ADC 3 continued
Adolescent therapeutic communities for juveniles
(be careful with this one. Facilities get kickbacks from judges similar to cash for kids in Pennsylvania) modifications needed for youth include: increased supervision to prevent you from leaving the program are engaging in antisocial behavior and negative peer activities: more recreational activities from a leisure skill building and prevent boredom you write. Greater family involvement, academic education, increase staff to use ratio: separation used by gender except for occasional program activities; and limiting the size of the program to 45 or fewer youth.
The scapegoat
(n.) a person or thing carrying the blame for others usually the second child. since the hero has the positive attention, the second child seeks what is left (negative attention). The role is to take attention away from the alcoholic by accepting blame for the family's troubles. Usually has peers whose parents also have problems. Frequently becomes involved with drugs, alcohol, vandalism, and sexual promiscuity, trouble with the authorities and the police. The scapegoat is very hurt, lonely and often very ashamed of their actions. Scapegoats often become the next generation of alcohol and drug abusers.
Interventions in group therapy
****Leader interventions are dependent upon taking up point of urgency at the moment to forward. Interventions include; focusing attention of the group on a process issue, encouraging the group staying here now, putting responsibility for group growth on the group, encouraging members to express feelings, suggesting a group move on to another topic session has become unconstructive, focusing attention on difficult groups functioning, remaining silent to raise the tension level, provoking a discussion about hot of not atmosphere that exist in the group, interpreting, disclosing, eliciting responses, directing members to activity. When patient group denial counsel needs directly confront the denial in order to work through it to the group can continue. When conducting groups and making interventions, co-facilitation with two leaders can be useful
Why would feelings be counseling skill and action
, Counsel determines that the ability to talk openly express feelings may be an obstacle in reaching this goal in the treatment goal for clients to learn to deal with their feelings without using a drug counselor could consider progress is being made in the client; reports that they shared their anger with their wife by describing how they felt, cried openly in group and talking about guilt feelings, and angry confrontation with a group member, hits a punching bag feeling tense, being able to say no if they always did like giving. Revenge of, learning to be more assertive, the client said that they feel it dangerous to express feelings account circuits you having close relationships with others complex, to assess the client underlying feelings account throughout the must rely upon what?
Intellectualization Defense Mechanism
- An attempt to avoid expressing actual emotions associated with a stressful situation by using the intellectual process of logic, reasoning and analysis. (me)
Rationalization (defense mechanism)
- Attempting to make excuses or formulate logical reasons to justifying unacceptable feelings or behaviors. EX: John tells the rehab nurse, "I drink because its the only way I can deal with my bad marriage and awful job."
Repression (defense mechanism)
- Involuntary blocking of unpleasant feelings and experiences from ones awareness. EX: An accident victim can remember nothing about the accident (laughing when not appropriate)
Examples of sexual harassment
- Making demands for sexual favors - Physically assaulting someone - Stalking off color jokes, unwanted touching unwanted attention, remarks, gestures.
reaction formation (defense mechanism)
- Preventing unacceptable thoughts or behaviors from being expressed by exaggerating opposite thoughts or types of behaviors. EX: Jane hates nursing. She attended nursing school to please her parents. During career day, she speaks to prospective students about the excellence of nursing as a career.
Regression (defense mechanism)
- Responding to stress by retreating to an earlier level of development and the comfort measures associated with that level of functioning. EX: When 2 year old Jay is hospitalized for tonsillitis he will drink only from a bottle, although his mother states he has been drinking from a cup for over 6 months.
Aversion Therapy for Alcoholism
-Alcohol is paired with a chemical that causes nausea and vomiting -Straightforward classical conditioning
How to work with clients in precontemplation stage.
-Commend the client for coming to substance abuse treatment -establish rapport, ask permission to address the topic of change and build trust -Elicit, listen to, and acknowledge the aspects of substance use the client enjoys. -evoke doubt or concerns in the client about substance use -explore the meaning of the events that brought the client to trx or the results of previous trx -obtain the clients perspective of the problem -offer factual info about the risks of substance use (PFL) -Personalized feedback about assessment findings help a significant other intervene -examine discrepancies between the clients and others perceptions of the problem behavior express concern and keep the door open.
As sobriety lengthens, the client can shift some attention in counseling to;
-Repairing relationships -starting new relationships -Improving job performance -Finding enjoyable leisure activities -Living a normal life without alcohol However, it is important for the counselor to maintain some focus on the dependence or abuse throughout treatment so the client will not forget that the cause of the problems is solving is alcohol/drugs
goals of psychodynamic therapy
-conflicts between id, ego, and superego -uncover past traumas -make what is unconscious, conscious
Techniques of REBT
-engage in active dialogue with the client -counselor does NOT have to feel with the client -but understand and identify the clients irrational beliefs -client creates new judgements that are rational(logical) based on data from the clients life. -------client replaces irrational illogical thoughts with new ones and practices this. Client is instructed to practice new behaviors that act out other new messages and reinforce them.
classical conditioning paradigm
-first identified by Ivan Pavlov -involves conditioning of automatic or repulsive responses (emotions or physical responses) -know the classical conditioning paradigm (dog experiment) (US,UR,CS,CR) unconditioned stimulus, leads to specific response. Unconditioned stim. is paired with CStimulus= cond .Stimulus alone leads to response.
Systemiatic desensitization
-relaxation methods list of anxiety producing stimuli is decided upon from least to most upsetting -Desensitization works on the assumption that a person cannot be anxious and relaxed at the same time -The client picks up the least anxiety producing stimuli until they feel anxious. -when anxiety occurs, client stops and relaxes -client repeats the process with the next anxiety producing stimuli. Through the entire list of anxiety producing stimuli and it no longer produces stimuli.
It is helpful for maintaining sobriety by:
-support groups -explaining the spouse the importance of recovering alcoholic's needs to attend these meetings -Getting and working with a sponsor -Joining other activities that the client enjoyed before alcohol took over their life -getting these support systems in place early in outpatient counseling or before leaving in patient treatment.
what are the advantages of behavioral therapy
. Chart initially modified are specified as to the use are clearly any results can be readily evaluated. 2. Use of explicit learning principles sound basis for interventions as a result of the demonstrated scientific validity. Number three. The economy of time and cost is quite good. I then brought out that she behavior therapy compared favorably with those of other approaches. Behavioral therapy usually achieves results in a short period of time is generally directed to specific symptoms leading to faster many individuals to stress and to our financial class. In addition more people can be treated by even therapists. Generally speaking the more pervasive and vaguely defined the client problem is less likely behavioral therapy is to be useful. For what appears to be only rarely rmployed in axis II personality disorders or specific symptoms are rare. On the other hand he needs are the backbone approaches to treating sexual dysfunction. The meta-analysis of therapeutic outcomes earns the expectations that behavioral therapy has a place in the treatment of neurotic disorders particularly where anxiety is manifest features and therefore read it powerful type a exposure techniques of behavioral therapy can be brought to bear. Thus although behavioral therapy is not a cure off it has earned in a relatively brief period of highly respected place, available psychosocial treatment approaches
V code or 900 code
. Expanding listing of the code is including the DSM-V although the DSM-V did not include directions for formatting, counselors may also use special notations and psychosocial rations relevant to diagnosis. Counselors will no longer go a GAF score on Axis V. It advises clinicians to find ways to no distress and/or disability and functioning perhaps using World Health Organization assessment schedule as dimensional assessment function.
Why are halfway houses and sober living facilities important
. Sober living usually serves help those individuals transition from residential treatment facilities back to the daily lives. For some individuals returning home to their old environment where they used to live would be stressful and triggering some sober living serves as a way to help those individuals transition back into daily life while helping them to maintain a recovery
Denying- 8 parts
1. Blaming-others for their problems 2. Disagreeing-The client disagrees with a suggestion without making an alternative 3. Excusing-Clients make excuses 4. Claming impunity-the client claims that she is not in any danger 5. Minimizing-the counselor is exaggerating 6. Pessimism-client makes statement about himself or others that are not pessimistic, defeatist, or negative in tone. 7. Reluctance-the client expresses reservations and reluctance about information or advice given 8. Unwillingness to Change-lack of desire to change
What is overdosing?
A frequent complication of substance use. Drug overdose can be purposeful with a suicide ethical or due to carelessness and unpredictable strength of substance purchase from street dealers and mixing of Morgan one type of substance or as a result of increasing doses that a person must take to experience intoxicating effects. Substance overdose can be life-threatening emergency with specifics of substance use. Substances with the present expert danger so slow that removing and heart rate, drops in body temperature and result is general unresponsiveness. Substances with stimulatory effects and didn't dangerously increase the heart rate and blood pressure producing abnormal heart rhythms and increasing body temperature induces seizures and cause erratic behavior
When a client child and the child they were punished severely by an alcoholic father, was, he told that she wanted to do was never shown affection, counselor and expect to have
A poor self image and difficulty trusting others and sharing feelings
systematic desensitization
A type of exposure therapy that associates a pleasant relaxed state with gradually increasing anxiety-triggering stimuli. Commonly used to treat phobias.
Antabuse (disulfiram)
Action: interrupts metabolism of ETOH, causing toxic build up if it is consumed side effects: if ETOH is consumed while on this: headache, N&V, flushing, diaphoresis, hypotension, tachycardia Nursing Implications: must wait 12 hours to take antabuse after last drink Pt Education: must avoid ETOH for 14 days after last dose of antabuse
What are ways that are important to release energy and interest directivity in group therapy
Active verbal participation in discussions. Structured exercises which can use decelerating devices too, grew, can help people get in touch with some suppressed emotions, and role-playing such as acting out dialogue situations
Important things to know about AA
Addiction is a disease. It progresses. People cannot be cured only put in remission. Primary goal of AAA similar to self-help groups and is to achieve total abstinence from alcohol or other drugs, affect changes in personal values and interpersonal behavior and continued participation in the Fellowship to give both and receive help from others with similar problems. There is an admission of powerlessness, assessment of character defects, overcoming shortcomings that contribute to the addiction, learning the tools of nondrug center living, and restructuring damaged relationships and committing to a higher power.
Why is detox important
Addiction is a medical illness with related psychological and social dimensions. Substance-abuse problems progressed from experimental to addictive use for some people. This process occurs more quickly for something does for others. Detoxification is necessary to patients for the treatment process. It is particularly important for those that become dependent on alcohol and other central nervous system depressants, opiate drugs and cocaine. Until the bodies free on the effects of the drugs distorted thoughts and feelings and produces difficult recovery to begin
General types of forms using during the admission intake and assessment screening
Admission intake form-basic information such as name address employer family mission will contact emergency etc. B. Initial assessment form-three statements about presenting problems and immediate client needs detox, residential and outpatient C. Treatment or-client's agreement to the general terms the treatment such as type of treatment number of sessions, I'm in camper, D. Financial form-separated client financial status, generally used to determine the cost or necessary during two insurance companies E. Release of information forms such as the fire ring permission of the client these of information is to outside party to receive information from party such as former treatment provider therapist and probation or parole officers family division etc.
The training to teach the family how to intervene?
Family must realize that alcohol/drugs are the primary problem-most other problems result from it. the session helps family member realize the importance of denial and understand why the alcoholic will not seek help without the intervention. The family must learn how its own behavior enables the alcoholic to continue drinking and have the motivation to change the behavior. The family must understand how it has effected all of them-and resolve their own denial before attempting to confront the alcoholics denial. A plan for the day of intervention is made.
Therapy client sensitive issues
Feelings and issues such as abuse, violence and incest the counselor must; be able to communicate empathy, be able to focus client put aside their own value system, understand personality theory help organize information about what people behave your ways, not deny the client feelings and concerns.
Functions of the leader in group therapy.
Emotional stimulation, meaning attribution or explanation of the world, exec execution function, Yalom's writing suggested the most successful groups are conducted by leaders who show what?
Advantages of group counseling
Emotional support, group problem solving, modeling effect, attitudinal and belief examples. People can hide for a while until ready to speak up, they can see more than one person at a time, it is cost effective. There is vicarious and direct learning. Members are expected to caer about one another.
Expressing empathy with African-American clients
Empathize with African-American clients is first and foremost to be genuine person not just a counselor or question. Client may begin the relationship asking questions about the person not the professional, an attempt to locate in the world. It's as if the client's internal dialogue says as you try to understand me by what pathways perspective life experiences and values are you coming to the understanding of me? Typical questions my African-American clients have asked me are; are you Christian, where are you from, what part of town you live, who are your folks, are you married? I don't know if these questions were asked because Utah
clients in the action stage can be most effectively helped with clinicians...
Encourage clts in trx and reinforce the importance of remaining in recovery support a realistic view of change through small steps acknowledge difficulties for clients in early stages of change help the client identify high risk situations through a functional analysis and develop appropriate coping strategies to overcome these assist the client in finding new reinforcers of positive change assess whether the client has strong family and social support.
What we do with new members in group therapy?
Establish group ground rules, statements about the purpose of the group, statements of expectations of group members and leaders.
treatment goals of group therapy may include
Establishing abstinence, integration of the individual into the group, stabilization of individual functioning, relapse prevention and identifying preventing prevention and working through long-standing problems that had been obscured or exacerbated by substance abuse.
Evaluation in counseling-five issues involved in evaluating the information the client provides
Five issues include: nature and severity of the presenting problem, causes of the problem, relief of symptoms, clients readiness for counseling, client counselor match
Therapeutic drugs for long acting psychosis
Fluanxol-flupenthixol Modecate-fluphenazine decanoate Piportal L4- (Piotiazine) Haldol LA- haloperidol decanoate
What is immediacy?
Focuses on current interactions between client and patient. Will enables resolution of an immediate issue between the counselor and client. Role models helping behavior that the client can use in other relationships
When the new changes to the DSM-V what diagnosis will be cited as primary diagnosis first
For example a client presents with depressive symptoms during withdrawal the severe cocaine use disorder. She just revealed that she is being sexually abused by her husband who just kicked her out of her home. His client would receive a diagnosis of 292.84 cocaine -induced depressive disorder during withdrawal. An additional diagnosis of 304.20 severe cocaine use disorder would also be recorded as well as 995.83 spouse violence, sexual, suspected, initial encounter and the 60.0 homelessness. Any subsequent litigation related to mental health diagnosis would follow
Expressing empathy with Native American clients
For many traditional Native American groups, expressing empathy begins with the introduction. Native Americans generally expect the clinicians to be aware of and practice of culturally accepted norms for introducing oneself and showing respect. For example in first meeting and now about persons expected to say his name, clear relationship or ethnic origin and place of origin. Physical contact contact is kept to a minimum except for brief handshake may be no more than a soft touch the palms
Why is therapy so powerful in groups
For numerous reasons but the central factor involved is the aspect of denial. For chemically dependent individuals whose defense mechanisms and systems is often very strong, but your support and peer pressure that occurs in groups can be quite effective in breaking through the denial
SMART Recovery
It is also a group such as alcoholics models. Mark addictive behavior is use complex maladaptive behavior or a bad habit rather one of disease. Smart encourages increasing self-reliance probably reliance on higher power. Smart discourages use of the all or none labels as alcoholic or I do first to consider addictive behavior as lying on a continuum. Smart does not have a sponsor system. Individuals who meet privately with newcomers to the recovery process. Encourages individuals who might want level individual environment to seek psychotherapy. Smart recovery program is called four-point program. One. Enhancing and maintaining motivation to abstain, 2. Coping with cravings 3. Solving problems by rationally managing thoughts, feelings, and behaviors, and 4. Developing and maintaining lifestyle balance. Many of the methods of teaching the four-point program are drawn from cognitive behavioral psychotherapy especially from rationally noted behavioral therapy or are EBT. Start smart sponsors about 225 weekly support groups including Sun and correctional facilities and and outside of the United States. Smart also publishes several publications and has quarterly newsletters has recommended reading lists and sponsors chat room via websites and sponsors and Internet will serve
Gathering information in part one of stages of counseling
Gathers as much information as realistically possible are valid assessment and treatment. Type of information collected is' client's perception of the problem motivation for seeking help duration of the problem previous ways of coping: adaptive responses, defense mechanisms support systems relevant past history expectations have counseling will help time and energy commitment
day or partial hospitalization that involves what
It is an example of combined setting treatment. It involves treatment in the program during normal working hours but the person returns home during the evening hours. Individual lives at home and has to assume more responsibility than would be the case in inpatient treatment. A prerequisite for this type of treatment is a supportive stable family
Goal of therapy of Transactional Analysis
Goal is to identify the types of transaction in which the client participates. Identify games, clients role in the script, client is helped to function form the rational adult position which is considered the healthiest place.
