Publication Trends of Addiction Counseling: A Content Analysis of the Rate and Frequency of Addiction-Focused Articles in Counseling Journals

Natalie M. Ricciutti, Willough Davis

Substance use disorders (SUDs) and addictions are prevalent client issues that counselors are likely to encounter. Yet, researchers have previously found that counseling journals publish articles about addiction issues at lower rates when compared to other topics. The purpose of this study was to determine recent publication rates of addiction-focused articles in 24 counseling journals between 2016 and 2023. We determined that only 174 (4%) of 4,356 articles published in counseling journals explored addictions-related issues. We conducted a multiple regression analysis and found that the publishing journal had a significant predictive relationship with the publication of addiction-focused articles, while publication year did not. We provide implications for counselors, researchers, reviewers, and journal editors to advocate for the publication of addiction-focused literature for the benefit of the counseling profession.

Keywords: substance use disorders, addictions, counseling journals, publication rates, addiction-focused articles

     Addiction treatment is an important and necessary service to both individuals and communities. The 2022 National Survey on Drug Use and Health published by the Substance Abuse and Mental Health Services Administration (SAMHSA; 2024) estimated that 48.7 million people have a substance use disorder (SUD). The same survey also found that approximately 21.5 million adults in the United States have co-occurring substance use and mental health disorders. These figures indicate that SUDs and addictions are prevalent issues that counseling professionals are likely to treat. Accordingly, the U.S. Bureau of Labor Statistics (2024) estimated that the job outlook for substance abuse, behavioral disorder, and mental health counselors is expected to grow by 18% by 2032. This rate of growth is notably faster than the average career growth rate of 5% for those counseling fields. For this reason, it is important that counselors have access to resources that help them learn about addiction issues and treatment in order to better serve their clients. Research articles are one type of resource counselors and counselors-in-training use regularly (Golubovic et al., 2021; Lee, 2014).

Despite the value placed on published counseling literature (Council for the Accreditation of Counseling and Related Educational Programs [CACREP], 2024; Golubovic et al., 2021), counselors have reported difficulty finding articles written about evidence-based addiction treatment practices and research (Doumas et al., 2019; McCuistian et al., 2023; Ricciutti & Storlie, 2024; Sperandio et al., 2023). Previous researchers also found that addiction-focused articles make up a small percentage of the overall counseling literature (Moro et al., 2016; Wahesh et al., 2017). The potential lack of addiction literature in counseling journals may contribute to professionals being uninformed about evidence-based practices and techniques (Golubovic et al., 2021; Lee, 2014). The purpose of this study was to conduct a conceptual content analysis to determine: (a) the rate and frequency of addiction-focused articles that were published in counseling journals from 2016 to 2023, (b) the journals that published the most addiction-focused articles, (c) the most common type of articles published (quantitative, qualitative, mixed methods, conceptual, etc.), and (d) if publishing journal and year of publication predicted the frequency of published addiction-focused articles.

Addiction Issues in Counseling Specialty Areas
     SUDs, addictions, and addiction-related issues are prevalent across a variety of populations and age groups and can be common co-occurring disorders (SAMHSA, 2021, 2024). Addictions are also considered to be a continuously growing public health crisis (Matsuzaka & Knapp, 2020; SAMHSA, 2014; Wing Lo et al., 2020). Given the scope and magnitude of addiction prevalence, counselors are likely to work with individuals with an SUD or addiction in treatment, academic, and clinical settings (Chetty et al., 2023). It is vital that counselors across all counseling specialties are informed about addiction-related issues.

One specialty area in which knowledge about SUD and addiction treatment is of the utmost importance is college counseling. According to the American College Health Association (2023), 65.9% of students reported alcohol use and 30.4% reported cannabis use in the previous 3 months. Additionally, 12.8% of the students who reported alcohol use demonstrated moderate or high risk; 20.5% of the students who reported cannabis use demonstrated moderate or high risk. Researchers have found that use of other substances such as opiates (Schulenberg et al., 2019), unprescribed medication (Sharif et al., 2021), and vaping products (National Institutes of Health, 2020) have all recently increased among college students. College students are also susceptible to developing internet addiction (Krishnamurthy & Chetapalli, 2015; Pu et al., 2023) and sex addiction (Giordano & Cashwell, 2018; Giordano et al., 2017), which are categorized as behavioral addictions (American Psychiatric Association, 2022). Counseling services have been found to have a positive impact on college student substance use (Pu et al., 2023; Zhang et al., 2020). However, students enrolled in counseling programs are not required to complete addiction counseling courses (CACREP, 2024). Some college counselors have reported that they lack the addiction counseling training and competence needed to work with students with an SUD or addiction (DePue & Hagedorn, 2015; Giordano & Cashwell, 2018). The prevalence of substance use and addiction issues in university settings suggests that college counselors may benefit from evidence-based addiction counseling literature.

Career counseling is another specialty area in which professionals may work with individuals experiencing SUDs and addictions. Addiction can impact an individual’s occupational wellness as well as their ability to secure and maintain employment (Allen & Bradley, 2015; Siu et al., 2019). Sherba et al. (2018) found that individuals with addictions experienced difficulty finding and sustaining employment. Researchers also identified that employment issues increased relapse rates for individuals in recovery (Sánchez-Hervás et al., 2012). Conversely, individuals with an SUD or addiction who received career counseling services experienced an increase in career maturity and career self-efficacy (Allen & Bradley, 2015) and a decreased risk of relapse (Kim et al., 2022). Yet, similar to college counselors, future career counselors are not required to take an addiction counseling course (CACREP, 2024). Graham (2006) found that this lack of education may cause career counselors to engage in treatment with biases that may negatively impact the therapeutic alliance. Therefore, career counselors need access to addiction counseling information, as it can be a beneficial aspect of an effective and well-rounded treatment plan and potentially decrease counselors’ biases.

Clinical mental health counselors (CMHCs) may often work with individuals with addictions. It is estimated that 7.7 million American adults have both a diagnosable mental health disorder and an SUD or addiction (Han et al., 2017; SAMHSA, 2024). Common comorbidities include mood and anxiety disorders (Kingston et al., 2017), attention-deficit hyperactivity disorder (Harstad et al., 2014), personality disorders (Medeiros & Grant, 2018; Pennay et al., 2011), and schizophrenia (Menne & Chesworth, 2020). For this reason, CMHCs are likely to work with individuals with addictions who initially seek treatment for a mental health disorder. Han et al. (2017) also found that individuals with comorbid mental health disorders and SUDs may seek out different treatment providers for each diagnosable issue. For example, clients may work with a CMHC for a mood disorder and an addiction counselor for an SUD. This dual treatment approach can be problematic because the providers may be unaware of the individual’s co-occurring disorders, and they may provide contradicting information and treatment (Han et al., 2017). Further, comorbid diagnoses have been found to be more effectively treated when one counselor uses integrated therapeutic modalities for both mental health and SUDs (Chetty et al., 2023). Thus, CMHCs must have access to research and information about SUDs and addiction issues to effectively treat individuals with comorbid disorders.

Like other specialties, marriage or couples and family counseling can be impacted by addiction-related issues. Addiction can lead to decreased trust between married or coupled partners (Molla et al., 2018) and an increased risk of marital dissolution and divorce (Torvik et al., 2013). In family systems, researchers found that having a child with an addiction was associated with lower family quality of life and lower marital satisfaction (Hamza et al., 2021). Children are more likely to experience attachment issues and mental health concerns if one or both parents have an addiction (Patton et al., 2019). Marriage or couples and family counselors must be aware of the impact SUD and addiction issues can have on their clients, as well as effective, evidence-based practices in order to support the development of healthy couple and family functioning.

