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Dr. Gary W. Barkman
President, AACT



Greetings my friends in the Lord’s Name.  Here you have before you the new newsletter of the AACT.  It has a new look and it has a new way of presenting itself.  Previously we kept the newsletter up for two months and then redid the whole thing.  Our approach this time is different.  We will add up to five articles and rotate one off each week and add another… so each article will be viewable for about 5 weeks.


We will be adding some of the articles that are on the new AACT CD… You may request one and for a small offering to AACT and postage, we will send it to you.  Dr. Alan Kitay, our Vice President will be featured often on this newsletter, he is now preparing a second CD to be available to you to assist in your counseling ministry.


AACT is starting Regional Conferences.  We have one tentatively scheduled… in the early planning stages for the 6th and 7th of October, 2006 in the Washington DC area.  We are also planning one for Houston area and possibly one in Southern California.


So read on… and if you are not a member, become one now as this established, highly esteemed organization continues to grow and make a difference for Christ through Pastoral Counseling.




Dr. Gary Barkman

President AACT




Reverend Virginia Bieber
AACT Member, New York City


By Virginia Bieber BCC, MBC



Everyone at some time experiences anxiety.  If we are Christians, the question is often asked should we be experiencing anxiety?  Yes we trust God, and He is always with us.  Yet we live in frail human bodies that beat fast during anxiety.  Yes even with great faith, we can occasionally be vulnerable to anxiety.  In physical terms, anxiety is a condition of varying levels of discomfort, driven by the fear response that takes place in the lower part of our brain.  When we are in a emotional state that is commonly associated with  apprehension, a sense of turmoil, uneasiness or both, anxiety can come upon you at any time and last either minutes or days.  Mild anxiety can appear when something worries us, when we can’t make an immediate decision about something and often when the memory of a stressful situation from the past occurs.  Serious anxiety doesn’t appear without a cause.  It could start over a simple response to emotional and physical pain.  Eventually, anxiety responses can be learned in the lower part of the brain just like other habit patterns, such as anger and addiction.  Anxiety can be triggered by memories or learned responses.


There is also beneficial results of anxiety.  Anxiety can also be helpful as well as harmful to us.  When disaster approaches us, we become highly anxious.  Our senses become focused, our blood pressure and heart rate increase, and our adrenaline flows.  This is called hyper-vigilance.  Our bodies produce hormones to speed up our metabolism while our digestive system slows down, to preserve blood for our muscles.  The liver releases stored cholesterol for long-term energy, and adrenal glands release cortisone (an anti-inflammatory) as well as cause an increase in sugar burning for fuel).  Anxiety can help us cope effectively with most emergencies. 


Never-the-less, anxiety can also cause problems.  This happens when the brain declares an unwanted emergency.  When we experience a little stress, the lower part of our brain may respond as though we were facing a life-threatening situation, causing the release of adrenaline and other neuro-chemicals that make us tense and hyper-vigilant.


The body does not need constant emergencies or excess adrenaline, especially if we are not physically active.  When anxiety is chronic, it can harm us emotionally and physically.  So often the increase in emotional pain leads to greater anxiety.  With chronic anxiety a imbalance takes place in the brain chemistry, and is followed by  depression taxing the nervous, circulatory, and digestive systems  Besides making us alert in a crisis situation, anxiety has an additional function.  It serves as an antidote to emotional and physical pain.  Since anxiety can create emotional pain, how can it also stop emotional pain.  In small amounts anxiety is an effective smoke screen, a diversion from other emotional pain that may be occurring in our lives.  It can mask our emotional pain in two ways.  One, it draws our attention away from what really bothers us (this is the root).  Two, just like anger, anxiety stimulates the release of endorphins.  These serve as a temporary solution to ease emotional and physical pain.  The problem is that if we let anxiety get out of hand it can create more problems than it really solves.


It is necessary to accept the presence of emotional pain in our lives if we want to handle it in a healthy way.  If we fight against the presence of anger, difficulty in our lives and emotional pain, we end up very ill.  We do have hope, there are healthy response patterns that we can learn in our lower brain to supersede the unhealthy ones.  There are many practical methods that can be used to break the destructive pattern of learned anxiety.  But before we can learn, it is necessary to make sure our response to our emotional pain is healthy.


