An Overview of CDS 113: Treatment Principles of Chemical Dependency CDS (Chemical Dependency Studies) 113 is a class which provides

a working knowled ge of treatment principles and models. It will explore the anatomy of addiction of addiction and the principles and process of treatment. This includes principl es of relapse, relapse prevention and stages of recovery. This paper is a summary and discussion of the what we learned and the issues we discussed. I would note that my use of alcoholic and addict are interchangeable and I intend for them t o have the same meaning. It is not intended that I focus on one more than other, nor to imply a belief that an alcoholic is not an addict as alcohol is also con sidered a drug. Whether an alcoholic or an addict the treatment process and its theo ries remains the same and as such, the terms are used interchangeable for this d iscussion. Boards, Terminology and Acronyms Some of the first discussions we had were in regards to the licensing and certif ication boards related to the chemical dependency field. The Department of Healt h (DOH) is the agency for Washington state that issues licenses to Chemical Depe ndency Professionals (CDP). They make sure the educational and professional requ irements are met in order to be licensed as a CDP. They are also the agency that oversees continuing education that is required to maintain a CDP license. They guidelines they follow for their administrative processes are set forth in the W ashington Administrative Code (WAC) are regulations of executive branch agencies (such as the DOH) that are issued by authority of statutes. Regulations are a s ource of primary law in Washington State and the rules that the DOH follows. Thi s is for a CDP that wants to work in Washington. To be nationally certified, Nat ional Association of Alcohol and Drug Abuse Counselors (NAADAC) is the agency th at provides that certification. Some other essential organizations in the chemical dependency field include the Division of Behavioral Health and Recovery (DBHR) which was formerly known as th e Division of Alcohol and Substance Abuse (DASA). The DBHR agency that audits, c ertifies and monitors treatment programs. And the American Society of Addiction Medicine (ASAM) and the American Medical Association. ASAM is important because they develop the treatment criteria and also perform research in the area of ad diction. Another important agency to know of is the Substance Abuse and Mental H ealth Service Administration (SAMHSA) which was developed in 1992 by Congress an d is the federal government agency that is in charge of improving the quality an d availability of prevention, treatment and rehabilitative services in order to reduce illness, death, disability and cost to society resulting from substance a buse and mental illnesses. As a basic foundation for the class, and the chemical dependency field, we discu ssed some acronyms necessary to have knowledge of in order to work as a chemical dependency counselor. The following is a brief list of acronyms (which is simil ar to shorthand) that are associated with the chemical dependency field: tx sx dx hx = = = treatment symptoms diagnosis history

Models, Theories and Philosophy After some discussion about the above, we continued on to examine the treatment process and the underlying principles. It is important to remember that addictio n is a disease of the brain when discussing treatment. Keeping that in mind, the class focused mainly on the Developmental Model as a format for treatment progr ams and is the format that which most treatment programs are based upon. The Dev