School counselors also face SUD and addiction-related issues among their students and can work in the areas of intervention and prevention. Substance use at an early age may increase the risk of developing an addiction later in life (Nelson et al., 2015). According to the National Institute on Alcohol Abuse and Alcoholism (2024), 29.8% of high school students reported current alcohol use, 13.2% reported current electric vape use, and 19.8% reported current marijuana use. Some students may also be at risk of developing behavioral addictions, such as internet gaming disorder (Chibbaro et al., 2019; Sylvestro et al., 2023). Similar to marriage or couples and family counselors, school counselors may also work with students whose parents have an addiction (Bröning et al., 2012). These children are at a higher risk of experiencing mental health issues (Patton et al., 2019), experimenting with substances, and developing an addiction themselves (Järvinen, 2015; Leijdesdorff et al., 2017). School counselors play a vital role in the early intervention of substance use and the prevention of addictions because of their position as school-based helping professionals (Bröning et al., 2012). Consequently, school counselors, and all counseling professionals, must have access to accurate, peer-reviewed, evidence-based literature about general addiction issues and specific topics relevant to their specialty.

Addiction-Focused Research and Publications
     Despite evidence that substance use and addiction issues are common in every area of counseling (Allen & Bradley, 2015; Han et al., 2017; Pu et al., 2023), previous researchers have found that these issues are not reflected in published research (Moro et al., 2016; Wahesh et al., 2017). In 2017, Wahesh et al. reviewed articles published in 23 counseling journals from 2005 to 2014 and found that 4.5% (210 out of 4,640) were focused on addiction-related topics. They also found that an average of 23.33 addiction-focused articles were published each year from 2005 to 2014. Wahesh et al. highlighted that many journals had the capacity to publish more addiction-focused articles but did not. For example, the Journal of Specialists in Group Work published a total of 209 articles between 2005 and 2014. Only five of those articles were focused on addictions or addiction-related issues. The researchers also analyzed changes in publication trends by year and determined that, of the 210 articles focused on addiction-related topics, most were published in 2011 (n = 30) and 2012 (n = 30), while the fewest articles were published in 2008 (n = 14) and 2009 (n = 17). Wahesh et al. concluded that their results may stem from journals rejecting addiction-focused articles and/or addiction counseling researchers submitting their work to journals in other professions (e.g., psychology, social work, public health).

Moro et al. (2016) found similar results when they explored the prevalence of addiction-related articles in four counseling journals published between 2007 and 2011. They found that the Journal of Counseling and Development (JCD) published three (5.1%) addiction-related articles, Measurement and Evaluation in Counseling and Development (MECD) published two (12.9%) articles, Counseling Outcome Research and Evaluation published four (19%) articles, and Counselor Education and Supervision (CES) did not publish any addiction-related articles. Moro et al. also analyzed the frequency of addiction counseling topics presented at the Association for Counselor Education and Supervision conferences during that time frame. Thirty-six out of 1,966 (1.8%) conference presentations discussed addictions, addiction counseling, or addiction counseling education. These results are particularly concerning because many practicing counselors obtain continuing education through reading articles and attending conferences. Counselors may not have other avenues for learning about addiction-related research and evidence-based treatment if the information is not disseminated to the profession via published literature or conference presentations (Moro et al., 2016).

This lack of published literature and conference presentations has led counselors to advocate for more information about addictions and addiction-related issues. Both Moro et al. (2016) and Wahesh et al. (2017) stressed the importance of publishing more addiction-focused articles in counseling journals. Wahesh et al. specifically advocated for research that focuses on how addictions impact diverse groups, subcommunities, and evidence-based practices. Regarding diverse groups, Chaney (2019) explored the degree to which LGBTQ+ populations were included in articles published in the Journal of Addiction and Offender Counseling (JAOC). Chaney found that five (1.78%) out of the 281 articles published since the inauguration of the journal in 1980 to 2018 were focused on LGBTQ+ individuals. Behavioral addictions are another type of addiction that counselors have reported treating (Király et al., 2020; Oka et al., 2021; Ricciutti & Storlie, 2024), yet there is a dearth of published research (Giordano, 2019; Ricciutti, 2023; Wilson & Johnson, 2013). Ricciutti & Storlie (2024) interviewed practicing counselors about their experiences working with clients with process addictions, and all of the participants indicated that they had trouble finding relevant evidence-based practices and techniques in counseling literature. Carlisle et al. (2016) called for more research about the treatment of internet gaming disorder by counselors. Chaney and Burns-Wortham (2014) advocated for more research about sex addiction among the LGBTQ+ community.

Published research is a necessity for the counseling and counselor education professions (Giordano et al., 2021; Golubovic et al., 2021; Lee, 2014). Advancement in counseling practices cannot occur without the constant publication of exemplary research. Some counseling subtopics have seen a surge in published research within the previous decade (i.e., diversity and multicultural issues). Addiction counselors, researchers, and educators have repeatedly called for more addiction counseling information to be published in counseling journals (Golubovic et al., 2021; Moro et al., 2016; Ricciutti & Storlie, 2024; Wahesh et al., 2017). At this time it is unclear if these calls have been answered and if changes have been made. If they have not, it may reflect the lack of addiction-related content being published in counseling journals.

The purpose of this research study was to update the research done by Wahesh et al. (2017) and to determine: (a) the rate and prevalence of addiction articles that have been published in counseling journals between 2016 and 2023, (b) which journals published the most addiction-focused articles, (c) the type of addiction-focused articles (e.g., quantitative, qualitative, mixed methods) published, and (d) if the publishing journal and year of publication predicted the frequency of published addiction-focused articles. We hope that this research will highlight any changes that counseling journals have made to publish more information about addictions and addiction counseling since
the Wahesh et al. review was published in 2017.

Research Questions
     Four research questions guided this study:

RQ1:   What was the rate and percentage of addiction-focused articles that were published in counseling journals between 2016 and 2023?

RQ2:   Which journals published the most addiction-focused articles?

RQ3:   What type of article was most commonly published (e.g., quantitative, qualitative, mixed methods, content analysis, literature review)?

RQ4:   Did the publishing journal and the year of publication predict the frequency of published addiction-focused articles?

Methodology

We used journal websites and the library resources at the university where the study took place to answer the research questions. We followed Delve et al. (2023) and Hsieh and Shannon’s (2005) recommended guidelines for conducting a conceptual content analysis research study. These guidelines supported our choice to: (a) focus on the concept of addiction-focused counseling research, (b) identify specific words presented in text form (e.g., “addiction,” “substance use,” “addiction counseling”), (c) follow a combined deductive and inductive coding process by categorizing segments of the text that represent the focused concept, (d) take steps to address potential coder disagreements, and (e) use appropriate subjective interpretation based on our expertise.

Our research team included one professor, Natalie M. Ricciutti, and one doctoral-level graduate student, Willough Davis. Ricciutti has a degree in counselor education and supervision, with specializations in addiction counseling and addiction education, and extensive experience conducting content analysis research. At the time of the study, Davis was enrolled in a counselor education and supervision program and has a strong clinical background in addiction counseling. Davis also assisted in the study to fulfill requirements of an independent study about content analyses. We are both White females who have previously completed multiple courses in research methods. Ricciutti determined the purpose of the study, outlined the coding process, and trained Davis to identify and include relevant data prior to and throughout the study. Davis completed the initial review and categorization of the addiction counseling literature and Ricciutti provided feedback weekly.

Journal Search and Data Collection
     In an attempt to update Wahesh et al.’s (2017) study with fidelity, the data collection and review processes in the current study remained the same, with a few exceptions. First, we chose a timeline of 8 inclusive years instead of 9 because 8 years had passed since Wahesh et al. ended their data collection in 2015. Second, we selected the same 23 counseling journals for our study and added the Journal of School Counseling, bringing our journal total to 24. We organized the 24 journals into a list for data collection purposes (Table 1). This list included national journals (n = 19, 79.2%), regional journals (n = 3, 12.5%), and international journals (n = 2, 8.3%). National journals included JCD, CES, JAOC, and the Professional School Counselor; regional journals included Counselor Preparation and Supervision and Teaching & Supervision in Counseling; and international journals included the International Journal for the Advancement of Counseling and the Asia Pacific Journal of Counseling & Psychotherapy. We conducted a thorough review of all the articles published in the 24 journals, which resulted in a total of 4,356 articles.

