Alcoholics may choose to take a first drink, but they can’t simply choose which drink will be their last. Addictions wield incredible power, Dr. Christine Chasek said. She trains counseling students to respect that power, and respect addicts for battling it.
Chasek learned that lesson decades ago while interning at a Kearney halfway house.
“There was a client there and he was a big, burly motorcycle-type guy. Big scruffy beard, heavyset and really tall. … He lost his wife, his family, his kids, and they’d meant the world to him,” Chasek said.
He told Chasek that before he entered treatment, he’d kept vodka on his headboard. Each night he’d wake up to drink, so withdrawal wouldn’t make him sick.
With tears in his eyes, the man asked a simple question: “How do I stop this?”
Moments such as that one challenged Chasek’s biases about substance abuse, and sparked her desire to improve alcohol and drug counseling by improving the way counselors are trained.
“He would be one person you would just probably turn and walk away from, if you saw him on his motorcycle, out in front of a bar or wherever. In fact, he ended up running with a tough crowd, because that’s where he fit in. But to get to know him, and the pain and how helpless he felt … we can’t take people at face value. We don’t know what they’re dealing with, and if you can get through that denial and that tough stuff, you can really make an impact.
“I want to train people so they can sit across from somebody like this and have that compassion, and help them. To have the knowledge, the skills and the heart of it,” she said.
An assistant professor at the University of Nebraska at Kearney since 2012, Chasek has found many ways to improve counselor training – as a teacher, as a researcher, as a therapist, and as the Kearney director for the Behavioral Health Education Center for Nebraska. That state program promotes behavioral health services in rural areas.
She’s published research on addiction counseling programs, including two book chapters, and has mentored numerous student research projects into publication.
Last year, Chasek’s teaching and professional service earned the American Counseling Association’s Emerging Professional award, the Addictions/Offender Educator Excellence Award from the International Association of Addiction and Offender Counselors, and UNK’s Faculty Mentoring of Graduate Student Research Award.
The international award honored Chasek for her mentorship, and for her teaching approach that emphasizes experiential learning. In one course, for example, Chasek asks students to examine their own addictions. That way, students understand the physical and emotional response their clients will have when asked to give up addictive substances.
Students can be surprised to find how much they rely on soda, video games, coffee, or even exercise.
In one nomination letter for the award, a student wrote that during Chasek’s course, one of her classmates quit an addiction. She found the strength to quit because she felt supported by the other students.
“I thought ‘Wow, this counseling business can really make a difference in someone’s life, and quickly,’” the student wrote.
Chasek’s teaching style developed from her professional experience and her research, which has led her to a three-pronged approach for training addiction counselors – attitudes, knowledge, and skills.
“The stigma part is the attitudes and the discrimination. What are my attitudes toward (addiction and substance abuse) as I come in to learn about it? The knowledge piece is (the information students are) learning in a book and taking tests over. Then the middle part is this experiential piece, or the skills. Can I sit down across from somebody and empathize with them, and treat them? Do I have experiences working with people, actually doing it?”
Chasek incorporated those elements into her Competency Based Alcohol and Drug Supervision Model, published in the 2015 book “Annual Review of Addictions and Offender Counseling II: Best Practices.” The model for supervisors of addiction counselors uses philosophy statements to help counselors explore their beliefs about addiction and treatment.
The approach represents Chasek’s contribution to an ongoing debate in her profession.
“We’re really struggling with what makes the best addiction counselor. … Is it experience – ‘I’ve been there, done that, and I’m in recovery?’ Or, is it ‘I’m like a medical doctor, I’m highly trained, I know the treatment, I know the models and I can help you.’ And that is a huge war.
“It stuns me. I think there’s a place for both.”
Chasek said she first realized the importance of counselor attitudes in graduate school, while working for South Central Behavioral Services in Kearney. She noticed that substance abuse was treated differently than other mental or behavioral health problems, by professionals as well as the public.
“At the halfway house, nobody wanted to do the intensive outpatient groups (for substance abuse).
It was like the less glamorous kind of work,” she said.
That observation led to Chasek’s first published article, “Assessing Counseling Students’ Attitudes Regarding Substance Abuse and Treatment,” in the Journal of Addictions and Offender Counseling. She found a correlation between student attitudes about substance abuse and their attitudes about treatment; those with stereotypically moralistic ideas about substance abuse were less likely to be optimistic about treatment. A lack of optimism, in turn, makes effective treatment less likely.
