Substance Abuse: Information For School Counselors, Social Workers, Therapists, and Counselors 6th Edition, (Ebook PDF

Substance Abuse: Information for
School Counselors, Social Workers,

Therapists, and Counselors 6th Edition,
(Ebook PDF)
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Preface vii
• Chapter 4 on culturally and ethnically diverse populations was also revised to reflect new and
updated information, including risk factors for diverse populations, immigration and the
effects on substance use and abuse, bullying, and cultural competencies.
• As with each edition, we have updated all survey data and included new information on
topics that have arisen in the field since the last edition. This includes synthetic cannabinols
(Chapter 2), treatment access and effectiveness (Chapter 8), methamphetamine exposure
(Chapter 12), women and substance abuse (Chapter 12), phases of codependency
(Chapter 13), transmission of HIV (Chapter 14), and assessment and treatment of gambling
disorders (Chapter 15).
MyCounselingLab®
This title is also available with MyCounselingLab–an online homework, tutorial, and assessment
program designed to work with the text to engage students and improve results. Within its struc-
tured environment, students see key concepts demonstrated through video clips, practice what they
learn, test their understanding, and receive feedback to guide their learning and ensure they master
key learning outcomes.
• Learning Outcomes and Standards measure student results.
MyCounselingLab organizes all assignments around essential learning outcomes and national
standards for counselors.
• Video- and Case-Based Exercises develop decision-making skills.
Video-and Case-based Exercises introduce students to a broader range of clients, and there-
fore a broader range of presenting problems, than they will encounter in their own pre-
professional clinical experiences. Students watch videos of actual client-therapist sessions or
high-quality role-play scenarios featuring expert counselors. They are then guided in their
analysis of the videos through a series of short-answer questions. These exercises help
students develop the techniques and decision-making skills they need to be effective counse-
lors before they are in a critical situation with a real client.
• Licensure Quizzes help students prepare for certification.
Automatically graded, multiple-choice Licensure Quizzes help students prepare for their cer-
tification examinations, master foundational course content, and improve their performance
in the course.
• Video Library offers a wealth of observation opportunities.
The Video Library provides more than 400 video clips of actual client-therapist sessions and
high-quality role plays in a database organized by topic and searchable by keyword. The
Video Library includes every video clip from the MyCounselingLab courses plus additional
videos from Pearson’s extensive library of footage. Instructors can create additional assign-
ments around the videos or use them for in-class activities. Students can expand their obser-
vation experiences to include other course areas and increase the amount of time they spend
watching expert counselors in action.
Acknowledgments
As with any effort such as this, many people have contributed to the final product. We want to thank
Gary Pregal, Katie Swanson, Susan Malby-Meade, Frank Tirado, Priscilla Wu, and the late Cheri
Dunning for their efforts on the first edition of this text. Julie Hogan, codirector of CSAP’s Center
viii Preface
for the Application of Prevention Technologies, and Nancy Roget, director of the Center for the
Application of Substance Abuse Technologies at the University of Nevada, Reno, provided valua-
ble insights in the development of the second edition. In preparing the third edition, we relied on the
work of the Addiction Technology Transfer Centers (funded by the Center for Substance Abuse
Treatment) and the Centers for the Application of Prevention Technologies (funded by the Center
for Substance Abuse Prevention). These outstanding networks helped us identify relevant issues
and concepts. We are also grateful to the late John Chappel, emeritus professor of psychiatry and
behavioral sciences at the University of Nevada, Reno, for reviewing Chapter 2 material in earlier
editions.
In preparing the fourth edition, we thanked Sabina Mutisya, doctoral student at the University
of Nevada, Reno, for her invaluable assistance with research, and the reviewers who provided help-
ful suggestions for revision: Debra Morrison-Orton, California State University, Bakersfield;
Nadine Panter, University of Nebraska, Kearny; and George M. Andrews, Baltimore City College.
In the fifth edition, special thanks were given to Dr. Susan Doctor. She is an expert in fetal
alcohol spectrum and shared her incisive knowledge of it in Chapter 12. We also thank Melissa
Huelsman, a counseling doctoral student, who did library searches and combined the references.
In this current edition, we want to thank Mona Martinez, a doctoral student, for her assistance
with research and references. We also thank the following reviewers for their invaluable sugges-
tions for this revision: Nancy K. Brown, University of South Carolina; Jason Eccker, Washington
University; Valerie Gebhardt, University of Illinois, Springfield; and Kevin J. Nutter, University of
Arizona and Northern Arizona University.
Gary L. Fisher
Thomas C. Harrison
Brief Contents
Chapter 1 The Role of the Mental Health Professional in Prevention and Treatment 1
Chapter 2 Classification of Drugs 11
Chapter 3 Models of Addiction 34
Chapter 4 Culturally and Ethnically Diverse Populations 47
Chapter 5 Confidentiality and Ethical Issues 83
Chapter 6 Screening, Assessment, and Diagnosis 97
Chapter 7 Motivational Interviewing and Brief Interventions 116
Chapter 8 Treatment of Alcohol and Other Drugs (AOD) 129
Chapter 9 Co-occurring Disorders and Other Special Populations 151
Chapter 10 Relapse Prevention and Recovery 162
Chapter 11 Twelve Step and Other Types of Support Groups 178
Chapter 12 Children and Families 191
Chapter 13 Adult Children and Codependency 219
Chapter 14 Hiv/Aids 238
Chapter 15 Gambling and Other Behavioral Addictions 254
Chapter 16 Prevention 282
ix
Contents
Chapter 1 The Role of the Mental Health Professional in Prevention

and Treatment 1
The Need for Generalist Training 2
Philosophical Orientation 4
Professional Orientation 5
Attitudes and Beliefs 6
Denial, Minimization, Projection, and Rationalization 6
Helping Attitudes and Behaviors 7
Overview of the Book 9
Chapter 2 Classification of Drugs 11

Case Examples 11
Comprehensive Drug Abuse Prevention and Control Act 12
The Concept of Dangerousness 12
Definitions 13
The Neurobiology of Addiction 14
Central Nervous System Depressants 15
Drugs in This Classification 18
Routes of Administration 18
Major Acute and Chronic Effects 18
Overdose 19
Tolerance 19
Withdrawal 19
Central Nervous System Stimulants 20
Overdose 22
Tolerance 22
Withdrawal 22
Opioids 23
Overdose 24
x
Contents xi
Tolerance 24
Withdrawal 24
Hallucinogens 25
Overdose 25
Tolerance 26
Withdrawal 26
Cannabinols and Synthetic Cannabinols 26
Overdose 27
Tolerance 27
Withdrawal 27
Inhalants and Volatile Hydrocarbons 28
Route of Administration 28
Overdose 28
Tolerance 28
Withdrawal 28
Anabolic Steroids 29
Overdose 29
Tolerance 29
Withdrawal 29
Club Drugs 30
Drugs Used in the Treatment of Mental Disorders 30
Drugs Used in the Treatment of Psychotic Disorders 31
Drugs Used in the Treatment of Affective Disorders 31
Drugs Used in the Treatment of Attention Deficit
Disorder 31
Summary 33 • Additional Reading 33 • Internet
Resources 33 • Further Discussion 33
xii Contents
Chapter 3 Models of Addiction 34

Case Examples 34
The Moral Model 36
Sociocultural Models of Addiction 37
Psychological Models of Addiction 38
Disease Concept of Addiction 39
Evidence to Support the Disease Concept 41
Critics of the Disease Concept 42
Advantages of the Disease Concept 43
Disadvantages of the Disease Concept 44
Biopsychosocial Model of Addiction 44
Summary 46 • Internet Resources 46 • Further Discussion 46
Chapter 4 Culturally and Ethnically Diverse Populations 47

Case Examples 47
Native Americans and Alaska Natives 48
Background 49
Values 50
Risk Factors for Alcohol and Other
Drug Abuse 51
Asian Americans and Pacific Islanders 54
Background 55
Values 55
Risk Factors for Alcohol and Other Drug Abuse 57
African Americans 59
Background 60
Values 62
Latino and Hispanic Populations 66
Background 66
Values 67
The Elderly, Disabled, and Sexual Minority Populations 71
Helping Culturally and Ethnically Diverse Populations 74
Issues for the Helping Professionals 74
Assessment and Treatment Issues 75
Summary 81 • Internet Resources 82 •
Further Discussion 82
Contents xiii
Chapter 5 Confidentiality and Ethical Issues 83

Case Examples 83
Confidentiality: 42 Code of Federal Regulations, Part 2 (42 CFR) 84
Does 42 CFR Apply to You? 84
The General Rule 85
Written Consent 86
Other Exceptions to the General Rule 87
Other Confidentiality Issues 88
Confidentiality and School Counseling 89
Health Insurance Portability and Accountability Act (HIPAA) 90
Drug Testing 90
Documentation 91
Ethics 92
Scope of Practice 92
Client Welfare 92
Managed Care 93
Application of Confidentiality Regulations 94
Chapter 6 Screening, Assessment, and Diagnosis 97

Case Examples 97
Definitions of Use, Misuse, Abuse, and Dependence or Addiction 98
Screening 100
Psychosocial History 101
AOD Use History 102
Family History 103
Social History 104
Legal History 104
Educational History 104
Occupational History 105
Medical History 105
Psychological and Behavioral Problems 106
Signs of Adolescent Substance Abuse 106
Self-Report Inventories 107
Michigan Alcohol Screening Test 108
CAGE 108
Alcohol Use Disorders Identification Test 108
Problem-Oriented Screening Instrument for Teenagers 109
Addiction Severity Index 109
xiv Contents
Referral 109
Diagnosis 111
The Diagnostic and Statistical Manual of Mental Disorders, Fifth
Edition (DSM-V ) 111
Chapter 7 Motivational Interviewing and Brief Interventions 116

Case Examples 116
Client Engagement 118
Motivational Interviewing 118
Four General Principles of MI 118
Ambivalence 119
Eliciting Change Talk 120
Client Resistance and Counselor’s Behavior 120
Transition from Resistance to Change 122
MI and Stages of Change 122
MI Applications to Case Examples 124
Research Outcome Studies 125
Brief Interventions 125
Chapter 8 Treatment of Alcohol and Other Drugs (AOD) 129

Case Examples 129
Recovery-Oriented Systems of Care 130
How Many Are in Treatment? How Many Need Treatment? 130
What Happens in Treatment? 131
Approaches to Treatment 131
Treatment Strategies and Techniques 134
Example of Treatment Plan 134
Individual, Group, and Family Counseling 135
Support Groups 136
Lifestyle Changes 136
Education 137
Aftercare 137
Treatment Settings 138
Choice of Treatment Setting 138
Therapeutic Communities 139
Inpatient and Residential Treatment 139
Partial Hospitalization and Day Treatment 140
Intensive Outpatient and Outpatient 140
Contents xv
Principles of Effective Treatment 141

Evidence-Based Treatment 143
Case Example Applications 144
Treatment Effectiveness 144
Special Problems in Treatment 146
Recovering Individuals as Counselors 146
Confrontation as a Treatment Strategy 146
The Use of Medication 147
Controlled Use 147
Natural Recovery 148
Chapter 9 Co-occurring Disorders and Other

Special Populations 151
Case Examples 151
Definitions 152
Prevalence 152
Types of COMD 153
Treatment 155
Other Special Populations 156
Ethnically Diverse Populations 156
Elderly 157
Adolescents 158
Persons with Disabilities 158
Women 159
Lesbian, Gay, Bisexual, and Transgender Individuals 160
Criminal Justice Populations 160
Chapter 10 Relapse Prevention and Recovery 162

Case Examples 162
Need for Generalist Training in Relapse Prevention 163
Definitions of Slip and Relapse 163
Frequency of Slips and Relapses 164
Is Relapse in Addiction Similar to Other Chronic Conditions? 164
Models of Relapse Prevention 164
The Cenaps Model 164
A Cognitive-Social Learning Model 166
Essential Components of Relapse Prevention 168
Assessment of High-Risk Situations 168
xvi Contents
Coping with High-Risk Situations 169

Support Systems 171
Lifestyle Changes 171
Preventing Slips from Escalating 174
Recovery 175
Recovery Support Services 176
Recovery and Spirituality 176
Chapter 11 Twelve Step and Other Types of Support Groups 178

Case Examples 178
Alcoholics Anonymous 179
History of AA 180
What AA Is About 180
The Twelve Steps and the Twelve Traditions 181
The Twelve Steps 182
The Twelve Traditions 182
Elements of AA Meetings 183
Research on AA 184
AA and Spirituality 184
Misconceptions Regarding AA 185
Other Twelve Step Groups 185
Advantages and Disadvantages of Twelve Step Groups 186
Other Types of Support Groups 187
Many Roads, One Journey 187
Women for Sobriety 188
Secular Organizations for Sobriety/Save Our Selves (SOS) 188
Moderation Management 189
Smart Recovery® 189
Chapter 12 Children and Families 191

