Addiction Counseling Competencies - CEU Matrix

CONTENTSCurriculum Committees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v1998 National ATTC Curriculum Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v2005 Update Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viForeword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .viiIntroduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1Section 1: Transdisciplinary Foundations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5I. Understanding Addiction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7II. Treatment Knowledge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13III. Application to Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19IV. Professional Readiness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27Section 2: Practice Dimensions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35I. Clinical Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37II. Treatment Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53III. Referral . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67IV. Service Coordination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77V. Counseling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99VI. Client, Family, and Community Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131VII. Documentation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141VIII. Professional and Ethical Responsibilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151Section 3: Additional Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .161Cultural Competency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162Internet Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163Attitudes Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164Recovery Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166Section 4: Appendices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .169A. Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170B. The Competencies: A Complete List . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176C. National Validation Study: Defining and Measuring the Competenceof Addiction Counselors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188D. Complete Bibliography. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196E. Other Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 224iii

CURRICULUM COMMITTEES1998 NATIONAL ATTC CURRICULUM COMMITTEEAffiliations indicated below are those at the time of the work.David A. Deitch, Ph.D. (Chair)Alan M. Parsons, M.S.W., ACSWPacific Southwest ATTCUniversity of California San DiegoLa Jolla, CaliforniaNortheastern States ATTCState University of New York at AlbanyAlbany, New YorkG.E. Carrier, Ph.D.Nancy Roget, M.S., MFT, LADCRepresenting the Texas ATTCAlvin Community CollegeAlvin, TexasMountain West ATTCUniversity of Nevada–RenoReno, NevadaSteven L. Gallon, Ph.D.Susanne R. Rohrer, RN, M.B.A.Northwest Frontier ATTCOregon Health and Science UniversitySalem, OregonCenter for Substance Abuse TreatmentSubstance Abuse and Mental HealthServices AdministrationWashington, D.C.Paula K. Horvatich, Ph.D.Mid-Atlantic ATTCVirginia Commonwealth UniversityRichmond, VirginiaMary Beth Johnson, M.S.W.ATTC National OfficeUniversity of Missouri–Kansas CityKansas City, MissouriHendi Crosby Kowal, M.P.H.DC/Delaware ATTCDanya International, Inc.Silver Spring, MarylandLinda NicholasGreat Lakes ATTCUniversity of Illinois–ChicagoJane Addams School of Social WorkChicago, IllinoisAnne Helene Skinstad, Psy.D.Prairielands ATTCUniversity of IowaIowa City, IowaPatricia L. Stilen, LCSW, CADACMid-America ATTCUniversity of Missouri–Kansas CityKansas City, MissouriSusan A. Storti, RN, M.A.ATTC of New EnglandBrown UniversityProvidence, Rhode IslandElleen M. Yancey, Ph.D.Southeast ATTCMorehouse School of MedicineAtlanta, Georgiav

Addiction Counseling Competencies2005 UPDATE COMMITTEEPaula K. Horvatich, Ph.D. (Chair)Randolph Muck, M.Ed.Mid-Atlantic ATTCVirginia Commonwealth UniversityRichmond, VirginiaCenter for Substance Abuse TreatmentSubstance Abuse and Mental HealthServices AdministrationRockville, MarylandCarol Davidson, M.S.W., CDPEvergreen Treatment ServicesSeattle, WashingtonSteven L. Gallon, Ph.D.Northwest Frontier ATTCOffice of Alcohol and Drug Abuse ProgramsSalem, OregonMichael Hoge, Ph.D.Annapolis CoalitionYale UniversityNew Haven, ConnecticutJames Holder, M.A., LPC-S, MACNational Association for Alcohol andDrug Addiction CounselorsMcLeod Behavioral HealthFlorence, South CarolinaMary Beth Johnson, M.S.W.ATTC National OfficeUniversity of Missouri–Kansas CityKansas City, MissouriLinda Kaplan, M.A.National Association for Childrenof AlcoholicsRockville, MarylandCaptain Florentino (Tino)Merced-Galindez, M.S.N., RNCenter for Substance Abuse PreventionSubstance Abuse and Mental HealthServices AdministrationRockville, MarylandPaul D. Nagy, M.S., LCAS, LPC, CCSDuke Addictions ProgramDuke University Medical CenterDurham, North CarolinaNancy Roget, M.S., MFT, LADCMountain West ATTCUniversity of Nevada–RenoReno, NevadaGerard J. Schmidt, M.A., LPC, MACNAADAC–The Association for AddictionProfessionalsValley HealthCare SystemMorgantown, West VirginiaMichael Shafer, Ph.D.Pacific Southwest ATTCTuscon, ArizonaJames L. Sorensen, Ph.D.San Francisco General HospitalUniversity of California–San FranciscoSan Francisco, CaliforniaPatricia L. Stilen, LCSW, CADACMid-America ATTCUniversity of Missouri–Kansas CityKansas City, MissouriDeborah Stone, Ph.D.Center for Mental Health ServicesSubstance Abuse and Mental HealthServices AdministrationRockville, MarylandPamela Waters, M.Ed., CAPPSouthern Coast ATTCFlorida Certification BoardTallahassee, Floridavi

