Client perceptions of the ideal addictions counselor.

Addicted persons in a residential treatment center rated the traits which they felt were the most positive and negative in a counselor. Lists of traits were developed by having one group of clients make a list, in their own words, of positive and negative traits. These traits were compiled into lists from which other groups of clients rated the top 10 positive and the top 10 negative counselor traits. Profiles were developed for eight subgroups (Males, Females, Black Clients, White Clients, Alcoholics, Cocaine Addicts, Younger Clients: 18-23 years old, and Older Clients: 43+ years). Significant differences were found in the type of counselor preferred by various groups within the sample. The data suggest that addicted persons, while using colorful and imprecise language, have definite preferences and aversions toward certain counselor traits. These findings should be useful to counselors as well as those involved in training programs.

The mentally ill substance abuser: challenges for the administrator.

Despite a high incidence of dual diagnosis among substance abusers and among the mentally ill, few programs provide the comprehensive services needed to address both problems simultaneously. Dual diagnosis presents a series of challenges for administrators: Which problem should be addressed first? Should admission criteria be altered to exclude such clients? Can more comprehensive services be offered within existing funding? Differences between the two domains of treatment exacerbate their inability to work together. Substance abuse programs often employ "recovering" individuals as treatment staff and offer relatively brief inpatient programs, often using confrontational approaches. Self-help groups are frequent adjuncts to treatment but disdain the use of prescribed medications. In contrast, programs for the chronic mentally ill usually do not employ former clients, have longer lengths of stay, include use of medications to alter behavior, and are more supportive and educational. Overcoming barriers to treatment must involve change in policies related to funding, staff training, admission criteria and differences in philosophy of treatment.

Antecedents of relapse and recent substance use.

The present study investigated determinants of relapse and antecedents of recent use for 30 substance abusers re-entering inpatient treatment. A structured interview assessment revealed that the patients relapsed within two months following previous treatment, yet waited 2.7 years before re-entering treatment. Alcohol was often the initial and subsequently the most frequently used substance. Determinants of relapse were a variety of interpersonal and intrapersonal events. However, antecedents to recent use were almost exclusively negative emotional states such as depression and loneliness. Implications for treatment are presented.