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The Addiction Treatment Planner has been written for individual, group, and family counselors and psychotherapists who are working with adults and adolescents who are struggling with addictions to mood-altering chemicals, gambling, abusive eating, nicotine, or sexual promiscuity. The problem list of chapter titles reflects those addictive behaviors and the emotional, behavioral, interpersonal, social, personality, legal, medical, and vocational issues associated with those addictions. Whereas the focus of the original Chemical Dependence Treatment Planner was limited exclusively to substance abuse and its associated problems, the focus of later editions has been expanded to include other common addictive behaviors as well as other behavioral problems and psychiatric conditions in which addictive behavior may occur.

This sixth edition of The Addition Treatment Planner has been improved in many ways:

 Updated with new and revised evidence-based objectives and interventions

 Addition at the outset of every chapter of an evidence-based Objective and two Therapeutic Interventions highlighting the importance of establishing a positive relationship with the client

 Revised, expanded, and updated References to Empirical Support for Evidence-based Chapters (Appendix G) are now listed online at www.wiley.com/go/jongsma/addictiontp6e

 Revised, expanded, and updated self-help book list in the Bibliotherapy Suggestions (Appendix A)

 More suggested homework assignments from Homework Planners integrated into the interventions

 Updated Appendix F, which provides an Alphabetical Index of Sources for the Assessment Instruments and Clinical Interview Forms Cited in Interventions

 New chapters on Opioid Use and Panic Disorder/Agoraphobia

 Renamed chapters for Depression – Unipolar (formerly Unipolar Depression) and Readiness for Change (formerly Treatment Resistance)

 Exclusive use of DSM-5 (ICD-10-CM) diagnostic labels and codes into the Diagnostic Suggestions section of each chapter

This edition of the Planner continues to give special attention to the Patient Placement Criteria (PPC) developed by the American Society of Addiction Medicine (ASAM). In the ASAM contents we have listed our presenting problem chapters under each of the six assessment dimensions:

1 Dimension 1: Acute intoxication and/or withdrawal potential

2 Dimension 2: Biomedical conditions and complications

3 Dimension 3: Emotional, behavioral, or cognitive conditions and complications

4 Dimension 4: Readiness to change

5 Dimension 5: Relapse, continued use, or continued problem potential

6 Dimension 6: Recovery/living environment

The Addiction Treatment Planner has treatment planning content applicable to problems discovered in all of the six assessment dimensions.

Also included (Appendix D) is a form that can be used to assess the client under the six ASAM dimensions. The checklist provides material for efficient evaluation of the client on each of the six dimensions. This form has been developed and is utilized by the staff at Keystone Treatment Center, Canton, South Dakota, where Dr. Perkinson is the clinical director. It is not copyrighted and may be used or adapted for use by our readers.

Interventions can be found in each chapter that reflect a 12-step recovery program approach, but you will also find interventions based on a broader psychological and pharmacological model. Because addiction treatment is often done in a residential setting through a team approach, interventions have been created that can be assigned to staff members of various disciplines and modalities: nursing, medical, group counseling, family therapy, or individual therapy. We hope that we have provided a broad, eclectic menu of objectives and interventions from which you can select to meet your client's unique needs. Ideally, we have also provided a stimulus for you to create new objectives and interventions from your own clinical experience that have proven to be helpful to addictive clients.

Evidence-based practice (EBP) is steadily becoming the standard of care in mental health care as it has in medical health care. Professional organizations such as the American Psychological Association (APA), National Association of Social Workers, and the American Psychiatric Association, as well as consumer organizations such the National Alliance for the Mentally Ill (NAMI) have all endorsed the use of EBP. In some practice settings, EBP is becoming mandated. Some third-party payers are requiring use of EBP for reimbursement. It is clear that the call for evidence and accountability is being increasingly sounded. So, what is EBP and how is its use facilitated by this Planner?