Case Examples 191
Family Structure and Dynamics 192
Homeostasis 193
Subsystems and Boundaries 193
Roles 195
Family Rules 197
Children’s Exposure to AOD 198
Contents xvii
Prenatal Exposure to Alcohol and Other Drugs 198

Interpersonal Exposure to Alcohol and Other Drug Abuse 199
Family Exposure to Alcohol and Other Drugs 201
CASE EXAMPLE 201
Nontraditional Families and Special Populations 203
Women and Alcoholism 207
Assessment of Problems in Women 208
Treatment Concerns for Women 209
Helping Families 210
Underlying Family Themes 210
Barón’s Integrative Cross-Cultural Model 213
Kaufman and Kaufman’s Family Types 216
Chapter 13 Adult Children and Codependency 219

Case Examples 219
ACOAs 220
Clinical Characteristics and Empirical Research 221
Risk Factors 222
Assessment and Treatment Considerations 223
Assessment of ACOAs 223
Implications for Intervention 223
Codependency 224
Definitions of Codependency 225
Characteristics of Codependent Individuals 226
Assessing for Codependency 227
Implications for Mental Health Professionals 229
Mental Health Professionals’ Own Codependency 229
Relationship of ACOA, AA, Al-Anon, and Codependency 231
Critics of the ACOA–Codependency Movement 231
Codependency and Diversity 233
Feminist Critiques of Codependency 233
Chapter 14 Hiv/Aids 238

Case Examples 238
Incidence and Prevalence 239
HIV and AIDS 240
Stages 240
Testing for Hiv 240
xviii Contents
Transmission of HIV 241

Coinfection: HIV Infection and Other Diseases 241
High-Risk Groups 243
Women 243
Culturally and Ethnically Diverse Populations 244
Adolescents 244
Other High-Risk Groups 245
Assessment of Clients for HIV and AIDS: Signs and Symptoms 246
Physical Signs and Symptoms 247
Helping HIV-Infected Clients 247
Hiv-Related Issues Specific to the Helping Professional 250
Disclosure Laws and Confidentiality 250
Needle Exchange 251
Chapter 15 Gambling and Other Behavioral Addictions 254

Case Examples 254
Prevalence of Gambling and Gambling Problems 255
Definitions of Gamblers and Problem Gambling 259
Other Behavioral Addictions 259
The Debate Over Behavioral Addictions 260
The Eating Disorders 262
Chronic Obesity 262
Binge-Eating Disorder 263
Bulimia Nervosa and Anorexia Nervosa 263
Addiction to Sex and Love 265
Internet Addiction 266
Cyberaffairs 267
Impact of Internet Abuse on Relationships, Students,
and Workers 268
Addiction to Work: Workaholism 269
Structure of Workaholism 270
Assessment and Treatment Issues 271
Gambling 271
Treatment, Resources, and Support 272
Resources 273
Support 273
Treatment of Other Behavioral Addictions 274
Assessment and Diagnosis 274
Contents xix
Treatment 276
Summary 279 • Internet Resources 281 • Further
Discussion 281
Chapter 16 Prevention 282

CASE EXAMPLES 282
Why Are Prevention Efforts Needed? 282
Policy Issues in Prevention 283
Drug Free? 283
Gateway Drugs 284
Supply versus Demand 285
Legalization 286
Prevention Classification Systems 287
The Institute of Medicine Classification System 287
Classification by Prevention Strategy 287
Classification by Risk and Protective Factors 289
What Works in Prevention 290
Evaluation of Prevention Programs 290
Evidence-Based Prevention 296
Prevention Resources 297
Prevention Specialists 297
Summary 297 • Internet Resources 298 • Further
Discussion 298
References 299
Credits 329
Index 331
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Chapter 1
The Role of the Mental Health

Professional in Prevention
and Treatment
It has become almost trite to recite the problems related to the use of alcohol and other drugs
(AOD)1 in our society. Various statistics are frequently reported in newspaper articles, surveys, and
research studies. The array of graphs, percentages, and dollar amounts in the billions numb the
mind. It is not our purpose to contribute to this data avalanche in an effort to convince you that the
abuse of AOD causes a variety of serious problems in our country. If you are reading this book, you
are probably in a training program to prepare for a career in one of the helping professions and, one
hopes, you have some awareness of the severity of this problem. On the other hand, our experience
in training mental health professionals has taught us that there is a need for a framework to under-
stand the extent to which AOD issues affect not only the lives of those individuals you will be work-
ing with, but also your own lives and the society in which we live. Therefore, allow us to provide
this framework with a few facts.
According to annual survey data, in 2013, more than 17 million Americans aged 12 and
older needed treatment for an alcohol or illicit drug problem (Substance Abuse and Mental Health
Services Administration, 2014). The Substance Abuse and Mental Health Services Administration
conducts a yearly survey on the use of all drugs, legal and illegal, in the United States (Substance
Abuse and Mental Health Services Administration, 2014). In 2013, 9.4% of all individuals aged
12 and older reported using an illicit drug in the past month. In the 12 to 17 age group, 11.6% had
used alcohol in the past month and 6.2% had engaged in binge drinking. In the same age group,
5.6% smoked cigarettes. According to the Centers for Disease Control and Prevention (2014c),
1
As is the case with many areas in the helping professions, terminology can be confusing. In this book, we will use the term
alcohol and other drugs (AOD) to clearly indicate that alcohol is a drug and to avoid having the reader omit alcohol from
any discussion about drugs. If tobacco is relevant to a discussion, we will generally refer to “alcohol, tobacco, and other
drugs.” The term illegal drugs will be used to refer to substances such as marijuana, heroin, cocaine, methamphetamine, and
ecstasy, which are illegal under most or all circumstances. Illicit drugs are illegal drugs as well as legal drugs used inappro-
priately, such as prescription pain medications.
The use of terms such as alcoholism, drug addiction, chemical dependency, and substance abuse can also be problem-
atic. In Chapter 2, we will give some definitions of terms used in the field, and, in Chapter 6, we provide the criteria to
diagnose AOD conditions. However, because these terms are used in this chapter, you should think of alcoholism as an
addiction to the drug alcohol. Drug addiction refers to the addiction to drugs other than alcohol. Chemical dependency
includes addiction to AOD. Substance abuse means that there have been individual or societal problems as a result of AOD
use. After reading Chapters 2 and 6, you should have a more useful understanding of these terms.
1
2 Chapter 1 • The Role of the Mental Health Professional in Prevention and Treatment
approximately 88,000 annual deaths in the United States are attributable to alcohol, the third
leading cause of lifestyle-related deaths in our country. In contrast, almost 40,400 annual deaths
are attributable to illicit drugs (Centers for Disease Control and Prevention, 2013b). The Centers
for Disease Control and Prevention (2015i) reported 480,000 annual deaths in this country as a
result of tobacco use.
The relationship between AOD, crime, and violence has also been clearly established. The
National Center on Addiction and Substance Abuse at Columbia University published an extensive
study of this relationship. Of the 2.3 million Americans in jails and prisons, 1.5 million met the cri-
teria for a substance use disorder (see Chapter 6) and another 458,000 had a history of AOD prob-
lems, were under the influence of AOD at the time crimes were committed, committed crimes to buy
AOD, were incarcerated for an AOD violation, or some combination of these factors. AOD were a
factor in 78% of violent crimes; 83% of property crimes; and 77% of crimes involving public order,
immigration or weapon offenses, and probation/parole violations (National Center on Addiction and
Substance Abuse at Columbia University, 2010). In reviewing literature on the relationship between
child abuse and substance abuse, Lee, Esaki, and Greene (2009) indicated that between one-half and
two-thirds of abuse cases involved caretaker substance abuse, and 80% of cases resulting in foster
care were linked to substance abuse. In studying the relationship between substance abuse and
domestic violence, Fals-Stewart and Kennedy (2005) found that 50% of partnered men in substance
abuse treatment had battered their partner in the past year. Fals-Stewart (2003) reported that these
patients were 8 times more likely to batter on a day in which they had been drinking.
The monetary costs of AOD abuse also provide tangible evidence of the significance of these
problems. In a study for the Centers for Disease Control and Prevention (2011), the 2006 costs of
alcohol abuse were estimated at $223.5 billion. More than 70% of the costs of alcohol abuse were
due to lost work productivity, 11% due to health-related issues, 9% attributable to law enforcement
and criminal justice involvement, and 6% due to automobile accidents. Other drug abuse costs the
United States $193 billion annually (National Institute on Drug Abuse, 2015). Ironically, for every
dollar that states spend on substance abuse and addiction, about 96 cents is spent on shoveling up
the wreckage caused by AOD use and only about 2 cents is spent on prevention and treatment (the
rest is spent on research, regulation, and interdiction; National Center on Addiction and Substance
Abuse at Columbia University, 2009).
We risk contributing to the data avalanche to illustrate that the abuse of AOD is like a tree
with many branches. The trunk is AOD abuse, but the branches are the multitude of other problems
caused by or related to AOD. To avoid totally clogging your mind with statistics and/or completely
depressing you before you read the rest of this book, we neglected to describe other branches of the
tree such as the decreased work productivity, excessive school truancy and work absenteeism, and
detrimental effects on partners, children, and fetuses resulting from AOD abuse. However, these
and other branches exist and are the concern of all helping professionals.
The Need for Generalist Training