The idea of substance abuse as a moral failing, or choice, dates back to the temperance movement. Chasek said those attitudes sparked programs such as Alcoholics Anonymous in the mid-20th Century. Professionals didn’t want to work with people who had addiction problems, so recovering addicts were recruited and given some training as counselors.
“So it was kind of like a make-do thing. It worked. The AA model and all those, it’s people who struggle helping other people who struggle, which is great. But what happened was it left out the whole education piece. So our people who are highly trained, knowledgeable, skilled, were not going into the addiction field.”
In the 1980s, Chasek said, the profession’s pendulum swung to understand addictions more as a disease than a choice. And today, psychologists consider addiction a biological and sociopsychological problem. While choice is a component of substance abuse, there are also social and biological factors.
So with a new understanding of the disease, students need updated training. Along with understanding and empathy, Chasek said, counselors need a solid knowledge of the drugs being abused, the mechanisms of the drugs, what each one does to the brain, and what the withdrawal effects are.
“If you come in to see me and you’re withdrawing off heroin, you’re going to be uncomfortable but you’re not in danger. But if you come to see me and you’re withdrawing off alcohol, you could potentially die. That’s the deadliest drug to withdraw from. So we have to train because our social construct is it’s no big deal, let them sleep it off.
“With heroin, (we think) ‘oh my God those people are scary,’ or with methamphetamine (we think) ‘get them to the doctor right away,’ but it’s the opposite. So they need to know all the classes of drugs, what all the withdrawal effects are, what it does to the brain, all the treatment techniques. We need to know more, we really do.”
Training Models Vary
Along with the knowledge and empathetic attitude, today’s counselors need real-life skills. Chasek said her latest research, which expands on findings she presented at the 2016 American Counseling Association meeting in Montreal, Canada, assesses the strengths and weaknesses of various counselor-training models. She’s found that experiential programs, such as those at community colleges, do a better job than four-year degree programs of giving students counseling skills.
“We’re giving them knowledge and we’re challenging their attitudes, but we’re not putting them out there and saying ‘hey, this is what it’s like to sit across from somebody under supervision.’”
At the same time, people training through the experiential route may be more likely to use less
“One of the old ways of treating (addiction) was to break down people’s denial and resistance, get in their face and tell them they’re bad people and they have to quit doing this. We call it the hot seat, kind of berating them until they get better. That, we’ve found, doesn’t work very good. It’s the least effective method, but I think it’s still being taught in that experiential route.”
While Chasek’s research has focused primarily on counselor training, her students take her into much different territory. Chasek encourages students to develop their classroom research projects for publication, and they pick whatever subjects interest them.
The paper that sparked Chasek’s focus on student research came from graduate student Kaitlin Wilson. Reading Wilson’s paper on food addiction, Chasek said, she was struck by the quality of the content.
“She had found an assessment tool that was in development. I’d never seen it before,” Chasek said, and she knew others in her profession would want to see it too. She approached Wilson about developing the paper further, and “Food Addiction” was published in an international professional newsletter in 2015.
Chasek now specifies in her syllabi that students have the opportunity for publication in her courses. Many take her up on that offer, which means a lot of out-of-class work.
“The chair kind of jokes that there’s always students lined up outside my door,” she said. “I’ve never sat down and put a number to it. To me, I get benefit out of it, they get benefit out of it, the profession gets benefit out of it.”
Chasek tries to incorporate real-life experience into her courses, and draws on her professional experiences to give students real-life examples. With dual licensure for mental health and alcohol and drug counseling, Chasek still treats clients part-time. She said the work helps her stay current on the issues facing her profession.
“When I was doing my rehab work in the halfway house it was a lot of alcohol and a lot of methamphetamine. Now in the field there’s still alcohol, methamphetamine not quite so much, but heroin is huge, and opioids. The opioid epidemic is crazy … and these are different clients. These are not heroin addicts we think about from the projects or on the streets. These are people who have been on prescriptions for pain, and then they get hooked on them, and there’s so much shame and stigma because what happens is you can’t get the pain medicine anymore, so you turn to illegal means, and heroin is cheap.
“One of the last clients was a mom, at home, and (she) had surgery. Fast forward and she’s trying to buy heroin, and still trying to take kids to school and all that.”
Making sure those clients have access to counseling is Chasek’s mission as director of Behavioral Health Education Center for Nebraska’s Kearney office. She said her appointment came partly because her dual licensure and academic position are a rare combination, and partly because of her location outside Lincoln and Omaha. The program’s goal is to address the shortage of mental and behavioral health professionals in outstate Nebraska.