Borrowing from the Institute of Medicine's definition (Institute of Medicine, 2001), the APA has defined EBP as, “the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences” (APA Presidential Task Force on EBP, 2006). Consistent with this definition, we have identified those psychological treatments with the best available supporting evidence, added Objectives and Interventions consistent with them in the pertinent chapters, and identified these with this symbol: . As most practitioners know, research has shown that although these treatment methods may have demonstrated efficacy, factors such as the individual psychologist (e.g. Wampold, 2001), the treatment relationship (e.g. Norcross, 2019), and the patient (e.g. Bohart & Tallman, 1999) are also vital contributors to optimizing a client's response to psychotherapy. As noted by the APA, “Comprehensive evidence-based practice will consider all of these determinants and their optimal combinations.” (APA, 2006, p. 275). For more information and instruction on constructing evidence-based psychotherapy treatment plans, see our 12 DVD-based training videos entitled Evidence-based Psychotherapy Treatment Planning (Jongsma & Bruce, 2010–2012).

The sources we used to identify the evidence-based treatments integrated into this Planner are multiple and, we believe, high quality. They include rigorous meta-analyses, current critical, expert reviews, as well as EBP guideline recommendations. Examples of specific sources include the Cochrane Collaboration reviews; the work of the Society of Clinical Psychology identifying research-supported psychological treatments; evidence-based treatment reviews (e.g. David, Lynn, & Montgomery, 2018; Nathan & Gorman, 2015), as well as critical analyses of the process through which EBP is defined (e.g. Dimidjian, 2019; Norcross, Hogan, Koocher, & Maggio, 2017). EBP guidelines informing the selection process include those from the APA, American Psychiatric Association, the National Institute for Health and Clinical Excellence (NICE) in the United Kingdom, and the National Institute on Drug Abuse (NIDA) to name a few.

Although sources may vary slightly in the criteria they use for judging levels of empirical support, we favored those that use more rigorous criteria, typically requiring demonstration of efficacy through randomized controlled trials or clinical replication series, good experimental methodology, and independent replication. Our approach was to evaluate these various sources and include those treatments supported by the highest level of evidence and for which there was consensus across most of these sources. For any chapter in which EBP is indicated, references to the sources used to identify them can be found online at www.wiley.com/go/jongsma/addictiontp6e. In addition to these references to empirical support, we have also included a Professional Reference appendix listing references to Clinical Resources. Clinical Resources are books, manuals, and other resources for clinicians that describe the details of the application, or the “how to,” of the treatment approaches described in a chapter.

We recognize that there is debate regarding EBP among mental health professionals, who are not always in agreement regarding the best treatment, what factors contribute to good outcomes, or even what constitutes “evidence.” We also recognize that some practitioners are skeptical about changing their practice based on psychotherapy research. Our intent in this book is to accommodate these differences by providing a range of treatment plan options, including those consistent with the “best available research” (APA, 2006), those reflecting common clinical practices of experienced clinicians (that may have not been subjected to study), and some that reflect promising emerging approaches. Our intent is to allow users of this planner an array of options so that they can construct what they believe to be the best plan for their particular client.

More recently, psychotherapy research is moving toward trying to identify evidence-based principles of psychotherapeutic change that cut across the various individual psychotherapies that have largely been the focus of outcome research. An example of this call in seen in Goldfried (2019), in which he advances the following principles:

 Promoting client expectation and motivation that therapy can help,

 Establishing an optimal therapeutic alliance,

 Facilitating client awareness of the factors associated with his or her difficulties,

 Encouraging the client to engage in corrective experiences, and

 Emphasizing ongoing reality testing in the client's life.

Although many endorse this effort, at the time of this writing it is still in progress. Consequently, our approach to identifying objectives and interventions consistent with EBPs reflects what has been done from the “principles” approach as well as the research demonstrating the efficacy and effectiveness of individual models. Perhaps the field will advance enough by the next edition of this planner to include only evidence-based principles of psychotherapeutic change. Until then, we believe that the approach we have taken reflects the current state of the science.

