Addiction, it has been said, is a condition that crosses all socioeconomic, gender, age, and cultural lines. The more we learn about addiction, the more it seems that anyone, from anywhere, regardless of their background, can fall prey – especially when we consider the wide range of substances that people can become addicted to.
And no longer are addictions exclusive to illegal drugs or alcohol. In fact, prescription medication addiction – one of the fastest growing categories of addiction – is becoming increasingly common. As addictive pain medications like oxycodone are prescribed with greater frequency and wider range, the reality is that more people from are being exposed to potentially very addictive medications.
With greater exposure to addictive pain medication a broader range of people are being exposed – and that means people from a variety of cultures.
The implication, as one study led by researchers at the Center for Addiction and Mental Health (CAMH), and published in the Journal of Clinical Psychiatry evidences, is that people of Chinese and South Asian cultures may experience more severe mental illness at the time of hospital admission that other patients (Chiu et al., 2016).
Another implication is that Asian tobacco companies are now poised to enter the global market, which is likely to mean more people smoking – and addicted to tobacco – nationwide (Lee et al., 2017).
With a wider range of cultures exposed to addictive substances – and having them directly marketed to them – the concept of cultural competence becomes increasingly important for those clinicians who treat addiction.
Knowing what is expected and considered appropriate for each culture is a critical competent of establishing rapport with patients from different cultures. For example, one study found that handshaking – a Western staple greeting – is viewed more positively by Westerners than East Asians (Katsumi et al., 2017).
It is these social norms, argue sociologists, that govern our lives by giving us implicit and explicit guidance on what to think and believe, how to behave, and how to interact with others. When following the social folkways, mores, taboos, and laws of those from another culture, we gain a feeling of trust from them – which in the clinical setting, is indispensable.
Related Online Continuing Education (CE) Courses:
Improving Cultural Competence in Substance Abuse Treatment is a 4-hour online continuing education (CE) course that proposes strategies to engage clients of diverse racial and ethnic groups in treatment. Culture is a primary force in the creation of a person’s identity. Counselors who are culturally competent are better able to understand and respect their clients’ identities and related cultural ways of life. This course proposes strategies to engage clients of diverse racial and ethnic groups (who can have very different life experiences, values, and traditions) in treatment. The major racial and ethnic groups in the United States covered in this course are African Americans, Asian Americans (including Native Hawaiians and other Pacific Islanders), Latinos, Native Americans (i.e., Alaska Natives and American Indians), and White Americans. In addition to providing epidemiological data on each group, the course discusses salient aspects of treatment for these racial/ethnic groups, drawing on clinical and research literature. While the primary focus of this course is on substance abuse treatment, the information and strategies given are equally relevant to all types of health and mental health treatment. Course #40-39 | 2015 | 75 pages (54 w/o references) | 30 posttest questions
Prescription Drug Abuse is a 3-hour online continuing education (CE) course that examines the misuse of prescription drugs (including opioids) in the United States. Misuse of prescription drugs means “taking a medication in a manner or dose other than prescribed; taking someone else’s prescription, even if for a legitimate medical complaint such as pain; or taking a medication to feel euphoria” and is a serious public health problem in the United States. When taken as prescribed, medication can be of great benefit to a patient, helping reduce pain, save lives, and improve one’s overall quality of life. However, when individuals misuse their prescribed medications or take medications not prescribed to them, the consequences can be disastrous. Illicit drug use, including the misuse of prescription medications, affects the health and well-being of millions of Americans. Among other deleterious effects, cardiovascular disease, stroke, cancer, infection with the human immunodeficiency virus (HIV), hepatitis, and lung disease can all be affected by drug use. The important thing to remember is that the medications are not inherently bad in and of themselves – it is how people use (and abuse) them that creates a problem. This course will discuss what drives people to abuse prescription drugs and how they obtain them; diagnostic criteria for substance use disorder; history and progression of prescription drug abuse, including types and classes of drugs used; and the cost of prescription drug abuse on addicts and non-addicts alike. The course will then review the sequence of treating individuals who have a prescription drug use disorder, including screening, assessment, diagnosis, treatment, and maintenance. Screening tools, assessment instruments, treatment programs, and evidence-based recommendations are included. Comorbidity between substance use disorder and mental disorders is also discussed. Course 31-00 | 2018 | 50 pages | 20 posttest questions