What are signs of abuse and dependency of central nervous system depressants
Gradually increasing use, periods of intoxication, functional impairment, unsuccessful tends to decrease or discontinue use
Motivational interviewing
It is collaborative, person centered, client-centered technique in which you become a helper in the change process and express exceptions in your client. Is a way to interact with substance using clients and not merely as an adjunct to other therapeutic approaches in the style counseling that can help resolve any ambivalence that prevents the clients realizing personal goals.
DSM-V substance related and addictive disorders
It is expanded to include addictive disorders; however our gambling disorder falls in this category. Previous substance dependence and substance use criteria are combined into one overarching disorder: substance use disorders. Significant changes have been made in coding, recording, and specifiers for these disorders
What is needed for an intervention to work?
It is prepared carefully under the guidance of a trained person. It is conducted in a loving, honest, and non-hostile manner. There is a trx system in place that will accept the client. The family is committed to recovery and will continue trx for themselves regardless of the outcome of the intervention.
Type 4 typical client; the client who brings confusion to the group
It is way intent to control and groupt. You regarding crisis when one issue is resolved and others raised important. As a monopolizing agent our client is important for the counselor to identify the Peter Pan or early in the group confronting and not the individual dominate the group-otherwise will continually create a crisis
What are several techniques that a leader may use that are helpful in group therapy
Group commentary, here and now focus, questions directed to individual members, role-playing new behavior, seeking insight, commonality, self-disclosure by the leader
Use of methadone
It is well researched and its effectiveness as part of the detoxification brought process okay drugs and supported. However when you drag treatments for leading withdrawal symptoms have not been well researched or have resulted in contradictory findings. This is an area requiring additional medical research. As of any medical problem when medication such as methadone, and antabuse and others are use supervision by physician required
What can interfere with clients readiness for counseling
It may be necessary to refer the client for medical assistance, food and shelter assistance and self-help group support
What happened to the not otherwise specified in DSM-V
It was a limited set of purchase practitioners can be more specific diagnosis. As a replacement DSM-V is two options for case cases in which clients present condition the criteria for a specific category other specified stores and unspecified disorders. Use of other specified disorder allowed to identify the reason why the client is not a charitable server. Unspecified sort is used when clinician choose not to specify was denied diagnosing a more specific sorter determined that there is not enough information be more specific
Type 5 difficult client; Intoxicated client
Group leader is to ask the individual to be immediately. Alcohol drug use of the client is not the responsibility of the Council or the group. It is responsibility of intoxicated client. Inebriation may be a way of acting out conflicts. Strachan excluded a group member may be at risk to relapse is when they show a rigid compliance to the suggestions of the group regarding sobriety. It shows little thought and the clients part so there is no owning of the problem or solution. Is impossible to do everything everyone suggested he frustrated toss it all away. The appropriate use of a discussion on drinking which may occur as a result of intoxicated member is to express feelings regarding use, society and slips
.What is the most effective means of promoting change in personal growth and drug counseling
Group therapy
Group therapy as a microcosm of society
Group therapy as a microcosm of society although feedback may be confrontational at times a trusting relationship among group members will foster the acceptance of feedback and allow the individual to gain some understanding and psychological growth. Hence the group can be seen as a microcosm of society provide a safe arena for each memory to try out new behavior
4Hallucinogen related disorders
Grouping of substances that can have the same type of alteration cognition and perception users. These are most often taken orally the summer smoked or injected. Includes ecstasy lysergic acid and BMA CA psychedelic mushrooms have a long half-life can extend from hours to days. Jesus order hasn't had no problems rate of 0.1%adults with men more likely the government to engage in use. Hallucinogens can have long-term effects of brain functioning. Withdrawal from hallucinogens is not been clearly documented in the drop criterion is not present hallucinogens's order. However counselor should identify specific substance ecstasy use disorder rather than a more general hallucinogens disorder
Group therapy and role-playing new behaviors
Groups that provide a safe place to practice new behaviors a leader can direct members to perform certain tasks. A member may be resolving a conflict that is called the book in the group and outside. John and what you tell Paul others laughing at you has hurt you and made you angry. Tell each member sue it I trust you. A member may also practice up for an upcoming situation in the real world you role-playing
Elicit Self-Motivational Statements
Have the client make arguments for change rather than the counselor. requires the client argue for change and persuade themselves that they want to and can improve.
Reality therapy view of the person as healthy
Healthy person is a responsible person, A healthy person satisfies their own needs to be loved, and to feel worthwhile, satisfaction occurs without harming others, there is a sense of purpose in life and connection with others. Child is taught right from wrong.
Gestalt view of the person
Healthy person is one who experiences form a meaningful and balanced pattern. Healthy person-continues to grow and experiences genuine interactions with people, objects and the environment. Healthy person, lives in the present, responsible for their own thoughts, feelings and actions and accepts pain as well as pleasure.
What is the purpose of detoxification
Help the patient stabilize physically and psychologically to body street drugs or the effects of alcohol. There are several days objectives that can be targeted. Promoting health of the individual penny composter measures to reduce the control seizures parables on drugs. Also include screening for treating infectious diseases and other medical problems. Drug education or relapse prevention program can begin to detoxification some tension a family, vocational, religious, legal problems in some settings. It is this. That there is a recruit and prepare persons for appropriate longer-term treatment programs.
What is important to understand about goals in therapy
Helping process should be turned into a concrete system of change is important to set goals that are specific and measurable. The large problems a possible solution must be broken down smaller pieces that allow the client to meet him one step at a time. These small successes will eventually add up to our success and helped keep the client motivated high and goals must be realistic and healthy. I must agree on and own the goals to make them work
What is an example of contemplation client conflict
I can picture how quitting heroine can improve my self-esteem but I can't imagine never shooting up again
What is the client conflict in precontemplation?
I don't see how my cocaine warrants concern I hope that by agreeing to talk about it my wife will feel reassured
What is an example of client conflict during preparation
I'm feeling good about setting a quit date but I'm wondering if I have the courage to follow through
empathy
Identification with and understanding of another's situation, feelings, and motives use of reflective listening and sharp attention to each new clients statement and the continual generation of hpotheses as to the underlying meaning
Concreteness as a counseling skill
Identifying specific behaviors, behaviors feelings or situations relevant to the problem-prevents vagueness which allowed the problem to continue because vagueness cannot be challenged. For example vagueness would be I always blow things up example concreteness would be I watch TV all night instead of studying. It may involve asking client from our permission to clarify general statements. Can involve not allowing the client to ramble.
example of negative reinforcement
Ignoring a child who is whining for attention will stop the whining. Ignoring!
Transactional Analysis (4) life positions
Im not ok-youre ok Im not ok-youre not ok Im ok-youre NOT ok Im ok- Youre ok
What are the first four criteria for substance use disorders
Impaired control, social impairment, risky use, and pharmacological criteria
When with a self-help approach first applied to drug addiction
In Lexington Kentucky in 1947. Narcotics Anonymous is modeled after alcohol models although they are not pileated is a 12 step program. Narcotics Anonymous different organization with diverse jargon, style, substance and social traditions. It is concerned with the problem of addiction and members may have had experiences with any or all entire range of abusable psychoactive substances. Vast referrals to the two organizations should be made with care. AA focuses on alcohol dependence and behaviors while and a focus on drug addictions and uses drugs specific language approaches.
What is extinction in classical conditioning?
In classical conditioning, is the weakening of the conditioned response when the unconditioned stimulus is absent. exp: After conditioning the dog to salivate at the sound of a bell, Pavlov rang the bell repeatedly in a single session and did not give the dog any food. Eventually the dog stopped salivating.
Why have the use of tobacco declined since the 1960s
In part from heightened awareness and the health risks restrictions on smoking possibility. However African-American and Hispanic populations also less inclined. Those in lower socioeconomic backgrounds on market more likely to begin smoking and less likely to quit successfully
Orientation task or counselor presenting clients rights the following
In partial access to treatment, recognition of personal big beauty, individualized treatment provided by qualified,,, staff, and assurance of personal privacy, visits, mail and help her family and friends are appropriate not, the right of review of treatment plan, the explanation of client in language that the client can understand, documentation of explanation of clients rights. Each requirement should be considered and included some states are more stringent patient rights requirements know your state requirement. Provided for the facility. Assign bed. that they have probably been orientated ed it needed cleaning up close and personal belongings. And make sure forms are completed and signed
Example of ignoring
Inattention, nonanswer, no response, sidetracking
Anxiety disorders On DSM-V
Include separate diagnostic categories for Agoura for a phobia and panic disorder. Client will need to experience panic to be diagnosed with agoraphobia. The anxiety disorder section includes diagnostic interior for panic attacks. Specify what panic attacks me now be used across all diagnostic categories of anxiety with other sections of the DSM-V
Stimulant related disorders
Includes amphetamines, cocaine, or other stimulants. methamphetamine, dextroamphetamine, . Can be taken orally, injected or smoke typically result in drastic changes in behavior, feelings of subjective well-being. Finally and aggressive behavior Christmas dinner using can lead to interpersonal and legal difficulties.
What is substance withdraw
Includes physiological and psychological effects from stopping reducing substance utilization after significant, prolonged use. Can be distinctly unpleasant and trigger cycle renewed use to counterbalance the deleterious effects of the withdrawal. An individual can become intoxicated by and have withdrawal from more than one substance, consummately. DSM five includes criteria set specific to withdraw from each substance; generally withdrawal criteria are opposite what one would expect with substance intoxication for the criteria. It can occur with or without comorbid diagnoses of a substance use disorder
What is in section 3 of the DSM-V
Includes several new disorders for study, such as attenuated psychosis syndrome which describes individuals at high risk for psychosis you do not meet criteria for a psychotic disorder, Internet gaming disorder, nonsuicidal self injury, and suicidal behavior disorders. It also contains a detailed discussion of culture and diagnosis, including tools for in-depth cultural assessment and description of some common cultural date gnosis syndromes, idioms of distress and causal explanations relevant to clinical practice
What are common symptoms of opiate withdrawal
Increased blood pressure, increased pulse rate, increased temperature, Pelo erection IE goosebumps, increase pupil size dilation, rhinorrhea, lacrimation, tremor, insomnia, vomiting, nausea, muscle aches, abdominal cramps, irritability, anorexia, weakness tiredness, diarrhea, restlessness, headache, dizziness, sneezing, hot or cold flashes in drug craving
positive reinforcement
Increasing behaviors by presenting positive stimuli, such as food. A positive reinforcer is any stimulus that, when presented after a response, strengthens the response. A reward or treat
negative reinforcement
Increasing behaviors by stopping or reducing negative stimuli, such as shock. A negative reinforcer is any stimulus that, when removed after a response, strengthens the response. (Note: negative reinforcement is not punishment.) Child comes home with all A's and no longer has to do chores for a month.
Peer pressure and peer support in groups therapy?
Individual can begin to identify with others and admit their problems. His admission can come from about the power that universality gives it to combat the cultural forces that can lead to denial. Through confrontation the group can assist in altering the substance abusers defensive style and help eliminate their distortions that lead to denial
Adolescent and spouses in family therapy drug treatment
Adolescent involved in family therapy has been shown to have half the recidivism rate of those not receiving the service. There's also evidence that family therapy improves adolescent retention and resist residential treatment programs. Family treatment has also been favorably correlated with a spirit of methadone, legal opiates, and marijuana. Has been down the alcohol person to receive treatment with their spouses, including without all credit interventions in marital therapy or more compliant, decreased or drinking more rapidly, and relax more slowly and study participants received only alcohol focused treatment with their spouses. He also maintained that her marital satisfaction were likely to stay in treatment and persons receiving treatment with minimal spouse involvement. In general family family involvement enhances assessment and intervention increases motivation treatment
Neuroleptic Malignant Syndrome
Adverse reaction to antipsychotics with severe "lead pipe" rigidty, FEVER, and mental status changes. Blood pressure goes up and down. Dazed and confused, difficulty breathing, rapid heart rate, sweating, shakiness.
There are four categories of pharmacological substances better used for treatment of substance use disorders. What are the four categories?
Agonists, antagonists,antidipsotropics, psychotropic medication
The family is drawn into the alcoholic's life
Alcohol cannot bear to feel they cannot tolerate family members expressing honest feelings. Alcoholic may deny it to themselves but no that they are the source of the same families anger shame and discussed. As Alec called loses control of her own life a demand to gain control over the family's life. And weapon of power is alcohol. Family learns about his life around the drinker and alcohol. Nothing must be done to upset the alcoholic or to provide a reason for drinking. It is not possible to family things it can control the alcoholic drinking and the family increasingly fears alcohol and tries desperately to control it back if things deeper and deeper into the alcoholic web
Where does alcohol detoxification usually occur
Alcohol intoxication is usually provided in a hospital setting for five days or less. Medical supervision is needed to provide medications, therapy computers measure the correct water electrolyte imbalances. Alcohol detoxification also may be provided in nonhospital settings but the rate of successful completion have been much lower. Patients who need medical or psychiatric care have your housing or coexisting drug dependence are unemployed or have come to an usual visit intoxication and less likely to succeed outpatient treatment and are more likely to hospitalization
Substance -related disorders include 10 classes of drugs what are they
Alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, studies, hypnotics, and anxiolytics, stimulants, tobacco and other unknown substances
Give an example of diagnostic label should may be included according to DSM-V
All diagnostic labels include the name of the substance, suggest cannabis use disorder, cannabis intoxication, cannabis withdrawal. Individual meets the criteria for multiple substance -related diagnoses they're all listed. The manual is explicit in noting the likelihood of comorbidity of substance -related disorders
What are the benefits of outpatient treatment
Allows individuals live at home, continue working and is be involved in family activities while receiving treatment. It is usually less expensive than residential treatment alternatives. It also allows for longer terms of four of the individual and his possible with inpatient programs. When considering referring individuals for outpatient treatment programs include a motivation for treatment, ability to discontinue use of drugs or alcohol, social support system, employment situation and medical conditions, psychiatric status and past treatment history. Those remaining outpatient non-methadone treatment longer and you have better outcomes than shorter-term client. Dropout rates are high
What is role playing?
An act of orienting one's own behavior to a set of expectations defined by a role. Eventually we adopt the attitude of that role. Is a process where participants pretend to be in a particular situation- the situation is not real but the feelings that come up are real. The client can address the feelings and the counselor or other participants can let the client know hot the behavior affected them with discussion of possible alternative behavior. Allows client to practice new and scary behavior in a safe place
Section 3 the DSM-V also provides;
An alternative model for diagnosing personality disorders. This model is a radical change in the current diagnostic structure introducing hybrid dimensional categorical model which evaluate symptomology characterizes five broad areas of personality pathology. As opposed to separate diagnostic criteria, this proposed model identify six personality types the specific pattern of impairment and traits
Why would families need to be seen in the drug counseling setting
Even one individual is being seen family dynamics and family issues are predominant. They are part of the clients ongoing recovery. Family systems include families of origin, extended family to immediate families. Every individual in a families asked effects that family dynamics. It is no surprise that alcohol and drug dependency affects family dynamics. Family systems are complex integration of relationships and team members. The multiplicity of these dynamics warrants were much family! Counseling alcohol or drug an individual. Is a family disease. Effects of chemical dependency vary with each family member but nonetheless they are present and every member is affected. Each member takes on a roll with the family. Family members become codependent as a result have see themselves because of personalities and her ability to deal a substance abuser are affected. Codependent people often become enablers both with substance abuse family members and other relationships. Children of alcoholics usually carry their codependency with them into adulthood. Adult children of alcoholics or ACOA's commonly experienced low self-esteem impulsiveness and difficulties intimate relationships.