Some years ago, one of the authors of this text was asked by a local school district to conduct an
independent psychological evaluation of a 14-year-old student who was a freshman in high school.
The young man’s parents were dissatisfied with the school district’s evaluation of their son and had
asked for another opinion. The youngster was failing most of his classes and was skipping school
frequently. The parents were quite sure that their son had a learning disability that would explain his
difficulties. The district’s school psychologist had tested the student and not found a learning disa-
bility. The school counselor had suggested that there may be an emotional problem and recom-
mended family counseling. In addition, a weekly progress check was initiated at school so the
Chapter 1 • The Role of the Mental Health Professional in Prevention and Treatment 3
parents could be kept informed of assignments and homework that their son needed to complete.
They had also hired a tutor. However, none of these interventions seemed to be helping, so the inde-
pendent evaluation was requested.
In reviewing the test information, no indications of a learning disability were found. An AOD
assessment (which will be discussed in Chapter 6) was conducted, and there was evidence that the
young man was using AOD on a daily basis. The parents said that they allowed their son and his
friends to drink in their home because they believed that this would prevent them from using “drugs”
and from drinking and driving. The parents were defensive about their own AOD use and rejected
suggestions that the cause of their son’s problems could be related to his AOD use. A couple of
months later, there was a request for the young man’s records from an AOD treatment program. He
was referred to the program following an arrest for stealing alcohol from a convenience store.
One of us was supervising a master’s student who was in a marriage and family therapy intern-
ship. The intern had been seeing a family of four (mom, dad, and two children, aged 3 and 9) who
were referred to our university counseling clinic by Children’s Protective Services. A child abuse
report had been filed at the 9-year-old’s elementary school because of bruises on the youngster’s
face. The father explained that he had slapped his son because of his frustration with the boy’s
behavior and “back-talking.” The parents complained of frequent conflicts related to parenting tech-
niques and family finances. The intern had developed an intervention plan that included referring the
parents to a parent education program and working with the family on “communication skills”
including “I-messages” and conflict resolution procedures. The intern was frustrated because the
parents had failed to follow through on the parent education classes and had not made much progress
in improving their communication patterns. It was suggested that the intern assess the AOD use of
the parents, and she did so at the next session. The mother and father had a heated argument about the
father’s drinking. They did not show up for their next appointment and, when the intern called, the
mother said that they were discontinuing counseling because the father said it was a waste of time.
We regularly consult with a social worker in private practice. One of the social worker’s cli-
ents is a woman in her early 30s who sought counseling for “depression.” The woman had been
married twice and described a series of failed relationships. Her first husband was an alcoholic and
the second was a polydrug abuser. For two years, she had been living with a man who was in recov-
ery from cocaine addiction. However, she found out that he had been having numerous affairs dur-
ing their relationship. The woman, who has a master’s degree, could not understand why she
continued to become involved with this kind of man. She felt that there must be something wrong
with her because the men in her life needed alcohol, other drugs, or other women. Her father was an
alcoholic and verbally abusive, and she had also been sexually molested by her paternal grandfather.
In the three situations described, the “helping professionals” (school psychologist, school
counselor, marriage and family therapy intern, social worker) were not involved in providing sub-
stance abuse treatment, but they needed information and skills in the AOD field to perform their job
functions in a competent manner. The authors of this text have worked in schools as a teacher and a
school psychologist, in a mental health clinic, in a university athletic department, and in private
practice. We currently train school counselors and marriage and family therapists as well as sub-
stance abuse counselors. We have found that the frequency of AOD-related problems is so perva-
sive in the helping field that the lack of training in this area would result in inadequate preparation
for mental health professionals. When you read the statistics on the relationship between domestic
violence, child abuse, other crime, and AOD, it should be clear that this relationship also applies to
criminal justice personnel.
It would be unreasonable to expect all helping professionals to have the same set of skills as
substance abuse counselors. We don’t expect substance abuse counselors to be able to plan educa-
tional interventions or to do family therapy. Similarly, school and mental health counselors, social
workers, and marriage and family therapists do not need to be able to monitor detoxification or to
develop treatment plans. However, all mental health professionals will encounter individuals who
need assessment and treatment for AOD problems and clients who are having problems as a result
of relationships with individuals with AOD problems. Included in the related problems that mental
health professionals (school counselors, mental health counselors, rehabilitation counselors, psy-
chologists, social workers, and marriage and family therapists) will encounter are children who
have been fetally affected by parental AOD use, the psychological impact on children and adults
who live or have lived with caretakers who abuse AOD, and the intrapersonal and interpersonal
problems of individuals who are in relationships with people who abuse AOD. Many of you have
read about fetal alcohol syndrome, adult children of alcoholics, and codependency, which are
included in these “related” problems. All of these issues will be discussed in this text.
We hope that you are convinced that mental health professionals need training in the AOD
field, not only to identify those clients who need further assessment and treatment, but also for the
multitude of related problems that all mental health professionals will encounter on a regular basis.
As with many areas in the mental health field, there are differing views on the causes and treatment
of alcoholism and drug addiction based on the variety of disciplines concerned with these problems
and the philosophical orientation of different individuals.
Philosophical Orientation
Jerome is a 47-year-old African American man who had been arrested for a DUI (driving under the
influence). It was his third DUI, and he had previously been in an alcohol treatment program. He
had been arrested previously for writing bad checks and spousal abuse. He is unemployed and
dropped out of school in the 10th grade. An assessment revealed a long history of AOD use begin-
ning at age 12. Jerome’s mother was an alcoholic, and he was raised by his grandmother. He does
not know his biological father.
Jerome’s problem may be viewed in different ways by different professionals, depending on
their training and experiences. A sociologist may focus on the environmental and cultural factors
that modeled and encouraged AOD use. Some psychologists might attend to the fact that Jerome
experienced rejection by his biological parents that led to feelings of inadequacy. The use of AOD
might be seen as a coping mechanism. A physician might be impressed by the family history of
alcoholism and hypothesize that Jerome had a genetic predisposition for chemical dependency. A
social worker may think that Jerome’s unemployment and lack of education resulted in discourage-
ment and consequent AOD use. A criminal justice worker may see his behavior as willful miscon-
duct and believe that punishment is necessary.
These differing views of the causes and treatment of Jerome’s problem are not unusual in the
mental health field. However, what is unique in the AOD field is that many drug and alcohol coun-
selors, others involved in the treatment of alcoholics and other addicts, and many people who are
recovering from AOD problems believe that Jerome has a disease that has affected him mentally,
physically, socially, emotionally, and spiritually. This spiritual component separates AOD prob-
lems from other mental health problems and has had implications for the understanding and
treatment of AOD problems. (We will discuss spirituality in AOD recovery in Chapter 10.) One
implication is that methods to attend to the spiritual aspect of treatment (e.g., Alcoholics Anonymous)
are a common component of treatment. Another implication is that there are many individuals
involved in the treatment of AOD problems who do not have formal training as counselors but who
are “in recovery” and hold a fervent belief in a particular orientation to treatment. This belief may
be based not on scientific evidence, but instead on their own experience and the experience of other
recovering individuals. This phenomenon is similar to an individual’s religious beliefs that cannot
(and should not) be disputed by research since the beliefs are valid for that individual. Clearly, the
potential for disagreement and controversy exists when scientific and spiritual viewpoints are
applied to the same problem, which has certainly been the case in this field.
In Chapter 3, we will discuss the different models of addiction and will thoroughly discuss the
“disease concept” of addiction. Our point here is that we believe that the AOD field requires an
openness on the part of the mental health professional to consider a wide variety of possible causes
of AOD problems and to employ a multitude of methods by which people recover from these prob-
lems. We have worked with people who discontinued their use of AOD without any treatment,
individuals who stopped after walking into a church and “finding Jesus,” clients and students who
swear by Alcoholics Anonymous (AA), and people who have needed a formal treatment program.
If you work in a treatment program, you tend to see people who have experienced many life
problems related to AOD use. It is easy to develop a viewpoint about substance abuse based on
these clients’ experiences. It is important to remember that treatment providers do not see those
people who modify or discontinue their AOD use through methods other than formal treatment.
This book is written from the perspective of the mental health professional working in a gen-
eralist setting rather than from the perspective of a substance abuse counselor in a treatment setting.
Therefore, we will provide the type of information we believe all mental health professionals need
in the AOD field to work effectively in schools, community agencies, and private practice, rather
than providing all the information needed to work as a substance abuse counselor in a treatment set-
ting. We want to provide a balance in the types of viewpoints that exist in this field so that you can
understand these perspectives. We will describe the popular literature in certain areas (e.g., adult
children of alcoholics) and contrast this with research in the area so that you can understand that
clinical impressions and research do not always match. Finally, we want to communicate our belief
that it is not advisable to adopt universal concepts of cause and treatment in this field. In other areas
of mental health treatment, we encourage practitioners to assess a client and to develop treatment
strategies based on the individual and group characteristics of the client. The same rules should
apply in the AOD field.
Professional Orientation
Over the years, this text has been used in undergraduate and graduate courses for students prepar-
ing for careers in criminal justice, social work, marriage and family therapy, mental health coun-
seling, rehabilitation counseling, school counseling, school psychology, and substance abuse
counseling. As a student, the manner in which you use the information in this book in your career
will be dependent on factors such as your personal experiences with the topics, the philosophical
orientation of your program, when you take this course in your studies, and your eventual job
placement. For example, a social worker who is employed by a hospice may not have as much
regular contact with substance abuse issues compared to a social worker involved with investigat-
ing child abuse cases. An elementary school counselor will encounter plenty of family issues
related to AOD but less abuse by students compared to a high school counselor. The point is that,
although you may have a clear vocational goal, it is not possible for you to know in what job set-
ting you will find yourself in 5 or 10 years. Your program of study may have an orientation to
understanding human behavior that is not consistent with what you read in some chapters. That is
to be expected and is part of the learning process for students preparing for careers in the helping
professions. Regardless, we want to encourage you to avoid filtering what you learn through a
lens of “I don’t need to know that because I won’t be dealing with that in my career” or “I don’t
believe that. It doesn’t fit with my view of human behavior.” Challenge anything you read here
but keep an open mind.
Attitudes and Beliefs

Close your eyes for a minute and visualize an alcoholic. What did your alcoholic look like? For
most people, the alcoholic is a white male, middle-aged, who looks pretty seedy. In other words, the
stereotypical skid row bum. Did you visualize somebody who looks like former President Bush?
Did you visualize one of your professors? Did you visualize a professional athlete?
Attitudes and beliefs about alcoholics and drug addicts have an effect on the mental health
professional’s work. Imagine that you are a mental health counselor and a well-dressed, middle-
aged woman comes to see you complaining of symptoms of depression. If you hold false beliefs
about alcoholics, such as that they must be dirty and drunk all the time, you might fail to diagnose
those clients who do not fit your stereotype.
To help students understand their own attitudes about alcoholics and drug addicts, we have our
students attend an AA or Narcotics Anonymous meeting as a class assignment. We encourage
you to do this as well (if you do go to a meeting, make sure you attend an “open” meeting [see
Chapter 11]). In addition to acquiring a cognitive understanding of this type of support for alcohol-
ics and addicts, students report interesting affective reactions that provide information about their
attitudes. For example, many students report that they want to tell others at the meeting that they are
there for a class assignment and that they are not alcoholics. Our response is that unless you believe
that alcoholism or drug addiction is simply a condition that some people develop and has nothing to
do with morals or a weak will, you would not care if you were mistakenly identified as alcoholic or
drug addicted. If you do care, you must believe that alcoholics and drug addicts have some type of
character flaw. This realization helps many potential mental health professionals modify their atti-
tudes and beliefs about alcoholism and drug addiction.
A second type of affective reaction that students report is being surprised with the heterogene-
ity of the group. At most meetings, they see well-dressed businessmen and women, young people,
blue-collar workers, unkempt people, articulate individuals, and people obviously impaired from
their years of using AOD. Seeing such a variety of people tends to destroy any stereotypes the stu-
dents may have.
Although we believe that potential mental health professionals may hold any belief system
they want, the belief that alcoholism or drug addiction is due to a moral weakness or a character
flaw may have a detrimental effect on providing or finding appropriate help for those with AOD
problems. For example, imagine that you are a marriage and family therapist and that you are seeing
a couple in which one partner is drinking excessively. You believe that changing heavy drinking to
moderate drinking is largely a matter of willpower and desire, and you communicate this to the
drinking partner. If this individual is addicted to alcohol, your belief system will be incompatible
with this client’s reality. Your client may experience shame, because he or she is not strong enough,
or anger at your lack of understanding. Resistance and termination are frequent outcomes, and the
client fails to get the proper help. Therefore, if you do believe that excessive AOD use is largely due
to moral weakness or character flaws, you would be well advised to refer these cases to others.
Denial, Minimization, Projection, and Rationalization

Imagine (or maybe you don’t have to imagine) that you are in love with someone you believe to be
the most wonderful person in the world. You cannot imagine living without this person and firmly
believe that you need this person to survive. Your mother sits you down one day and tells you that
you must no longer associate with this person. She tells you that this person is destroying your life,
that you have changed since becoming involved with this person, and that all of your family and
friends believe that you need to break off the relationship before something terrible happens to you.
How would you react? You might tell your mother that she is crazy and that all her complaints
about this person are untrue (denial). Perhaps you acknowledge that your person does have some
little quirks, but they really don’t bother you (minimization). You tell your mother that she and the
rest of your family and friends are really jealous because they do not have someone as wonderful as
you (projection) and that you may have changed but that these changes are for the better and long
overdue (rationalization).
We use this analogy so you can develop an empathic understanding of what many AOD-
addicted individuals experience. Obviously, the “love object” in this case is the individual’s drug of
choice. The addicted individual may be seen as having an intimate and monogamous relationship with
alcohol or other drugs and may believe that he or she needs the drug to function and survive. In the
same way that people deny that a relationship has become destructive, the addicted individual may
deny that alcohol or other drugs have become destructive in spite of objective evidence to the contrary.
The defense mechanisms of denial, minimization, projection, and rationalization are used so that the
person does not have to face a reality that may be terrifying: a life without alcohol or other drugs.
Although we know that it may be easy for you to intellectually understand, these concepts as
applied to alcoholics and other drug-addicted people, we have found it useful for our students to have
a more direct experience with their own use of defense mechanisms. At the first session of our sub-
stance abuse class, we ask the students to choose a substance or activity and abstain from this sub-
stance or activity for the semester, and that the first thing that popped into their heads and was
rejected because it would be too hard to give up is the thing they should choose. Students usually
choose substances such as alcohol, coffee, chocolate, or sugar, or activities such as gambling (we live
in Nevada, where gambling is legal) or watching television. Some choose tobacco and an occasional
courageous student will choose an illegal drug. The students record their use of the defense mecha-
nisms through journal entries and write a paper about the experience at the end of the semester.
If you are wondering whether some students “blow off ” the assignment and just make up the
material in their journals and papers, the answer is “of course.” When the assignment is given, this
issue is discussed. The students are told that they can do anything they want to; the instructor will
never know the difference. However, there is some reason for potential mental health professionals
to take a close look at themselves if they are unwilling to abstain from a substance or activity for
15 weeks, particularly when they will be encouraging clients to abstain from alcohol or other drugs
for a lifetime.
We encourage you, our reader, to examine your own use of denial, minimization, projection,
and rationalization, particularly in regard to your own use of AOD. Mental health professionals are
not immune to AOD problems and are just as likely to use these defense mechanisms as anyone else
is. As you read the rest of this book, take some time to examine your own substance-using behavior.
If there is a problem, this would be the ideal time to get some help. This would certainly be prefer-
able to becoming one of the many impaired professionals who may cause harm to their clients and
themselves.
Helping Attitudes and Behaviors

