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As more agencies compete for state and federal dollars, they are moving toward hiring professionals that are trained both as Licensed Professional Counselors as well as Certified Addiction Counselors.  In many agencies, being a certified addictions counselor can increase your rate of pay between $1.50 and $3 per hour or $3000 to $6000 per year, and make you eligible for a variety additional positions in addictions counseling.

The Florida Certification Board, for example, has certification programs for Certified Addictions Counselors (CAC), Certified Addictions Professionals (CAP), Certified Online Counselor, and Certified Mental Health technician.  Many of these certifications have different levels based on your education.  For example, persons in Florida who are already licensed professional counselors, licensed mental health counselors, or licensed clinical social workers through the Florida Board of Mental Health Counseling can take online training in addiction counseling from a FCB or NAADAC approved provider in order to become a Certified Addictions Counselor.   AllCEUs provides affordable online continuing education credits for counselors, and NBCC approved continuing education and online training for addictions and mental health professionals.

In Iowa, people are allowed to get all of their certified addiction counselor training hours online; however, once you are certified, you can only get up to 50% of your continuing education courses from online resources.

Want to get certified? You can get all of your required training through AllCEUs click here to go to our addictions counselor training portal.

Check with your state addiction counselor certification board to see what their requirements are.  In many cases, the hours you have already worked in community mental health can count towards your contact hours for certification.

While some people believe that you cannot effectively work with veterans unless you have “been there,” there are many others who believe that once clinicians understand the culture, they can be a very effective part of a multidisciplinary team.

After working with veterans for the last 8 years, I believe four of the biggest problems working with civilian counselors have been: Their lack of understanding of chain of command and the military way of doing things; their lack of knowledge about terms (You can find a short list here: http://www.itstactical.com/intellicom/language/military-acronymsterminology-and-slang-reference/), an excessive focus on talking about feelings and lack of understanding regarding the need to compartmentalize those feelings in order to function.

In the military, there is a definite chain of command. Subordinates are expected to do what they are told, whether they like it or not. It is not a democracy. There is no suggestion box for improving workplace conditions. Subordinates do not question superior officers. Asking a patient: “Did you tell him how that made you feel?” or “What would have happened if you had suggested…” and sometimes “Maybe you should talk to someone higher up the chain of command” would be completely inappropriate and destroy any rapport. Understanding this hierarchical culture is essential to working with a veteran or active duty soldier. (As an aside, helping significant others embrace this concept is crucial as well.) Understanding the terminology is vital to understanding what is being said. While it may not destroy rapport, it can disrupt momentum when a patient is recounting what happened. Growing up in a family of law enforcement and military people, I always thought everyone knew 10-codes. They were part of my vocabulary. I would find myself stumbling through conversations sometimes to try and back up and explain in civilian terms what I was saying. You can imagine how a patient in crisis, who is immersed in recounting what happened, might get frustrated. Remember that terminology differs to an extent between branches of the military.

Finally, the focus on feelings. We do want our patients to identify their feelings, but many soldiers are not comfortable talking about the “F-word” right away. Replacing the term “feeling” with “reaction” can be somewhat helpful. Labeling feelings in your paraphrases can also be quite helpful. For many veterans, talking about feelings is also difficult because they have compartmentalized for so long. Imagine storing stuff in boxes in your attic for years. Some of the boxes are labeled. Some of them are not. You are not quite sure what you’ll find in any of them. Accessing feelings and reactions can be much like exploring a dark, crowded attic. It can be very intimidating to open those Pandora’s Boxes for fear that something they did not want to remember would be in there, or they will be overcome and not able to close the box again.

It is important for people (veterans or not) to understand the function of their emotional reactions. There is a purpose. This can help them feel the feeling, then make an educated decision about what (if anything) to do with it. Dialectical Behavior Therapy approaches are very useful as is Cognitive Processing Therapy. You can watch an introduction to the course AllCEUs recently did on the new PTSD criteria in the DSM V and an overview of Cognitive Processing Therapy.

These will provide just a few tips for working with veterans. Look here for additional resources, and stay tuned for more helpful information.

 

Critical Incident Stress

As an Approved Continuing Education Provider for NBCC, we are supporting the Joining Forces Initiative to help clinicians better serve military service members and their families.  Visit our resources page Military Resources for Family, Friends, Employers  or Military Resources for Clinicians

The Foundations of Recovery article series is designed to highlight scholarly research and aid addiction counselors in translating that knowledge into practice with their patients with co-occurring disorders.  In order to provide solace from the problems related to substance abuse and mental health issues, therapists need to focus on addressing all the concerns patients bring including PTSD and co-occurring mood disorders.  This article focuses on three studies done by Paige Crosby Ouimette which focus on the factors that may impact long-term recovery for persons with co-occurring disorders.  The findings are not black and white, but do provide support for screening for co-occurring disorders, including PTSD, referrals for concurrent psychiatric treatment and participation in outpatient programs in addition to self-help support groups.

