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Running head: SMITH TREATMENT PLAN
1
SMITH TREATMENT PLAN
3
Treatment Plan Grading Rubric
Element
Criteria
Points
Possible
Points Earned
Instructor’s Comments
Content of Treatment Plan
Additional screening and assessment instruments identified with
BioPsychoSocialSpiritual (BPSS) and explained
Diagnoses clearly identified and are accurate. (DSM codes
needed). Consideration of self-report vs other sources of
information appropriatelyComment by Jill: See bubbled
comments below Comment by Jill: See bubbled comments
below and read comments this page
Treatment Plan: Clearly address current functioning, mental
health, substance use, and faith/spirituality with thorough
recommendations with plan following Comment by Jill: See
bubbled comments below and read comments this page
Relevant details identified from Perkinson, Jongsma, and Bruce
(2014) and other course resources
Clearly identified best treatment setting Comment by Jill: See
bubbled comments below and read comments this page
Comment by Jill:
Conclusions
32
23
Co-Occurring Disorder (COD) is actually the concern here with
3 areas operating related to alcohol, opioids, and depression.
Benzodiazepenes could be added as a 4th, but can be determined
after detox. Further investigation is needed after suicidality and
overdosing more than once regarding self reported, but
unconfirmed, BiPolar mental illness, as well. It would not be
appropriate to ignore any one of the areas above especially in
one with suicidal ideations and her past history of comas.
Future opioids should come through her psychiatrist only unless
communication is established between you, psychiatrist and
pain doctor. You will need third party waivers signed by client
from start of therapy to communicate with any previous
psychiatrist and pain doctors, who can be determined. These
plans always offer ongoing evaluation and continual review
open to additions and changes as the case moves forward to
prioritize necessities and meet previously undisclosed or
unknown concerns. These can be updated in the treatment plan
and are also noted in the progress notes. Your codes needed to
be more specific on both of the substances and depression.
Diagnostic Impressions is not the same as the diagnostic
portion. Setting is not clear other than detox. Spirituality is
addressed but would not be a coded problem. Conclusion is
noted
APA Format
Title Page in current APA format with running head in correct
APA style
Font, level headings, margins are in correct APA Style
Citations properly used in all needed places and match reference
list
If quotations are include, all APA requirements are met, not
used unnecessarily/excessively.
Plagiarism free*
Reference Page is in current APA format
* Higher deduction and other consequences might be applied
for plagiarism.
10
10
Most of your attention to APA detail is fine for a paper of this
nature.
Grammar/Writing
Sentences: coherent, varied, complete, clear, and concise
wording
Punctuation including proper use of comma, period, semicolon,
etc.
Spelling and vocabulary: exemplifies profession writing,
precise, unambiguous, appropriate
Grammar: proper and consistent use of verb tense, noun-
pronoun agreement,
Paragraph: clear and contains one major idea
8
8
No detrimental grammar or writing concerns
COMMENTS:
*I have graded this in spite of 63% Safe Assign. Above 30 % is
a red flag. Much of this report is not yours. But there are so
many errors, to have used these reports, you still need to
reevaluate its contents. For the high safe assign I am taking an
additional -10
Actually, Sally has attempted to use the labels to assist her by
self-report in giving previous diagnosis during the Case History,
where she also reported not having a psychiatrist. Hence, she
needs to be evaluated by the treatment center’s psychiatrist (if
it’s a treatment center) shortly or as soon as detox and/or
stability is complete to determine accuracy of any additional
psychiatric diagnoses beyond Depression and need for any
medications, which only a Psychiatrist can prescribe in our MH
systems along with her two SUD’s related to alcohol and
prescribed opioid abuse or dependence. See bubbled comments
also. Total
50
31
Case History Treatment Plan:
Sally Smith
Comment by Jill: Previously written and presented section
toward assignment is not graded here
Case History for Treatment Plan
Report Regarding Sally Smith
Name: Sally Smith
SS#: 000-00-0000
Age: 42 years old
Date of Examination: 9/1/2016
Examiners: Fred Looney, PhD
Chief Complaint: Mental functioning
Sources of Information
Clinical Interview with Sally Smith
Medical Records
Brief Mental Status Examination
Wechsler Adult Intelligence Scale-IV (WAIS-IV)
Background Information
Ms. Smith is a 42-year-old African American female. She
currently lives with her mother. She states she has one adult son
from a prior marriage. Ms. Smith states she has a 2-year nursing
degree and was employed as a nurse until 2015. She indicates
that she does not attend church currently, but her mother attends
on a weekly basis. As a child, she attended Sunday school and
church periodically.
Ms. Smith states that she has been unable to work as a nurse
due to medical problems. She reported that for years she had
problems with high blood pressure, and, one day, she passed out
and was put on a respirator. With further questioning, she
reports that, on the day of this hospitalization, she drank an
alcoholic beverage that reportedly was laced with “some drug.”
Her medical records show a positive drug screen of
benzodiazepines. The medical records state she was “brought in
a comatose state” and was intubated.
The doctor’s records state that Ms. Smith had told him she had
been taking OxyContin for pain and had gone to lunch with
friends and had two drinks. When asked about the information
in the medical records, Ms. Smith admitted to some problematic
drinking during a one-year time frame. However, her reported
history and the medical records do not coincide. Medical
records report a diagnosis of alcohol poisoning.
Her medical history includes inflammatory bowel disease, acute
gastritis, atypical chest pain, hypertension, and a history of
alcohol abuse with elevated alcohol levels during admission.
Ms. Smith states she has a history of depression and was
admitted to a state hospital in 2016 due to suicidal ideations.
She states her abusive alcoholic drinking is related to her
depression. She does admit to consuming a “small” bottle of
vodka on a daily basis at the height of her drinking. She denies
any current alcohol use and is reportedly under the care of a
doctor. She states her current diagnosis is bipolar disorder. She
reports that she hears voices in her head and, at times, verbally
responds to them. Ms. Smith was not able to list the medications
she is currently on, nor are there any recent medical records as
to her current medical conditions. Most recent record is January
2016.Mental Status and Behavioral Observations
Attitude and Behavior: Ms. Smith was friendly and cooperative
throughout the interview. She appeared to respond in a genuine
manner when asked questions. At times, however, she appeared
to be confused with the information requested of her. Her
speech was slurred at times, and she had a glazed look about
her.
Appearance: Ms. Smith appeared neat but casually dressed. She
seemed to show adequate attention to her grooming needs. Ms.