Eight types of denying
Blaming, disagreeing, excusing, minimizing, claiming impunity, pessimism, reluctance, unwillingness to change
What is the function of counseling types of counseling?
Individual group or significant others utilization of special skills to assist in visuals families or groups in achieving objectives through: exploration of problems and its ramifications, examination of attitudes and earrings, consideration of alternative solutions, and decision-making. Kaplan/therapy is basically a relationship with a counselor to help client mobilize resources to resolve their problems and modify attitudes and values. Pastor must be able to demonstrate a working knowledge of three Approaches. These may include reality therapy, behavioral therapy, counseling systemic counseling, transactional analysis, strategic family therapy, client-centered therapy etc. for the counselor must be able to explain the rationale for using specific approach for a particular client. For example, a behavioral approach might be suggested for clients who are resistant, figurative, and having difficulty anticipating consequences regulating impulses. On the other hand the cognitive approach may be appropriate for clients depressed insightful and articulate
Residential or inpatient treatment programs
Individual lives in the facility while participating in treatment. Can be defined as inpatient or residential programs. Some detoxification programs as well as therapeutic communities are hospital-based programs are in this category. Programs are most appropriate for individuals who have not been successful in outpatient settings, there is a very serious substance abuse problems those needing con commit medical or psychiatric care or observation and those without a stable social support system in the community. Inpatient programs are most restrictive structured and protected types of programs.
It was more likely to develop alcohol use disorders with what people
Individuals living cultures were alcohol availability and use our widespread are more prone to development of the disorder. This is especially true if there is a genetic predisposition to alcohol use disorders as in the case of almost 50% of individuals develop the disorder. From a physiological standpoint individuals with bipolar disorder, schizophrenia and general impulsivity concerns of a heightened risk for alcohol-related disorders
Transactional Analysis Parent
Ingrained voice of authority. Formed by external unquestioned events and influences as we grow up. Similar to Freuds super ego. Acts as Conscious. *Taught* concept of life
Definition of intake
Intake is the administrative and initial procedures for admission to the program. The following supplemental expansion includes: intake usually becomes an extension of the screening when a decision to admit is formally made and documented. Much of the intake process includes various forms. Typically the client and counsel regarding mission or entity, document initial assessment information, collect financial data signed consent to treatment and assign a primary counselor. It's usually what happened after my evaluations from a sassi
What is mental retardation now referred to
Intellectual disability. Severity of disability is not determined by adaptive functioning rather than IQ score. New criterion severity measures for mild, moderate, severe, and profound intellectual disability. Intellectual development of the stories placed in parentheses reflect the term used in ICD
Effects of withdrawal from cocaine
Irritability, weakness, reduced energy, hypersomnia depression, loss of concentration, diminished capacity to experience pleasure, increased appetite, and part paranoid ideations. Cocaine dependent person will experience cravings for the drug this leads to another episode of drug binging
Individual counseling for substance abuse
Is a one-to-one counselor encounter between a client and counselor. Counselors are usually trained professionals but they may be a paraprofessional or peer counselor. The specific counseling approach are methods used in individual treatment are substance abusers come from modalities originally developed to treat other conditions. Regardless of particular counseling model endorsed arson tasks or goals individual treatment that usually are seen across all coaches. These include, helping individual resolve to stop using psychoactive substances, teaching coping skills to help a person avoid relapse after cheating initial. Assets, changing reinforcement contingencies, fostering management of painful feelings and improving interpersonal functioning and enhancing social support. Usually when people got individual counseling substance abusers have the goal of controlled use especially for alcohol. Therapist can help patients explore their motivation and set appropriate treatment goals including Google vastness. Is where he finds a motivational interviewing going on. Identifying circumstances that increase the likelihood of resuming drug use and practicing strategies for coping with high risk since situations are other parts of the treatment process. For many substance abusers drug use has been the entire focus of their lives. Stopping to help and filling in her timing fine rewards and replace those derived from drug use. AA does not do this as much. Many drug involved persons have never achieve satisfactory adult relationships or vocational skills because drug abuse is initiated during adolescent or early adult years. Individual interventions can help to maintain a motivation during the process of learning skills and recovery. Individual therapy often includes techniques to elicit strong feelings and help you to learn except the end of managing them with a protected environment of the therapeutic setting. For persons who have emotional or anxiety disorders combined treatment with medication and individual counseling may be appropriate.
Claudia black- The placator
Is considered the sensitive child yes is always trying to make others feel better. Does not seem to be disappointed or upset because she will only express these feelings in privacy. Seems to be warm, caring, problem-free child. Directs attention away from themselves so no one sees any problems. Feels guilty because they cant really fix things. As adults, they do not have equal relationsips because they always give more than they take, seeking out people who do not take emotional responsibility
How do psychotropic medications help withdrawal
Is control various symptoms associated with drug use in the draw. This includes anxiety, antipsychotics, antidepressants and lithium have been tested. There are two categories of therapeutic medications
What are examples of eligibility criteria for screening
Is determined by the program's goals and objectives, target population, and funding requirements. It is the eligibility criteria and the diagnostic criteria. Criteria may be the client might include age, sex, red, legal status, veteran data levels, reference source, physical condition, psychological functioning, outside for available, previous treatment efforts,. Actually it might also include environment and philosophy program and when the program is a detoxification unit, inpatient, residential, or outpatient program
. What are self attending skills
Is in touch with themselves include awareness of councils a message especially the clients material is activating the counselor's personal issues. Awareness of counselors on physical and emotional needs and ways get a minute outside of sessions or focus remains on the client. Remaining center regardless of the clients material by practicing relaxation techniques
Tobacco intoxication in the DSM-V and withdrawal sx
Is not included in the DSM-V. Tobacco withdrawal is a new diagnosis DSM-V and about symptoms of irritability, anxiety, difficulty concentrating, increased appetite, restlessness, depressed, and insomnia.
Assertiveness therapy continued
Is viewed as "appropriate expression of thoughts and feelings with regard to the rights of others. Typically policies in weeks desire certain behaviors are first fractals setting. It is guided by the therapist, the individual is encouraged to practice the new, more appropriate certain behaviors in real-life situations. It is often attention is focused on developing more effective interpersonal skills. intentional assertion is believed to inhibit anxieties as the situation and aleviate maladaptive anxiety. It tends to foster more that interpersonal behaviors. It is highly useful in certain situations but it does have limitations. It is largely irrelevant for all the ice involving nonpersonal stimuli. It may be abuse or someone feels rejected by someone. It may tend to aggravate rather than resolve the problem. But it does help maladaptive anxiety can be traced to lack of self assertiveness.
What does the removal of the abuse and dependence categories allow counselors to do
It allows counselors to assess severity on three levels which tend to enhance the tailored treatment options
How to self-disclosure by the leader helping group therapy
It enhances discussions, it expresses feelings of anxiety and uncertainty that was happening in the group. Expresses anger towards a group member and. To share positive feelings with progress in the group to admit personal conflict that are similar to those that members
What is good about individual counseling versus AA
It has more tools to learn to deal with emotional past, emotional present, aversion techniques, family problems. It has more tools for people who are subject to playing family roles in alcoholic family such scapegoat. This is not covered in AA and is very important. There is more privacy in a one-to-one relationship and maybe the client is never had with a parent. AA involves a lot of self blame. It does little for those who have been lifelong victims of abuse. It does more to help those with personality disorders that do not lend themselves to group involvement.
The newest version of the DSM
It includes approximately the same number of disorders as the one before. This goes against popular trend within healthcare to increase rather than decrease the number of diagnoses available to practitioners. Despite being similar numbers several major changes affect manual as a whole. Unlike the previous version that was organized by 16 diagnostic classes, one general section and 11 appendices, the DSM-V is divided into three sections, 20 diagnostic classes to general sections for medication -induced problems and other conditions that may be a critical attention and seven appendices. All it also lists to set the ICD codes using ICD-9 CM codes as the standard coding system and ICD 10 CM codes in parentheses. These are included because after October 1, 2014 all practitioners must be in alignment with the HIPAA HIP AA which requires use of ICD 10 codes
According to Freud, when does personality form?
By age 5
psychotherapeutic drugs to treat Bipolar Mania
Carbamazepine ( Epitol, tegretol) Valporic acid (Depakene, Valproate, Valrelease,) Olanzapine (Zyprexa) Risperdone (Respiridol) Haloperidol (Haldol)
Motivational interviewing is based on what theory
Carl Rogers optimistic and humanistic the and behavioral change from the client in addition to creating client discrepancies to enhance motivation for positive change. Essentially motivational interviewing activate the ability for beneficial change and everyone possesses. Although some people can continue to change and are on others require more formal treatment and support over the long journey of recovery. Even for clients the low readiness motivational interviewing serves as a vital prelude for later therapeutic work. people's capabilities for exercising free choice and changing the process of self actualization. The therapeutic relationship for both Rogerian and and motivational interviewers is a democratic partnership. Your role in motivational interviewing is directed
What is emotional stimulation that is provided in group settings
Challenge, confrontation, self-disclosure, caring, support, accepting, praise
I'm Ok--You're Not Ok
Child does not receive enough nurturing, never develops trust, may have been abused, does not trust anyone. -This is a position of survival. They will blame others for all that goes wrong and will not accept any responsibility.
Stuttering is now referred to as what
Childhood onset fluency disorder
Problematic group therapy defense mechanisms
Client behavior which is meant to interfere with the progress of"Blocking
To assess a client underlying feelings accounts are often has to rely on what?
Client body posture, verbal content of discussion, client information and tone of voice, teams that repeat during the session
Gestalt Techniques of treatment-
Client does the changing and integrating. The counselor acts as a catalyst to speed up the process. -safe caring environment, provides "here and now" challenge to speed up growth. , point out parallels between a clients interpersonal relationships and the client interaction, dream analysis, focus on body language or something client said. Exercises to experience rather than talk about self. Acts as a guide and helps the client make appropriate choices that will integrate the self into a whole and help them interact more effectively with the environment.
Uncomfortable thoughts and feelings in group
Client is recognizing uncomfortable thoughts and feelings are often necessary for persons to grow. Many people want to be better but do not want to pay for an effort pain or discomfort. It is important for the client to realize that there will be some uncomfortable moments during the growth process
Type one client who can't relate
Client is related to this is superficial aspects of others in the group who seem different from themselves. If the client will stay for a few sessions they will began to see the underneath the different problems and faces as dealings are similar and they can relate to them. It may still choose to run away using the excuse of being different. A variation on the theme the client feels that their problems are so different no one could possibly understand them
Why are motivational enhancements needed for substance abuse counseling?
Clients may still need a surprising amount of support and encouragement to stay with a chosen program or course of trx. Even after a successful discharge, they may need support and encouragement to maintain the gains they have achieved and to know how to handle recurring crises that may mean a return to problem behaviors. 2. second, many clients remain ambivalent in the action stage of change or vacillate between some level of contemplation-with associated ambivalence and continuing action. Clients who do take action are suddenly faced with the reality of stopping to reducing substance use. This is more difficult than just contemplating action. Thinking about change is less scary than following through.
5 opening strategies for early sessions
Clinicians who use MI as a preferred style have found that the five strategies discussed below useful in the early stages of treatment. Based on the 5 principles described in the previous notecards. 1. express empathy, develop discrepancy, avoid argument, adjust address their natural ambivalence. help explore ambivalence I a safe setting. 1. ask open ended questions 2. Listen Reflectively 3. Summarize 4. Affirm 5. Elicit self motivational statements
Responsibility of the Listener
Concentrate on listening which required tuning out distractions show interest listen for the whole message not the details make sure you understand the message and ask for clarification before commenting on it Do not interrup the speaker but make anot, mental or written on points to clarify.
What is the advantage of dropping the multi axial system
Conference what counselors from a wellness perspective have been claiming for decades-that differentiation among emotional, behavioral, set physiological, and psychosocial and contextual factors is misleading and convey the message that mental illness and unrelated to physical biological or medical problems. Combining these axes has the potential to be more inclusive, embracing aspects of the clients functioning. However practitioners will need to be intentional and systematic when incorporating a more holistic assessment annotations into diagnostic processes so that their diagnoses do not become a simple listing of primary DSM-V disorders
HMOs are medical insurance companies that:
Control the delivery of health care. alternative to the traditional fe for svs delivery system. Delivers wide ranging health svs to their enrolled members for a fixed, prepaid fee, covering a particular time period. Most members are healthy middle class working people and their families. It includes basic and supplementary svs such as physicians, outpatient and inpatient, mental health, emergency, family planning, immunizations, physical exams.
What are some advantages of group therapy
Cost-effectiveness, line 1 professional to work with several different individuals it once, sharing learning among group members and the potential to work through problems from earlier stages of growth as group members may reflect characteristics of members family of origin
Transactional analysis techniques of treatment-
Counselor analyzes the clients transaction in terms of their script- a diagram may be used to facilitate understanding, counselor identifies the script theme and problems. Counselor helps CLT rewrite the script to become healthier and more representative of the person.
Self-disclosure and counseling
Counselor shares personal information with the client such as ideas values and attitudes and experiences. Must relate directly to the clients duration. Can build a sense of trust report between counselor and client. It can enable accounting relationship to the deeper levels. Excessive self-disclosure shift the focus from the client to the counselor. Minimal self-disclosure gives the appearance of aloofness
Personal problems and professional effectiveness
Counselors must recognize the effect of professional impairment on professional performance and should be willing to seek appropriate trx for oneself or a colleague. When personal problems impair a counselor it does not justify ethical misconduct -MANY counselors seek treatment for emotional problems without committing an ethical violation. Included in this is the potential for relapse.
What are criteria five to seven in the DSM five
Criteria covers social, occupational, and interpersonal problems
Motivational Interviewing -Avoid Argument
DO not argue with a client who is hostile, defiant, or provocative. Trying to convince a client that a problem exists or that change is needed could precipitate more resistance. If you try to take a side, the client will just take the other side. The goal is to "WALK WITH THE CLIENT" not DRAG them through it.
What is the definition of orientation
Describing the client: Gen. nature of old program, the rules governing client conduct infractions to disciplinary action are discharged from the program, a nonresidential program the hours during which services are available, treatment cost to be borne by the client if any and, clients rights. Orientation may be provided before, during or after the client screening intake. It can be conducted in an individual, group or family context. Portions of the orientation me other personnel for specific parts of the treatment such as medication
Detoxification opiate drugs
Detox is needed with drugs as initial treatment for opiate dependence usually heroin addicts are entering a drug-free rehabilitation program. Detox also made the matter what a person who has been stabilized on methadone wishes to discontinue its use. According to recent regulations but FDA methadone can be used for detoxification up to 100 and 80 days
What are the rules of an alcoholic family?
Every family has rules that keep family running smoothly some rules are spoken while others are unspoken but understood. In a family the rules of a better person are you alcoholic-rules reflect the disease: inhumane; rigid regarding designed to maintain status quo also drinking can continue. Should The rules are: struggles to continue drinking alcohol the most important thing in the families life. The family plot stop from. No other family events or issues can ever be more important. Alcohol does not claim drinking blame is placed on someone else in the family usually the spouse or child was acting out. Everyone must protect the alcoholic consequences of drinking. Don't talk to anyone about family situation including outside family members outsiders, laying information our new information into the family to up on family member strong. There's a rigid insistence on family loyalty. Don't feel- those who live with women of an alcoholic learned that they cannot be trusted. His family members are not being genuine cannot be trusted. Outsiders are not considered because of rules about everyone must protect the consequences and do not talk to about the situation.
