114 The Professional Counselor | Volume 12, Issue 2 questions during the intake process can initiate conversations about psychoactive drugs. Counselors also have the opportunity to educate clients on the biopsychosocial impact of psychoactive drugs that may play a role in their presenting concerns (Kaut & Dickinson, 2007). Assessment also allows counselors to educate clients on the risks and benefits of CAM and OTC use. Diagnosis Knowledge about clients’ use of herbal supplements, OTCs, and dietary supplements is important, as clients may unknowingly experience substance-induced problems. For example, garcinia cambogia, a popular weight-loss herbal supplement, can induce mania (Hendrickson et al., 2016). Clients who have taken garcinia cambogia may present with manic symptoms such as grandiosity, decreased need for sleep, irritability, and hallucinations (Hendrickson et al., 2016). Psychosis has also been induced by L-dopa and dendrobium extract, found in OTC performance-enhancing supplements (Flynn et al., 2016), and by herb–herb interactions when taking multiple supplements simultaneously (Wong et al., 2016). Because of the potential for substance-induced problems, counselors should make differential diagnoses by discussing all potential conditions that may be causing the client’s symptoms, which includes ruling out substance etiology (First, 2013). Case Conceptualization To understand the nature, history, and context of clients’ presenting concerns, counselors should engage in a case conceptualization process. Macneil et al. (2012) recommended considering predisposing, precipitating, perpetuating, and protective/positive factors that may contribute to or alleviate the client’s presenting concerns. Counselors should consider how herbal supplements, OTCs, and dietary supplements may be a precipitating, perpetuating, and/or positive factor, as these substances may contribute to or alleviate clients’ symptoms. Treatment Planning Counselors consider a client’s diagnosis, presenting concerns, and case conceptualization information to make a personalized treatment plan (Macneil et al., 2012). If CAMs and OTCs are relevant to the client’s treatment, counselors may include the monitoring of such substances as an intervention. This would include assessing the client’s use and compliance with their medication regimen, inquiring about side effects, and evaluating how these factors relate to the client’s mental health. Counselors should only practice within the scope of their license, and clients must be referred to qualified medical providers for any medical or medicinal concerns. Counselor roles may include the referral of a client to a specialist such as a psychiatrist for medication evaluation as a component of the client’s treatment plan. Counselors should ensure that physicians they refer to provide quality care. Client Advocacy Counselors may advocate for their clients and consult with prescribers on clients’ behalf (Bentley & Walsh, 2013). Again, a significant concern is that clients frequently do not discuss the use of alternative treatments with their physician (Abraham et al., 2017; Agbabiaka et al., 2017). Direct inquiry into the use of CAMs and OTCs and client education can bring about greater clarity and the opportunity to ask clients to discuss these with their medical providers (Agbabiaka et al., 2017). Counselors can encourage and educate clients on how to discuss CAMs and OTCs with their physician or psychiatrist. When assessing, educating, referring, and advocating, counselors must abide by ethical and legal standards.
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