elopmental Model will be discussed in-depth shortly, but for now it is important to understand that there are other treatment models and those will be briefly d iscussed below. In regards to a treatment program, whether it be based on the Developmental Mode l or a not, the theory that the philosophy drives the treatment model is essential . What that means is whatever philosophy it is that your organization believe in or follows, that philosophy will dictate the model of treatment provided. For e xample, if the organization you work for believes that bad/poor morals are the r eason behind addiction, they will focus their treatment model on teaching good m orals because they believe that will solve the addiction problem. As noted above, there are many different types and philosophies/theories of trea tment models in addition to the Developmental Model. They include: Medical Model: This is a program based in a hospital or institutional-type sett ing or environment and a medical doctor treats the individual. It is a model tha t is more science-based and treats addiction as a physical illness. In this case , social influences are mostly ignored as to the cause of the illness. This model does not allow for the addict to assume responsibility for his or her behavior b ecause they see themselves as a victim of an illness. Behavior Modification Model: This is an aversion therapy based model. Aversion therapy is a form of psychological treatment where the patient is exposed to sti mulus while simultaneously being subjected to some form of discomfort. This cond itioning is intended to cause the patient to associate the stimulus with unpleas ant sensations in order to stop the specific behavior. Such as if you bite your nails, putting an unpleasant-tasting product on a persons fingernails will disco urage them from biting their fingernails. In terms of an addict, an alcoholic fo r example, the patient would receive unlimited amounts of alcohol until they are experiencing extreme physical reactions that are not welcoming, such as vomitin g, with the idea that they will associate the alcohol with vomiting, or whatever the negative reaction was, and this will help them to stop drinking by retraini ng the memory against the pleasurable aspects of using alcohol. This is sometime s referred to as the Schick-Shay model, named after a program that specializes in this form of treatment. Psychological Model: This model is based on the idea that views chemical depende ncy as being rooted in abnormalities of a persons personality or character. It fo llows the line of thinking that an addictive personality exists in such individual s and that they have personality characteristics such as poor impulse control, l ow self-esteem, an inability to cope with stressors, egocentricity, manipulative traits and a need for control and power, while feeling impotent and powerless. This model is based on the idea that in order to treat the person, in essence th eir entire personality must be over-hauled. Social Model: The Social Model is a model that believes that if you change the a ddicts social and environmental structure, such as their job, home issues and red ucing stressors on the addicts life will lead to successful treatment of the addi ction. Alcoholics Anonymous (AA) Model: This model is based on the philosophy of the AA program which peer-based support program that is centered around a 12 step prog ram. Included in the 12 steps is that the addict must accept that his or her own willpower is insufficient to conquer addiction and they must avoid taking that first drink or using that next time. The idea behind AA is that it will provide a pathway for the alcoholic or addict to take towards recovery and a gradual spi ritual renewal. Belief in a higher-power, not necessarily a God, is essential in t he program.

Multivariate Model: This model is a combination of several different models but focuses on the theory that people are different and as such, respond differently to interactions between the individual and their environment. The model suggest s that effective treatment planning and evaluation requires measurement of a per sons physical, psychological and social functioning as they relate to their drug or alcohol use. Minnesota Model: The Minnesota Model, which is also known as the Hazelton Model, requires that the abstinence is required of the alcoholic/addict. They use the philosophy of the first five steps of the 12 steps as the basis of the model. Th is model is what started the 28 day treatment program trend that is now popular. T wo of the long-term treatment goals are total abstinence from all mood-altering substances and an improved quality of life. The fundamental base of the program incorporates the theories and philosophies in which AA is built upon. Therapeutic Community: A Therapeutic Model based treatment program is one that is a residential based, long-term treatment program. Such programs usually run i n length around 24 months and teaches addicts how to behave and live drug and al cohol-free while living in a community of recovering addicts. There is an emphas is on teaching the addict personal and social responsibility. Patients in these programs interact in structured and unstructured ways to influence attitudes, pe rceptions, and behaviors associated with drug or alcohol use. In addition to the community as a primary foundation for change, a second treatm ent philosophy that the Community Model relies upon is self-help. And by that, i t means that the individuals in treatment are the main contributors to the chang e process. Basic Principles of Addiction Continuing on, we discussed that there are seven basic principles of addiction. They are essential and used by most treatment programs and are as follows: 1. Primary Disease: Addiction is a primary disease as opposed to being a second ary disease. That is, that it exists in and of itself and is not secondary to an other condition; that it is not a symptom of another disease. 2. Progressive: The disease is progressive and there are stages of progress of t he disease (early, middle and late). The fact that it is a progressive disease m eans that it will only get worse, never better, if left untreated. And if left u ntreated, it can often be fatal. 3. Loss of Control: Loss of control can be described as not being able to contr ol how much a person will drink once they have taken that first drink. Simply pu t, the alcoholic cannot control his or her consumption once the drinking has beg un. 4. Denial/Delusion: Denial is a habitual and unconscious defense mechanism which allows a person (and possibly his or her family) to deny the nature and extent of the addicted persons problem. It is a rejection of thoughts, feelings, needs o r other realities that they are not consciously able to tolerate and deal with. Delusion is when a person truly begins to believe the lies and half truths that they tell themselves. This is a dangerous area because this is when they start t o think they have it under control. Delusion is chronic denial and also what perpe tuates drug and alcohol use. 5. Affects Entire System: Addiction affects many systems, not just the biologica l system. Addiction is a Biological - Psychological - Social (bio - psycho - soc ial) disease. By this it means that it affects the body, the mind and the social structure of the addict. The social structure includes the addicts family, frien