Several type of group approaches using alcohol and drug involved persons include what
Exploratory groups, supportive groups, interactional groups, interpersonal problem-solving groups, educational groups, and activity groups
What are exploratory groups (explore feelings)
Explore and interpret members feelings and help them develop greater ability to tolerate distressing feelings without resorting to altering substances
Prevalence of substance abuse or use
Extremely high with 22.6 million individuals in the United States and putting use of illegal substances within the past month; this project represents 8.9% of the total population over 12 years of age. 51.8% of children ages 12 and older had used alcohol and 27.4% had used tobacco has. According to the study 23.5 million people age 12 or over needed treatment for illicit drug or alcohol problem which represents 93% of US population 12 or older
Other changes to DSM-V
Diagnoses are now in terms of symbols to apology presumed underlying all abolished together. This is indicative of a lifespan approach by the DSM-V task force. Will notice that the soldiers multiply diagnosed in childhood such as intellectual disabilities are renamed and now don't do world down developmental disorders and if you're at the beginning of manual. Diagnoses are common in older adults such as neurocognitive disorders. The end of the DSM-V. Supposed to help with differential diagnoses. Structural changes include significant medication to overall classification of disorders. Mood disorder section and separated into two distinct classes: depressive disorders and bipolar and related disorders. Anxiety disorders and broken into three separate diagnosis chapters: anxiety disorders, obsessive-compulsive and related disorders, and trauma and is stress or related disorders. Another large structural and philosophical change the DSM-V eliminate disorders usually does diagnose in infancy, childhood or adolescence. Disorders in a section were incorporated into a new joint neurodevelopmental disorder chapter or if not seem to be in our book neurodevelopmental nature relocated another specific section asked the DSM-V. He justified his change of many sorters in this section are also seen adulthood such as ADHD and many disorders seen in childhood may be precursors to concerns in adulthood. England commissions to erroneously there is a clear distinction between adult and childhood disorders. Critics felt his division was confusing and provided clinicians from diagnosing children and adults orders such as major depression are? Stress disorders. Likewise adults diagnosed disorders ADHD able to stigmatize limiting treatment diagnosis. Diagnosis is not removed from the section such as child disorders can now be found within their associated sections just later manual. Being eating disorders in the DSM-V now included Pike and rumination.
What are barriers to communication?
Differences in perception, lack of basic knowledge, emotions, appearance, external distractions... Visible discomfort, poor listening, poor organization by the speaker leads to confusion, language, lack of interest by speaker or listener
DOR
Differential reinforcement of other responses- progression from ECT therapy. behaviors incompatible with the undesired behavior are positively reinforced. For children with antisocial behavior, or destructive behavior, positive reinforcement might be used for every sign of constructive play. Any reinforcement that has been maintainig maladaptive behavior is removed. Even with ECt- non punitive trx has been recommended for self-injurous behaviors.
What are the physical effects of opioids
Due to injection are many risks for infection and disease. Opiates include marketing oxycodone heroine. Counselors must be where the rest of needle sharing, high risk for HIV, hepatitis and tuberculosis. Suicide rate in high mortality rate for opioid users.
Symptoms of alcohol detoxification
Eating including disturbances and sleeping, shakes tremors sweat clouding of the sensorium, hallucination agitation hallucination and agitation, elevated temperature changes in pulse rate, convulsions some of these symptoms can be fatal. There is a potential for suicide so there should be clearly defined procedures to follow an individual is experiencing alcohol intoxication. Used to be implemented in a variety of settings including jails, shelters and other congregate living situations
What are examples of controlled environments
Jails, locked hospital units, therapeutic living settings
what are the expectations of counseling?
Practical issues which set limits for example typical number of sessions, meeting times and dates. Expectations such as Explains what they expect from the client which is punctuality honesty, effort to resolve problems, use of alcohol or drugs sessions. If these expectations are not met the counselor when you confront them with the problem. It is important for the client to shared expectations of the counselor can fix and visit perceptions. Hope of a quick fix. Hope of becoming friends and socializing. Think it that may be helpful or unhelpful. Other issues that the that the counselor needs to discuss our; the extent of countless availability, extent of nature confidentiality, take the focus of helping the process of the helping process, counselors theoretical orientation,. Frequent mistake that beginning counselors make with client's failure to openly discuss each other's expectations which can later in fear of establishing trust and rapport.
What are examples of poor listening
Preconceived ideas of what the speaker is saying thinking of responses while the speaker is still talking? listening for details rather than the entire message? Evaluating the right or wrong of the message and sender before fully understanding the message
What are the four guidelines to giving feedback
Present feedback information simple, concrete terms. The intention is to provide information not to impress the client and counselor's profound knowledge. Identify the client strengths that will help resolve the problem and weaknesses that can cause a problem and/or will get in the way of resolving it. He open to questions during or after feedback. Make recommendations regarding the start of the counseling such as begin individual, marital or family or group counseling. Suggest that accounting may be more qualified or refer to an alternative form of help such as medical attention self-help group or class. Or suggest suggest no further counseling because the client concern are normal and there is no problem to resolve, intake session provided the necessary information to the client to handle things alone, client would not be helped by counseling at this time
Neurocognitive disorders DSM-V
Previously cognitive disorders removes language regarding dementia, includes enhanced attention to a range of impairment as evidenced by incorporation of mild and major neurocognitive disorders, and includes additional attention to neurological assessment and basis of the condition
Short-term therapeutic communities where residents remain an average of 3 to 6 months
Primary goal of this approach is to help persons attain drug-free lifestyle, much less emphasis is placed on resocialization. is appropriate for persons from a stable social and family environment
Four types of questions that evoke self-motivation statements
Problem recognition, concern, intention to change and optimism
Length of stay in therapeutic communities
Ranges from 6 to 24 months. These are to show that the longer clients remain therapeutic communities the more likely they are to have positive results unless they don't belong there to begin with. However traditionally dropout rates are high. Approximately 15 to 25% of those admitted to therapeutic communities complete programming graduate. That 25% dropout within two weeks and about 40% by three months. One study found that early dropouts from long-term therapeutic communities have common psychosocial characteristics including a new card
Signs and symptoms of cocaine use
Rapid heart rate, elevated or depressed blood pressure, dilated pupils, weight loss, wide variations in energy level, severe mood disturbances, psychosis and paranoia
Signs and symptoms of amphetamine use
Rapid heartbeat, elevated or depressed blood pressure, dilated pupils, weight loss excessive high energy, inability to sleep, confusion occasional paranoid psychotic behavior
In motivational interviewing was a glorification with the client or sharing common past experiences not encourage
Recent personal history the same problem area may compromise a counselor's ability to provide a critical conditions of change. Key component of expressing empathy is reflected.
What is paraphrasing?
Reflecting back the gist of what was said in the listener's own words with no inner interpretation. Purpose is to show Stephen the listener's attention and understands. To enable speaker to clarify any misunderstandings on the spot. To help speaker clarify the expand thoughts.
What is reflecting without interpretation?
Reflecting what was said and on said and taking up on feelings and attitudes. Purpose is to provide a speaker with feedback on how the listener has heard interpreted what was said. To build understanding and develop intimacy. This is done on skillfully the speaker does not feel listened to or understood any reactive anger or frustration
double sided reflection
Reflections that capture both sides of a dilemma that is fostering ambivalence
Amplified Reflection
Reflects back what the clt has said in an amplified or exaggerated form - to state it in an even more extreme fashion than the clt has done. I don't know why my wife is worried about my drinking. I don't drink more than my neighbors? So your wife worries needlessly?
The following list is a summary of the major structural changes in DSM-V
Removal of the multiaxial system: modification to chapter order to reflect adult developmental approach: division into three sections DSM section 1 basics, section 2 diagnostic criterion codes, section 3 emerging measures and models, replacing of the first diagnostic chapter disorders usually first diagnosed in infancy, childhood or our lessons with a new neurodevelopmental this chapter disorder, inclusion of both ICD-9-CM and ICD 10 CM codes, modifications and classifications of disorders: bipolar and related disorders and depressive disorders are now standalone chapters: anxiety disorders were separated into three distinct categories (anxiety disorders, obsessive-compulsive and related disorders, and trauma and stress related disorders): and removal of an OS and inclusion of other specified in unspecified disorders
Changes to schizophrenia spectrum and other psychotic disorders
Remove special treatment of bizarre delusions and hallucinations involving conversations or commentary. Schizophrenia no longer includes attention to five subtypes
Superego (Freud)
Represents the conscience, holds rules, values for socially acceptable behavior
Simplified Reflection
Responding to resistance with nonresistance
What are three types of systematic reinforcement
Response shaping, token economies, and behavioral contracting
What is communication disorders now referred to as
Restructured to include social communication disorder. SCE or social communication disorder is intended to identify persistent difficulties in the social use of verbal and nonverbal communication.
What are criteria eight and nine focus on DSM manual
Risk-taking surrounding use of substance
Insurance fraud and client advocacy
SUD counselor should act as advocates for any efforts which strive to institute changes in public policy and legislation that benefit their clientele. They must avoid the urge to mislead an insurance company in any way that is illegal and unethical.
Screening involves establishing a client rapport. How is this related
Screening is the first step in establishing a four with a potential client. Maybe the client first attempts to seek help and opportunity provide emotional support and guidance.
What other two diagnostic categories that have been added to communication disorders
Language disorders and speech disorders. Language disorder combines expressive and mixed receptive expressive language disorders
Signs and symptoms of hallucinogens
May exhibit anxiety or depression, paranoia, unusual behavior in response nations that does not sites voices sounds or smells that appear to be real. Signs include dilated pupils, rapid heart rate, tremor shakes lack of coordination sweating flashbacks, reexperiencing hallucination on after stopping the substance use also a symptom of hallucinogenic use
Why is family therapy so important for dysfunctional patterns in drug addiction
May include denial of the problem, stable scapegoating all family members on the identified abusers, use of guilt by the addict to coerce the family and supporting their habit, -2 location, lack of consistent limit setting my parent. Children of alcoholics are more likely to develop emotional and psychosocial communication skills, difficulties expressing feelings, role and identity confusion, and problems of trust and intimacy. Approximately 30% of children from alcoholic families Mary alcoholics. Alcoholic fathers are apt to abuse their children to violence, sexual seduction or salt alcohol more likely to neglect their children. Family also need to be educated about the deadly consequences of substance abuse and help in setting limits. Behavior techniques may be used to run the family members responses that figure drug use in their place, methods of reinforcing positive behavior may need to be taught. Communication centered therapy maybe need to teach people to state messages clearly incorrect discrepancies and communication among family members. Family interventions may include classes to help parents, siblings and other understand substance abuse. Both educational and counseling interventions to improve coping and parenting skills may be beneficial
Inpatient hospital treatment
Maybe located in hospitals or in specialized chemical dependency setters. Chemical dependency treatment, Minnesota model 28 day programs or Hazelden type treatments are terms that may be used to denote this type of treatment approach. Many of the programs are privately financed hesitations are usually employed persons or have employed spouses or parents with private insurances. The goal of treatment is abstinence or alcohol or other drugs.
Systems of health care coverage and reimbursement
Medicaid, Medicare, HMO's
Detrimental effects of medication
Meds are often used to trx COD's. However, they often have abuse and addiction potential. Some meds might have effects that are stimulating, sedating, or euphorigenic. They may promote physical dependence and tolerance. This can lead to longer use and higher dosages.
What is seeking therapy in group therapy?
Members are often not aware of their own thoughts and feelings and the impact of the behavior on others. Question on deposit assessment and insight and behavior change. When you do this had two other people react to you? When you do this what are you hoping will happen
What is the usual age of initial substance use
Mid-teen years and conduct disorder is often comorbid with substance use disorders in adolescence. Considering the negative psychological and physiological and environmental effects of substance -related disorders is critical to assess thoroughly engage in treatment modalities early in the course of disorder
How substance use disorders may be rated by severity of addiction
Mild, moderate, and severe. In addition the removal terms of use independent support the fluid and progressive nature of substance use disorders and conceptualize in the manual
What is good at reducing cravings
Mindfulness training
what are responding skills or therapists?
Minimal encouragers such as uh huh, yes, and go on Silence- indicates the conselor has the time to let the client proceed at their own pace and is not going to jump in with questions. Utilizes attending skills relaxes and begins trust. Trust is also counsel is, shows interest in understanding, provides background information can be jeopardized by: accounts are not being aware of their own counter transferring reaction. the counselor constantly reassuring the client When a client has a high level of trust in the counselor it is safe to indicate pain in front of the counselor In trying to build rapport with a client in denial who has been referred for a suspected alcohol problem the counselor may want o focus on the excellent employment and gradually work through the denial
4-5 criteria indicate what severity index
Moderate
Because of cost, availability and insurance reimbursement several adaptations in the community have been developed these include;
Modified therapeutic communities where stays last and average of 6 to 9 months, short-term therapeutic these were residents remain an average of 3 to 6 months adolescent therapeutic communities for juveniles therapeutic communities in correctional facilities to begin treatment process in jails and prisons
Token economies (behaviorist perspective)
More tokens received is correlated with more positive years. real life understanding of how monies earned how the delay in immediate satisfaction. Token economies are also poorly understood by the layperson and many of whom who see them as inhumane. Some people believe that behaviors should be changed through medication positive behaviour is rewarded with tokens that can be exchanged for privileges, treats, or reinforcers - part of behaviourist perspective
The hostile client in group therapy
Most hostile clients is anger way to cover up here. Hostility can also be the result of excessive stress, cancer group members remind them of someone threatening. Inappropriate treatment by the counselor or group members. It is not helpful to the client and the Councilor to avoid the hostility or allow inappropriate expression of the hostility. The counselor must guide the client appropriate expressions for the hostility and to deal with the underlying fears
What are downfalls of individual therapy
Most importantly it's more expensive. Involvement in group treatment approaches also has a range of mutual support and modeling of coping strategies. The group can represent a family that they never had and can interplay experiences of their own family with a group modeling. Is an opportunity to try out new behaviors in a controlled environment.individual therapy does not offer.
Obsessive-compulsive disorders and DSM-V.
New chapter on obsessive-compulsive and related disorders groups such as OCD, body dysmorphic disorder and trichotillomania together as opposed to having them scattered throughout the manual. Also includes several new disorders including excoriation or skin picking disorder and hoarding disorder. Hoarding disorders characterized by persistent difficulty disposing of possessions, regardless of monetary or personal value
Buprenorphine
Next agonist-antagonist agent. THis long acting in blocks effects of opiate drugs. It produces less physical withdrawal symptoms do occur with its use. the approved marketing monotherapy products Subutex and a buprenorphine/naloxone combination product Suboxon. Suboxone for use in opiate addiction treatment. Combination product is designed to decrease the potential for abuse by injection. Maximum number of patients and positional may treat with the people marketing is limited by law. Because of this there is a physician and treatment locator website to assist programs and clinicians find available resources
Is controlled use of hallucinogens during religious observances considered a diagnosable condition
No
Is there a specifier for physiological dependence the DSM-V
No
Does the DSM-V identify caffeine use a disorder
No although evidence supports caffeine use as a condition. There is no dopamine creation from caffeine which doesn't render itself as the substance abuse disorder. Average caffeine consumption is about 2 to 3 small cups of coffee today. Thus caffeine use disorders included in section 3 of the manual of the condition for further study although DSM-V includes The intoxication and withdrawal as diagnosable disorders
Is detox ateatment modality
No what is necessary first step treatment process. Intoxication provides medical support services needed to alleviate short-term sx cravings including physical discomfort.
Early remission in DSM-V
Not more than 12 months absence of meeting diagnostic. Criteria and at least three months. So between three and 12 months of meeting diagnostic criteria for substance use disorders absence
What is behavior modification
Often incorporated in various treatment modalities. It increases rewards for positive, prosocial behavior. Rewards may increase praise, tension, activities, and material items. For negative or antisocial behavior, responses that are unpleasant or withheld rewards may help to extinguish them onto behavior. Programs that gradually give participants increase freedom and they show responsibility or using positive rewards. Some programs have levels or steps or phases that participants must earn for appropriate behavior. Rewards are privileges increase freedom and decrease supervision.
