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vi Contents
PA RT 3
The Context of Change 185
Cha pter 8 General Model of Prevention 241
Determining the Purpose of
Working with Families 185 Prevention 243
Family Systems Approach 185 Developing a Causal Model 244
Making Initial Systemic Changes 189 Producing Change 245
Community Reinforcement and Evaluating Programs 249
Family Training 191
Effectiveness of Prevention
Deepening and Maintaining Programs 252
Change 193
Center for Substance Abuse
Effects on Children 198 Prevention Strategy 254
Multicultural Competence in Family Summary 256
Counseling 202
Questions for Thought and
Summary 204 Discussion 257
Questions for Thought and References 257
Discussion 204
References 206
Appendix
Cha pter 9
Appendix A: Psychosocial and
Successful Service Substance Use History 259
Programs 209 Appendix B: Initial Behavioral
Assessment and Functional
Environmental Contingencies 210
Analysis 271
Placement Criteria 218
Appendix C: Comprehensive Drinker
Health Care Reform 219 Profile 277
Assessing Needs 222 Appendix D: Family Drinking
Process Evaluation and Outcome Survey 301
Evaluation 227 Appendix E: Useful Web Sites 303
Multiculturalism and Social Justice 233 Appendix F: Valuable Treatment
Summary 234 Manuals 305
Questions for Thought and
Discussion 235 Glossary 309
References 236 Name Index 317
Subject Index 319
Cha pter 10
Preventing Substance
Abuse 239
Community Responses to Substance
Abuse 240
Copyright 2019 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
New in This Edition
Substance abuse counseling is a changing field that has overcome past pre-
dominant models in truly fundamental ways. Central assumptions that guide
a counselor’s work have shifted, moving programs toward better outcomes and
a more clearly defined client focus. By using self-efficacy and personal skill
development, clients are learning to effectively manage environmental risks.
Through a true partnership between practitioners and their clients, clients are
empowered to employ scientifically developed best practices provided by their
counselors. New medications combine counseling with medical treatments,
allowing for a well-rounded treatment approach that considers all aspects of
a client’s needs. All of these changes have truly shifted the focus of substance
abuse counseling to place the client at the very center of the change equation.
This edition of Substance Abuse Counseling both responds to these changes
and helps move them forward in a positive fashion. Through a clear emphasis
on the need to close the gap between research and practice, the necessity of
treating each client with dignity and respect, and using a multicultural perspec-
tive, this text remains on the cutting edge of substance abuse counseling. Fur-
ther, by recognizing the social context of substance use behavior, this edition
focuses on both an individual client and the community as a whole.
The current (and emerging) substance abuse paradigm accepts the central-
ity of evidence-based practices and recognizes the key role of respectful collab-
oration. Evidence-based practices are discussed throughout the text and they
are given more emphasis in this edition. Motivational interviewing (MI) is at
the center of accepted practice and makes competence in MI a requirement for
excellence. This edition of Substance Abuse Counseling includes an updated chap-
ter devoted to this important topic, explaining MI concepts and practices and
including examples from such divergent fields as criminal justice, health care,
and family therapy. MI has been brought to the front throughout the book as it
is a central organizing principle for competent addictions treatment. We have
focused on the connection between research and implementation, reviewing
up-to-date applications of evidence-based practices in individual, group, and
family counseling. Our long-time recognition of the importance of the social
context of substance use is noted throughout the text, as is the notion that
client advocacy is central to the counselor’s role in any setting. We review the
competencies involved in effective advocacy and apply them to the substance
abuse counselor’s work. of course, client and advocacy and respect for diversity
go hand-in-hand, and we have infused a multicultural perspective throughout
vii
viii New in This Edition
the book. To this end, social justice is now clearly discussed as a central element
of effective approaches to substance abuse counseling.
This edition also boasts an expanded discussion of pharmacological treat-
ments for substance abuse, and an increased coverage of evidence-based
practices in all domains. We have also expanded the matter of diagnosis and
assessment, and the Diagnostic and Statistical Manual of Mental Disorders, Fifth
Edition, is covered in depth.
Material on multiculturalism has been substantially expanded, along with
updated cases to respect multicultural perspectives. the concepts of social jus-
tice and ethical codes have also been updated and expanded. these updates
ensure that counselors have firm guidelines to follow when implementing an
ethical approach to treatment and navigating client–counselor relationships.
To aid readers in navigating the text, learning objectives and key terms have
been added for each chapter. Each chapter begins with learning objectives that will
be fully addressed throughout the chapter. A learning objective icon helps guide
readers to where they can quickly locate important information throughout the
chapter. Key terms are in a bold font, with full definitions added in the glossary.
Both of these additions will be instrumental in homework and test preparation.
Furthermore, this edition includes several instructor supplements to aid in
class preparation and testing, including an instructor’s PowerPoint presenta-
tion, an instructor’s manual, and a test bank to accompany each chapter. Each
resource is fully aligned with the text.
Lastly, this edition is complemented by MindTap. MindTap, a digital teach-
ing and learning solution, helps students be more successful and confident in
the course—and in their work with clients. MindTap guides students through
the course by combining the complete textbook with interactive multimedia,
activities, assessments, and learning tools. Readings and activities engage stu-
dents in learning core concepts, practicing needed skills, reflecting on their atti-
tudes and opinions, and applying what they learn. Videos of client sessions
illustrate skills and concepts in action, while case studies ask students to make
decisions and think critically about the types of situations they’ll encounter on
the job. Instructors can rearrange and add content to personalize their MindTap
course, and easily track students’ progress with real-time analytics. and Mind-
Tap integrates seamlessly with any learning management system.
ACKNOWLEDGMENTS
This book could not have been completed without the support of a number of
people. Our students and colleagues at the University of Maine and Governors
State University helped by providing fresh perspectives and by allowing us to
share our earliest conceptualizations.
We would also like to acknowledge the reviewers of previous editions whose
wise counsel led us toward significant improvements: Diana Sabados (George
Washington University), George Andrews (Baltimore City Community Col-
lege), Roberta Miranda (Nevada State College), Roxanne Howes (Sitting Bull
College), Susan Beck (Wallace State Community College), Elizabeth Maloney
(San Joaquin Delta College), Jeff Sandoz (Troy University), Michael Slavkin
New in This Edition ix
(Ivy Tech Community College), Kyle Brezinski (University of Toledo), Rachel

Evans, and Angela Shindoll (Tarrant County College).
We want to recognize our publisher, especially the very talented staff who
brought this project to fruition. We are especially indebted to Julie Martinez, Ann
Loch, Melissa Sacco, Seth Schwartz, Anubhav Kaushal, Jennifer Ziegler, and Julia
Giannotti. We often see statements from authors that their books would not have
been completed without the help and support of their editors. In regard to these
professionals, this statement is truer than usual. We thank them for their dedicated
oversight and careful attention to detail in editing this edition.
Our collaborator and friend, Judith Lewis, passed away on March 20, 2014.
Her thinking and guidance is felt throughout this book. We are thankful for our
long-time collaboration and we miss her very much.
Robert Q. Dana
Gregory A. Blevins
ABOUT THE AUTHORS

Dr. Robert Q. Dana is the vice president for student life and dean of students
at the University of Maine. He has direct responsibility for all campus-life pro-
grams including Greek life, alcohol and drug education programs, residence
life, counseling services, and campus-wide crisis management services.
He received his doctorate in human development counseling from Vander-
bilt University in Nashville, Tennessee. Dr. Dana has been an addictive behav-
iors researcher and practitioner. His writings on substance abuse have included
studies on the epidemiology and etiology of alcohol and other drug abuses.
Dr. Dana has served as an extramural reviewer for state and federal agencies and
as a journal reviewer. He teaches courses on addictions and is a member of the
graduate faculty at University of Maine.
Dr. Gregory A. Blevins is a retired professor emeritus from the College of