We would also like to note that for those selecting EBT objectives and interventions in their treatment, fidelity to the EBT as it was delivered in the studies demonstrating its efficacy or effectiveness offers the best chance for reproducing its results for your client. A demonstration of this point was witnessed in a recently published meta-analysis examining 12-Step Facilitation Therapy (TSF; Kelly, Humphreys, & Kelly, 2020). The review found that TSF manualized interventions intended to increase Alcoholics Anonymous (AA) participation during and following alcohol use disorder (AUD) treatment lead to enhanced abstinence outcomes compared to other well-established treatments over the next few months and for up to three years. Of note was that fidelity to the TSF treatment model was critical to this outcome as conveyed in this statement by the authors:

…when different types of TSF interventions were tested against each other, the more intensive TSF interventions (e.g. those that include actively prescribing AA participation and ongoing monitoring of AA attendance and related experiences; personal linkages to existing AA members) often worked better at improving drinking-related outcomes than the ‘“treatment as usual (TAU) TSF”’ intervention. This suggests that although many treatment professionals may believe that they “‘already do 12-step’” (i.e. implement TSF strategies) because they hand out 12-step literature or mention 12-step groups to patients, this alone may not be sufficient to achieve a superior benefit (Kelly, Humphreys, & Yeterian, 2013). The types of TSF strategies used do matter, and the more intensive strategies, such as those evaluated herein, enhance participation rates and outcomes compared to the more routine 12-step-oriented TAU. Some of these strategies could be clinical linkage to existing members (e.g. Manning, et al. 2012; Timko, Debenedetti, & Billow, 2006), or active prescription of attendance versus leaving it to people to decide for themselves whether they want to attend AA (e.g. Walitzer, Dermen, & Barrick, 2009) (p. 33).

Throughout this Planner we cite references and include an appendix of clinical resources, including treatment manuals and books, which describe the how-to of delivering the EBT with high fidelity, and we recommend them for those who share the value of delivering treatment with the intent to maximize the client's outcome.

At the beginning of each chapter, as we launch into the process of offering ideas for treatment interventions for the presenting problem, we have listed one Client Objective along with two associated Therapeutic Interventions that emphasize the critical nature of a therapeutic relationship. These options were derived from the research on empirically supported relationship factors (e.g. Norcross, 2002) and disseminated most recently in Norcross & Lambert (2018) and Norcoross & Wampold (2018). The relationship factors cited are as follows: collaboration with the client regarding the treatment process, agreement on the clear goals and expectations of therapy, demonstration of consistent empathy toward the client's feelings and struggles, verbalization of positive regard toward and affirmation of the client, and the collection and delivery of client feedback based on the client's appraisal of his/her progress in therapy (Norcross & Lambert, 2018; Norcross & Wampold, 2018). The body of research on relationship factors supports the conclusion that establishing a strong therapeutic relationship is necessary to optimize the treatment outcome. Accordingly, any of the other objectives and interventions that are selected to be included in a client's treatment plan should be integrated into and supported by an effective, foundational therapeutic relationship, and speaks to including this Client Objective and two associated Therapeutic Interventions in every treatment plan.

Each of the chapters in this edition has also been reviewed with the goal of integrating homework exercise options into the interventions. Many of the client homework exercise suggestions were taken from and can be found in the Addiction Treatment Homework Planner (Lenz, Finley, & Jongsma, 2014) and the Adult Psychotherapy Homework Planner (Jongsma & Bruce, 2014) along with a few from the Adolescent Psychotherapy Homework Planner (2014). You will find many more homework assignments suggested in this sixth edition of The Addiction Treatment Planner than in previous editions.

The bibliotherapy suggestions listed in Appendix A of this Planner have been significantly expanded and updated from previous editions. The appendix includes many recently published offerings as well as more recent editions of books cited in our earlier editions. All of the self-help books and client workbooks cited in the chapter interventions are listed in this appendix. There are also many additional books listed that are supportive of the treatment approaches described in the respective chapters. Each chapter has a list of self-help books consistent with it listed in this appendix.