Smith did appear to have a slight odor, seemingly of alcohol.
Quality of Thinking: Ms. Smith’s thinking appears pressured
and unorganized. Her reported history does not follow written
reports; however, she does not appear to understand the
inconsistencies. Her self-report appears to be what she believes
to be her honest answer.
Abstraction Skills: Ms. Smith’s abstract thinking appears very
limited; she was unable to explain how work and play are
similar or why people are put on parole.
Affect and Mood: Ms. Smith appeared docile and cooperative
throughout interview. However, the examiner continually
needed to redirect her and help keep her focused.
Orientation: Ms. Smith was oriented x’s 3.
Memory: Ms. Smith’s memory appears limited as evident in her
ability to only repeat 4 numbers forward and 3 backwards.
Attention and Concentration: Ms. Smith appeared to attend to
all tasks at hand.
Judgment and Insight: Ms. Smith’s judgment and insight appear
limited in her inability to follow logical order and recognize
inconsistencies.Intellectual Functioning Testing Results and
Interpretations
Wechsler Adult Intelligence Scale-IV (WAIS-IV)
WAIS–IV Scale Score
Verbal Comprehension 67 (Extremely Low)
Perceptual Reasoning 73 (Borderline)
Working Memory 73 (Borderline)
Processing Speed 100 (Average)
Full Scale 67 (Extremely Low)
General Ability 99 (Average)
Ms. Smith is functioning in the Extremely Low range of
intellect, with her Verbal Comprehension Index score
significantly, but not rarely, lower than her Working Memory
and Processing Speed. In addition, her current functioning is
inconsistent with reported prior achievement and
functioningDiagnostic Report and Treatment Planning
This section presents Ms. Smith’s diagnostic report and
treatment plan. The report is based on the current information
collected about her from a clinical interview conducted, medical
records available, a brief mental status assessment and the
Wechsler Adult Intelligence Scale-IV (WAIS-IV). The
following is revealed:
Ms. Smith’s medical issues began during her spell as a nurse.
She reports that her medical problems led to her terminating a
nurse career she had prior to 2015. Her main problems were
associated with high blood pressure for years. She also
confesses to drinking an alcoholic drink laced with a certain
drug. The following is a summary of her SUD screening results
and assessment. SUD Screening Results
Her SUD screen results indicate a positive drug screen of
benzodiazepines. Her medical history also indicates that she had
hypertension, atypical chest pain, inflammatory bowel disease,
acute gastritis as well as alcohol poisoning. Besides having a
history of depression, Ms. Smith also indicates she had a
drinking problem for one year. She indicates that these two
were highly related and whenever she feels depressed she would
look for a “small” bottle of vodka. She reports that she
currently does not take any alcohol. SUD Assessment Results
Ms. Smith admits having had a drinking problem for a year.
During her peak times, she would drink vodka, in what she
described as small amounts. She also agreed to have been taking
OxyContin for pain. Her medical history records also indicate
that she had been diagnosed with alcohol poisoning. Diagnostic
Impressions Comment by Jill: Diagnostic Impressions are not
the same as the codings under diagnosis. A paragraph on
impressions was needed
303.90 F10.20 Alcohol Use Disorder, Moderate
or Severe
291.2 F10.27 Moderate or Severe Alcohol Use
Disorder with Alcohol-Induced Major Neurocognitive Disorder,
Nonamnestic-Confabulatory Type
305.50 F11.10 Opioid Use Disorder, Mild
. Comment by Jill: Need depression in your list since she is
suicidal
307.89 F54 Psychological Factors Affecting Other
Medical Conditions Comment by Jill: Not certain
296.80 F31.9 Unspecified Bipolar and Related
Disorder Comment by Jill: Do not add at this time. This was
self-reported with no confirmation from health care provider
293.82 F06.0 Psychotic Disorder Due to
Another Medical Condition with Hallucinations Comment by
Jill: To be determined by psychiatric eval along with bipolar
and any possible bipolar meds
V62.89 265.8 Religious or Spiritual Problem
Comment by Jill: Don’t add uncertain diagnoses to client
filesRecommendations
Based on the above, therefore, the following recommendations
are deemed necessary:
· A thorough medical history should be created, based on the
story she has told as well as her medical history. There is need
to marry these two so that they speak the same language.
· Ms. Smith’s mental and behavioral assessment suggests that
she also needs to see a psychologist/psychiatrist who will help
her get through her anxiety. This will also improve her
cognitive thinking, further improving her abstraction and
judgement skills.
· Ms. Smith should be taken through therapy to reduce the
chances of relapse; given that she is likely an alcoholic. This is
in line with the report she gave about dealing with an alcohol
problem for over a year.
· Medically-Assisted Detoxication is recommended. Bio-
Psycho-Social-Spiritual Assessment
Family History – Current Family: She reported that she used to
accompany her mother to Sunday school at a young age but
stopped. She is 42 years old and currently lives with her mother.
She also has a son.
Family History – Family of Origin: Ms. Smith’s family has
always been based on a strong Christian background. Her
mother always attends church weekly, however, this is not true
for Ms. Smith.
Vocational/Educational/Financial History: Ms. Smith reported
that she had taken a 2-year bachelor’s degree course in Nursing
and had served as a nurse till 2015. However, her family does
not seem to have any financial issues. The fact that she was
taken to school indicates that they might have been in a good
financial position.
Military History: Ms. Smith does not report any military
history.
Legal Assessment: Ms. Smith does not report any legal history.
This may point that she is a law-abiding citizen.
Social/Leisure Assessment: Ms. Smith is a social person and
enjoys having lunch and taking drinks with her friends. Her
attitude and behavior are also friendly and cooperative.
Spiritual/Cultural History: Ms. Smith’s mother is a staunch
Christian who attends church at least once every week. While
Ms. Smith herself used to attend church periodically, she no
longer attends church as often as she should.
Psychological Assessment: Ms. Smith’s psychological
assessment is based on the facts reported from observing her
mental status and behavior. Her attitude and behavior indicate
that she is friendly, honest and cooperative. Her flow of
thought, however, indicated that she is tense and appears to be
under pressure all the time, making her judgement questionable.
Her abstraction skills are somewhat limited, so is her memory.
It is important to note that she is attentive, meaning that her
levels of concentration are high.
Sexual History and Orientation: Ms. Smith was married, has a
son, meaning that her sexual orientation is heterosexual. She is
currently single.
