Overview of Curriculum
Curriculum Options
The full certificate program includes all three of the tracks listed below. Participants can register for the full program or single tracks.
Track 1: Addictions Treatment Foundational Skills
It is understandable that individuals struggling with substance abuse problems are often highly ambivalent about engaging and committing to treatment and recovery, especially upon initial contact with a helping professional. The skills of engagement and enhancement of client motivation are thus critical for anyone seeking to effectively assist substance-involved populations. Additional understanding of and ability to appropriately assess individuals according to whole-person frameworks is also important. This set of learning session will focus on these foundational knowledge and skill areas, as well as touching on broad, well-established treatment approaches for successfully addressing addictive disorders.
1. Engagement, and Understanding Difficult Behavior Change
When improved service outcomes are sought in the behavioral healthcare field, the focus typically turns to upgrading the involved treatment modality. While attention to evidence-based treatment interventions is important, an increasing amount of rigorous research has found that the quality of the relationship between practitioner and service recipient is at least equally important, if not more so. This module reviews the evidence showing the impact of relational factors on treatment outcomes, and discusses demonstrated strategies for improving the interpersonal aspects of engagement and subsequent service delivery that impact outcome success.
Learning Objectives:
- Identify nine evidence-based relational elements and describe why valuing the client relationship is important.
- Describe the importance of engagement and how it relates to the entire therapeutic/treatment sequence.
- List the four variables in the "change equation" for difficult behavior, and their relative importance.
2. Stages of Change and Motivational Enhancement
One of the most significant contributions to the field of addictions treatment over the past decade has been the consideration of the client's stage of readiness to change. This module will explore the history and development of the seminal Transtheoretical Model of Change, and how that model has informed the subsequent "stages of treatment" framework embodied in the Substance Abuse Treatment Scale (SATS). Additionally, this module will cover the implications for intervention corresponding to various stages of change/treatment, the place of motivational enhancement, and how these perspectives can inform effective addictions treatment.
Learning Objectives:
- Identify six stages in the transtheoretical model of change.
- Describe why it is important to identify a client's stage of change before attempting treatment interventions.
- Describe the primary goals and types of interventions corresponding with the four stages of treatment.
3. Motivational Enhancement Skills I
Utilizing various content resources, including material developed and popularized by William R. Miller and Stephen Rollnick, this module is intended to provide an introduction to Motivational Interviewing for practitioners working with substance-involved clients. This training session will lay a foundation for participants to begin to develop their Motivational interviewing/enhancement skills in the service of better facilitating forward progress with substance-using clients who are ambivalent about making the behavioral changes necessary to appropriate sustainable recovery.
Learning Objectives:
- Describe the four phases of working with clients in the motivational interviewing framework.
- Identify the 5 strategic skills of motivational interviewing and describe how they are useful in working with ambivalent clients.
- Describe how the spirit of motivational interviewing is different from some traditional addictions treatment approaches.
4. Motivational Enhancement Skills II
Utilizing various content resources, including material developed and popularized by William R. Miller and Stephen Rollnick, this module is intended to provide basic Motivational Interviewing skill-building for practitioners working with substance-involved clients. This training session will deepen and advance participants' development of Motivational interviewing/enhancement knowledge and techniques in the service of better facilitating forward progress with substance-using clients who are ambivalent about making the behavioral changes necessary to appropriate sustainable recovery.
Learning Objectives:
- Distinguish between simple and complex forms of reflective listening.
- Describe ten techniques for evoking change talk.
- Distinguish between four types of preparatory change talk and three types of mobilizing change talk.
5. The Brain Chemistry of Addiction, Withdrawal and PAWS
Substances of abuse are often divided into the categories of Depressants, Stimulants, and Hallucinogenics. The use of substances from each of these categories lead to identifiable symptoms corresponding with intoxication and withdrawal syndromes. This module covers the symptom constellations of intoxication, acute withdrawal, and post-acute withdrawal from each of these substance types, including the neurochemical mechanisms of action underlying each one. Implications for understanding relapse and relapse prevention strategies will also be discussed.
Learning Objectives:
- Identify the acute withdrawal syndromes from depressant, stimulant, and hallucinogenic substances of abuse.
- Describe how neurochemistry functions in both intoxication and withdrawal syndromes and their associated symptoms.