Cultural Awareness in Clinical Practice is a 3-hour online continuing education (CE/CEU) course that provides the foundation for achieving cultural competence and diversity in healthcare settings. Cultural competence, responding to diversity and inclusion, are important practices for healthcare professionals. This course will help you to gain an awareness of bias and provide strategies to adjust your clinical mindset and therapeutic approach to adapt to “the other” – people who differ in color, creed, sexual identification, socio-economic status, or other differences that make inclusion difficult. Inclusion is defined as “the state of being included” or “the act of including,” which is something all clinicians should strive for. This course is designed to provoke thought about culture, diversity, and inclusion. Even though research for evidence-based practice is somewhat limited in this area, the concept of cultural competency (however it is defined and measured) is a key skill for healthcare professionals to create an inclusive therapeutic environment. Course #31-07 | 2018 | 57 pages | 20 posttest questions
Professional Development Resources is a nonprofit educational corporation 501(c)(3) organized in 1992. We are approved to sponsor continuing education by the American Psychological Association (APA); the National Board of Certified Counselors (NBCC); the Association of Social Work Boards (ASWB); the American Occupational Therapy Association (AOTA); the American Speech-Language-Hearing Association (ASHA); the Commission on Dietetic Registration (CDR); the Alabama State Board of Occupational Therapy; the Florida Boards of Social Work, Mental Health Counseling and Marriage and Family Therapy, Psychology & School Psychology, Dietetics & Nutrition, Speech-Language Pathology and Audiology, and Occupational Therapy Practice; the Ohio Counselor, Social Worker & MFT Board and Board of Speech-Language Pathology and Audiology; the South Carolina Board of Professional Counselors & MFTs; the Texas Board of Examiners of Marriage & Family Therapists and State Board of Social Worker Examiners; and are CE Broker compliant (all courses are reported within a few days of completion).
Gender Identity and Transgenderism is a 3-hour online continuing education (CE) course that reviews issues in the formation of gender identity and the possible resultant condition of transgenderism, formerly transsexuality.
E-Therapy: Ethics & Best Practices is a 3-hour online continuing education (CE) course that examines the advantages, risks, technical issues, legalities and ethics of providing therapy online.
Medical Marijuana is a 3-hour online continuing education (CE) course that presents a summary of the current literature on the various medical, legal, educational, occupational, and ethical aspects of marijuana.
Improving Communication with Your Young Clients is a 3-hour online continuing education (CE/CEU) course that teaches clinicians effective and practical communication and conversational skills to use with young clients and their families.
HIV/AIDS: Therapy and Adherence is a 3-hour online continuing education (CE/CEU) course that discusses adherence issues in populations at high risk for HIV infection and provides strategies for healthcare professionals to encourage people with HIV to seek and maintain medical treatment.
Building Resilience in your Young Client is a 3-hour online continuing education (CE/CEU) course that offers a wide variety of resilience interventions that can be used in therapy, school, and home settings.
Clergy Stress and Depression is a 4-hour online CEU course that provides clinicians with an understanding of the complex factors that cause stress and depression in clergy, along with recommendations for prevention and treatment.
Prescription Drug Abuse is a 3-hour online CEU course that examines the effects of the rise in prescription drug abuse, as well as treatment options for abusers.
Couples No-Fault Counseling is a 3-hour online continuing education (CE/CEU) course that teaches how to help couples to give up their BAD (blame, argue & defend) communication style and replace it with active listening.
The Grieving Self is a 3-hour online continuing education (CE/CEU) course that looks at stories of the bereaved to determine the major issues to address to reconnect those who grieve to a stable sense of self.
Domestic violence is more prevalent than you may realize. 95% of the cases involve female victims of male partners, but the female often isn’t the only victim. An estimated 3.2 million children living in America witness incidents of domestic violence annually. Witnessing has an array of meanings. It includes seeing the actual event of physical or sexual abuse occur, hearing threats or other violent noises from another room, observing the aftermath from the abuse like blood, bruises, tears, or broken items, and being aware of the tension in the household like the fear when the abuser is present. The child is like an extension of their abused parent− when the mother gets abused, it’s like the child gets abused. Here are some of the long-term effects of domestic violence on children.
Physical Health Problems
Unfortunately, children aren’t always just witnessing these attacks− sometimes they are on the receiving end of it as well. Other physical symptoms of growing up in a violent home include stomachaches, headaches, bedwetting, and inability to concentrate. Experts believe that children who grow up in abusive homes think that violence is an effectual way to resolve conflicts and solve problems. This may result in the child replicating the violence and intimidation that they witnessed when they were younger in their teen and adult relationships, and can lead to the cycle of violence with their children.