In its final report entitled Achieving the Promise: Transforming Mental Health Care in America, the president's New Freedom Commission on Mental Health called for recovery to be the “common, recognized outcome of mental health services” (New Freedom Commission on Mental Health, 2003). To define recovery, SAMHSA within the US Department of Health and Human Services and the Interagency Committee on Disability Research in partnership with six other federal agencies convened the National Consensus Conference on Mental Health Recovery and Mental Health Systems Transformation (SAMHSA, 2004). Over 110 expert panelists participated, including mental health consumers, family members, providers, advocates, researchers, academicians, managed care representatives, accreditation bodies, state and local public officials, and others. From these deliberations, the following consensus statement was derived:

Mental health recovery is a journey of healing and transformation for a person with a mental health problem to be able to live a meaningful life in a community of his or her choice while striving to achieve maximum human potential. Recovery is a multifaceted concept based on the following 10 fundamental elements and guiding principles:

 Self-direction

 Individualized and person-centered

 Empowerment

 Holistic

 Nonlinear

 Strengths-based

 Peer support

 Respect

 Responsibility

 Hope

These recovery model principles are defined in Appendix C. We have also created a set of Goal, Objective, and Intervention statements that reflect these 10 principles. The clinician who desires to insert into the client treatment plan specific statements reflecting a Recovery Model orientation may choose from this list.

In addition to this list, we believe that many of the Goal, Objective, and Intervention statements found in the chapters reflect a recovery orientation. For example, our assessment interventions are meant to identify how the problem affects this unique client and the strengths that the client brings to the treatment. In addition, an intervention statement such as, “Help the client to see the new hope that addiction treatment brings to the resolution of interpersonal conflicts” from the “Suicidal Ideation” chapter is evidence that recovery model content, such as the principle of hope, permeates items listed throughout our chapters. However, if the clinician desires a more focused set of statements directly related to each principle guiding the recovery model, they can be found in Appendix B.

We have done a bit of reorganizing of chapter content for this edition. We have renamed the “Unipolar Depression” chapter to become “Depression – Unipolar.” A new chapter entitled “Opioid Use Disorder” is returned as a separate chapter due to the epidemic use of this drug that is sweeping the country. “Opioids were involved in 46,802 overdose deaths in 2018 (69.5% of all drug overdose deaths). Two out of three (67.0%) opioid-involved overdose deaths involve synthetic opioids.” (Hedegaard, Miniño, & Warner, 2020; Wilson, Kariisa, Seth, Smith, & Davis, 2020). In recognition of the seriousness of this societal problem we have created a chapter to address this issue.

We have updated the Diagnostic Suggestions section at the end of each chapter by deleting all references to DSM-IV and ICD-9. Since the date for mandatory use of DSM-5 (ICD-10-CM) codes and labels for billing purposes was October 2014, we have removed the transitional content of DSM-IV.

At the end of each chapter's list of objectives and interventions there is a reference to administration of a client satisfaction survey. Appendix D contains resource material for examples of various types of satisfaction assessment instruments.

Lastly, some clinicians have asked that the objective statements in this Planner be written such that the client's attainment of the objective can be measured. We have written our objectives in behavioral terms and many are measurable as written. For example, this objective from the “Anxiety” chapter is one that is measurable as written because it either can be done or it cannot: “Verbalize an understanding of the cognitive, physiological, and behavioral components of anxiety and its treatment.” But at times the statements are too broad to be considered measurable. Consider, for example, this objective from the “Anxiety” chapter: “Identify, challenge, and replace biased, fearful self-talk with positive, realistic, and empowering self-talk.” To make it quantifiable a clinician might modify it to read, “Give two examples of identifying, challenging, and replacing biased, fearful self-talk with positive, realistic, and empowering self-talk.” Clearly, the use of two examples is arbitrary, but it does allow for a quantifiable measurement of the attainment of the objective. Or consider this example reflecting a behavioral activation objective: “Identify and engage in pleasant activities on a daily basis.” To make it more measurable the clinician might simply add a desired target number of pleasant activities, thus: “Identify and report engagement in two pleasant activities on a daily basis.” The exact target number that the client is to attain is subjective and should be selected by the individual clinician in consultation with the client. Once the exact target number is determined, then our content can be very easily modified to fit the specific treatment situation. For more information on psychotherapy treatment plan writing, see Jongsma (2005).

We hope you find these improvements to this sixth edition of the Planner useful to your treatment planning needs.