- Describe three relapse prevention strategies, and how to address the challenges of post-acute withdrawal from various substances.
6. The Twelve-Step Model and other Peer-led Resources
The 12-Step model, originally developed as part of Alcoholics Anonymous, has a demonstrated history of success as an avenue of recovery for alcohol-dependent individuals, as well as widespread adaptation to address other substance and behavioral addictions. Yet the 12-Step model is not without its critics, and various other peer-led models have developed that embody some philosophical and other differences. This module will educate participants about the history and distinctive of the 12-Step model, its application to a variety of substance and behavioral addictions, and the potential goodness-of-fit for clients with the 12-Step approach and other models. Additionally, discussion will address strategies for building and utilizing connections with community-based, peer-led groups for the benefit of those receiving addictions treatment.
Learning Objectives:
- Identify the 12 Steps and 12 Traditions of Alcoholics Anonymous and their various wider applications.
- Compare and contrast the 12-Step model/approach with other peer-led models/approaches.
- Describe how to build and leverage partnerships with 12-Step fellowships and other peer-led support groups in the local community.
7. Cognitive Behavioral Approaches (CBT)
Cognitive-behavioral approaches in addictions treatment have had wide application, with demonstrated success. This module covers the basic principles and distinct elements of cognitive- behavioral therapy, as well as reviewing research findings on the application of CBT in addictions treatment, including Project MATCH. Additionally, participants will be provided with two manualized treatment intervention models for use with clients addicted to alcohol, and to cocaine.
Learning Objectives:
- Describe the efficacy findings of cognitive behavioral therapy from the Project MATCH research study.
- Identify five distinctive elements of cognitive behavioral therapy compared with other intervention models.
- Describe two evidence-based applications of cognitive behavioral approaches, for use with clients addicted to alcohol, and to cocaine.
8. Stage-matched Group Work
A variety of types of therapeutic group work have emerged in the addictions field, ranging from didactic formats, to skill-building sessions, to process-oriented work. This module will address the goodness-of-fit between these various types of group work and clients at various stages of addictions treatment. Additionally there will be opportunities for participants to be introduced to content/curriculum in support of providing each of the three levels of stage-matched group work.
Learning Objectives:
- Describe the differences between didactic, process, and skill-building treatment groups.
- Describe how utilizing three different types of group work enhances treatment effectiveness at different stages.
- Identify content/curriculum for use in delivering each of the three levels of stage-matched group work.
9. Behavioral Addictions
For the majority of time that addiction treatment has been available in the United States, the focus has been on the destructive misuse of alcohol and/or other chemical substances. However, “behavioral addictions” such as gambling, compulsive sexual behavior, and an increasing variety of internet-related pursuits have gained increasing amounts of attention, as unchecked involvement has led to negative outcomes that have impaired quality-of-life and level-of-functioning for many. This module defines a useful working definition of behavioral or process addiction, and addresses various treatment approaches that have been shown to be effective.
Learning Objectives:
- Outline a meaningful clinical, working definition of “addiction” that applies to both substance use disorders and behavioral/process conditions.
- Describe the leading candidates for consideration as behavioral/process addictions in the areas of gambling, spending money, eating, relationships, sexual behavior, and internet-related activities.
- Briefly describe approaches to treatment and recovery for behavioral/process addiction.
10. Transferring Addictions & Harm Reduction
The observed phenomena of individuals pursuing abstinence from a primary addictive substance or behavior sequentially replacing that addictive behavior with another is well-established. Understanding this "replacement addiction" equips treatment providers to more effectively intervene and support optimal recovery outcomes with those demonstrating this pattern. Harm reduction refers to strategies or interventions that are intentionally purposeful for treatment with individuals who are customers for such approaches, when they may be too ambivalent to pursue abstinence-based recovery. This module addresses both of these important topics in significant depth.
Learning Objectives:
- Describe 5 aspects of understanding replacement addiction.
- Define harm reduction and when it is ethically and clinically indicated as a treatment option in support of sustainable recovery.
- Describe the ways in which the so-called “opioid epidemic” has impacted harm-reduction strategies involving opiate replacement medications.
