Essay Grade

Addiction
Counseling
Competencies
The Knowledge, Skills, and
Attitudes of Professional Practice
21
TAP 21
Technical Assistance Publication Series
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ADDICTION COUNSELING
COMPETENCIES
The Knowledge, Skills, and
Attitudes of Professional Practice
Technical Assistance Publication (TAP) Series
21
U.S. Department of Health and Human Services
Substance Abuse and Mental Health Services Administration
Center for Substance Abuse Treatment
5600 Fishers Lane
Rockville, MD 20857
Acknowledgments
A number of people deserve recognition for their tireless and dedicated work on this document. The publication was originally conceived and written by the National Addiction Technology Transfer Center (ATTC)
Curriculum Committee. The Committee, one of six national committees designed to serve the ATTC Network,
comprises representatives from several ATTC Regional Centers and the ATTC National Office. This group was
responsible for the original 1998 publication and for the 2000 draft on which this updated edition is based
(see page v). A second Committee convened in 2005 to update and finalize the current document (see page
vi). Karl D. White, Ed.D., and Catherine D. Nugent, M.S., served as the Center for Substance Abuse Treatment
(CSAT) ATTC Project Officers. Christina Currier served as the CSAT Government Project Officer. This
publication was produced by JBS International, Inc. (JBS), under the Knowledge Application Program (KAP)
contract number 270-04-7049.
D
The views, opinions, and content of this publication are those of the authors and do not necessarily
reflect the views, opinions, or policies of SAMHSA or HHS.
Public domAin notice
All materials appearing in this volume except those taken directly from copyrighted sources are in the public
domain and may be reproduced or copied without permission from SAMHSA or the authors. Citation of the
source is appreciated. However, this publication may not be reproduced or distributed for a fee
without the specific, written authorization of the Office of Communications, SAMHSA, HHS.
E
This publication may be ordered or downloaded from SAMHSA’s Publications Ordering Web page at http://
store.samhsa.gov. Or, please call SAMHSA at 1-877-SAMHSA-7 (1-877-726-4727) (English and Español).
R
Center for Substance Abuse Treatment. Addiction Counseling Competencies: The Knowledge, Skills, and
Attitudes of Professional Practice. Technical Assistance Publication (TAP) Series 21. HHS Publication No.
(SMA) 15-4171. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2006.
O
Quality Improvement and Workforce Development Branch, Division of Services Improvement, Center for
Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, 5600 Fishers Lane,
Rockville, MD 20857.
HHS Publication No. (SMA) 15-4171
First Printed 2006
Revised 2007, 2008, 2009, 2011, 2012, 2013, 2014, 2015, and 2017
No substantive revisions have been made to this publication since its original printing.
C
Curriculum Committees. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v
1998 National ATTC Curriculum Committee. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v
2005 Update Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vi
Foreword. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Section 1: Transdisciplinary Foundations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
I. Understanding Addiction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
II. Treatment Knowledge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
III. Application to Practice. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
IV. Professional Readiness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Section 2: Practice Dimensions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
I. Clinical Evaluation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
II. Treatment Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
III. Referral. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
IV. Service Coordination. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
V. Counseling. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
VI. Client, Family, and Community Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
VII. Documentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
VIII. Professional and Ethical Responsibilities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Section 3: Additional Resources. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Cultural Competency. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
Internet Resources. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Attitudes Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
Recovery Bibliography. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
Section 4: Appendices. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
A. Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
B. The Competencies: A Complete List. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177
C. National Validation Study: Defining and Measuring the Competence
of Addiction Counselors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
D. Complete Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
E. Other Contributors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225
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1998 nAtionAl Attc curriculum committee
Affiliations indicated below are those at the time of the work.
David A. Deitch, Ph.D. (Chair)
Pacific Southwest ATTC
University of California San Diego
La Jolla, California
Alan M. Parsons, M.S.W., ACSW
Northeastern States ATTC
State University of New York at Albany
Albany, New York
G.E. Carrier, Ph.D.
Representing the Texas ATTC
Alvin Community College
Alvin, Texas
Nancy Roget, M.S., MFT, LADC
Mountain West ATTC
University of Nevada–Reno
Reno, Nevada
Steven L. Gallon, Ph.D.