Health and Human Services at Governors State University. He held positions as
the assistant dean of the college, chair of the Addictions Studies and Behavioral
Health Department, and full professor of Addictions Studies. He completed the
specialty certificate in alcohol and drug abuse in 1974 and a doctorate in sociol-
ogy in 1979 at Western Michigan University. Dr. Blevins is a founder and life
member of the International Coalition for Substance Abuse Educators and has
served as a trainer for the Bemidji Area Office of Indian Health Services since
1988. Dr. Blevins is married to Vicki Lyn Blevins. Their daughter, Stacy, is hap-
pily married to Andy.
Dr. Judith A. Lewis passed away on March 20, 2014. She was a loving mother
and grandmother who retired in 2008 from Governors State University, where
she served as professor and chair of Addictions Studies and Behavioral Health.
She was a past president of the American Counseling Association and the Inter-
national Association of Marriage and Family Counselors, and she had been a
formative contributor to the substance abuse field for many years.
PART 1 Introduction
Chapter 1
Substance Abuse
Counseling
L e ar n i n g O b j e cti v e s
After reading this chapter you should be able to:
1.1 Describe modern approaches to substance abuse counseling and
conceptualizations.
1.2 Define substance abuse.
1.3 Characterize evidence-based practices.
1.4 Articulate best approaches to conceptualizing substance abuse counseling
approaches.
1.5 Delineate pharmacological approaches to treating substance use disorders.
1.6 Outline multicultural approaches to treating substance use disorders.
1.7 Explain a social justice view of substance abuse counseling.
1.8 Apply ethical concepts to caring for individuals with substance use problems.
1.9 Develop examples of different treatment modalities and their utilization.
1.10 Paraphrase effective and comprehensive approaches to substance use
disorder treatment.
SUBSTANCE ABUSE COUNSELING FOR TODAY LO 1.1
The last few years brought fundamental changes to the practice of substance
abuse counseling. Although some pockets of traditional practice remain, a par-
adigm shift has left 20th-century models far behind. When we look back, we
may find it difficult to believe that not long ago the American “conventional
wisdom” about substance abuse was built more on mythology than on science.
The myth at the center of past practice involved the notion that clients dealing
with substance abuse issues were different from other human beings and could
not enter the collaborative relationships that counselors normally like to build
with their clients. Many members of the community of helping professionals
actually joined with the general public in believing that successful interven-
tions required aggressive confrontation and prescriptive treatment plans.
In contrast, current substance abuse counselors know that a collaborative
and respectful approach is not just humane but also effective. They are aware
that the most successful interventions are the ones that best fit the client’s
2 PART 1 Introduction
current life situation and concerns. They view their clients within a context
that includes family, community, and even national policy. They are commit-
ted to the process of closing the gap between research and practice and believe
that a scientific approach to substance abuse problems trumps an approach
guided by opinion and personal belief.
The quest for advancement in substance abuse counseling practice is not
just an intellectual exercise. It is a path to real improvement in real people’s
lives. Look at the following examples and then consider what kind of help
might best meet the needs of human beings who are in pain.
• Marvin was caught selling a small amount of cocaine and served some
time in prison. After his release, he was determined to put that part of his
life behind him. Now, however, he is back at home, and has begun to lose
hope. His family, his friends, and the people he knows in the neighbor-
hood all seem to be involved in drug use. A problematic economy makes it
seem almost impossible for him to find employment. He says he can’t find
a way out.
• Last week, Kathy’s drug and alcohol abuse created a medical crisis that
brought her to the hospital emergency department. She had tried to with-
draw from drug use a number of times over the last few years, but every time
she sought help, her life partner, Roy, threatened to leave her. She knows
she should choose recovery, but this relationship still comes first.
• Robert is a ninth-grade student who has been the victim of constant bul-
lying and a teacher, the only adult whose help he sought, suggested that
he try to act more “masculine” in order to avoid this problem. Although
other students in Robert’s grade were experiencing similar problems, they
all tended to avoid one another rather than take the chance of being
seen together. The only group that would accept Robert turned out to be
focused on alcohol use and Robert felt that it was worth it to move in that
direction himself.
• Nine-year-old Melissa has always seemed to be a bright, outgoing, and
well-adjusted child. Lately she has come to school more exhausted every
day, falling asleep at times when she would normally have been actively
engaged. Melissa insists that nothing is wrong, but the reality is that her
father has returned to binge drinking after years in recovery. Though
her mother’s attention has been focused on this crisis, Melissa has been
shouldering much of the responsibility for taking care of her two pre-
school siblings.
• Marian is very serious about her career in sales. She is aware of the glass
ceiling that has kept women from progressing very far in her company,
so she does everything she can to fit in. She goes to the bar with her col-
leagues when they invite her, and she dines with clients when she can.
Recently, she has had some warnings at the office that her drinking is
getting out of hand. She is worried that she is suddenly careening off her
desired career path.
• Eduardo’s mental health counselor has referred him to a highly regarded
methadone program in the neighborhood because of his newly developed
Chapter 1 Substance Abuse Counseling 3
heroin habit. The fact that Eduardo is an undocumented immigrant has

never blocked him from receiving counseling services but the methadone
program requires proof of legal residency. Eduardo needs help but cannot
receive it, even though his counselor has learned that there is no state law
that requires this documentation.
These situations illustrate a few of the ways substance abuse can cause serious
problems. Marvin, Kathy, Robert, Melissa, Marian, and Eduardo also help to
demonstrate just how heterogeneous the faces of substance abuse really are.
The fact is that counselors in all settings find themselves confronting substance
abuse issues every day. Marvin might seek help from a substance abuse special-
ist, but he would be just as likely to enter the helping system through contact
with a counselor in the community mental health or criminal justice system.
Robert or Melissa might come to the attention of a school or family counselor.
Kathy might be reached through the health system, but could also be helped
effectively by a counselor specializing in work with couples. Marian might be
referred to an employee assistance or career counselor. Eduardo was identified
as someone in need of methadone treatment by his mental health therapist.
Wherever an individual enters the network of helpers, however, he or she
deserves competent attention.
National initiatives designed to improve substance abuse treatment argue
that there should be no wrong door to treatment. Effective systems ensure
that an individual needing treatment will be identified and assessed and will
receive treatment, either directly or through appropriate referral, no mat-
ter where he or she enters the realm of services (Substance Abuse and Mental
Health Services Administration, 2017a). The implication of this statement is
that all helpers, whether or not they consider themselves “addiction special-
ists,” have a responsibility to respond to problems associated with substance
use. The school counselor who hopes to prevent the negative consequences of
adolescent drug use, the family therapist who wonders why a particular family
system seems unusually rigid and secretive, the mental health counselor facing
a client’s steady deterioration—all these people confront substance abuse issues
every day. They can appropriately deal with these issues if they learn to recog-
nize the abuse of alcohol and other drugs and adapt their counseling or referral
skills to meet the needs of affected clients.
The purpose of this book is to help counselors develop the basic knowledge
and skills they will need to deal with their clients’ substance abuse problems.
Some counselors will choose to specialize, devoting a major portion of their
professional careers to substance abuse issues. For them, this text will provide a
general framework on which to base further study. Other practitioners will see
themselves as generalists, working with heterogeneous client populations and
addressing substance abuse problems as they arise. These counselors will find
guidelines in the book for adapting their current skills and techniques to the
special needs of substance-dependent clients. Our intention is not to promote
any one theory at the expense of others but, rather, to describe the methods
that are best supported by current research and, above all, to encourage an indi-
vidualized approach based on the unique needs of each client.
DEFINING SUBSTANCE ABUSE LO 1.2
A counselor who wants to carry out appropriate assessments for clients and col-
laborate on action plans needs to begin with at least a working definition of sub-
stance abuse. For general counseling purposes, a substance abuse problem
is assessed if a client’s use of alcohol or other mood-altering drugs has undesired
effects on his or her life or on the lives of others. The negative effects of the
substance may involve impairment of physiological, psychological, social, or
occupational functioning. In terms of our working definition, use of a drug that
modifies the moods or behaviors of the user is not necessarily considered sub-
stance abuse unless the user’s functioning is negatively affected. We also differ-
entiate between substance abuse and addiction, defining a client’s problem as
addiction only when physical symptoms of withdrawal or tolerance to the sub-
stance are present. Among the psychoactive substances associated with abuse
or addiction are alcohol, sedative hypnotics, opioids, amphetamines, cannabis,
cocaine, and tobacco. (Chapter 2 provides an overview of these drugs and their
physiological effects.)
Of all of the substances likely to cause problems among clients, alcohol is
the most common. Alcohol abuse has major effects on the physical health of
drinkers. In addition, it plays a major role in many of society’s most pressing
concerns, including accidents, violence, criminal behavior, family problems,
and productivity loss. Clearly, a problem of this magnitude affects so many cli-
ents in so many ways that no counselor can overlook it.
Counselors in virtually any setting can also expect to see a large num-
ber of clients affected by drugs other than alcohol. Many people routinely
use marijuana, cocaine, stimulants, sedatives, and tranquilizers, and millions
are addicted to nicotine. Opioid abuse and dependence is now a national
epidemic. As we have said, the mere use of a drug is not automatically prob-
lematic. The substance users who need the assistance of counselors are those
who have developed life problems or health risks from their drug use. Thus,
the counselor should recognize individual differences among substance-
using clients and try to address drug use in the context of the client’s life in
totality.
Defining Modern Substance Abuse Counseling