d and co-workers; they are all affected in one way or another by the addicts dise ase. And if left untreated, the addiction will have an effect on the entire syste m in which it exists, and the will destroy how these relationship function and ev entually those relationships will deteriorate and become dysfunctional. Some exa mples of problems that may arise within these systems if the addiction is not tr eated include cirrhosis of the liver, psychological and mental health issues, di vorce and/or separation, loss of friendships, and being fired from their employm ent or a demotion. 6. Able to Arrest, Not Cure: Alcoholism/addiction is a disease that is treatable but not curable. Meaning that a person can treat the disease and get it into a stage of remission but they will always be an alcoholic or addict. A person is nev er cured of alcoholism or addiction. 7. Mimics Other Disorders: Alcoholism and addiction both mimic other disorders i n that the symptoms can be associated with other conditions such as mental healt h issues. For example, someone who is using methamphetamine can appear to sympto ms similar to those of people who have been diagnosed with a bi-polar mental hea lth disorder. Alcoholism or addiction can appear and present as something else o ther than drug or alcohol use. Other diseases it can present as are along the li nes are mostly mental health, such as personality disorders or anxiety, but it c an also present as dementia or other diseases that have symptoms similar to thos e of alcoholism or addiction. The Developmental Model With the foregoing base of knowledge having been discussed in class to provide a foundation, the Developmental Model was a much discussed topic in the class sin ce most treatment programs are based on this model. The main idea of the Develop mental Model is that treatment is one step at a time, set by step, and that you build upon those steps only as the client is ready to proceed on to the next ste p; good treatment is developmental. You cannot push a client to continue onto the next step or phase prematurely as it can jeopardize their treatment program. The y need to have full healed and grown in their current step, phase or process bef ore moving on to the next. This is because it is essential that they have a foun dation to build on before moving forward. Additionally, clients are different st ages at different times and progress at a different pace than each other; no two people will have the exact same treatment process. Effective treatment is a dev elopmental process. There are three keys issues of the Developmental Model. Those three keys issues are: 1. The Long-Term Perspective: Meaning that treatment for addiction is not a sho rt-term process, it is very lengthy. In our society today, we want quick fixes t o problems, and there is no addiction treatment program that is a quick fix to the disease. Addicts too sometimes expect an instant, permanent cure. During this t ime, major changes are made in the values, beliefs and way of living of the addi ct and those changes take time and cannot happen overnight. Treatment can take y ears, many years. 2. Individualization of Treatment: The road traveled by addicts prior to treatment are all different, there are no two that are the same. Thus, nor should two peo ple have the exact same treatment program experience. How people get to certain places and the people who have gotten them to that point, theyre all different. T he acceptance of loss of control and the decision to want to be free from drugs or alcohol are extremely personal to each person and interpreted individually by that person. As such, it is essential that the course and pace of the addicts tr eatment should be determined by the addict, not the counselor.