Northwest Frontier ATTC
Oregon Health and Science University
Salem, Oregon
Susanne R. Rohrer, RN, M.B.A.
Center for Substance Abuse Treatment
Substance Abuse and Mental Health
Services Administration
Washington, D.C.
Paula K. Horvatich, Ph.D.
Mid-Atlantic ATTC
Virginia Commonwealth University
Richmond, Virginia
Mary Beth Johnson, M.S.W.
ATTC National Office
University of Missouri–Kansas City
Kansas City, Missouri
Hendi Crosby Kowal, M.P.H.
DC/Delaware ATTC
Danya International, Inc.
Silver Spring, Maryland
Linda Nicholas
Great Lakes ATTC
University of Illinois–Chicago
Jane Addams School of Social Work
Chicago, Illinois
Anne Helene Skinstad, Psy.D.
Prairielands ATTC
University of Iowa
Iowa City, Iowa
Patricia L. Stilen, LCSW, CADAC
Mid-America ATTC
University of Missouri–Kansas City
Kansas City, Missouri
Susan A. Storti, RN, M.A.
ATTC of New England
Brown University
Providence, Rhode Island
Elleen M. Yancey, Ph.D.
Southeast ATTC
Morehouse School of Medicine
Atlanta, Georgia
v
Addiction Counseling Competencies
2005 uPdAte committee
Paula K. Horvatich, Ph.D. (Chair)
Mid-Atlantic ATTC
Virginia Commonwealth University
Richmond, Virginia
Carol Davidson, M.S.W., CDP
Evergreen Treatment Services
Seattle, Washington
Steven L. Gallon, Ph.D.
Northwest Frontier ATTC
Office of Alcohol and Drug Abuse Programs
Salem, Oregon
Michael Hoge, Ph.D.
Annapolis Coalition
Yale University
New Haven, Connecticut
James Holder, M.A., LPC-S, MAC
National Association for Alcohol and
Drug Addiction Counselors
McLeod Behavioral Health
Florence, South Carolina
Mary Beth Johnson, M.S.W.
ATTC National Office
University of Missouri–Kansas City
Kansas City, Missouri
Linda Kaplan, M.A.
National Association for Children
of Alcoholics
Rockville, Maryland
Captain Florentino (Tino)
Merced-Galindez, M.S.N., RN
Center for Substance Abuse Prevention
Substance Abuse and Mental Health
Services Administration
Rockville, Maryland
Randolph Muck, M.Ed.
Center for Substance Abuse Treatment
Substance Abuse and Mental Health
Services Administration
Rockville, Maryland
Paul D. Nagy, M.S., LCAS, LPC, CCS
Duke Addictions Program
Duke University Medical Center
Durham, North Carolina
Nancy Roget, M.S., MFT, LADC
Mountain West ATTC
University of Nevada–Reno
Reno, Nevada
Gerard J. Schmidt, M.A., LPC, MAC
NAADAC–The Association for Addiction
Professionals
Valley HealthCare System
Morgantown, West Virginia
Michael Shafer, Ph.D.
Pacific Southwest ATTC
Tucson, Arizona
James L. Sorensen, Ph.D.
San Francisco General Hospital
University of California–San Francisco
San Francisco, California
Patricia L. Stilen, LCSW, CADAC
Mid-America ATTC
University of Missouri–Kansas City
Kansas City, Missouri
Deborah Stone, Ph.D.
Center for Mental Health Services
Substance Abuse and Mental Health
Services Administration
Rockville, Maryland
Pamela Waters, M.Ed., CAPP
Southern Coast ATTC
Florida Certification Board
Tallahassee, Florida
vi
F
Counselors who treat people with substance use disorders do life-changing work on a daily
basis, amid difficult circumstances that include staff shortages, high turnover, low salaries,
and scant program funding. Counselors come to this important work by various paths and
with vastly different skills and experience. The diversity of backgrounds and types of
preparation can be a strength, provided there is a common foundation from which counselors
work. This publication addresses the following questions: What professional standards should
guide substance abuse treatment counselors? What is an appropriate scope of practice for
the field? Which competencies are associated with positive outcomes? What knowledge,
skills, and attitudes (KSAs) should all substance abuse treatment professionals have in
common?