Problem Areas
Problem #1: Substance Use
Problem #2: Chronic Pain/Medical Issues
Problem #3: Bipolar Disorder
Problem #4: Treatment Resistance
Problem #5:Relapse Proneness
BPSS Summary
Name: Sally Smith
Marital Status: Single
Residence: N/A
Employment: Unemployed (Former Nurse)
Family Situation: She has a son from a previous marriage and
currently lives with her mother.
Reason for entering treatment: Mental functioning
Alcohol/Drug History: She used to drink a “small” bottle of
vodka. Was once diagnosed with alcohol poisoning
Medical Assessment: Medical history indicates she had
inflammatory bowel disease, acute gastritis, atypical chest pain,
hypertension, and a history of alcohol abuse
Mental Status: Based on the Wechsler Adult Intelligence Scale-
IV (WAIS-IV) IQ test results, results, Ms. Smith’s verbal
comprehension is extremely low. Her perceptual reasoning and
working memory are on the borderline while her processing
speed and full-scale scores are average and extremely low
respectively. Her general mental ability is therefore described
as average.
Psychological Summary: Her attitude and behavior indicates
that she is friendly, honest and cooperative. Her flow of
thought, however, indicated that she is tense and appears to be
under pressure all the time, making her judgement questionable.
Relapse Issues: Ms. Smith reports that she is not currently
utilizing substances to cope with her mental and medical issues.
However, her labs and affect report otherwise. Treatment Plan
(Problems 1-5)
PROBLEM #1: Substance Use Disorder
GOAL: Establish a sustained recovery, free from the use of all
mood-altering substances (Perkinson, Arthur, & Bruce, 2014).
Objective 1: Provide honest and complete information from a
chemical dependence biopsychosocial history (Perkinson,
Arthur, & Bruce, 2014).
Intervention 1: Gather a complete drug/alcohol history from the
client, including the amount and pattern of her use (Perkinson,
Arthur, & Bruce, 2014).
Objective 2: Participate in a medical evaluation to assess the
effects of chemical dependence (Perkinson, Arthur, & Bruce,
2014).
Intervention 2: Refer the client for an examination to determine
consequences of substance use (Perkinson, Arthur, & Bruce,
2014).
Objective 2: Cooperate with an evaluation by a physician for
psychotropic medication (Perkinson, Arthur, & Bruce, 2014).
Intervention 2: Assess the need for psychotropic medication for
any mental/emotional comorbidities (Perkinson, Arthur, &
Bruce, 2014).
PROBLEM #2: Chronic Pain
GOAL: Regulate pain without addictive medications (Perkinson,
Arthur, & Bruce, 2014).
Objective 1: Describe the nature, history, and impact of chronic
pain, medical issues, and substance abuse (Perkinson, Arthur, &
Bruce, 2014).
Intervention 1: Assess the manifestation of chronic pain/medical
issues, its history, triggers, and methods of coping (Perkinson,
Arthur, & Bruce, 2014).
Objective 2: Cooperate with a thorough medical examination to
rule out any alternative causes for pain and explore treatment
options (Perkinson, Arthur, & Bruce, 2014).
Intervention 2: Refer the client to a physician to undergo an
examination.
Objective 3: Follow through with pain management (Perkinson,
Arthur, & Bruce, 2014).
Intervention 3: Discuss cautious-use of medications to manage
pain (Perkinson, Arthur, & Bruce, 2014).
PROBLEM #3: Bipolar Disorder Comment by Jill: Not to be
added to reports until after detox and stabilization allows
psychiatric review
GOAL: Alleviate mood symptoms and return to previous level
of effective functioning (Perkinson, Arthur, & Bruce, 2014).
Objective 1: Describe the personal history of mood changes and
associated changes in behavior (Perkinson, Arthur, & Bruce,
2014).
Intervention 1: Encourage client to share her thoughts and
feelings, express empathy, and build rapport while assessing
symptoms of the mood disorder (Perkinson, Arthur, & Bruce,
2014).
Objective 2: Identify depressive behavior patterns and list
several instances in which it led to addiction (Perkinson,
Arthur, & Bruce, 2014).
Intervention 2: Assess the client’s addictive behavior history
(Perkinson, Arthur, & Bruce, 2014).
Objective 3: Turn over at least one problem to a higher power
each day (Perkinson, Arthur, & Bruce, 2014).
Intervention 3: Assign the client to turn over one problem each
day to a higher power (Perkinson, Arthur, & Bruce, 2014).
PROBLEM #4: Treatment Resistance
GOAL: Accept the powerlessness and unmanageability that
addiction has brought to life, and actively engage in the
treatment process (Perkinson, Arthur, & Bruce, 2014).
Objective 1: Share the feelings that surround admission to
treatment (Perkinson, Arthur, & Bruce, 2014).
Intervention 1: Probe the reasons why the client is resisting
treatment (Perkinson, Arthur, & Bruce, 2014).
Objective 2: Cooperate with biopsychosocial assessment and
accept the treatment recommendations (Perkinson, Arthur, &
Bruce, 2014).
Intervention 2: Share the results of the assessment, medical
labs, and recommendations with client (Perkinson, Arthur, &
Bruce, 2014).
Objective 3: Provide data for a Stage of Change assessment
(Perkinson, Arthur, & Bruce, 2014).
Intervention 3: Assess client’s position in the Stage of Change
(Perkinson, Arthur, & Bruce, 2014).
PROBLEM #5: Relapse Proneness
GOAL: Maintain freedom from addiction without experiencing
relapse (Perkinson, Arthur, & Bruce, 2014).
Objective 1: Write a detailed chemical use history, describing
treatment attempts and the specific situations surrounding
relapse (Perkinson, Arthur, & Bruce, 2014).
Intervention 1: Assign the client to write a chemical use history,
describing her attempts at recovery and the situations
surrounding relapse (Perkinson, Arthur, & Bruce, 2014).
Objective 2: Verbalize the powerlessness and unmanageability
that result from addiction and relapse (Perkinson, Arthur, &
Bruce, 2014).
Intervention 2: Help the client see the powerlessness and
unmanageability that result addiction and relapse using a 12-
step recovery program’s Step 1 exercise (Perkinson, Arthur, &
Bruce, 2014).
Objective 3: Verbalize that continued alcohol/drug abuse meets
the 12-step program concept of insanity (Perkinson, Arthur, &
Bruce, 2014).