What are track marks?
Other signs related to the form in which the substances used. For example heroine certain other opioid drugs and certain forms of okay maybe injected. The person using injectable substance may track marks or hourly visible signs of the site of injection with possible redness and swelling and pain which substance is injected. Furthermore, poor judgment brought on by substance use can result in injections being made under dangerously unhygienic conditions. These and factory conditions in real use of shared needles are risk factors for major infections of the heart as well as infectious agent IHIV and certain forms of hepatitis and tuberculosis.
Three Ego States in Transactional Analysis
Parent, adult, child
Why is it not enough Research done on medications used to recover from addiction
Part of the negative stereotype of drug abusers. Number of persons you could benefit from particular pharmacological treatment prediction is also comparatively small. It involved in developing medications for addictive disorders, and pharmaceutical therapy industry would not realize a degree of profit or recovery investments research and development to the extent desired. So the suit proves it's all about money although I would disagree that there wouldn't be enough people that would benefit. There is also concern medications will be used in combinations other illegal drugs. We see this with the methadone. Pharmaceutical companies worried of drugs and other companies will gain a bad reputation if this occurs
Modeling is also good with
Phobias. Learning more fearless behaviors with tools to handle situations they are afraid of reinforce methods to overcome fear.
Maslow's hierarchy of needs
Physiological needs, safety needs, belongingness and love needs, esteem needs, self actualization needs
What are four categories of peer groups
Positive peer influence peer groups to emphasize group interaction and positive influence of the group on individual member peer teaching programs-emphasize youth conveying information to their peers peer counseling, facilitating, and helping programs- focus on peers helping peers. To these programs used to provide is helpful to develop a sense of responsibility. The helper often benefits more than the peer who was helped. Peer Participation programs-creates new roles for the youth, giving them decision making power and responsibility These groups emphasize youth empowerment and accountability.
What is response shaping
Positive reinforcement is often used in response to shaping. Establishing a gradual approximation response that is not as individuals need repertoire. This technique has been used extensively in working with children's behavior problems. Shipping was decided on to Have a problem with his glasses initially was trying to expect that candy associated sound. And training was began with empty eyeglass frames. This was to get him to wear glasses. When he picked up the classes he was reinforced. For holding and carrying. But bring friends closer to his eyes and going and he had his reinforce was fruit or candy. T through successful proclamations the boy finally learned to wear his glasses. This is similar to how we train dogs
Axis 5: Global assessment of functioning (gaf) special notations for disability are listed by using the codes or ICE 10 z and the code.
Use V codes and ICD 10-Z codes
There are three classifications of use for substances in the DSM-V
Use, intoxication, and withdrawal.
What is group commentary
Useful with majority of members are engaged in counterproductive behavior such as silence, during this, chatting and scapegoating. Statement sessions the following make the group address what issues and avoiding; what's right on the group right now? What is a silent thing? What are we avoiding by talking about the World Series?
How are the medications for cocaine abuse administered
Usually administered on an outpatient basis and accompanied by counseling. However for persons with psychiatric or medical problems such as pregnancy or myocardial damage in patient care is recommended. Patient dropout rates for these treatments especially outpatient programs tend to be high as it usually takes one or two weeks from therapeutic effects of medication to begin. In answer on the craving of single craving and cocaine use may continue
Step meetings in AA
Usually close and consistent discussion of one of the 12 steps
The hero
Usually the oldest child, provides self worth to the family. appears to have it all together. The hero knows something is wrong and feels oblifated to fix it-tries to fix the problem between parents by achieving some thing that will make them proud and forget the problem. -each achievement is a temporary fix -hero tries compulsively harder for the next curing achievement -feels like a failure, guilty and not good enough when unable to fix everything.
The Mascot
Usually the third or middle child. Senses that something is wrong in the family but gets reassurance from other members that nothing is wrong. This causes anxiety and continual conflict for the child as their sense of reality and what others tell them conflict. "going crazy". feels less frightened when others give them attention. develops behaviors such as clowning around or being cute, that will draw attention to herself. Attention provides reinforcement to continue these behaviors; child does not continue to grow and mature but is stuck in the babyish behavior. No one takes the mascot seriously leading them to feel unimportant and inadequate and to suffer from low -self-esteem with anxiety. The compulsive need for attention is often misunderstood and misdiagnosed as 1. hyperactivity, 2. Schizophrenia, 3. paranoia In helping the mascot it is important to reassure them that the fear that some thing was wrong with the family was a fact, not a crazy notion-with support, reassurance, and training in interpersonal skills, the mascot can finally grow up.
Benzodiazepines
Valium and Xanax, librium, buspirone
The leader intervenes in group processes to counteract such nonfunctional behavior as what
Verbal abuse by the member-by careful monitoring of the group leader can often prevent inappropriate expressions of anger, hostility and scapegoating. Rambling and storytelling which prevents genuine self-disclosure. Harmful gossiping especially about missing members which leads to discrete decreased trust. Rescuing another member cannot finish working out issue. Invasion of privacy which leads to decreased safety, we draw which blocks individuals of group. Boredom-if the counselors board so is the group. The subverting of group discussion by member requesting a one-on-one session are refusing to talk except to his or her own counselor. Domination by one member which leads to resentment group. Minimizing the problems of the group or individual doesn't have to work on it. Rationalizing all thought no feelings.
In order to be effectively be a group leader. a leader should do what
Volunteer to participate in group experience, encourage members to behave in particular way, provide feedback on members behavior, arouse tension in the group in order to uncover hidden conflicts and resolve them
Reality Therapy Techniques
WARM, CARING RELATIONSHIP-if the client does NOT feel that the therapist cares.IT WILL NOT WORK! Evaluate how successful their behavior is in meeting needs without harming anyone else. -LITTLE TIME ON PAST HX, -Focus on the PRESENT, Counselor teaches the client-WHAT OBJECTIVE and MORAL reality is (Who decides what this is??) How to get ones needs met within reality because reality does not adapt to the individual. COUNSELOR MAKES PLAN FOR CHANGE! client learns to act responsibly, leads to increased self worth, counselor accepts no excuse for irresponsible behavior.
Skilled that help establish rapport include;
Warm tone of voice, encouraging for prompt senses tell me more about that, nonthreatening questions such as that is questions which do not. Threaten or attack client, appropriate self-disclosure sharing some sloppy personal information which went by openness production focus client, and clarifying confusing information such as that is asking for a final final questions from certain clients response clear that can you tell me more about the frequency in which your smoking marijuana?
Tasks involved in intake
What are tasks involved a. Intake is an extension of the screening process and it occurs after client accepted into treatment. V. Intake interview was instrumental in engaging client treatment process beginning to develop a relationship to program. Intake interview consist primarily of admission forms. D. Information collected intake will form the basis of the client's treatment plan E. Primary categories generally assigned to the client's time at this time. Counselor and client discussed confidentiality on this point.
What are the goals of therapeutic community
What are the goals of therapeutic community rehabilitation or habilitation of the total individual changing negative patterns of behavior, thinking, and feeling that predispose drug use development of a drug free lifestyle
Scripts of transactions
What is a script? theme of a person's life, developed in childhood, Strongly influenced by parents, family, childhood culture. It contains the persons life choices and problems. Act out scripts with games people play.
Oh what is the definition of confidentiality
What is the definition of sharing the federal regulation of session. 20, possible issues, client is out thing that he should be addressed per session in order to reduce or trust. Regulation should explain client for session writing; should be presented in a way to client know that they are in the best interest there is also federal regulations: recovery progress providing or drug abuse diagnosis treatment vertebral treatment which is directly or indirectly better resisted. Allow disclosure of information that clients only under certain circumstances; and When the client is writing Client commits or threatens to commit a crime on the premises on or against program personnel E. Two qualified persons conducting I research program evaluation audit . It required by court order even under these circumstances the requirements are strict regarding the disclosure of client information criminal penalties for violation of the regulations . Alert medical emergency
Concern statements
What is there about your drinking right you or other people might see as it reason for concern? What worries you about your drug use? Working imagine happening to you? In what ways does his concern you? What do you seek will happen if you don't make a change?
When designing an orientation program one should consider what factors?
What the client needs program in order to assimilate as quickly as possible. The best method to present information. How to handle problems or questions that might arise during orientation. How to present rules regulations and consequences for infractions. This is especially important because clients may be upset order use went into the program and they needed their presentation. Presenting verbally and following up with written guidebook is a good choice. You may begin with the development of a relationship with primary counselor and patient rights.
Problem recognition statements
What things make you think this is a problem? What difficulties have you had in relation to your drug use? In what ways do you think you are other people have been harmed by your drinking? In what ways has this been a problem for you? How has your use of tranquilizer stop you from doing what you want to do?
Affirm (Motivational Interviewing)
When done sincerely, it supports and promotes self-efficacy. acknowledges the difficulties of the client. More confident about marshaling their inner resources to take action and change behavior. Emphasizes their past experiences that demonstate strength and success or power can prevent discouragement.
Problems occur with Reality Therapy when;
When trying to meet our needs it violates the moral codes of not hurting others of doing things out of love. This is irresponsible, conflict causes unhappiness and leads to more difficulty in meeting needs, Conflict causes person to lose more contact with objective and moral reality.
Was most common approach to detoxification opiate drugs
Which blocks and withdrawn drug cravings. Down can be gradually reduced. Combining it with counseling services, but on can help addicts quit using illicit drugs. It has reduced criminal behaviors associated with obtaining and taking drugs. Vocational educational services: this is a cessation of illegal drug use can help individuals lead more stable productive lives. Clonidine- another drug that is you sometimes because it can block many of the signs and symptoms of opiate withdrawal. Acupuncture and electric stimulation of the central nervous system of also been used as adjunct therapies alleviate withdrawal symptoms of opiate drugs. Reducing injection drug use and needle sharing among heroin addicts also diminishes the risk of contracting or spreading HIV
Im not ok- you're not ok
Without enough nurturing, the infant will come to see themselves as bad, they feel hopeless,
WFS
Women for sobriety has been providing services to alcoholics since 1976. His 13 statement program of positive and encourages emotional and spiritual growth, the new life program is effective in helping women overcome alcoholism by learning a whole new lifestyle. W FS came forth to the belief that women alcoholics require different kind of program in recovery than the kinds of programs used for mail alcoholics. The success of the WS FSU life program has shown this to be true. The psychological and emotional needs for women in recovery are very different from those for male alcoholics in the program recognizes and addresses these needs
Chapter 1 functions of counseling screening intake orientation and assessment. What is the definition of screening
Screening is the process by which a client is determined appropriate and eligible for admission to the program. Eligibility criteria are generally determined focus, target operation and funding requirements of the counseling program or agency. The criteria are easily ascertained. Mainly the client age, sex, residence, legal status, veteran status, legal income level, and reference source. Additionally is imperative the counselor use appropriate diagnostic criteria to determine whether the applicant alcohol or drug use constitutes abuse. All counselors must be able to describe the criteria they use and demonstrate competence by presenting examples of how the use of alcohol or other drugs have become dysfunctional or particular client. Determination of potential clients appropriate and smart program requires a greater degree of judgment and skill counselor and is influenced by the program environmental modality to inpatient outpatient residential chemotherapy detoxification or daycare. For doctors include physical condition of the client, the psychological functioning of the client, outside support and resources client, previous treatment efforts, motivation and philosophy of the program
What is a referral
Screening process and then referral it is not appropriate. Catherine needs to be loved for about other programs.
DSM section overview
Section 1-provides a summary of revisions and changes as well as information regarding utilization of the revised manual. Section 2-includes all diagnoses broken into 20 separate chapters ordered by similarity to one another. Because comorbid symptoms are clustered together, counselors can now better differentiate between disorders are distinctively different but have similar symptom characteristics or etiologies. Section 3-includes conditions that require further research for they can be considered for adoption in the upcoming version of the DSM is an extended expanded look at how practitioners can better understand clients from a multicultural perspective and propose model for diagnosing personality disorders
Support for families
Self help groups-al-anon, alateen, ACOA, Nar-Anon. Community Mental Health - The centers provide a wide variety of services to the individual and families. These include; crisis management, marital counseling, family counseling, financial counseling, information and referral. Education in the following; stress management, re-entry workshop, financing a college education, resume writing, parenting skills, retirement, and smoking cessation
Self-help programs
Self-help or twelve-step organizations involve mutual hope among peers experiencing similar problems. Self-help groups often in churches community facilities, prisons, and other locations but they generally claim no political or religious affiliation. Numbers in AA believe that addiction is a disease that can never be cured. It is easy to leave the disease can be arrested and those in remission are recovered alcoholics. Self-help groups may only be an intervention used by some persons to and chemical dependence however some self-help groups often used in tandem with other treatment modalities such as residential or outpatient treatment programs often experience members as sponsors to your members creating a person-to-person guidance system in times of crisis in creating bonds between them
What are psychosocial approaches programs modalities
Self-help programs, individual counseling, group counseling and treatment, family therapy, and behavioral modification
detoxification from other CNS depressants
Send discontinuation of this drug may result in life-threatening withdrawal. You should define steps to take to ensure the safety of individuals withdrawing from CNS depressants. Seagram's signals of withdrawal include the following; tremor, hyperreflexia, agitation, hypertension, tachycardia, insomnia, diaphoresis, cognitive impairment, seizures, weakness, anorexia, irritability, anxiety restlessness, headache, muscle aches, depression, to this, depersonalization, parenthood, and hypersensitive duty to touch latent sound. Execution from the strategy by gradually reducing the substance use or substituting similar acting drug and gradually tapering off it. Phenobarbital is often used drugs substitute for this purpose
What have study showed that inpatient treatment what have study showed about inpatient treatment
Several studies have consistently found a chemical dependency or inpatient treatment is more effective for persons with alcohol addiction and for those he's presenting problem is another drug addiction. Persons addicted to more than one substance or polydrug users have the poorest prognosis. So inpatient is best for alcohol
DSM sexual identity disorders
Sexual and gender identity disorder section is now divided into three separate sections: sexual dysfunction, gender dysphoria, and paraphilia disorders. Pedophilia disorders now refer to as pedophilic disorder
Withdrawal symptoms stimulants
Significant depressive symptoms as well as medical conditions that include cardiac difficulties, seizure, neurocognitive impairment, respiratory problems. Stimulant stimulant related disorders are likely to cocoa or other substance related disorders and Gambling disorders. It is notable that amphetamines are sometimes medically prescribed to treat ADHD, obesity and narcolepsy
How to work with silent client
Silence is a behavior. Silence may be saying that the client interfere self-disclosure, is a perfectionist and will speak only when they can be perfect which is never, feels threatened by a member situation or large groups of people, may fear losing control, or maybe trying to manipulate and control the group. In general the silent client does not grow and change as much as a client who actively participates. Counselor can encourage participation by; inviting the client to speak, content commenting on his or her nonverbal behavior as it is important that the counselor and other members do not get caught up in intuitive power struggles though. After a number of weeks of silence if there's no movement toward some involvement counselor may choose to see the client in individual counseling setting and terminate the client from group
What are problematic client behaviors
Silent client, boring client, monopolizing client, self-righteous client, hostile client
What three stages of counseling
Stage I: responding to the client frame of references stage II stimulating the client to alternative frame of reference stage III. Helping to act Stage IV : termination
Signs and symptoms of phenylcycladine abuse;
Static eye movements, rapid heartbeat, decreased pain. Lack of muscular coordination. A major belligerence, predisposition of violence, impulsiveness and agitation
What is an example of client conflict during action stage
Staying clean for the past three weeks really makes me feel good but part of me want to celebrate by getting loaded
What is length of stay have to do with successful treatment outcomes in residential settings
Studies are conflicting. Some studies say length of stay for some subgroups has been correlated with successful treatment outcomes however other evaluations of effectiveness have been contradictory
MAT's or Medication Assisted
Substance abuse is a chronic disease. The use of psychoactive active substances may result in both physical and psychosocial addiction. Thus one treatment has shown favorable outcomes in medication assisted treatments is the use of proven consumer medical supervision. Pharmacotherapies are designed to be adjunctive to formal therapies and are not intended to be used as an independent or solo therapy. The goal of medication assisted treatment includes; reducing use of illicit drugs or alcohol, producing criminal behavior and improving social behavior and psychological well-being. Another goal is urgent imperative to control and prevent the spread of substance abuse related infectious diseases such as HIV and AIDS and tuberculosis. Four people are already infected, treatment for alcohol and other drug addiction may stabilize their physical condition, boosting your system and delay or prevent the onset of serious illness
What are inhalants
Substances whose fumes are sniffed or inhaled to give effect
Intervention and work
Supervisors can threaten discipline. Not all supervisors are aware of the harmful effects of their alcohol or drug use. Many have a job that they can do adequately while using. The workplace is often the last part of life to be effected.
