Application to Practice

Competency 9

Understand the established diagnostic criteria for substance use disorders, and describe treatment modalities and placement criteria within the continuum of care.


  • Established diagnostic criteria, including but not limited to current Diagnostic and Statistical Manual of Mental Disorders (DSM) standards and current International Classification of Diseases (ICD) standards.
  • Established placement criteria developed by various States and professional organizations.
  • Strengths and limitations of various diagnostic and placement criteria.
  • Continuum of treatment services and activities.


  • Openness to a variety of treatment services based on client need.
  • Recognition of the value of research findings.

Competency 10

Describe a variety of helping strategies for reducing the negative effects of substance use, abuse, and dependence.


  • A variety of helping strategies, including but not limited to:
    • evaluation methods and tools
    • stage-appropriate interventions
    • motivational interviewing
    • involvement of family and significant others
    • mutual-help and self-help programs
    • coerced and voluntary care models
    • brief and longer term interventions.


  • Openness to various approaches to recovery.
  • Appreciation that different approaches work for different people.

Competency 11

Tailor helping strategies and treatment modalities to the client’s stage of dependence, change, or recovery.


  • Strategies appropriate to the various stages of dependence, change, and recovery.


  • Flexibility in choice of treatment modalities.
  • Respect for the client’s racial, cultural, economic, and sociopolitical backgrounds.

Competency 12

Provide treatment services appropriate to the personal and cultural identity and language of the client.


  • Various cultural norms, values, beliefs, and behaviors.
  • Cultural differences in verbal and nonverbal communication.
  • Resources to develop individualized treatment plans.


  • Respect for individual differences within cultures.
  • Respect for differences between cultures.

Competency 13

Adapt practice to the range of treatment settings and modalities.


  • The strengths and limitations of available treatment settings and modalities.
  • How to access and make referrals to available treatment settings and modalities.


  • Flexibility and creativity in practice application.

Competency 14

Be familiar with medical and pharmacological resources in the treatment of substance use disorders.


  • Current literature regarding medical and pharmacological interventions.
  • Assets and liabilities of medical and pharmacological interventions.
  • Health practitioners in the community who are knowledgeable about addiction and addiction treatment.
  • The role that medical problems and complications can play in the intervention and treatment of addiction.


  • Open and flexible with respect to the potential risks and benefits of pharmacotherapies to the treatment and recovery process.

Competency 15

Understand the variety of insurance and health maintenance options available and the importance of helping clients access those benefits.


  • Existing public and private payment plans including treatment orientation and coverage options.
  • Methods for gaining access to available payment plans.
  • Policies and procedures used by available payment plans.
  • Key personnel, roles, and positions within plans used by the client population.


  • Willingness to cooperate with payment providers.
  • Willingness to explore treatment alternatives.
  • Interest in promoting the most cost-effective, high-quality care.

Competency 16

Recognize that crisis may indicate an underlying substance use disorder and may be a window of opportunity for change.


  • The features of crisis, which may include but are not limited to:
    • family disruption
    • social and legal consequences
    • physical and psychological
    • panic states
    • physical dysfunction.
  • Substance use screening and assessment methods.
  • Prevention and intervention principles and methods.
  • Principles of crisis case management.
  • Posttraumatic stress characteristics.
  • Critical incident debriefing methods.
  • Available resources for assistance in the management of crisis situations.


  • Willingness to respond and follow through in crisis situations.
  • Willingness to consult when necessary.

Competency 17

Understand the need for and the use of methods for measuring treatment outcome.


  • Treatment outcome research literature.
  • Scientific process in applied research.
  • Appropriate measures of outcome.
  • Methods for measuring the multiple variables of treatment outcome.


  • Recognition of the importance of collecting and reporting on outcome data.
  • Interest in integrating research findings into ongoing treatment design.

Uses of the Competencies

The Competencies has been used in a number of different ways in Montana. It was incorporated into the Montana certification and oral exam process. In higher education settings at colleges and universities, The Competencies has been used to define behavioral expectations and objectives for addiction counseling courses. Clinically, it has been used to establish “employment competencies” for counselors working in a hospital-based setting with clients who abuse substances. These employment competencies were also modified for use by substance abuse counseling programs on the Crow Indian Reservation and the Rocky Boy Indian Reservation.


Members of the National ATTC Curriculum Committee reviewed the bibliography from the first printing of The Competencies. Following previously established guidelines, the Committee reviewed and linked each reference with a specific transdisciplinary foundation. Primarily textbooks are referenced in this section; however, such texts are not mutually exclusive of the practice dimensions.