We must first accept the fact of emotional pain in our lives, then we are to handle it in a healthy way.  If we fight against it or deny it, then we are fighting against the world that God created for us.  One can not control all our pain and stress.  This is why it is necessary to accept it and TRUST GOD to manage it. 


How do we accept the pain?  We must learn to grieve our life’s losses and hurts.  This grief is not feeling sorry for ourselves, it is simply allowing ourselves to feel the pain that already exists.  We are so afraid to allow ourselves to feel pain that is already there.  What do we do, we deny it.  We cover it up with something else.    We need to recognize our pain (which is the root of anxiety).  Some people bury the pain with drugs, compulsions, and habits that are not healthy (these are the symptoms). 


First, pay attention to your body’s response to stress.  Remember that your body is simply demonstrating a survival skill, just trying to survive.  Often when the symptoms are so uncomfortable and we think something terrible is going to happen, fears set in.   


Second have patience and trust God to manage it.




"Steps to Overcome Problems"

by Dr. Don Dunlap


"All Scripture is inspired by God and is useful for
teaching, reproof, correction, and training in righteousness, so that the man of God may be thoroughly equipped for every good work."
II Timothy 3:16-17


The Scriptures contain significant principles for a successful life and relationships.

"Grace and peace be yours in abundance through the knowledge of God and of Jesus our Lord. His divine power has given us everything we need for life and godliness through our knowledge of him ..."
II Peter 1:2-3

1. Genuine faith in Christ

2. Dealing with personal offenses

3. Guilt resolution

4. Self-Identity

5. Overcoming worry, anxiety, and stress

6. Family responsibilities

7. Response to difficulties and suffering

8. Attitudes and actions regarding matters


This is God's means of bringing us to an awareness of how we may have violated or neglected His Word and commandments. This may be accomplished through God's Word, the Holy Spirit, or the reproofs of life.

1. Depression, anxiety, stress

2. Family or Marriage Conflict

3. Traumatic Circumstances

4. Work Difficulties

5. Financial Problems

6. Substance Abuse

7. Relationship Problems

8. Physical pain


This process involves applying scriptural principles to specific life situations.

1. Insights from Scripture related to particular needs

2. Practical and specific steps of action

"No testing has come upon you except what is common to man. And God is faithful; he will not let you be tested beyond what you can bear. But when you are tested, he will also provide a way out so that you can stand up under it."
I Corinthians 10:13

"For these commands are a lamp, this teaching is a light, and the corrections of discipline are the way to life."
Proverbs 6:23

Training In Righteousness

This principle involves developing biblical skills for consistent growth in the Christian life.

1. Learning to pray

2. Understanding and ingesting the Scriptures

3. Principles for living the Christian life

4. The importance, purpose, function, and membership of the local church

5. Ministry to others

"Everyone who competes in the games goes into strict training. They do it to get a crown that will not last; but we do it to get a crown that will last forever."
I Corinthians 9:25

"You were taught, with regard to your former way of life, to put off your old self, which is being corrupted by its deceitful desires; to be made new in the attitude of your minds; and to put on the new self, created to be like God in true righteousness and holiness."
Ephesians 4:22-24




Greetings my Friends,

I am Alan Kitay.  We have downloaded hundreds of files for your using.  We at AACT hope this will help you in your practice of Pastoral counseling and therapy.


Please read the article preceeding this note and the one following.  And if you also have an article you wish to submit please submit it to one of the email addresses listed on this website.  We are here to serve you... let us help.


If you have questions please write.  We can offer helps and training.


Dr. Alan Kitay
Vice President, AACT



      Substance-Use Disorders


 Substance-use disorders include those related to the use of a drug of abuse, the side effects of a prescribed or over-the-counter medication, and toxin exposure. They are divided into two general groups: substance-use disorders (dependence and abuse) and substance-induced disorders (intoxication and withdrawal).


