
Months
 Formal/organized training only. For military training,
only include training that can be used in civilian life,
i.e., electronics or computers.
Months
E2. Training or Technical education completed:
E4. Do you have a valid driver's license?
 Valid license; not suspended/revoked.
0 - No 1 - Yes
E5. Do you have an automobile available?
 If answer to E4 is "No", then E5 must be "No". 0 - No 1 - Yes
Does not require ownership, only requires
availability on a regular basis.
E6. How long was your longest full time job?
 Full time = 35+ hours weekly;
does not necessarily mean most
recent job.
/
Yrs / Mos
E7. Usual (or last) occupation?
(specify) ______________________________
(use Hollingshead Categories Reference Sheet)
E9
Does someone contribute the majority of
your support?
0 - No 1 - Yes
E10. Usual employment pattern, past three years?
1. Full time (35+ hours)
5. Service
2. Part time (regular hours) 6. Retired/Disability
3. Part time (irregular hours) 7. Unemployed
4. Student
8. In controlled environment
 Answer should represent the majority of the last 3 years, not just
the most recent selection. If there are equal times for more than one
category, select that which best represents more current situation.
E11. How many days were you paid for working
in the past 30 days?
 Include "under the table" work, paid sick days and vacation.
242
EMPLOYMENT/SUPPORT COMMENTS
(Include question number with your notes)
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
Page 3
243
EMPLOYMENT/SUPPORT (cont.)
For questions E12-17:
How much money did you receive from the following sources in the past 30 days?
E12. Employment?
 Net or "take home" pay, include any
"under the table" money.
E13. Unemployment Compensation?
E14. Welfare?
 Include food stamps, transportation money
provided by an agency to go to and from
treatment.
E15. Pensions, benefits or
Social Security?
 Include disability, pensions, retirement,
veteran's benefits, SSI & workers' compensation.
E16. Mate, family, or friends?
 Money for personal expenses, (i.e.
clothing), include unreliable sources of income
(e.g. gambling). Record cash payments only,
include windfalls (unexpected), money from
loans, gambling, inheritance, tax returns, etc.).
E17. Illegal?
Cash obtained from drug dealing,
stealing, fencing stolen goods, gambling,
prostitution, etc. Do not attempt to convert
drugs exchanged to a dollar value.
E18. How many people depend on you for
the majority of their food, shelter, etc.?
 Must be regularly depending on patient, do include alimony/child
support, do not include the patient or self-supporting spouse, etc.
E19. How many days have you experienced
employment problems in the past 30 ?
 Include inability to find work, if they are actively looking for work,
or problems with present job in which that job is jeopardized.
For Question E20, ask the patient to use the Patient Rating scale.
E20. How troubled or bothered have you been by these
30 days?
 If the patient has been incarcerated or detained during the
problems.
E21. How important to you now is counseling for
these employment problems?
 The patient's ratings in Questions E20-21 refer to Question E19.
 Stress help in finding or preparing for a job, not giving them a job.
CONFIDENCE RATINGS
Is the above information significantly distorted by:
E23. Patient's misrepresentation
0-No 1-Yes
E24. Patient's inability to understand?
0-No 1-Yes
244
employment problems in the past
past 30 days, they cannot have employment
EMPLOYMENT/SUPPORT COMMENTS
(Include question number with your notes)
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
Page 4
245
ALCOHOL/DRUGS
Route of Administration Types:
1. Oral 2. Nasal 3. Smoking 4. Non-IV injection
5. IV
 Note the usual or most recent route. For more than one route, choose the most severe. The routes are listed from least severe to
most severe.
Lifetime Route of
Past 30 Days
(years)
Admin
D1
Alcohol (any use at all)
D2
Alcohol (to intoxication)
D3
Heroin
D4
Methadone
D5
Other Opiates/Analgesics
D6
Barbiturates
D7
Sedatives/Hypnotics/
Tranquilizers
D8
Cocaine
D9
Amphetamines
D10 Cannabis
D11 Hallucinogens
D12 Inhalants
D13 More than 1 substance
per day (including alcohol)
246
D17. How many times have you had Alcohol DT's?