What is direct learning in a group therapy setting?
Support and acceptance by a group of people provides a strong sense of belonging. It helps to meet intimacy and relatedness needs. It promotes growth The interactions with others promotes the learning of healthy and interpersonal relationships. It allows the practice of new behaviors before trying them in the real world. Permits honest feedback
Nature and severity of presenting problem
Symptoms can be used to determine the progress in the counseling. Symptoms will decrease as the person resolves his or her problems
What is substance intoxication
Syndrome that develops temporarily after ingestion of a substance. Subsequent psychological changes result from the physiological effects of the substance. Intoxication often includes alterations in tension, thinking, judgment, perception, interpersonal behavior, psychomotor behavior and wakefulness. The diagnosis of substance intoxication a separate from substance use disorder in a specific substantive of intoxication is a disorder. Intoxication is a different diagnosis then use disorder although it may be comorbid
Two types of interrupting
Talking over, cutting off
what are interpersonal problem solving groups? What are interpersonal problem-solving groups
Teaching approach to solving interpersonal problems and recognizing the problem exists, defined the problem, generating possible solutions, and selecting the best alternative
What is a termination stage of therapy
Terminations estate and accounting process it is not the last session is the agreement between counselor and client that: things have improved from a client, they are on their way towards meeting goals or have met them, they do not need to continue the special supported conference confronted relationship because they are capable of handling life without it. The question of termination can be introduced by the counselor or the client. Counselor should be carefully to explain the client their recommendation for termination of treatment. Counselor may use appropriate levels of self-disclosure to assist the client handling termination issues and the client may act out these issues or show anger or fear at the thought of termination. In order to decrease discomfort of an abrupt ending the number of sessions and group work are tapered off. Tapering may involve linking four sessions per week to two sessions per week to monthly sessions over a group of several months. In group therapy members do not taper termination because it is disruptive to members who are continuing
Adoption of non-axial system
The DSM-V now has a removal of the multiaxial system and discontinuation of the Global assessment of functioning scale. Table 1 includes a comparison of additional multiaxial and the nonaxial system. Axis one, two and three are now combined with the assumption that there is no differentiation between medical and mental health conditions. Rather address psychosocial and contextual factors affecting clients on Axis IV, counselors will now list V codes or 900 code
During initial interview and client reports that his brother died a month ago and they are unproductive and have been in the streets since his wife threw him out last week how should the council begin the process of counseling
The counselor should begin by helping process for the most immediate issue of housing
During the session accountant notices that a client is getting progressively more agitated and suspects a potential for violence
The counselor should continue to reflect and interpret the client behavior using extra caution. And empathetically self disclose the client know that their own feelings and concerns when the client behaves like this. We show the client of a commitment to them and continue trying to problem solve. Think of their own safety and escape plan if agitation increases
What happens in intervention if the client clings to denial in the face of all the evidence?
The family must make it clear that they plan to continue treatment and indicate as concretely as possible how life will change -These changes will make the alcoholic more uncomfortable because on one will be protecting her any longer -At times, it may be necessary for the family to leave the alcoholic if treatment is refused-live would be too harmful to the family to continue living with drinking. - supervisors at work can also be part of the intervention if there is a threat of discipline.
Post intervention Treatment
The family needs to continue in trx. joined by the newly sober substance abuser. They begin experiencing the feelings that were previously forbidden. TO clarify and document the problems caused by the abuser. To begin changing the pathological relationships that exist; a. helping each person step out of their role b. helping to develop a healthy, balanced family that includes the former functional former abuser Develop new family rules that are flexible and humane Developing trust among family members. The family may become temporarily more unstable as the family pushes to become normal.
The self righteous client in group therapy
The goal of this client is to be right at any cost. A often struggle with life yet have little to show for it. The result was a sense of failure and shame. These feelings are covered up by moral self-righteousness. The client frequently appears for his in common does not been involved in processes until they can take a moral stand which attempt to prove everyone else is wrong. In time group members become resentful and often attack the client who refuses to be shaken from the conviction of being right. If the counselor can catch on with client. For a hostility solidifies they can help to the group into the client. Feelings. They need to be right in the pattern of generating hostility are typical adults who grew up in alcoholics or other dysfunctional families. Knowing this information at the onset of the group can keep the counselor and the potential behavioral patterns
Why are co-facilitation of groups useful?
The leaders are to complement and support one another, leaders can assume different roles, provides objectivity for each leader, it can lessen initial anxiety of the group. Having co leaders of both sexes can also recreate a family dynamic that touches on issues of childhood.
Rational recovery-guide for professionals
The means for self-discovery from addiction to any mind altering substance. Uses addictive voice recognition technique or a PRT. Based on successful experience itself great people is not a form of counseling or therapy or part of a psychological theory, nor does it contain spiritual or religious guidance. It is simply the brief self-discovery in a brief educational format.
What is the symptomology of caffeine withdrawal
The newly diagnosable condition require stopping caffeine use after prolonged daily consumption with physical symptoms including headache, fatigue, dysphoric mood, difficulty concentrating, and possible like symptoms that cause clinically significant distress. It is interesting enough that excessive caffeine uses often seen in individuals with mental health disorders such as eating disorders and other substance -related disorders and incarcerated individuals. The growing popularity of energy drinks with high caffeine content poses a concern especially because young people are frequent consumers of those beverages
What is parroting?
The patient repeats back exactly what was said without paraphrasing during the informed consent process.Or it is repeating the whole or in parts of the speaker's own words. Purposes refer a point back to speaker for further clarification or explanation. Is also to buy the poster time for speaking. For example client and I was so angry want to punch him. And the counselor tape Jim? Client says really punch them because you know what else he did? Client I'll have a problem now call. I just get drunk now and then counselor now and then client yet a few times a month
What strengthens contemplation to preparation?
The process of talking about and setting goals strengthens commitment to change. The clinician tasks broaden from using Motivational strategies to increase readiness-the goals of precontemplation and comtemplations stages suing these strategies to strengthen a clients commitment to help them make a firm decision to change. Help the client form self efficacy.
Crossed transaction model
The sender gives a message in one ego state and it is received by the receiver in a different ego state. "Where are the intake forms, Jane?" "You should know by now that they are always kept in the third drawer on the right"
behavioral contracting
The therapist and the client draw up a contract to which they both agree to abide. The structuring of the treatment relationship explicitly stated quite a clear idea of each person's role in the treatment, the actual responsibilities of the client are outlined in the system of rewards is going to go enter change behavior, the limitations of the treatment in terms of the length and focus of the session are specified, by agreement some behaviors may be eliminated from the treatment focus thereby establishing appropriate content of the treatment sessions, and clear treatment goals can be defined. Criteria for determining success or failure in achieving these goals can be done into the program
What is interpersonal communication?
The transmission of messages between two or more people. It consists of each person's interest interpersonal material an organization of the material presented and listening ability
Therapeutic communities
Therapeutic communities are self-contained residential programs emphasize self-help and rely heavily on addicts as peer counselors, administrators and role models. They provide a highly structured live with program stages through which members must progress, this advancement is noted with special tasks and ceremonies. Stages progressively demand more responsibilities and provide the freedom. Group encounter sessions are often confrontational, focusing on openness and honesty. Social and vocational skills are also taught. Example lighthouse in Mays landing, NJ
Modified therapeutic to these were stays last and average of 6 to 9 months
Therapeutic community the goals of treatment are more limited the primary objective is to help residents achieve a drug-free state require practical living skills. tHis models appropriate for persons with minimal social support systems
What is group therapy
Therapies often combined with other treatment modalities to provide a structured comprehensive treatment program for substance abusers. Group therapy can be defined as: an assembly chemically patients usually 5 to 10 number meet regularly at least once a week and under the guidance of a professional reader usually a professional therapist or addiction counselor, the purpose of promoting abstinence from all mood altering chemicals and recovery from addiction
The personality disorders section change the DSM-V
There has been it has not changed and will maintain the same 10 categories cover section 300 measures and models includes a framework framework for diagnosing personality disorders using treat specific methodology
How is the need for confidentiality to be addressed directly group therapy
There's no way to enforce confidentiality among members of the need to realize its importance in maintaining based on my own value not outside punishment. Broken confidentiality lead to broken trust.
Antagonists (drugs)
These drugs block the actions of neurotransmitters Invade receptors because it is close in shape to neurotransmitter plugs in the space that the drug blocks the neurotransmitter. They do not produce the same effect of the abuse drugs and they are not addicting. You present the effects of the abuse drug are blocked because they cannot act in the brain in the usual way. We do not produce expected results from experiences. It may be used for persons who do not want to be maintained on drug substitutes. They are also used at times for persons leaving other drug-free treatment programs and reentering the unity to diminish the risk of relapse.
Antidipsotropics
These drugs create adverse physical reactions were person consumes the substance abuse. It creates aversion. Examples inclue; antabuse (disulfiram) interferes with the metabolism of alcohol, fachial flushing, heart palpitaions rapd heart rate, difficulty breathing, nausea, vomiting and drop in blood pressure when combined with alcohol. It has been succesful in preventing relapse
What drugs (medications) stop people from abusing other drugs?
These drugs help patients stop using drugs and medications reduce acute drug withdrawal symptoms, medically maintain patients, decreased drug cravings, and block the drugs reinforcing effects. These include methadone, clonidine, buprenorphine, desipramine, bromocriptine, naltrexone
what are examples of antagonists?
These drugs occupy the same receptor sites in the brain as specific drugs of abuse. They do not produce the same effect as the abuse drugs from their non-addicting. Examples include naltrexone and buprenorphine. Naltrexone, is an opiate antagonist. Buprepnorphine is a mixed agonist antagonist agent
Therapeutic communities and correctional facilities to begin treatment process in jails and prisons
These focus on socialization, positive value information, and education. When released inmates are referred to other treatment agencies in the community. This approach attempts to form a strong, positive, anti-drug culture; develop work teams; provide referral and transition services. Successful programs must have good working relationships between treatment and correctional personnel
When a client to account for a long story about a friend who told others the client problem the counselor can assume that?
They are concerned that the counselor will also betrayed a confidence
What are criteria 10 and 11 for substance use disorder in the DSM-V
They are related to tolerance and withdrawal respectively. Assuming an individual meets a general requirement of clinically significant impairment or distress when it's a pattern of use just to specific criteria must be met to justify some diagnosis
Problems with monopolizing clients in group
They do not seem to notice other members negative reactions. They may belittle other members problems to gain attention. And feel that they have most of the problems of anyone in the group. In a tag along another member statements by cleaning some similarity in an shifting attention to themselves. They cannot stand five and will chatter a ramble to avoid it. They will ask another member a series of questions last for help and advice and then proceed to say why that won't work in a situation. Other members may initially believe there is a talker and the groups they don't have to self disclose. In a country that had a little time and attention. In act out this resentment by dropping out of the group, making veiled attacks on the monopolize or Anderson group sessions. Eventually by memorable usually attacked the monopolize or any fairly brutal attack leasing weeks of frustration. The rest of the group is supportive of the attacks and the monopolize reveals demolished and possibly drops out. To prevent the frustration attack cycle the counselor must address the issue early on. Is appropriate for earlier to ask the group why they are letting the person do all the talking and work in the group. In discussing the monopolizing behavior the counselor must point out that the compulsive talking hides the client-less talking and more substantive goal in a group session
Type III difficult client; the client who enjoys irritating others
They do this by not understanding, not remembering, breaking rules and returning innocence. This is essentially passive aggressive behavior which people have learned to adopt when feeling helpless. Confrontation usually does not work well because the client will outwardly profess innocence and imminently delight in gotcha. Teaching healthier ways to express anger, get attention and get needs met they work at the client is trying to change their behavior
What are biologically-based treatment centers?
They include medication -assisted treatment are MAT's and acupuncture
REBT view of the person
Thinking and feeling are two processes but are closely linked together. Event--> Person's Thought and feelings about event--> action. A-B=C EVENT DOES NOT CAUSE ACTION! But thoughts and feelings about the event causes actions. 2. In childhood, the person is taught to think and feel certain things about him/herself, others and the world. Judgement is placed on each thing. Collection of these judgements become the persons belief system from which they experience in life. Belief systems are distorted because of irrational thinking.
Sedative, hypnotic or anxiolytic disorders
This class of substances includes all prescription sleeping medications numbers all anxiety medications. Great danger is the swift buildup of tolerance and withdrawal from the substances, often resulting in craving. Individuals in adolescence and early adulthood are the highest disorder and often engage in content and uses other substances.
Describe the substance related disorder chapter 5 continue on as represented with the diagnosis continuum
This continuum is represented by replacing distinct categories of substance abuse and dependence with 11 standard enumerated criteria for substance use disorder. Two of the three criteria must be present for the severity indicator of mild 4 to 5 for moderate and six or more for severe Additionally craving has been included as a criterion legal difficulties have been excluded as.
What are the symptoms of cannabis withdrawal
This is found the DSM-V includes physical symptoms rising after cessation of use, which is defined as daily or almost daily use for a minimum several months. It includes irritability, anger, aggression,, sleep disturbances are a few
That begin in jails and prisons therapeutic communities for drug treatment
This modality has been considered appropriate for hard-core drug users involved criminal activities. Treatment approach is not specific to any particular class of drugs. Individual dependent on any illicit drug or a combination of drugs are accepted in therapeutic communities. Characteristically, participants in therapeutic needs have experienced problems with social adjustment and conventional's family and occupational responsibilities because of drug-seeking and in some cases before initiating drug use. Therapeutic communities are often seen as the next step person continued to harass less restrictive treatment settings.
therapeutic medication for schizophrenia (short acting)
Thorazine-phenothiazines Haldol-butyrophenones Clorazil-(Clorazil) Stelazine-trifluoperazine Orap-pimozide Fluanxol-flupenthixol Largactil-chlorpromazine
Discussion meetings in AA
Those in which a member describes personal experiences and lead to discussion I topic related to recovery
There are two broad categories of treatment programs and modalities. What are they?
Those that are biologically based, and those that are behaviorally and psychologically based
Who is individual therapy most valuable for
Those with psychiatric problems for victims of abuse, individuals that have problems that cannot be understood by those in the group for example, sexual abuse and cult mind control. Those suffering with other personality disorders or even ADHD would benefit from individual counseling.
What are assumptions of new group members
To rent either dropping our disruptive behavior these expectations must explore and clarify for the client six accepted the group during the first session. During this period to decrease misunderstandings and orientation should be held before the new client reaches the group or during our session
Questions directed to individual members in group therapy
To resolve interpersonal issues such as what you feel about Mac said about not trusting you? What do you want right now? And to include members into the reaction process. What is your reaction Ted to the conflict Alan bill? How does it make you feel when I laugh at your problem?
Types of treatment approaches used in facilities
Twelve-step, individual, group, and family counseling and behavioral modification
2 x 4 programs
Two-phase approaches. The individual is hospitalized for first. For a short period of time usually two weeks. This ensures complete detoxification. This is followed by outpatient treatment. However there is the option to return to inpatient care if you're she is unable to function in less restrictive outpatient programs
Who uses inhalants?
