PSY460 Final
cocaine and pregnancy
-3-5% chance of having a baby with birth defect with any cocaine usage -by-products stay in urine of pregnant woman for 30 hours and 2-7 days in a newborn -crosses placenta and enters baby's circulation; can be found in urine and hair -has been found in breast milk; some infants show signs of intoxication following nursing -can cause miscarriage -appears in semen and may reduce the number of sperm or increase the number of abnormal sperm; may be associated with developmental problems; should avoid cocaine for 3 months prior to conception
Women for Sobriety
-AA meetings were rigid, dogmatic, and chauvinistic and actually increased Kirkpatrick's desire to drink (similar to other women) -roots in feminist movement -hypocrisy of AA members who refuse mediations when needed or the heavy use of substitute addictions -argues that women drink because of frustration, loneliness, emotional deprivation and harassment, while men drink for power -holistic approach to recovery
cenaps model
-disease model is underlying philosophy -recognition that chemical dependency is a biopsychosocial disease -recognition for need of lifelong abstinence -developing and using an ongoing recovery program to maintain abstinence -diagnosis and treatment of other problems or conditions that can interfere with recovery
cognitive social learning model
-doesn't have prerequisite that patients have 'primary goals' of treatment -views addictive behaviors as 'overlearned behaviors that can be analyzed and modified in the same manner as other habits' -particularly interested in: determinants, consequences -emphasizes need to attend to behaviors, thoughts, and feelings to assist in relapse prevention -critical to be armed with tools to deal with high risk situations
cenaps relapse prevention program
-abstain from all drugs -separate from people, places, and things that promote use of drugs -stop compulsive self defeating behaviors that suppress painful feelings or irrational thoughts -learn to manage feelings without the use of substances -learn to change addictive thinking patterns -identify and change mistaken core beliefs that promote irrational thinking
Many Roads, One Journey
-argues that issues such as child abuse, sexism, racism, poverty, and homophobia are in opposition to 12 step concepts such as conformity, humility, personal failings, and powerlessness -to admit to powerlessness over anything may rekindle the feelings of powerlessness in abusive situations -16 steps for 'discovery and empowerment' with an emphasis on powerfulness, choice, and relationship of behavior to culture
treatment planning involves:
-assessment and diagnosis -written treatment plan: statement of problem long term goals measurable short term objectives strategies to achieve goals/objectives review and target dates -aftercare plan
essential components for relapse prevention
-assessment and identification of high risk situations -coping skills to effective and safely abstain from AOD -support systems: safe house, sober friends, avoiding triggers and toxic people -lifestyle changes: work, recreation, fitness and health -leisure time: idle hands are devil's workshop -social and communication skills -self care -financial planning -relationships -balance
Moderation Management
-behavioral change program and support group developed in 1994 to assist problem drinkers to modify their use -not for alcohol dependence disorder -premise is: alcohol abuse is a learned behavior rather than a disease -9 step program -does not dis/encourage abstinence as a goal, but does acknowledge that moderation may not be a workable goal for some
cenaps relapse prevention procedures
-client self assessment -education about relapse -identification of the signs of relapse and relapse progression -strategies -involvement of others (friends, family)
interpersonal exposure
-denial -distortion and secrecy -attachment-separation and loss -family functioning conflict and breakdown -violence, abuse, living with fear -role reversal, confusion, child as caretaker
difficulties of AA
-differentiating between religion and spirituality -clear Judeo-Christian foundation -concept of powerlessness -many simply substitute alcohol for another addiction (caffeine, smoking, AA meetings)
interventions for AOD use during pregnancy
-difficult to treat person with cognitive impairment resulting from in utero exposure to alcohol -interventions focus on person's strengths using simple strategies to provide routine, repetition, and structure -interventions can not stop
advantages of AA