Exposure to domestic violence as a child can lead to Post-traumatic Stress Disorder. Children’s interpersonal violence exposure wasn’t always recognized as a potential antecedent to PTSD, but now it is acknowledged that extraordinarily stressful events can occur as part of children’s habitual experiences. Recent definitions of trauma stressors now include moments within ordinary circumstances that are capable of causing death, injury, or threaten the well-being of a loved one or the child itself. Signs of PTSD include:
Reliving the event: Memories of the event can resurface at any given moment, evoking the same feelings of fear and horror that occurred during the actual event. Nightmares, flashbacks, and triggers like seeing, hearing, or smelling something that causes the child to relive the traumatic event are forms of these re-experiencing symptoms.
Avoiding situations that remind the child of the event: The child may try to avoid situations or people that trigger those memories of a past event of domestic violence. They may keep busy or avoid seeking help because it keeps them from having to think or talk about the event.
Negative changes in beliefs and feelings: The self-image the child possessed may change, as well as the way they view others. There are many aspects to this symptom, including a belief that the world is completely dangerous and no one can be trusted, or a lack of loving or positive feelings in relationships.
Hyperarousal: The child may be jittery, irritable, angry, or always alert and on the lookout for danger. Trouble sleeping and concentrating may occur, or they may be startled by loud noises or surprises.
If you relocate as a result of a domestic violence situation, be aware that even moving to a new place can have emotional effects on children. If they’re removed from a familiar school or friends, they may face depression and other challenges. This should be addressed in any kind of therapy.
Often a matter of coping with the domestic violence and the consequences it brings, children who experience violent and traumatic events use drugs and alcohol to numb the pain and block out the memories. Substance abuse is most likely a learned behavior. Regular alcohol abuse is one of the leading risk factors for partner violence, and the risk of violence increases when both partners abuse drugs or alcohol.
Therapy and Treatment Options
There are numerous organizations that offer several avenues for child victims of domestic violence to address their issues and attempt to heal. Group and individual therapy, as well as dyadic treatments with their non-offending parent are essential components of intervention. The National Domestic Violence Hotline for victims is 1-800-799-SAFE (7233). Their website, www.thehotline.org, provides information about local programs or resources available.
How Children Become Violent is a 6-hour online continuing education (CE) course that was written for professionals working in the mental health, child welfare, juvenile justice/criminal justice, and research fields, as well as students studying these fields. The authors’ goal is to make a case for the fact that juvenile and adult violence begins very early in life, and it is both preventable and treatable.
PTSD Vicarious Traumatization: Towards Recognition & Resilience-Building is a 2-hour online continuing education (CE) course that outlines some of the basic differences between primary traumatization, secondary traumatization, VT, and compassion fatigue; discusses many of the signs and symptoms of VT; provides questions for self-assessment of VT; and provides coping suggestions for providers who are involved in trauma work or those who may have VT reactions.
Professional Development Resources is a nonprofit educational corporation 501(c)(3) organized in 1992. Our purpose is to provide high quality online continuing education (CE) courses on topics relevant to members of the healthcare professions we serve. We strive to keep our carbon footprint small by being completely paperless, allowing telecommuting, recycling, using energy-efficient lights and powering off electronics when not in use. We provide online CE courses to allow our colleagues to earn credits from the comfort of their own home or office so we can all be as green as possible (no paper, no shipping or handling, no travel expenses, etc.). Sustainability isn’t part of our work – it’s a guiding influence for all of our work.
We are approved to offer continuing education by the American Psychological Association (APA); the National Board of Certified Counselors (NBCC); the Association of Social Work Boards (ASWB); the American Occupational Therapy Association (AOTA); the American Speech-Language-Hearing Association (ASHA); the Commission on Dietetic Registration (CDR); the Alabama State Board of Occupational Therapy; the Florida Boards of Social Work, Mental Health Counseling and Marriage and Family Therapy, Psychology & School Psychology, Dietetics & Nutrition, Speech-Language Pathology and Audiology, and Occupational Therapy Practice; the Ohio Counselor, Social Worker & MFT Board and Board of Speech-Language Pathology and Audiology; the South Carolina Board of Professional Counselors & MFTs; the Texas Board of Examiners of Marriage & Family Therapists and State Board of Social Worker Examiners; and are CE Broker compliant (all courses are reported within one week of completion).