FOREWORDCounselors who treat people with substance use disorders do life-changing work on a dailybasis, amid difficult circumstances that include staff shortages, high turnover, low salaries,and scant program funding. Counselors come to this important work by various paths andwith vastly different skills and experience. The diversity of backgrounds and types ofpreparation can be a strength, provided there is a common foundation from which counselorswork. This publication addresses the following questions: What professional standards shouldguide substance abuse treatment counselors? What is an appropriate scope of practice forthe field? Which competencies are associated with positive outcomes? What knowledge,skills, and attitudes (KSAs) should all substance abuse treatment professionals have incommon?Workforce development is essential to the field of substance use disorder treatment.The Substance Abuse and Mental Health Services Administration (SAMHSA) has includedworkforce development in its Matrix of Priority Programs. A major focus of this workforcedevelopment strategy is improving the competencies of professionals in the field. This updatededition of Technical Assistance Publication (TAP) 21: Addiction Counseling Competencies:The Knowledge, Skills, and Attitudes of Professional Practice (The Competencies) is a keycomponent 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 abusetreatment counselors should master to do their work effectively. TAP 21 has been used todevelop and evaluate addiction counseling curricula, advise students, and assess counselingproficiencies.The overarching competencies in this updated version of TAP 21 remain largely unchangedfrom the original TAP 21. The KSAs have been changed from those in the 1998 edition whennecessary, 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 reflectchanges in the field. The competencies are defined by sublists of the KSAs needed to mastereach 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 technicalinformation to the substance abuse treatment field. This updated version of TAP 21 exemplifiesthe flexibility of the TAP format. We are grateful to the members of the ATTC Network and staffand to all those who participated in the validation and updating of these competency lists.Charles G. Curie, M.A., A.C.S.W.AdministratorSubstance Abuse and Mental Health Services AdministrationH. Westley Clark, M.D., J.D., M.P.H., CAS, FASAMDirectorCenter for Substance Abuse TreatmentSubstance Abuse and Mental Health Services Administrationvii

INTRODUCTIONIn 1998, the Substance Abuse and Mental Health Services Administration (SAMHSA) and theCenter for Substance Abuse Treatment (CSAT) published Addiction Counseling Competencies:The Knowledge, Skills, and Attitudes of Professional Practice (The Competencies) as TechnicalAssistance Publication (TAP) 21. Developed by the National Curriculum Committee of theAddiction Technology Transfer Center (ATTC) Network, TAP 21 identifies 123 competenciesthat are essential to the effective practice of counseling for psychoactive substance usedisorders. TAP 21 also presents the knowledge, skills, and attitudes (KSAs) counselors needto become fully proficient in each competency.TAP 21 has been widely distributed by SAMHSA’s National Clearinghouse for Alcohol and DrugInformation (NCADI) and the ATTC Network. It has become a benchmark by which curricula aredeveloped and educational programs and professional standards are measured for the field ofsubstance abuse treatment in the United States. In addition, it has been translated intoseveral languages.Because the ATTC Network is committed to technology transfer, after the initial publicationof TAP 21, the National Curriculum Committee began exploring ways to enhance the document for future printings. Successful technology transfer requires more than presenting goodinformation. 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 otherwords, getting the right information across in a way that makes it useable. The NationalCurriculum Committee examined how best to package and present TAP 21 to help peoplelearn key elements and adopt new strategies. The result was a revision of TAP 21—a processthat was begun in 2000, was completed in 2005, and resulted in the current publication.HISTORY OF THE COMPETENCIESIn 1993 CSAT created a multidisciplinary network of 11 ATTC Regional Centers geographicallydispersed across the United States and in Puerto Rico and the U.S. Virgin Islands. Since itsinception, the ATTC Network has collaborated with diverse international, national, State,regional, and local partners from multiple disciplines to recruit qualified addiction treatmentpractitioners and enhance academic preparation and professional development opportunitiesin the substance abuse treatment field.The National Curriculum Committee, composed of ATTC Directors, was established at theNetwork’s inaugural meeting. The committee’s initial charge was to collect and evaluateexisting addiction educational and professional development curricula and establish futurepriorities for ATTC curriculum development. This effort led to researching existing practiceand professional literature and defining an extensive list of addiction practice competenciesdetermined to be essentia l to effective counseling for substance use disorders. These initialcompetencies would serve as benchmarks to guide future ATTC curriculum design, development, and evaluation.1