-free -tremendous variety (times, places, etc) -people who share similar concerns and problems provide support to one another -social network of safe and social people -structure and ritual provides comfort and calm; may be especially appealing given many with AOD problems habituate to chaos and unpredictability -themes of release, gratitude, humility and tolerance are helpful for anyone, particularly for folks with excessive blame, guilt, embarrassment, and spiritual/existential difficulties
opiate and pregnancy
-have more medical problems than other babies -cross placenta and unborn baby can become dependent on the drug -babies can suffer withdrawal symptoms after birth -often born premature and underdeveloped -suffer breathing problems and infections -can increase SIDS -may cause miscarriage or premature labor
exposure to cigarettes
-low birthweight -intrauterine grown restriction -sudden infant death syndrome
fetal alcohol syndrome
-low birthweight -small head circumference -failure to thrive -developmental delay -organ dysfunction -facial abnormalities: smaller eye openings, flattened cheekbones, indistinct philtrum -epilepsy -poor coordination/fine motor skills -poor socialization skills (difficulty building and maintaining friendships and relating to groups) -lack of imagination or curiosity -learning difficulties (poor memory, inability to understand concepts such as time and money, poor language comprehension, poor problem solving skills) -behavioral difficulties (hyperactivity, inability to concentrate, social withdrawal, stubbornness, impulsiveness, anxiety)
secular organizations for sobriety/save our selves
-needs of free thinkers aren't met in AA -firm adherence to disease concept of addiction; rejects spirituality is a necessary component for recovery -central component is 'sobriety priority' but emphasizes sobriety, personal growth, secularism, humanism 5 secular guidelines for recovery: -acknowledgement of alcohol problem -choosing to remain sober one day at a time -reach out to those in/directly affected by their alcohol use -work toward self-acceptance -take responsibility and provide meaning to your life
partial hospitalization/day treatment
-occur in hospitals or treatment facilities -last throughout day, client returns home at night benefits: quick application of tools still immersed in normal daily life risks: AOD use when unsupervised
inpatient and residential treatment
-often associated with hospitals -client gradually reintroduced to normal environment -typically 28 days -can include medications to ease detox -highly structured -24 hour supervision -total treatment immersion -very expensive
scapegoat
-opposite of family hero -acts out and accepts family's blame for its problems -acting out: abuse of AOD, behavior problems, truancy, delinquency, poor school performance -act upon their feelings of anger, hurt, or rejection
lost child
-quiet, withdrawn, aloof -lonely -depressed -rejected -difficulty connecting with others and prefer to be alone -may be perceived as anti-social
recovery
-relapse prevention is part of life long recovery -intentional action to live substance free (how it's done is individual) -relapse prevention encompasses every aspect of a persons life (need to be cautious to not overwhelm patient) -recovery support system exists in a variety of settings -recovery is a process that requires a number of different types of support systems
therapeutic communities
-residential treatment environment -typical duration is 1+ years -highly structured -system of reward and punishment -group confrontation -self reflection -confession of past wrong doing
family hero
-typically the oldest child -perfectionism can range from school achievement to relationships with siblings and even cleanliness -family hero shouldered the responsibility of taking care of everyone -self worth requires approval of others
american society of addiction medicine treatment levels
0.5- early intervention 1- outpatient services 2- intensive outpatient/partial hospitalization 3- residential 4- inpatient
principles of effective treatment
1 addiction is a complex but treatable disease that affects brain function and behavior 2 no single treatment is appropriate for all individuals 3 treatments needs to be readily available 4 effective treatment attends to multiple needs of the individual, not just the drug abuse 5 remaining in treatment for an adequate period is crucial 6 behavioral therapies, including individual, family, or group counseling, are the most commonly used forms of treatment 7 medications are an important element of treatment for many patients; especially when combined with other therapies 8 an individual's treatment and service plan must be assessed continually and modified as necessary to ensure that it meets his or her changing needs 9 many drug addicted individuals also have other mental health disorders 10 medical detox is only the 1st stage of treatment and will not change use alone 11 treatment does not need to be voluntary to be effective 12 possible AOD use during treatment must be monitored continually 13 treatment programs should provide assessment for infectious diseases