Intervention 3: Using a 12-step recovery program’s Step 2
exercise, help the client to see the insanity of her disease
(Perkinson, Arthur, & Bruce, 2014).
Conclusion
Patients with Substance Use Disorder often require therapy
ranging from different aspects. However, before giving it to
them, there is need to conduct a thorough diagnosis of the
patient to ascertain their status. Sally Smith’s case is a perfect
example of how half-done diagnostics can result to an
escalation of the problem rather than solving it. Prior to the
information provided in this diagnostic report, Ms. Smith’s
medical records does not coincide with her medical history.
This, in most cases, makes it hard to conduct effective therapy
that would cure such a patient.
Information needs to be collected from various sources as was
the case in this report. Ms. Smith’s information was collected
through Clinical Interviews, Medical Records, Brief Mental
Status Examination and even the IQ-test for adults i.e. Wechsler
Adult Intelligence Scale-IV (WAIS-IV). All these provided
enough information to make the recommendations made for her
to be taken through. The information indicated that she
probably suffers from depression and alcoholism. She also has
memory issues. She can thus get the help she needs from
specific health care practitioners.
References
Hester, R. K., & Miller, W. R. (2003). Handbook of alcoholism
treatment approaches (3rd ed.).
New York, NY: Allyn & Bacon. ISBN: 9780205360642.
Perkinson, R., Jongsma, A., & Bruce, T. J. (2014). The
addiction treatment planner (5th ed.).
Hoboken, NJ: Wiley. ISBN: 9781118414750.
Christina C. DISCUSSION BOAR #1
200 WORD REPLY
AA and Spirituality
Except for two or three attendances to AA there seems
to be more people refusing to acknowledge God as their higher
power (at least in my area) and believing it is all about will
power, which is fine to a point, but ultimately it comes down to
God’s Grace that gives us strength with our daily struggles.
Mathew 19:26 (KJV) God said, “Believe in me and all things
are possible”. Clinton & Scalise (2013) states in part 4
“Processing Addictions”, two of the four key elements to the
“Road to Recovery”, is 1. Clean out the infection and 2. Renew
the mind (p. 254).
Cleaning out the infection entails breaking the power of denial
and as a Christian Counselor that would not only include the
denial of whether there is a problem, but also with who is in
charge concerning that problem. Renewing the mind entails
breaking the power of disbelief (Clinton & Scalise, 2013)
therefore, if we truly believe God can heal us and we are truly
remorseful, he will.
Go along with the above, I notice in AA is for those that have
not fully recovered Step 1 being able to admit powerlessness
over the disease (Hester & Miller, 2003 p. 170), is the hardest
step for all or most all to get past. Each person, some like
myself more hardheaded that the rest, just can not except being
out of control of our lives. Some victims of abuse which you
will meet in AA, have taken steps to gain control over their
lives from the abuse and it pours over to the addiction because
that person’s headstrongness is so deep it is virtually
unchangeable therefor, making it a constant battle, to allow
themselves to feel comfortable, with the thought they may not
be able to control addiction alone. That person does not want to
ever be abused again under any circumstance.
Then to persuade that same person they are not in control of
their lives; their first initial response might be “BULL”.
As a Counselor, I would ask this person “What would you do if
someone tried to hurt or abuse you today”? I might get a
response like, “I would fight back and not submit out of fear”.
Then, I would say, Alcohol is the abuser, stealing from you of
everything that is “beautiful” such as Children, “good” such as
Jobs or Happiness, and “peaceful” such as the serenity of self-
perseverance. Will you be willing to fight for those things?
Would you like to learn how? Would you be willing to put
into practicesome ways of changing your life? Can we say a
prayer and ask for help? What I may be able to plant in this
person’s life today, may save their life tomorrow.
References
Mathew 19:26, (n.d.). Retrieved February 28, 2018 from:
https://www.kingjamesbibleonline.org/Bible-Verses-
About-All-Things-Are-Possible/
Clinton, D., & Scalise, D. (2013). Addictions and Recovery
Counseling. Grand Rapids, MI: Baker Books.
Hester, R. K., & Millier , W. R. (2003). Handbook of
Alcoholism Treatment Approaches: Effective
Alternitives (Third ed.). Boston, MA: Pearson Education.
Robert C. DISCUSSION BOARD #2
200 WORDS
Attending Narcotics Anonymous (NA) meetings have given me
a broader understanding and insight into the different variables
of substance use disorders (SUD). The group that I am
attending is a very engaged group who refers to God as the
“Higher Power” and professes that He is the one who helps
them daily to achieve the goal of sobriety. According to Hester
and Miller (2003) reveals “the hope for the hopeless condition”
is revealed when the individual turns over their life to a higher
power and follow “a spiritual path to recovery” (p. 3). Many of
the individuals who seized the opportunity to share in a
discussion usually gave credit to God for preserving them
during their journey and for creating the NA program.
Furthermore, many of them recognize their addiction as a
disease that they couldn’t solve themselves. Therefore, they
have embraced the concept of spiritually surrendering and
giving “up control to the Lord” as Clinton and Scalise (2013)
disclosed.
Within counseling it is important to establish a
relationship with the client in order to do a personal
assessment. According to Clinton and Scalise (2013) it is
necessary for counselors who are assisting those with addictions
to “address strongly the concept of building and maintaining
relationships with their clients” (p. 57). I believe it is equally
important in the counseling setting to allow the individual to
practice spiritual principles in order to develop a system of self-
accountability and disciplines. As the client learns to pray to
God they began to depend on Him as the true fulfillment of
life. Therefore, helping one who is struggling with an addiction
become aware of the deadly cycle of trying to fill a void that
only God can fill, will help them jump off the roller coaster of
insanity. According to Clinton and Scalise (2013) those who
are struggling with an addiction and have not found a
relationship with Jesus Christ “are working to fill this vacuum
with all the wrong things” (p. 57). Therefore, it is pertinent
that the counselor addresses the spiritual needs of the client
before proceeding.
My own personal worldview is based on biblical
principles and values. Therefore, I agree that the most
important thing in life is having an individual discover the
Creator of our purpose and being. My philosophy is that God is
the manufacturer who knows how to the creation is supposed to
function. Consequently, the creation must return to the
manufacturer for instructions and repairs. The scripture in 2
Corinthians 5:17 tells us that “if any man be in Christ, he is a
new creature, old things are passed away, behold all things have
become new” (KJV). I believe that when an individual totally
surrenders to Jesus Christ, only then will they experience that
new victorious life. According to 2 Corinthians 2:14 “thanks be
unto God, which always causes us to triumph in Christ (KJV).