3. A Developmental Framework: Recovery is a developmental process. Remember, dev elopmental means to build upon. A program with a developmental framework is base d on a progressive building process. The alcoholism recovery process is one of c onstruction and reconstruction of a persons fundamental identity and resultant vi ew of the world. Learning is a developmental process and includes the alcoholic or addict learning to be normal without the use or alcohol or drugs through behavi oral change, cognitive reorganization and restructuring and object substitution and replacement. In additional to the three key issues of the Developmental Model, there are thre e key components as well. Those components are: 1. The Alcohol/Substance Axis: The alcohol axis represents the individuals focus on alcohol, behaviorally and cognitively. It reflects to the degree to which alc ohol dominates and directs the daily life of the individual and that persons inte rpretation of that dominance. With the progressive development of alcoholism, th e alcohol axis becomes the dominating force and organizing principle.# 2. Environmental Interactions: To keep alcohol or substances as the organizing p rinciple in the addicts life, and to preserve the belief that they are not addict ed, the addict must construct and interpret environmental interactions as way th at fit and maintain their belief system.# It includes justifying interactions or activities as a rationalized solution to a secondary interaction rather than se eing the alcohol or substance as the problem. 3. Interpretation of Self and Others: This encompasses the individuals view of th emselves and the world around them. The alcoholic is dominated by the false beli ef in self-control and their thought process encompasses denial. The alcoholics a bility to process incoming information is severely restricted to the point that such information interferes with the alcoholics belief in self-control and denial of any alcoholism. Thus, the interpretation of self and others is very narrow a nd influenced by the predominant focus on alcohol.# Alcohol becomes the dominant need in the alcoholics life and the addiction must be vigorously and strongly de nied by the addict so that they do not have to come to the full realization and see the reality of his or her addiction. The Developmental Model has four phases/stages of treatment: (1) drinking, ransition, (3) early recovery and (4) on-going recovery phase. Within each ose four phases is a goal (what youre trying to accomplish), a focus (the or attention on an area of concern) and an objective (what you actually do complish the goal) of each phase. (2) t of th effort to ac

The Drinking Phase Goal: The goal of the drinking phase is to get the alcoholic or addict into trea tment. This is important and essential to the beginning of being able to arrest the disease. Focus: Alcohol/Substance Axis; try to get the alcoholic/addict to understand how destructive the alcohol or substance abuse is to them. Objectives: There are many objectives in this phase and they include interventio n techniques, setting boundaries and to stop enabling the addict. You want to ge t them into treatment so part of the objective is to educate them not only on th e disease but the treatment process. Give the addict information about treatment

and try to get them to understand that they cannot control the alcohol or subst ances and admit a loss of control. Many times the alcoholic justifies his or her drinking by blaming others and rationalize their use, so the realization of the loss of control is an extremely huge hurdle. This is also how the addict protec ts themselves mentally and emotionally from the reality of the extent of their a ddiction. This is an important phase and you want to make sure the addict is comfortable s o they will be more receptive to participating in the treatment process because this is the very beginning of them moving from active drinking and using, to abs tinence. The Transition Phase Goal: The goal of the transition phase is to break the delusion. Delusion is chr onic denial so it is essential that they truly understand and surrender to the b elief that they are an addict. You want the addict to accept that they have a pr oblem and be willing to commit to starting to build a new life without alcohol o r substances. Breaking the delusion is when the client is shifting their identity from I am not an addict to I am an addict. Focus: Alcohol/Substance Axis; trying to get the addict to understand how destru ctive the alcohol/substances are to them and those around them. Objectives: Since most of the time in treatment is spent in the transitional ph ase, it makes sense that there are quite a few objectives for this phase. Starti ng with the initial contact, it is important that the client is comfortable and informed and to achieve this, it is crucial to engage them and that a rapport is established between the addict and the counselor. This involves engaging the cl ient and it is essential to engage the client because the more involved, or estab lished with a counselor they feel, the more likely they are to follow through wit h treatment. A good rapport can be an invaluable tool when it comes to working w ith a client not only at the initial engagement but throughout the entire treatm ent process.

