Annual Review of Addictions and Offender Counseling, Volume III: Best Practices

Annual Review of Addictions and Offender Counseling, Volume III

Best Practices

Edited by

Pamela S. Lassiter

and Trevor J. Buser

Annual Review of Addictions and Offender Counseling Volume III

Best Practices

Copyright © 2017 Wipf and Stock Publishers. All rights reserved. Except for brief quotations in critical publications or reviews, no part of this book may be reproduced in any manner without prior written permission from the publisher. Write: Permissions, Wipf and Stock Publishers, 199 W. 8th Ave., Suite 3, Eugene, OR 97401.

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Table of Contents

Title Page

Chapter 1: Editorial

Chapter 2: Synthetic Drugs

Chapter 3: Beyond the Prescription

Chapter 4: Social Skills Training for Male Youth in Treatment for Substance Use Disorder

Chapter 5: Promoting Resilience in Children of Alcoholics

Chapter 6: The Professionals and Procedures Involved in Drug Courts

Chapter 7: Avatar Assisted Therapy

Chapter 8: Best Practices in Counseling Gay Male Youth with Substance Use Disorders

Chapter 9: The Importance of Storytelling for Older Women in Alcoholics Anonymous

Chapter 10: The Impact of Addictions Education on Attitudes of Students

Chapter 11: Wearing their Shoes

Chapter 12: The New Leaf Experience

1

Editorial

The Annual Review of Addictions and Offender Counseling, Volume III: Best Practices is the third volume in a series of peer-reviewed edited books sponsored by the International Association of Addiction and Offender Counselors (IAAOC), a division of the American Counseling Association (ACA). All of the articles included in this volume have been peer reviewed by the Editorial Board of the Journal of Addictions and Offender Counseling (JAOC). As a product of IAAOC, the mission of the Annual Review is to produce high quality publications representing practice-focused scholarship and innovations in the field. Continuing the mission of the first two volumes, this volume provides a forum for publications addressing a broad array of topics in the field of addictions and offender counseling, including drug education, intervention strategies, multicultural considerations, and counselor education.

The following section provides a description of each chapter included in this volume.

Synthetic Drugs: What School and Mental Health Counselors Need to Know

LaShauna M. Dean

This chapter provides information on synthetic drugs, specifically Spice, Bath Salts, and Flakka. Dosage, legal, and historical information are discussed and common effects and trends of each drug are addressed. Implications for counselors are also provided.

Beyond the Prescription: The Other Side of Opioid Painkillers

Shainna Ali, Gulnora Hundley, and M. Kristina DePue

Counselors should be aware of the national prescription opioid pandemic, knowledgeable about implications for users and society, and familiar with and skilled in the necessary methods of assisting clients with dependence on painkillers. This chapter provides essential information for counselors concerning use, misuse, and abuse of opioids in order to effectively assist clients.

Social Skills Training for Youth in Treatment for Substance Use Disorder

Oksana Kravets and Jenepher Lennox Terrion

Social competence is both a protective factor and a risk factor for substance use disorder in adolescent males so providing training in social skills development should be part of addiction counseling efforts. This paper recommends training approaches and techniques to be used in addiction and offender counselling.

Promoting Resilience in Children of Alcoholics: A Family Perspective

Shaywanna Harris and S. Kent Butler

Children of Alcoholics (COAs) research has provided pertinent data on risk and protective factors as well as best practices and interventions that may promote resilience within this population. Familial relationships have been identified as a major protective factor for COAs, however, research promoting family therapy as an enhancement to resilience is scarce. The purpose of this chapter is to provide counselors with a current resilience-based and alcoholism-focused family therapy model and interventions that may improve resilience in COAs.

The Professionals and Procedures Involved in Drug Courts

John T. Petko

Counseling students who graduate from programs have coursework on addiction counseling but are often unfamiliar with the processes that are involved in drug courts. This chapter provides a brief history of drugs courts, defines what a drug court is, and identifies the processes that are involved in drug courts as well as the professionals who comprise the drug court team. Resources for counselors working in drug courts are provided.