Counselors-in-training are often encouraged to be aware of and discuss issues that they think would be difficult for them to address with clients in counseling. A first-year counseling student recently disclosed that due to his values of multicultural awareness and acceptance, he would find it difficult to work with a client who expressed any prejudices in counseling. Given the counseling profession’s shift to a multicultural and social justice paradigm when working with clients, this is a valid concern but one rarely discussed when training counselors to work with culturally different individuals.
How should counselors handle prejudices that clients express in counseling? Do these prejudices need to be addressed if they are not related to the client’s presenting issue? The counseling profession has established values of awareness, knowledge and skills in multicultural counseling and social justice as a way to address power, privilege and oppression. Focus has largely been placed on how to guide treatment of culturally different clients in ways that acknowledge their unique worldviews. Under the banner of social justice and advocacy, counselors must also address the societal, historical and political issues that continue to oppress others. However, little information has been provided on how to address the biases of clients who may hold power and privilege in society, especially White clients who express prejudices.
Granted, prejudice is not a common presenting issue that brings clients to counseling. However, it is not uncommon for clients to express such values and beliefs in the counseling context. We are all cultural beings with unique values, histories and worldviews, and racism and prejudice affect everyone in some way. As counselors, we are taught to work within the worldview of the client, and social justice maintains that we must also work within a conceptual framework of how oppression at individual, societal and institutional levels can affect a person’s growth and development. By addressing biases that clients bring to counseling — biases that have the potential to be harmful to their own growth and the growth of others — we are addressing aspects of their worldview, while also adhering to the values of social justice.
I experienced this dilemma firsthand while working with college students during my training as a counselor. Feeling caught off guard, I struggled with how to handle a situation in which a client expressed racial stereotypes in counseling. I had little guidance from supervisors or professors concerning how to make sense of the situation. After researching the meaning of racism and prejudice and discussing with other counselors the best way to meet clients’ needs while also addressing power and privilege, I developed some considerations and interventions that counselors can use if they ever experience a client expressing prejudices in counseling.
In multicultural counseling and social justice training, counselors are primarily exposed to information that will help culturally different and oppressed clients, even as these counselors focus on awareness of their own prejudicial experiences and culture. This article addresses ways to work with clients who have the power to oppress. This is an issue that is aligned with the goals of social justice, albeit at an individual level, in an attempt to address biases in those who hold them.
Of course, culturally different persons can also express biases and stereotypes toward other groups, but these biases may have different meanings and origins. The interventions and conceptual issues presented in this article can be tailored to other situations, but the emphasis is largely around working with White clients who endorse stereotypes or biases toward people commonly oppressed in society. Therefore, the goal is to provide counselors with considerations and possible interventions to help these clients gain more insight and awareness that will potentially stimulate their personal growth.
Addressing Prejudice: Is it Ethical?
I have already made an argument concerning why it is important to address clients’ prejudices when expressed in counseling, both for the individual and society. However, I had many questions about my role as a counselor when I experienced this situation with a client. Was it my job to address prejudice if the client didn’t see it as an issue? Would I be promoting an “agenda” that was not part of the client’s worldview?
Ethically, we have a responsibility to respect the client’s worldview by maintaining an accepting and nonjudgmental stance. At the same time, it is our ethical responsibility to work within an understanding of social justice and advocacy. As with most ethical dilemmas, there are various ways to handle this situation but rarely a clearly defined “right” way to act. One possible path is to avoid addressing the client’s comments in therapy. But ignoring the issue could result in colluding with the client’s attitudes and maintaining the status quo of oppression. It could also send the message to the client that it is acceptable to avoid uncomfortable discussions. A counselor who experiences strong negative feelings toward the client’s values and beliefs but does not address the client about them may become resentful and critical of the client, possibly causing an impasse in counseling.
On the other hand, several consequences could occur if the counselor does address the client’s racist statements and beliefs. For example, the way the counselor addresses the issue may cause the client to feel embarrassed, ashamed or misunderstood, especially if the client is aware of the negative connotations of being viewed as “racist.” The context of therapy, the counselor-client dynamics and the way in which the client presents these beliefs are important considerations. For instance, let’s say a counselor who identifies as gay is working with a client who makes homophobic statements in counseling. This situation is both professionally and personally relevant to the counselor, who considers disclosing to the client that he identifies as gay. Before doing so, however, the counselor must ask who will really benefit from such a disclosure — the counselor or the client?