 Delirium Tremens (DT's): Occur 24-48 hours after last drink, or
significant decrease in alcohol intake, shaking, severe disorientation,
fever, , hallucinations, they usually require medical attention.
ALCOHOL/DRUGS COMMENTS
(Include question number with your notes)
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
Page 5
247
ALCOHOL/DRUGS (cont.)
How many times in your life have you been treated for :
D19.
Alcohol abuse?
D20.
Drug abuse?
 Include detoxification, halfway houses, in/outpatient counseling,
and AA or NA (if 3+ meetings within one month period).
D21.
How many of these were detox only:
Alcohol?
D22.
Drugs?
 If D19 = "00", then question D21 is "NN"
If D20 = ‘00’, then question D22 is “NN”
D23.
How much money would you say you spent during the past 30 days on:
Alcohol?
D24.
Drugs?
 Only count actual money spent. What is the financial burden caused by drugs/alcohol?
D25. How many days have you been treated as
an outpatient for alcohol or drugs in the
past 30 days?  Include AA/NA
For Questions D28-D31, ask the patient to use the Patient Rating scale.
The patient is rating the need for additional substance abuse treatment.
How many days in the past 30 have you experienced:
D26. Alcohol problems?
How troubled or bothered have you been in the past 30 days by these
D28. Alcohol problems?
How important to you now is treatment for these:
D30. Alcohol problems?
How many days in the past 30 have you experienced:
D27. Drug problems?
 Include only: Craving, withdrawal symptoms,
disturbing effects of use, or wanting to stop and being unable to.
How troubled or bothered have you been in the past 30 days by these
D29. Drug problems?
How important to you now is treatment for these:
D31. Drug problems?
CONFIDENCE RATINGS
Is the above information significantly distorted by:
D34. Patient's misrepresentation?
0-No 1-Yes
D35. Patient's inability to understand?
0-No 1-Yes
248
ALCOHOL/DRUGS COMMENTS
(Include question number with your notes)
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
Page 6
249
LEGAL STATUS
L1. Was this admission prompted or suggested by the
criminal justice system?
0 - No 1 -Yes
 Judge, probation/parole officer, etc.
L2. Are you on parole or probation?
 Note duration and level in comments.
L3  Shoplift/Vandal
0 - No 1 -Yes
How many times in your life have you been arrested and
charged with the following:
L10 Assault
L4  Parole/Probation
L11 Arson
L5  Drug Charges
L12 Rape
L6  Forgery
L13 Homicide/Mansl.
L7 Weapons Offense
L14 Prostitution
L8 Burglary/Larceny/B&E
L15 Contempt of Court
L9  Robbery
L16 Other: _________
 Include total number of counts, not just convictions. Do not include
juvenile (pre-age 18) crimes, unless they were charged as an adult.
 Include formal charges only.
L17 How many of these charges resulted
in convictions?
 If L03-16 = 00, then question L17 = "NN".
 Do not include misdemeanor offenses from questions L18-20 below.
 Convictions include fines, probation, incarcerations, suspended
sentences, and guilty pleas.
How many times in your life have you been charged with the following:
L18. Disorderly conduct, vagrancy,
public intoxication?
L19. Driving while intoxicated?
L20. Major driving violations?
 Moving violations: speeding, reckless driving,
no license, etc.
L21 How many months were you incarcerated
in your life?
 If incarcerated 2 weeks or more, round this up
to 1 month. List total number of months incarcerated.
L24. Are you presently awaiting
charges, trial, or sentence?
0 - No 1 - Yes
L25. What for?
 Use the number of the type of crime committed: 03-16
and 18-20
 Refers to Q. L24. If more than one, choose most severe.
 Don't include civil cases, unless a criminal offense is involved.
L26. How many days in the past 30, were
you detained or incarcerated?
250
 Include being arrested and released on the same day
L27. How many days in the past 30 have
you engaged in illegal activities for profit?