Typically found between ages of 12 and 17 the criteria for use disorder. It is quite dangerous and can be fatal. 22% of inherent abusers who died of sudden sniffing death syndrome or cardiac arrest for first-time users. This problem afflicts children from all socioeconomic backgrounds and from families with both high and low levels of parental education
ego defenses-
Unconscious mental processes of the ego used to resolve conflict and prevent feelings of anxiety and depression. It helps keep the unacceptable thoughts and impulses from the awareness where they would have to be looked at by 1 themselves, 2. Other people 3. The counselor who will use the information to move along the progress of trx by helping the individual understand the nature of the defense mechanism.
Is marijuana withdraw in the DSM-V
Under cannabis yes
In any group counseling situation there are number of factors that allow group setting to instill change. The one therapeutic factor that seems to have the most profound effect on chemically dependent individuals is what
Universality
The Lost Child
a child who helps the family maintain balance by not causing problems. usually the youngest child. This child's role is to cause no trouble for the family. Receives little positive or negative attention from the family; needs are not attended to, no praise for achievements. Not reassured about fears. Creates a fantasy world where things are as she would like them to be. Has little interpersonal experience so makes humiliating mistakes she she goes to school causing more withdrawal. Becomes a loner who has trouble with intimacy.If she enters trx for intimacy prognosis is good. the self reliance developed in isolation is a strength. Addressing the repressed anger of being ignored, increasing self-esteem, feeling accepted and learning interpersonal skills will break the prison of isolation Without treatment the lost child looks towards leading a lonely life sometimes seeking relief in alcohol, rugs, and OTC medications
Disruptive Mood Dysregulation Disorder
a childhood disorder marked by severe recurrent temper outbursts along with a persistent irritable or angry mood. Was designed to separate it from the over diagnosis of bipolar disorder in children.
Transactional games
a complementary transaction of a short term nature, maintains the relationship at a superficial level, players hide the real meaning of the transaction. Payoff- the players gain something through the interaction, but do not gain genuine intimacy.
premenstrual dysphoric disorder (PMDD)
a condition associated with severe emotional and physical problems that are closely linked to the menstrual cycle. Added to depressive disorders
rational-emotive behavior therapy (REBT)
a confrontational cognitive therapy, developed by Albert Ellis, that vigorously challenges people's illogical, self-defeating attitudes and assumptions
reframing the situation
a good strategy to use when a client denies personal problems is reframing-offering a new and positive interpretation of negative information provided by the client. It acknowledges the validity of the clients raw observations but offers a new meaning for them. The concept of relative tolerance to alcohol provides an good opportunity for reframing. Many people do not think they have a drinking problem if they can hold their own!
client-centered therapy
a humanistic therapy, developed by Carl Rogers, in which the therapist uses techniques such as active listening within a genuine, accepting, empathic environment to facilitate clients' growth. (Also called person-centered therapy.)
Reality Therapy (we live in the present so focus on this)
a method of analysis developed by Glasser to help clients focus on the present rather than past experiences
Operant Conditioning (Skinner)
a type of learning in which behavior is strengthened if followed by a reinforcer or diminished if followed by a punisher
modeling therapy
a type of therapy characterized by watching and imitating models that demonstrate desirable behaviors. Behavioral therapy. If we had to only learn from our own behaviors.life would be laborious. People are spared needless error. It does not seem to require intrinsic reinforcement. Anticipation of a reinforcement may also make an individual more likely to perform a behavior. Learn from family, friends, teachers etc.
modeling therapy
a type of therapy characterized by watching and imitating models that demonstrate desirable behaviors/ behaviorism.
Working with unfamiliar populations
can create a limitation. (minority, religious group) COUNSELORS ARE OBLIGATED to obtain the necessary guidance and or additional training required to assure competent treatment or research related to such populations. If the counselor does not feel competent the counselor must seek consultation or give a referral. Coursework for cultural awareness or on special populations should be a must for all counseling professionals.
Substance abuse and child abuse
can occur in any social class, families of violence may also have times of extreme tenderness, alcohol and child abuse related arrests are linked, a child abuser may not have severe psychological problems but may have decreased inhibitions due to the influence of alcohol and drugs.
ACOAs
carry over into their adulthood their childhood problems related to alcohol -they need help in dealing with their feelings, -difficulty with intimate relationships -higher risk for development of alcohol/drug dependence -they continually seek approval or flaunt contempt -are either super responsible or irresponsible
authoritarian leadership style
characterized by a leader who takes charge, makes all the decisions, and dictates strategies and work tasks. Take the psychoanalytic approach. Used the educational model. It responsible for the success of the group
Responsibility of the Speaker when communicating
choose a time and a place with as few distractions as possible Request the listeners attention Organize the message and provide a brief but complete message 8 -who what where when why and how, use an appropriate level of language and define terms, Request feedback maintain eye contact erease distracting mannerisms and gestures
In the preparation stage clinicians should try to:
clarify goals of the clts goals and strategies for change discuss trx options and community resources with permission, offer expertise and advice Negotiate a change or tx plan and a behavior contract; take into consideration- 1. intensity and amount of help needed 2. Tiemframe 3. available social support, identifying who, where and when 4. Identifying sequential steps 5. problems; legal, financial, health concerns Consider and lower barriers to change by anticipating possible problems help the celit enlist social support explore trx expectancies and client role have clients publicly announce their change plans to significant others in their lives.
2 theories of behaviorism
classical conditioning, operant conditioning
Goals of Behavioral Genetics
client learns new responses to old stimulus
Interrupting-1. Talkin over 2. Cutting off
client speaks while the clinician is still speaking, without waiting for pause Cutting off-the client breaks in with words obviously intended to cut the clinician. (Now wait a minute..Ive heard ENOUGH!)
Precontempation Stage
clients not concerned with their use or not considering change. This phase may last for years. A significant other may find their behavior problematic. A counselor can gently create doubt that their use is harmless. Lea to the conviction that substance abuse is having or will have in the future.
From preparation to action
clinician should be open to clients readiness to move through the next stage. Clients recognize important discrepancies in their lives is too uncomfortable a state to remain in for long, and unless change is begun they can retreat to using defenses such as minimizing or denying to decrease their discomfort.
Transactional Analysis Child
collection of feelings, thoughts and behaviors that the individual experienced as a child (2-5 years old).
Examples of outpatient non-methadone treatment
community mental health facilities, private clinics, professional therapists in private practice (Abbey Road) professional therapists in private practice are examples of setting sin which outpatient treatment is offered.
Accurate empathy
counselor can truly understand what the client is feeling or experiencing
Limitations of therapeutic techniques
counselor should recognize boundaries and limitations of competencies and scope of practice. They should not offer services outside these limits. Working with PTSD and repressed memories have been known to cause a great deal of problems even for therapists with training. With the expansion of "addictions" therapists have been trying to use these techniques with these issues as well. Stay within your competency and scope.
Cause of the symptoms
a. Medical, psychological or both b. In needs are not being met are causing the symptoms such as Maslow's hierarchy of needs
Behavioral changes from COD medications
acceleration and retardation of motor activity.
Empathetic style of listening
acceptance of clients and their feelings nonjudgemental collaborative relationship allows you to be a supportive and knowledgeable consultant Sincerely compliments rather than denigrates listens rather than tells gently persuades, understands that the decision to change is the clients provides support throughout the recovery process
psychoactive drugs
all drugs of abuse
Drug treatment and cost
all health care costs rising, especially drug treatment. Health care coverage and reimbursement that enable consumers to use services take a variety of forms in addition to traditional coverage by private companies through client's employers. MANY states have recently mandated that coverage for SUD problems be included in insurance policies and that reimbursement occurs at a level that is reasonable and comparable to traditional health care coverage. The counselor, especially in a facility, may play a variety of roles that would require them to be familiar with the ciletns and their familiar with systems of 3rd party payers. esp. Medicaid.
What are behavioral therapy techniques good for?
altering maladaptive behavior when a reinforcement is adminstered contiguous with a desired response, when a person knows what is expected and why the reinforcement is given. GOAL= to achieve the desired response, bring them under the control and self monitoring of the individual
What is intrapersonal communication?
an inward talking to oneself It consists of all past and present experiences and feelings. Is influenced by cultural and ethnic background. And in contains goals and ideals and self-concepts, royalties, prejudices obligations and goals
punishment
any event or object that, when following a response, makes that response less likely to happen again
Dual relations
any interaction other than the client‐professional relationship. providing therapy to friends, relatives, students, and colleagues. supervisor and therapist, Socializing with clients can cause problems. It can change the ability to be objective and increasing the ability to likelihood of transferrance and countertransference.
The enabler
assumed by the person who is emotionally closest to the alcoholic, usually the spouse. The enabler provides protection that enables the alcoholic to keep drinking: 1. making excuses 2. taking over the responsibilities 3. by rescuing the alcoholic from negative consequences: initially protects out of love or loyalty later protects from habit, shame and guilt the person appears capable and strong to outsiders.
What are attending skills
attending skills develop a trusting relationship between the client and counselor. Physical attending include-being a comfortable working distance the objects act as barriers to counselor and client. The client maintaining relaxed body posture. Leaning towards a client indicating interest, making eye contact. Psychological attending skills include: observation of client screaming, posture, speed of movement and facial expressions. Is there congruency between verbal and nonverbal words and expressions. Identify feelings. Listen for the client vocalizations.. What is the tone of voice? Is it whining demanding seductive or sad? Are the recurring themes? Or feelings? Representational mode is the people perceive the world through their senses often when things become predominantly perception and this dominance is reflected in speech, hearing and touch. Such as I see what you mean right here you a feel for what you. The counselor begins to respond to the client using words with the same representation of the client understood its
Three styles of leadership
authoritarian, democratic, laissez-faire
Competency and Responsibility of the Beginner Counselor
beginner counselor are likely to be less competent, due to a lack of experience with a wide variety of trx issues. Must be aware that consultation and clinical supervision is there to help them adequately treat clients versus when co-therapy ore referral is required. This is important if the counselor working with the client is an intern or counselor in training. In many states clients must be informed in the beginning of the session
implosive therapy
behavioral therapy a type of counterconditioning that has the client imagine the most anxiety inducing thing first, in the hopes that they will realize that their fear is irrational. they are Type A therapies to treat anxiety based on extinction Behavioral therapy.. Type A therapies that focus on modifying affect. Hypnosis or drugs may be used to enhance this experience in a safe setting. If a person is afraid of drowning..they may be suggested to imagine that they actually Are drowning AKA in vitro desensitization.
Competing Reinforcement
behaviors that win out over substance abuse over time. Doing volunteer work, connecting with socially acceptable friends, improving their self efficacy, becoming involved in 12 step based activities, setting goals to improve their work, education, exercise, and nutrition. Spending more time with their families and significant others. Participating in spiritual or cultural activities, socializing with nonsubstance using friends, earning new skills or improving in such areas as sports, art, music and other hobbies.
True feelings of the Hero
beneath the facade the hero is angry. She has tried hard, but no one really apprecieated the effort in an acceptable way. When she gets tired of trying, leaves the family in an acceptable way; -joins the military -goes off to college (ME) -gets married (ME) -takes a job in a distant city Heros are perfectionists and without help may become; workaholics, abusers of prescription medication, the next generation of enablers. (OUCH)
other side effects of antipsychotic meds
blurred vision, sexual dysfunction, constipation, diminished enthusiasm, dizziness, drowsiness, dry mouth, low BP, muscle rigidity, nasal congestion, restlessness, sensitivity to bright lights, slurred speech , upset stomach, weight gain.
DSM-V (Diagnostic and Statistical Manual of Mental Disorders)
World standard reference for client evaluation and diagnosis. The manual allows professional counselors to break down the complexity of clients presenting problems and practical language for practitioners and clients alike. Sometimes referred to as the psychiatric Bible. DSM is intended to be applicable in various settings and used by mental health practitioners and researchers of different backgrounds and orientations. The DSM is prevalent by professional counselors who provide services and mental her health centers, psychiatric hospitals, employee assistance programs, tension centers, private practice, or other community settings must be well-versed in client conceptualization" diagnostic assessment using the manual. For those in private practice, agencies and hospitals a diagnosis using DSM-V criteria as are necessary for third-party payment and for certain types of recordkeeping and reporting. Even professionals are not traditionally responsible for diagnosing such a score career counselor should understand the offense of a recognized eight diagnostic problems or complaints and participate in discussions and treatment regarding these issues.
Leadership styles in group therapy
Year she may choose to remain an uninvolved observer little disclosure. Here she may actively participate in a group with a lot of self-disclosure. No matter how much leader shares he or she still has a role of leader. He or she will never be truly just another member
Is creating a criterion
Yes
Our alcohol use and criminal activity linked
Yes without to 40% of state prisoners reporting that they were under the influence of alcohol during commission of a crime for which they were incarcerated. Genetic factors can contribute to alcohol craving which makes certain individuals particularly bottles of alcohol use disorders since craving often exists after cessation of alcohol use.
Inpatient or outpatient care for detox
You are very findings regarding the Portland inpatient were outpatient care. Inpatient care is clearly necessary when the individual is associated psychiatric or medical problems. Because of the potential for life-threatening withdrawal symptoms, alcohol detoxification option takes place in a hospital or other medical facility. Patient retention and detoxification programs also significantly greater and inpatient programs impart outpatient care. What are some research findings are merging into the outpatient alcohol intoxication is beneficial and adjacent is much more cost-effective.
interpersonal relationships and conflictual situations
counselors duty to other professionals when situations arise that may cause conflict. Arises where trx is sought from a counselor but the client is already in similar therapy with another MH professional. The client has the right to choose which professional to work with. Principle 10a stipulates that the SUDC counselor should not offer services except with the knowledge of other professional or after the termination of the clients relationship with the other professionals. If the client wants to change who they seek help from they must tell the other counselor directly. If they will not agree to this course of action..the counselor should ask the client to contact the other professional and discuss the problem. The two counselors should either work together or not offer svs if the client is unwilling to take steps to terminate the other relationship
Extinction (operant conditioning)
decreases in the frequency of a behavior when the behavior is no longer reinforced. A particular behavior is weakened by the consequences of not experiencing a positive condition or stopping a negative condition.
Drugs have been used to counteract cocaine withdrawal problems
desipramine hydrochloride; amantadine, bromocriptine, flupenthixol, finally, BUPRENOPHINE
Therapeutic effects of medication
desired effect of medication that may help with recovery such as anxiolytics and antidepressents, antipsychotics, etc.
how to increase clients participation in treatment
develop a nurturing rapport with clients induct clients into their role in the trx process explore what clt expects from trx and determine discrepancies prepare the client so that they know that something embarrassing, emotionally awkward and uncomfortable moments but that such moments are a normal part of the recovery process. investigate barriers of treatment investigate congruence between intrinsic and extrinsic motivation Explore noncompliance in the context of ambivalence reach out to demonstrate continuing personal concern and interest to encourage clients to remain in the program.
displacement reaction
discomfort is created by one person but ther is too much anxiety to talk directly with the person, so the individual take out their feelings on someone or something less threatening.
Summarize
distilling the essence of what a client has expressed and communicating it back. It reinforces what has been said , show that you have been listening carefully, and prepare the client to move on. It is a good way to begin and end each counseling session and to provide a natural bridge when the client is transitioning between stages of change. It helps guide where the session should start, what to minimize or left out. It helps to consider their own responses and experiences. It gives the session an opportunity to notice what might have been overlooked.