At a minimum, counselors should give clients the option and space to discuss racial and other prejudicial issues in the context of their own worldviews and experiences. Before deciding how to intervene in similar situations involving clients’ prejudices, counselors should take the following important steps.
Consider the client’s goals and how prejudice is related to these goals.
Assess the client’s racial identity.
Assess the function these stereotypes and biases serve for the client.
Consider how the racist comments relate to cultural racism.
Assess what cultural values and strengths maintain these beliefs.
Identify cultural strengths the client can use to stop relying on these biases.
Clarify your own motivations and reactions in the process of addressing prejudice.
Assess the client’s motivation for change in this area.
Conceptualization and Interventions
Similar to counseling for most other issues, it is not always feasible to expect clients who express prejudices and biases to completely resolve all of their issues. Much of the change in the area of prejudice depends on the factors just discussed and how much clients wish to change this aspect of themselves. However, at minimum it may be important to develop an awareness of the origins and functions of clients’ prejudicial attitudes as a means of better understanding their presenting issues. This can assist counselors in developing appropriate interventions that ultimately address clients’ concerns and possibly help them become more aware of their own biases.
One useful way to conceptualize White clients in relation to prejudices is through Janet Helms’ White racial identity development model. The idea of a White identity focuses mainly on the implications of having unearned, race-based power and privilege with the potential to oppress others who do not have that same privilege. The model emphasizes the transition from being unaware of one’s White racial background to an awareness and integration of one’s Whiteness into other parts of identity by giving up power and appreciating differences. The developmental status of a client will affect how he or she views other races and the relationship the client has with other races.
The first status in the White racial identity development model is contact. A client who is in the contact stage may claim not to see race (color-blind attitude) and may not understand the meanings associated with race. The disintegration status usually occurs when a White person is confronted with and feels guilty about racial inequality but experiences ambivalence about how this inequality relates to him or her. The reintegration status is usually triggered by an experience in which the White individual feels he or she has been treated unfairly or discriminated against. This individual may believe in the superiority of being White and in the intolerance of other races.
Afterward, the person may move into the pseudo-independence status, which is characterized by an intellectual understanding of White privilege. However, the person still may lack any concrete experiences related to this understanding. The immersion/emersion status involves the person having a more personal understanding of how he or she contributes to racism in society. However, the person may be hypervigilant to the point of having extreme reactions to perceived racism. Moving past this status will allow a person to attain autonomy, or a nonracist identity. These statuses are not fixed and absolute, of course, but they provide a useful tool in recognizing how clients see their White identity and understanding their reactions to issues of race.
When I work with clients who express certain thoughts, feelings or behaviors that they find problematic, I usually look for their origins and the functions that they serve in clients’ lives. I also apply this method in situations in which clients express prejudices during counseling, asking where these attitudes came from and what purpose they serve for the client. Assessing the client’s experiences with racism, social and familial history with prejudice, and parental reactions to race and culturally different people in childhood provides useful information about the origin of these values. It also allows the counselor to better empathize with and validate the client’s current experience instead of shaming the client or judging the client’s values.
The function of these attitudes is also very important for understanding the deeper meaning of the attitudes outside of the judgmental stance of “racism.” When a person’s self-esteem is threatened, especially in a racially charged situation, there is a tendency to defend with an in-group (pro-White) bias. The use of prejudicial comments or beliefs may be more powerful for White individuals who also hold another aspect of their identity that is oppressed. For example, a White gay man may express racist beliefs in reaction to a situation where his sexuality is threatened. This can lead to unhealthy and inaccurate distortions of information to preserve identity and avoid painful emotions associated with unearned privilege. Denial and rationalization of racial issues and prejudice is a way for clients to avoid painful aspects of race-related issues and any responsibility for privileged behavior. Stereotyping less privileged cultures can also allow clients to avoid changing the way they interact with others, while placing the blame for prejudice on those who are oppressed. These reactions tend to emerge when clients feel that some aspect of their identity is being threatened and they need to find a way to defend against those uncomfortable feelings.
Interventions can be loosely tailored to the client’s identity status and the function of these prejudicial beliefs to gain insight and move to a more integrated understanding of White privilege and oppression. For example, helping clients explore the origin of their beliefs can help them connect their past experiences to their current attitudes, which can raise awareness and increase insight. This also models to the client ways to address difficult conversations concerning race and prejudice. Counselors can also provide psychoeducation about the history of oppressed groups to clients who deny the existence of prejudice in society and in their own behavior or attitudes.