This book discusses only substance-use disorders since substance intoxification and substance withdrawal are typically treated by immediate hospitalization to ensure the safety of the client. Many hospitals are equipped with treatment programs ranging from inpatient detoxification to outpatient treatment programs and support groups focused on abstinence. There are four levels of treatment: (1) outpatient, (2) intensive outpatient with partial hospitalization and structured programs, (3) around-the-clock inpatient care, and (4) acute inpatient care with 24-hour monitoring.





Substance dependence disorders are coded by substance:


Alcohol dependence (303.90)

Amphetamine dependence (304.40)

Cannabis dependence (304.30)

Cocaine dependence (304.20)

Hallucinogen dependence (304.50)

Inhalant dependence (304.60)

Nicotine dependence (305.10)

Opioid dependence (304.00)

Phencyclidine dependence (304.60)

Sedative, hypnotic, or anxiolytic dependence (304.10)

Polysubstance dependence (304.80)


A diagnosis of substance dependence can be applied to every class of substance except caffeine. The symptoms of dependence are generally similar across the classes, although in some instances the symptoms are less salient and, in a few instances, not all symptoms apply. Substance dependence is characterized by a cluster of physical, mental, and behavioral symptoms indicating that the individual continues use of the substance despite significant substance-related problems with three or more of the symptoms occurring at any time in a twelve-month period. Impairment is clinically significant.



Behavioral Symptoms

(severity index: 1, mild; 2, moderate; 3, intensive)




With physiological dependence

Without physiological dependence

Early full remission

Early partial remission

Sustained full remission

On agonist therapy                                                                                                                        

In controlled environment


Three or more of the following at any time in a twelve-month period:







1.  Need for increased amounts of the substance to reach desired effect




2.  Diminished effect with continued use of same amount of substance




3.  Characteristic withdrawal syndrome




4.  Same or related substance taken to avoid withdrawal symptoms




5.  Substance taken in larger amounts or over a longer period of time




6.  Persistent desire or unsuccessful effort to reduce or control use of substance




7.  Inordinate amount of time spent to obtain, use, or recover from substance




8.  Important social, occupational, or recreational activities are abandoned or reduced




9.  Substance use continues despite knowledge of a persistent related physical or psychological problem







Substance abuse disorders are coded by substance:


Alcohol abuse (305.00)

Amphetamine abuse (305.20)

Cannabis abuse (305.20)

Cocaine abuse (305.60)

Hallucinogen abuse (305.30)

Inhalant abuse (305.90)

Opioid abuse (305.50)

Phencyclidine abuse (305.90)

Sedative hypnotic or anxiolytic abuse (305.40)


In contrast to substance dependence, a diagnosis of substance abuse covers a maladaptive pattern of substance use resulting in clinically significant impairment as manifested by only one symptom over a twelve-month period. Substance abuse does not apply to caffeine or nicotine.



Behavioral Symptoms

(severity index: 1, mild; 2, moderate; 3, intensive)


One or more of the following over a twelve-month period:







1.  Repeated substance use leading to failure to fulfill major work, home, or school obligations




2.  Repeated substance use in physically dangerous situations




3.  Recurrent substance-related legal problems




4.  Continued substance use despite resulting social or interpersonal problems





SUBSTANCE-USE DISORDERS--(_________________)



Client: ___________________________________  Date: ______________


I.  OBJECTIVES OF TREATMENT--Dependence or Abuse

    (select one or more)


1.  Confront denial of substance abuse.

2.  Recognize and accept abuse as a disease.

3.  Refer to AA, NA, or rational recovery group.

4.  Sustain sobriety.

5.  Increase quality of life.

6.  Understand self-sabotaging behavior.

7.  Reduce/eliminate shame/guilt.

8.  Identify people, places, and things that trigger abuse.

9.  Prevent relapse.



    (select goals and interventions appropriate for your client)







Discuss treatment plan with therapist and agree on target problems.


Discuss treatment plan and agree on target problems.


Join in treatment. Treatment outlook is improved as feelings of anger and isolation are diminished.


Cultivate therapeutic alliance or collaborative relationship with client to instill trust and enhance outcome of treatment.


Understand and accept possible need for hospitalization. Resolve fear of hospitalization.


Explain possible need for hospitalization.


Confirm or deny substance abuse.