Workforce development is essential to the field of substance use disorder treatment.
The Substance Abuse and Mental Health Services Administration (SAMHSA) has included
workforce development in its Matrix of Priority Programs. A major focus of this workforce
development strategy is improving the competencies of professionals in the field. This updated
edition of Technical Assistance Publication (TAP) 21: Addiction Counseling Competencies:
The Knowledge, Skills, and Attitudes of Professional Practice (The Competencies) is a key
component of that strategy.
In 1998, in cooperation with its Addiction Technology Transfer Center (ATTC) Network,
SAMHSA published TAP 21, a comprehensive list of 123 competencies that substance abuse
treatment counselors should master to do their work effectively. TAP 21 has been used to
develop and evaluate addiction counseling curricula, advise students, and assess counseling
proficiencies.
The overarching competencies in this updated version of TAP 21 remain largely unchanged
from the original TAP 21. The KSAs have been changed from those in the 1998 edition when
necessary, in light of new thinking in the field. The competencies and the KSAs in practice dimensions that address clinical evaluation and treatment planning have been revised to reflect
changes in the field. The competencies are defined by sublists of the KSAs needed to master
each competency. Bibliographies have been supplemented with new publications through 2005.
The format has been improved to make the information more accessible and useful.
SAMHSA’s TAP series provides a flexible format for the timely transfer of important technical
information to the substance abuse treatment field. This updated version of TAP 21 exemplifies
the flexibility of the TAP format. We are grateful to the members of the ATTC Network and staff
and to all those who participated in the validation and updating of these competency lists.
Kana Enomoto, M.A.
Acting Deputy Assistant Secretary
Substance Abuse and Mental Health Services Administration
Kimberly A . Johnson, Ph.D.
Director
Center for Substance Abuse Treatment
Substance Abuse and Mental Health Services Administration
vii
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I
In 1998, the Substance Abuse and Mental Health Services Administration (SAMHSA) and the
Center for Substance Abuse Treatment (CSAT) published Addiction Counseling Competencies:
The Knowledge, Skills, and Attitudes of Professional Practice (The Competencies) as Technical
Assistance Publication (TAP) 21. Developed by the National Curriculum Committee of the
Addiction Technology Transfer Center (ATTC) Network, TAP 21 identifies 123 competencies
that are essential to the effective practice of counseling for psychoactive substance use
disorders. TAP 21 also presents the knowledge, skills, and attitudes (KSAs) counselors need
to become fully proficient in each competency.
TAP 21 has been widely distributed by SAMHSA’s Public Engagement Platform (PEP) and the
ATTC Network. It has become a benchmark by which curricula are developed and educational
programs and professional standards are measured for the field of substance abuse treatment
in the United States. In addition, it has been translated into several languages.
Because the ATTC Network is committed to technology transfer, after the initial publication
of TAP 21, the National Curriculum Committee began exploring ways to enhance the document for future printings. Successful technology transfer requires more than presenting good
information. It entails transmitting scientific knowledge in a way that makes it understandable,
feasible to implement in a real-world setting, and supportable at a systematic level—in other
words, getting the right information across in a way that makes it useable. The National
Curriculum Committee examined how best to package and present TAP 21 to help people
learn key elements and adopt new strategies. The result was a revision of TAP 21—a process
that was begun in 2000, was completed in 2005, and resulted in the current publication.
History of The CompeTenCies
In 1993 CSAT created a multidisciplinary network of 11 ATTC Regional Centers geographically
dispersed across the United States and in Puerto Rico and the U.S. Virgin Islands. Since its
inception, the ATTC Network has collaborated with diverse international, national, State,
regional, and local partners from multiple disciplines to recruit qualified addiction treatment
practitioners and enhance academic preparation and professional development opportunities
in the substance abuse treatment field.
The National Curriculum Committee, composed of ATTC Directors, was established at the
Network’s inaugural meeting. The committee’s initial charge was to collect and evaluate
existing addiction educational and professional development curricula and establish future
priorities for ATTC curriculum development. This effort led to researching existing practice
and professional literature and defining an extensive list of addiction practice competencies
determined to be essential to effective counseling for substance use disorders. These initial
competencies would serve as benchmarks to guide future ATTC curriculum design, development, and evaluation.