Ambivalence is a common reaction for clients in the disintegration status. Counselors could use interventions to help these clients understand and process ambivalent feelings such as guilt. Counselors who understand a client’s own history with discrimination can help the client connect those experiences and negative emotions with the experiences of others who are subjected to discrimination. This allows the client to develop empathy and understanding for others.
Clients who show a higher-level status of White identity may benefit from exploring what it means to be White and learning to be more flexible in their emotions and reactions to racism. Finally, counselors who understand the deeper meaning of a client’s prejudicial comments (for example, insecurity) can better tailor interventions to address the core issue so the client no longer has to rely on maladaptive coping strategies.
Broaching the subject of prejudice and privilege can be difficult for clients and counselors. Counselors first need to develop a solid therapeutic relationship with their clients to establish trust and prevent shame. Counselors also need to be aware of why and how they respond or do not respond to clients’ values so they can avoid reacting in ways that meet their own needs rather than those of their clients. Therefore, it is important for counselors to be aware of their own experiences and attitudes toward prejudices.
Counselors who are uncomfortable with the topic may avoid discussing it or deny its importance to the client’s concerns. Negative reactions such as guilt, anger or identification with a client’s values may cause a counselor to become blind to the client’s needs and appropriate interventions. Counselors who are not completely comfortable with their own White identity may unintentionally distance themselves from the client in an attempt to avoid White guilt and to identify as a nonracist White person. How a counselor responds to a client’s values has an impact on the effectiveness of counseling. It is important for counselors to monitor their own reactions and maintain self-awareness to properly meet their client’s needs.
Counselors work with important aspects of clients such as their attitudes, values and beliefs. A concern for many counselors, especially beginning counselors, is how to handle client values that conflict with their own. Counselors who are aware of potential problems that clients may present them with in counseling will be more prepared to respond and intervene in effective ways. Hot topics such as racism and prejudice can be especially problematic for counselors who value the tenets of multicultural awareness and social justice in their personal and professional lives, making it difficult to respond therapeutically. Regardless, it is our responsibility as counselors to respect clients’ values. This does not mean, however, that those values cannot be addressed in helpful ways in counseling.
I wanted to highlight this dilemma because it is infrequently discussed in counselor training or workshops. Therefore, the situation can be very jarring and unexpected for counselors. The ideas outlined in this article are just starting points for counselors to consider should they encounter clients who express prejudicial attitudes in counseling sessions. It is important to think about how interventions in counseling can best benefit the client, while also keeping in mind our professional values of multicultural awareness and social justice.
Those interested in more information on this topic can refer to Bailey P. MacLeod’s article “Social Justice at the Microlevel: Working With Clients’ Prejudices,” published in the July 2013 issue of the Journal of Multicultural Counseling and Development.
Bailey P. MacLeod is a doctoral student in the Department of Counseling at the University of North Carolina at Charlotte. Contact her at firstname.lastname@example.org.
Professional Development Resources is approved to offer continuing education by the American Psychological Association (APA); the National Board of Certified Counselors (NBCC); the Association of Social Work Boards (ASWB); the American Occupational Therapy Association (AOTA); the American Speech-Language-Hearing Association (ASHA); the Commission on Dietetic Registration (CDR); the Alabama State Board of Occupational Therapy; the Florida Boards of Social Work, Mental Health Counseling and Marriage and Family Therapy, Psychology & School Psychology, Dietetics & Nutrition, Speech-Language Pathology and Audiology, and Occupational Therapy Practice; the Ohio Counselor, Social Worker & MFT Board and Board of Speech-Language Pathology and Audiology; the South Carolina Board of Professional Counselors & MFTs; and by the Texas Board of Examiners of Marriage & Family Therapists and State Board of Social Worker Examiners.
Excessive alcohol use continues to be a drain on the American economy, according to a study released by the Centers for Disease Control and Prevention (CDC). Excessive drinking cost the U.S. $249 billion in 2010, or $2.05 per drink, a significant increase from $223.5 billion, or $1.90 per drink, in 2006. Most of these costs were due to reduced workplace productivity, crime, and the cost of treating people for health problems caused by excessive drinking.