Reference
Clinton, T., & Scalise, E. (2013). The quick-reference guide to
addictions and recovery counseling: 40 topics, spiritual
insights, and easy-to-use action steps. Grand Rapids, MI: Baker
Books.
Hester, R. K., & Miller, W. R. (2003). Handbook of alcoholism
treatment approaches (3rd ed.). New York, NY: Allyn & Bacon.

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  • 1. Running head: SMITH TREATMENT PLAN 1 SMITH TREATMENT PLAN 3 Treatment Plan Grading Rubric Element Criteria Points Possible Points Earned Instructor’s Comments Content of Treatment Plan Additional screening and assessment instruments identified with BioPsychoSocialSpiritual (BPSS) and explained Diagnoses clearly identified and are accurate. (DSM codes needed). Consideration of self-report vs other sources of information appropriatelyComment by Jill: See bubbled comments below Comment by Jill: See bubbled comments below and read comments this page Treatment Plan: Clearly address current functioning, mental health, substance use, and faith/spirituality with thorough recommendations with plan following Comment by Jill: See bubbled comments below and read comments this page Relevant details identified from Perkinson, Jongsma, and Bruce (2014) and other course resources Clearly identified best treatment setting Comment by Jill: See bubbled comments below and read comments this page Comment by Jill: Conclusions 32 23
  • 2. Co-Occurring Disorder (COD) is actually the concern here with 3 areas operating related to alcohol, opioids, and depression. Benzodiazepenes could be added as a 4th, but can be determined after detox. Further investigation is needed after suicidality and overdosing more than once regarding self reported, but unconfirmed, BiPolar mental illness, as well. It would not be appropriate to ignore any one of the areas above especially in one with suicidal ideations and her past history of comas. Future opioids should come through her psychiatrist only unless communication is established between you, psychiatrist and pain doctor. You will need third party waivers signed by client from start of therapy to communicate with any previous psychiatrist and pain doctors, who can be determined. These plans always offer ongoing evaluation and continual review open to additions and changes as the case moves forward to prioritize necessities and meet previously undisclosed or unknown concerns. These can be updated in the treatment plan and are also noted in the progress notes. Your codes needed to be more specific on both of the substances and depression. Diagnostic Impressions is not the same as the diagnostic portion. Setting is not clear other than detox. Spirituality is addressed but would not be a coded problem. Conclusion is noted APA Format Title Page in current APA format with running head in correct APA style Font, level headings, margins are in correct APA Style Citations properly used in all needed places and match reference list If quotations are include, all APA requirements are met, not used unnecessarily/excessively. Plagiarism free* Reference Page is in current APA format * Higher deduction and other consequences might be applied for plagiarism.
  • 3. 10 10 Most of your attention to APA detail is fine for a paper of this nature. Grammar/Writing Sentences: coherent, varied, complete, clear, and concise wording Punctuation including proper use of comma, period, semicolon, etc. Spelling and vocabulary: exemplifies profession writing, precise, unambiguous, appropriate Grammar: proper and consistent use of verb tense, noun- pronoun agreement, Paragraph: clear and contains one major idea 8 8 No detrimental grammar or writing concerns COMMENTS: *I have graded this in spite of 63% Safe Assign. Above 30 % is a red flag. Much of this report is not yours. But there are so many errors, to have used these reports, you still need to reevaluate its contents. For the high safe assign I am taking an additional -10 Actually, Sally has attempted to use the labels to assist her by self-report in giving previous diagnosis during the Case History, where she also reported not having a psychiatrist. Hence, she needs to be evaluated by the treatment center’s psychiatrist (if it’s a treatment center) shortly or as soon as detox and/or stability is complete to determine accuracy of any additional psychiatric diagnoses beyond Depression and need for any medications, which only a Psychiatrist can prescribe in our MH systems along with her two SUD’s related to alcohol and prescribed opioid abuse or dependence. See bubbled comments also. Total 50
  • 4. 31 Case History Treatment Plan: Sally Smith Comment by Jill: Previously written and presented section toward assignment is not graded here Case History for Treatment Plan Report Regarding Sally Smith Name: Sally Smith SS#: 000-00-0000 Age: 42 years old Date of Examination: 9/1/2016 Examiners: Fred Looney, PhD Chief Complaint: Mental functioning Sources of Information Clinical Interview with Sally Smith Medical Records Brief Mental Status Examination Wechsler Adult Intelligence Scale-IV (WAIS-IV) Background Information Ms. Smith is a 42-year-old African American female. She currently lives with her mother. She states she has one adult son from a prior marriage. Ms. Smith states she has a 2-year nursing degree and was employed as a nurse until 2015. She indicates that she does not attend church currently, but her mother attends on a weekly basis. As a child, she attended Sunday school and church periodically. Ms. Smith states that she has been unable to work as a nurse due to medical problems. She reported that for years she had
  • 5. problems with high blood pressure, and, one day, she passed out and was put on a respirator. With further questioning, she reports that, on the day of this hospitalization, she drank an alcoholic beverage that reportedly was laced with “some drug.” Her medical records show a positive drug screen of benzodiazepines. The medical records state she was “brought in a comatose state” and was intubated. The doctor’s records state that Ms. Smith had told him she had been taking OxyContin for pain and had gone to lunch with friends and had two drinks. When asked about the information in the medical records, Ms. Smith admitted to some problematic drinking during a one-year time frame. However, her reported history and the medical records do not coincide. Medical records report a diagnosis of alcohol poisoning. Her medical history includes inflammatory bowel disease, acute gastritis, atypical chest pain, hypertension, and a history of alcohol abuse with elevated alcohol levels during admission. Ms. Smith states she has a history of depression and was admitted to a state hospital in 2016 due to suicidal ideations. She states her abusive alcoholic drinking is related to her depression. She does admit to consuming a “small” bottle of vodka on a daily basis at the height of her drinking. She denies any current alcohol use and is reportedly under the care of a doctor. She states her current diagnosis is bipolar disorder. She reports that she hears voices in her head and, at times, verbally responds to them. Ms. Smith was not able to list the medications she is currently on, nor are there any recent medical records as to her current medical conditions. Most recent record is January 2016.Mental Status and Behavioral Observations Attitude and Behavior: Ms. Smith was friendly and cooperative throughout the interview. She appeared to respond in a genuine manner when asked questions. At times, however, she appeared to be confused with the information requested of her. Her speech was slurred at times, and she had a glazed look about her.