In addition to providing them with information about the treatment process and a nswering nay questions they may have as to what to expect from treatment, you wa nt to motivate them and encourage success. Explain to them that they have a dise ase, and that it is treatable and that its not their fault they are an alcoholic/ addict. This helps to realize how they got where they are and to take away some of the shame, or feelings that they are a weak and rotten person that are associ ated with addiction. You want to make sure they know that it is not the end of t he world to live drug and alcohol-free and that its the beginning of a new life a nd new opportunities for them. And at the same time, you also want to educate th e family on the disease and its effects. It is also extremely vital to make sure they feel that they are in a comfortable place where they can feel secure in expressing their feelings, thoughts, fears and concerns. Try to provide structure and support for them to stay drug and alc ohol-free. You also want to be sure that they do not feel isolated or detached b ecause those feelings can be detrimental to the treatment process, especially at this early phase. An extremely important step (or objective) within this phase is that even though at this point the addict is already in treatment, treatment cannot truly begin until the delusion is broken so it is essential that the delusion gets broken. I

n breaking the delusion, it means the addict needs to come to the conclusion tha t he or she cannot control their alcohol or drug use and that they need to have complete abstinence from alcohol or drugs. This is where they come to admit they are an addict and begin to see themselves as such. Or, in other terms, they are surrendering. This is the point at which the addict has to surrender to the addic tion. Surrender is the collapse of the logical framework that supported a belief in control.# Surrender is essential in order for treatment to begin and is a cr itical and crucial moment which indicates that the delusion has been broken. Thi s is when they start to have control over their lives again. This is also the phase in which the addict is introduced to 12 step meetings and the theories behind the 12 steps. Also, many addicts get to this phase because they are sick and tired of being sic k and tired. But no matter how they get there, the important thing is that they g et themselves into a treatment program.

The Early Recovery Phase Goal: The goal of the early recovery phase is to solidify the new identity of th e addict and provide meaning and new behaviors to go with that new identity. Focus: Alcohol/Substance Axis and Environment; try to get the addict to have acc eptance and surrender. Make sure they are adjusting to their new identity and le arning to identify with being an addict. Objectives: The objectives of the early recovery phase are mainly focused around the changes within that the addict has made in terms of not identifying their p erson as an addict, but as someone who is living drug and alcohol free. This inc ludes making sure the client is comfortable and adjusting to their new identity and assisting them with learning how to interact in life as a new non-user. Anot her objective associated with this is helping them to establish new friends and learn communication skills. Since this can also be associated with a mourning of the old identity that the addict associated themselves with, it can include feeli ngs of depression and loss so be sure to watch for this. You want to teach cope with friends mily that use, it gs they can do to ing with feelings them how to have fun without using substances and also how to and family members who are using. In regards to friends and fa is important to inform them about cravings and teach them thin overcome them. Teaching them ways of identify feelings and cop in a positive way will help them with these issues.

Teaching them effective time management strategies and how to incorporate struct ure into their lives is a vital tool for their success and that makes it a neces sary objective that must be discussed with the addict. Another objective in this phase is to assist clients in developing an effective relapse prevention plan or recovery plan. You also want to encourage on-going su pport and make sure they understand the importance of on-going 12 step program p articipation, including sponsorship. Also teaching clients how to manage thoughts of using is an essential objective in this phase. There are a lot of changes that are made in the transition phase with most of it being personal growth within the addict. As to not counter-act this positive an d forward movement, it is necessary that the family is also being treated and th