Avatar Assisted Therapy: A Novel Technology Based Intervention to Treat Substance Use Disorders

Michael S. Gordon, Steven B. Carswell, Erica N. Peters, Susan Tangires, Timothy W. Kinlock, Frank J. Vocci, and Lauren Restivo

Avatar assisted therapy (AAT) allows treatment providers and clients to interact from separate and remote locations in real time via a web based platform using avatars, which are digital self-representations within virtual environments. This chapter discusses this novel technology based intervention, including its strengths and limitations. Initial results of a pilot study (N = 54) suggest that AAT is a feasible means of providing substance abuse counseling via the Internet and there was significant patient interest in participation based on scheduling convenience and the ability to be anonymous.

Best Practices in Counseling Gay Male Youth With Substance Use Disorders

Michael D. Brubaker and Michael P. Chaney

Substance use rates are higher among gay male youth than their heterosexual counterparts, often corresponding with high-risk behaviors that compromise their health and well-being. This chapter explores the etiology of substance abuse among this population and recommends best practices to effectively treat gay male youth. A case study demonstrates the application of gay-affirming treatment principles. Clinical implications and future directions are discussed.

The Importance of Storytelling for older Women in Alcoholics Anonymous

Lauren S. Ermann, Gerard Lawson, and Penny L. Burge

This phenomenological study explores storytelling and older women in Alcoholics Anonymous (AA). Results suggest a number of significant benefits associated with both recounting and listening to stories in AA. Implications for counselors are discussed.

The Impact of Addictions Education on Attitudes of Students:

Amanuel Haile Asfaw, Kevin Vance, Kyoungho Lee, David Meggitt, Jane Warren, Jennifer Weatherford, and Grant Sasse

Negative attitudes and beliefs towards addictions can impair effective interventions; education enhances empathy and intervention skills. This study measured changes in addictions attitudes in Master’s students for two years following completion of a 15-week addictions counseling course. Treatment optimism scores increased significantly.

Wearing their Shoes: Creating Counselors’ Understanding of Addiction through Empathy

Christina Rosen and Geoffrey G. Yager

Empathy is an essential building block to an effective therapeutic alliance. Empathy is particularly crucial for substance abuse counselors. This chapter describes a self-instructional approach assisting counselors to develop awareness of themselves and of their clients’ internal world.

The New Leaf Experience: College Student Substance Use Treatment and Addiction Counselor Training Clinic

Amy E. Williams, Eleni M. Honderich, and Charles F. Gressard

The history of a college-based substance abuse clinic (New Leaf) is described. Along with servicing college students, the clinic provides training in motivational interviewing (MI) and supervision for counseling students alongside opportunities for conducting research. Considerations for developing similar programs are included.

Acknowledgements

As editors, we would like to acknowledge the excellent work of the JAOC Editorial Board. Their careful reviews and wise advice helped our authors refine their work in meaningful ways, raising the quality of each contribution. The JAOC Editorial Board includes the following dedicated professionals:

Lyndon Abrams, The University of North Carolina at Charlotte

Shainna Ali, University of Central Florida

Wanda P. Briggs, Winthrop University

Kathleen Brown-Rice, University of South Dakota

Michael Chaney, Oakland University

Rochelle Cade, Mississippi College

Christine Chasek, University of Nebraska at Kearney

Philip Clarke, Wake Forest University

Angela Colistra, Drexel University

John Culbreth, The University of North Carolina at Charlotte

M. Kristina Depue, University of Florida

Kevin Doyle, Longwood University

Susan R. Furr, The University of North Carolina at Charlotte

Sandy Gibson, The College of New Jersey

Amanda Giordano, The University of North Texas

Kristopher M. Goodrich, University of New Mexico

Shaywanna Harris, University of Central Florida

Leigh Falls Holman, The University of Memphis

Melanie Iarussi, Auburn University

Nathaniel Ivers, Wake Forest University

Dayle Jones, University of Central Florida

Gerald A. Juhnke, The University of Texas at San Antonio

John M. Laux, The University of Toledo

Todd F. Lewis, North Dakota State University

Gabriel I. Lomas, Western Connecticut State University

Virginia Magnus, University of Tennessee at Chattanooga

Keith Morgen, Centenary College

Samir Patel, Murray State University

Dilani Perera-Diltz, Lamar University

Christina Hamme Peterson, Rider University

Edward Wahesh, Villanova University

Joshua Watson, Texas A&M University-Corpus Christi

Additionally, we would like to offer special thanks to Corrine C. Rutt, Daniella L. Muller and Mena S. Farag (Editorial Assistants) from Rider University and to Dr. Kathleen Brown-Rice (JAOC, Assistant Editor) for all of their hard work in the editorial and manuscript management process.

Pamela S. Lassiter

Department of Counseling

The University of North Carolina at Charlotte

Charlotte, North Carolina

Trevor J. Buser

Department of Graduate Education, Leadership, and Counseling

Rider University

Lawrenceville, New Jersey

2

Synthetic Drugs

What School and Mental Health Counselors Need to Know

LaShauna M. Dean

¹

Synthetic Drugs

Synthetic drugs include a variety of man-made, synthesized drugs. This article will focus on Spice, Bath Salts, and Flakka. This class of drugs has rapidly become a public health crisis, with over 400 overdoses being reported on the East Coast alone since April 2015 (New Jersey Regional Operations Intelligence Center Drug Monitoring Initiative, 2015 ). Additionally, synthetic drugs have been labeled the emergent drug of abuse among college students and young adults, making synthetics a necessary class of drugs to understand for counseling professionals (Hu, Primack, Barnett, & Cook, 2011 ; Saha, Wilson, & Adger, 2012 ; Van Pelt, 2012 ). All of the synthetic drugs in this class share the commonalities of being highly addictive, unpredictable in their effects, and having an ever-changing list of chemical compounds in their ingredients. This article will provide background and dosage information, will review physical and mental health effects, and rates of occurrence for each drug. Educational and clinical implications for counselors will be addressed as well.

Spice

Spice is a synthetic cannabinoid originally created to study how marijuana affects brain function in the relief of chronic pain by scientist, John W. Huffman (Zucchino, 2011). Huffman and colleagues at Clemson University created a compound that chemically replicated the effects of the active ingredient in marijuana, Tetrahydrocannabinol. Hoffman reported that he never intended for the synthetic marijuana he created to be used as a new drug on the market, but somehow the formula got into the hands of illegal drug producers and became available on the market in the mid 2000’s (Cohen, 2014; Zucchino, 2011). Since then, Spice has been widely used by people who were seeking to avoid detection on urine drug screens, primarily those in the criminal justice system, adolescents and young adults, and individuals in the military (Cohen, 2014; Substance Abuse and Mental Health Services Administration [SAMHSA], 2014). Spice is difficult to detect on urine and blood drug tests due to the changing chemical structure of the drug. As manufacturers of the drug alter the chemical compounds in Spice, drug-testing companies have a difficult time creating tests that will identify those compounds.

The psychoactive chemicals in Spice are sprayed onto shredded plant materials and sold in small packets (Saha et al., 2012; SAMSHA, 2014). Users can then either roll it in traditional wrapper-paper used in marijuana joints for smoking or they can add it an e-cigarette to be vaporized. Unfortunately, the actual chemical formula of Spice is unknown as producers are constantly changing the compounds used to avoid detection by government officials (SAMSHA, 2014; Van Pelt, 2012). This presents one of the greatest dangers to users, as there is no set list of chemicals in each Spice packet (Papanti et al., 2013). In 2011, the Drug Enforcement Administration (DEA) placed a temporary ban on the five most commonly found synthetic marijuana compounds: JWH-018, JWH-073, JWH-200, CP-47,497, and cannabicyclohexanol (SAMSHA, 2014). In July 2012, a full federal ban was enacted on synthetic marijuana making it a Schedule I drug, meaning that it is highly addictive and has no medical value (SAMSHA, 2014).