We reviewed the title, abstract, keywords, and full narrative of each of the 4,356 articles to determine whether or not each was about addiction or substance use–related issues. We labeled articles as addiction-focused if they used addiction-related terminology in the title, abstract, keywords, and/or full narrative. Common terminology included specific types of substance or behavioral addictions, addiction recovery, addiction treatment, and addiction counseling. We also included articles if they focused on addictions or addiction-related topics. Common topics included evidence-based addiction treatment practices, issues related to specific SUDs and behavioral addictions, risk and protective factors of addictions, the impact of addiction and/or substance use among specific populations, and addiction counseling education.

We collected data by categorizing each addiction-focused article’s relevant information in an Excel spreadsheet. This included the article title, the publishing journal, year of publication, the article’s keywords, type of article (e.g., original research, conceptual, literature review), and the type of research the article included (if relevant; quantitative, qualitative, mixed methods). Similar to the inclusion process, we excluded articles if they did not have an addiction-related focus, and they did not include addiction-related terminology in the title, abstract, keywords, and full narrative. Ricciutti reviewed Davis’s categorization of articles and data coding during weekly meetings to ensure coder agreement. We both reviewed articles when it was unclear if an article was focused on addiction-related content. When necessary, we discussed an article’s focus until we resolved disagreements and reached consensus on inclusion or exclusion. Lastly, we cross-referenced our collected data with the 4,356 articles to ensure that we included all of the published addiction-focused articles. We determined that no articles needed to be added or removed. The data was transferred into SPSS (Version 28) for analysis.

Data Analysis
     We used descriptive statistics to answer the first research question and to determine the rate and percentage of all addiction-focused articles published in counseling journals between 2016 and 2023. For the second research question, we used descriptive statistics to determine the rate and percentage of the addiction-focused articles published in each journal. For the third research question, we used descriptive statistics to determine the rate and percentage of the type of articles and the research methodology researchers used. We also used descriptive statistics to determine the number of the type of article and type of methodology published each year (Figures 1 and 2). We conducted a multiple regression analysis to answer the final research question to determine the predictive relationship between the independent variables of publishing journal and year of publication as well as the dependent variable of frequency of published addiction-focused articles.

Table 1

Addiction-Focused Article Trends per Journal

Journal Total Number of Articles Number of Addiction-Focused Articles Percentage of Addiction-Focused Articles
Adultspan Journal 62 0 0%
Asia Pacific Journal of Counseling and Psychotherapy 96 0 0%
Counseling Outcome Research and Evaluation 79 4 5.0%
Counseling and Values 107 2 1.87%
Counselor Education and Supervision 178 1 0.56%
The Family Journal 448 20 4.46%
International Journal for the Advancement of Counseling 281 7 4.49%
The Journal for Specialists in Group Work 141 2 1.42%
Journal of Addiction & Offender Counseling 67 51 74.63%
Journal of College Counseling 118 15 13.56%
Journal of Counseling & Development 324 14 4.32%
Journal of Counselor Preparation and Supervision 305 4 1.31%
Journal of Creativity in Mental Health 316 12 4.11%
Journal of Employment Counseling 114 1 0.89%
Journal of Humanistic Counseling 117 3 2.56%
Journal of LGBT Issues in Counseling 155 4 2.58%
Journal of Mental Health Counseling 182 6 3.29%
Journal of Multicultural Counseling & Development 148 2 1.35%
Journal of School Counseling 172 3 1.74%
Journal of Technology in CE&S 49 0 0%
Measurement and Evaluation in Counseling and Development 167 6 3.59%
The Professional Counselor 227 11 4.85%
Professional School Counselor 408 2 0.98%
Teaching and Supervision in Counseling 95 2 2.11%

Note. Total number of articles is 4,356. Number of addiction-focused articles is 174.

Figure 1

Type of Addiction-Focused Articles Published per Year

Note. N = 174.

Figure 2

Type of Research in Published Addiction-Focused Articles per Year

Note. N = 121.


Results

Of the 4,356 articles published in 24 counseling journals from 2016 to 2023, we identified 174 (4%) as focused on addiction counseling or other addiction-related issues (Table 1). Regarding our second research question, JAOC had the highest rate and percentage of addiction-focused articles at 74.63% (n = 51). Adultspan Journal, Asia Pacific Journal of Counseling & Psychotherapy, and Technology in CES were tied with the lowest percentage of addiction-focused articles at 0%. Regarding the third research question, the most common type of article was original research (n = 121, 69.5%). Other types of articles included conceptual pieces (n = 45, 25.9%), literature reviews (n = 5, 2.9%), meta-analyses (n = 2, 1.1%), and book reviews (n = 1, 0.6%). Figure 1 provides a description of the type of addiction-focused articles published during each year. Of the 121 original research articles, 86 (71.1%) were quantitative studies, 29 (24%) were qualitative studies, three (2.5%) were content analyses, and three (2.5%) were mixed method studies. Figure 2 provides a description of the type of research conducted in each addiction-focused published article during each year.

Regarding the fourth research question, we first calculated yearly analyses to determine the number of addiction-focused articles published in counseling journals each year (Table 2). The year 2016 had the lowest number of published addiction-focused articles (n = 13, 7.5%), while 2021 had the highest (n = 28, 16.1%). On average, 21.75 addiction-focused articles were published each year from 2016 to 2023. Next, we conducted a multiple linear regression analysis to determine if journal and year of publication had a predictive relationship with the frequency of published addiction-focused articles. This analysis resulted in a statistically significant regression model, F(2, 187) = 4.134, p = .018, R2 = 0.42. Finally, we examined the individual predictors (i.e., independent variables). We found that publishing journal had a significant predictive relationship with the frequency of published addiction-focused articles, (Beta = −.192, t(189) = −3.682, p = .008). In other words, some journals were significant predictors of being more likely to publish addiction-focused articles than others. We also found that publication year did not have a significant predictive relationship with the frequency of published addiction-focused articles (Beta = .07, t(189) = .973, p = .332).

Table 2

 Addictions-Focused Articles Published Per Year

Year n %
2016 13 7.5
2017 24 13.8
2018 19 10.9
2019 25 14.4
2020 18 10.3
2021 28 16.1
2022 22 12.6
2023 25 14.4

Note. Total N = 174.

Discussion

The purpose of this study was to examine the frequency of addiction-focused articles published in counseling journals in recent years. We reviewed 4,356 articles published in 24 counseling journals from 2016 to 2023 to determine the frequency and percentage of addiction-focused literature in the counseling profession. The results indicate only 174 (4%) of those articles were focused on addiction counseling or other addiction-related issues. This percentage is less than previously identified by Wahesh et al. (2017), who found that 210 (4.5%) out of 4,640 articles published from 2005 to 2014 were about addiction issues. Publication year also did not have a significant, predictive relationship with publication rates. This result suggests that national and global events occurring between 2016 and 2023 (e.g., the opioid epidemic, the COVID-19 pandemic) did not statistically impact the publication of addiction-focused articles in counseling journals.

We also determined that the majority of addiction-focused articles were original research, many of which used quantitative analytic techniques. This result reflects a long-standing trend toward quantitative methodologies in the counseling and other helping professions (Berríos & Lucca, 2006; Marshall et al., 2025; Oh et al., 2017). We also found that only three of the 174 addiction-focused articles used mixed methods techniques. This number is lower than Wahesh et al.’s (2017) finding of six mixed methods studies. Researchers and professionals in counseling have called for more mixed methods research to achieve well-rounded study findings (Ponterotto et al., 2013; Wester & McKibben, 2019). Our results indicate that this change has yet to occur with addiction-focused research published in counseling journals.

It is worth noting the differences we found in publication rates by journal when considering potential reasons for the lack of addiction-focused counseling literature. The specific journal and the publication of addiction-focused articles had a significant, predictive relationship. Unsurprisingly, JAOC published the most addiction-related literature in both number and percentage. Yet, it had one of the lowest numbers of total published articles (67 from 2016 to 2023; Table 1). As discussed, counselors have reported experiencing difficulty finding relevant, evidence-based addiction counseling literature to support their practice (Chaney, 2019; Ricciutti & Storlie, 2024; Wilson & Johnson, 2013). This struggle may be because the only addiction counseling journal has one of the lowest publication rates out of the 24 journals included in this study.