Refer for or administer the Substance Abuse Subtle Screening Inventory (SASSI) to accurately identify chemical dependency.


As appropriate, be hospitalized or enter into suicide pact agreeing to inform therapist of ideations and plans, and to provide prior notification before any action.


Assess possible homicidal or suicidal effects of substance dependence. If homicidal, notify authorities. If actively suicidal, hospitalize immediately. If client has suicidal ideations, but no plan, enter into suicide pact.


Follow through with psychiatric evaluation and accepts hospitalization and detoxification if necessary.


Refer client for psychiatric evaluation and/or hospitalization if required.


Follow up on medical referral. Understand existing and potential physical problems related to substance.


Refer client for medical evaluation to identify physical problems caused by or exacerbated by substance use.


Help construct genogram. Describe family interactions.


Create genogram to better understand interactions of family members (see Behavioral Techniques, Chapter 22).


Identify potential genesis of substance abuse in family of origin.


Investigate chronological history of client and family substance use.


Confront denial and understand contributing factors.


Explore level of distressed thinking or denial, and assess client's level of cognitive and intellectual functioning that contributes to substance use.


Be freed to work on the problems rather than deny you have problems.


Help client overcome denial by looking at the facts of substance use and the problems they have caused.


Maintain a strict meds schedule.


Discuss importance of medication regimen.


Work on underlying issues that contribute to substance dependence.


Evaluate client for possible dual diagnosis and treat other symptoms, e.g., anxiety, depression, social phobia, etc. See appropriate treatment plan.


Comply with referral.


Refer for acupuncture if appropriate.


Understand patterns of stress that lead to substance use.


Explore past patterns of substance use in relation to life stressors.


Attend NA or AA and obtain a sponsor, or attend rational recovery group.


Refer client to twelve-step program (NA or AA) or to rational recovery group if NA/AA is rejected.


Understand process you must undergo to get clean.


Explain mourning process and help client mourn substance of choice.


Recognize and avoid potential triggers for relapse.


Identify person, place, and thing triggers that may cause backsliding or relapse.


Maintain a daily journal to monitor feelings rather than act them out.


Assign client to maintain a daily journal of his/her feelings and reactions.


Learn new techniques for dealing with destructive urges.


Teach client relaxation techniques, hypnosis, or creative visualization to cope with feelings. Provide audiotape for home use.


Recognize family triggers and avoid enablers.


Investigate family conflicts and identify enablers that aid in client's substance use.


Replace ritualistic behavior with more rational response.


Investigate ritualistic behaviors related to substance use and teach client more rational behaviors.


Realize destructive effects of substance on your quality of life.


Explore and identify the effects of substance use on the client's social, family, occupational, and other relations.


Improve family relations.


Conduct family sessions or refer to family therapist.


Family discovers better ways of dealing with client.


Refer family to Alanon for support.


Become more knowledgeable about the disorder.


Assign books on substance disorders as homework (see Chapter 24).


Develop understanding that disorder is not your fault, but must be constantly worked on to control.


Review issues of shame and guilt that may cause or contribute to substance use and dependence.


Make commitment to someone else for sobriety.


Obtain a contract or commitment for abstinence.


Develop alternate behaviors to substance use.


Discuss alternate behaviors to substance use, e.g., exercise, sports, hobbies, etc.


Diminish anger and aggression toward self and others.


Guide client in releasing anger and aggression toward self and others.


Make use of support systems when you feel substance use triggers are being activated.


Help client create support systems and resources in environment to maintain sobriety.


Gain confidence in role-playing sessions.


Conduct role-playing exercises to help client deal with persons, places, and things that trigger substance use.


Apply role-playing experience in external environment.


Guide client in practicing his new skills in the real world.


Reinforce success and improve skills as needed.


Retrain as necessary and reinforce successes.


Become aware of your negative or ambivalent feelings toward others.


If appropriate, identify client's lack of empathy for others.


Be armed with alternate behaviors to prevent relapse.


Teach client alternative constructive behaviors to prevent relapse.


Discuss and resolve termination issues with therapist. Discuss termination plan.


Discuss and resolve issues of separation anxiety and dependence with client. Develop termination plan.


Attend support group.


Refer client to active support group.