Track 2: Addictions Treatment Processes & Clinical Interventions
Successful treatment of addictive disorders typically includes various elements and processes that the effective practitioner needs to not only know about, but also to know how best to invoke those treatment elements in a manner that will be the best fit for each individual service recipient. Additionally, there are time-tested, evidence-based therapies with proven positive outcomes that practitioners would benefit from knowing about, either for direct provision or for the purposes of informing referrals. This set of sessions will focus on these learning targets, as well as equipping participants with the professional ethics knowledge and perspectives necessary for working with substance-involved populations.
11. Screening and Referral
Screening is oftentimes considered to be a quick and necessary prerequisite to the more sophisticated and involved work of addictions treatment, but does this view miss some important elements? Competent screening and informed referral are, in reality, critical steps in the overall process of assisting those who struggle with substance use disorders. This session will address the ways in which screening and referral represent key, initial intervention opportunities that set the course of what follows either well, or poorly.
Learning Objectives:
- Describe the six dimensions of the American Society of Addiction Medicine's Patient Placement Criteria (ASAM PPC-2R), and how they inform level-of-care determination and referral.
- Describe how screening is critically related to assessment and treatment planning.
- Identify five brief screening instruments and describe how they may be effectively utilized.
12. Treatment Orientation & Psychoeducation
Frequently intake/orientation is sometimes viewed as a check-list of motions to go through to get demographic and insurance information in support of subsequent treatment. However, intake/orientation can instead be approached as unique opportunities to engage with a client in a manner that will impact the success of the treatment that follows. This session will cover how "front-door" services can serve as valuable interventions in their own right, to begin to build therapeutic rapport, to identify stage-of-change and enhance motivation, to empower clients' ownership of their recovery, and to raise client awareness, all in the service of more successful treatment outcomes. Ongoing didactic psychoeducation interventions and materials will also be covered.
Learning Objectives:
- Describe the importance of providing a menu of treatment options during initial orientation to services.
- Describe how orientation and education are in themselves important interventions impacting subsequent treatment.
- Describe a comprehensive source of quality, low-cost, substance-specific educational materials and how to access them.
13. Multiaxial Assessment, Case Presentation and Treatment Planning
Positive treatment outcomes are predicated upon comprehensive, multiaxial assessment leading to accurate diagnosis followed by effective and engaged treatment planning. This module will review the importance of whole-person assessment, including appropriate application of diagnostic criteria for Substance Abuse and Dependence (from the DSM-IV) and Substance Use Disorder (from the DSM-5), and how multiple elements need to inform subsequent recovery-oriented, strengths-based, stage- matched treatment planning in the service of successful client outcomes.
Learning Objectives:
- Describe the 4 diagnostic criteria elements for Substance Abuse and the 7 criteria elements for Substance Dependence from the DSM-IV, and the changes to Substance Use Disorder diagnostic criteria in the DSM-5.
- Describe how assessment is critically related to treatment planning.
- Demonstrate how to conduct effective, recovery-oriented, strengths-based, stage-matched treatment planning.
14. Stages of Change and Treatment - Measuring and Documenting Progress
If recovery is real, individuals receiving effective addictions treatment will move forward through the stages of change/treatment toward increasingly successful and sustainable wellness and quality of life. This module will educate participants on how the "Stages of Change" model relates to the Stages of Treatment framework, how to recognize when clients are moving forward, and what adjustments in the treatment plan are indicated to support continuing forward progress. Reflecting client's forward movement through efficient, meaningful progress note documentation will also be discussed.
Learning Objectives:
- Identify the 6 stages of the Transtheoretical Model of Change align with the 8 stages of the Substance Abuse Treatment Scale (SATS), and describe how each are important, useful frameworks.
- Describe how to adjust stage-matched treatment planning as recovery occurs.
- Demonstrate how to write useful stage-matched progress notes.
15. Family Systems and Natural Supports
Substance abuse and dependence disorders have a profound effect on the family as well as the individual. Understanding how to treat family and natural support systems can improve relationship skills, interactions, and long-term outcomes. Effective treatment in a family context requires an understanding of the role of the family in the disorder. Family therapy strategies include changing maladaptive patterns of interacting with the individual with substance use disorder. Models, techniques, and principles will be presented as well as stages of motivation in treatment and recovery. Cultural issues pertaining to family involvement will be also discussed.