Another reason for the publication rate may be a lack of addiction-focused articles being submitted to counseling journals. Instead, counseling researchers with expertise in addiction issues may be submitting their manuscripts to journals in other professions (e.g., psychology, social work, public health, etc.). We did not find a study exploring the rates of addiction-focused articles in the psychology, social work, or public health professions to compare with our findings. Yet, these professions each have many addiction and substance use–focused journals where researchers can choose to submit their work. A Google Scholar (2024) search of all addiction journals’ h5-indices (i.e., the number of articles published in the last 5 years) and h5-medians (i.e., the median number of citations for articles in the h5-index) shows that the top 20 publications at the time of this writing are the psychology journals the International Journal of Mental Health and Addiction, Drug and Alcohol Dependence, and Addictive Behaviors. JAOC was not included in that list.

The results may also be due to the small number of counseling researchers and educators with expertise in addiction issues compared to the overall profession. A number of studies have found that many counseling students leave their programs without the necessary academic experience to competently practice addiction counseling (Golubovic et al., 2021; Lee, 2014; Ricciutti & Storlie, 2024). As discussed, CACREP (2024) standards do not include addiction counseling content requirements for many of the specialty practice areas. Ricciutti & Storlie (2024) found that the lack of education caused some counselors to report that addiction counseling was not part of their professional identity. For this reason, we join Moro et al. (2016) in advocating for the inclusion of an addictions course into the counseling core curriculum. Requiring a course for all students may help future counselors incorporate addiction counseling into their professional identity. Doing so could instill future counselors with a passion for addiction issues and eventually lead to an increase in addiction-focused manuscripts submitted for publication in counseling journals.

Recommendations for Counselors, Counselor Educators, and Researchers
     Addiction-focused literature published in counseling journals is highly relevant for practicing counselors, counseling researchers, and the overall profession. Substantial value is placed on published research to advance the counseling profession (CACREP, 2024; Golubovic et al., 2021). SUD and addictions are common primary and co-occurring disorders (SAMHSA, 2021, 2024) and the job outlook for addiction and substance use counselors is expected to grow rapidly (U.S. Bureau of Labor Statistics, 2024). Counselors in every specialty area need relevant, evidence-based research about SUD and addiction issues to inform their practice. Yet, we found the publication of addiction-focused articles to be low, with some journals failing to publish anything about addiction issues from 2016 to 2023. Journals may want to consider how to solicit addiction-focused content for publication to fill this research gap.

The existing prevalence rates of addiction-focused articles may, in part, stem from researchers not submitting articles about addiction issues to counseling journals. Researchers may believe that their manuscript is likely to be rejected if it is sent to a journal that has not published an addiction-related article in recent years. We encourage authors and researchers to push against this potential belief and consider submitting their addiction-focused manuscripts to journals that have not recently published articles about the topic. This practice could inform editors and reviewers about addiction-related issues in the counseling profession, as well as help authors reach new audiences who may not normally read addiction-focused articles. Counselors and researchers also can attempt to advocate for the inclusion of addiction-focused articles in the journals they frequently read. This advocacy can come in the form of writing letters to journal editors to request more addiction content. Practicing counselors can also work to conduct addiction-focused research studies through their agencies, practices, schools, or universities. The information gleaned from studies that are conducted in novel settings with diverse populations would be highly relevant to the profession and help grow the existing body of literature.

An increase in addiction-focused research studies and submitted manuscripts is only the first step toward a higher prevalence of published articles. Journal review boards and editors must be willing to expand the aims, scope, and acceptable topics to include addiction-related issues. For example, addiction issues are highly relevant in every counseling specialty area, including school counseling (Bröning et al., 2012). Yet, the Professional School Counselor published two addiction-focused articles and the Journal of School Counseling only published three (Table 1). This is despite recent evidence that substance use and addiction issues continue to be a common issue among children and adolescents in the last decade (National Institute on Drug Abuse, 2023). Editors and reviewers expanding journals’ scope and acceptable topics for consideration may allow researchers with an expertise in addiction counseling to feel more confident sending their manuscripts to counseling journals other than JAOC.

Journals can sponsor special issues that are dedicated to addiction-related topics. We urge researchers, writers, journal editors, and reviewers to consider the long-term implications and benefits of providing more addiction-focused articles to the entire counseling profession. These journal practices will help grow the existing literature over time; expand addiction-related topics to a variety of co-occurring disorders and populations; and provide new opportunities for continuing education, much of which can be obtained through reading and contributing to journal articles. For example, Chaney (2019) called for more literature about substance use and addiction among the LGBTQ+ community. The Journal of LGBT Issues in Counseling could combine both topics in a special issue. Finally, we encourage CACREP to consider adding new addiction counseling standards to their next edition at both the master’s and doctoral levels. As discussed, counselors in every specialty area are likely to work with individuals with addictions and SUDs (Bröning et al., 2012; Kim et al., 2022; Patton et al., 2019). Yet, many have reported their training and skills in this area have fallen short of competence (DePue & Hagedorn, 2015; Giordano & Cashwell, 2018; Han et al., 2017). It is necessary that all counselors receive education in addiction counseling in order to better serve their clients or students.

Limitations
     This study is not without limitations. First, as with any conceptual content analysis, researcher error and subjective interpretation of the data is a potential limitation. Although we fully reviewed each of the 4,640 articles, we identified addiction-focused articles, in part, through the inclusion of addiction terminology in the title, abstract, keywords, and narrative. It is possible we unintentionally excluded relevant articles or included articles that were irrelevant because we did not use statistical measures of interrater reliability. Similarly, it is possible there was addiction-related language and terminology that we were unfamiliar with, causing us to exclude articles that should have been included. We also may have allowed our unconscious biases to impact our data inclusion process throughout the study. We worked to mitigate this potential limitation by reviewing each article in full and by following recommended guidelines for conducting a conceptual content analysis (Delve et al., 2023; Hsieh & Shannon, 2005).

Second, this study focuses on addiction articles published in 24 counseling journals from 2016 to 2023. For this reason, it is possible that our study may not accurately reflect published addiction-focused articles over a broader period of time or with different journals. We encourage future researchers to review additional counseling journals not included in this study, such as state counseling journals or local university counseling journals. Third, we only collected and analyzed data that was publicly available—published articles in counseling journals. We did not gather data on the number of addiction-focused manuscripts that were submitted to journals but not published. Future researchers may consider contacting counseling journal editors to ascertain the rate of submitted manuscripts that were not published for any reason (e.g., rejected, author pulled their manuscript). Researchers can then compare the number of submitted addiction manuscripts with the number of published articles. Doing so may incorporate data excluded from this study and determine if the small number of addiction-focused articles is due to lack of quality submissions or potential reviewer and editor bias. Researchers could also conduct a similar study with journals in other helping professions (e.g., psychology, social work, public health) to determine if our results reflect a common trend in the publication of addiction-focused articles.

Conclusion

We explored the prevalence of addiction-focused articles published in 24 counseling journals from 2016 to 2023 and found recent publication rates to be low. We reported the journals that have published addiction-focused articles during that time frame, the type of articles published, and the potential impact of journal and year of publication. We compared our findings with Wahesh et al. (2017) and determined that the prevalence and rate of addiction articles has not increased since 2005. The lack of information may make it difficult for counselors in every specialty area to learn about addiction issues relevant to their clients or students. Finally, we provided information about the importance of addiction literature in the counseling profession and the implications of journals expanding their aims and scopes to include addiction issues.

 

Conflict of Interest and Funding Disclosure
The authors reported no conflict of interest
or funding contributions for the development
of this manuscript.


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Natalie M. Ricciutti, PhD, NCC, LPCC, LCASA, is an assistant professor at the University of North Carolina Charlotte. Willough Davis, MEd, NCC, LCMHC, LCASA, is a doctoral candidate at the University of North Carolina Charlotte. Correspondence may be addressed to Natalie M. Ricciutti, University of North Carolina Charlotte, 9201 University City Blvd., Charlotte, NC 28223, nricciut@charlotte.edu.