Although we have encountered many mental health professionals with AOD problems, we have found
that a more pervasive problem may be the potential mental health professionals who gravitate
to the helping professions because of unresolved issues in their lives. Although there may be a sincere
desire to help others, these potential mental health professionals may actually be unhelpful to clients.
For example, in our counselor education program, we find that many of our students are adult children
of alcoholics. Now, that is no problem in and of itself. In fact, as we will discuss in Chapter 13, many
adult children of alcoholics have the same or fewer problems than other adults. However, being raised
by one or more alcoholic caretakers may lead to certain characteristic ways of behaving that could
have implications for a mental health professional’s effectiveness. For example, a graduate student in
marriage and family therapy whom we will call Debbie (we are changing all of the names of students
and clients we are using in this book to protect anonymity) decided to pursue a career in the helping
professions because everyone told her that she was easy to talk to and was a good listener. Debbie said
that she was one of those people to whom total strangers immediately told their life stories.
Debbie was raised by her biological parents, both of whom were alcoholics. Within her fam-
ily, she had developed a method of behaving that would minimize the probability of conflict devel-
oping. She did most of the cooking and cleaning at home, took care of her younger siblings, and
worked very hard at school. Debbie reported being in a constant state of anxiety because of her
worry that she had “missed” something that would send one of her parents into a rage.
In hindsight, it is easy to see that Debbie developed a false belief that she could control her par-
ents’ moods and behavior by making sure that everything was perfect at home and by her achieve-
ments at school. It is not unusual for children raised by alcoholic caretakers to develop a role designed
to divert attention away from the real problem in the family. (Again, this will be discussed in detail in
Chapter 13.) However, the development of this childhood role had implications for Debbie’s work as
a marriage and family therapist. We noticed that she was quite hesitant to confront clients and that she
seemed very uncomfortable with conflict. Debbie had more than the usual anxiety for a student when
counseling and brooded excessively when her clients did not immediately feel better. Clearly, the
characteristic ways Debbie had learned to behave as a child were having a detrimental effect on her
development as a marriage and family therapist in spite of the fact that people found her easy to talk to.
Another of our graduate students in counseling, Patricia, was taking our substance abuse
counseling course. She failed her midterm examination. Patricia came to see the instructor and
explained that the content of the course generated a great deal of emotion for her because her par-
ents were alcoholics and she had been married to a drug addict. Because of these emotions, she said
that she had difficulty concentrating on the lectures and the reading material and in following
through on class assignments (students were required to attend an AA and an Al-Anon [for family
members of alcoholics] meeting). The instructor communicated his understanding that the course
could have that impact on people with history and experiences in the substance abuse area and sug-
gested that Patricia drop the course (he offered a passing withdrawal) and pursue counseling for
herself. Patricia chose to avoid working on these issues, she stayed in the course, and failed.
Because most of you who are reading this text are graduate students, this may strike you as
rather harsh. However, consider the alternative. Let’s say that the instructor had offered his under-
standing and allowed Patricia to remain in the course without dealing with these issues and passed
her. Would Patricia be able to work effectively with individuals and families in which there were
alcohol or other drug problems, with adult clients who were raised by substance abusing caretakers,
or with clients living with alcohol or other drug-abusing partners? In an attempt to avoid these prob-
lems, she might do a poor job of assessment, or she might ignore the signs and symptoms of alcohol
or other drug problems. Or she might ignore or fail to inquire about substance abuse in the family of
origin or in the current family of her clients. In short, we believe that her unwillingness to face these
problems would result in her being a less effective counselor.
What about Debbie? Her excessive anxiety and concern with her performance prevented her
from objectively looking at her clients and her own counseling behaviors. Debbie’s fear of conflict
resulted in an unwillingness to confront her clients, which limited her effectiveness. Fortunately,
Debbie was receptive to feedback and suggestions. She did some work on her own issues, and she
has become a fine marriage and family therapist.
This discussion is not meant to discourage those of you who are adult children of alcoholics,
are in recovery from an alcohol or other drug problem, or have lived or are living with an addicted
person from pursuing your careers. It is our experience that most people who want to become help-
ing professionals have a need or desire to help people that is based on family-of-origin issues that
may adversely affect their work. This is certainly the case with both of us. It is not a problem if you
enter a training program in one of the helping professions because of your own need to be needed.
It is a problem if you avoid examining your own issues and fail to take steps to resolve these issues
in order to avoid ineffective (or in some cases, harmful) work with clients.
In this particular field, we find helping professionals who cannot work effectively with clients
because of their own AOD use or their experiences with AOD use in their families of origin and/or with
partners. In the rest of this book, we will attempt to provide you with information that will enable you
to deal effectively with the direct and indirect problems resulting from AOD use that social workers,
school counselors, mental health counselors, marriage and family therapists, and other helping profes-
sionals will encounter. However, all of this information will be useless if your own use patterns or
issues are unresolved and if they impact your work. Because denial is so pervasive, we encourage you
to seek objective feedback regarding the necessity to work on your own use of alcohol or other drugs or
on other issues and, if necessary, to choose a course of action with professional assistance. But please,
for your own benefit and for the benefit of your future clients, don’t choose to avoid these issues.
Overview of the Book

In our choice of chapter topics and the orientation of each chapter, we have tried to maintain the
primary goal of providing useful information in the AOD field to general mental health profession-
als. Therefore, Chapter 2 (Classification of Drugs), Chapter 3 (Models of Addiction), Chapter 8
(Treatment of Alcohol and Other Drugs (AOD)), and Chapter 11 (Twelve Step and Other Types of
Support Groups) are overviews of these topics. We have attempted to provide enough detail about
treatment and Twelve Step groups to reduce any myths about these activities and to allow mental
health professionals to make informed referrals. Issues that usually provoke some controversy
among generalists (e.g., the disease concept, relative dangers of different drugs) are also discussed.
In several chapters, we have attempted to integrate the role of the mental health professional
in working with clients with AOD problems with the specialist in the field. In Chapter 6 (Screening,
Assessment, and Diagnosis), Chapter 7 (Motivational Interviewing and Brief Interventions), and
Chapter 10 (Relapse Prevention and Recovery), our goal is that you will understand the types of
AOD services that mental health professionals in generalist settings provide.
In this latest edition, we have added a chapter (9) titled Co-occurring Disorders and Other
Special Populations. Although these topics were covered in earlier editions, there is an increasing
trend throughout treatment programs to provide treatment for substance use disorders and other
mental disorders simultaneously. Because of this trend, mental health providers are having more
direct treatment contact with clients diagnosed with substance use disorders. Therefore, we believe
that all helping professionals need to be familiar with co-occurring disorders and the treatment
implications of working with these clients.
Chapter 12 (Children and Families), Chapter 13 (Adult Children and Codependency), and
Chapter 15 (Gambling and Other Behavioral Addictions) involve issues related to AOD problems.
In many instances, mental health professionals may work with clients having these problems. In
each of these chapters, we have attempted to provide sufficient depth of coverage so that you will
have a conceptual framework to understand the relationship of these topics to AOD and to under-
stand the implications for treatment.
Chapter 4 is an in-depth discussion of multicultural issues in the AOD field. As with all mental
and other health-related topics, it is essential to understand both individual and group characteristics
of clients. The cultural context of AOD use is of crucial importance in both prevention and treatment.
We have chosen to highlight its importance by devoting a chapter to the topic rather than integrating
multiculturalism into each chapter. Therefore, we encourage you to maintain an awareness of diver-
sity issues as you read the remaining chapters.
Chapter 5 concerns confidentiality and ethics. In teaching a substance abuse counseling class
to mental health generalists, we have found nearly universal ignorance of the fact that almost all
mental health professionals are bound by federal confidentiality regulations. Students often per-
ceive this topic as “dry.” However, we have seen the consequences of lack of awareness of confi-
dentiality regulations. So, please have the stamina to wade through this chapter.
The relationship between HIV/AIDS and substance abuse is discussed in Chapter 14. Our inclu-
sion of a chapter on this topic reflects the increasing need for awareness among all mental and other
health professionals regarding transmission and prevention of this and other communicable diseases.
Having only one chapter on prevention (Chapter 16) does not imply that the subject is unim-
portant. Indeed, if prevention efforts were more successful, there would be less need for the rest of
this book. Clearly, school counselors and school social workers must be well-informed about effec-
tive prevention approaches. However, successful prevention involves all aspects of a community,
and all helping professionals must be involved. We are particularly interested in increasing your
awareness of our public policy regarding the marketing of legal drugs (alcohol and tobacco) and its
effect on prevention efforts.
In each chapter after this introductory chapter, there will be case examples at the beginning of
the chapter. We have based these case examples on our own clinical experiences, but have obvi-
ously changed anything that would personally identify a person. The case examples will be used to
illustrate points and concepts.
At the ends of chapters, major points are bulleted in a Summary section. We have added
Internet resources for those of you who want more information on subjects in the chapters. Finally,
there are some discussion questions designed to provoke your thinking about issues.
We need to mention an aspect of writing style so you understand what we are trying to do
in this book. The tone of our writing may be less scholarly than you are accustomed to. We have
taught many university courses and have used a lot of textbooks. We also were students for a long
time. From these experiences, we found that many textbooks were marvelous, nonpharmaceutical
methods to induce sleep. Although accurate and scholarly, the stilted style was often a barrier to
acquiring information. It has been our intention to make this book accurate and informative but with
a lower probability of causing drowsiness. Let us know if it worked.
MyCounselingLab for Addictions/Substance Abuse
Try the Topic 1 Assignments: Introduction to Substance Abuse Counseling.

Chapter 2
Classification of Drugs
Case Examples
1 Casey is a 48-year-old man who visits his primary care physician. He complains of insom-
nia, anxiety, frequent acid indigestion, and fatigue. On his blood panel, he shows some
impairment in his liver functioning. He is borderline diabetic and has hypertension.
2 Matilda is a 33-year-old woman who comes in to an emergency room complaining of severe
lower back pain. An x-ray is negative. She is restless and agitated, has a runny nose, and
complains of an upset stomach. Her vital signs are normal.
3 Chris and his wife are seeing you for marriage and family therapy. Chris works in the finan-
cial industry in a high-paced, stressful environment. His wife says Chris hardly sleeps and
does not eat regularly. His moods are erratic. The couple has some financial problems, which
Chris attributes to bad investments. The couple was court-ordered to counseling following a
domestic violence incident.
As we noted in Chapter 1, this textbook is designed for the mental health professional (e.g., school
counselor, mental health counselor, rehabilitation counselor, social worker, marriage and family
therapist) who will encounter AOD problems with clientele but who, generally, will not provide
treatment for these problems. Therefore, the goal of this chapter is to provide an overview of the
drugs (including alcohol and tobacco) that are most often abused and drugs that are used in
the treatment of some mental disorders. However, a thorough understanding of the pharmacology of
drugs and related issues (e.g., medical management of overdose, use of psychotropic medications in
the treatment of mental disorders) would require far more attention than one chapter can offer. Also,
information in this area changes rapidly as a result of research. For example, there is no medication
that has been found to be effective in significantly reducing cocaine craving. However, there is
considerable research in this area. By the time you read this book, there may be pharmacological
management of cocaine withdrawal that does not currently exist. We are including an additional
reading list at the end of this chapter if you want to acquire more comprehensive information on the
topics discussed. In addition, we encourage you to develop contacts with AOD treatment providers
who are likely to remain current with regard to research in this area. This will reduce the probability
that you will pass along misinformation or outdated information to your clients.
Different methods exist that are used to classify drugs. We will use the method that classifies
drugs by their pharmacological similarity. Drugs exist that do not fit nicely into one classification,
and these will be noted. For each drug classification, we will mention the common drugs contained
in the classification and some common street names, the routes of administration, major acute and
11
12 Chapter 2 • Classification of Drugs
chronic effects, signs of intoxication, signs of overdose, tolerance, and withdrawal. First, however,
we will present information on the federal schedule of drugs, a discussion of the concept of
“dangerousness,” some simple definitions of terms that will be helpful in understanding the rest of
the chapter, and a brief overview of the neurobiology of drugs.
Comprehensive Drug Abuse Prevention and Control Act