An effective paradigm for substance abuse counseling requires a fresh
approach, a new mindset, and, in fact, a new definition. In the past, a sub-
stance abuse counselor might have seen his or her role in terms of a narrow
focus on substance use behaviors. Although the interruption of these behav-
iors generally comes early in the counseling process, today’s counselors know
that it is their job to view each client not through a virtual microscope but
through a wide-angle lens. Substance abuse counseling should now be
defined as a practice that is (a) evidence-based, (b) respectful and positive
toward clients, (c) complex, (d) collaborative, (e) contextual, (f) multicultur-
ally competent, (g) oriented toward social justice, and (h) built on a strong
base of professional ethics.
EVIDENCE-BASED PRACTICES LO 1.3
One of the major shortcomings of substance abuse treatment in the past was
a certain rigidity in the choice of methods, a tendency of treatment centers to
rely too heavily on their familiar practices at the expense of fresh possibilities.
Although a number of options are available in some areas of the United States,
treatment alternatives in many regions are still severely limited, and clients who
find themselves unable to fit into mainstream approaches have few choices.
Especially in alcoholism facilities, certain practices have become so common
that caregivers, managers, community members, and even clients tend to accept
these practices without question. Yet these methods are grounded neither in
theory nor in behavioral research. Many counselors assume, for instance, that
“educating clients about alcoholism” is a necessary and possibly even sufficient
mechanism for engendering sobriety; yet one would be hard pressed to find
real support for the generalization that the provision of information can be
counted on to bring about desired changes in attitude or behavior. Similarly,
confrontational counselor behaviors, long thought to be the key components
of addiction treatment, have not shown evidence of effectiveness. If anything,
methods designed to convince clients of their impairment have been associated
not only with resistance but also with a lack of behavior change.
In general terms, evidence-based practices are “approaches to preven-
tion or treatment that are validated by some form of documented scientific
evidence … (and) stand in contrast to approaches that are based on tradition,
convention, belief, or anecdotal evidence” (Substance Abuse and Mental Health
Services Administration, 2017b). When a substance abuse professional is in the
process of making a decision about whether to use a particular method, he or
she normally takes into account whether the procedures have been developed
through a scientific method and have been found to be more effective than
standard treatment. Additionally, any evidence-based practice should carry with
it a specific set of procedures that can be disseminated for accurate replication.
A focus on evidence-based practices does not imply the existence of a con-
crete list of treatments that can be applied to every client, which therefore
becomes the new treatment as usual. In fact, focusing on evidence is more likely
to be a mindset that allows practitioners to think through their treatment deci-
sions by weighing available scientific information and considering client needs.
The very notion of a scientific approach brings with it the assumption that any
list of “what works” is certain to be in a state of constant change as new data
become available. The key to success for a substance abuse counselor is simply
to be aware of the advances in the field and to integrate these advances into
one’s practice.
Full-time helping professionals, including counselors, have always found
it difficult to keep up with research by regularly perusing scientific journals.
It is reasonable, however, to expect that awareness of current research studies
will continue to grow because of Internet access. Consider, for example, the
enormous benefit of the National Registry of Evidence-Based Programs
and Practices (Substance Abuse and Mental Health Services Administration,
2017b). This online, searchable registry lists interventions that have gone
through extensive review processes. Each listing includes not only descriptive
information about the program but also ratings of outcome research, dissem-
ination materials, and populations studied. Among the general interventions
with strong ratings are Motivational Enhancement Therapy, Motivational
Interviewing, Relapse Prevention Therapy, Twelve-Step Facilitation, Behavioral
Couples Therapy, and Skills Training. Each of these approaches tends to appear
in “what works” lists, but this registry includes the backup data and literature
reviews that a scientifically oriented counselor would always want to have.
A RESPECTFUL AND POSITIVE APPROACH LO 1.4
In contrast to the now-discredited notion that substance abuse clients are

unable to participate in their own treatment planning, current thinking empha-
sizes the idea that treatment should be proffered in ways that are respectful,
supportive, and encouraging (Center for Substance Abuse Treatment, 2017).
Counselors have learned that a respectful and supportive approach can bring
better results than an aggressive one. In fact, the use of a respectful and positive
approach is an evidence-based practice. As Miller and Carroll (2006) point out:
When randomly assigned, counselors’ clients often differ widely in outcomes

even if they are ostensibly delivering the same manual-guided treatment. Coun-
selors who are higher in warmth and accurate empathy have clients who show
greater improvement in drug use and problems. As early as the second session,
clients’ ratings of their working relationship with the counselor are predictive of
treatment outcome. (p. 301)
The body of research in support of motivational interviewing provides

even more potent evidence of the power of the collaborative relationship.
“Motivational interviewing is a directive and client-centered counseling style
for eliciting behavior change by helping clients explore and resolve ambiva-
lence” (Rollnick & Miller, 1995). The spirit of motivational interviewing arises
from the basic idea that the motivation for change comes from within the cli-
ent and is elicited by a skilled and supportive interviewer who recognizes that
the client holds the decision-making responsibility for his or her own life. The
motivational interviewer knows that the decision to change comes not from
the client’s basic traits but from the counselor–client interaction. This seem-
ingly simple intervention can bring about significant change.
Clients tend to enter the counseling process feeling ambivalent about
change; the last thing a counselor would want to do is to create a situation
that engenders defensiveness. Moreover, people dealing with substance abuse
concerns frequently begin treatment at a time when their hope for a better life
is at a low point. They can benefit from a dose of optimism, a sense of possi-
bility, and a feeling that their lives are worth saving. Think about the examples
discussed at the beginning of this chapter. Marvin, for instance, is very much
aware of the problems that have dogged him for as long as he can remember.
Given his sense of hopelessness, the best possibility of change for him depends
on his developing a new ability to visualize success.
A counselor who has a respectful attitude toward people grappling with

addiction recognizes that clients hold the ultimate responsibility for their own
recovery. Encouraging clients to accept this challenge is not just humane; it is
also empirically supported. People who believe in the possibility of controlling
their own lives seem better able to engage in health-enhancing behaviors, includ-
ing those relating to substance abuse. In fact, people’s self-efficacy—their
belief in themselves and their ability to tackle their behaviors—plays a pivotal
role in whether, how, and why someone will try to change maladaptive and
disruptive behaviors like excessive drinking or drug use.
Thus, clients dealing with any pressing life problem are most likely to suc-
ceed in making and maintaining behavior changes if they have positive percep-
tions of their self-efficacy. When they are dealing with substance abuse issues,
self-efficacy becomes even more important as a means of preventing relapse.
Given the importance of self-efficacy for the maintenance of positive behaviors
and the prevention of relapse, the counselor should reinforce each client’s sense
that control is possible. Treatment should focus on enhancing the client’s feel-
ings of personal mastery, especially through the provision of opportunities to
plan for and practice appropriate coping behaviors.
Substance Abuse Diagnosis: Continuum, Not Dichotomy