Exploring Experiential Learning Through an Abstinence Assignment Within an Addictions Counseling Course

Chad M. Yates, Alexia DeLeon, Marisa C. Rapp

Counselors-in-training may struggle in working with addictions populations for various reasons, including limited training, pre-existing stigma toward the population, and low self-efficacy treating substance use disorders. This is concerning because professional counselors have the highest proportion of clients with a primary substance abuse diagnosis. The authors explored the experiential learning approach of an abstinence project within an addictions course in an attempt to give students a genuine experience that parallels what an individual with an addiction may experience. The authors utilized generic qualitative analysis to explore the experience of 17 counseling students completing the abstinence assignment. The emergent themes of (1) concrete experiences, (2) dealing with cravings, (3) student’s self-reflection of learning, and (4) empathetic understanding and challenging attitudes are presented. Finally, future areas of research and implications for counselor educators are discussed.

Keywords: substance use disorders, abstinence assignment, generic qualitative analysis, counselors-in-training, addictions

Counselor educators face considerable challenges in providing comprehensive and effective training for counselors-in-training (CITs) serving persons with substance use disorders (SUDs). These challenges include students’ unfamiliarity with addictions or addicted populations, few opportunities to infuse addictions-related materials into the general curriculum, and no uniform national curriculum standards for addictions-related education (Chasek, Jorgensen, & Maxson, 2012; Salyers, Ritchie, Cochrane, & Roseman, 2006). This is concerning, as addiction remains a consistent issue for the general population. Approximately 21.5 million Americans meet criteria for an SUD (Substance Abuse and Mental Health Services Administration, 2015), reinforcing the need for competent addictions counselors. Professional counselors (excluding specified addictions counselors) have the highest proportion of clients with a primary substance abuse diagnosis, in comparison to social workers, psychologists, and psychiatrists (Harwood, Kowalski, & Ameen, 2004). Additionally, CITs also treat clients with addictions much more frequently during their training. Salyers et al. (2006) found that a high percentage of CITs see clients in their practicum and internship experiences who present with substance abuse concerns. Due to the frequency of addiction concerns counselors and CITs treat, it is imperative that counselor education programs continue to address training necessary to accommodate these concerns.

In response to the growing need to train effective addictions counselors, the Council for Accreditation of Counseling & Related Educational Programs (CACREP; 2016) constructed standards that counselor educators should infuse within the curriculum. The integration of the standards across all CACREP-accredited programs has been slow, but a 2013 survey of programs found that 76.7% of counseling graduates had at least one course related exclusively to substance abuse counseling (Iarussi, Perjessy, & Reed, 2013). This is a substantial increase considering Salyers et al.’s (2006) findings that only 58.2% of counseling graduates had taken at least one course related to substance abuse counseling. Starting in 2009 and continuing within the 2016 standards, CACREP specifically called for counselors to understand the theories and etiology of addictions and addictive behaviors, including strategies for prevention, intervention, and treatment (CACREP, 2016). These changes have provided steps toward greater competency in the treatment of addictions; however, most students still have only one course during their program devoted to addictions (Chasek et al., 2012). As most counseling education programs continue to only have a single course devoted to addictions education, it is critical to investigate the educational experiences of CITs and explore the educational experiences that maximize student learning.

A common concern when educating CITs about addictions is the attitudes and biases they bring with them to an addictions course (Chasek et al., 2012). The pre-existing attitudes and behaviors espoused by CITs are often derived from moralistic notions of addiction (Chasek et al., 2012). Clinicians’ negative attitudes toward persons with addictions often lead to reduced outcomes in treatment (McLellan, Lewis, O’Brien, & Kleber, 2000). Blagen (2007) suggested that negative attitudes need to be addressed during training to help CITs facilitate relationship building with persons with addictions. A common tool utilized in addictions training to foster empathy and understanding of persons with addictions is the abstinence assignment. The abstinence assignment asks students to abstain from a substance or behavior for a set period and journal about the experience. This learning approach has been explored in a pharmaceutical education program (Baldwin, 2008), allowing students to successfully meet all four of the course’s learning objectives: (1) describe feelings and experiences related to the process of withdrawal from habituating or addicting substances or activities; (2) describe the importance of abstinence in the maintenance of recovery from habituating or addicting substances or activities and discuss the implications of relapse to the recovery process; (3) discuss the importance of support systems in recovery from habituating or addicting substances; and (4) describe the process of addiction and recovery (Baldwin, 2008).

Baldwin (2008) found generally favorable opinions of the assignment and strong ties to reflective learning through class surveys conducted before and after the assignment. However, no study to date has explored students’ learning processes during an abstinence assignment. The aim of the current study was to understand the pedagogy behind the abstinence assignment and to explore the experience of students completing the project. It was hoped that the study would reveal if the abstinence assignment could foster empathetic experiences for persons with addiction and if the assignment could enhance understanding of withdrawal, craving, and relapse. Specific research questions included: (a) what, if any, were the empathetic experiences of students concerning clients with addictions; (b) how was the concept of craving experienced and made meaningful by participants; (c) what were the elements of the learning process for participants completing the abstinence assignment; and (d) how did students find ways to deal effectively with cravings and abstinence through the project? This study utilized qualitative data analysis methodology to explore the experiences of 17 CITs who completed an abstinence assignment during their addictions course. A review of pertinent literature follows.

CITs often face considerable difficulty learning addiction-specific tools and skills. These challenges typically arise due to students’ limited exposure to persons who are addicted, limited experiences of cravings and triggers, limited understanding of the lives of those with addictions, and limited self-efficacy of being effective with this population (Harwood et al., 2004). This lack of awareness, coupled with classroom material that is disconnected from the students’ experiences, may lead students to feel unprepared for treating clients with addiction concerns. The infusion of experiential learning activities is one way to counter the above concern. Kolb (1984) stated that learning new concepts involves directly encountering these concepts within real world experiences. In Kolb’s theory, “Learning is the process whereby knowledge is created through the transformation of experience” (Kolb, 1984, p. 38). Effective learning is seen when a person progresses through a cycle of four stages: (1) having a concrete experience, followed by (2) observation of and reflection on that experience, which leads to (3) the formation of abstract concepts (analysis) and generalizations (conclusions), which are then (4) used to test hypotheses in future situations, resulting in new experiences (Kolb, 1984). Experiential learning is a means of acquiring knowledge through action and feelings; it creates an emotional understanding and challenges attitudes (Warren, Hof, McGriff, & Morris, 2012).

Sias and Goodwin (2007) explored an experiential learning approach of CITs attending 12-step meetings and then journaling their experience. Students attending 12-step meetings reported growth and new awareness of the experience of persons with addictions. Students described the fear and uncertainty clients faced when beginning a support group. They also reported challenging their pre-existing stereotypes of persons with addictions, through interacting with those in recovery. Results from studies such as Sias and Goodwin (2007) can help further understanding of the barriers in learning about addictions and also help educators implement experiential learning approaches more intentionally.

Barriers to Learning

In training emerging clinicians to work with persons with addictions, research has revealed that many trainees lack empathy and emotional understanding for this population (Baldwin, 2008; Giordano, Stare, & Clarke, 2015; Sias & Goodwin, 2007). Research has shown the struggles CITs may experience in showing empathy, emotional understanding, and challenging bias toward persons with addictions. These struggles may impact the quality of care toward persons with addictions (Chasek et al., 2012; Giordano et al., 2015). Furthermore, many CITs report poor self-efficacy in being clinically effective with persons struggling with addictions (Harwood et al., 2004). Celluci and Vik (2001) found that approximately 144 mental health providers in Idaho who treated persons with an SUD rated their graduate training as inadequate preparation for treating clients with an SUD. The importance of strong educational experiences is reinforced by Carroll (2000). Carroll reported that CITs with more addictions courses were increasingly likely to treat or refer a client for an SUD and to think of an SUD as a distinct disorder, compared to CITs with less addictions training.