Spice is easily obtainable on the Internet and in neighborhood stores. It is typically more expensive than marijuana, with 2.5 grams costing around $30, making it more popular among White and Hispanic males from more affluent families (Cohen, 2014; Stogner & Miller, 2014). It is being marketed as not for human consumption to avoid the application of the Analogue Act. According to Cohen (2014), the Analogue Act states that analogues, which are similar versions of other scheduled drugs, can be treated as a controlled substance if its effects are similar to or greater than the original drug its meant to mimic. By labeling Spice, and other synthetic drugs, as not for human consumption, drug manufactures were able to largely avoid federal prosecution. It is commonly sold under names such as: K2, Spice, Spice Gold, Skunk, Yucatan Fire, Zen, Cloud Nine, Artic Synergy, Black Mamba, Mr. Nice Guy, Natures Organic, Genie, and Bombay Blue (Papanti et al., 2013; SAMSHA, 2014, p. 1).

Effects of Spice

Users of Spice have reported experiencing short-term symptoms such as dry mouth, dehydration, rapid heart rate, nausea and vomiting, agitation, seizures, confusion, and heart attacks (National Institute on Drug Abuse [NIDA], 2012a; Saha et al., 2012; SAMSHA, 2014). Spice often has severe psychoaffective effects such as euphoria, anxiety, aggression, sadness, paranoia, delusions, hallucinations, and psychosis (NIDA, 2012a; Saha et al., 2012; SAMSHA, 2014). In fact, Papanti et al. (2013) coined the term spiceophrenia which is a state of psychosis characterized by hallucinations and delusions in chronic and acute users of synthetic cannabinoid (p. 379). The long-term effects of spice are largely unknown as this is a relatively new drug on the market (SAMSHA, 2014). However, it is important to note that the chemist who created the chemical compounds commonly found in Spice has warned about the long-term consequences of use, saying that serious and unpredictable psychological effects are possible (Cohen, 2014; Zucchino, 2011, para. 14).

Deaths have been associated with Spice usage, with the Centers for Disease Control and Prevention reporting 15 deaths related to Spice usage in the first six months of 2015 (Kraft, 2015). These deaths are often caused by a reduced blood supply to the heart, which can lead to a heart attack (SAMSHA, 2014). Additionally, users have reported experiencing physical and psychiatric withdrawal symptoms as well as signs of addiction (SAMSHA, 2014; Wagner et al., 2014). These effects highlight the differences in marijuana use and the dangers of using synthetic cannabinoids, with the main differences being the increased potential for addiction, death, and severe and long lasting psychological effects seen in synthetic cannabinoids.

Occurrence

According to the 2012 Monitoring the Future Survey, Spice was the second most widely used substance among 10th and 12th graders after marijuana, and third among 8th graders after marijuana and inhalants (NIDA, 2012b). Part of its popularity among younger individuals could be due in part to marketing (Cohen, 2014; SAMSHA, 2014). Packets of Spice are widely available on the Internet and local stores (i.e. convenience stores, gas stations, and local smoke shops) and are sold with very misleading labels such as pictures of Buddha, serenity, and nature, leading users to believe that it is organic, safe and legal (Cohen, 2014). However, these marketing strategies are extremely misleading as it is highly addictive and causes a more intense and prolonged high than marijuana (SAMSHA, 2014).

Calls to US poison control centers regarding negative reactions to the drug increased by 330% from January 2015 to April 2015 according to the Centers for Disease Control (as cited by Law, Schier, Martin, Chang, & Wolkin, 2015). This is not surprising as SAMSHA (2014) reported that spice is four to 100 times more potent than the psychoactive ingredient found in marijuana, and often lacks the antipsychotic properties found in marijuana, a fact that many users may not know. In addition, the overall effects of the drug are largely unknown due to the changing combination of ingredients used in synthetic cannabinoids (Cohen, 2014; Wagner et al., 2014).