Treatment providers sometimes oversimplify the assessment of substance abuse
problems, creating a dichotomy that fails to confront the complexity of the
diagnostic process. Such oversimplification is particularly common in dealing
with alcohol problems. Some people still assume that they can identify alco-
holism as a unitary disease and that once this identification has been made, a
particular course of treatment can be described. In fact, what is usually called
alcoholism is a multivariate syndrome. Drinkers vary in terms of consump-
tion, physical symptoms, patterns of drinking behavior, life consequences
of drinking, personality, social environment, gender, culture, and a variety
of other factors. Given the differences among individuals, no one treatment
plan—and no one label—could possibly be appropriate for all clients.
The difficulty with the dichotomous classification of yes or no for addic-
tion-related concerns lies in its implicit assumption that because we know that
a client is an “alcoholic” or an “addict” we know how to treat him or her. If we
are to make appropriate treatment decisions, we need to do a great deal more
than label a client’s dysfunction. The use of a dichotomous diagnosis, whether
of alcoholism or drug addiction, actually interferes with treatment planning
by masking individual differences. This simplistic approach to assessment also
lessens the potential effectiveness of treatment by discouraging early interven-
tion in cases of problematic drinking or drug use. An either/or diagnosis leads
inexorably to a generalized, diffuse treatment package that at worst may be
ineffective and at best may meet the needs only of individuals with serious,
chronic, long-standing substance abuse disorders. Insistence on a clear diagno-
sis of “alcoholism,” for instance, drives away from treatment many people who
are not necessarily dependent on alcohol but who could benefit from assistance
in dealing with life problems associated with incipient alcohol abuse. If we wait
until people are ready to accept a diagnosis of “alcoholism” or “addiction,” we
may be missing an opportunity to help them when they are best able to benefit
from counseling. Miller and Carroll (2006) point out that “there is . . . no clear
moment when a person ‘becomes’ dependent or addicted” and that “interven-
tions appropriate to one region of the continuum may be unhelpful or even
counterproductive at another level of development” (p. 296).
Suppose that instead of conceptualizing substance abuse disorders merely as
present or absent, we view drug or alcohol use along a continuum from non-
problematic to highly problematic, as shown in Figure 1.1. The figure shows,
from left to right, six categories of substance use.
Such a continuum does not imply progression. An individual who begins
to develop problems does not necessarily move along the continuum from left
to right. On the contrary, the various points on the continuum may represent
different individuals, some of whom move from less serious to more serious
involvement, some of whom stay at one point for an indefinite length of time,
and some of whom may move back and forth between problematic and non-
problematic substance use.
Because of the difficulty in predicting the course of substance use for any
one individual, counselors need to be as helpful as possible in responding to the
client’s needs as they are presented at the time of first contact. The notion that
substance abuse problems may increase in seriousness over time is understand-
ably difficult for clients with as yet minor difficulties to accept. Many treatment
providers label the client’s hesitancy as “denial” and wait for the individual
to develop a sufficient number of problems to warrant acceptance of the label
of “alcoholic” or “addict.” More appropriately, counselors should attempt to
devise treatment plans that fit the nature and seriousness of the client’s cur-
rent difficulties. Consider, for example, the case of Robert, who was introduced
at the beginning of this chapter. It is apparent that Robert could benefit from
assistance in addressing the life problems that are associated with his drinking.
It is much less apparent that Robert’s drinking could be termed alcoholic. The
counselor’s focus should be on helping this student make decisions and plans
for getting his life back on track. Insisting on the acceptance of a specific diag-
nosis might well be damaging to the process.
A counselor can explore a client’s life situation to get a sense of where the
individual stands on the continuum from nonproblematic to severely prob-
lematic drug use. It is not possible, however, to determine through the use of
any objective measure whether an individual client should, or should not, be
offered help. The fact that traditional treatment approaches have tended to be
appropriate only for those clients clustered at the far right of the continuum
means that services have in effect been withheld from people exhibiting minor
or moderate problems. Where is the cutoff point below which a client should
Nonuse Moderate, Heavy, Heavy use; Heavy use; Dependence;

nonproblematic nonproblematic moderate serious life and health
use use problems problems problems
figure 1.1
Continuum of Substance Abuse
be denied services? Someone with many serious life problems related to drug
use clearly needs help, but an individual whose problems are only at the begin-
ning stage may also benefit from assistance, albeit of a less intensive nature.
Thus, an individual who has been arrested for driving under the influence of
alcohol deserves a chance to learn how to discriminate his or her blood alco-
hol level. A young person developing problems associated with the careless use
of substances deserves an opportunity to learn responsible decision-making. A
person who has learned to abuse drugs as a way of dealing with grief or stress
deserves the services of a counselor who can help in the formation of more
appropriate coping methods. These clients need help that is not sullied by the
process of labeling or by the assumption that progression of their problems is
easily predictable. They need to be seen as individuals who can be assisted with-
out being forced to accept diagnoses that they see as inapplicable.
Collaborative Treatment Planning

Counselors who move away from dichotomous diagnoses find themselves
increasingly able to provide help tailored to the individual needs of their cli-
ents. When we think of the people we serve as complex, multifaceted human
beings, we can work in collaboration with our clients to develop change plans
that are as unique as the clients themselves. This process depends on the coun-
selor’s recognition that no one goal or treatment outcome is likely to be appro-
priate for every client.
The client’s substance abuse must be considered in the context of other life
problems, although not necessarily in terms of causality. Substance abuse tends
to be associated with a variety of social, psychological, familial, and financial
problems. The counselor does not need to determine whether these problems
are a cause or a result of substance abuse. Each of a client’s major concerns
should be addressed as part of the counseling process under the assumption
that a favorable outcome involves rehabilitation across several life domains.
Only a collaborative assessment process that sets individualized goals and takes
note of individual strengths as well as deficits can lead to comprehensive treat-
ment. Thus, each client’s plan for change should include long-term goals and
short-term goals that reflect the individual’s commitments and deal with both
substance use and other issues. Among the general life areas that might be
addressed, depending on the individual’s concerns, are:
• resolving or avoiding legal problems

• attaining financial stability
• attaining stability in family relationships
• setting and meeting career goals
• improving social skills
• improving assertion skills
• enhancing physical health and fitness
• learning more effective methods for coping with stress
• developing more effective problem-solving and decision-making skills
• learning relaxation skills
• learning to recognize and express feelings
• adapting more effectively to work or school

• developing social-support systems
• increasing involvement in recreation and social pursuits
• dealing with mental health issues
• increasing self-esteem and self-efficacy
Obviously, not every client needs to set goals in each of these areas. The
assessment process should identify issues that can be addressed through indi-
vidualized treatment, with interventions then tailored to the specific outcomes
desired.
The assessment process should also guide the counselor and client toward
individualized goal setting with regard to future substance use. One of the goals
of substance abuse counseling, by its very definition, is a change from a prob-
lematic level of substance use to a nonproblematic level (abstinence or responsi-
ble use). Yet even this one generalization is subject to adaptation from client to
client. In each individual case, the client and counselor must work together to
decide on the most desirable outcome in terms of substance use. This decision
is especially complex when the drug of choice is alcohol. A debate has raged for
many years over the possibility that people who have had concerns about alco-
hol use might be able to achieve moderation. Yet much of the controversy sur-
rounding the concept of controlled drinking—that is, whether a client can
learn to moderate or control their drinking—arises from the way the issue is
framed. Writers and clinicians concerned about the dangers of controlled drink-
ing tend to ask whether that goal is “possible for alcoholics.” Instead, the ques-
tion should be “What outcomes seem to be most appropriate for what types of
clients in what situations?” Clearly, there are individuals for whom controlled
drinking is an inappropriate objective, just as there are individuals more likely
to relapse when they attempt abstinence. People who have long-standing prob-
lems with alcohol, who now have many life problems associated with drinking,
who show signs of being physically addicted to alcohol, who have health prob-
lems that might be exacerbated by alcohol use, or who have been unsuccessful
at drinking moderately are not good candidates for moderation and should be
encouraged to opt for a goal of abstinence.
It is not surprising that those who treat alcoholism tend to be put off by any
mention of controlled drinking as an option. Until recently, almost all of the
clients who sought help for alcohol problems fit the profile of the person for
whom abstinence was the only safe goal. Now, however, the client population
has become more heterogeneous. As we see younger, less-seriously impaired
people in treatment, we need to consider involving clients more actively in
deciding on their own treatment aspirations. Clinicians who are frightened by
the concept of controlled drinking tend to believe that although many people
would be harmed by a goal of moderation, none would be put at any particular
risk by striving for abstinence. If drinkers are young and healthy, if they have
not shown signs of physical dependence on alcohol, if their problem drinking
is of recent onset, if they have few life problems associated with alcohol use,
and if they object to abstinence, they may do best working toward moderating
their drinking.
In every case, a client’s commitment to a goal is a major factor in his or her

ability to reach it. The key to setting goals in this important area is a recogni-
tion that differential outcomes are not only possible but may also be preferable
to a rigid insistence that each client must fit the counselor’s preconceived ideal.
The discussion by Marlatt, Larimer, and Witkiewitz (2012) of harm reduction
provides a helpful conceptualization. Harm reduction recognizes abstinence as
an ideal outcome but accepts alternatives that reduce harm. Marlatt et al. point
out that requiring abstinence as a precondition for receiving help may place an
unnecessary barrier in the way of entry into treatment. Instead, they suggest,
we should meet people on their own terms and thereby encourage small steps
toward positive change.
The counselor who has worked out a reasonable set of goals with the client
can use a number of techniques for reaching those goals. Among the counseling
methods frequently used in the substance abuse field are behavioral self-control
training (teaching clients the techniques they need to change their own behav-
iors); contingency management (identifying and manipulating environmental
contingencies that reward or punish the substance use behaviors); relaxation,
assertion, and social skills training; couple and family therapy; career coun-
seling; cognitive restructuring (helping clients alter their appraisals of self and
environment); assistance with problem solving and decision making; aversive
conditioning (coupling substance use with a real or imagined unpleasant expe-
rience); stress management training; group counseling; lifestyle and recreational
planning; provision of information about the effects of psychoactive drugs; and
referral to such self-help organizations as Alcoholics Anonymous and Narcotics
Anonymous. Of course, the counseling process often takes place in the context
of an agency that also uses pharmacological components.
MEDICATION-ASSISTED TREATMENT LO 1.5
The SAMSHA Center for Substance Abuse Treatment (2017) provides this over-
view of pharmacological treatments:
Medications Used in Medication-Assisted Therapy
A misconception associated with medication-assisted therapy (MAT) is
that it substitutes one drug for another. Instead, these medications relieve the
withdrawal symptoms and psychological cravings that cause chemical imbal-
ances in the body. MAT programs provide a safe and controlled level of med-
ication to overcome the use of an abused opioid. Research has shown that
when provided at the proper dose, medications used in MAT have no adverse
effects on a person’s intelligence, mental capability, physical functioning, or
employability.
Opioid-Dependency Medications
Methadone, buprenorphine, and naltrexone are used to treat opioid depen-
dence and addiction to short-acting opioids such as heroin, morphine, and
codeine, as well as semi-synthetic opioids like oxycodone and hydrocodone.
People may safely take medications used for MAT for months, years, several
years, or even a lifetime.
Opioid Overdose Prevention Medication