There was a rush into the mental health profession in the 1980s, Chasek said, but those people are now reaching retirement age. At the same time, the demand for mental health counseling is rising. BHECN develops programs to bring more well-trained professionals into more areas.
At a spring high school track meet, Chasek said, she saw firsthand the problem BECN is trying to address. A man in the bleachers was alone, and way overdressed for the very hot day. After he collapsed, Chasek found a nurse working the concessions stand, and learned that the town doctor was running the track meet. Both of them knew the man, and knew he had schizophrenia. All they could do, though, was call an ambulance and take him to the emergency room.
“He needs a psychiatrist. This really is that example that people don’t have access to the care and treatment they need, and then it ends up costing more money – the emergency room was the only option,” she said.
Part of Chasek’s job is educating nursing and physician assistant students about the signs of addiction, so they can identify it in patients. The center also helps place counseling interns in rural areas, offers continuing education, and promotes the counseling profession to high school students. In its sixth year, Chasek said BHECN is now assessing how many students its programs have recruited into the mental health profession, how many are staying in rural Nebraska, and how many counseling jobs have been created.
“Anecdotally, (communities) have opened a few more clinics, they’ve opened a whole series of integrated health sites out in the Panhandle,” she said.
Regardless of the role she’s playing – teacher, counselor, scholar, administrator – Chasek’s vision and mission remain to bring well-trained counselors to people who need them. And that means changing the images people carry about substance abuse.
“A lot of people look away and have a lot of pre-conceived ideas and stigmas around addiction, and that’s why part of my research has been how to train counselors who do that work to combat that stigma and, I feel, discrimination. … That’s what I try to help students understand, that when you work with people you have to understand that they just can’t quit.”
Title: Assistant Professor, Counseling and School Psychology; Director, Behavioral Health Education Center-Kearney.
Education: Ph.D., Counselor Education and Supervision, University of South Dakota, 2012; Master of Science, Community Counseling, University of Nebraska at Kearney, 1999; Bachelor of Science, Psychology, University of Nebraska at Kearney, 1992.
Years at UNK: 11
Career: Outpatient Clinician, Michael Burke and Associates; Associate Director of Counseling and Health Care, UNK; Program Director Specialized Children’s Services, South Central Behavioral Services; Outpatient Clinician, South Central Behavioral Services; Family and Youth Program Specialist, South Central Behavioral Services.
Family: Husband, Jerry; Daughter, Ashley, 21; Sons Jacob, 16, and Marshall, 15.
Hobbies/Interests: Reading, gardening, sports, learning
Licensure & Certification: National Certified Counselor, National Board for Certified Counselors; Licensed Professional Counselor, Licensed Independent Mental Health Practitioner, Licensed Mental Health Practitioner and Licensed Alcohol and Drug Counselor, Nebraska Department of Health and Human Services; Internationally Certified Alcohol and Drug Counselor, International Certification and Reciprocity Consortium.
Honors/Awards: International Association of Addiction and Offender Counselors, Addictions/Offender Educator Excellence Award, December 2015; American Counseling Association National Award, Robert H. Rencken Emerging Professional Leader Award, April 2016.
Areas of research/specialization: Addiction Counseling, Addiction Counseling Training and Preparation, Professional Issues in Counselor Preparation and Identity, Mental Health and Addiction Counseling Outcomes.
Courses taught: Counseling Techniques; Clinical Treatment Issues in Addiction Counseling; Diagnosis and Treatment of Emotional and Mental Disorders; Research Methods in Counseling; Alcohol and Drug Assessment, Case Planning, and Management; Medical and Psychosocial Aspects of Addiction; Theories of Counseling; Adult Development; Counseling Across the Lifespan.
Recent Published Articles:
• “A Comparison of the Borderline Personality Disorder Scales in The MCMI-III and Personality Assessment Inventory with a Criminal Justice Population,” Ideas and Research You Can Use, 2016.
• “Addiction Counseling Practice Competencies and Curriculum in CACREP-Accredited Programs,” Ideas and Research You Can Use, 2015.
• “Competency Based Alcohol and Drug Clinical Supervision Model,” Annual Review of Addiction and Offender Counseling II: Best Practices,” 2015.
• “Older Adults and Addiction,” Embracing Diversity: Treatment and Care in Addiction Counseling, 2014.
• “Assessing Counseling Student’s Attitudes Regarding Substance Abuse and Treatment,” Journal of Addiction & Offender Counseling, 2012.