Individuals who have a dual diagnosis of substance abuse and chronic mental illness pose unique challenges in the delivery of vocational rehabilitation services. Barriers to service provision include an underestimation of prevalence; agency classifications that require a separation of disability conditions into primary and secondary disability; a lack of counselors’ awareness of the unique needs of this population; and the impact of negative attitudes and stigma on vocational success. Although individuals with dual diagnosis can benefit from rehabilitation services and stable employment, changes in the traditional service delivery system are recommended. To address the unique needs of this population, rehabilitation practitioners are encouraged to seek specialized training and continuing education through regional training programs and interagency consultation.

Vocational Rehabilitation Needs of Individuals Dually Diagnosed with Substance Abuse and Chronic Mental Illness

The Social Construction of Co-Dependency in the Treatment of Substance Abuse

This research was initiated to determine if differences exist in the attitudes of vocational rehabilitation counselors toward substance abusing clients. Using the Substance Abuse Attitude Survey (SMS), ninety-one vocational rehabilitation counselors were surveyed regarding their beliefs and attitudes toward substance abuse and substance abusers. Results comparing those counselors with and without training in substance abuse issues found those with trainning reported significantly more positive attitudes than their non-trained counterparts in only two areas. However, the attitudes of all counselors were found to be somewhat negative.

Comparisons of Vocational Rehabilitation Counselors' Attitudes Toward Substance Abusers

This investigation examined the reliability and validity of a rating scale for codependency in substance abuse treatment. The investigators developed an example-anchored rating scale to operationalize codependency as substance abuse counselors construe it in practice, and recruited 27 counselors for a counterbalanced multiple-treatment experiment. Counselors were randomly assigned to one of four continuing education workshops for rating-scale training, and asked to evaluate codependency in five videotaped cases. Semistructured case interviews were videotaped with a male and a female from five adult populations to vary the gender and codependency of cases: (1) outpatients in treatment for addiction, (2) outpatient spouses, (3) members of Codependents Anonymous, (4) United States Bureau of Land Management smoke jumpers, and (5) college students majoring in business or economics. To control for gender effects, one workshop presented male cases, one workshop presented female cases, and two workshops presented cases of both genders. To control for order effects, the assignment of videotapes to workshops was randomized to counterbalance the order in which counselors viewed them. The findings suggest that the rating scale yields reliable and valid evaluations of codependency without appreciable gender bias.

The development, reliability, and validity of a clinical rating scale for codependency.

Alcoholism, America's third leading disabling condition, is discussed in regard to (a) its relation to other disabilities relevant to rehabilitation counseling, (b) its more critical symptoms, (c) intervention and confrontation, and (d) signs of recovery. Based on a theoretical “hourglass” model of alcoholism, aids for diagnosis and treatment, as well as recommendations for counselor training, are presented.

Alcoholism: A Pervasive Rehabilitation Counseling Issue

This article discusses substance abuse counseling in relation to rehabilitation counseling. Its purpose is to suggest that the profession of rehabilitation counseling can have a positive impact on the professionalization of substance abuse counseling. Key issues in substance abuse treatment that are important for rehabilitation counselors to understand are discussed. Implications for rehabilitation counseling and rehabilitation counselor education are presented.

E.W. Stude

Papers

Professionalization of Substance Abuse Counseling