Another potential learning barrier for students is negative stigma toward persons with addictions. Society’s negative portrayal of those battling addictions may play a role in counselor trainees’ perceptions and attitudes regarding this population (McLellan et al., 2000). For instance, the general public is reported as viewing persons with drug addictions negatively, as blameworthy and dangerous (Corrigan, Kuwabara, & O’Shaughnessy, 2009). CITs possess similar negative attitudes, beliefs, and biases regarding addictions and addiction treatment (Chasek et al., 2012). These authors investigated CITs’ attitudes toward persons with addictions and the effectiveness of substance abuse counseling. They concluded that students who had less bias toward persons with addictions were more likely to view treatment for substance abuse as effective.

Counselor educators are charged with the responsibility to ensure that competent counseling professionals are entering the field (CACREP, 2016). As present research shows the struggles that many CITs are facing in relation to persons with addictions, it is vital that further research is conducted to examine how counselor educators can remedy this known lack of empathy and emotional understanding through pedagogical intervention. Although anecdotal evidence from past generations of counselor educators has shown the experiential assignment of abstaining from a substance as useful, to date no counseling literature exists that shows empirical evidence for this assumption. Consequently, we investigated the experience of students utilizing the abstinence assignment and built upon the limited understanding of integrating an abstinence assignment into addictions curriculum.

Qualitative Research Design

Generic qualitative analysis (GQS; Percy, Kostere, & Kostere, 2015) was employed as a qualitative methodology to examine the pedagogical implications of utilizing an abstinence assignment within an addictions course. GQS seeks to understand and discover the perspectives and worldviews of participants and is intended to explore what participants directly experienced, or what the experience was about (Percy et al., 2015). The present study utilized existing abstinence journals and reflection summaries that included descriptions and reflections of students’ experiences of participating in the abstinence assignment; it was deemed appropriate to use a qualitative methodology that would support the analysis of these data resources (Percy et al., 2015).

Participants

The participants selected for the study were master’s-level counseling students enrolled in their second and last year of study. These students were enrolled in an addictions counseling course, and a major course requirement was an abstinence assignment. Students were instructed to select a substance or behavior from which they wished to abstain for 4 weeks. There was a total of 17 participants (14 females and three males). The ages of participants ranged from 24 to 44 years with a mean age of 26. All 17 participants identified as White. Participation in the study was solicited after the participants completed their abstinence journals and reflective summaries, and received grades for the assignment. The participants were informed that participation in the study was completely voluntary and would have no impact on their grade. Data analysis was conducted once the course was completed. Of the 17 participants, the following is a list of the chosen substances or behaviors with the number of students: Soda or Carbonated Beverages (3), Sugar (4), Alcohol (3), Eating Out at Restaurants (2), Social Media or Entertainment Activities (3), Procrastination (1), and Evening Snacking (1).

Abstinence Assignment

This exercise was designed to help students experience some of the feelings/thoughts that addicted individuals experience when they quit their drug or behavior of choice. Students were told: This exercise requires that you give up a substance (e.g., nicotine, caffeine, or alcohol) or a behavior (e.g., eating sweets, playing video and computer games, watching television) for a period of 4 weeks. During this assignment, you will write a goodbye letter to your substance or behavior detailing why you are choosing to give up the substance or behavior and what the substance or behavior means to you, and you will keep an abstinence log of your experiences. This log will describe your feelings and reactions, especially focusing on times you “lapse” or experience cravings (minimum one page log of two entries per week). Finally, you will write a summary paper, which will serve as the conclusion to the 4-week exercise.

Data Analysis and Trustworthiness Procedures

The researchers obtained Institutional Review Board approval prior to the analysis of the data. Data analysis procedures were followed according to the guidelines set forth by Percy et al. (2015). The researchers first familiarized themselves with the study materials—which included a goodbye letter to the substance or behavior, abstinence journals, and reflection summaries—by reading through each item and making notations (highlights) about significant statements that reflected the research questions for the study. The above step was performed independently by the first and second author for all 17 transcripts. The two researchers (authors one and two) met at two different times, once halfway through the initial transcript analysis and again at the end to compare and contrast notes.

After this step was completed, the researchers compared notes to identify common theme listings from the data. The researchers created a definitional agreement for each emergent theme. The goal of this step was to isolate significant themes represented in both researchers’ notes. Each researcher had to agree that there was ample evidence to support this theme and agree on the mutual definition of this theme. To aid the researchers in coding, the work of Kolb’s Experiential Learning Model (Kolb, 1984) was incorporated into the coding procedures to link existing learning theory steps to the process that was being discovered within the transcripts. Once the coding structure was in place, the first author coded each of the 17 participant transcripts. Coding each participant was performed by highlighting significant statements that represented the theme and its definition. For example, the researcher coded a significant statement from Participant 1: I can see why this is so difficult for some people to stay sober; I’m having a hard time and only . . . giving up sugar. This significant statement was coded as empathy. Upon completion of this coding, both researchers independently reviewed the list of significant statements under each theme and noted if the statement was representative of the existing theme definition. If the significant statement was not representative, it was either discarded or represented under a more appropriate theme.

The researchers met upon completion of this step to share the results of the review of significant statements. The researchers then decided if each change to the significant statement was warranted. Following the above step, the researchers organized all themes into similar categories. After this categorization was complete, the researchers utilized an auditor outside of the study who shared a similar background and training in qualitative research to review the significant statements under each theme and identify if they were representational to the existing theme definition and if the themes fit within their designated category. The auditor made notes about significant statements to discard or to move to another theme. Upon completion of the auditor’s review, the category, theme structure, and theme definitions were emailed to each participant of the study for member checking. Each participant was asked to comment on the list of themes and the researchers’ definitions of each theme to ensure that they were credible. Participants with comments for the researchers were contacted again, and category and theme structures were reviewed and revised based on the participants’ input.

Results

Four themes emerged during the data collection process. The first theme was “concrete experiences” of the participants completing the abstinence assignment. This theme contained several subthemes, such as withdrawal cues, cravings, relapse, justifications of relapse, shame after relapse, and triggers. The second theme that emerged was “dealing with cravings.” Within this theme were the subthemes of replacement behaviors and relapse avoidance. The third theme contained elements of “student’s self-reflection of learning.” This theme contained two subthemes: reflective observation and abstract conceptualization. The last theme consisted of statements showcasing students engaging in empathetic understanding and challenging their attitudes or perceptions of persons with addictions.

Theme One: Concrete Experiences

Theme One contained participant descriptions of completing the abstinence assignment. These concrete experiences, cravings, relapse, and shame over relapse are similar to experiences of persons beginning and sustaining recovery. The most often identified statement from participants was craving for their identified substance. Participant 3 journaled, “Sometimes I wish I could just take all of my cravings and put them in a jar and smash the jar so I don’t have to deal with them anymore.” Beginning to deny the use of a substance had begun to produce strong desires often unknown by participants. Participant 15, who abstained from soda, described hearing a soda dispenser and the physical effect she noticed in her body for the first time, “It was odd to note that I had a sensation go through my entire body as I heard it. It made me think and consider Pavlov’s dogs. Truthfully, I thought about Diet Coke the rest of the day.” Cravings were often accompanied by withdrawal in participants who had given up substances they had consumed over long periods. Participant 12 reported, “Today I was run-down and fatigued, and I developed a low-grade headache that stayed with me all day. And even though I ate more than I usually eat in a day, I felt like I was starving.”

Reading through the 17 participants’ journals, researchers found consistent patterns of subthemes often occurring in a sequential order. The subthemes order was descriptive of a trigger or cravings, followed by relapse, justification for the relapse, and finally shame and guilt over the relapse. Upon review of the participants’ transcripts, this pattern was found in 15 of the 17 participants and occurred between one and three times per participant. Participant 13, who abstained from sugar, described a cycle of trigger, craving, relapse, justification of relapse, and shame over relapsing: “Tonight was Superbowl Sunday. My aunt made a gluten free cake with dulce de leche and strawberries on top, and I ate two slices . . . I felt like I deserved it because I was doing so good on this abstinence assignment.” Participant 13 further recalled, “I feel a little bad about it now, but I honestly feel like it was justifiable and I plan on going back to the no sugar and no gluten thing again tomorrow anyway.”

