Monitoring Drug Use Behaviors

Give a frequency rating of 4 (or above) if this occurs and a rating of 1 if it does not. A frequency rating of 4 may be given even if the counselor does not explicitly ask about cocaine use (i.e., "Have you used any drugs at all since we last met?"). A lower quality should be given in this instance, however. To receive a high quality rating, the monitoring must be done at the beginning of the session.

Give a frequency rating of 4 (or above) if this occurs and a rating of 1 if it does not. Rate quality according to how completely and competently it is covered. To receive a high quality rating, the counselor must do a full drill at the beginning of the session and establish the date of last use.

At least one specific question must be asked to get a rating of 4 or above. Sample questions: "Did you want to use this week?" or "Did you have any cravings/urges this week?"

The situations must be explicitly tied into drug use to get a rating of 4 or above.

The feelings must be explicitly tied into drug use to get a rating of 4 or above. Sample question: "Have those feelings led you to pick up?"

This must occur specifically within the context of a discussion on withdrawal/postacute withdrawal symptoms. To receive a rating of 4 or above, specific monitoring questions must be asked.

Encouraging Abstinence

To get a rating of 4 or above, the counselor must offer plans or suggestions or discuss concrete ideas.

If only implicit, do not rate frequency above 4.

This should be concrete, referring to the treatment plan and whether the client is doing what s/he agreed to do (i.e., meetings, group therapy, abstinence, phone calls, etc.).

This refers to past or progressing consequences, rather than future or possible ones. Also, consequences should relate directly to the client.

Encouraging 12-Step Participation

Includes frequency of attendance and type of group.

Includes suggesting that the client get a sponsor, attend more meetings, attend different types of meetings, etc.

Relapse Prevention

Stressors refer to any ongoing external situation to which the client must adapt (e.g., employment, relationships, kids). The counselor must specifically tie the stressor into recovery (e.g., "Does that make you want to use?" "What can you do instead of using?" "How does this affect your recovery?" "Has this led you to use in the past?") to receive a rating of 4 or above. If the patient complains but the counselor does not respond, F=1. Frequency reflects the presence of discussion, and quality reflects the helpfulness of discussion.

This includes the people, places, and things of the relapse (i.e., what happened when the relapse occurred).

This should occur in the context of relapse prevention and includes identifying specific relapse symptoms. Changes in thoughts, attitudes, and behaviors count as relapse symptoms.

Includes questions, such as "How can you interrupt it?" and "What can you do differently?" as well as interventions, such as formulating safety or crisis plans. An actual relapse does not have to have taken place; change in attitude, behavior, and thinking counts here as part of the relapse process.

Educating The Client

Includes talking about the stages of addiction, tolerance, diagnostic criteria, etc., in a didactic manner that is informative and declarative.

Miscellaneous

If this behavior does not occur (F=1), rate quality low only if it is clear that the patient does have feelings of anger that need to be addressed. If the patient explicitly states that s/he is angry and the counselor ignores it, rate F=1, Q=1. If the patient implies that s/he may be angry (e.g., describes a situation in which a person would typically be angry) and the counselor ignores it, rate F=1, Q=3. If the patient does not mention anything in the session that indicates there may be anger issues, rate F=1, Q=4. For F > 1, the counselor must offer concrete suggestions for how to deal with anger to receive a quality rating of 4 or above.

To receive a rating of 4 or above, the counselor must suggest concrete behavioral changes tailored specifically to the patient and her/his circumstances.

If this behavior does not occur (F=1), rate quality low only if it is clear that the patient does have a compulsive behavior that needs to be addressed. Quality ratings depend both on the counselor's response and the degree to which a problem seems to be present. If the patient explicitly states that s/he has a problem with a compulsive behavior and the counselor ignores it, rate F=1, Q=1. A rating of F=1, Q=4 is equivalent to N/A, meaning that the counselor does not address the problem, and there does not seem to be a problem to discuss. As Q approaches 1, it becomes more obvious that there is a problem. For Q > 4, the therapist must address the problem, and Q approaches 7 as the intervention becomes more helpful.

This item only refers to family issues that are related to drug use and/or other negative behaviors. The focus must be on the way that these issues affect the patient. The counselor must explore the ways in which family issues relate to recovery for Q > 4.

Things That Should Not Be Done

Refers to the cognitive model in which the therapist identifies the dysfunctional cognitions and then engages the client in a cognitive process of developing cognitive coping strategies.

Summary

A rating of 4 means that the counselor was an acceptable IDC counselor. A rating below 4 means that the counselor was unacceptable in some way - s/he did not adhere to the IDC manual, exhibited inappropriate behavior, was a poor counselor, etc. A rating above 4 means that the counselor was an especially good IDC counselor.

How difficult do you think this patient was to treat? If the patient was easy, rate her/him low (1, 2, or 3). If the patient was difficult, give a high rating (5, 6, or 7). A rating of 4 means that the patient was of about average difficulty.

Treatment Modality

How confident are you of your answer?

How confident are you of your answer?

How confident are you of your answer?