In 1970, the Comprehensive Drug Abuse Prevention and Control Act (often referred to as the
Controlled Substances Act) was passed by the U.S. Congress. As part of this law, drugs are
placed in one of five “schedules,” with regulatory requirements associated with each schedule.
Schedule I drugs have a high potential for abuse, no currently accepted medical use in treatment
in the United States, and a lack of a safe level of use under medical supervision. Drugs on
Schedule I include heroin, methaqualone (Quaalude), LSD, and marijuana. Schedule II drugs also
have a high abuse potential and can lead to psychological or physical dependence. However,
these drugs have an accepted medical use in treatment. These drugs include morphine, PCP,
cocaine, and methamphetamine. As you can probably surmise, the criteria for the other schedules
involve less abuse potential, increased medical uses, and less likelihood of psychological and
physical dependence.
As you will see from our discussion of the classification of drugs, the way some drugs are
classified is clearly illogical. For example, benzodiazepines such as Valium and Xanax are Schedule
IV drugs, with part of the criteria for inclusion being that the drugs have a lower abuse potential
than drugs on Schedules I, II, and III. In reality, these drugs have at least the same if not greater
abuse potential than marijuana, a Schedule I drug. However, the inclusion of a drug on a certain
schedule is related to public policy, which will be discussed in Chapter 16. For example, the reclas-
sification downward of a drug such as marijuana would be politically difficult, and the reclassifica-
tion of benzodiazepines upward would be resisted by the manufacturers of these drugs.
The Concept of Dangerousness

Related to the preceding discussion of schedules of drugs is the concept of the inherent dangers
of certain drugs. Tobacco, alcohol, and other drugs are not safe to use. There are acute and
chronic dangers that vary by drug. For example, there is little acute danger from the ingestion of
a glass of wine by an adult. The acute danger of injecting cocaine is far greater. Chronic use of
any drug (including alcohol) has an increased risk, but the danger of smoking one pack of ciga-
rettes a day for 40 years is greater than the dangers from drinking one beer a day for 40 years.
Danger is also related to the method used to administer a drug. Smoking a drug or injecting it
produces the most rapid and intense reaction, while ingesting a drug generally produces effects
with longer duration, but less intensity. Snorting drugs is in between, but has more similarities
to smoking and injecting than ingesting. Although any method of administration may be danger-
ous both acutely and chronically, smoking or injecting drugs tends to result in the most acute
problems because these routes of administration rapidly introduce the drug to the bloodstream
and, subsequently, to the brain. Also, smoking drugs causes damage to the respiratory system, and
the intravenous use of drugs may cause serious problems including abscesses, blood clots, allergic
reactions to the substances used to “cut” the drug, and communicable diseases such as hepatitis
and HIV.
It is certainly important that you understand the acute and chronic effects of different drugs and
the addictive potential of tobacco, alcohol, and other drugs. However, it is essential that you under-
stand that any of the psychoactive drugs we discuss in this chapter can be used in an addictive manner.
Chapter 2 • Classification of Drugs 13
You will learn that hallucinogens are not physically addicting in the sense that body tissues require
these drugs for normal functioning. However, this does not imply that people are immune from seri-
ous problems resulting from the use of hallucinogens. Alcohol is clearly an extremely dangerous
drug in spite of the fact that many people use the drug moderately without problems. Marijuana is not
as acutely or chronically dangerous as cocaine, but that does not mean it can be used safely. We have
worked with clients who have serious life problems from marijuana use. This is not a sermon to “Just
Say No.” It is a caution to avoid concluding that you can direct clients away from some drugs to other
drugs, and a caution to avoid using your own experience with AOD as a basis for determining which
drugs are safe and which are dangerous.
Definitions
Terminology in the AOD field can be confusing. One author may have a very specific meaning for
a particular term, while another may use the same term in a more general sense. An analogy might
be the use of the term neurotic in the mental health field. Although one professional may use this
term when referring to some very specific disorders, another may use it to describe a wide variety
of mental health problems. However, there is no universal agreement about how some of these
terms should be used. Therefore, the following definitions should assist you in understanding this
chapter and the rest of the book, but you may find differences in definitions as you read professional
and popular literature in the AOD field.
Addiction: Compulsion to use alcohol or other drugs regardless of negative or adverse
consequences. Addiction is characterized by psychological dependence (see the following
section) and, often (depending on the drug or drugs) physical dependence (see below). As we
will discuss in Chapter 15, the term addiction is sometimes applied to behaviors other than
AOD (e.g., eating, gambling).
Alcoholism: Addiction to a specific drug: alcohol.
Chemical dependency: A term used to describe addiction to alcohol and/or other drugs and
to differentiate this type of addiction from nonchemical addictions (e.g., gambling).
Dependence: A recurrent or ongoing need to use alcohol or other drugs. Psychological
dependence is the need to use alcohol or other drugs to think, feel, or function normally.
Physical dependence exists when tissues of the body require the presence of alcohol or other
drugs to function normally. All psychoactive drugs can produce psychological dependence
and many can produce physical dependence.
Intoxication: State of being under the influence of alcohol or other drugs so that thinking,
feeling, and/or behavior are affected.
Psychoactive drugs: Natural or synthetic chemicals that affect thinking, feeling, and behavior.
Psychotropic drugs: Chemicals used to treat mental disorders.
Substance abuse: The continued use of alcohol and/or other drugs in spite of adverse
consequences in one or more areas of an individual’s life (e.g., family, job, legal, financial).
Tolerance: Requirement for increasing doses or quantities of alcohol or other drugs to
create the same effect as was obtained from the original dose. Tolerance results from the
physical or psychological adaptations of the individual.
Cross-tolerance: Refers to accompanying tolerance to other drugs from the same
pharmacological group. For example, tolerance to alcohol results in tolerance to minor
tranquilizers such as Xanax, even when the individual has never used Xanax.
14 Chapter 2 • Classification of Drugs
Reverse tolerance: Refers to a condition in which smaller quantities of a drug produce the
same effects as did previous larger doses.
Withdrawal: Physical and psychological effects that occur when a drug-dependent
individual discontinues alcohol or other drug use.
The Neurobiology of Addiction1

Drugs affect the brain by impacting the way nerve cells send, receive, and process information.
Drugs such as heroin and marijuana activate neurons by mimicking natural neurotransmitters.
Other drugs such as methamphetamine and cocaine cause nerve cells to release extremely large
amounts of neurotransmitters or prevent the normal reuptake of neurotransmitters into the nerve
cells (see Figure 2.1).
Most drugs of abuse directly or indirectly target the brain’s reward system by releasing or
blocking the reuptake of the neurotransmitter dopamine. Dopamine is present in regions of the
brain that regulate movement, emotion, cognition, motivation, and feelings of pleasure. When
dopamine floods the neuron system in the brain’s reward center, euphoria results. Natural
human behaviors (e.g., eating, sex) also release dopamine and the person experiences pleasure.
Because our brains are designed for the survival of the species, we want to repeat these natural,
pleasurable activities. However, when drugs stimulate the brain’s reward center, our brain is in
effect “fooled” into believing that drug taking is also a survival behavior that should be
repeated.
Many naturally pleasurable activities are not habitually repeated like drug taking can be. The
neurobiological explanation is that 2 to 10 times more dopamine is released by drugs than by natu-
ral activities. Furthermore, depending on the method that drugs are administered, this dopamine
release is almost immediate and is very intense. Therefore, the euphoric properties of drug taking
can be very powerful and highly reinforcing.
FIGURE 2.1 Effect of drugs on neurotransmitters.
1
This information comes from the National Institute on Drug Abuse (NIDA) Drugs, Brains, and Behavior—The Science of
Addiction (2010). Available at http://www.nida.nih.gov/scienceofaddiction/index.html. All material, including illustrations,
is in the public sector.
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DANCE ON STILTS AT THE GIRLS’ UNYAGO, NIUCHI
Newala, too, suffers from the distance of its water-supply—at least

the Newala of to-day does; there was once another Newala in a lovely
valley at the foot of the plateau. I visited it and found scarcely a trace
of houses, only a Christian cemetery, with the graves of several
missionaries and their converts, remaining as a monument of its
former glories. But the surroundings are wonderfully beautiful. A
thick grove of splendid mango-trees closes in the weather-worn
crosses and headstones; behind them, combining the useful and the
agreeable, is a whole plantation of lemon-trees covered with ripe
fruit; not the small African kind, but a much larger and also juicier
imported variety, which drops into the hands of the passing traveller,
without calling for any exertion on his part. Old Newala is now under
the jurisdiction of the native pastor, Daudi, at Chingulungulu, who,
as I am on very friendly terms with him, allows me, as a matter of
course, the use of this lemon-grove during my stay at Newala.
FEET MUTILATED BY THE RAVAGES OF THE “JIGGER”
(Sarcopsylla penetrans)
The water-supply of New Newala is in the bottom of the valley,

