Addiction Counselor Exam Review
Episode 20
Dr. Dawn-Elise Snipes, PhD, LPC-MHSP, LMHC
Executive Director: AllCEUs Counselor Education
Podcast Host: Addiction Counselor Exam Review, Counselor Toolbox and Happiness Isn’t Brain Surgery

Specific population considerations
~ Aspects of the client’s identity may influence the client’s substance using behavior, the responsiveness to treatment, and the recovery process
~ These factors include race, ethnicity, age, sexual orientation, and the presence of co-occurring disorders including trauma
~ Rather than placing a person and established treatment slot treatment providers are learning the importance of modifying in adapting services to meet an individual client’s needs
~ SAMHSA has produced multiple publications that dealt in depth into the treatment needs and recommended practices for specific types of disorders and or populations
Specific populations continued
~ Substance abuse treatment programs typically reported 50 to 75% of their clients have co-occurring disorders
~ Medical settings site proportions of 20 to 50%
~ The term co-occurring disorders replaces the terms dual disorder or dual diagnosis
~ Co-occurring disorders refers to co-occurring substance use and mental disorders
~ A diagnoses of a co-occurring disorder occurs when at least one disorder of each type can be established independent of the other
~ Review SAMHSA TIP 42 for more information
Specific populations continued
~ Criminal justice
~ For many people in need of substance abuse treatment contact with a criminal justice system is the first acknowledgment of the need for treatment or opportune did you receive services
~ Longstanding patterns of poor coping skills, criminal values and beliefs, lack of education, and minimal job skills may require an intensive treatment approach particularly among offenders with a prolonged history of substance abuse and crime
~ Addiction professionals must be able to communicate effectively with judges, probation officers, and other criminal justice system personnel functioning as a community treatment team
~ Leaders in both criminal justice and treatment systems need to develop shared goals and clear systems of care for addicted offenders both while they are incarcerated in after their release
Specific populations continued
~ HIV and AIDS
~ HIV is most efficiently transmitted through the exposure to contaminated blood
~ injection drug users represent the largest HIV infected substance abusing population in the United States
~ Sexual contact is another route of HIV transmission
~ Substance use treatment can play an important role in helping individuals reduce risk taking behavior
~ Substance use treatment serves as a HIV prevention
~ HIV and AIDS, substance abuse disorders, and mental disorders interact in a complex fashion, each acting as a potential catalyst or obstacle in the treatment of the other two
~ Treatment goals include living substance free, slowing or halting the progression of the disease, and reducing risk taking behavior

Specific populations continued
~ HIV and AIDS
~ Treating HIV and AIDS is extremely complex
~ Individuals with substance use disorders whether or not they are HIV infected are subject to the higher rates of mental disorders than the rest of the population
~ Counseling is an important part of treatment
~ Risk reduction allows for a comprehensive approach to HIV and AIDS prevention which promotes changing the substance-related and such related behaviors
~ Substance use treatment programs can help reduce the spread of other blood borne infections including hepatitis B and C viruses
~ Counselor should be familiar with Federal and state laws protecting information about client and substance abuse treatment, and state laws protecting HIV and AIDS related information
Specific populations continued
~ Physical and cognitive disabilities
~ People with physical and cognitive disabilities are more likely to have a substance use disorder and are less likely to get effective treatment
~ 20% of persons with disabilities have a substance use disorder
~ These individuals are less likely to complete treatment because physical, attitudinal or communication barriers limit their treatment options or render their treatment experience is unsatisfactory
~ The Americans with disabilities act states that both public and private facilities must be equally accessible
~ Barriers to communication must be removed and discriminative policies and practices eliminated
~ Accommodating people with coexisting disabilities in treatment for substance use disorders include such things as adjusting counseling schedules, providing interpreters, suspending the no medication rules, and overcoming people’s fears and ignorance