Learning Objectives:
- Describe how family systems theory informs the understanding of addiction as a "family disease" and associated treatment strategies.
- Identify the 3 concepts of enabling, codependence, and the Drama Triangle, and describe how to present these concepts to clients and "family" members, including family-of-origin, family-of-procreation, and family-of-choice.
- Identify available recovery support resources for family members, how to access them, and why they are important.
16. Detoxification Approaches and Strategies
How do "social" detoxification programs differ from "subacute" or "medically supervised" detoxification approaches? Which works better, going "cold turkey," or gradually tapering off with pharmacological support? Are there non-medication strategies for successfully supporting individuals through withdrawal and detoxification? This session will answer these questions and more, from a client-centered, recovery-oriented perspective.
Learning Objectives:
- Describe the differences between "social," "subacute," and "medical" detox, and when each of these 3 is indicated.
- Describe the pros and cons of the strategies of pharmacologically assisted detox vs cold turkey.
- Identify 5 psychosocial strategies used to support clients through withdrawal from different substance.
17. Motivational Enhancement Therapy (MET)
Motivational Interviewing concepts were converted into a manualized therapy approach dubbed "Motivational Enhancement Therapy (MET), as part of the large Project MATCH research project that compared outcomes between this approach, and other approaches based on cognitive-behavioral therapy, and twelve-step facilitation therapy. All were found to be effective for some clients some of the time. This session will equip participants to be able to deliver MET, as one intervention approach for use with good-fitting clients.
Learning Objectives:
- Describe the efficacy findings of Motivational Enhancement Therapy from the Project MATCH research study.
- Identify 5 distinctive elements of Motivational Enhancement Therapy compared with other intervention models.
- Describe scripted session guidelines for delivering the Motivational Enhancement Therapy intervention.
18. Twelve-Step Facilitation Therapy (TSF)
AA's 12-Step model for recovery from alcoholism was converted into a manualized therapy approach dubbed "Twelve-step Facilitation Therapy (TSF)," as part of the large Project MATCH research project that compared outcomes between this approach, and other approaches based on cognitive-behavioral therapy, and motivational enhancement therapy. All were found to be effective for some clients some of the time. This session will equip participants to be able to deliver TSF, as one intervention approach for use with good-fitting clients.
Learning Objectives:
- Describe the efficacy findings of Twelve-Step Facilitation therapy from the Project MATCH research study.
- Identify 5 distinctive elements of Twelve-Step Facilitation therapy compared with other intervention models.
- Describe scripted session guidelines for delivering the Twelve-Step Facilitation therapy intervention.
19. Contingency Management
Contingency management (CM) is a science-based method for increasing motivation to change. CM uses a system of incentives and disincentives to assist individuals in meeting their recovery goals. CM has been implemented with at-risk groups such as dually- diagnosed, homeless, pregnant women, adolescents, and criminally-involved individuals. Developing contingency management programs, maximizing community resources, and innovative ways to incorporate contingency management in drug courts, probation programs, and group treatment programs will be discussed.
Learning Objectives:
- Describe how the concepts of operant conditioning, and positive and negative reinforcement impact behaviors in the direction of addiction or recovery.
- Identify the 5 steps for designing an effective Contingency Management program.
- Describe what research findings indicate about the effective use of Contingency Management in addiction treatment.
20. Empowerment Case Management
Case management is a crucial skill for effective advocacy and service with individuals with substance use disorders. Providing empowerment-based case management within a social justice framework can serve to connect clients with needed resources and eliminate the prevalent stigma of substance use disorders in the community as a whole, and among medical and social service providers specifically. Advocacy and case management competencies as part of a holistic treatment process will be practiced.
Learning Objectives:
- Describe the difference between empowering and enabling and why it is important in treating addictive disorders.
- Identify 5 strategies in empowerment and advocacy for and with clients with substance use disorders.
- Describe the importance of case management services being aligned with overall treatment goals and efforts.
Track 3: Addictions Treatment with Complex & Comorbid Populations
As behavioral healthcare service delivery has become increasingly concerned with effective treatment for co-occurring mental health and substance use disorders, integrated care models, and dual-diagnosis-informed interventions have emerged and become well- established. The more recent acknowledgement of the importance of further integration with physical healthcare treatment services is also highly pertinent to successful and sustainable treatment of substance-involved populations. This set of learning sessions will focus on addictions treatment with individuals having complex and comorbid circumstances and conditions, including mental health, physical health, criminal justice, and trauma issues.