ey too are learning about the disease. This is also the most critical stage for relapsing. At this point in treatment t he addict is still learning to live a new life free of alcohol and drugs yet at th e same time they are often eager to move on with their lives, at times much too quick that what they are really ready for. This can cause them to easily get ove rwhelmed because they have taken on more than they can in-fact handle. They star t new relationships, take on huge projects, begin new programs, all which can gi ve them a feeling of having bitten off more than they can chew and in terms of r elapsing, this can be an extremely dangerous situation. The On-Going Recovery Phase Goal: The goal of the on-going recovery phase is expansion and interaction of th e addict with regards to interpersonal relationships and environmental concerns. There is also a goal to focus the addict on building the base of a new belief s ystem about themselves in relation to alcohol and a world in which they are fre e of alcohol and substances. Focus: Alcohol/Substance Axis and Environment; making sure the addict is partici pating in self-examination and reflection, that they are expressing their feelin gs and examining relationship and family issues while making his or her spiritua l beliefs clearer and stronger. Objectives: This phase is usually entered after the addict has been in recovery for a period of two to five years and the objectives of this phase focus mainly on personal growth. The addict should be looking out for opportunities for on-going personal growth and also seeking out opportunities for healthy relationships, including romantic relationships. They should be able to be successful in being more in-depth with their counseling and therapy in regards to dealing with past traumas or experie nces which were painful. During the on-going recovery phase, the addict should be encouraged to continue learning how to identify, express and cope with feelings, especially those of an xiety and fear. This also includes identifying on-going support for recovery and developing a recovery plan which keeps life fresh and honest. Another objective is making sure the client is not only learning by exercising i ssues regarding on-going time management and the structuring of their lives in g eneral. As the individual starts developing interpersonal relationships once again, thos e relationships and environmental concerns start to become more important as the individual begins to integrate internal needs with external demands. Much of th e process of on-going recovery is the development and fine tuning of the self in relation to a larger whole. Co-Occurring Disorders A co-occurring disorder is defined as when a mental illness and a chemical depen dency (an addiction) occur at the same time. For co-occurring disorders, you tre at both illnesses as primary disorders and at the same time. You cannot leave on e illness untreated because it will be detrimental to the other. Possible co-occ urring issues associated with alcohol or drug addiction include Schizophrenia an d other psychotic disorders (which is the most severe), bi-polar disorder, depre ssion, anxiety, PTSD, ADHD, sexual abuse and eating disorders. Another term associated with co-occurring disorders is co-morbidity, which is a term used by mental health professionals to describe two disorders occurring at

the same time. Additional terms associated with co-occurring disorders include MICA (mental illness and chemical addicted) and MISA (mental illness and Substan ce Abuser). Stages of Change The Stages of Change were established by Prochaska & DiClemente and are the stages that describe a persons motivation, readiness or progress towards modifying the problem behavior (the addiction). The stages follow along with the phases in the Developmental Model. The stages include: Pre-Contemplation: Not currently considering change: "Ignorance is bliss". The p erson is not considering quitting in the next six months. Contemplative: Ambivalent about change: "Sitting on the fence". The person is no t considering change within the next month. Determination: Some experience with change and are trying to change: "Testing th e waters". The person is planning to quit within the next 30 days. Action: Actually doing the work of being drug and alcohol free and practicing n ew behavior. The person is staying clean for three to six months. Maintenance: Continued commitment to sustaining new behavior. At this point they have been clean for more than six months and up to five years. Motivational Interviewing Motivational interviewing is a technique that is currently strong within the che mical decency field and has been established and noted as being a very effective way to counsel. It is a directive, client-centered counseling style for eliciti ng behavior change by helping clients to explore and resolve ambivalence. Compar ed with nondirective counseling, motivational interviewing is more focused and g oal directed.# Motivation interviewing is an interpersonal style, not at all restricted to form al counseling settings. It is a subtle balance of directive and client-centered components shaped by a guiding philosophy and understanding of what triggers cha nge.# You want the addict to realize and understand what theyre thinking for them selves. You dont want lecture the addict, you want to let them figure it out for themselves while you are asking questions that leading them to those self-discove ries. It is the style with which feedback is delivered# and should communicate re spect. One of the positive aspects of motivational interviewing is that it allows the c lient to weigh the pros and cons of changing versus not changing their substance use behaviors. A client s belief that change is possible is needed to instill h ope about making those difficult changes. Clients who have previously tried and been unable to achieve or maintain the desired change are only creating doubt ab out their ability to succeed. In motivational interviewing, counselors support s elf-value by focusing on previous successes and highlighting skills and strength s that the client already has. To me I see that as a strength because reinforcin g the positive steps or changes they have made is encouraging and gives them a s ense of self-pride. It also allows them to see that they can make changes and ca n give them the self-confidence needed to adjust their behaviors that are associ ated with substance use. Another strength is centered around empathy. Empathy involves seeing the world t hrough the clients eyes, thinking about things as the client thinks about them, f eeling things as the client feels them and sharing in the clients experiences. Th is approach provides the basis for clients to be heard and understood, and in tu