some 1,600 feet lower down. The way is not only long and fatiguing,
but the water, when we get it, is thoroughly bad. We are suffering not
only from this, but from the fact that the arrangements at Newala are
nothing short of luxurious. We have a separate kitchen—a hut built
against the boma palisade on the right of the baraza, the interior of
which is not visible from our usual position. Our two cooks were not
long in finding this out, and they consequently do—or rather neglect
to do—what they please. In any case they do not seem to be very
particular about the boiling of our drinking-water—at least I can
attribute to no other cause certain attacks of a dysenteric nature,
from which both Knudsen and I have suffered for some time. If a
man like Omari has to be left unwatched for a moment, he is capable
of anything. Besides this complaint, we are inconvenienced by the
state of our nails, which have become as hard as glass, and crack on
the slightest provocation, and I have the additional infliction of
pimples all over me. As if all this were not enough, we have also, for
the last week been waging war against the jigger, who has found his
Eldorado in the hot sand of the Makonde plateau. Our men are seen
all day long—whenever their chronic colds and the dysentery likewise
raging among them permit—occupied in removing this scourge of
Africa from their feet and trying to prevent the disastrous
consequences of its presence. It is quite common to see natives of
this place with one or two toes missing; many have lost all their toes,
or even the whole front part of the foot, so that a well-formed leg
ends in a shapeless stump. These ravages are caused by the female of
Sarcopsylla penetrans, which bores its way under the skin and there
develops an egg-sac the size of a pea. In all books on the subject, it is
stated that one’s attention is called to the presence of this parasite by
an intolerable itching. This agrees very well with my experience, so
far as the softer parts of the sole, the spaces between and under the
toes, and the side of the foot are concerned, but if the creature
penetrates through the harder parts of the heel or ball of the foot, it
may escape even the most careful search till it has reached maturity.
Then there is no time to be lost, if the horrible ulceration, of which
we see cases by the dozen every day, is to be prevented. It is much
easier, by the way, to discover the insect on the white skin of a
European than on that of a native, on which the dark speck scarcely
shows. The four or five jiggers which, in spite of the fact that I
constantly wore high laced boots, chose my feet to settle in, were
taken out for me by the all-accomplished Knudsen, after which I
thought it advisable to wash out the cavities with corrosive
sublimate. The natives have a different sort of disinfectant—they fill
the hole with scraped roots. In a tiny Makua village on the slope of
the plateau south of Newala, we saw an old woman who had filled all
the spaces under her toe-nails with powdered roots by way of
prophylactic treatment. What will be the result, if any, who can say?
The rest of the many trifling ills which trouble our existence are
really more comic than serious. In the absence of anything else to
smoke, Knudsen and I at last opened a box of cigars procured from
the Indian store-keeper at Lindi, and tried them, with the most
distressing results. Whether they contain opium or some other
narcotic, neither of us can say, but after the tenth puff we were both
“off,” three-quarters stupefied and unspeakably wretched. Slowly we
recovered—and what happened next? Half-an-hour later we were
once more smoking these poisonous concoctions—so insatiable is the
craving for tobacco in the tropics.
Even my present attacks of fever scarcely deserve to be taken
seriously. I have had no less than three here at Newala, all of which
have run their course in an incredibly short time. In the early
afternoon, I am busy with my old natives, asking questions and
making notes. The strong midday coffee has stimulated my spirits to
an extraordinary degree, the brain is active and vigorous, and work
progresses rapidly, while a pleasant warmth pervades the whole
body. Suddenly this gives place to a violent chill, forcing me to put on
my overcoat, though it is only half-past three and the afternoon sun
is at its hottest. Now the brain no longer works with such acuteness
and logical precision; more especially does it fail me in trying to
establish the syntax of the difficult Makua language on which I have
ventured, as if I had not enough to do without it. Under the
circumstances it seems advisable to take my temperature, and I do
so, to save trouble, without leaving my seat, and while going on with
my work. On examination, I find it to be 101·48°. My tutors are
abruptly dismissed and my bed set up in the baraza; a few minutes
later I am in it and treating myself internally with hot water and
lemon-juice.
Three hours later, the thermometer marks nearly 104°, and I make
them carry me back into the tent, bed and all, as I am now perspiring
heavily, and exposure to the cold wind just beginning to blow might
mean a fatal chill. I lie still for a little while, and then find, to my
great relief, that the temperature is not rising, but rather falling. This
is about 7.30 p.m. At 8 p.m. I find, to my unbounded astonishment,
that it has fallen below 98·6°, and I feel perfectly well. I read for an
hour or two, and could very well enjoy a smoke, if I had the
wherewithal—Indian cigars being out of the question.
Having no medical training, I am at a loss to account for this state
of things. It is impossible that these transitory attacks of high fever
should be malarial; it seems more probable that they are due to a
kind of sunstroke. On consulting my note-book, I become more and
more inclined to think this is the case, for these attacks regularly
follow extreme fatigue and long exposure to strong sunshine. They at
least have the advantage of being only short interruptions to my
work, as on the following morning I am always quite fresh and fit.
My treasure of a cook is suffering from an enormous hydrocele which
makes it difficult for him to get up, and Moritz is obliged to keep in
the dark on account of his inflamed eyes. Knudsen’s cook, a raw boy
from somewhere in the bush, knows still less of cooking than Omari;
consequently Nils Knudsen himself has been promoted to the vacant
post. Finding that we had come to the end of our supplies, he began
by sending to Chingulungulu for the four sucking-pigs which we had
bought from Matola and temporarily left in his charge; and when
they came up, neatly packed in a large crate, he callously slaughtered
the biggest of them. The first joint we were thoughtless enough to
entrust for roasting to Knudsen’s mshenzi cook, and it was
consequently uneatable; but we made the rest of the animal into a
jelly which we ate with great relish after weeks of underfeeding,
consuming incredible helpings of it at both midday and evening
meals. The only drawback is a certain want of variety in the tinned
vegetables. Dr. Jäger, to whom the Geographical Commission
entrusted the provisioning of the expeditions—mine as well as his
own—because he had more time on his hands than the rest of us,
seems to have laid in a huge stock of Teltow turnips,[46] an article of
food which is all very well for occasional use, but which quickly palls
when set before one every day; and we seem to have no other tins
left. There is no help for it—we must put up with the turnips; but I
am certain that, once I am home again, I shall not touch them for ten
years to come.
Amid all these minor evils, which, after all, go to make up the
genuine flavour of Africa, there is at least one cheering touch:
Knudsen has, with the dexterity of a skilled mechanic, repaired my 9
× 12 cm. camera, at least so far that I can use it with a little care.
How, in the absence of finger-nails, he was able to accomplish such a
ticklish piece of work, having no tool but a clumsy screw-driver for
taking to pieces and putting together again the complicated
mechanism of the instantaneous shutter, is still a mystery to me; but
he did it successfully. The loss of his finger-nails shows him in a light
contrasting curiously enough with the intelligence evinced by the
above operation; though, after all, it is scarcely surprising after his
ten years’ residence in the bush. One day, at Lindi, he had occasion
to wash a dog, which must have been in need of very thorough
cleansing, for the bottle handed to our friend for the purpose had an
extremely strong smell. Having performed his task in the most
conscientious manner, he perceived with some surprise that the dog
did not appear much the better for it, and was further surprised by
finding his own nails ulcerating away in the course of the next few
days. “How was I to know that carbolic acid has to be diluted?” he
mutters indignantly, from time to time, with a troubled gaze at his
mutilated finger-tips.
Since we came to Newala we have been making excursions in all
directions through the surrounding country, in accordance with old
habit, and also because the akida Sefu did not get together the tribal
elders from whom I wanted information so speedily as he had
promised. There is, however, no harm done, as, even if seen only
from the outside, the country and people are interesting enough.
The Makonde plateau is like a large rectangular table rounded off
at the corners. Measured from the Indian Ocean to Newala, it is
about seventy-five miles long, and between the Rovuma and the
Lukuledi it averages fifty miles in breadth, so that its superficial area
is about two-thirds of that of the kingdom of Saxony. The surface,
however, is not level, but uniformly inclined from its south-western
edge to the ocean. From the upper edge, on which Newala lies, the
eye ranges for many miles east and north-east, without encountering
any obstacle, over the Makonde bush. It is a green sea, from which
here and there thick clouds of smoke rise, to show that it, too, is
inhabited by men who carry on their tillage like so many other
primitive peoples, by cutting down and burning the bush, and
manuring with the ashes. Even in the radiant light of a tropical day
such a fire is a grand sight.
Much less effective is the impression produced just now by the
great western plain as seen from the edge of the plateau. As often as
time permits, I stroll along this edge, sometimes in one direction,
sometimes in another, in the hope of finding the air clear enough to
let me enjoy the view; but I have always been disappointed.
Wherever one looks, clouds of smoke rise from the burning bush,
and the air is full of smoke and vapour. It is a pity, for under more
favourable circumstances the panorama of the whole country up to
the distant Majeje hills must be truly magnificent. It is of little use
taking photographs now, and an outline sketch gives a very poor idea
of the scenery. In one of these excursions I went out of my way to
make a personal attempt on the Makonde bush. The present edge of
the plateau is the result of a far-reaching process of destruction
through erosion and denudation. The Makonde strata are
everywhere cut into by ravines, which, though short, are hundreds of
yards in depth. In consequence of the loose stratification of these
beds, not only are the walls of these ravines nearly vertical, but their
upper end is closed by an equally steep escarpment, so that the
western edge of the Makonde plateau is hemmed in by a series of
deep, basin-like valleys. In order to get from one side of such a ravine
to the other, I cut my way through the bush with a dozen of my men.
It was a very open part, with more grass than scrub, but even so the
short stretch of less than two hundred yards was very hard work; at
the end of it the men’s calicoes were in rags and they themselves
bleeding from hundreds of scratches, while even our strong khaki
suits had not escaped scatheless.
NATIVE PATH THROUGH THE MAKONDE BUSH, NEAR

MAHUTA
I see increasing reason to believe that the view formed some time
back as to the origin of the Makonde bush is the correct one. I have
no doubt that it is not a natural product, but the result of human
occupation. Those parts of the high country where man—as a very
slight amount of practice enables the eye to perceive at once—has not
yet penetrated with axe and hoe, are still occupied by a splendid
timber forest quite able to sustain a comparison with our mixed
forests in Germany. But wherever man has once built his hut or tilled
his field, this horrible bush springs up. Every phase of this process
may be seen in the course of a couple of hours’ walk along the main
road. From the bush to right or left, one hears the sound of the axe—
not from one spot only, but from several directions at once. A few
steps further on, we can see what is taking place. The brush has been
cut down and piled up in heaps to the height of a yard or more,
between which the trunks of the large trees stand up like the last
pillars of a magnificent ruined building. These, too, present a
melancholy spectacle: the destructive Makonde have ringed them—
cut a broad strip of bark all round to ensure their dying off—and also
piled up pyramids of brush round them. Father and son, mother and
son-in-law, are chopping away perseveringly in the background—too
busy, almost, to look round at the white stranger, who usually excites
so much interest. If you pass by the same place a week later, the piles
of brushwood have disappeared and a thick layer of ashes has taken
the place of the green forest. The large trees stretch their
smouldering trunks and branches in dumb accusation to heaven—if
they have not already fallen and been more or less reduced to ashes,
perhaps only showing as a white stripe on the dark ground.
This work of destruction is carried out by the Makonde alike on the
virgin forest and on the bush which has sprung up on sites already
cultivated and deserted. In the second case they are saved the trouble
of burning the large trees, these being entirely absent in the
secondary bush.
After burning this piece of forest ground and loosening it with the
hoe, the native sows his corn and plants his vegetables. All over the
country, he goes in for bed-culture, which requires, and, in fact,
receives, the most careful attention. Weeds are nowhere tolerated in
the south of German East Africa. The crops may fail on the plains,
where droughts are frequent, but never on the plateau with its
abundant rains and heavy dews. Its fortunate inhabitants even have
the satisfaction of seeing the proud Wayao and Wamakua working
for them as labourers, driven by hunger to serve where they were
accustomed to rule.
But the light, sandy soil is soon exhausted, and would yield no
harvest the second year if cultivated twice running. This fact has
been familiar to the native for ages; consequently he provides in
time, and, while his crop is growing, prepares the next plot with axe
and firebrand. Next year he plants this with his various crops and
lets the first piece lie fallow. For a short time it remains waste and
desolate; then nature steps in to repair the destruction wrought by
man; a thousand new growths spring out of the exhausted soil, and
even the old stumps put forth fresh shoots. Next year the new growth
is up to one’s knees, and in a few years more it is that terrible,
impenetrable bush, which maintains its position till the black
occupier of the land has made the round of all the available sites and
come back to his starting point.
The Makonde are, body and soul, so to speak, one with this bush.
According to my Yao informants, indeed, their name means nothing
else but “bush people.” Their own tradition says that they have been
settled up here for a very long time, but to my surprise they laid great
stress on an original immigration. Their old homes were in the
south-east, near Mikindani and the mouth of the Rovuma, whence
their peaceful forefathers were driven by the continual raids of the
Sakalavas from Madagascar and the warlike Shirazis[47] of the coast,
to take refuge on the almost inaccessible plateau. I have studied
African ethnology for twenty years, but the fact that changes of
population in this apparently quiet and peaceable corner of the earth
could have been occasioned by outside enterprises taking place on
the high seas, was completely new to me. It is, no doubt, however,
correct.
The charming tribal legend of the Makonde—besides informing us
of other interesting matters—explains why they have to live in the
thickest of the bush and a long way from the edge of the plateau,
instead of making their permanent homes beside the purling brooks
and springs of the low country.
“The place where the tribe originated is Mahuta, on the southern
side of the plateau towards the Rovuma, where of old time there was
nothing but thick bush. Out of this bush came a man who never
washed himself or shaved his head, and who ate and drank but little.
He went out and made a human figure from the wood of a tree
growing in the open country, which he took home to his abode in the
bush and there set it upright. In the night this image came to life and
was a woman. The man and woman went down together to the
Rovuma to wash themselves. Here the woman gave birth to a still-
born child. They left that place and passed over the high land into the
valley of the Mbemkuru, where the woman had another child, which
was also born dead. Then they returned to the high bush country of
Mahuta, where the third child was born, which lived and grew up. In
course of time, the couple had many more children, and called
themselves Wamatanda. These were the ancestral stock of the
Makonde, also called Wamakonde,[48] i.e., aborigines. Their
forefather, the man from the bush, gave his children the command to
bury their dead upright, in memory of the mother of their race who
was cut out of wood and awoke to life when standing upright. He also
warned them against settling in the valleys and near large streams,
for sickness and death dwelt there. They were to make it a rule to
have their huts at least an hour’s walk from the nearest watering-
place; then their children would thrive and escape illness.”
The explanation of the name Makonde given by my informants is
somewhat different from that contained in the above legend, which I
extract from a little book (small, but packed with information), by
Pater Adams, entitled Lindi und sein Hinterland. Otherwise, my
results agree exactly with the statements of the legend. Washing?
Hapana—there is no such thing. Why should they do so? As it is, the
supply of water scarcely suffices for cooking and drinking; other
people do not wash, so why should the Makonde distinguish himself
by such needless eccentricity? As for shaving the head, the short,
woolly crop scarcely needs it,[49] so the second ancestral precept is
likewise easy enough to follow. Beyond this, however, there is
nothing ridiculous in the ancestor’s advice. I have obtained from
various local artists a fairly large number of figures carved in wood,
ranging from fifteen to twenty-three inches in height, and
representing women belonging to the great group of the Mavia,
Makonde, and Matambwe tribes. The carving is remarkably well
done and renders the female type with great accuracy, especially the
keloid ornamentation, to be described later on. As to the object and
meaning of their works the sculptors either could or (more probably)
would tell me nothing, and I was forced to content myself with the
scanty information vouchsafed by one man, who said that the figures
were merely intended to represent the nembo—the artificial
deformations of pelele, ear-discs, and keloids. The legend recorded
by Pater Adams places these figures in a new light. They must surely
be more than mere dolls; and we may even venture to assume that
they are—though the majority of present-day Makonde are probably
unaware of the fact—representations of the tribal ancestress.
The references in the legend to the descent from Mahuta to the
Rovuma, and to a journey across the highlands into the Mbekuru
valley, undoubtedly indicate the previous history of the tribe, the
travels of the ancestral pair typifying the migrations of their
descendants. The descent to the neighbouring Rovuma valley, with
its extraordinary fertility and great abundance of game, is intelligible
at a glance—but the crossing of the Lukuledi depression, the ascent
to the Rondo Plateau and the descent to the Mbemkuru, also lie
within the bounds of probability, for all these districts have exactly
the same character as the extreme south. Now, however, comes a
point of especial interest for our bacteriological age. The primitive
Makonde did not enjoy their lives in the marshy river-valleys.
Disease raged among them, and many died. It was only after they
had returned to their original home near Mahuta, that the health
conditions of these people improved. We are very apt to think of the
African as a stupid person whose ignorance of nature is only equalled
by his fear of it, and who looks on all mishaps as caused by evil
spirits and malignant natural powers. It is much more correct to
assume in this case that the people very early learnt to distinguish
districts infested with malaria from those where it is absent.
This knowledge is crystallized in the
ancestral warning against settling in the
valleys and near the great waters, the
dwelling-places of disease and death. At the
same time, for security against the hostile
Mavia south of the Rovuma, it was enacted
that every settlement must be not less than a
certain distance from the southern edge of the
plateau. Such in fact is their mode of life at the
present day. It is not such a bad one, and
certainly they are both safer and more
comfortable than the Makua, the recent
intruders from the south, who have made USUAL METHOD OF
good their footing on the western edge of the CLOSING HUT-DOOR
plateau, extending over a fairly wide belt of
country. Neither Makua nor Makonde show in their dwellings
anything of the size and comeliness of the Yao houses in the plain,
especially at Masasi, Chingulungulu and Zuza’s. Jumbe Chauro, a
Makonde hamlet not far from Newala, on the road to Mahuta, is the
most important settlement of the tribe I have yet seen, and has fairly
spacious huts. But how slovenly is their construction compared with
the palatial residences of the elephant-hunters living in the plain.
The roofs are still more untidy than in the general run of huts during
the dry season, the walls show here and there the scanty beginnings
or the lamentable remains of the mud plastering, and the interior is a
veritable dog-kennel; dirt, dust and disorder everywhere. A few huts
only show any attempt at division into rooms, and this consists
merely of very roughly-made bamboo partitions. In one point alone
have I noticed any indication of progress—in the method of fastening
the door. Houses all over the south are secured in a simple but
ingenious manner. The door consists of a set of stout pieces of wood
or bamboo, tied with bark-string to two cross-pieces, and moving in
two grooves round one of the door-posts, so as to open inwards. If
the owner wishes to leave home, he takes two logs as thick as a man’s
upper arm and about a yard long. One of these is placed obliquely
against the middle of the door from the inside, so as to form an angle
of from 60° to 75° with the ground. He then places the second piece
horizontally across the first, pressing it downward with all his might.
It is kept in place by two strong posts planted in the ground a few
inches inside the door. This fastening is absolutely safe, but of course
cannot be applied to both doors at once, otherwise how could the
owner leave or enter his house? I have not yet succeeded in finding
out how the back door is fastened.
MAKONDE LOCK AND KEY AT JUMBE CHAURO