21. Dual Disorders Treatment Frameworks
It is becoming increasingly common that individuals presenting for treatment for substance use disorders also report struggling with one or more symptoms of an emotional or mental health disorder. Ever since 2002, the Department of Health and Human Services' National Survey on Drug Use and Health has shown findings that more respondents report having dual disorders than having only one or the other. Several frameworks have emerged to guide providers in the development and implementation of effective dual disorders treatment. This session will focus on 2 of the leading models, and what practitioners can learn to guide their own practice with dually disordered populations.
Learning Objectives:
- Identify the 26 domains of the Integrated Dual Disorders Treatment model, and which are most impactful.
- Identify the 7 domains of the "Dual Diagnosis Capability" framework for application to traditional substance abuse (DDCAT), mental health (DDCMHT), and primary care (DDCHCS) programs.
- Describe how to access useful cost-free information and resources to develop or enhance dual disorders treatment delivery.
22. Cultural Humility and Competence
Sensitivity to and knowledge about unique cultural factors has long been regarded as important to effective addictions treatment service delivery. The struggle for providers has often been about how much of which culturally relevant information to focus on becoming educated about. To further complicate the matter, increasing and valid recognition is being given to cultural aspects other than ethnicity - culture of socioeconomic class; culture of gender; culture of sexual orientation, etc. This session will cover this important area of interpersonal practice and provide useful cultural information, within the context of the emerging approach of "cultural humility."
Learning Objectives:
- Describe the pros and cons of different approaches to considering culture and ethnicity in addictions treatment.
- Identify 12 gender-responsive principles for addressing the specific substance abuse treatment needs of women.
- Identify 5 important cultural issues when working with LGBT individuals.
23. Legal System / Criminal Justice Interface
Addictions treatment providers have increasing opportunity to interface with the criminal justice system on behalf of their shared clientele. Influencing probation/parole conditions, actively teaming with Drug Court programs, and involvement with transition-planning for those returning to the community from prison all represent significant chances to leverage legal involvement in the direction of optimally positioning clients for successful recovery. This session will cover key principles and strategies for coordination, integration, and collaboration between addictions treatment and criminal justice service providers.
Learning Objectives:
- Identify 6 key principles and 4 models of Drug Court programs and describe the demonstrated efficacy of this approach.
- Describe other ways of integrating addictions treatment with legal case processing including strategies for interfacing with probation and parole departments.
- Identify the 8 elements of transition planning to support continuity of offender treatment for substance use disorders from institution to community.
24. Addiction and Spirituality
Moreso than many other areas of healthcare, spirituality has been acknowledged as an important factor in much of the American history of addictions treatment, primarily in association with the 12-Step model popularized by Alcoholic Anonymous. Yet there have also been barriers in the way of more straightforward assessment and inclusion of the use of spiritual resources in the formal treatment of substance use disorders. This session will review the history, and consider the appropriate place of spirituality in the treatment of addiction, including the increasing focus placed on identifying each client's unique spiritual assets in the service of them becoming activated in support of recovery.
Learning Objectives:
- Identify 3 historical barriers and bridges between spirituality/religion and addictions treatment.
- Demonstrate how a comprehensive assessment of client spirituality can effectively inform treatment planning.
- Identify 9 guidelines for using religious/spiritual interventions in addictions treatment.
25. Physical Health Concerns, including Communicable Diseases
Individuals with substance use disorders often experience co-morbid physical health conditions, either as sequelae of their substance use issues, or as unrelated conditions which can be complicated in identification and intervention by their substance use disorder. To provide services for clients with substance use disorders, collaboration with communicable disease, primary, and specialist medical providers is crucial. In this approach, designing interventions to promote health, effectively manage pain, and lower risk for communicable disease transmission are individual and public health issues, and an important part of integrated substance abuse treatment.
Learning Objectives:
- Describe physical health sequelae that are indicators of at least 3 different types of substance abuse.
- Describe the relationship between HIV, Hepatitis B & C, and other infectious diseases and substance abuse.
- Describe smoking cessation treatment interventions in primary care and addictions treatment settings.