FDA-approved naloxone is an injectable drug used to prevent an opioid over-
dose. According to the World Health Organization, the use of naloxone is essen-
tial to a functioning health care system.
Alcohol Use Disorder Medications
Disulfiram, acamprosate, and naltrexone are the most common drugs used
to treat alcohol use disorder. None of these drugs provide a cure for the disorder,
but they are effective for people who participate in a MAT program.
Any combination of methods may be appropriate for a specific client. It would

not be effective, however, to use this entire group of interventions as a sin-
gle package for all substance-abusing clients. Addressing problems beyond the
narrow band of substance use behaviors is an important strategy, but it can
be workable only to the degree that it is adapted to match each client’s actual
needs.
Social Context
A fundamental attribution error is a common error that skews the ways
in which people explain human behaviors. When making a fundamental attri-
bution error we would explain a behavior by suggesting it is a result of some-
one’s bad genes, or behaviors, or some internal aspect of the person rather
than trying to explain the behavior in the context of an environment such as a
heavy-drinking peer group.
Unfortunately, people in the helping professions are as prone to misattri-
bution as anyone else and the tendency to overlook the role of environmental
factors permeates many approaches to counseling and therapy. To the detri-
ment of their clients, helpers sometimes focus more attention on negative
internal characteristics than on the social, cultural, political, and economic
factors that affect their clients’ lives. Too often, the counseling spotlight stays
on the clients’ diagnoses, rather than on their strengths, and on their personal
vulnerabilities, rather than their environments. The result is that clients feel
increasingly powerless.
The tendency to view problems as internal to the client is especially preva-
lent in substance abuse treatment, where addictive behaviors are often viewed
as resulting from personal traits that are resistant to change. However, substance
use behaviors are powerfully affected by social context. Moos (2006) examined
four theoretical perspectives that provide explanations of the role of social con-
text in substance use. Social control theory emphasizes the degree to which “strong
bonds with family, school, work, religion, and other aspects of traditional soci-
ety motivate individuals to engage in responsible behavior and refrain from
substance use” (Moos, 2006, p. 182). In contrast, the absence of these bonds
makes substance abuse more likely. Similarly, behavioral choice theory sees sub-
stance abuse as less likely to occur when the individual’s environment provides
reinforcements that serve as alternatives to the reinforcing effects of substance
use. Social learning theory emphasizes that the modeling effects of drug-related
attitudes and behaviors are prevalent in the individual’s environment. Stress
and coping theory explains that stressors in the social environment can lead to
substance abuse in the absence of healthier coping skills. What all of these per-
spectives indicate is that the individual’s social context—from family to com-
munity to the public arena—can increase the risk of substance abuse or protect
against it. A counseling process that is built on the awareness of social context
emphasizes both client empowerment and multidimensional treatment.
Empowerment Strategies
As important as it is for counselors to recognize the impact of the social envi-
ronment, it is even more important that their clients come to understand it.
People who fail to see the broader context of their problems often feel bogged
down, mired in self-blame, and helpless. Understanding one’s life in a broader
context is actually empowering. As Lewis, Arnold, House, and Toporek (2013)
point out, counselors who use an empowerment-based approach with
their clients should be able to:
• identify strengths and resources of clients and students
• identify the social, political, economic, and cultural factors that affect the
clients/students
• recognize the signs that indicate that an individual’s behaviors and con-
cerns reflect responses to systemic or internalized oppression
• help those at an appropriate developmental level identify the external barri-
ers that affect their development
• train students and clients in self-advocacy skills
• help students and clients create self-advocacy action plans
• assist students and clients in carrying out action plans
Multidimensional Treatment
When clients eliminate problematic substance abuse from their lives, they are
sometimes surprised when other concerns fail to fade away. Some problems
remain, either because their etiology was independent of substance abuse or
because years of heavy drinking or drug use have created multiple life problems
too serious to be ignored. It is for this reason that counseling must be multidi-
mensional, focusing on specific drug-use behaviors but also seeing them in the
larger context of the client’s psychological, social, and vocational functioning.
Counselors who believe in individualized efficacy-enhancing treatment
tend to appreciate the importance of a number of factors beyond the individu-
al’s specific substance-abusing behaviors. They realize that in the long run cli-
ents’ recovery depends not just on their intrapersonal qualities but also on the
nature of their social environments and on their repertoire of skills for coping
with the real world in which sobriety must be maintained.
Social, cultural, biological, and psychological factors interact reciprocally in
both the etiology and the resolution of substance-related problems. A major
implication of this view is that efforts toward prevention and rehabilitation
aimed at changing alcohol and drug use may not be maximally effective if they
are limited in focus to the substance use behavior itself or to an isolated domain
of the individual’s life. Instead, interventions should focus simultaneously on
multiple domains.
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prisoners came down? If they did, it would spoil everything.
For half a minute Royce waited in a fever of suspense. Then, to his great
joy, the men formed single file again and began to cross the bridge.
Now he had a new anxiety—the fear that John would not act quickly
enough. But the first of the Tubus was still some yards from the farther bank
when there was a slight swishing sound, a tremendous splash, and a babel of
yells from the men whom the cutting of the ropes had plunged into the river.
Then John, drenched with water, but beaming with delight, came rushing
up to join his master, who, with Gambaru, had left his hiding-place and
stationed himself at the near side of the bend.
As Royce had expected, the shouts of the men had the effect of bringing
up the nearest man of the escort at the double, leaving the group of prisoners,
of which he was in charge, to follow. The moment he showed himself round
the corner Royce dealt him a blow that stretched him on the ground.
Gambaru, acting on Royce's instructions, instantly pounced on the man, tore
the turban from his head, and calling to John to assist him, stuffed into his
mouth a gag made of the linen, and pinioned his arms with strips shred from
his loincloth.
Royce, meanwhile, stood waiting for the next man, at the same time
watching with some anxiety the operations of his Hausas. All, perhaps,
depended on their quickness. His anxiety was needless. With ready wit John
perceived the nature of his master's design, and within twenty seconds the
fallen Tubu was helpless and harmless.
COLLAPSE
A few moments later a second Tubu dashed round the bend. Like the
first, he had left his gang of prisoners, and run ahead to discover the cause of
the outcry, which had now ceased, for the men of the advance guard had
been carried far down the rapid stream.
The second man was served as the first had been. A third and a fourth
appeared, only to meet the same fate. Then there was a pause. Either the
remaining members of the escort had not heard their comrades' yells, or the
ensuing silence had reassured them.
Three-parts of the column of captives had meanwhile been left

unguarded. But the wretched creatures marched slowly on. Roped together,
men and women, with their captors before and behind, they did not dream of
attempting to escape. They were too weary and listless to feel any curiosity
about the brief noise ahead of them. There was nothing to flash a gleam of
hope into their dejected minds.
The first gang of them, a full score in number, dragged their tired feet
round the bend. Their heads were downcast, but a sudden exclamation from
John caused some of them to look up in startled surprise. Among them were
Kulana and three others of Royce's carriers.
John instantly slit the rope that fastened the first couple by the neck, and,
passing along the line, set the prisoners free one after another. Dejection
gave way to joy, silence to shouts and laughter.
"Take those rifles and spears," said Royce to his men, pointing to the
weapons of the Tubus who had been laid low. "Kulana, tell these prisoners to
stand aside by the river bank and keep quiet."
All this had been done out of sight of the rest of the column. In a few
minutes the second gang came up. These were liberated like the first; there
were three more of Royce's Hausas among them.
Again there was an interval; then the third gang appeared, and Royce
thrilled with delight when he saw Challis among them.
"Here I am, old man," he called.

