Treating Alcohol and Drug Problems in Psychotherapy Practice

Doing What Works

Arnold M. Washton and Joan E. Zweben

HardcoverPaperbacke-bookprint + e-book
February 6, 2006
ISBN 9781572300774
Price: $88.00
312 Pages
Size: 6" x 9"
June 23, 2008
ISBN 9781593859800
Price: $38.00
312 Pages
Size: 6" x 9"
November 14, 2011
ePub and PDF ?
Price: $38.00
312 Pages
print + e-book
Paperback + e-Book (ePub and PDF) ?
Price: $76.00 $41.80
312 Pages

Written specifically for the office-based psychotherapist, this practical guide describes how to detect, assess, diagnose, and treat clients presenting with a range of alcohol and drug problems. Detailed is an integrated, flexible psychotherapeutic approach that emphasizes building a strong therapeutic relationship, engaging clients “where they are,” and addressing substance use within the larger context of their lives. The authors describe in very pragmatic terms how to use a combination of motivational, cognitive-behavioral, 12-step, and psychodynamic techniques with clients in different stages of change. Techniques are brought to life with numerous case vignettes, and appendices include reproducible client forms and handouts.

“Intended for health care professionals from all disciplines, this book is written in a style that is non-technical and easy to absorb....I felt this book to be particularly useful and appropriate for learners beginning training in addiction counselling. It covers all the major themes, theories, and practices, and the issues discussed remain current and relevant.”

Journal of Mental Health

“This book offers clear and specific practice suggestions for working with individuals with substance use disorders ranging from managing bill collection to tips for managing relapse triggers. It provides a basic foundation for understanding substance use disorders and will help the interested clinician to build skill for working with individuals who have substance use disorders. Although the book is aimed at office-based mental health practitioners, it would be a helpful resource for any mental health or substance use treatment practitioner as well as graduate students. Its emphasis on utilizing an integrated approach to meet individuals where they are is particularly salient for social workers....The authors have done a tremendous job synthesizing practice wisdom and research-based knowledge on working with individuals with substance use disorders into a clear and concise resource that clinicians can use in their day-to-day practice.”

Journal of Social Work Practice in the Addictions

“This text provides a sophisticated snapshot of substance-abuse treatment today, extending the provision of substance-abuse services by private practitioners.”


“Many people interested in clinical work with alcoholics and addicts will benefit from making this a centerpiece of their library.”

Families in Society

“I highly recommend this book to clinical practitioners and graduate students in the mental health professions. Graduate students will find this book to be quite comprehensive and helpful in understanding how to create a therapeutic environment supportive of client change.”

—Dennis L. Thombs, PhD, Department of Health Education and Behavior, University of Florida

“This is the kind of book psychotherapists need. Washton and Zweben provide the most important information available about alcohol and drug problems together with state-of-the-art intervention methods. Truly comprehensive, this volume contains detailed sections on a wide range of relevant topics, such as frequently abused drugs, typical comorbid disorders, the utilization of self-help groups, and relapse prevention. Anchored in the concept of adapting treatment to the client’s stage of change, Washton and Zweben’s approach to treatment is truly integrative and evidence based and incorporates the most effective strategies for intervention.”

—Jay L. Lebow, PhD, ABPP, LMFT, Senior Scholar and Clinical Professor, The Family Institute at Northwestern University

“This comprehensive and highly-readable book provides thoughtful and thorough guidance on all aspects of alcohol and drug abuse treatment in an office-based practice. The integrated, multifaceted approach described by these experienced and respected clinicians covers screening, assessment, treatment planning, engagement, treatment, and relapse prevention. Each aspect of treatment is superbly addressed in a pragmatic, accessible, and flexible manner. This book will serve as an invaluable resource for all office-based practitioners, regardless of disciplinary background.”

—Gerard J. Connors, PhD, Research Institute on Addictions, University at Buffalo, State University of New York

“Despite the prevalence of alcohol and other drug abuse, psychotherapists typically receive inadequate training in treating these problems and are reluctant to take on substance-abusing patients. This practical book promises to change all that. Washton and Zweben show clinicians how to assess the problem, engage the patient, develop a plan, carry out the treatment, deal with relapse, and more. This book will be enormously valuable for psychologists, social workers, counselors, and anyone else wishing to sharpen their skills in the treatment of the substance-abusing person, from graduate students to experienced clinicians.”