Bath Salts

Bath salts are synthetic cathinones that replicate the effects of amphetamines (NIDA, 2015a; SAMSHA, 2014). Cathinone occurs naturally in the Khat plant, which is a flowering evergreen shrub native to East Africa and the Arabian Peninsula, and acts as an amphetamine-like stimulant (SAMSHA, 2014). The active ingredient in bath salts is Methylenedioxypyrovalerone (MDPV), which was designated a Schedule I drug by the DEA (Office of National Drug Control Policy, 2015). MDPV is reported to be ten times stronger than cocaine (Marder, 2015; NIDA, 2015a). Methylone (Methylenedioxy-N-methylcathinone) is another common active ingredient found in bath salts (Wagner et al., 2014); MDVP is more expensive and potent whereas Methylone is less expensive and requires higher doses for the intended high (Wagner et al., 2014; Winder, Stern, & Hosanagar, 2013. However, while the main chemicals in bath salts have been banned, manufacturers are expected to create chemically similar ingredients, by making minor changes to the original chemical formula, with the aim of evading the legal restrictions, making this an extremely dangerous and unpredictable drug to use (NIDA, 2015a).

Bath salts have the appearance of crystallized rocks or as white or off-white powder and can be smoked, injected, or snorted (NIDA, 2015a; SAMSHA, 2014). Saha et al. (2012) additionally reported that some users are using bath salts rectally. Similar to Spice, it is commonly sold online and in local neighborhood stores under names such as: Ivory Wave, Blow, Red Dove, and Vanilla. Typically, packets of bath salts range in dosage/concentration of between 200-500 mgs and retail for between $20 and $75 (Cohen, 2014; Miotto, Striebel, Cho, & Wang, 2013). Again, the label not for human consumption is used to avoid federal regulation (Miotto et al., 2013, p. 2). Bath salts often look like commonly used bath products or aromatic potpourri, deceptively leading users to feel that can be used to relax the user in a safe way (Miotto et al., 2013).

Effects of Bath Salts

The most common effects of bath salt use are psychoaffective effects which include severe paranoia, delirium, delusions, anxiety which can trigger panic attacks, anger, stimulation resulting in a decreased need for sleep, self-injurious behavior, psychosis, and violent, aggressive behavior (NIDA, 2015a; Saha et al., 2012; SAMSHA, 2014). These psychoactive symptoms have been described as horrible with users reporting seeing demons, monsters, and foreign soldiers or aliens (Allegany Health Department, 2015). However, the most notable effect of using bath salts is violent and self-injurious behavior. Marder (2015) reported on a 21-year old male named Dickie Sanders who reportedly had no prior history of mental illness. However after ingesting bath salts in November 2010, he experienced strange and psychotic behavior for five days which included having a frightening delusion that 25 police officers were outside of his house, leading him to slit his own throat. While he survived that suicide attempt and was reportedly feeling better, his psychotic symptoms reemerged and he fatally shot himself in the middle of the night, even after receiving treatment at a hospital for the hallucinations. That is one of many similar stories in which new psychosis or exacerbated psychosis has been reported following the use of bath salts, and while a causal link has not been established, further study is needed to understand the long-term psychiatric effects of bath salts.

Additionally, due to its similarity to amphetamines, bath salt usage also leads to several adverse physical health effects such as rapid heart rate, high blood pressure, muscle spasms, strokes, heart attacks, seizures, decreased appetite, severe perspiration, and a risk for organ failure due to the body temperature raising to dangerous levels (NIDA, 2015a; Miotto et al., 2013; Saha et al., 2012; SAMSHA, 2014). These effects are complicated by the problem of dosage variability, ranging from five to 90 mgs or more depending on the active ingredients in the product (Winder et al., 2013). Scientists tested one package of bath salts for the amount of MDPV and found only 17 milligrams while another package contained 2,000 milligrams accounting for the varied effects on users (Marder, 2015).