1
Addiction Counseling Competencies
In addition to its own work, the National Curriculum Committee reviewed and incorporated
other publications on the work of addiction counselors.1 In 1995 the committee’s work
resulted in the ATTC publication Addiction Counselor Competencies. Subsequent to this
publication, the ATTCs conducted a national survey to validate the competencies (see appendix
C). Results supported virtually all of the competencies as being essential to the professional
practice of addiction counseling.
In 1996, the International Certification and Reciprocity Consortium (ICRC) convened a national
leadership group to evaluate the need for model addiction counselor training. After careful
deliberation, the group concluded that much of the work to define such a curriculum standard
had already been accomplished by the ATTC National Curriculum Committee and the ICRC in
the National Curriculum Committee’s Addiction Counselor Competencies and the ICRC’s 1996
Role Delineation Study,2 respectively.
Soon after, CSAT agreed to fund a collaborative effort to finalize a document that could be used
as a national standard. CSAT convened a panel—The National Steering Committee for Addiction
Counseling Standards (NSC)—that comprised representatives from five national educational,
certification, and professional associations. The NSC was successful in achieving unanimous
endorsement of the Addiction Counselor Competencies—a milestone in the addiction
counseling field.
Based on this foundation, the National Curriculum Committee began to delineate the KSAs
that undergird each competency statement. Input was solicited from a number of key national
organizations and selected field reviewers. In 1998 CSAT published the results of this groundbreaking work as TAP 21 (The Competencies).
After TAP 21 was published, the National Curriculum Committee systematically conducted
focus groups and a national survey to elicit feedback from the field about the impact of TAP 21.
Although feedback was uniformly positive and thousands of copies of TAP 21 were disseminated
through SAMHSA’s PEP and the ATTC Network, refinements were needed to improve the utility
of the publication and enhance its effect in both the addiction practice and educational systems.
Feedback obtained from the survey and the focus groups indicated a need for additional information to help the field incorporate the competencies into daily practice. Feedback also suggested
that there was no need to change the competencies. The most common suggestions were to
refine the 1998 publication by presenting the content in a more user-friendly fashion and linking
it to professional literature and specific applications. The National Curriculum Committee revised
TAP 21 in 2000 based on the feedback of dedicated addiction practice and education professionals;
however, this revision was never published.
A new Update Committee was convened in 2005 to update the revised 2000 edition with literature
published between 2000 and 2005. The Update Committee consisted of some of the original members from the National Curriculum Committee; representatives from NAADAC—The Association for
Addiction Professionals, CSAT, the Center for Mental Health Services, the Center for Substance
Abuse Prevention, the National Association for Children of Alcoholics, and the Annapolis Coalition;
treatment providers; and experts in addiction research. The current updated edition retains
all of the feedback-based improvements of the 2000 revised version and adds relevant literature
2
1
Birch and Davis Corporation (1986). Development of Model Professional Standards for Counselor Credentialing. Dubuque, IA:
Kendall/Hunt Publishing.
2
International Certification and Reciprocity Consortium (ICRC)/Alcohol and Other Drug Abuse (1991). Role Delineation Study for
Alcohol and Other Drug Abuse Counselors. Raleigh, NC: ICRC.
Introduction
published after 2000. In addition, the competencies and KSAs of several practice dimensions,
in particular those that address clinical evaluation and treatment planning, were rewritten to
reflect current best practices.
W
The Model
When creating The Competencies, the National Curriculum Committee recognized a need to
emphasize three characteristics of competency: knowledge, skills, and attitudes. Many hours
were spent conceptualizing a differentiated model when designing TAP 21—a model that could
address general KSAs necessary for all practitioners dealing with substance use disorders while
explaining the more specific needs of professional substance abuse treatment counselors.
The first section of the model addresses the generic KSAs. This section contains the transdisciplinary foundations, comprising four discrete building blocks: understanding addiction,
treatment knowledge, application to practice, and professional readiness. The term “transdisciplinary” was selected to describe the knowledge and skills needed by all disciplines (e.g.,
medicine, social work, pastoral guidance, corrections, social welfare) that deal directly with
individuals with substance use disorders.