  • 6. Appearance: Ms. Smith appeared neat but casually dressed. She seemed to show adequate attention to her grooming needs. Ms. Smith did appear to have a slight odor, seemingly of alcohol. Quality of Thinking: Ms. Smith’s thinking appears pressured and unorganized. Her reported history does not follow written reports; however, she does not appear to understand the inconsistencies. Her self-report appears to be what she believes to be her honest answer. Abstraction Skills: Ms. Smith’s abstract thinking appears very limited; she was unable to explain how work and play are similar or why people are put on parole. Affect and Mood: Ms. Smith appeared docile and cooperative throughout interview. However, the examiner continually needed to redirect her and help keep her focused. Orientation: Ms. Smith was oriented x’s 3. Memory: Ms. Smith’s memory appears limited as evident in her ability to only repeat 4 numbers forward and 3 backwards. Attention and Concentration: Ms. Smith appeared to attend to all tasks at hand. Judgment and Insight: Ms. Smith’s judgment and insight appear limited in her inability to follow logical order and recognize inconsistencies.Intellectual Functioning Testing Results and Interpretations Wechsler Adult Intelligence Scale-IV (WAIS-IV) WAIS–IV Scale Score Verbal Comprehension 67 (Extremely Low) Perceptual Reasoning 73 (Borderline) Working Memory 73 (Borderline) Processing Speed 100 (Average) Full Scale 67 (Extremely Low) General Ability 99 (Average) Ms. Smith is functioning in the Extremely Low range of intellect, with her Verbal Comprehension Index score significantly, but not rarely, lower than her Working Memory and Processing Speed. In addition, her current functioning is inconsistent with reported prior achievement and
  • 7. functioningDiagnostic Report and Treatment Planning This section presents Ms. Smith’s diagnostic report and treatment plan. The report is based on the current information collected about her from a clinical interview conducted, medical records available, a brief mental status assessment and the Wechsler Adult Intelligence Scale-IV (WAIS-IV). The following is revealed: Ms. Smith’s medical issues began during her spell as a nurse. She reports that her medical problems led to her terminating a nurse career she had prior to 2015. Her main problems were associated with high blood pressure for years. She also confesses to drinking an alcoholic drink laced with a certain drug. The following is a summary of her SUD screening results and assessment. SUD Screening Results Her SUD screen results indicate a positive drug screen of benzodiazepines. Her medical history also indicates that she had hypertension, atypical chest pain, inflammatory bowel disease, acute gastritis as well as alcohol poisoning. Besides having a history of depression, Ms. Smith also indicates she had a drinking problem for one year. She indicates that these two were highly related and whenever she feels depressed she would look for a “small” bottle of vodka. She reports that she currently does not take any alcohol. SUD Assessment Results Ms. Smith admits having had a drinking problem for a year. During her peak times, she would drink vodka, in what she described as small amounts. She also agreed to have been taking OxyContin for pain. Her medical history records also indicate that she had been diagnosed with alcohol poisoning. Diagnostic Impressions Comment by Jill: Diagnostic Impressions are not the same as the codings under diagnosis. A paragraph on impressions was needed 303.90 F10.20 Alcohol Use Disorder, Moderate or Severe 291.2 F10.27 Moderate or Severe Alcohol Use Disorder with Alcohol-Induced Major Neurocognitive Disorder, Nonamnestic-Confabulatory Type
  • 8. 305.50 F11.10 Opioid Use Disorder, Mild . Comment by Jill: Need depression in your list since she is suicidal 307.89 F54 Psychological Factors Affecting Other Medical Conditions Comment by Jill: Not certain 296.80 F31.9 Unspecified Bipolar and Related Disorder Comment by Jill: Do not add at this time. This was self-reported with no confirmation from health care provider 293.82 F06.0 Psychotic Disorder Due to Another Medical Condition with Hallucinations Comment by Jill: To be determined by psychiatric eval along with bipolar and any possible bipolar meds V62.89 265.8 Religious or Spiritual Problem Comment by Jill: Don’t add uncertain diagnoses to client filesRecommendations Based on the above, therefore, the following recommendations are deemed necessary: · A thorough medical history should be created, based on the story she has told as well as her medical history. There is need to marry these two so that they speak the same language. · Ms. Smith’s mental and behavioral assessment suggests that she also needs to see a psychologist/psychiatrist who will help her get through her anxiety. This will also improve her cognitive thinking, further improving her abstraction and judgement skills. · Ms. Smith should be taken through therapy to reduce the chances of relapse; given that she is likely an alcoholic. This is in line with the report she gave about dealing with an alcohol problem for over a year. · Medically-Assisted Detoxication is recommended. Bio- Psycho-Social-Spiritual Assessment Family History – Current Family: She reported that she used to accompany her mother to Sunday school at a young age but stopped. She is 42 years old and currently lives with her mother. She also has a son. Family History – Family of Origin: Ms. Smith’s family has
  • 9. always been based on a strong Christian background. Her mother always attends church weekly, however, this is not true for Ms. Smith. Vocational/Educational/Financial History: Ms. Smith reported that she had taken a 2-year bachelor’s degree course in Nursing and had served as a nurse till 2015. However, her family does not seem to have any financial issues. The fact that she was taken to school indicates that they might have been in a good financial position. Military History: Ms. Smith does not report any military history. Legal Assessment: Ms. Smith does not report any legal history. This may point that she is a law-abiding citizen. Social/Leisure Assessment: Ms. Smith is a social person and enjoys having lunch and taking drinks with her friends. Her attitude and behavior are also friendly and cooperative. Spiritual/Cultural History: Ms. Smith’s mother is a staunch Christian who attends church at least once every week. While Ms. Smith herself used to attend church periodically, she no longer attends church as often as she should. Psychological Assessment: Ms. Smith’s psychological assessment is based on the facts reported from observing her mental status and behavior. Her attitude and behavior indicate that she is friendly, honest and cooperative. Her flow of thought, however, indicated that she is tense and appears to be under pressure all the time, making her judgement questionable. Her abstraction skills are somewhat limited, so is her memory. It is important to note that she is attentive, meaning that her levels of concentration are high. Sexual History and Orientation: Ms. Smith was married, has a son, meaning that her sexual orientation is heterosexual. She is currently single. Problem Areas Problem #1: Substance Use Problem #2: Chronic Pain/Medical Issues Problem #3: Bipolar Disorder
  • 10. Problem #4: Treatment Resistance Problem #5:Relapse Proneness BPSS Summary Name: Sally Smith Marital Status: Single Residence: N/A Employment: Unemployed (Former Nurse) Family Situation: She has a son from a previous marriage and currently lives with her mother. Reason for entering treatment: Mental functioning Alcohol/Drug History: She used to drink a “small” bottle of vodka. Was once diagnosed with alcohol poisoning Medical Assessment: Medical history indicates she had inflammatory bowel disease, acute gastritis, atypical chest pain, hypertension, and a history of alcohol abuse Mental Status: Based on the Wechsler Adult Intelligence Scale- IV (WAIS-IV) IQ test results, results, Ms. Smith’s verbal comprehension is extremely low. Her perceptual reasoning and working memory are on the borderline while her processing speed and full-scale scores are average and extremely low respectively. Her general mental ability is therefore described as average. Psychological Summary: Her attitude and behavior indicates that she is friendly, honest and cooperative. Her flow of thought, however, indicated that she is tense and appears to be under pressure all the time, making her judgement questionable. Relapse Issues: Ms. Smith reports that she is not currently utilizing substances to cope with her mental and medical issues. However, her labs and affect report otherwise. Treatment Plan (Problems 1-5) PROBLEM #1: Substance Use Disorder GOAL: Establish a sustained recovery, free from the use of all mood-altering substances (Perkinson, Arthur, & Bruce, 2014).