  • American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, DC: American Psychiatric Association.
  • Bennett, L.A., Reiss, D., et al. (1987). The Alcoholic Family. New York: Basic Books.
  • Berg, I.K., & Miller, S.D. (1992). Working With the Problem Drinker: A Solution-Focused Approach. New York: W.W. Norton.
  • Brown, S. (Ed.) (1995). Treating Alcoholism. San Francisco: Jossey-Bass.
  • Cavanaugh, E.R., Ginzburg, H.M., et al. (1989). Drug Abuse Treatment: A National Study of Effectiveness. Chapel Hill, NC: University of North Carolina Press.
  • Chiauzzi, E.J. (1991). Preventing Relapse in the Addictions: A Biopsychosocial Approach. New York: Pergamon.
  • Deitch, D., & Solit, R. (1993). Training of drug abuse treatment personnel in therapeutic community methodology. Psychotherapy, 30(2):305-316.
  • Donigian, J., & Malnati, R. (1997). Systemic Group Therapy: A Triadic Model. Pacific Cove, CA: Brooks/Cole.
  • Ettore, E. (1992). Women and Substance Use. New Brunswick, NJ: Rutgers University Press.
  • Evans, K., & Sullivan, J.M. (2001). Dual Diagnosis: Counseling the Mentally Ill Substance Abuser (2nd ed.). New York: Guilford Press.
  • Flores, P.J. (1997). Group Psychotherapy With Addicted Populations: An Integration of Twelve-Step and Psychodynamic Theory (2nd ed.). New York: Haworth Press.
  • Galanter, M. (1993). Network Therapy for Alcohol and Drug Abuse. New York: Guilford Press.
  • Institute of Medicine (1990). Treating Drug Problems, Volume 1: The Report. Washington, DC: National Academy Press.
  • Levin, J.D. (1995). Introduction to Alcoholism Counseling: A Bio-Psycho-Social Approach (2nd ed.). New York: Taylor & Francis.
  • Lewis, J.A. (Ed.) (1994). Addictions: Concepts and Strategies for Treatment. Gaithersburg, MD: Aspen Publishers.
  • McCrady, B.S., & Miller, W.R. (Eds.) (1993). Research on Alcoholics Anonymous: Opportunities and Alternatives. New Brunswick, NJ: Rutgers Center of Alcohol Studies.
  • McLellan, A.T., Woody, G.E., et al. (1988). Is the counselor an “active ingredient” in substance abuse rehabilitation? An examination of treatment success among four counselors. Journal of Nervous and Mental Disease, 176:430-432.
  • Meyers, R.J., & Smith, J.E. (1995). Clinical Guide to Alcohol Treatment: The Community Reinforcement Approach. New York: Guilford Press.
  • Miller, N.S., Gold, M.S., & Smith, D.E. (Eds.) (1997). Manual of Therapeutics for Addictions. New York: Wiley-Liss.
  • Miller, W.R., & Heather, N. (Eds.) (1998). Treating Addictive Behaviors: Processes of Change (2nd ed.). New York: Plenum Press.
  • Moos, R.H., Finney, J.W., & Cronkite, R.C. (1990). Alcoholism Treatment: Context, Process, and Outcome. New York: Oxford University Press.
  • Murphy, L.L., & Impara, J.C. (Eds.) (1996). Buros Desk Reference: Assessment of Substance Abuse. Lincoln, NE: Buros Institute of Mental Measurements.
  • Najavits, L.M., & Weiss, R.D. (1994). Variations in therapist effectiveness in the treatment of patients with substance use disorder: An empirical review. Addictions, 89:679-688.
  • Prochaska, J.O., DiClemente, C.C., & Norcross, J.C. (1992). In search of how people change: Applications to addictive behaviors. American Psychologist, 47:1102-1114.
  • Rutzky, J. (1998). Coyote Speaks: Creative Strategies for Psychotherapists Treating Alcoholics and Addicts. Northvale, NJ: Jason Aronson.
  • Vannicelli, M. (1992). Removing the Roadblocks: Group Psychotherapy With Substance Abusers and Family Members. New York: Guilford Press.
  • Washton, A.M. (1995). Psychotherapy and Substance Abuse: A Practitioner’s Handbook. New York: Guilford Press.
  • Zweben, J.E. (Ed.) (1990). Understanding and preventing relapse. Journal of Psychoactive Drugs, 22(2).

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