rn, clients are more likely to honestly share their experiences in depth. This i s important because it takes you to the same level as the client and is along th e theory of walk a mile in someone elses shoes. I think it a client truly believes that you understand where they are coming from, or where theyve been, the client will be more trusting of you and that can only enhance the relationship you have with your clients. In motivational interviewing, it is encouraged that you ask open-ended questions . Open-ended questions are those that are not easily answered with a yes or now answer or short answer containing only a specific, limited piece of information. Open-ended questions invite elaboration and thinking more deeply about an issue . These are good because they allow the client to open up and actually engage wi th you. It gives them the freedom to express their thoughts and feelings. Inviti ng elaboration to your question also allows you to get more of what they are thi nking, feeling or experiencing. Additionally, just as with one of the ideas behind the Developmental Model, all clients move through the stages of change at their own unique pace. Damage can b e done to the client-counselor relationship if the counselor pushes the client t oo quickly towards a higher level of readiness or action. This is essential and extremely important because if pushed too fast, a client who is not ready is jus t being set up for failure. The focus of MI is heavily reliant on the client. And while the counselor is the one asking the questions, the addict is the one who is responsible for actually discovering and implementing the change. For some people this might be too much responsibility. People who have a substance abuse issue are usually not good at f ollowing directions and are often not held accountable to anyone except themselv es. So with not having accountability to someone seen as being in an authoritativ e position, they might not do what they need to do make the necessary changes . Also, since motivational interviewing is about looking at the inner-self, some p eople start to see things they might not like, which could be detrimental to the their treatment process and could send them in the opposite direction, rather t han them moving forward. ASAM Assessment An ASAM (American Society of Addition Medicine) assessment is where information is gathered from the client/addict to help figure out how severe their addiction problem is. It is used to determine a diagnosis and to formulate an individuali zed treatment plan for the client and what sort of placement would be best for t hem. For example, do they need to go to de-tox, do they need an in-patient or ou t-patient treatment program? The ASAM assessment is made to streamline criteria, meaning that two different examiners of the same individual should arrive at th e same conclusion as to that persons diagnosis and level of treatment recommended . The assessment also reviews the clients history and the interviewer is watching f or signs of the seven principles mentioned earlier (Primary Disease, Progressive , Loss of Control, Denial/Delusion, Affects Entire System, Able to Arrest, Not C ure, Mimics Other Disorders) and trying to determine whether they cannot stop or control their use. There are six dimensions to the ASAM assessment, and those are: 1. Acute Intoxication/Withdrawal Syndrome: This inquires as to when the addict l ast used and whether or not they are experiencing any withdrawal symptoms. It he lps to determine whether or not the client is going to require detox. Questions are asked about the clients previous withdrawal history and this helps to determi ne whether or not they are at risk for seizures during withdrawal.