Instances of complete breakdown on the students’ abstinence goals often appeared. These especially occurred with students who chose substances like grains, carbs, or sugar. The defining elements of these complete breakdowns were a sense of low self-efficacy and overwhelming guilt and shame. Participant 10, who abstained from fast food, expressed, “I have eaten at fast food restaurants three times since last Thursday . . . I literally feel disgusted at myself that I haven’t been able to control my cravings or at least have enough self-control to just be mindful about my choices.” The experience of emotional and physical symptoms related to abstaining from a behavior or substance prompted students to begin exploring effective personal strategies for dealing with their cravings.

Theme Two: Dealing With Cravings

Paralleling the experience of individuals in the early stages of recovery, participants actively dealt with cravings in various ways, including healthy and unhealthy coping mechanisms. When participants selected strategies that were unhealthy or unhelpful, the researchers labeled these as replacement behaviors. These behaviors often consisted of replacing their substances with other substances. For example, switching from sugary foods to fatty or salty foods, and avoiding a trigger or cravings by staying overly busy. These behaviors are not new to professionals working with clients with addictions. Below are examples of the participants engaging in these replacement behaviors. Participant 1, who abstained from soda, described noticing her behaviors as, “I ate a lot more . . . than I normally do. Because of how many chips I was eating I realized that I had replaced my drink [soda] with chips and salsa.” Noticing the pattern was a valuable learning experience that helped the participant to confront her substitution later in the assignment.

However, other students were unable to observe the ties connected to these behaviors and future relapse. Participant 5, who abstained from social media, reported, “I was also very busy the last couple of days because I’ve been preparing for my counseling presentation. Maybe I’ve successfully distracted myself from the temptation.” Nearly all participants reported engaging in replacement behaviors at some point in their experience. However, many of these participants discovered more successful ways to cope with triggers and cravings. When participants reported positive craving coping strategies, the researchers labeled these experiences as relapse avoidance strategies. These strategies often involved the elimination of potential triggering events or objects within the participants’ environments, relying on significant others and family members for support, talking to classmates about their cravings, and using healthy substitutions in place of their substance.

Participant 5 reported an instance of a relapse avoidance strategy: “I actually uninstalled and deactivated my Twitter. That way if I go to tweet something, I would have to download the app and activate my account. Two layers of activity would definitely put a damper on impulsivity.” Additionally, Participant 6, who had given up sugar, reported, “I got rid of all the sugar in the house.”

Relying on classmates and family was often described as essential from participants who reported they felt they had successfully abstained. Participant 3, who abstained from sugar, reported, “I talked with one of my friends about how the relapse has impacted my overall motivation and she really helped me get through and process.” Participant 5 added, “I’ve enlisted the help of my husband—(he) agreed to check my Twitter handle to make sure it is deactivated. This keeps me honest. I like the accountability piece because I can’t tweet in secret.” The healthy substitution often resembles behaviors like a step-down program or funneling energy into healthy activities and hobbies such as exercising or spending time with close friends. Participant 3, described replacing sugary sodas with a healthier alternative: “I found this type of soda . . . that is basically naturally flavored water. To say it’s curbed my sugar craving is an understatement.” Others described tending to general wellness to alleviate the stress associated with abstinence. Participant 7, who abstained from alcohol, reported, “I noticed myself going to sleep earlier yesterday . . . which I believe was a coping strategy for dealing with my irritability of trying to relax without allowing myself to have a drink.”

These strategies represent active experimentation and learning about how best to be successful at abstaining from the identified substance or behavior. Reflections on these experiences were essential to the learning goals associated with this project. The next theme explores these reflections and provides insight into the learning that was taking place throughout the assignment.

Theme Three: Student’s Self-Reflection of Learning

Theme Three explored the elements of personal learning the participants reflected upon. The researchers identified learning through Kolb’s Experiential Learning Model (Kolb, 1984). The researchers were interested in participants’ statements that evidenced reflective observations, defined as observations and reflections on what their experience was about and how it resonated with them. The researchers also were interested in participants’ statements that evidenced abstract conceptualization. We defined abstract conceptualization as the reflection upon concepts related to treating persons with addictions followed by generalizations from these reflections to future work with clients.

Examples of reflective observation can be found within Participant 2’s description of her difficulty in remaining abstinent from television for the assignment and how she discovered the difficulty of the change process within herself: “I feel like all I’ve done is replace not thinking because I watch mindless shows on television to not thinking because I play mindless games on my phone. I’ve thought about replacing it with exercise, but I feel myself rebelling against that.”

Many of the participants’ reflections facilitated greater awareness about how difficult it was to change any reinforced behavior or the difficulty of abstaining from a substance or behavior. Many reflected on discovering the difficulty of living without their substance or behavior. Participant 4, who abstained from social media, described, “It was very surprising to me when I realized how automatic my impulses were and how often I gave into them. During this time, my eyes were opened to how much this habit impacted my life.” In addition to discovering how hard it was to live without something they once enjoyed, many participants described experiencing new insight into the minds and behaviors of persons in recovery. Participant 13, who abstained from sugar, described, “It was much more difficult to abstain when I was around people who were consuming around me. I felt a greater social pressure and found myself feeling insecure (and) disconnected in social settings.” Participant 13 reported that pressure to continue was difficult to maintain: “Once I relapsed and we were nearing the end of the four weeks, it was hard for me to remain motivated to continue . . . the craving, the desire to connect with people and fit in, and the unexplainable high I get from eating sugar and gluten had to be outweighed by something else.”

Additionally, participants described the change process as something tangible and less theoretical. Participants could describe and reflect upon where they were within the stages of change and began to appreciate the difficulty of sustaining lasting change. Participant 11, who abstained from alcohol, described her awareness of the change process as, “Change doesn’t just happen overnight; it requires many things, including commitment, energy, the right motivation, and the right timing.” In addition, Participant 3, who abstained from sugar, added, “I talk in my notes at my site all the time about motivation for change and what that looks like for each of my clients, and I couldn’t even apply it to myself.”

The participants began to understand the experience of what counselors were asking clients to do by abstaining from drugs or alcohol. They also began to understand how to apply this learning to clients who were currently struggling with addictions and help with the understanding of the concepts of addiction. Participant 12, who abstained from sugar, reported, “This experience helped me understand how counterproductive it is to tell other people what they need to do to change. People don’t change until they are ready . . . to assume that a person will change just because someone tells them to is a mistake.”

Additionally, participants recalled what was most difficult about abstaining and built stronger conceptualizations about the role of triggers in relapse. Participant 17, who abstained from alcohol, reported, “I went dancing with some friends last night at a bar in town and found myself being asked several times why I wasn’t drinking.” This participant expressed the frustration about the experience as, “It began to get really annoying, and I feel (it) gave me some insight into the role that others play in the process of addiction and becoming sober, and how risky it can be in certain environments.”

The application of the experience of abstinence impacted all of the participants to some degree. Overall, they stated they felt a greater capacity of empathy for persons with addictions based upon how difficult abstinence was. Most participants reflected that the way they viewed a person in recovery was altered based on their experience of abstinence. The assignment generated new learning opportunities and understanding of the concepts of addiction and also enhanced their empathy for clients suffering from addictions. This enhancement of empathy was found within Theme Four, discussed below.

Theme Four: Empathy and Attitudes

The participants all stated that a significant learning outcome of the assignment was empathy for those with addictions. Participant 3, who abstained from sugar, reported, “I can see how people would struggle giving up drugs when their body has such a dependence on their drug of choice. I am struggling and counting down the days and I’m only giving up sugar.” This empathy was often associated with a strong protest that they were only experiencing a small proportion of the suffering that persons in recovery go through. Participant 10, who abstained from fast food, described growing his awareness of persons with addictions as, “I know one of my limitations in counseling is not being able to relate to my clients because I haven’t experienced some of the things that they have, like an addiction.” Participant 10 discussed the benefits from the abstinence assignment as, “by doing something as simple as this, I feel that I am in a much better place to help clients.”