Challis smiled feebly, and Royce was shocked to see the change in his
friend. His cheeks were pale and haggard, his eyes sunken and unnaturally
bright; his figure shrunken and bent.
"I'm nearly done for," he murmured, as Royce released him.
"Poor old chap! But we'll soon have you right again. Just rest here until
we have finished our job. John, get some water for Massa Chally."
He supported Challis to the foot of the grassy slope, and settled him
comfortably there. Then he returned to the bend.
In due order the rest of the prisoners came along, with the last two
members of the escort. When these had been dealt with, only the six men of
the rearguard remained to be disposed of.
Wishing to avoid a fight, Royce considered how to complete his work.

There would not be time to disarm each of the men in turn as they came
round the bend. An idea occurred to him. He ordered the whole party of
released prisoners to dispose themselves amid the tall rushes along the river
bank, and the Hausas to carry down the fallen Tubus. He himself assisted
Challis to reach a place of concealment. Thus, when the rearguard rounded
the bend, there was no one in sight along the open path.
The Tubus halted in amazement when their eyes fell on the broken
bridge. They looked this way and that in search of the prisoners, and Royce,
watching them through the rushes, feared that they might turn tail and
retreat. But after a few minutes they hastened forward, scanning the farther
bank to see if by some unknown means the prisoners had been able to cross
the river.
When they had almost reached the bridge-head, Royce stepped quickly
from his hiding-place with the armed Hausas, and ordered John to call to the
Tubus. At the shout they swung round, and saw facing them a white man and
seven Hausas covering them with rifles.
John called to them to surrender and throw down their arms. For a
moment they hesitated; then, recognising that between the rifles and the river
there was no escape, they cast their own weapons on the ground and made
signs of submission.
At Royce's instruction John ordered them to move away along the bank
of the river. Then six of the Hausas advanced, took their rifles, and returned.
And then the whole band of liberated prisoners sprang up from among the
rushes, and the place rang with their shouts of delight.
CHAPTER X
IN HOT PURSUIT
"Now for the next move," said Royce to Challis. "Feel better, old man?"
"Much! It's so good to see you again. But I'm fairly crocked."
"Never mind that. You'll be all right after a rest. We mustn't lose any time,
though. Can you tell me how far back the horsemen left you?"
"Two or three miles, I think. They went off to the left; of course I didn't
know why, though I see now."
"Well, there are about thirty of them, aren't there? They have probably
crossed the river by this time, higher up, and are waiting somewhere ahead.
We can't tell how long they will wait before they become uneasy, but no
doubt when they do they will ride to the bridge. Finding it broken down,
they will probably think that the whole party is making for the ford, and will
very likely ride back and round to meet them. That ought to give us several
hours."
"Little enough if they discover what has really happened."

"Yes; they've a great advantage of us in their horses. There's only one
thing to be done. With only fourteen rifles we can't fight them. We must get
back as quickly as we can. What luck to recover all our baggage!"
"There's food, too; not very much, certainly, which shows that the Tubus
aren't far from their own grounds."
"True, and their tribe may number hundreds for all we know. It's a ticklish
position for us. But we concealed near your camp the food we brought with
us. We must all get back as quickly as possible and secure that. I only hope
that we shan't be pursued, for we should stand no chance at all against
mounted men."
Royce wasted no time. First of all he had the six men of the rearguard tied
up like their comrades and laid at the edge of the rushes, where they would
be discovered by their friends when they returned to the bridge.
Then he selected four of the Hausas to carry Challis on a litter made of

their rifles. Soon the whole party was marching back along the track, John
leading with six of the men armed with rifles, Royce bringing up the rear
with the remainder.
There was a remarkable change in the demeanour of the negroes.

Whereas before they had marched slowly, listlessly, they now stepped out
with buoyant vigour. Freedom gave them new strength. The loads had been
distributed among them, so that each man's burden was light; and they
pressed on untiringly, only eager to get back to their homes.
Again and again Royce looked back anxiously along the track. There was
no sign of pursuit. Without halting a moment the party marched on until
nightfall, and then encamped, worn out, but happy, for they were pretty sure
that no attack would be made on them during the dark hours. Nevertheless,
Royce arranged for the guarding of the camp through the night by the
Hausas in turn.
He exchanged notes with Challis about all that had happened since they
parted.
"I've one hope," he said. "It is that the Tubus, knowing they have white
men to deal with, will not molest us further. They have experience of what
white men can do, because their lands are on French territory."
"But the French have little control over them, judging by their raids,"
replied Challis. "I fear we can't reckon on being left alone. They will be
enraged at the loss of a fine haul of slaves, and the men we left tied up will
tell them that there are only two of us. Besides, that man you call Goruba has
a score against you. It is clear to me now that at first he mistook me for you."
"The whole thing is sickening," said Royce. "It looks as though our
prospecting for tin is at an end. We can't proceed with hostile savages
hovering about us. But we've much to be thankful for."
As soon as it was light they broke up camp and resumed the march. The
long rest had greatly benefited Challis, whom, however, Royce would not
allow to walk.
The condition of some of his men made Royce anxious; but the negro has
great endurance, and the hope of reaching safety helped the men to keep up.
There was still no sign of pursuit, and Royce grew more and more
cheerful as time went on. In the afternoon the party arrived at Challis's
dismantled camp. In order to prevent a raid upon the provisions, Royce had
ordered John and Gambaru not to mention where they were hidden. On
reaching the spot, he led the main body of the prisoners some little distance
beyond, and commanded them to rest on the ground until food was brought
to them.
The calabashes were found just as John had left them. Food was served
out to the whole party—sparingly, for it was impossible to tell when another
supply could be obtained.
During the meal, Royce discussed the position with Challis. They decided
to give the prisoners the opportunity of returning to their homes. When it
was put to the poor negroes, most of them, including all the women, set off
at once in different directions. But a group of the men hung back.
"Dey want to stay with Massa," John explained.

"But I don't want them. We shall have to go back to the coast."
"Dat make um berry jolly, sah," said John. "Houses burnt; no place can
go; dey like berry much go with Massa."
"What do you say to that, Tom?" Royce asked of Challis.
"They had much better stay in their own country. But I suppose we can
hardly turn the poor fellows away. Let them come; I daresay they'll be tired
of it long before we reach Akassa."
"We'll start in about an hour, then—unless——"
"Unless what?"
"Well, the idea of chucking things up when we've come so many

hundreds of miles makes me sick. I was wondering whether after all we
couldn't make our way into French territory, and persuade the authorities to
back us up."
Before Challis could reply, there came a shout from Gambaru, who had
been stationed to keep watch.
"What does he say, John?" asked Royce.
"Him see horses, sah."
Royce sprang up, and ran to a stretch of rising ground from which the
country northward was visible for some miles. One glance was enough. The
negro horsemen were in pursuit.
Stooping so as to be as little visible as possible, Royce doubled back. It

was clear that to march southward with a mounted enemy on their heels
would be to court destruction. To take refuge in the bush or the woodland
would merely postpone the disaster for a short time. What could be done?
An idea flashed into his mind. Was there time to reach the fort in which
John and he had spent that unforgettable night? All depended on the number
of the horsemen he had just seen. If they were the men who had forded the
river, unreinforced, there was a bare chance.
By the time he regained the camp Royce had made up his mind.
"John, tell these men to carry the food and baggage into the forest
yonder," he said. "You must lead them. We will make for the fort. Give Mr.
Challis your rifle."
It was some minutes before the released prisoners, laden with their
bundles, had got under way. Meanwhile, Royce drew up the Hausas in line,
and, facing towards the oncoming horsemen, moved backward slowly
towards the forest.
The carriers had not yet gained the shelter of the trees when the Tubus,
some thirty in number, broke from cover and charged down upon the little
party. Royce was at one end of the line, Challis at the other.
"Don't fire until I give the word," said Royce.
The horsemen rode on with shrill yells, firing as they came. But their aim
was wild, and no one was hit. Slowly withdrawing, Royce kept his eye fixed
on them, whispering:
"Steady! Steady! Wait for the word."
The Hausas were panting with excitement, but not a man of them lifted
his rifle. At last, when the horsemen were little more than two hundred yards
away, Royce dropped on his knee.
"Now, boys!" he said.
Following his example, the Hausas fired. It was a somewhat ragged