This is the general way of closing a house. The Makonde at Jumbe
Chauro, however, have a much more complicated, solid and original
one. Here, too, the door is as already described, except that there is
only one post on the inside, standing by itself about six inches from
one side of the doorway. Opposite this post is a hole in the wall just
large enough to admit a man’s arm. The door is closed inside by a
large wooden bolt passing through a hole in this post and pressing
with its free end against the door. The other end has three holes into
which fit three pegs running in vertical grooves inside the post. The
door is opened with a wooden key about a foot long, somewhat
curved and sloped off at the butt; the other end has three pegs
corresponding to the holes, in the bolt, so that, when it is thrust
through the hole in the wall and inserted into the rectangular
opening in the post, the pegs can be lifted and the bolt drawn out.[50]
MODE OF INSERTING THE KEY
With no small pride first one householder and then a second

showed me on the spot the action of this greatest invention of the
Makonde Highlands. To both with an admiring exclamation of
“Vizuri sana!” (“Very fine!”). I expressed the wish to take back these
marvels with me to Ulaya, to show the Wazungu what clever fellows
the Makonde are. Scarcely five minutes after my return to camp at
Newala, the two men came up sweating under the weight of two
heavy logs which they laid down at my feet, handing over at the same
time the keys of the fallen fortress. Arguing, logically enough, that if
the key was wanted, the lock would be wanted with it, they had taken
their axes and chopped down the posts—as it never occurred to them
to dig them out of the ground and so bring them intact. Thus I have
two badly damaged specimens, and the owners, instead of praise,
come in for a blowing-up.
The Makua huts in the environs of Newala are especially
miserable; their more than slovenly construction reminds one of the
temporary erections of the Makua at Hatia’s, though the people here
have not been concerned in a war. It must therefore be due to
congenital idleness, or else to the absence of a powerful chief. Even
the baraza at Mlipa’s, a short hour’s walk south-east of Newala,
shares in this general neglect. While public buildings in this country
are usually looked after more or less carefully, this is in evident
danger of being blown over by the first strong easterly gale. The only
attractive object in this whole district is the grave of the late chief
Mlipa. I visited it in the morning, while the sun was still trying with
partial success to break through the rolling mists, and the circular
grove of tall euphorbias, which, with a broken pot, is all that marks
the old king’s resting-place, impressed one with a touch of pathos.
Even my very materially-minded carriers seemed to feel something
of the sort, for instead of their usual ribald songs, they chanted
solemnly, as we marched on through the dense green of the Makonde
bush:—
“We shall arrive with the great master; we stand in a row and have
no fear about getting our food and our money from the Serkali (the
Government). We are not afraid; we are going along with the great
master, the lion; we are going down to the coast and back.”
With regard to the characteristic features of the various tribes here
on the western edge of the plateau, I can arrive at no other
conclusion than the one already come to in the plain, viz., that it is
impossible for anyone but a trained anthropologist to assign any
given individual at once to his proper tribe. In fact, I think that even
an anthropological specialist, after the most careful examination,
might find it a difficult task to decide. The whole congeries of peoples
collected in the region bounded on the west by the great Central
African rift, Tanganyika and Nyasa, and on the east by the Indian
Ocean, are closely related to each other—some of their languages are
only distinguished from one another as dialects of the same speech,
and no doubt all the tribes present the same shape of skull and
structure of skeleton. Thus, surely, there can be no very striking
differences in outward appearance.
Even did such exist, I should have no time
to concern myself with them, for day after day,
I have to see or hear, as the case may be—in
any case to grasp and record—an
extraordinary number of ethnographic
phenomena. I am almost disposed to think it
fortunate that some departments of inquiry, at
least, are barred by external circumstances.
Chief among these is the subject of iron-
working. We are apt to think of Africa as a
country where iron ore is everywhere, so to
speak, to be picked up by the roadside, and
where it would be quite surprising if the
inhabitants had not learnt to smelt the
material ready to their hand. In fact, the
knowledge of this art ranges all over the
continent, from the Kabyles in the north to the
Kafirs in the south. Here between the Rovuma
and the Lukuledi the conditions are not so
favourable. According to the statements of the
Makonde, neither ironstone nor any other
form of iron ore is known to them. They have
not therefore advanced to the art of smelting
the metal, but have hitherto bought all their
THE ANCESTRESS OF
THE MAKONDE
iron implements from neighbouring tribes.
Even in the plain the inhabitants are not much
better off. Only one man now living is said to
understand the art of smelting iron. This old fundi lives close to
Huwe, that isolated, steep-sided block of granite which rises out of
the green solitude between Masasi and Chingulungulu, and whose
jagged and splintered top meets the traveller’s eye everywhere. While
still at Masasi I wished to see this man at work, but was told that,
frightened by the rising, he had retired across the Rovuma, though
he would soon return. All subsequent inquiries as to whether the
fundi had come back met with the genuine African answer, “Bado”
(“Not yet”).
BRAZIER
Some consolation was afforded me by a brassfounder, whom I

came across in the bush near Akundonde’s. This man is the favourite
of women, and therefore no doubt of the gods; he welds the glittering
brass rods purchased at the coast into those massive, heavy rings
which, on the wrists and ankles of the local fair ones, continually give
me fresh food for admiration. Like every decent master-craftsman he
had all his tools with him, consisting of a pair of bellows, three
crucibles and a hammer—nothing more, apparently. He was quite
willing to show his skill, and in a twinkling had fixed his bellows on
the ground. They are simply two goat-skins, taken off whole, the four
legs being closed by knots, while the upper opening, intended to
admit the air, is kept stretched by two pieces of wood. At the lower
end of the skin a smaller opening is left into which a wooden tube is
stuck. The fundi has quickly borrowed a heap of wood-embers from
the nearest hut; he then fixes the free ends of the two tubes into an
earthen pipe, and clamps them to the ground by means of a bent
piece of wood. Now he fills one of his small clay crucibles, the dross
on which shows that they have been long in use, with the yellow
material, places it in the midst of the embers, which, at present are
only faintly glimmering, and begins his work. In quick alternation
the smith’s two hands move up and down with the open ends of the
bellows; as he raises his hand he holds the slit wide open, so as to let
the air enter the skin bag unhindered. In pressing it down he closes
the bag, and the air puffs through the bamboo tube and clay pipe into
the fire, which quickly burns up. The smith, however, does not keep
on with this work, but beckons to another man, who relieves him at
the bellows, while he takes some more tools out of a large skin pouch
carried on his back. I look on in wonder as, with a smooth round
stick about the thickness of a finger, he bores a few vertical holes into
the clean sand of the soil. This should not be difficult, yet the man
seems to be taking great pains over it. Then he fastens down to the
ground, with a couple of wooden clamps, a neat little trough made by
splitting a joint of bamboo in half, so that the ends are closed by the
two knots. At last the yellow metal has attained the right consistency,
and the fundi lifts the crucible from the fire by means of two sticks
split at the end to serve as tongs. A short swift turn to the left—a
tilting of the crucible—and the molten brass, hissing and giving forth
clouds of smoke, flows first into the bamboo mould and then into the
holes in the ground.
The technique of this backwoods craftsman may not be very far
advanced, but it cannot be denied that he knows how to obtain an
adequate result by the simplest means. The ladies of highest rank in
this country—that is to say, those who can afford it, wear two kinds
of these massive brass rings, one cylindrical, the other semicircular
in section. The latter are cast in the most ingenious way in the
bamboo mould, the former in the circular hole in the sand. It is quite
a simple matter for the fundi to fit these bars to the limbs of his fair
customers; with a few light strokes of his hammer he bends the
pliable brass round arm or ankle without further inconvenience to
the wearer.
SHAPING THE POT
SMOOTHING WITH MAIZE-COB
CUTTING THE EDGE