Course and Treatment of Patients With Both Substance Use and Posttraumatic Stress Disorders

PAIGE CROSBY OUIMETTE, PAMELA J. BROWN and LISA M. NAJAVITS.  Addictive Behaviors. Volume 23, Issue 6, November–December 1998, Pages 785–795

Posttraumatic stress disorder (PTSD) is a common co-occurring diagnosis in patients with substance use disorders (SUDs). Despite the documented prevalence of this particular “dual diagnosis,” relatively little is known about effective treatment for SUD-PTSD patients. Based on this review, the following is noted: PTSD is highly prevalent in SUD patients, consistently associated with poorer SUD treatment outcomes, and related to distinct barriers to treatment. Specific treatment practices are recommended for substance abuse treatment providers: (a) All patients should be carefully screened and evaluated for trauma and PTSD; (b) referrals should be provided for concurrent treatment of SUD-PTSD, if available, or for psychological counseling with the recommendation that trauma/PTSD be addressed; and (c) increased intensity of SUD treatment should be offered in conjunction with referrals for family treatment and self-help group participation.

 

Influence of Outpatient Treatment and 12-Step Group Involvement on One-Year Substance Abuse Treatment Outcomes

Paige Crosby Ouimette, Rudolf H. Moos, John W. Finney (J. Stud. Alcohol 59: 513-522, 1998)

This study examined the effects of different types of aftercare regimens  on treatment outcomes.  Patients who participated in both outpatient treatment and 12-step groups fared the best on 1-year outcomes. Patients who did not obtain aftercare had the poorest outcomes. In terms of the amount of intervention received, patients who had more outpatient mental health treatment, who more frequently attended 12-step groups or were more involved in 12-step activities had better 1-year outcomes. In addition, patients who kept regular outpatient appointments over a longer time period fared better than those who did not.

 

Dual diagnosis patients in substance abuse treatment: relationship of general coping and substance-specific coping to 1-year outcome

Franz Moggi, Paige Crosby Ouimette, Rudolf H. Moos, John W. Finney

This study examined general and substance-specific coping skills and their relationship to treatment climate, continuing care and 1-year post-treatment functioning among dual diagnosis patients (i.e. co-occurrence of substance use and psychiatric disorders). Patients with co-occurring disorders (dual diagnoses) modestly improved on general and substance-specific coping skills over the 1-year follow-up period. Patients who were in programs with a dual diagnosis treatment climate and who participated in more 12-Step self-help groups showed slightly more gains in adaptive coping. Both general and substance-specific coping were associated with abstinence, but only general coping was associated with freedom from significant psychiatric symptoms. Therefore, enhancing general and substance-specific coping skills in substance abuse treatment may reduce dual diagnosis patients’ post-treatment substance use and improve their psychological functioning.

 

Twelve-Step and Cognitive-Behavioral Treatment for Substance Abuse: A Comparison of Treatment Effectiveness

Paige Crosby Ouimette, John W. Finney, Rudolf H. Moos.  Journal of Consulting and Clinical Psychology, 1997, Vol. 65, No. 2, 230-240

The comparative effectiveness of 12-step and cognitive-behavioral (C-B) models of substance abuse treatment was examined among 3,018 patients from 15 programs at U.S. Department of Veterans Affairs Medical Centers. Across program types, participants showed significant improvements in functioning from treatment admission to a 1-year follow-up.  Patients showed similar improvement at the 1-year follow-up, regardless of type of treatment received.

Summary of the Foundations

  • All patients should be carefully screened and evaluated for trauma and PTSD
  • Referrals should be provided for concurrent treatment of SUD-PTSD, if available, or for psychological counseling with the recommendation that trauma/PTSD be addressed
  • Increased intensity of SUD treatment should be offered in conjunction with referrals for family treatment and self-help group participation.
  • Patients whose aftercare programs were more intense (i.e. self-help groups plus therapy) and were longer in duration fared better at one year.

A lot has been going on at AllCEUs.  In January we started our live training each Saturday for people wanting to become Licensed Drug and Alcohol Counselors.  In addition to providing the course face-to-face, our diligent tech staff has set it up so the courses are simulcast in an online, interactive webinar form.  As if that was not enough, we are also creating an online, instructor led version of the same training. Participants will be able to watch the videos, read the materials and complete assignments when it is convenient.  Instructors will grade the assignments ad provide feedback as needed.  Additionally, the instructors are available for video chat and host a monthly (optional) group chat for all participants.

Our live, interactive Wednesday webinars are continuing.  We are gradually covering all of the best practices published by SAMHSA, the National Institute of Mental Health, the National Center for Child Traumatic Health, The Addiction Technology Transfer Center, and the counseling related best practices from Registered Nurses Association of Ontario.  We encourage you to drop by at http://allceus.com/live to watch the presentations for free on Wednesdays at 6pm CST, 7pm EST.   You only have to pay if you want to get CEUs. :)

Both the Wednesday and Saturday classes are approved for CEUs by NBCC, NAADAC, CAADAC and CBBS, among others.

In preparing for this week’s addiction counselor certification class, I came across this docs youtube channel.  http://www.youtube.com/user/jajsamos911

It is SO worth watching the videos and going to the site.  I wish I had a professor like him in grad school.  The series of videos I like the most is the Geezer’s Dirty Dozen.  In these presentations he gives you a pretty concise overview of a topic in 12 slides.

Here is his blog as well.  http://thepracticalpsychosomaticist.com/