5 basic steps to MI
1 build rapport, define purpose of discussion, get client permission to proceed 2 evaluate- is person a light, moderate, or at risk user 3 feedback- this is an interactive discussion; provide info then ask "what do you make of that" 4 explore possibility of setting goals- "I'm wondering where this leaves you now? What might you do with all of this information? What has to change?" 5 summary, closure, agreement on 'plan' follow up may be scheduled
minnesota model
1 people can change attitudes, beliefs, and behaviors 2 disease concept of addiction (medical model) 3 abstinence from all mood altering chemicals and improvement of lifestyle 4 adheres to principles of AA and NA (12 steps)
12 traditions
1. our common welfare should come first; personal recovery depends on AA unity 2. for our group purpose there is but one ultimate authority, a loving god as he may express himself in our group conscience. our leaders are but trusted servants, they don't govern 3. the only requirement for AA membership is a desire to stop drinking 4. each group should be autonomous except in matters affecting other groups or AA as a whole 5. each group has but one primary purpose- to carry its message to the alcoholic who still suffers 6. an AA group ought never endorse, finance, or lend the AA name to any related facility or outside enterprise, lest problems of money, property, and prestige divert us from our primary purpose 7. every AA group ought to be fully self supporting, declining outside contributions 8. AA should remain forever nonprofessional, but our service centers may employ special workers 9. AA as such ought never be organized; but we may create service boards or committees directly responsible to those they serve 10. AA has no opinion on outside issues; hence the AA name ought never be drawn into public controversy 11.our public relations policy is based on attraction rather than promotion; we need always maintain personal anonymity at the level of press, radio, and films 12. anonymity is the spiritual foundation of all our traditions, ever reminding us to place principles before personalities
12 steps
1. we admitted we were powerless over alcohol- that our lives had become unmanageable 2. came to believe that a power greater than ourselves could restore us to sanity 3. made a decision to turn our will and our lives over to the care of god as we understood him 4. made a searching and fearless moral inventory of ourselves 5. admitted to god, to ourselves, and to another human being the exact nature of our wrongs 6. were entirely ready to have god remove all these defects of character 7. humbly asked him to remove our shortcomings 8. made a list of all persons we had harmed and became willing to make amends to them all 9. made direct amends to such people wherever possible, except when to do so would injure them or others 10. continued to take personal inventory, and when we were wrong, promptly admitted it 11. sought through prayer and meditation to improve our conscious contact with gad as we understood him, praying only for knowledge of his will for us and the power to carry that out 12. having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs
people admitted to treatment programs
1.8 million for alcohol: 41.4% opiates: 20% marijuana: 17%
research findings of AA
12 steps associated with: -reduced substance use and improved psychosocial functioning -significantly reduced healthcare utilization and costs -form of continued care, not a substitute for acute treatment services -combination of professional treatment and AA provides best treatment outcomes
2009 in US
23m needed treatment 2.6m received it of those who didn't receive it: 5% felt they needed it 1/3 of 5% tried and failed to get treatment 2/3 made no effort to get help
AA preamble
AA is a fellowship of men and women who share their experience, strength, and hope with each other that they may solve their common problems and help others to recover from alcoholism. The only requirement for AA is a desire to stop drinking. No dues or fees for membership; self-support through own contributions. Not allied with any sect, denomination or politics, organization or institution; does not wish to engage in any controversy and neither endorses nor opposes any causes. Primary purpose is to stay sober and to help other alcoholics achieve sobriety.