Other participants described that empathy helped them deepen their understanding and care for those in their close family who had gone through addictions. Participant 17 reported, “I have personally observed my father going through his journey in alcohol and opiate addictions. I have felt the pain, suffering, frustration, and struggle as a family member, which makes this assignment very personal for me.” Participants reported these empathetic gains as important because they provided new perspectives on the lives of persons with addictions. Gaining empathy helped move participants closer to understanding persons with addictions as human beings who were attempting to steer themselves away from alcohol and drugs. This helped them to combat previous biased views of persons with addictions and altered previous attitudes and beliefs that are ineffective in helping this population.

Discussion

This study explored the pedagogy behind an abstinence assignment and the experiences of students who participated. Specifically, the researchers wished to discover (1) What, if any, were the empathetic experiences of students concerning clients with addictions; (2) how was the concept of craving experienced and made meaningful by participants; (3) how did students find ways to deal effectively with cravings and abstinence through the project; and (4) what were the elements of the learning process for participants completing the abstinence assignment? A discussion of the research questions, including analysis of the themes, follows.

Empathetic Experiences of Students

Addressing bias and negative stigma associated with persons with addictions is a major aim of most addictions courses, as negative stigma has contributed to lower therapeutic outcomes for clients struggling with addictions (McLellan et al., 2000). This study explored the empathetic understanding of students completing the abstinence assignment and found that participants reported accessing empathy for persons struggling with addictions through experiences of craving, triggers, and relapse. Moreover, students empathized with the pain and suffering that abstaining produced and described the needed patience of treating clients with addictions. This empathy was fostered through an experiential understanding of craving, which is better explored within the second research question of how students found ways to effectively deal with cravings and abstinence via the project.

Experiences of Craving

An essential element of Kolb’s Experiential Learning Model (Kolb, 1984) is concrete experience. A concrete experience is a learning stage that involves having students experience a phenomenon physically, mentally, and psychologically. Although the experiences from the abstinence assignment are only approximations of individuals with addictions, they may still be important, as they provide students insight into withdrawal, craving, triggers, relapse, shame, and justification concerning relapse. This study’s first theme supports the learning objective that students experienced genuine addiction-related experiences. Students were cognizant that their experiences may not have perfectly compared to individuals addicted to drugs and alcohol; however, they stated often that the abstinence assignment produced suffering and uncertainty over their ability to abstain successfully from their chosen substances or behaviors. Students also reflected upon how they learned to cope through effective and ineffective ways with the experiences of craving and relapse. This was encouraging, as it provided students with strategies on how to help future clients during recovery.

Effectively Dealing With Cravings

Students often struggle with understanding where to start treatment with persons entering recovery (Carroll, 2000). This uncertainty may stem from unfamiliarity with the experiences of addictions and from lack of awareness of appropriate therapeutic goals for clients suffering from addictions. Students in this study reported understanding the concepts of triggers and cravings much more tangibly, while often discussing how they would broach these topics more readily with clients after completing the abstinence assignment. The students also reported ways they found to effectively manage their cravings that they felt could be useful to explore with clients in the future. These ways included many of the well-established treatment interventions for addictions that advocate for removal of all substances or substance use–related materials from home; restructuring daily living to replace or avoid triggering things, places, or times; the building of a supportive structure of family and peers; allowing others to hold the person responsible for future substance use; limiting exposure to cross-dependency through the use of other substances; actively discussing current cravings and triggers with family or peer support; and relying on healthy living strategies, like eating and sleeping well, to bolster defenses against triggers. We see from the list above that students were able to extrapolate strategies through abstaining from a substance or behavior to their work with clients. A closer inspection of Theme Three, students’ self-reflection of learning, found further support for the application of this project.

Elements of the Learning Process

In examining the students’ learning process, this study was interested in discovering if Kolb’s model could be an effective explanation of students’ learning during the abstinence assignment. It was discovered that the stage of concrete experiences was experienced during the period of abstaining. The assignment also required a reflection log or journal and a summarization paper. Within these portions of the assignment, the researchers found ample evidence to support that students engaged in reflective observations that helped them assign meaning to their experiences during abstaining, and also provided room for students to actively think through what these experiences meant for their work with clients (i.e., abstract conceptualization). Due to time considerations and inaccessibility to students, the researchers were unable to observe elements of Kolb’s fourth stage (i.e., active experimentation). Future research might build upon the present design to investigate the application of skills with CITs having undergone an abstinence assignment.

Implications for Counselor Education

Madson, Bethea, Daniel, and Necaise (2008) explored current training within counseling psychology and mental health counseling programs and recommended key areas educators should attend to within the realm of addictions. These areas included: (a) thoroughly assess SUD, (b) determine the appropriate level of treatment, and (c) develop treatment plans that include evidence-based substance abuse treatment (Madson et al., 2008). Madson et al. identified key areas that closely aligned with CACREP Standard II.3.D., which calls for counselors to understand the theories and etiology of addictions and addictive behaviors, including strategies for prevention, intervention, and treatment. It is the authors’ belief that the abstinence assignment helps students prepare for the above standards in a way that surpasses traditional didactic content. Speculatively, this may be why the abstinence assignment has been seen as a hallmark of addictions training. Baldwin’s (2008) investigation of abstinence assignments found that 69% of participants felt the abstinence assignment had a major positive effect, and 44% of participants agreed that they better understood the process of addictions recovery as a result of the assignment. This study aimed to build upon Baldwin’s findings; specifically, to explore if the abstinence assignment was found valuable by students; and to discover if it provided a valuable learning experience about the phenomenological experiences of persons with addictions, an understanding of the symptoms of addictions, and an understanding of preliminary treatment approaches to use with clients. The researchers found key themes within the research that supported the assignment meeting the above learning goals. With these findings, the authors believe in the continued infusion of this assignment within counselor education.

The abstinence assignment carries pedagogical considerations for an educator to take into account before including it in the curriculum. These considerations include how an instructor intends to provide feedback and assess the reflection journals. Content of feedback should be considered to help elicit further reflection for the student to deepen the learning experience. Moreover, the instructor will want to consider ethical issues that may arise from the grading of this assignment. If a student is disclosing dangerous or high-risk behaviors or demonstrating signs or behaviors of a process addiction, instructors will need to address their concerns and support the student’s developmental needs.

Future Research

There are several recommendations for future research. First, future research is needed to examine the application of skills with counselors who have completed an abstinence assignment. Qualitative and quantitative inquiry could provide insight as to whether students are translating their learning from this assignment into clinical practice. Secondly, research may expand upon this study by examining students’ prior experience with addictions or persons struggling with addictions to inquire if prior knowledge influenced their learning experience. Finally, continued empirical exploration into additional pedagogical interventions to examine effectiveness in addictions curriculum is needed.

Limitations

Several limitations exist within the current study. A primary limitation known from the beginning of the study was the utilization of a class assignment as the primary means of data collection with all White participants. While other studies have utilized class assignments as means of data collection (Baldwin, 2008; Sias & Goodwin, 2007), it is unknown if participants provided consistently accurate representations of their progress, or if different types of students would have different experiences. This limitation was partially mitigated by encouraging journaling and reflection upon success and failures during abstinence. Another limitation was the inability to monitor the application of the learning material potentially being applied with internship clients.

Conclusion

Researchers investigated the pedagogical advantages of utilizing an abstinence project within an addictions course, along with exploring the empathetic understanding of students completing the abstinence project. Elements of their learning process were identified and results found that students reported increased empathy for persons struggling with addictions through their experience of abstinence. The authors recommend employing the abstinence assignment in an addictions course curriculum in counselor education. Future research is needed to examine the application of skills with counselors having undergone an abstinence assignment.

 

Conflict of Interest and Funding Disclosure

The authors reported no conflict of interest or funding contributions for the development of this manuscript.

 

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Chad M. Yates is an assistant professor at Idaho State University. Alexia DeLeon is an assistant professor at Lewis & Clark. Marisa C. Rapp is a doctoral student at Idaho State University. Correspondence can be addressed to Chad Yates, 921 South 8th Ave, Stop 8120, Pocatello, ID 83209-8120, yatechad@isu.edu.