26. Addiction and Personality Disorders
"Self-damaging impulsivity" is one of the criteria for Borderline Personality Disorder that is also found to be characteristic of addiction. This session will address the interplay of personality disorder and substance use disorder symptoms, and learn about how the etiology of disordered personality contains both risk factors for and contributing factors to the development of various addictions. The evidence-based practice model of Dialectical Behavior Therapy, as it has been applied to addicted populations (DBT-S), will be discussed.
Learning Objectives:
- Describe how symptoms of intoxication/withdrawal interact in toxic fashion with personality disorder symptoms.
- Describe how personality disorder symptoms are both a risk factor for, and consequence of, various addictions.
- Describe the effective treatment model for Borderline Personality Disorder and Addiction of Dialectical Behavior Therapy-S.
27. Addiction and Anxiety Disorders, including PTS/D
The co-incidence of unresolved and under-resolved trauma has been well researched and documented among substance-abusing populations. Along with other anxiety disorders, posttraumatic stress symptoms can represent serious obstacles to achieving sustainable, long-term recovery. An additional complication is represented by the fact that many medications prescribed for anxiety are themselves potentially mood-altering and habit- forming. This session will address the unique aspects of facilitating and supporting recovery from this combination of co-occurring disorders.
Learning Objectives:
- Describe how 3 symptoms of intoxication/withdrawal syndromes mimic anxiety disorder symptoms.
- Describe how anxiety disorder symptoms are both a risk factor for, and consequence of, various addictions.
- Identify 4 psychosocial strategies for managing anxiety without potentially addictive medications.
28. Addiction and Mood Disorders
Mood disorders are common co-occurring disorders for individuals with substance abuse issues. A substance-abusing lifestyle and its effect on interpersonal relationships often brings with it situations that contribute to sadness, hopelessness, and despair. In recovery, the negative states may be replaced with hopefulness, feelings of renewal, and optimism. Substance abuse and withdrawal may contribute to symptoms that mimic mood disorders or may exacerbate existing mood disorders. There are several interventions with demonstrated effectiveness for co-occurring mood disorders and addiction. Implications for treatment and recovery will be addressed.
Learning Objectives:
- Describe how 3 symptoms of intoxication/withdrawal syndromes mimic mood disorder symptoms.
- Describe how mood disorder symptoms are both a risk factor for, and consequence of, various addictions.
- Identify the risks of 2 different approaches to addressing mood disorder symptoms in addiction treatment.
29. Addiction and Thought Disorders
Working with individuals with co-occurring psychotic disorders and addiction can be very complex. It is not unusual for an individual with psychotic disorders to abuse substances. Numerous differential diagnosis issues must be considered including psychotic disorder as a co-occurring disorder, substance-induced psychosis, and medical conditions that may complicate accurate diagnostic formulation. Treatment implications as well as recovery principles will be discussed.
Learning Objectives:
- Describe how 3 symptoms of intoxication/withdrawal syndromes mimic thought disorder symptoms.
- Describe how thought disorder symptoms are both a risk factor for, and consequence of, various addictions.
- Identify 3 ways of adjusting co-occurring addictions treatment for clients with significant cognitive impairment.
30. Recovery-oriented Prescribing Practices and Pharmacological Recovery Supports
Can someone in recovery from addiction to a primary substance be helped by prescription medications for anxiety, pain, or sleep? Do prescription medications that diminish craving during withdrawal, or that cause an aversive reaction if use episodes occur be considered effective tools for sustainable recovery? What about medication-assisted treatment in the form of long-term opioid replacement? These and other questions will be addressed during this session.
Learning Objectives:
- Describe prescribing protocols/strategies for managing the use of potentially abusable medications.
- Identify 4 medications prescribed as strategies for assisting recovery efforts, and when they may be indicated.
- Describe Methadone treatment for opioid addiction, and what the research evidence shows re: efficacy.
Contact Information
Office of Continuing Education
1080 South University
Room 3652
Ann Arbor, MI 48109-1106
Phone: (734) 763-5723
Email: [email protected]
Alia G. Wesala
SSW Director of Continuing and Professional Education
Jaclyn Ruffolo
SSW CE Program Coordinator
Ashley Harvey
SSW CE Program Coordinator