  • 11. Objective 1: Provide honest and complete information from a chemical dependence biopsychosocial history (Perkinson, Arthur, & Bruce, 2014). Intervention 1: Gather a complete drug/alcohol history from the client, including the amount and pattern of her use (Perkinson, Arthur, & Bruce, 2014). Objective 2: Participate in a medical evaluation to assess the effects of chemical dependence (Perkinson, Arthur, & Bruce, 2014). Intervention 2: Refer the client for an examination to determine consequences of substance use (Perkinson, Arthur, & Bruce, 2014). Objective 2: Cooperate with an evaluation by a physician for psychotropic medication (Perkinson, Arthur, & Bruce, 2014). Intervention 2: Assess the need for psychotropic medication for any mental/emotional comorbidities (Perkinson, Arthur, & Bruce, 2014). PROBLEM #2: Chronic Pain GOAL: Regulate pain without addictive medications (Perkinson, Arthur, & Bruce, 2014). Objective 1: Describe the nature, history, and impact of chronic pain, medical issues, and substance abuse (Perkinson, Arthur, & Bruce, 2014). Intervention 1: Assess the manifestation of chronic pain/medical issues, its history, triggers, and methods of coping (Perkinson, Arthur, & Bruce, 2014). Objective 2: Cooperate with a thorough medical examination to rule out any alternative causes for pain and explore treatment options (Perkinson, Arthur, & Bruce, 2014). Intervention 2: Refer the client to a physician to undergo an
  • 12. examination. Objective 3: Follow through with pain management (Perkinson, Arthur, & Bruce, 2014). Intervention 3: Discuss cautious-use of medications to manage pain (Perkinson, Arthur, & Bruce, 2014). PROBLEM #3: Bipolar Disorder Comment by Jill: Not to be added to reports until after detox and stabilization allows psychiatric review GOAL: Alleviate mood symptoms and return to previous level of effective functioning (Perkinson, Arthur, & Bruce, 2014). Objective 1: Describe the personal history of mood changes and associated changes in behavior (Perkinson, Arthur, & Bruce, 2014). Intervention 1: Encourage client to share her thoughts and feelings, express empathy, and build rapport while assessing symptoms of the mood disorder (Perkinson, Arthur, & Bruce, 2014). Objective 2: Identify depressive behavior patterns and list several instances in which it led to addiction (Perkinson, Arthur, & Bruce, 2014). Intervention 2: Assess the client’s addictive behavior history (Perkinson, Arthur, & Bruce, 2014). Objective 3: Turn over at least one problem to a higher power each day (Perkinson, Arthur, & Bruce, 2014). Intervention 3: Assign the client to turn over one problem each day to a higher power (Perkinson, Arthur, & Bruce, 2014). PROBLEM #4: Treatment Resistance
  • 13. GOAL: Accept the powerlessness and unmanageability that addiction has brought to life, and actively engage in the treatment process (Perkinson, Arthur, & Bruce, 2014). Objective 1: Share the feelings that surround admission to treatment (Perkinson, Arthur, & Bruce, 2014). Intervention 1: Probe the reasons why the client is resisting treatment (Perkinson, Arthur, & Bruce, 2014). Objective 2: Cooperate with biopsychosocial assessment and accept the treatment recommendations (Perkinson, Arthur, & Bruce, 2014). Intervention 2: Share the results of the assessment, medical labs, and recommendations with client (Perkinson, Arthur, & Bruce, 2014). Objective 3: Provide data for a Stage of Change assessment (Perkinson, Arthur, & Bruce, 2014). Intervention 3: Assess client’s position in the Stage of Change (Perkinson, Arthur, & Bruce, 2014). PROBLEM #5: Relapse Proneness GOAL: Maintain freedom from addiction without experiencing relapse (Perkinson, Arthur, & Bruce, 2014). Objective 1: Write a detailed chemical use history, describing treatment attempts and the specific situations surrounding relapse (Perkinson, Arthur, & Bruce, 2014). Intervention 1: Assign the client to write a chemical use history, describing her attempts at recovery and the situations surrounding relapse (Perkinson, Arthur, & Bruce, 2014). Objective 2: Verbalize the powerlessness and unmanageability that result from addiction and relapse (Perkinson, Arthur, & Bruce, 2014).
