Chapter 1

History of Addiction Counseling

As you read in the first chapter, the long histories of caffeine and alcohol are highly complicated and continue to be so. Various factors including but not limited to geography, religion, ethnicity, and finances, have at times, been directly related to the complexities on both a large scale as well as on an individual basis. 

At the individual level, some individuals may have no history with caffeine and/or alcohol, having never used either. This could be related to any number of reasons including religion, being raised in an environment where caffeine and/or alcohol are not used, other cultural factors, or lack of exposure or access. This could also be due to choosing to abstain as a result of having a loved one in recovery, for health reasons, or simply making a personal decision to abstain from one or both substances. 

Alternately, other individuals who do consume caffeine and/or alcohol may have developed fairly uncomplicated relationships with one or both of these substances, with no significant incidents with either, and an ability to imbibe or not, at various times throughout life. Others still may have more complicated relationships with caffeine and/or alcohol, that may have historically been complicated or that have become more complicated at various times. 

My Personal History with Caffeine and Alcohol

To further consider your own relationship with caffeine and alcohol, please take some time to briefly document your personal history with caffeine and alcohol (not more than 1-2 pages for each), identifying various aspects of your relationships with these most popular substances. To do this, use the below bullet points to prompt you, adding in any other thoughts or reactions you have to develop your own history with these two substances:

·       Your earliest memories of caffeine and alcohol;

·       Early messages you may have received about each from family, religion/faith, media, peers, others;

·       Your first use/experience of each (if applicable);

·       Your relationship with each substance up to present day including any challenges or difficulties and/or special memories;

·       Any particular associations you have developed with each substance (e.g., coffee and work; alcohol and certain gatherings);

·       The role that various factors have played related to your use of the substance, such as geography, personal finances, time in life, religion, peers, family, health, etc. 

·       Any times you have stopped and/or stopped and started using the substance; 

·       Any perceived costs and/or benefits you identify with the substance to your life;

·       The role that each play in your life today and any connections you now have with the substance and family, friends, religion, 

·       The particular importance or lack thereof that the substance has for you today and why;

·       Anything else you wish to share about your relationship with each substance.

After you have developed your personal histories with both substances, take a minute to read through each and consider the following:

1. What, if anything, surprises you about what you documented?

2. Are you content with your current relationship with each substance?

3. If not, consider if and what you might do to become more comfortable with each substance and the role that is has in your life today. 

4. What, if any, benefit did the process of reflecting back on your histories with these substances have for you? 

Case Study

Kendra is a first-year graduate student in the Addiction Counseling program. She earned a bachelor’s degree in social work four years ago and has been working as a case manager in a foster care program since she graduated. One of the common issues she has witnessed in her work so far has been the number of birth parents who struggle with addiction—some of who have lost custody of their children as a result. However, Kendra has also noticed that the child welfare system is not equipped to directly provide treatment and/or services related to substance use. Rather, Kendra’s work largely focuses on ensuring the immediate needs of the children on her caseload are being served and providing some resources to connect birth parents and caregivers to as they try to reunify with their children. For birth parents struggling with addiction, this typically meant providing information about the local community mental health organization, a list of potential therapists, and the web resources to locate local 12 step meetings. Kendra has asked her supervisor what more their program could do to address addiction and has also raised the issue with peers, but is consistently reminded that addiction is not the focus of foster care, or the child welfare system, and that the system is already overburdened. 

During her work as a case manager, Kendra has also often been told that she is a really good listener, and that she is easy to talk to. This did not surprise Kendra since her friends had often told her that she is who they turn to most for advice. Having continued to hear this, and also realizing that she wanted to do more directly to help individuals through her work, had propelled Kendra to pursue graduate work in Counseling. She was intent on becoming a therapist and knew Counseling was a route she could take to do so. And, during her time exploring various academic programs, Kendra had found an Addiction Counseling program which would allow her both to become licensed as a mental health therapist and also to gain a specialty in addiction counseling. 

Her first two semesters of graduate school had already reinforced Kendra that she had made the right decision, and she was enjoying all that she was learning. Of course, she had also learned early on that therapy does not involve advice-giving, but rather using specific skills and interventions to assist individuals in achieving the change they wished to attain. Being in graduate school also made Kendra’s work in foster care that much more meaningful, and she had felt even more connected to her work since she began graduate school.

One of Kendra’s professors had discussed professional identity in class, and encouraged students to become connected to professional associations at both the state and national levels. Kendra had joined the National Association of Social Workers (NASW) when she was an undergraduate student but was not familiar with other professional associations. Kendra was intent on joining the American Counseling Association. But, she also wanted to explore other relevant professional associations that would further help her to fully embody her professional identity as a counselor as well as a therapist specializing in addiction. In addition, she already considered herself a foster care worker and was interested in deepening her connections to both foster care and the broader child welfare system. 