Binge drinking, defined as drinking five or more drinks on one occasion for men or four or more drinks on one occasion for women, was responsible for most of these costs (77 percent). Two of every 5 dollars of costs — over $100 billion — were paid by governments.
“The increase in the costs of excessive drinking from 2006 to 2010 is concerning, particularly given the severe economic recession that occurred during these years,” said Robert Brewer, M.D., M.S.P.H., head of CDC’s Alcohol Program and one of the study’s authors. “Effective prevention strategies can reduce excessive drinking and related costs in states and communities, but they are under used.”
Excessive alcohol consumption is responsible for an average of 88,000 deaths each year, including 1 in 10 deaths among working-age Americans ages 20-64.
Excessive alcohol use cost states and the District of Columbia a median of $3.5 billion in 2010, ranging from $488 million in North Dakota to $35 billion in California. Washington D.C. had the highest cost per person ($1,526, compared to the $807 national average), and New Mexico had the highest cost per drink ($2.77, compared to the $2.05 national average).
The 2010 cost estimates were based on changes in the occurrence of alcohol-related problems and the cost of paying for them since 2006. Even so, the researchers believe that the study underestimates the cost of excessive drinking because information on alcohol is often underreported or unavailable, and the study did not include other costs, such as pain and suffering due to alcohol-attributable harms.
Managing Chronic Pain in Adults With or in Recovery from Substance Use Disorders is a 5-hour online CEU course that explains the close connections between the neurobiology of pain and addiction, assessments for both pain and addiction, procedures for treatment of chronic pain management, side effects and symptoms of tolerance and withdrawal from pain medication, managing risk of addiction to pain medication and nonadherence to treatment protocols, maintaining patient relationships, documentation, and safety issues.
Developmental Effects of Alcohol is a 4-hour online CEU course that focuses on the impact of alcohol on the development of children and youth from birth through 20.
Professional Development Resources is approved by the American Psychological Association (APA) to sponsor continuing education for psychologists. Professional Development Resources maintains responsibility for all programs and content. Professional Development Resources is also approved by the National Board of Certified Counselors (NBCC); the Association of Social Work Boards (ASWB); the American Occupational Therapy Association (AOTA); the American Speech-Language-Hearing Association (ASHA); the Commission on Dietetic Registration (CDR); the Alabama State Board of Occupational Therapy; the Florida Boards of Social Work, Mental Health Counseling and Marriage and Family Therapy, Psychology & School Psychology, Dietetics & Nutrition, Speech-Language Pathology and Audiology, and Occupational Therapy Practice; the Ohio Counselor, Social Worker & MFT Board and Board of Speech-Language Pathology and Audiology; the South Carolina Board of Professional Counselors & MFTs; and by the Texas Board of Examiners of Marriage & Family Therapists and State Board of Social Worker Examiners.
John, 27, is an American Indian from a Northern Plains Tribe. He recently entered an outpatient treatment program in a midsized Midwestern city to get help with his drinking and subsequent low mood. John moved to the city 2 years ago and has mixed feelings about living there, but he does not want to return to the reservation because of its lack of job opportunities. Both John and his counselor are concerned that (with the exception of his girlfriend, Sandy, and a few neighbors) most of his current friends and coworkers are “drinking buddies.” John says his friends and family on the reservation would support his recovery—including an uncle and a best friend from school who are both in recovery—but his contact with them is infrequent.
John says he entered treatment mostly because his drinking was interfering with his job as a bus mechanic and with his relationship with his girlfriend. When the counselor asks new group members to tell a story about what has brought them to treatment, John explains the specific event that had motivated him. He describes having been at a party with some friends from work and watching one of his coworkers give a bowl of beer to his dog. The dog kept drinking until he had a seizure, and John was disgusted when people laughed. He says this event was “like a vision;” it showed him that he was being treated in a similar fashion and that alcohol was a poison. When he first began drinking, it was to deal with boredom and to rebel against strict parents whose Pentecostal Christian beliefs forbade alcohol. However, he says this vision showed him that drinking was controlling him for the benefit of others.
Later, in a one-on-one session, John tells his counselor that he is afraid treatment won’t help him. He knows plenty of people back home who have been through treatment and still drink or use drugs. Even though he doesn’t consider himself particularly traditional, he is especially concerned that there is nothing “Indian” about the program; he dislikes that his treatment plan focuses more on changing his thinking than addressing his spiritual needs or the fact that drinking has been a poison for his whole community.