  • 14. Intervention 2: Help the client see the powerlessness and unmanageability that result addiction and relapse using a 12- step recovery program’s Step 1 exercise (Perkinson, Arthur, & Bruce, 2014). Objective 3: Verbalize that continued alcohol/drug abuse meets the 12-step program concept of insanity (Perkinson, Arthur, & Bruce, 2014). Intervention 3: Using a 12-step recovery program’s Step 2 exercise, help the client to see the insanity of her disease (Perkinson, Arthur, & Bruce, 2014). Conclusion Patients with Substance Use Disorder often require therapy ranging from different aspects. However, before giving it to them, there is need to conduct a thorough diagnosis of the patient to ascertain their status. Sally Smith’s case is a perfect example of how half-done diagnostics can result to an escalation of the problem rather than solving it. Prior to the information provided in this diagnostic report, Ms. Smith’s medical records does not coincide with her medical history. This, in most cases, makes it hard to conduct effective therapy that would cure such a patient. Information needs to be collected from various sources as was the case in this report. Ms. Smith’s information was collected through Clinical Interviews, Medical Records, Brief Mental Status Examination and even the IQ-test for adults i.e. Wechsler Adult Intelligence Scale-IV (WAIS-IV). All these provided enough information to make the recommendations made for her to be taken through. The information indicated that she probably suffers from depression and alcoholism. She also has memory issues. She can thus get the help she needs from specific health care practitioners. References
  • 15. Hester, R. K., & Miller, W. R. (2003). Handbook of alcoholism treatment approaches (3rd ed.). New York, NY: Allyn & Bacon. ISBN: 9780205360642. Perkinson, R., Jongsma, A., & Bruce, T. J. (2014). The addiction treatment planner (5th ed.). Hoboken, NJ: Wiley. ISBN: 9781118414750. Christina C. DISCUSSION BOAR #1 200 WORD REPLY AA and Spirituality Except for two or three attendances to AA there seems to be more people refusing to acknowledge God as their higher power (at least in my area) and believing it is all about will power, which is fine to a point, but ultimately it comes down to God’s Grace that gives us strength with our daily struggles. Mathew 19:26 (KJV) God said, “Believe in me and all things are possible”. Clinton & Scalise (2013) states in part 4 “Processing Addictions”, two of the four key elements to the “Road to Recovery”, is 1. Clean out the infection and 2. Renew the mind (p. 254). Cleaning out the infection entails breaking the power of denial and as a Christian Counselor that would not only include the denial of whether there is a problem, but also with who is in charge concerning that problem. Renewing the mind entails breaking the power of disbelief (Clinton & Scalise, 2013) therefore, if we truly believe God can heal us and we are truly remorseful, he will. Go along with the above, I notice in AA is for those that have not fully recovered Step 1 being able to admit powerlessness over the disease (Hester & Miller, 2003 p. 170), is the hardest step for all or most all to get past. Each person, some like myself more hardheaded that the rest, just can not except being out of control of our lives. Some victims of abuse which you will meet in AA, have taken steps to gain control over their
  • 16. lives from the abuse and it pours over to the addiction because that person’s headstrongness is so deep it is virtually unchangeable therefor, making it a constant battle, to allow themselves to feel comfortable, with the thought they may not be able to control addiction alone. That person does not want to ever be abused again under any circumstance. Then to persuade that same person they are not in control of their lives; their first initial response might be “BULL”. As a Counselor, I would ask this person “What would you do if someone tried to hurt or abuse you today”? I might get a response like, “I would fight back and not submit out of fear”. Then, I would say, Alcohol is the abuser, stealing from you of everything that is “beautiful” such as Children, “good” such as Jobs or Happiness, and “peaceful” such as the serenity of self- perseverance. Will you be willing to fight for those things? Would you like to learn how? Would you be willing to put into practicesome ways of changing your life? Can we say a prayer and ask for help? What I may be able to plant in this person’s life today, may save their life tomorrow. References Mathew 19:26, (n.d.). Retrieved February 28, 2018 from: https://www.kingjamesbibleonline.org/Bible-Verses- About-All-Things-Are-Possible/ Clinton, D., & Scalise, D. (2013). Addictions and Recovery Counseling. Grand Rapids, MI: Baker Books. Hester, R. K., & Millier , W. R. (2003). Handbook of Alcoholism Treatment Approaches: Effective Alternitives (Third ed.). Boston, MA: Pearson Education. Robert C. DISCUSSION BOARD #2 200 WORDS Attending Narcotics Anonymous (NA) meetings have given me a broader understanding and insight into the different variables of substance use disorders (SUD). The group that I am attending is a very engaged group who refers to God as the
  • 17. “Higher Power” and professes that He is the one who helps them daily to achieve the goal of sobriety. According to Hester and Miller (2003) reveals “the hope for the hopeless condition” is revealed when the individual turns over their life to a higher power and follow “a spiritual path to recovery” (p. 3). Many of the individuals who seized the opportunity to share in a discussion usually gave credit to God for preserving them during their journey and for creating the NA program. Furthermore, many of them recognize their addiction as a disease that they couldn’t solve themselves. Therefore, they have embraced the concept of spiritually surrendering and giving “up control to the Lord” as Clinton and Scalise (2013) disclosed. Within counseling it is important to establish a relationship with the client in order to do a personal assessment. According to Clinton and Scalise (2013) it is necessary for counselors who are assisting those with addictions to “address strongly the concept of building and maintaining relationships with their clients” (p. 57). I believe it is equally important in the counseling setting to allow the individual to practice spiritual principles in order to develop a system of self- accountability and disciplines. As the client learns to pray to God they began to depend on Him as the true fulfillment of life. Therefore, helping one who is struggling with an addiction become aware of the deadly cycle of trying to fill a void that only God can fill, will help them jump off the roller coaster of insanity. According to Clinton and Scalise (2013) those who are struggling with an addiction and have not found a relationship with Jesus Christ “are working to fill this vacuum with all the wrong things” (p. 57). Therefore, it is pertinent that the counselor addresses the spiritual needs of the client before proceeding. My own personal worldview is based on biblical principles and values. Therefore, I agree that the most important thing in life is having an individual discover the Creator of our purpose and being. My philosophy is that God is
  • 18. the manufacturer who knows how to the creation is supposed to function. Consequently, the creation must return to the manufacturer for instructions and repairs. The scripture in 2 Corinthians 5:17 tells us that “if any man be in Christ, he is a new creature, old things are passed away, behold all things have become new” (KJV). I believe that when an individual totally surrenders to Jesus Christ, only then will they experience that new victorious life. According to 2 Corinthians 2:14 “thanks be unto God, which always causes us to triumph in Christ (KJV). Reference Clinton, T., & Scalise, E. (2013). The quick-reference guide to addictions and recovery counseling: 40 topics, spiritual insights, and easy-to-use action steps. Grand Rapids, MI: Baker Books. Hester, R. K., & Miller, W. R. (2003). Handbook of alcoholism treatment approaches (3rd ed.). New York, NY: Allyn & Bacon.