implications for intervention
CDC suggests school connectedness is a protective factor that can help insulate children from AOD use and thwart maladaptive behaviors protective factors: -adult support -belonging to a positive peer group -having commitment to education -positive perceptions of school environment
fetal alcohol spectrum disorders
FAS-fetal alcohol syndrome-0.5-2.0%/1000 births: chronic alcohol use during pregnancy; completely preventable pFAS-partial fetal alcohol syndrome ARBD-alcohol related birth defects ARND-alcohol related neurodevelopmental disorder: may occur with occasional binge drinking
other 12 step programs
Narcotics Anonymous Al-Anon Alateen
ambivalence
about change, characterizes contemplation MI resolves this ambivalence in favor of making changes to behavior
engagement
active involvement in treatment
agree with a twist
after client states: child and husband are against my drinking and you can't understand my stress I agree, substance use can be a family problem, not just one person's problem
four general principles of motivational interviewing
ambivalence elicit change talk client resistance and counselor behavior transition from resistance to change
types of resistance
arguing interrupting denying ignoring deal with by reflective listening
labeling trap
attempt to attach a diagnostic label
the stage of change model and motivational interviewing form the basis for:
brief interventions
models of relapse prevention
cenaps model cognitive social learning model
the process of motivating a person to actively involve him/herself in treatment is called:
client engagement
reframing
client relays angry story of mother being upset with substance use: your mother is scared and really cares about you
treatment settings
client should be placed in treatment setting with the least amount of restrictions, highest probability of success, and considering the factors determined through initial assessment
self motivational statements
cognitive affective behavioral
affective SMS
concern statements what worries your family about your use?
__________ is not a general principle of motivational interviewing:
confront resistance
decisional balance
creating pros and cons list
methamphetamines and pregnancy
difficult to pinpoint specific chemicals responsible for effects
american society of addiction medicine patient placement criteria
dimension 1: intoxication/withdrawal risk dimension 2: biomedical conditions/complications dimension 3: emotional/behavioral conditions/complications (inc. psych conditions) dimension 4: readiness to change dimension 5: relapse potential dimension 6: recovery environment
ethnically diverse populations
diversity in treatment population and staff is beneficial attitudes of AOD problems may present a barrier for person seeking treatment customs, beliefs, and language of a group must be considered
special treatment groups
elderly adolescents persons with disabilities women LGBT criminal justice populations clients with co-occurring disorders
how to combat ambivalence
empathy decisional balance avoid traps: confront, question and answer, expert trap, labeling trap, premature focus trap in MI: open ended questions reflective listening affirmations support strategic summaries elicit self motivational statements SMSs: reasons for change come from the client
recovery oriented systems of care
encompasses treatment, relapse prevention, and recovery principles: -continuity of care -inclusion of family, community, and peers -individualized and comprehensive services across the lifespan -culturally responsive services -community anchored services -inclusion of voices and experiences of recovering individuals and their families -outcome drives and researched based services
special problems in treatment
recovering individuals as counselors confrontations as treatment strategy use of medication controlled use natural recovery
Dynamic Case Management
expands intra-agency case management to interagency case management pulling together and providing services from a number of agencies to collaborate and create a single case management plan
roles family members take to maintain homeostatis
family hero scapegoat lost child mascot provides a sense of purpose helps cope with anxiety
premature focus trap
focus on AOD issue before client is ready
confrontation
generally no empirical support for it; why use it when other empirically supported methods exist
brief interventions
good for clients who are sub-diagnostic, but have moderate risk for problems can also work for those who meet diagnostic criteria, as well
inpatient
high cost staffing intensive little evidence of positive return on investment medical detox social detox residential program
treatment strategies and techniques
individual, group, family counseling support groups lifestyle changes education aftercare
intensive outpatient/outpatient treatment
intensive outpatient treatment: -mental health centers and clinics -3-4 days a week -2-4 hours each evening outpatient treatment: -mental health centers and clinics -1-2 evenings a week -1-2 hours each evening
behavioral SMS
intentions to act what do you think has to happen?