volley, but at the short range almost every shot told. Many saddles were
emptied; some of the enemy drew rein; others galloped on, to be met by a
second volley, which completely broke the charge. The survivors wheeled
their horses and dashed madly back towards the bushes from behind which
they had emerged.
"Now, boys, with me!" cried Royce.
He led them at the double across the open space into the belt of woodland
which John with his party had already entered. His stand had given them a
respite, but there could be little doubt that this troop of the enemy was
merely an advance guard, for Goruba was not among them. Everything now
depended on whether the fort could be reached before Goruba came up with
a much larger force.
"Step out as quickly as possible, boys," said Royce. "Their horses won't
be much good to them if we get into the fort. You have done well."
CHAPTER XI
A STRATEGIC RETREAT
John, the headman, was very intelligent. His sense of locality and
direction appeared to be good. But Royce felt a little anxious about his
ability to act as guide in their march towards the fort. The man had only
visited it once. Hurrying to the head of the column, he said:
"You are quite sure you can find the way?"
"Nebber lose it, sah!" replied John, with a gurgling laugh at his own
simple joke. "Savvy way all same quite correct."
"Very well. Remember that we all depend on you. You will save time by
getting some of these new men to take turns with our boys in carrying the
stuff. I leave you to arrange that."
The party now consisted of more than forty men. John went ahead with
two or three of his original gang and the released prisoners, who numbered
over a score. Some distance in the rear came Royce and Challis with the rest
of their boys, armed.
"I'm a little doubtful whether we are doing the right thing," Royce
remarked to his companion.
"Why?" asked Challis.
"Because I'm out of my element. I don't know in the least how these
Tubus are likely to act. If they were a civilised enemy, I should be sure that
the check we have just inflicted would not choke off the pursuit. In that case
we should be doing the right thing—the only thing, in fact, to avoid
extermination."
"You mean that if we have choked them off, we ought to be hurrying

away to the south?"
"That's it. My experience in field days with the Scouts and the O.T.C.
doesn't help much now."
"I'm not so sure of that," said Challis. "I think you have done jolly well so
far."
"Well, looking at matters from the worst point of view, and assuming that
the Tubus will still come after us, I don't see that we could do better than we
are doing. The difficulty is this: if we get into the fort, we escape immediate
destruction, but we are in no position to stand a siege. Our ammunition will
hold out a good while, but our food won't."
"Still, we shall gain a little time. Perhaps they won't pursue us farther. If
they do, they may sheer off when they find us behind defences. Let us hope
for the best."
They were marching through thin forest on more or less undulating

ground. In some places, while the trees and bush offered few obstacles to
men marching on foot, they would considerably impede horsemen. In others,
the country was so open that mounted men would gain on them.
Whenever they passed over stretches of open ground, they would halt for
a few minutes, and scan the country behind for signs of the enemy. It was on
such clear spaces that most was to be feared.
In the forest land the party had a certain advantage over mounted
pursuers. They could avail themselves of cover far more effectually than was
possible for horsemen. They could move nearly as fast, and more safely and
secretly. A tree or a bush that would conceal a man on foot might give little
cover to a horse and its rider.
They had marched for two or three hours, and had just halted on the brink
of a stream for rest and refreshment, when Royce, mounting to the crest of a
low hillock, caught sight of three or four horsemen amid the scrub far in
their rear, on the other side of the stream.
He watched them anxiously, hoping that they were not the forerunners of
a more numerous body. In a few minutes his worst anticipations were
confirmed. At a little distance behind the small group of horsemen stretched
a long column, vastly more numerous than the band whom he had checked
and put to flight. There could be no doubt that a large force of Tubus was in
hot pursuit.
With a quick eye Royce examined the ground, calculating the chances of
making a stand. The hillock was covered with brushwood that gave excellent
cover; the enemy, on the other hand, before they could reach the stream,
must pass over a wide space of almost open land.
They had evidently descried the fugitives. Royce felt very uneasy as he
caught fleeting glimpses of horsemen moving among the tall grass for some
distance up and down stream. It was clear that they were taking advantage of
their superior numbers to try to outflank him. There was no time to be lost if
a successful resistance were to be made.
He shouted to Challis to bring all the men from the low ground up the
hillock.
"We must try to make a stand here," he said. "If we go on we are bound to
be ridden down."
He placed the unarmed men well to the rear, and posted the others in a
crescent line behind the scrub on the crest of the hillock, facing the enemy.
"Lie flat on your faces," he said, "and fire when I give the word."
The Tubus had been advancing in column at a trot, but within a few
hundred yards of the hillock they opened out into line, and came on at a
gallop with fierce cries. In the centre was a gigantic negro whom Royce
recognised as Goruba.
The Hausas kept absolute silence, awaiting their leader's command. It

came when the Tubus were no more than two hundred yards distant. The
rifles flashed; several of the horsemen fell; some halted behind the largest
bushes near to them; others turned and galloped to the shelter of a clump of
trees.
Royce rose on his knees, and peering over the brushwood, anxiously
scanned the farther bank up and down stream. In both directions the flanking
movement was continuing, and what was more serious, in response to a
mighty shout from Goruba, whose tall form could be seen threading its way
between the bushes in the distance, the Tubus dismounted, and tethering
their horses, began to work their way forward on foot.
Royce tried to pick off the leader, who was clearly something of a
strategist. But the negro took such skilful advantage of the bushes that Royce
was never able to get a clear shot at him.
His intention was obvious. It was to hold the party in front, while his men
crept round on each flank, and enveloped them.
"We run the risk of being surrounded," Royce called to Challis at the
other end of the line; "there's nothing for it but to retreat."
To retreat, even with a disciplined force, is, as Royce knew, one of the
most hazardous operations of warfare. The risks were tenfold with his
Hausas, none of whom had served in the West African Rifles, who have
become such excellent soldiers under the training of their British officers.
But they were a compact little band, all devoted to him, and he decided to
take the risk.
First sending word to the unarmed men to make all speed to the rear with
their loads, he divided his little force into two parties.
"You see that ridge yonder?" he said to Challis, pointing to a bush-

covered position some distance away. "Fall back to that slowly with your lot.
I'll join you as soon as I can."
Challis set off. Meanwhile Royce retained his position, and kept up a
steady fire on the enemy as they advanced, creeping on yard by yard under
cover of the bushes.
"Whenever you see a man, shoot!" said Royce to the Hausas. "Don't
shoot without marking your man."
The Tubus made no use of their firearms. Royce and his men were hidden
from them by the brushwood, and they did not waste their shots on an enemy
whom they could not see. No doubt, Royce reflected, this was a mode of
warfare to which they were unaccustomed. They were used to carry all
before them in a dashing charge, and he wondered at their persistence under
the new conditions.
Presently a shrill whistle from the rear announced that Challis had taken
up his position on the ridge. The space between was a long undulation, only
a few yards of which, at the rearward end, were in view of the enemy.
"Now, boys, run!" said Royce.
Heading his men, he sprinted down the incline, rushed up the farther
acclivity, and dashed past Challis and his party, calling to Challis to hold the
Tubus until he had gained a new position still farther to the rear.
He noticed a clump of trees a little to the right, nearer the bank of the
river, and made straight for that. As he ran towards it, he came within view
of the horsemen working round on the left flank. They immediately wheeled
round, and galloped hard in pursuit.
But their course brought them below the ridge on which, all unknown to
them, Challis and his band lay concealed. As they rode past, within range of
about a hundred yards, a sudden volley on their right flank sent some of
them reeling to the ground. The rest, taken all aback, swerved to the left, and
dashed frantically away towards their main body, who had now become
aware that the hillock was deserted, and were surging up it.
"Well done, Tom!"
The ringing words came faintly from the rear. Challis brushed his sleeve
across his sweating brow, and ordered his men to run with him.
It was something to have gained half-an-hour without the loss of a man.
CHAPTER XII
A STAMPEDE
Taking advantage of the flight of the flanking party, Royce pushed on as

soon as he was rejoined by Challis, in order to gain a denser portion of the
forest, where the pursuers would be much more impeded than his own men.
He had two other reasons. The carriers had gone on by themselves,

without guidance, and it was probable that they would take a wrong
direction. Further, there was a possibility that in the absence of the white
men they would be seized with panic, and stampede, leaving their loads. The
Hausas could not at once carry and fight, and all the fighting strength would
be needed if the enemy still came on.
It seemed that the double check which the Tubus had suffered had
daunted them, at any rate for the time being; for Royce, looking back, saw
no sign of their having crossed the ridge.
About ten minutes later he came up with the carriers, who, on reaching
the edge of the thicker woodland, had prudently halted from fear of losing
the way. John again went ahead with them as guide, Challis following at a
short interval with his section, and Royce with the remainder acting as
rearguard.
The march through the forest entailed a disadvantage which almost