 Exclude simple drug possession. Include drug dealing, prostitution,
selling stolen goods, etc. May be cross checked with Question E17
under Employment/Family Support Section.
For Questions L28-29, ask the patient to use the Patient Rating scale.
L28. How serious do you feel your present legal problems are?
 Exclude civil problems
L29. How important to you now is counseling
or referral for these legal problems?
 Patient is rating a need for additional referral to legal counsel
CONFIDENCE RATINGS
Is the above information significantly distorted by:
L31. Patient's misrepresentation?
0 - No 1- Yes
L32. Patient's inability to understand?
0 - No 1 - Yes
251
for defense against criminal charges.
LEGAL COMMENTS
(Include question number with your notes)
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
Page 7
252
FAMILY/SOCIAL RELATIONSHIPS
F1. Marital Status:
1-Married
3-Widowed 5-Divorced
2-Remarried 4-Separated 6-Never Married
 Common-law marriage = 1. Specify in comments.
F3.
Are you satisfied with this situation?
0-No 1-Indifferent 2-Yes
 Satisfied = generally liking the situation. - Refers to Questions F1 & F2.
F4. Usual living arrangements (past 3 years):
1-With sexual partner & children
6-With friends
2-With sexual partner alone
7-Alone
3-With children alone
8-Controlled Environment
4-With parents
9-No stable arrangement
5-With family
 Choose arrangements most representative of the past 3 years. If there is an even split in time between these arrangements, choose
the most recent arrangement.
F6.
Are you satisfied with these arrangements?
0-No 1-Indifferent 2-Yes
Do you live with anyone who:
F7.
Has a current alcohol problem?
F8
Uses non-prescribed drugs?
0-No 1-Yes
0-No 1-Yes
F9. With whom do you
spend most of your free time? 1-Family 2-Friends 3-Alone
 If a girlfriend/boyfriend is considered as family by patient, then they
must refer to them as family throughout this section, not a friend.
F10. Are you satisfied with spending your free time
this way?
0-No 1-Indifferent 2-Yes
 A satisfied response must indicate that the person generally
likes the situation. Referring to Question
F9.
Have you had significant periods in which you have experienced serious problems getting along with:
0 - No 1 - Yes
Past 30 days In Your Life
F18. Mother
F19. Father
F20. Brother/Sister
F21. Sexual Partner/Spouse
F22. Children
F23. Other Significant Family
(specify)_________________________
F24. Close Friends
F25. Neighbors
F26. Co-workers
 "Serious problems" mean those that endangered the relationship.
 A "problem" requires contact of some sort, either by telephone or in person.
Did anyone abuse you?
0- No 1-Yes
253
Past 30 days
F28.
Physically?
F29.
Sexually?
In Your Life
 Caused you physical harm.
 Forced sexual advances/acts.
FAMILY/SOCIAL COMMENTS
(Include question number with your notes)
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
254
Page 8
255
FAMILY/SOCIAL (cont.)
How many days in the past 30 have you had serious conflicts:
F30. With your family?
For Questions F32-34, ask the patient to use the Patient Rating scale.
How troubled or bothered have you been in the past 30 days by:
F32. Family problems ?
FHow important to you now is treatment or counseling for these:
F34. Family problems
 Patient is rating his/her need for counseling for family
problems, not whether the family would be willing to attend.
How many days in the past 30 have you had serious conflicts:
F31. With other people (excluding family)?
For Questions F33-35, ask the patient to use the Patient Rating scale.
How troubled or bothered have you been in the past 30 days by:
F33. Social problems?
How important to you now is treatment or counseling for these:
F35. Social problems
 Include patient's need to seek treatment for such
social problems as loneliness, inability to socialize, and
dissatisfaction with friends. Patient rating should refer to
problems.
CONFIDENCE RATING
Is the above information significantly distorted by:
F37. Patient's misrepresentation?
F38. Patient's inability to understand?
0-No 1-Yes
0-No 1-Yes
256
dissatisfaction, conflicts, or other serious
FAMILY/SOCIAL COMMENTS
(Include question number with your notes)
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
Page 10
257
PSYCHIATRIC STATUS
How many times have you been treated for any
psychological or emotional problems:
P1.