—Sigurd Ackerman, MD, President and Medical Director, Silver Hill Hospital

“I highly recommend this important resource. Of particular interest to psychotherapists in private practice, the book describes a variety of evidence-based approaches to working with clients who have addictive behavior problems, including those with concurrent disorders or dual diagnosis. The authors provide a 'how-to' treatment guide that will appeal to a wide range of readers, including psychologists, psychiatrists, social workers, and addiction counselors, as well as students in graduate training courses.”

—G. Alan Marlatt, PhD, Addictive Behaviors Research Center and Department of Psychology, University of Washington

“Finally, office-based therapists do not have to avoid or refer clients with substance use disorders and can get the detailed, practical, and science-based information they need to work with them. Washton and Zweben offer a patient-oriented, integrative, sophisticated, and practical approach that can increase the competence and confidence of all therapists, even the most knowledgeable, in managing alcohol and drug problems in their offices. They are first and foremost clinicians, with years of clinical experience with and knowledge of alcohol and drugs and the patients who abuse them. Their guide presents wise advice for managing everything from appointments and billing, to dependence and medications, to patients who relapse and how to incorporate referral to self-help groups. This guide empowers therapists with a wealth of information, advice, understanding, and strategies to help their patients move through the entire process of change to sustained recovery from alcohol and drug problems. It is easy to read and eminently useable. Every mental health practitioner should read this guide and keep it at hand. Your practice and your patients will be better off for it.”

—Carlo C. DiClemente, PhD, Department of Psychology (Emeritus), University of Maryland, Baltimore County

“This book fills an important gap by showing how the treatment of substance dependence can and should be integrated into the broader practice of psychotherapy. Writing in a clear and engaging style, the authors provide information that psychotherapists need to know about the addictions and how to treat them. They do a terrific job of integrating concepts and techniques of psychotherapy with addictions treatment. This book is a gem that psychotherapists of every orientation will find extremely valuable.”

—Hal Arkowitz, PhD, Department of Psychology, University of Arizona

“Practical, clear, inexpensive, and theoretically sound.”

—Cynthia A. Briggs, PhD, Department of Counselor Education, Winona State University

Table of Contents

I. Basic Issues and Perspectives

1. Introduction

2. Nature, Course, and Diagnosis of Substance Use Disorders

3. Pharmacology and Overview of Psychoactive Substances

4. Ingredients of the Integrated Approach: Doing What Works

5. Considerations in Addressing Concurrent Psychiatric and Substance Use Disorders

6. The Role of Medications

II. Clinical Strategies and Techniques

7. Assessment

8. Individualized Goal Setting and Treatment Planning: Meeting Patients "Where They Are"

9. Taking Action

10. Preventing Relapse

11. Psychotherapy in Ongoing and Later-Stage Recovery

12. Group Therapy

13. Facilitating Participation in Self-Help Programs


1. Self-Administered Patient Questionnaire

2. 10 Tips for Cutting Down on Your Drinking

3. Inventory of "Triggers" for Alcohol and Drug Use

4. Substance Abuse Websites

About the Authors

Arnold M. Washton, PhD, is an addiction psychologist in private practice in New York City (Recovery Options) and Princeton, New Jersey (The Washton Group). A specialist in the treatment of substance use and other behavioral health problems since 1975, Dr. Washton has served on the faculty in Psychiatry at New York University School of Medicine and on the voluntary staff of the University Medical Center at Princeton. He was the founding president of the Division on Addictions of the New York State Psychological Association and has served on advisory boards for the U.S. Food and Drug Administration and special committees of the U.S. Senate, the U.S. House of Representatives, and the American Psychological Association. Dr. Washton's clinical work, teaching activities, and publications have often focused on integrating the principles and practices of client-centered psychotherapy into the treatment of addictions.

Joan E. Zweben, PhD, is a clinical psychologist with over 35 years of experience in treating addiction and in training treatment practitioners. These practitioners include peer counselors, social workers, marriage and family counselors, psychologists, criminal justice personnel, nurses, and physicians. She has a broad-based background in treatment of both alcoholism and drug dependence and has experience with both residential and outpatient modalities. She has served on numerous work groups focused on policy issues. Dr. Zweben is the founder and Executive Director of the 14th Street Clinic (1979-2007) and the East Bay Community Recovery Project (1989-present). Through these organizations, she has collaborated with researchers locally and nationally since 1981. She is the author of 4 books and over 55 articles or book chapters and editor of 15 monographs on treating addiction.


Mental health practitioners, including clinical psychologists, clinical social workers, psychiatrists, counselors, family therapists, and nurses. Also of interest to substance abuse treatment specialists.

Course Use

Serves as a text in advanced undergraduate- and graduate-level courses on substance abuse and addiction. Also useful as a supplemental text in psychotherapy courses.