The second section of the model specifically addresses the professional practice needs, or
practice dimensions, of addiction counselors. Each practice dimension includes a set of competencies, and, within each competency, the KSAs necessary for effective addiction counseling
are outlined. Many additional competencies may be desirable for counselors in specific settings.
Education and experience affect the depth of the individual counselor’s knowledge and skills; not all
counselors will be experienced
and proficient in all the compeFigure 1. Components in the CompetenCies model
tencies discussed. The National
Curriculum Committee’s goal
for the future is to help ensure
that every addiction counselor
possesses, to an appropriate
degree, each competency listed,
regardless of setting or treatment model.
The relationship of the components in the competencies
model is conceptualized as
a hub with eight spokes (see
figure 1). The hub contains
the four transdisciplinary foundations that are central to the
work of all addiction professionals. The eight spokes are
the practice dimensions, each
containing the competencies
the addiction counselor should
attain to master each practice
dimension.
3
Addiction Counseling Competencies
Recommended Readings
Journal articles, book chapters, and other critical literature for each transdisciplinary foundation
and practice dimension have been reviewed and included in this document. Moreover, separate
bibliographies on attitudes and recovery have been added, as have lists of Internet and cultural
competency resources. These can be found in section 3.
Appendices
Appendices include a glossary (appendix A), a complete list of the competencies (appendix B),
a summary of the results of the Committee’s National Validation Study of The Competencies
(appendix C), a complete bibliography with a detailed overview of the methodology used for
literature searches (appendix D), and a list of people who acted as field reviewers or provided
research assistance (appendix E).
Companion Volume—TAP 21-A
As a companion to this volume on counselor competencies, CSAT is publishing TAP 21-A,
Competencies for Substance Abuse Treatment Clinical Supervisors, which discusses the qualities
and abilities integral to supervising substance abuse treatment clinicians.
U
Since its inception, The Competencies has been improving addiction counseling and addiction
counselor education across the country in a number of ways. The most common reported
applications have been in curriculum/course evaluation and design for higher education;
personal professional development; student advising, supervision, and assessment; assessment
of competent practices; design of professional development and continuing education programs; and certification standards/exams. Examples of how The Competencies is being used
are given on the following pages:
Montana. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Illinois . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Nebraska. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
New York . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Missouri. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Texas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Puerto Rico. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
International Applications. . . . . . . . . . . . . . . . . . . . . . 59
New England . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
Idaho, Oregon, and Washington. . . . . . . . . . . . . . . . . . 74
Nevada. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Texas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
Florida . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Virginia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Northeast. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Idaho . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Washington. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
California. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
Oregon and Wisconsin. . . . . . . . . . . . . . . . . . . . . . . . . 135
Iowa. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
Georgia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
Alaska, Hawaii, Idaho, Oregon, and Washington. . . . . 155
4
Section 1:
introduction to tHe trAnsdisciPlinAry foundAtions
T
Addiction professionals work in a broad variety of disciplines but share
an understanding of the addictive process that goes beyond the narrow
confines of any one specialty. Specific proficiencies, skills, levels of involvement with clients, and scope of practice vary widely among specializations. At their base, however, all addiction-focused disciplines are built
on four common foundations.
This section focuses on four sets of competencies that are transdisciplinary in that they underlie the work not just of counselors but of all
addiction professionals. The four areas of knowledge identified here
serve as prerequisites to the development of competency in any of the
addiction-focused disciplines.
T
Understanding Addiction
Treatment Knowledge
Application to Practice
Professional Readiness
Regardless of professional identity or discipline, each treatment provider
must have a basic understanding of addiction that includes knowledge of
current models and theories, appreciation of the multiple contexts within
which substance use occurs, and awareness of the effects of psychoactive
drug use. Each professional must be knowledgeable about the continuum
of care and the social contexts affecting the treatment and recovery
process.
Each addiction specialist must be able to identify a variety of helping strategies
that can be tailored to meet the needs of individual clients. Each professional
must be prepared to adapt to an ever-changing set of challenges and
constraints.
Although specific skills and applications vary across disciplines, the attitudinal components tend to remain constant. The development of effective
practice in addiction counseling depends on the presence of attitudes
reflecting openness to alternative approaches, appreciation of diversity,
and willingness to change.