P2.
In a hospital or inpatient setting?
Outpatient/private patient?
 Do not include substance abuse, employment, or family counseling. Treatment episode = a series of more or less
continuous visits or treatment days, not the number of visits or treatment days.
 Enter diagnosis in comments if known.
P3. Do you receive a pension for a psychiatric disability?
0-No 1-Yes
Have you had a significant period of time (that was not a direct result of alcohol/drug use) in which
you have:
0-No 1-Yes
Past 30 Days
P4.
Experienced serious depressionsadness, hopelessness, loss of
interest, difficulty with daily function?
P5.
Experienced serious anxiety/ tension,
uptight, unreasonably worried,
inability to feel relaxed?
P6.
Experienced hallucinations-saw things
or heard voices that were not there?
P7.
Experienced trouble understanding,
concentrating, or remembering?
Lifetime
For Items P8-10, Patient can have been under the influence of alcohol/drugs.
P8.
Experienced trouble controlling violent behavior including episodes of rage, or violence?
P9. Experienced serious thoughts of suicide?
 Patient seriously considered a plan for taking
his/her life.
P10. Attempted suicide?
 Include actual suicidal gestures or attempts.
P11. Been prescribed medication for any
psychological or emotional problems?
 Prescribed for the patient by MD. Record "Yes" if a medication
was prescribed even if the patient is not taking it.
P12. How many days in the past 30 have you experienced these psychological or emotional problems?
 This refers to problems noted in Questions P4-P10.
For Questions P13-P14, ask the patient to use the Patient Rating scale
P13. How much have you been troubled or bothered by these psychological or emotional problems in the
past 30 days?
 Patient should be rating the problem days from Question P12.
P14. How important to you now is treatment for
these psychological or emotional problems?
CONFIDENCE RATING
Is the above information significantly distorted by:
P22 Patient's misrepresentation?
0-No 1-Yes
258
P23. Patient's inability to understand?
0-No 1-Yes
PSYCHIATRIC STATUS COMMENTS
(Include question number with your comments)
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
Page 11
259
WHAT’S INSIDE
 What makes an effective counselor?
 What facilities use trained counselors?
 Ethics: God’s Ethics, Man’s Ethics & Professional Codes
of Ethics
 Documentation & Case Management
 Understanding 12 Step Programs
 Addiction Intervention
 Pharmacology
 Glossary of Brain & Nervous System Anatomy
 The Deception & Dangers of Humanistic Psychology
 Crisis Counseling
 Spiritual Gifts Inventory
 California Code Of Regulations For Rehabilitation
Agencies Pertaining To Confidentiality & Data Collection
 Government Resources And Web Sites
 Measuring Addiction Severity
About the Author
Michael Belzman is a Professional Christian Counselor, Certified by the
Association of Christian Alcohol & Drug Counselors Institute and
Licensed under New Hope Outreach, a Ministry of the Independent
Assemblies of God, International. He received his Masters degree in
Counselor Education from Boston University with a focus on Marriage &
Family Counseling where he completed his clinical practicum under
the supervision of an M.D. psychiatrist and director of the Child and
Pastor Mike
Family Services Clinic.
After graduation he did post graduate studies in psychology for two years at
the University of Marburg in Germany and taught psychology at the overseas
division of City Colleges of Chicago. He was also a member of the faculty of Antioch
University where he taught psychology. Prior to becoming director of New Hope, he
had 30 years of valuable experience, which included that of drug & alcohol
counselor, social worker, mental health counselor, and university educator. He
received theological training from Fuller Theological Seminary and the Graduate
Theological Union. He is an ordained minister in the Independent Assemblies of God,
International, and is served as associate pastor of the Rialto North Foursquare
Church. He has had over 25 years of counseling experience with a primary focus
upon Substance Abuse, Marriage & Family, Anger Management, Domestic Violence,
Non-Substance Addictions, and Mental Health Issues.
260