Addiction Counseling CompetenciesIn addition to its own work, the National Curriculum Committee reviewed and incorporatedother publications on the work of addiction counselors.1 In 1995 the committee’s workresulted in the ATTC publication Addiction Counselor Competencies. Subsequent to thispublication, the ATTCs conducted a national survey to validate the competencies (see appendixC). Results supported virtually all of the competencies as being essential to the professionalpractice of addiction counseling.In 1996, the International Certification and Reciprocity Consortium (ICRC) convened a nationalleadership group to evaluate the need for model addiction counselor training. After carefuldeliberation, the group concluded that much of the work to define such a curriculum standardhad already been accomplished by the ATTC National Curriculum Committee and the ICRC inthe National Curriculum Committee’s Addiction Counselor Competencies and the ICRC’s 1996Role Delineation Study, respectively.Soon after, CSAT agreed to fund a collaborative effort to finalize a document that could be usedas a national standard. CSAT convened a panel—The National Steering Committee for AddictionCounseling Standards (NSC)—that comprised representatives from five national educational,certification, and professional associations. The NSC was successful in achieving unanimousendorsement of the Addiction Counselor Competencies—a milestone in the addictioncounseling field.Based on this foundation, the National Curriculum Committee began to delineate the KSAsthat undergird each competency statement. Input was solicited from a number of key nationalorganizations 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 conductedfocus 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 disseminatedthrough SAMHSA’s NCADI and the ATTC Network, refinements were needed to improve the utilityof 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 suggestedthat there was no need to change the competencies. The most common suggestions were torefine the 1998 publication by presenting the content in a more user-friendly fashion and linkingit to professional literature and specific applications. The National Curriculum Committee revisedTAP 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 originalmembers from the National Curriculum Committee; representatives from NAADAC—The Association for Addiction Professionals, CSAT, the Center for Mental Health Services, the Center forSubstance Abuse Prevention, the National Association for Children of Alcoholics, and the Annapolis Coalition; treatment providers; and experts in addiction research. The current updated editionretains all of the feedback-based improvements of the 2000 revised version and adds relevant1Birch and Davis Corporation (1986). Development of Model Professional Standards for Counselor Credentialing. Dubuque, IA:Kendall/Hunt Publishing.International Certification and Reciprocity Consortium (ICRC)/Alcohol and Other Drug Abuse (1991). Role Delineation Study forAlcohol and Other Drug Abuse Counselors. Raleigh, NC: ICRC.2

Introductionliterature published after 2000. In addition, the competencies and KSAs of several practicedimensions, in particular those that address clinical evaluation and treatment planning,were rewritten to reflect current best practices.WHAT YOU WILL FIND INSIDEThe ModelWhen creating The Competencies, the National Curriculum Committee recognized a need toemphasize three characteristics of competency: knowledge, skills, and attitudes. Many hourswere spent conceptualizing a differentiated model when designing TAP 21—a model that couldaddress general KSAs necessary for all practitioners dealing with substance use disorders whileexplaining 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 withindividuals with substance use disorders.The second section of the model specifically addresses the professional practice needs, orpractice dimensions, of addiction counselors. Each practice dimension includes a set of competencies, and, within each competency, the KSAs necessary for effective addiction counselingare 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 theFIGURE 1. COMPONENTS IN THE COMPETENCIES MODELcompetencies discussed. TheNational Curriculum Committee’s goal for the future is tohelp ensure that every addictioncounselor possesses, to an appropriate degree, each competency listed, regardless of settingor treatment model.The relationship of the components in the competenciesmodel is conceptualized asa hub with eight spokes (seefigure 1). The hub contains thefour transdisciplinary foundations that are central to the workof all addiction professionals.The eight spokes are the practice dimensions, each containingthe competencies the addictioncounselor should attain to master each practice dimension.3

Addiction Counseling CompetenciesRecommended ReadingsJournal articles, book chapters, and other critical literature for each transdisciplinary foundationand practice dimension have been reviewed and included in this document. Moreover, separatebibliographies on attitudes and recovery have been added, as have lists of Internet and culturalcompetency resources. These can be found in section 3.AppendicesAppendices 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 forliterature searches (appendix D), and a list of people who acted as field reviewers or providedresearch assistance (appendix E).Companion Volume—TAP 21-AAs a companion to this volume on counselor competencies, CSAT is publishing TAP 21-A,Competencies for Substance Abuse Treatment Clinical Supervisors, which discusses the qualitiesand abilities integral to supervising substance abuse treatment clinicians.USES OF THE COMPETENCIESSince its inception, The Competencies has been improving addiction counseling and addictioncounselor education across the country in a number of ways. The most common reportedapplications have been in curriculum/course evaluation and design for higher education;personal professional development; student advising, supervision, and assessment; assessmentof competent practices; design of professional development and continuing education programs; and certification standards/exams. Examples of how The Competencies is being usedare given on the following pages:Montana . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24Illinois . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31Nebraska. . . . . . . . . . . . . . .

Institute for Addiction and Criminal Justice Studies. This distance learning course package was developed for CEU Matrix by John H. Tinsley, Ph.D. It is based on information found in the manual Addiction Counseling Competencies: The Knowledge, Skills, and Attitudes of Professional Practice (TAP 21) from the Substance Abuse and Mental Health .