Occurrence

While reports indicate that synthetic cathinones were available in the 1920s, it reemerged on the Internet around 2008 and 2009 (Saha et al., 2012). Calls related to overdosing on bath salts have increased by 20 times between 2010-2011 according to the American Association of Poison Control Centers (Hu et al., 2011; Van Pelt, 2012). Additionally, this drug has been found to be prevalent in individuals in their twenties (Hu et al., 2011; SAMSHA, 2014; Van Pelt, 2012), with 63% of emergency room visits in Michigan, for example, being males between the ages of 20 and 29. Like the marketing for Spice, the packing for bath salts gives users the illusion that it is safe and can be used for stress-relieving properties. Common packaging includes words like euphoric and soothing are complimented by spa-like pictures of serene flowers and colors (Miotto et al., 2013). However, the adverse psychoaffective and physiological reactions are far from euphoric.

Flakka

Flakka is a relatively new synthetic that emerged on the market in 2010 (NIDA, 2015b). However, its history dates back to the 1960s when drug developers created it as a central nervous stimulant (Katselou et al., 2016). It is chemically similar to bath salts and is also a synthetic cathinone. The active ingredient in Flakka is Alpha-pyrrolidinopentiophenone (alpha-PDP), which was classified as a Schedule I drug and banned by the DEA in 2014 (NIDA, 2015b). Flakka derives its name from flaca meaning a thin, pretty woman in Spanish (Califano, 2015) and is sometimes called gravel. Flakka has the appearance of a white or pink, foul smelling crystal and is often sold under the labels of plant food, bath salts, stain removers, or jewelry cleaners (Katselou et al., 2016). Like the other drugs in the group, it is also labeled not for human consumption Users can eat, snort, inject, or more commonly vaporize it in an e-cigarette. Vaporizing Flakka sends the drug very quickly into the blood stream making an overdose more likely (Califano, 2015; NIDA, 2015b). Average doses/concentration of the drug vary depending on route of administration: 10mg if the drug is smoked; 35mg if taken orally; and 400mg if vaporized; however an effective dose starts at 100mg requiring users to sometimes take larger amounts for the intended effect (Katselou et al., 2016).

Effects of Flakka

Flakka has similar physical and psychoactive effects as bath salts (NIDA, 2015a). It also causes the body to overheat leading to many users stripping their clothes off. The noticeable difference occurs in a psychoactive state known as excited delirium (Glatter, 2015, para. 2). Excited delirium is a state of hyperstimulation and paranoia in which users experience hallucinations and violent, aggressive behaviors, and potentially multiple organ failure and abnormally rapid heart rate (Katselou et al., 2016). During this state, superhuman strength is also reported making it difficult for bystanders and/or police officers to subdue the individual (Califano, 2015, p. 28). Additional physical signs of adverse reactions which could lead to an overdose often include cardiovascular problems such as: hypertension, difficulty breathing, heart rhythm abnormalities and palpitations, and heart attacks (Katselou et al., 2016).

According to Miotto et al. (2013), most deaths involving cathinones occur after individuals experience excited delirium and other cardiovascular abnormalities. The effects of the Flakka usually last between three and four hours, however the effects can linger on for several days (Glatter, 2015). The NIDA and other sources have reported several deaths related to using Flakka, including heart attacks, death by suicide, and a premature baby who died after his mother used Flakka during her pregnancy (Alanez, 2015; Arnold, 2015; Katselou et al., 2016; Laughlin, 2015; NIDA, 2015b), making this another extremely unpredictable and dangerous drug.

Occurrence

Flakka is available worldwide however it is most prevalent in Florida, with other reported use in Texas, Ohio, and Tennessee (Califano, 2015; Glatter, 2015). Flakka is typically manufactured in China, Pakistan, and India and is available online in larger quantities, then sold on the streets for as little as five dollars. This highlights two major concerns of using Flakka; the first being that its low cost makes it more easily available and therefore easier to abuse (Rizzio & Rice, 2015). The second issue is that the contents and dosage within the packets are largely unknown so