The following knowledge and attitudes are prerequisite to the development of competency in the professional treatment of substance use
disorders. Such knowledge and attitudes form the basis of understanding on which discipline-specific proficiencies are built.
5
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UNDERSTANDING ADDICTION
7
Transdisciplinary Foundation I
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uuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuu
TF understAnding Addiction
C
Understand a variety of models and theories of addiction and other problems
related to substance use.
Knowledge
Attitudes
● Terms and concepts related to theory,
● Openness to information that may differ
● Scientific and theoretical basis of model
● Appreciation of the complexity inherent
etiology, research, and practice.
from medicine, psychology, sociology,
religious studies, and other disciplines.
● Criteria and methods for evaluating
models and theories.
● Appropriate applications of models.
● How to access addiction-related literature
from personally held views.
in understanding addiction.
● Valuing of diverse concepts, models,
and theories.
● Willingness to form personal concepts
through critical thinking.
from multiple disciplines.
C
Recognize the social, political, economic, and cultural context within which
addiction and substance abuse exist, including risk and resiliency factors that
characterize individuals and groups and their living environments.
Knowledge
Attitudes
● Basic concepts of social, political,
● Recognition of the importance of
economic, and cultural systems and their
impact on drug-taking activity.
● The history of licit and illicit drug use.
● Research reports and other literature
contextual variables.
● Appreciation for differences between
and within cultures.
identifying risk and resiliency factors for
substance use.
● Statistical information regarding the
incidence and prevalence of substance
use disorders in the general population
and major demographic groups.
9
Addiction Counseling Competencies
C
Describe the behavioral, psychological, physical health, and social effects of
psychoactive substances on the person using and significant others.
Knowledge
Attitudes
● Fundamental concepts of pharmacological
● Sensitivity to multiple influences in the
properties and effects of all psychoactive
substances.
● The continuum of drug use, such as
developmental course of addiction.
● Interest in scientific research findings.
initiation, intoxication, harmful use,
abuse, dependence, withdrawal, craving,
relapse, and recovery.
● Behavioral, psychological, social, and
health effects of psychoactive substances.
● The effects of chronic substance use
on clients, significant others, and
communities within a social, political,
cultural, and economic context.
● The varying courses of addiction.
● The relationship between infectious
diseases and substance use.
C
Recognize the potential for substance use disorders to mimic a variety of
medical and mental health conditions and the potential for medical and
mental health conditions to coexist with addiction and substance abuse.
Knowledge
Attitudes
● Normal human growth and development.
● Symptoms of substance use disorders that
● Willingness to reserve judgment until
are similar to those of other medical and/
or mental health conditions and how
these disorders interact.
● The medical and mental health conditions
that most commonly exist with addiction
and substance use disorders.
● Methods for differentiating substance use
disorders from other medical or mental
health conditions.
10
completion of a thorough clinical
evaluation.
● Willingness to work with people who
might display and/or have mental health
conditions.
● Willingness to refer for treating conditions
outside one’s expertise.
● Appreciation of the contribution of
multiple disciplines to the evaluation
process.
TF 1. Understanding Addiction
B
Members of the National ATTC Curriculum Committee reviewed the bibliography from the
first printing of The Competencies. Following previously established guidelines, the Committee reviewed and linked each reference with a specific transdisciplinary foundation. Primarily
textbooks are referenced in this section; however, such texts are not mutually exclusive of the
practice dimensions.
TF I. Understanding Addiction
Akers, R.L. (1992). Drugs, Alcohol, and Society: Social Structure, Process, and Policy.
Monterey, CA: Brooks/Cole.
Baer, J.S., Marlatt, G.A., & McMahon, R.J. (Eds.) (1993). Addictive Behaviors Across the
Life Span. Newbury Park, CA: Sage Publications.
Bennett, L.A., Reiss, D., et al. (1987). The Alcoholic Family. New York: Basic Books.
Blevins, G.A., Dana, R.Q., & Lewis, J.A. (1994). Substance Abuse Counseling: An Individual
Approach (2nd ed.). Pacific Grove, CA: Brooks/Cole