John’s counselor recognizes the importance of connecting John to his community and, if possible, to a source of traditional healing. After much research, his counselor is able to locate and contact an Indian service organization in a larger city nearby. The agency puts him in touch with an older woman from John’s Tribe who resides in that city. She, in turn, puts the counselor in touch with another member of the Tribe who is in recovery and had been staying at her house. This man agrees to be John’s sponsor at local 12-Step meetings. With John’s permission, the counselor arranges an initial family therapy session that includes his new sponsor, the woman who serves as a local “clan mother,” John’s girlfriend, and, via telephone, John’s uncle in recovery, mother, and brother. With John’s permission and the assistance of his new sponsor, the counselor arranges for John and some other members of his treatment group to attend a sweat lodge, which proves valuable in helping John find some inner peace as well as giving his fellow group members some insight into John and his culture.
To provide culturally responsive treatment, counselors and organizations must be committed to gaining cultural knowledge and clinical skills that are appropriate for the specific racial and ethnic groups they serve. Treatment providers need to learn how a client’s identification with one or more cultural groups influences the client’s identity, patterns of substance use, beliefs surrounding health and healing, help-seeking behavior, and treatment expectations and preferences. Adopting Sue’s (2001) multidimensional model in developing cultural competence, this course identifies cultural knowledge and its relationship to treatment as a domain that requires proficiency in clinical skills, programmatic development, and administrative practices. This course focuses on patterns of substance use and co-occurring disorders (CODs), beliefs about and traditions involving substance use, beliefs and attitudes about behavioral health treatment, assessment and treatment considerations, and theoretical approaches and treatment interventions across the major racial and ethnic groups in the United States.
Professional Development Resources is approved to offer continuing education by the American Psychological Association (APA); the National Board of Certified Counselors (NBCC); the Association of Social Work Boards (ASWB); the American Occupational Therapy Association (AOTA); the American Speech-Language-Hearing Association (ASHA); the Commission on Dietetic Registration (CDR); the California Board of Behavioral Sciences; the Florida Boards of Social Work, Mental Health Counseling and Marriage and Family Therapy, Psychology & School Psychology, Dietetics & Nutrition, Speech-Language Pathology and Audiology, and Occupational Therapy Practice; the Ohio Counselor, Social Worker & MFT Board; the South Carolina Board of Professional Counselors & MFTs; and by the Texas Board of Examiners of Marriage & Family Therapists and State Board of Social Worker Examiners.
Culture is a primary force in the creation of a person’s identity. Counselors who are culturally competent are better able to understand and respect their clients’ identities and related cultural ways of life. This course proposes strategies to engage clients of diverse racial and ethnic groups (who can have very different life experiences, values, and traditions) in treatment. The major racial and ethnic groups in the United States covered in this course are African Americans, Asian Americans (including Native Hawaiians and other Pacific Islanders), Latinos, Native Americans (i.e., Alaska Natives and American Indians), and White Americans. In addition to providing epidemiological data on each group, the course discusses salient aspects of treatment for these racial/ethnic groups, drawing on clinical and research literature. While the primary focus of this course is on substance abuse treatment, the information and strategies given are equally relevant to all types of health and mental health treatment. Course #40-39 | 2015 | 75 pages | 30 posttest questions
This online course provides instant access to the course materials (PDF download) and CE test. Successful completion of the online CE test (80% required to pass, 3 chances to take) and course evaluation are required to earn a certificate of completion. You can print the test (download test from My Courses tab of your account after purchasing) to mark your answers on it while reading the course document. Then submit online when ready to receive credit.
Professional Development Resources is approved by the American Psychological Association (APA) to sponsor continuing education for psychologists; by the National Board of Certified Counselors (NBCC ACEP #5590); the Association of Social Work Boards (ASWB #1046, ACE Program); the California Board of Behavioral Sciences (#PCE1625); theFlorida Boards of Clinical Social Work, Marriage & Family Therapy, and Mental Health Counseling (#BAP346) and Psychology & School Psychology (#50-1635); the South CarolinaBoard of Professional Counselors & MFTs (#193); and the Texas Board of Examiners of Marriage & Family Therapists (#114) and State Board of Social Worker Examiners (#5678).
The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation. SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on America’s communities. Congress established the Substance Abuse and Mental Health Services Administration (SAMHSA) in 1992 to make substance use and mental disorder information, services, and research more accessible. http://www.samhsa.gov/