FINISHING THE BOTTOM
LAST SMOOTHING BEFORE

BURNING
FIRING THE BRUSH-PILE

LIGHTING THE FARTHER SIDE OF
THE PILE
TURNING THE RED-HOT VESSEL
NYASA WOMAN MAKING POTS AT MASASI

Pottery is an art which must always and everywhere excite the
interest of the student, just because it is so intimately connected with
the development of human culture, and because its relics are one of
the principal factors in the reconstruction of our own condition in
prehistoric times. I shall always remember with pleasure the two or
three afternoons at Masasi when Salim Matola’s mother, a slightly-
built, graceful, pleasant-looking woman, explained to me with
touching patience, by means of concrete illustrations, the ceramic art
of her people. The only implements for this primitive process were a
lump of clay in her left hand, and in the right a calabash containing
the following valuables: the fragment of a maize-cob stripped of all
its grains, a smooth, oval pebble, about the size of a pigeon’s egg, a
few chips of gourd-shell, a bamboo splinter about the length of one’s
hand, a small shell, and a bunch of some herb resembling spinach.
Nothing more. The woman scraped with the
shell a round, shallow hole in the soft, fine
sand of the soil, and, when an active young
girl had filled the calabash with water for her,
she began to knead the clay. As if by magic it
gradually assumed the shape of a rough but
already well-shaped vessel, which only wanted
a little touching up with the instruments
before mentioned. I looked out with the
MAKUA WOMAN closest attention for any indication of the use
MAKING A POT. of the potter’s wheel, in however rudimentary
SHOWS THE a form, but no—hapana (there is none). The
BEGINNINGS OF THE embryo pot stood firmly in its little
POTTER’S WHEEL
depression, and the woman walked round it in
a stooping posture, whether she was removing
small stones or similar foreign bodies with the maize-cob, smoothing
the inner or outer surface with the splinter of bamboo, or later, after
letting it dry for a day, pricking in the ornamentation with a pointed
bit of gourd-shell, or working out the bottom, or cutting the edge
with a sharp bamboo knife, or giving the last touches to the finished
vessel. This occupation of the women is infinitely toilsome, but it is
without doubt an accurate reproduction of the process in use among
our ancestors of the Neolithic and Bronze ages.
There is no doubt that the invention of pottery, an item in human
progress whose importance cannot be over-estimated, is due to
women. Rough, coarse and unfeeling, the men of the horde range
over the countryside. When the united cunning of the hunters has
succeeded in killing the game; not one of them thinks of carrying
home the spoil. A bright fire, kindled by a vigorous wielding of the
drill, is crackling beside them; the animal has been cleaned and cut
up secundum artem, and, after a slight singeing, will soon disappear
under their sharp teeth; no one all this time giving a single thought
to wife or child.
To what shifts, on the other hand, the primitive wife, and still more
the primitive mother, was put! Not even prehistoric stomachs could
endure an unvarying diet of raw food. Something or other suggested
the beneficial effect of hot water on the majority of approved but
indigestible dishes. Perhaps a neighbour had tried holding the hard
roots or tubers over the fire in a calabash filled with water—or maybe
an ostrich-egg-shell, or a hastily improvised vessel of bark. They
became much softer and more palatable than they had previously
been; but, unfortunately, the vessel could not stand the fire and got
charred on the outside. That can be remedied, thought our
ancestress, and plastered a layer of wet clay round a similar vessel.
This is an improvement; the cooking utensil remains uninjured, but
the heat of the fire has shrunk it, so that it is loose in its shell. The
next step is to detach it, so, with a firm grip and a jerk, shell and
kernel are separated, and pottery is invented. Perhaps, however, the
discovery which led to an intelligent use of the burnt-clay shell, was
made in a slightly different way. Ostrich-eggs and calabashes are not
to be found in every part of the world, but everywhere mankind has
arrived at the art of making baskets out of pliant materials, such as
bark, bast, strips of palm-leaf, supple twigs, etc. Our inventor has no
water-tight vessel provided by nature. “Never mind, let us line the
basket with clay.” This answers the purpose, but alas! the basket gets
burnt over the blazing fire, the woman watches the process of
cooking with increasing uneasiness, fearing a leak, but no leak
appears. The food, done to a turn, is eaten with peculiar relish; and
the cooking-vessel is examined, half in curiosity, half in satisfaction
at the result. The plastic clay is now hard as stone, and at the same
time looks exceedingly well, for the neat plaiting of the burnt basket
is traced all over it in a pretty pattern. Thus, simultaneously with
pottery, its ornamentation was invented.
Primitive woman has another claim to respect. It was the man,
roving abroad, who invented the art of producing fire at will, but the
woman, unable to imitate him in this, has been a Vestal from the
earliest times. Nothing gives so much trouble as the keeping alight of
the smouldering brand, and, above all, when all the men are absent
from the camp. Heavy rain-clouds gather, already the first large
drops are falling, the first gusts of the storm rage over the plain. The
little flame, a greater anxiety to the woman than her own children,
flickers unsteadily in the blast. What is to be done? A sudden thought
occurs to her, and in an instant she has constructed a primitive hut
out of strips of bark, to protect the flame against rain and wind.
This, or something very like it, was the way in which the principle
of the house was discovered; and even the most hardened misogynist
cannot fairly refuse a woman the credit of it. The protection of the
hearth-fire from the weather is the germ from which the human
dwelling was evolved. Men had little, if any share, in this forward
step, and that only at a late stage. Even at the present day, the
plastering of the housewall with clay and the manufacture of pottery
are exclusively the women’s business. These are two very significant
survivals. Our European kitchen-garden, too, is originally a woman’s
invention, and the hoe, the primitive instrument of agriculture, is,
characteristically enough, still used in this department. But the
noblest achievement which we owe to the other sex is unquestionably
the art of cookery. Roasting alone—the oldest process—is one for
which men took the hint (a very obvious one) from nature. It must
have been suggested by the scorched carcase of some animal
overtaken by the destructive forest-fires. But boiling—the process of
improving organic substances by the help of water heated to boiling-
point—is a much later discovery. It is so recent that it has not even
yet penetrated to all parts of the world. The Polynesians understand
how to steam food, that is, to cook it, neatly wrapped in leaves, in a
hole in the earth between hot stones, the air being excluded, and
(sometimes) a few drops of water sprinkled on the stones; but they
do not understand boiling.
To come back from this digression, we find that the slender Nyasa
woman has, after once more carefully examining the finished pot,
put it aside in the shade to dry. On the following day she sends me
word by her son, Salim Matola, who is always on hand, that she is
going to do the burning, and, on coming out of my house, I find her
already hard at work. She has spread on the ground a layer of very
dry sticks, about as thick as one’s thumb, has laid the pot (now of a
yellowish-grey colour) on them, and is piling brushwood round it.
My faithful Pesa mbili, the mnyampara, who has been standing by,
most obligingly, with a lighted stick, now hands it to her. Both of
them, blowing steadily, light the pile on the lee side, and, when the
flame begins to catch, on the weather side also. Soon the whole is in a
blaze, but the dry fuel is quickly consumed and the fire dies down, so
that we see the red-hot vessel rising from the ashes. The woman
turns it continually with a long stick, sometimes one way and
sometimes another, so that it may be evenly heated all over. In
twenty minutes she rolls it out of the ash-heap, takes up the bundle
of spinach, which has been lying for two days in a jar of water, and
sprinkles the red-hot clay with it. The places where the drops fall are
marked by black spots on the uniform reddish-brown surface. With a
sigh of relief, and with visible satisfaction, the woman rises to an
erect position; she is standing just in a line between me and the fire,
from which a cloud of smoke is just rising: I press the ball of my
camera, the shutter clicks—the apotheosis is achieved! Like a
priestess, representative of her inventive sex, the graceful woman
stands: at her feet the hearth-fire she has given us beside her the
invention she has devised for us, in the background the home she has
built for us.
At Newala, also, I have had the manufacture of pottery carried on
in my presence. Technically the process is better than that already
described, for here we find the beginnings of the potter’s wheel,
which does not seem to exist in the plains; at least I have seen
nothing of the sort. The artist, a frightfully stupid Makua woman, did
not make a depression in the ground to receive the pot she was about
to shape, but used instead a large potsherd. Otherwise, she went to
work in much the same way as Salim’s mother, except that she saved
herself the trouble of walking round and round her work by squatting
at her ease and letting the pot and potsherd rotate round her; this is
surely the first step towards a machine. But it does not follow that
the pot was improved by the process. It is true that it was beautifully
rounded and presented a very creditable appearance when finished,
but the numerous large and small vessels which I have seen, and, in
part, collected, in the “less advanced” districts, are no less so. We
moderns imagine that instruments of precision are necessary to
produce excellent results. Go to the prehistoric collections of our
museums and look at the pots, urns and bowls of our ancestors in the
dim ages of the past, and you will at once perceive your error.
MAKING LONGITUDINAL CUT IN
BARK
DRAWING THE BARK OFF THE LOG
REMOVING THE OUTER BARK

BEATING THE BARK
WORKING THE BARK-CLOTH AFTER BEATING, TO MAKE IT

SOFT
MANUFACTURE OF BARK-CLOTH AT NEWALA

To-day, nearly the whole population of German East Africa is
clothed in imported calico. This was not always the case; even now in
some parts of the north dressed skins are still the prevailing wear,
and in the north-western districts—east and north of Lake
Tanganyika—lies a zone where bark-cloth has not yet been
superseded. Probably not many generations have passed since such
bark fabrics and kilts of skins were the only clothing even in the
south. Even to-day, large quantities of this bright-red or drab
material are still to be found; but if we wish to see it, we must look in
the granaries and on the drying stages inside the native huts, where
it serves less ambitious uses as wrappings for those seeds and fruits
which require to be packed with special care. The salt produced at
Masasi, too, is packed for transport to a distance in large sheets of
bark-cloth. Wherever I found it in any degree possible, I studied the
process of making this cloth. The native requisitioned for the
purpose arrived, carrying a log between two and three yards long and
as thick as his thigh, and nothing else except a curiously-shaped
mallet and the usual long, sharp and pointed knife which all men and
boys wear in a belt at their backs without a sheath—horribile dictu!
[51]
Silently he squats down before me, and with two rapid cuts has
drawn a couple of circles round the log some two yards apart, and
slits the bark lengthwise between them with the point of his knife.
With evident care, he then scrapes off the outer rind all round the
log, so that in a quarter of an hour the inner red layer of the bark
shows up brightly-coloured between the two untouched ends. With
some trouble and much caution, he now loosens the bark at one end,
and opens the cylinder. He then stands up, takes hold of the free
edge with both hands, and turning it inside out, slowly but steadily
pulls it off in one piece. Now comes the troublesome work of
scraping all superfluous particles of outer bark from the outside of
the long, narrow piece of material, while the inner side is carefully
scrutinised for defective spots. At last it is ready for beating. Having
signalled to a friend, who immediately places a bowl of water beside
him, the artificer damps his sheet of bark all over, seizes his mallet,
lays one end of the stuff on the smoothest spot of the log, and
hammers away slowly but continuously. “Very simple!” I think to
myself. “Why, I could do that, too!”—but I am forced to change my
opinions a little later on; for the beating is quite an art, if the fabric is
not to be beaten to pieces. To prevent the breaking of the fibres, the
stuff is several times folded across, so as to interpose several
thicknesses between the mallet and the block. At last the required
state is reached, and the fundi seizes the sheet, still folded, by both
ends, and wrings it out, or calls an assistant to take one end while he
holds the other. The cloth produced in this way is not nearly so fine
and uniform in texture as the famous Uganda bark-cloth, but it is
quite soft, and, above all, cheap.
Now, too, I examine the mallet. My craftsman has been using the
simpler but better form of this implement, a conical block of some
hard wood, its base—the striking surface—being scored across and
across with more or less deeply-cut grooves, and the handle stuck
into a hole in the middle. The other and earlier form of mallet is
shaped in the same way, but the head is fastened by an ingenious
network of bark strips into the split bamboo serving as a handle. The
observation so often made, that ancient customs persist longest in
connection with religious ceremonies and in the life of children, here
finds confirmation. As we shall soon see, bark-cloth is still worn
during the unyago,[52] having been prepared with special solemn
ceremonies; and many a mother, if she has no other garment handy,
will still put her little one into a kilt of bark-cloth, which, after all,
looks better, besides being more in keeping with its African
surroundings, than the ridiculous bit of print from Ulaya.
MAKUA WOMEN

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Substance Abuse: Information For School Counselors, Social Workers, Therapists, and Counselors 6th Edition, (Ebook PDF

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Substance Abuse: Information for

School Counselors, Social Workers,

Chapter 1 The Role of the Mental Health Professional in Prevention

Chapter 2 Classification of Drugs 11

Chapter 3 Models of Addiction 34

Chapter 4 Culturally and Ethnically Diverse Populations 47

Chapter 5 Confidentiality and Ethical Issues 83

Chapter 6 Screening, Assessment, and Diagnosis 97

Chapter 7 Motivational Interviewing and Brief Interventions 116

Chapter 8 Treatment of Alcohol and Other Drugs (AOD) 129

Principles of Effective Treatment 141

Chapter 9 Co-occurring Disorders and Other

Chapter 10 Relapse Prevention and Recovery 162

Coping with High-Risk Situations 169

Chapter 11 Twelve Step and Other Types of Support Groups 178

Chapter 12 Children and Families 191

Prenatal Exposure to Alcohol and Other Drugs 198

Chapter 13 Adult Children and Codependency 219

Chapter 14 Hiv/Aids 238

Transmission of HIV 241

Chapter 15 Gambling and Other Behavioral Addictions 254

Chapter 16 Prevention 282

The Role of the Mental Health

The Need for Generalist Training

Attitudes and Beliefs

Denial, Minimization, Projection, and Rationalization

Helping Attitudes and Behaviors

Overview of the Book

MyCounselingLab for Addictions/Substance Abuse

Try the Topic 1 Assignments: Introduction to Substance Abuse Counseling.

Comprehensive Drug Abuse Prevention and Control Act

The Concept of Dangerousness

The Neurobiology of Addiction1

FIGURE 2.1 Effect of drugs on neurotransmitters.

Newala, too, suffers from the distance of its water-supply—at least

The water-supply of New Newala is in the bottom of the valley,

NATIVE PATH THROUGH THE MAKONDE BUSH, NEAR

MAKONDE LOCK AND KEY AT JUMBE CHAURO

MODE OF INSERTING THE KEY

With no small pride first one householder and then a second

Some consolation was afforded me by a brassfounder, whom I

SMOOTHING WITH MAIZE-COB

CUTTING THE EDGE

LAST SMOOTHING BEFORE

FIRING THE BRUSH-PILE

TURNING THE RED-HOT VESSEL

NYASA WOMAN MAKING POTS AT MASASI

DRAWING THE BARK OFF THE LOG

REMOVING THE OUTER BARK

WORKING THE BARK-CLOTH AFTER BEATING, TO MAKE IT

MANUFACTURE OF BARK-CLOTH AT NEWALA

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