signs client is ready to change
lack of resistance fewer questions regarding the problem asks questions regarding change
outpatient
low cost counselor vs nurses/doctor higher return on investment greater flexibility least restrictive environment
intervention
moving from problem-identification to treatment; it's done to the client
family homeostatis
natural tendency of families to behave in such a manner as to maintain a sense of balance, structure, and stability, in the face of change 'elephant in the room'
emphasize personal choice
only you can make decisions for yourself
prenatal/postnatal exposure to AOD
passed through human placenta or breastmilk
treatment approaches
pharmacological approach cognitive behavioral therapy motivational enhancement therapy twelve step facilitation contingency management
cognitive SMS
problem recognition in what ways has marijuana been a problem for you?
expert trap
professional attempts to fix the problem by exerting expertise
motivational interviewing
provides a therapeutic environment where clients feel comfortable being honest about difficulties; such comfort is often lacking during confrontational approaches
relapse
return to uncontrolled AOD use following a period of abstinence
AA and spirituality
salient features: -group process -ego function development -empathic understanding -disintegration of pathologic narcissism well intentioned efforts to conceptualize effects of AA in terms of psychological theories and processes and to research AA through traditional scientific inquiry may be misguided 'it works if you work it, so work it if you're worth it' spiritual themes: -released (no longer a compulsion to drink) -gratitude (results from release of compulsion) -humility (powerlessness over alcohol) -tolerance (differences among people and of one's own shortcomings)
types of reflective listening
simple amplified double-sided shift-focus agree with a twist
lapse
slip brief episode of AOD use following a period of abstinence
double-sided reflective listening
so whereas LSD opened a lot of doors for you, now you are starting to wonder if it's a bad example for your child
precontemplation
stage of change 1: unaware there's a problem task: provide information, raise awareness
contemplation
stage of change 2: considers there may be a problem, unsure whether they're willing to change it or not task: tip the balance towards change
determination
stage of change 3: looking for viable change plan task: develop strategies that are acceptable, accessible, and effective
action
stage of change 4: acting to bring about change task: monitor plans and alter as needed, maintain motivation
maintenance
stage of change 5: changes resulting action stage are kept, person continues working to keep change in place task: monitor situations for risk of relapse, learn new skills as needed to keep changes in place
relapse
stage of change 6: doesn't always happen; client returns to using substance because they don't have the skills needed to maintain the behavior change task: create an environment in the counseling relationship so that the client feels safe in discussing difficulties in maintaining the behavior change and to report relapses that often occur during the change process
SMART Recovery
started as alternative to support group that has scientific rather than spiritual orientation 4 main points: -enhance and maintain motivation to abstain -cope with urges -manage thoughts, feelings, and behaviors -balance momentary and enduring satisfactions differs from AA because: -teach increasing self reliance vs powerlessness -groups are discussions with one another, not to each other -encourages attendance for months and years, not a lifetime -there are no sponsors and it disavows labels such as 'alcoholic' and 'drunk'
the difference between engagement and intervention is:
the involvement of the client
behavioral model of treatment
techniques include classical and operant conditioning ex. -aversion therapy- use unpleasant stimulant (nausea, apnea, electric shock, images, etc) -contingency management- tangible incentives for abstaining -community reinforcement approach- biopsychosocial lifestyle change away from substance abuse manualized treatments from NIAAA: 12 step facilitation manual CBT MET pharmacological procedures used in tandem with other treatments
resistance SMS
this is dynamic and is a process shared by client and therapist; it's not a static personality feature that belongs to the client
the purpose of eliciting change talk is:
to help clients resolve their ambivalence
evidence based treatment
treatment with effective strategies that research has shown effective and has demonstrated consistent results in multiple studies SAMHSA: substance abuse and mental health service administration developed NREPP: national registry of evidence based programs and practices
treatment planning and plans
used by treatment staff to determine the clients needs and how to treat them substance abuse programs that are accredited must have individual treatment plans for all clients
shift-focus reflective listening
whoa, you're way ahead of me here, before talking about giving up smoking, it sounds like you may be more concerned about losing your friends right now
simple reflective listening
you're scared
amplified reflective listening
your mother is worried for absolutely no reason whatsoever *be careful not to sound sarcastic