2. Biomedical Conditions: This involves asking questions to find out if the clie nt has any medical conditions that might cause problems during the withdrawal/de tox phase. It also looks at whether these conditions could affect or interfere w ith the treatment process. 3. Emotional/Behavioral Conditions: This is in regards to mental health issues. Questions are asked in regards to whether or not the client has a psychological, behavioral or emotional issues that need to be addressed as to be sure they do not interfere with or complicate the treatment process. Another thing that is lo oked at is whether or not the client has been prescribed medication for these ty pes of issues and if so, are they actually taking the medication as prescribed? This is also where the client is asked whether or not they have any suicidal ide as. 4. Readiness to Change: How ready is the client to change is what is looked at h ere. Are they in treatment because they were court ordered, were they forced int o treatment in any way and are they resistant to change? Do they think they have a problem and do they want to make a change? 5. Relapse Potential: Is the client in danger of immediate relapse? Are they exp eriencing cravings and do they know how to cope with cravings? Is he or she adeq uately prepared to deal with relapse triggers? If they are on any medications fo r mental health issues, are complying with taking them as directed? 6. Recovery/Living Environment: Are there any people within the family, work or social systems that pose a threat to the clients ability to remain alcohol and/o r drug free? And does the client have positive support from his or her family, c o-workers and friends? Are there any issues, such as transportation, educational , housing or financial that need to be addressed. Another concern looked at is w hether or not the client has any demands required of them by either the courts, social services agencies or their employment that might motivate the client to b e successful in the treatment process. Relapse Dynamic It is important to note that a relapse is a process, not an event. When the addi ct or alcoholic actually uses, that is the final phase of the relapse process. A ccording to this theory, a person is actually relapsing long before they actuall y use and its not just the actual use, but the setting up of the event or situati on where the use takes place. There are many signs and symptoms of relapse that define the relapse dynamic and that are warning signs that a person is in the process of relapsing. An importa nt aspect regarding relapse is to get the client to identify their own individua l warning signs of a relapse because each person has their own unique and indivi dual risk factors and/or triggers. For most addicts, its hard for them to see rel apse symptoms within themselves and others around them are much quicker to see t he relapse coming. Because of that, it is good practice for the addict to inform those around them that if they see them participating in relapse behaviors to s ay something and point that out to them so the addict too becomes acutely aware of his or her actions and hopefully avoid the possibility of a relapse. When an addict relapses, they go right back to the stage they were in and the po int they were at when they entered treatment and stopped drinking or using. And because of that, it is critical that they get back into treatment as soon as pos sible because for some addicts, a relapse could very well equal death. If an addict does have a relapse, the most important thing is to not shame them and that they get back on track as soon as possible. The longer they are back dr

inking or using, the longer and harder it is for them to get back into sobriety. For some addicts, a relapse can be a therapeutic process. If they do relapse it i s important that you get them to learn from it. Like what happened, what was the process? For example, did they stop going to meetings or start hanging out with old friends who are still in active addiction? Try to get them to see what it w as that happened during the relapse process (before and after the using) that je opardized their sobriety. This is important for them to learn from it so as to p revent it from happening again in the future. While different for everyone, some general contributing factors of a relapse are (1) the addict not having the appropriate skills to deal with social pressures, interpersonal conflicts or negative emotions, (2) them putting themselves in hig h risk situations that are dangerous and jeopardize their sobriety, (3) thinking that they can control their use by testing themselves because they think they ca n control their drinking or usage, and (4) having continuous thoughts or physica l desires to use. Additionally, the addict is in danger of relapsing if he or sh e has a learning disability, has a high stress type personality, does not have a dequate coping skills and lacks impulse control and does not have a support syst em. Also, those addicts who are experiencing a separation or divorce, moving awa y from friends or changing schools or employment, suffering from the death of a family member or are experiencing a break-up in their relationship with their pa rtner are all higher risk for relapse. Because of all these factors and how stressful daily life can be, it is essentia l that people in recovery learn to do daily maintenance on themselves. That includ es dealing with and resolving interpersonal problems and situations. Learning ho w to regulate and deal with their own emotions is an especial part of helping th em maintain stabilization within. Establishing a daily routine, eating a proper diet, exercising and attending self-help group meetings are also strong skills t he addict needs to establishing in their lives during the recovery process. Havi ng structure in their lives is an essential component to remaining alcohol and d rug free. Conclusion Having just recently entered the Chemical Dependency Studies program at LCC, I a m very pleased that I took this class. I feel that I have learned an essential c omponent of how things actually work within the chemical dependency field and ha ve full working understanding knowledge of the Developmental Model. I believe th at having this knowledge is an excellent base for me to build upon as I continue working towards my goal of becoming a CDP. I truly enjoyed the class. It was an interactive discussion and thought it was w ell taught by someone who was not only qualified, but extremely knowledgeable, a nd for that I have great respect. I think Ms. Waltz did an excellent job of maki ng sure we learned, not just memorized, what she was wanting us to take away fro m the course. She made sure we did not just know what the Developmental Model wa s, but that we had an actual working understanding of how it and the components contained within. Taking her class was a pleasure and I look forward to opportun ity to learn from her again in the future.