Specific populations continued
~ Physical and cognitive disabilities
~ People disabilities are more likely to use substances in part because they experienced unemployment, lack of recreational options, social isolation, homelessness, and victimization or physical abuse more frequently than the general population
~ People who are deaf and identify with deaf culture will usually prefer specialized treatment programs
~ People with intellectual disabilities may find it easier to understand and participate in discussions with others with similar disabilities and may be more inclined to ask questions
~ Other disability conditions that may warrant some standalone services include traumatic brain injury, spinal cord injury, or severe or multiple disabilities
Specific populations continued
~ Women
~ Gender differences play a role in drug selection, use and treatment patterns
~ Women and men tend to abuse different drugs
~ The effects of drugs are different for women and men
~ Some approaches to treatment are more successful for women than men
~ Women used significantly more prescription drugs than men
~ Women and men appear to differ in their vulnerability to certain drugs
~ Women advance more rapidly from initial use to regular use to the first treatment episode
~ Women experience an effect call telescoping whereby they progress faster than men from initial use to alcohol and drug related consequences even when using a similar or lesser amount of substances
~ Women are more likely than men to have co-occurring substance use and mental health disorders including anxiety disorders and major depression
~ Women’s substance use problems are more stigmatized and less likely to be acknowledged than men
Specific populations continued
~ Women
~ Issues impacting women with substance use disorders
~ Shame and stigma
~ Physical and sexual abuse
~ Relationship issues including fear of losing children, fear of losing a partner, or needing a partner’s permission to obtain treatment
~ Treatment issues include lack of services for women, not understanding women’s treatment, long waiting lists, and lack of childcare services
~ Systematic issues include lack of financial resources, lack of clean and sober housing, lack of pregnancy/postpartum services, and poorly coordinated services
Specific populations continued
~ Women
~ Three primary types of services for women
~ Clinical treatment
~ Clinical support
~ Community support which includes everything from child care and transportation to housing services, family strengthening, recovery support services, employment services, vocational and academic services
~ Development of substance use disorders is viewed as a disconnection
~ Treatment stresses the development and repair of connections to others, oneself, ones beliefs and one’s culture
Specific populations continued
~ Pregnant women
~ Substance abuse often creates or is accompanied by an array of social problems including violence, child abuse and neglect, and family dysfunction
~ 5.4% of babies are born to illicit drug users
~ Substance abuse during pregnancy increases the risk of problems for both the mother and the fetus.
~ The March of Dimes web site has detailed information about these risks by the drug used
~ Pregnancy creates a window of opportunity to enter treatment, become abstinent, quit smoking, eliminate risk taking behaviors, and lead a healthier life
~ Additional specialized treatment needs include improving nutrition, childcare, financial support and identification and treatment of infectious diseases in both women and infants

Specific populations continued
~ Older adults
~ Nearly one in five have mental health and substance use conditions
~ Depressive disorders and dementia related behavioral and psychiatric symptoms are the most prevalent but substance use is a significant problem as well
~ Age alters the way people metabolize alcohol and drugs
~ Issues that trigger symptoms can include losses that frequently occur in old age
~ Differentiating between major depression and grief in the person with significant losses is often difficult
~ Cognitive functional and sensory impairments may complicate detection and diagnoses of mental health and substance use
Specific populations continued
~ Adolescents
~ The national institute on drug abuse has published a version of the principles of Adolescence substance use disorder treatment: a research based guide
~ Adolescent’s brains are still developing
~ Exposure to neurochemical changes and health consequences associated with addictive behaviors appear to cause more significant and long lasting brain changes for adolescents
~ It is important to remember too that adolescents are often in a very tumultuous life stage—ending childhood, developing identity, leaving home
Other Special Needs
~ Trauma Informed Care
~ Non-abstaining addictive behaviors (shopping, food, sex)

~ Just like it is vital to be aware of the special needs of persons from different races and ethnicities, it is also vital to recognize that there are other factors that require specialized skills.
~ Gender and age differences themselves produce a range of special issues that need to be considered in
~ Prevention
~ Assessment
~ Engagement
~ Treatment setting recommendations
~ Treatment approaches
More Resources
~ Adolescents
~ Older Adults
~ Pregnant and Postpartum
~ Cultural Competence