outweighed its advantages from the point of view of security. It was
impossible to see what the enemy were doing. They might have given up the
chase; they might be pressing on in the rear; they might still be working
round on the flanks, avoiding the woodland area, and outspeeding the
fugitives on more open ground.
For this reason Royce forced the pace as much as possible. From his
rather hazy recollection the fort was still five or six miles away, a distance
which he could scarcely hope to cover under three hours.
By degrees the forest thinned, and after about two hours' marching it
opened upon the lake which Royce had skirted on his return from the village.
By this time everybody was tired and hungry.
"We must take a spell of rest," he said to Challis. "I think it's scarcely
likely the Tubus have come through the forest after us."
"I'm glad enough," replied Challis. "A little more of this, and I shall crock
up again."
"Poor old chap! We must avoid that. It's certainly hard on you after what
you've gone through. Down loads, John. Serve out a meal. The boys can
drink from the lake; but let them beware of crocodiles."
"A thing has occurred to me," said Challis, as he sat with Royce waiting
until John had roasted some nuts for them. "Will Goruba suspect that we are
making for the fort, and get there first?"
"I don't think so. He is more likely to suppose that we are returning to the
village where we got our supplies. This is the direct route towards it; the fort
lies more to the left."
"That relieves my mind. But it's a pity we can't tell what the enemy are
doing."
"I'll go reconnoitring presently. The fort can't be more than a mile or two
away, and as it stands on an eminence it ought to be visible from the cliff
over there."
He pointed to the high ground which bordered one side of the lake.
"I'm inclined to think they have given it up," he continued. "Negroes

aren't very persevering as a rule, and they've had enough to damp their
spirits. It would be absurd to look for the same persistence in them that you
would expect in a civilised and disciplined enemy.... Well, John," he added,
as the Hausa came up with some roasted nuts spread on broad leaves, "is this
the best you can do for us?"
"Not good dinner all same, sah," said John, with a rueful look. "Get rabbit
some day."
"Yes, there's plenty of game about the fort, isn't there? Which is lucky for
us, considering that we have so many more mouths to feed."
Poor as the fare was, they ate it with a good appetite. Then Royce rose.
"I'll come with you," said Challis. "I'm curious to take a look at this fort
of yours."
"Come along, then. It's only about two hundred yards to the top of the
cliff. John will give us warning if anything happens."
Taking their rifles they set off, walking round the margin of the lake. On
their left stretched an open grassy space, beyond which was the forest from
which they had lately emerged.
The ground rose gradually. They were halfway up the ascent to the cliff
when Royce stopped suddenly.
"What on earth's that?" he said.
They halted, puzzled to account for a strange noise which seemed to

proceed from the forest on their left. At first a dull rumble, it grew in a few
seconds to a succession of heavy thuds, becoming louder moment by
moment, and mingled with sharp cracks like pistol shots.
"It can't be the Tubus charging through the trees," said Challis.
A shout from behind caused them to turn their heads. The men had leapt
to their feet, and were standing in a huddled group, with every sign of fear.
One, a young negro from among the released prisoners, was sprinting
towards them at full speed.
"We had better go back," said Royce, "or they'll get into a panic. The row
is terrific. A thousand cavalry couldn't make such an uproar.... Great Scott!"
AT THE EDGE OF THE CLIFF
Through the leafy screen of the forest a hundred yards away there had
emerged a large elephant, plunging forward at a lumbering gallop with trunk
uplifted. In another fraction of a second the whole of the light timber and
brushwood at the edge of the forest appeared to dissolve, and a wild mob of
scores of elephants burst like an enormous breaker upon the open space.
Petrified for a moment with amazement, the two Englishmen became

suddenly alive to their peril. Whether they went on in the direction intended,
or returned to their men, they would equally cut across the front of this
stampeding herd and must be overwhelmed.
"Straight for the edge of the cliff!" cried Royce.
They dropped their rifles and dashed to the right. It was forty or fifty
yards to the edge of the cliff; the elephants were already only about half that
distance behind them, gaining moment by moment. The ground shook under
the tremendous charge of the maddened beasts. To the fleeing men it seemed
that the breath from the gaping mouths scorched them.
A small spur of the cliff jutted to the left. The runners swung round on to
this and without a moments' pause took a header into the lake twenty feet
below.
When they came up to the surface they had to fight for breath in a
cauldron of broken water. They were both good swimmers, or they would
never have survived the sort of Niagara swirl in which they were now hurled
about and buffeted.
Only their instinctive leap to the left before they made the dive had saved
them from destruction. It had prevented the elephants from falling on top of
them, for some of the great beasts, charging straight ahead in a blind fury,
had plunged headlong over the brink into the lake.
The turmoil of the water soon subsided, and the swimmers, on regaining
the use of their faculties, found themselves in the company of the scattered
herd, all swimming in search of a landing-place.
In a few moments Royce caught at a branch of an overhanging tree, and

both he and Challis drew themselves up among the foliage, and watched the
ungainly animals swim by.
"Hope it's cooled their rage," said Royce in gasps. "We've had a narrow
squeak."
"Yes, indeed! Under several tons of elephant flesh we should have been
pretty well flattened out. What made them stampede, I wonder?"
"Our scent, perhaps. I hope they weren't started by the Tubus."
"We had better get back. It will be rather a feat to climb the cliff, by the
look of it."
They crept along the tree to the place where it sprang from the cliff, then
clambered up the steep face with the aid of straggling plants and knobby
projections.
When their heads appeared over the edge, there were loud shouts of joy,
and John came rushing up at the head of the whole party of negroes.
"Fink you gone dead, sah," he said, his broad face beaming. "All alive
and safe and sound, and always merry and bright. Yoi-aloo! Hurray!"
"Yes, we're all right," said Royce. "Is that my rifle?"
"All gone smash, sah," returned John, lifting the rifle which he had
picked up from the ground. "Massa Chally's all right, sah."
The lock and barrel of Royce's rifle had been smashed beyond repair by
the ponderous hoofs. Challis's was unbroken.
"Tibu, sah—where he go?" asked John, as they marched down to their

camping place.
"Who's Tibu?"
John explained that when the startling sounds came from the forest, Tibu,
one of the released negroes, had recognised them at once as made by
stampeding elephants, and had run up the cliff to warn the Englishmen.

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(eBook PDF) Substance Abuse

Counseling 6th Edition

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(Ivy Tech Community College), Kyle Brezinski (University of Toledo), Rachel

ABOUT THE AUTHORS

Dr. Gregory A. Blevins is a retired professor emeritus from the College of

SUBSTANCE ABUSE COUNSELING FOR TODAY LO 1.1

heroin habit. The fact that Eduardo is an undocumented immigrant has

DEFINING SUBSTANCE ABUSE LO 1.2

Defining Modern Substance Abuse Counseling

EVIDENCE-BASED PRACTICES LO 1.3

A RESPECTFUL AND POSITIVE APPROACH LO 1.4

In contrast to the now-discredited notion that substance abuse clients are

When randomly assigned, counselors’ clients often differ widely in outcomes

The body of research in support of motivational interviewing provides

A counselor who has a respectful attitude toward people grappling with

Substance Abuse Diagnosis: Continuum, Not Dichotomy

Nonuse Moderate, Heavy, Heavy use; Heavy use; Dependence;

Collaborative Treatment Planning

• resolving or avoiding legal problems

• adapting more effectively to work or school

In every case, a client’s commitment to a goal is a major factor in his or her

MEDICATION-ASSISTED TREATMENT LO 1.5

Opioid Overdose Prevention Medication

Any combination of methods may be appropriate for a specific client. It would

Three-parts of the column of captives had meanwhile been left

"Here I am, old man," he called.

"I'm nearly done for," he murmured, as Royce released him.

Wishing to avoid a fight, Royce considered how to complete his work.

"Little enough if they discover what has really happened."

Then he selected four of the Hausas to carry Challis on a litter made of

There was a remarkable change in the demeanour of the negroes.

"Dey want to stay with Massa," John explained.

"What do you say to that, Tom?" Royce asked of Challis.

"We'll start in about an hour, then—unless——"

"Well, the idea of chucking things up when we've come so many

"What does he say, John?" asked Royce.

"Him see horses, sah."

Stooping so as to be as little visible as possible, Royce doubled back. It

"Don't fire until I give the word," said Royce.

"Steady! Steady! Wait for the word."

"Now, boys!" he said.

Following his example, the Hausas fired. It was a somewhat ragged

"You are quite sure you can find the way?"

"Why?" asked Challis.

"You mean that if we have choked them off, we ought to be hurrying

They were marching through thin forest on more or less undulating

The Hausas kept absolute silence, awaiting their leader's command. It

"You see that ridge yonder?" he said to Challis, pointing to a bush-

"Now, boys, run!" said Royce.

"Well done, Tom!"

It was something to have gained half-an-hour without the loss of a man.

Taking advantage of the flight of the flanking party, Royce pushed on as

He had two other reasons. The carriers had gone on by themselves,

The march through the forest entailed a disadvantage which almost

"I'm inclined to think they have given it up," he continued. "Negroes