1. Review the American Counseling Association website to learn about the resources and benefits of membership, and consider joining.

2. Learn more about the International Association for Addiction and Offender Counseling, including the resources and benefits of membership, and consider joining.

3. Explore other professional associations relevant to individuals specializing in addiction treatment, and determine what might be most appropriate for you to join at this time or later.

4. Visit the Substance Abuse and Mental Health Services Administration (SAMHSA) website, and explore the site for various resources.

5. Explore your own state’s professional counseling association to learn about the resources and benefits of membership, and consider joining.

6. Consider if you have other aspects of your professional identity that you may wish to become more connected to just as Kendra is interested in becoming more connected in the child welfare system. And, if so, explore the relevant professional association to determine how you might become more engaged.

Reflection Questions

1. One of the unique factors in the field of addiction treatment is the number of recovering individuals who pursue work in it which differs significantly from other health-related fields. What do you believe are the benefits and potential challenges related to this?

2. What do you believe the next major piece of substance-related or addiction treatment-related legislation should specifically address?

Chapter Quiz

1. Both caffeine and alcohol are considered stimulants. 

   ___ True

   ___ False

2. Both caffeine and alcohol impact the central nervous system.

   ___ True

   ___ False

3. The effects of a psychoactive substance are often related to the substance type, dosage and the concentration of the substance in the body.

   ___ True

   ___ False

4. Schedule I substances are categorized as those with the least potential for abuse while Schedule V substances have the highest potential for abuse.

   ___ True

   ___ False 

5. Medical marijuana was first approved for use in a U.S. state in 1988 while the first state passed a law approving recreational use of marijuana in 2020.

   ___ True

   ___ False 

6. A requirement for a peer recovery coach is to also be in recovery whereas a sponsor for someone in AA does not need to be in recovery.

   ___ True

   ___ False

7. Alcoholics Anonymous was established in which decade:

   1. 1930’s

   2. 1940’s

   3. 1950’s

   4. 1960’s

   5. None of the above 

8. ____ is the most used psychoactive substance in the world today.

   1. Opioids

   2. Cocaine

   3. Alcohol

   4. Caffeine

   5. Marijuana

9. The first known self-help recovery group focused on alcohol in the United States was:

   1. Alcoholics Anonymous

   2. Daughters of Temperance

   3. Brothers of Temperance

   4. The Washingtonians

   5. The Franklin Society of Alcoholics

10. All but which substance have historically been both banned (i.e., prohibited) and permitted for use in the U. S. 

    1. Opioids

    2. Alcohol

    3. Marijuana

    4. Caffeine

    5. None; each has been both banned and permitted

11. Which type of opioid is responsible for the majority of overdose deaths in the U.S. since 2024:

    1. Opioids prescribed for dental care

    2. Heroin

    3. Opioids prescribed for medical care 

    4. Illicitly manufactured fentanyl

    5. None of the above

12. What do the Opium Act, Marihuana Act, and Harrison Act have in common?

    1. Each was designed to address a specific substance

    2. Each passed after 1950 

    3. Each is a state law that was passed in a western state

    4. Each passed after 2000

    5. None of the above

13. What is a unique feature of the Boggs Act?

    1. It established mandatory minimums for substance-related offenses

    2. It was designed to specifically address methamphetamine-related offenses

    3. It was designed to specifically address opioid-related offenses

    4. It was the first major substance-related legislation passed in 2000 

    5. All of the above 

14. The first mandatory minimum law required mandatory minimum sentences of:

    1. 6 mos. to 1 year

    2. 1-2 yrs.

    3. 2-5 yrs.

    4. 3-5 yrs.

    5. 5-7 yrs. 

15. The first mandatory minimum law included the following:

    1. Related to the possession, distribution and manufacturing of illegal substances

    2. Allowed for a waiver of minimum sentencing guidelines based on ethnicity

    3. Minimum sentences were different based upon type of substance-related offense

    4. All of the above

    5. a and b 

16. What do the Mental Health Parity and Addiction Equity Act and the Patient Protection and Affordable Care Act have in common?

    1. They were both signed in to law by President Clinton

    2. They were both signed in to law by President Obama 

    3. Each established greater parity for mental health and addiction treatment

    4. All of the above

    5. b and c

17. The International Certification and Reciprocity Consortium:

    1. Is the largest credentialing organization for addiction professionals

    2. Credentials entry-level peer recovery coaches as well as clinical supervisors with advanced degrees

    3. Has been around for more than 50 years

    4. Informs state certification requirements

    5. All of the above 

18. Identify two ethnic groups that were specifically and intentionally targeted by mandatory minimum sentencing laws in the U.S.

18. What did the Controlled Substances Act establish that is still widely used today?

19. Briefly explain what is meant by “professionalizing” the addiction treatment field.

20. Identify two professional associations for addiction professionals.