Violence in alcoholic families
does not effect only one member, child abuse often related to spousal abuse, wifes are often the recipient of serious injury
nonpsychoactive pharmacotherapy
don't cause psychomotor effects or euphoria, may at high doses. azapirones (buspirone), amino acids, beta blockers, antidepressants, monoamine oxidase inhibitors, antipsychotics, lithium, antihistamines, anticonvulsants, and anticholinergic
psychotropic medications
drugs that mainly affect the brain and reduce many symptoms of mental dysfunctioning
Agonists
drugs which mimic the activity of neurotransmitters. It can be substituted for the drug abuse to provide more controllable form of addiction. Properties and actions of these drugs are similar to those in particular abuse drugs. Using alleviates many of the withdrawal symptoms and often experienced by persons addicted to various psychoactive substances. Examples include methadone, and clonidine
The intervention
each family member reads his or her list that was rehearsed during the preparation -the alcoholic hears detail after detail of how their behavior has harmed the people he/she loves. So it it is difficult to maintain denial. -The leader of the confrontation proposes a treatment plan that the family has agreed to. If the intervention is well prepared and the family has made some recovery before the confrontation, there is a greater than 75% chance that the intervention will be a success. In some cases the alcoholic will cling to denial in the face of all the evidence.
empathic motivational interviewing
establishes a safe and open env. that is conducive to examine issues and eliciting personal reasons and methods for change. Understanding the clients unique perspective, feelings and values.
From contemplation to preparation
external and internal motivators must be considered -help client to determine the internal motivators that are more motivating towards change -help the clients to weigh the negative aspects of substance us so that the scale tips toward beneficial behavior 1. summarize concerns 2. explore pros and cons of substance use behavior 3. Normalize the clients ambivalence 4. Reintroduce feedback from previous assessments Examine the clients understand of change and expectations of trx reexplore the clients values in relation to change.
Medicaid
federal and state govt funded, means tested program that provides payment for medical and hospital services to people who cannot afford them. usually MANAGED through local public assistance offices. If the person has SSI they may qualify and be helped with applications for Medicaid at Social security offices.
founder of gestalt theory
frederick perls with the Polsters
Who usually reaches out for help in an intervention?
frequently, it is the enabler, hero, or an outside friend. The person needs to be assured that breaking the family rule of silence is a good thing. It is a healthy and loving thing to do.
Columbo Approach
good for clients who like to be in control. Clinician expresses understanding and continuously seeks clarification of the clients problems but appears unable to perceive any solution. Any stance of uncertainty or confusion can motivate the client to take control of the situation. by offering solutions to the clinician.
Laissez-faire leadership styles.
hands off approach. Leader acts as a member of the group. Leaderless. Communiation flows among the members. Used by leader who is ; Uncomfortable leadership role, is imitating a Tavistock model in which group members stand for themselves and a process come to terms regarding issues and other childhood issues, frequently this type of group is unproductive because the group has no guided through the development stages with the exception of the unproductive is Tavistock workshops for individuals who are prepared for leadership or leaderless approaches
What to do when a counselor is informed about domestic physical abuse of the clients children?
he or she has a legal obligation to inform the appropriate state or social service agencies.
How do we help clients maintain change?
help the client identify and sample substance free sources of pleasure ie new reinforcers support lifestyle changes affirm the clients resolve and self efficacy help the client practice and use new coping strategies to avoid a return to substance use. Maintain supportive contact.
Roles of counselors with medicaid
helping clients and their families make care related decisions by interpreting info for them, making social and environmental changes to ensure that the patient continues to receive the servs they need, case mngmt which would require the counselor have the ability of following utilizations requirements for reimbursement.
Reality Therapy Goal of therapy?
helping the individual get back in touch with objective and moral reality by making responsible choices.
Homework
helps clients to : 1. practice new behavior 2. Gain insight into old behavior by recording it as it occurs 3. be exposed to new concepts by reading 4 Become part of a self-help group by attending meetings
Psychodynamic
how behavior springs from unconscious drives and conflicts
in-vitro sensitization
implosion therapy
two techniques that rely on principles of extinction
implosive therapy and flooding
Reinforcement
in operant conditioning, any event that strengthens the behavior it follows
diabetes mellitus
insulin is not secreted adequately or tissues are resistant to its effects. Associated with atypical neuroleptics, excessive thirst, headaches, frequent urination, healing slowly, fatique.
Goal of therapy for Gestalt Therapy-
integration of experiences into a whole personality.
behaviorists theory
intersted only in observable behavior, not clients inner being. All people are subject to conditioning. Conditioning is learning a particular response to a certain stimulus.
tardive dyskinesia
involuntary movements of the facial muscles, tongue, and limbs; a possible neurotoxic side effect of long-term use of antipsychotic drugs that target certain dopamine receptors. More often seen in women, Risk increases with age and length of use.
Outpatient non-methadone treatment
involve trained professionals working with addicted persons to achieve and maintain abstinence while living in the community
Express empathy in Motivational Intervewing
is a specifiable and learnable skill for understanding another's meaning through the use of reflective listening. Sharp attention to what a client says, and continual generation of hypotheses as to the underlying meaning.
Im OK-youre ok
is the result of the child receiving enough nurturing and having developed trust. Person is able to feel good about themselves and others and form successful relationships. Has some conscious awareness that others do not.
Motivational Interviewing (MI) and coerced clients
it can be a challenge to engage coerced clients. It cannot be maintained by external pressure only. Motivation must come from internal forces. Provide intervention that is appropriate for their stage so that they may become invested in change.
Complimentary transaction states
it can be complimentary-sender gives a message in one ego state and it is received by the receiver in the same ego state. "Where are the forms Jane?" "In the drawer to the left"
acupuncture and drug treatment
it is a biological drug treatment. addiction represents an adaptation of the CNS activity in response to chronic drug administration, resulting in withdrawal sx. when drugs are discontinued. Acupuncture involves placing needles in a strategic body point usually outer ear. Treatment generally last for five minutes and are administered daily for the first few weeks and then they are decreased. Usually help for detoxification. Report is reduction in the draw symptoms and physical cravings for drug and alcohol. Acupuncture treatment is combined with comprehensive treatment approach including counseling, drug testing and other interventions. Advantages include low cost and lack of waiting lists. Transcutaneous electrical nerve stimulation portends produce similar results but uses a different technology both therapeutic technique can revive physiological reproductive toxicity for the potential for abuse that the inherent use of medications
Electric shock with alcoholism
it is aversion therapy. Behaviorism. Electri shocks to alcoholics in association with the sight, smell and taste of alcohol. Since the 1930's aversion therapy has been used with a wide range of maladaptive behaviors such as smoking, drinking, overeating, drug dependence, gambling, sexual varients, and bizarre psychotic behavior.
advice giving and counseling
it is helpful to offers more than one solution so if the client chooses to follow the advice, there is still some shared client responsibility.
INtervention CAN work if:
it is prepared for carefully under the guidance of a trained person, it is conducted in a loving, honest, and non-hostile manner There is a trx system in place that will accept the client The family is committed to recovery and will continue trx for themselves regardless of the outcome of the intervention.
common areas that clients will argue about
labels="alcoholic", "drug abuser". The label is NOT IMPORTANT! There is no reason why the therapist should badger cients to accept a label or exert great persuasive effort in this direction. accusing a client of being in denial or resistant or addicted is more likely to increase their resistance than to instill motivation for change. We advocate starting with their clients wherever they are, and altering their self-perception not by arguing about labels. Using this label is a personal decision. I do not label myself as a diabetic..but a Person with a disease of diabetes. I am not an alcoholic..but someone who struggles with a disease of addiction. I find that this works better for change.
Claudia black-the adjuster
learns to get along by denying that trouble some events bother them. Does not think or feel. does not draw attention to themselves just gets by. . frequently lacks direction a sense of responsibility or personal power, and stable relationship or work history. Seeks out chaos and chooses to remain ignorant of feelings.
Bipolar medication for treating depression
lithium(eskalith, carbolith, Cibalith, Duralith, Lithane, Lithazine, Lithobid, lithonate, lithotabs) eg..has LITH in the NAME, Carbamazepine (epitol, tegretol) lamotrigine (lamactal) fluoxetine (Prozac), ilmipramine (Janimine, tofranil), tranylcypromine (Parnate)
behavioral therapy
long history. Was not used therapeutically until 1960s due to prevalence of psychoanalysis. Strikingly demonstrated in dealing with a wide variety of manipulative behaviors and literally thousands of research publications have dealt with the systematic application of change principles to modify maladaptive behaviors Instead of exploring past traumatic events or inner conflicts to bring about personality change, they attempt to modify behavior directly by extinguishing or counter conditioning maladaptive reactions. such as anxiety, by manipulating environmental contigencies-reward, suspension of reward, punishment. Personality does not exist except in the form of modifiable behaviors. . Good when the other knows what the desired response s and what is expected, and why reinforcement is given. Ultimate goal is not only to achieve the desired response but to bring them under control and self-monitoring of the individual.
The person in behavioristic perspective
maladjusted person is seen as differing from other people on in they have failed to acquire competencies needed or coping with the problems of living, learned faulty reactions or coping patterns that are being maintained by some kind of reinforcement or both. They define the precise maladaptive behaviors to be modified and the adaptive behaviors to be achieved, learning procedures and and principles to be used.
Self efficacy
many clients do not have a well developed sense of self efficacy and fin it difficult to believe that they can begin or maintain behavioral change. Requires; eliciting and supporting hope, optimism, and the feasibility of accomplishing change. Recognize the client strengths. you must believe that the client can change. Tell them how similar clients have succeeded. They can use this as role models. Education can increase self-efficacy, credible, understandable, and accurate information helps clients understand how substance use progresses to abuse and dependency. Knowing the biology of addiction helps with resistance because it reduces shame and guilt. a difficult thing can be turned into little achievable steps.
additional treatment with COD
many require medications to help with other conditions. It helps stabilize the client during trx. Psychiatric medication is often Rx'ed based upon a thorough evaluation and results, subsequent review and re-evaluation of the case.
How do you develop discrepancy?
motivation for change is enhanced when clients perceive discrepancies between their current situation and their hopes for the future. Task is to help focus your clients attention on how current behavior differs from ideal or desired behavior. It is highlighted by raising your clients awareness of the negative personal, familial, or community consequences of a problem behavior and helping them confront the substance use that contributed to the consequences. SEPARATE BEHAVIOR FROM THE PERSON! Emphasize personal goals. Understand consequences of current behavior and how they deviate from desired outcomes. values. Use concern about this discrepancy to highlight the perception of discrepancy.
Does everyone use drugs need treatment
no, most do not.
Does empathy mean IDENTIFYING with the client?
no. This will actually compromise treatment.
psychoactive potential
not all psychiatric medications are psychoactive. Psychoactive meds have the ability cause acute psychomotor effects, and a relatively rapid change in mood or thought. Changes in mood include stimulation, sedation, and euphoria. Thoughts may include; disordering of thoughts, delusions, hallucinations, and illusions.
Can a counselor have a sexual relationship with a former patient?
not clearly prohibited by legal or ethical provisions, but are questionable for several reasons; it is difficult to tell when a client is actually terminated, do both parties have an equal voice in determining the direction a relationship takes.
Suboxone (buprenorphine/naloxone)
opioid analgesic and opioid antagonist combination. must be done with a specific doctor.
TEFRA Tax equity and Fiscal Responsibility Act of 1982
part of Medicaid. allowed states to charge persons receiving Medicaid benefits small copayments for some required and optional services. Exceptions include; emergency services, categorically needy minors, svs to the categorically needy in skilled nursing or intermediate care facilities or enrolled in HMOs
Siding with the negative
part of adapting with resistance. to take up the negative voice in the discussion. It is not reverse psychology. It is a therapeutic paradox. starts with stating what the client just said. Because if you side with resistance you get YES, BUT statements. " you have said that it is too difficult for you to change" So I am not sure you could change if you wanted to.
What is vicarious learning?
people learn about the consequences of an action by observing whether the behavior is reinforced or punished
The roles are forced on the family member and based upon:
position in position in the family, gender, age, birth order, ethnic custom, social class
Systematic desensitization can be used with which type of behavior?
positively or negatively reinforced behaviors.
What are the stages of change?
precontemplation, contemplation, preparation, action, maintenance
goal of therapy (Client-centered theory)
provide trusting atmosphere for client to self-direct growth and tap his own "vast resources", - evidence of growth includes a congruent self-concept, positive self-regard, internal locus-of-evaluation, and willingness to experience. Self acceptance and self-discovery creates self healing.
open-ended questions
questions that allow respondents to answer however they want. but without yes no answers
contingency of reinforcement
relationship between relation, operant class, and consequence. to further maintain these new behaviors voucher programs have proven to be effective when community support and resources are available. These sustain abstinence. Not all contingent incentives have to have a monetary value. In many cultures, money is not the greatest reinforcer.
list of defense mechanisms
repression, suppression, regression, reaction formation, projection, rationalization, displacement, sublimation
Rolling with Resistance (Motivational Interviewing)
resistance is a predictor of poor trx outcomes and lack involvement in the therapeutic process. One view is that the client is being DEFIANT. However, resistance is a signal that the client views the situation differently. And it is an opportunity to view the situation from their perspective. It gives an opportunity to respond in a new, surprising way to take advantage of the situation without being confrontational. Adjust to resistance. It is similar to avoiding arguments because it gives another opportunity to give empathy. Instead, divert the clients energy towards a positive change.
What is probing
seeking additional information from a speaker by asking questions
Losses from substance use
self-respect, respect by others, loss of an important relationship, promotions, career advancement, job and health
Client progress Notes
should regularly reflect attention being paid to the areas outlined in the trx plan. -documentation of progress and struggles in these specific areas should be noted.
Reinforcement potential
some drugs promote reinforcement. Or the increased likelihood of repeated use. It can occur by removal of negative symptoms or conditions or the amplification of positive symptoms or states. Example; self medication that delays or presents an unpleasant event such as withdrawal from occurring is a reinforcer. Example....benzodiazepine prevent withdrawal potential so it increases the likelihood of continued use. Positive reinforcement involves strengthening the possibility that a certain behavior will be repeated through reward and satisfaction ( drug induced euphoria) or drug induced feelings of well being. ie mild to moderate doses of opioids and stimulants.
Example of positive punishment
spanking, parking ticket
what are the benefits of HMO's?
staff, records, and facilities are more centralized. The following advantages of HMO's include; 1. they reduce the cost of health care by relying less on hospitalization, 2. they rely more on ambulatory and preventative svs by offering increased access to primary care 3. because of higher quality, continuity of care is improved and less unneeded surgery is performed, 4. they make productive use of auxiliary health professionals.
bromocriptine
stop cravings and relapse
desipramine
stop cravings and relapse
Claudia Blacks' acting out child
the child draws negative attn to himself though behavior such as delingquincy, feels angry, as adult continues to get involved in conflicts and chemical abuse.
Who is responsible for putting their life back together without alcohol and drugs.
the client
withdrawal
the discomfort and distress that follow discontinuing the use of an addictive drug. Clients attempts to avoid withdrawal syndromes often lead them to use additional drugs or continue use. Drugs that have increased tolerance and withdrawal potential have a greater risk for abuse and addiction
goal setting
the process of establishing desired results that guide and direct behavior. Goals are broken down into smaller steps that are now overwhelming. Goals are specific and measurable. Goals are realistic and healthy. They are re-invented periodically to make sure they are still what the client wants.
Problem Solving
the process of finding solutions to difficult or complex issues.
Ambivalence
the state of having contradictory or conflicting emotional attitudes. Individuals with substance abuse disorders are usually aware of the dangers of the substance using behavior the continued use substances anyway. They may want to start using substances but the same time they do not want to. Enter treatment programs that run the program the problems are not all that serious.Ambivalence euros can be characterized as ambivalence and they are natural, regardless of the honesty and readiness. It is important to understand and accept your plants and then learns because ambivalence is often the central problem-a lack of motivation in a manifestation of the sentiments. If you and your current temperate and in length and denial or resistance friction between you and your client tends to occur.
Behaviorism
the view that psychology (1) should be an objective science that (2) studies behavior without reference to mental processes. Most research psychologists today agree with (1) but not with (2).
When do you terminate counseling?
there is no clear time to terminate because the ideal of a client resolving all problems usually does not happen. Client behaviors that indicate whether it is time to terminate or not include: -saying they want to end therapy -saying they have made a lot of progress -feelings of loss at the approaching end of the relationship -bringing back old, unproductive behavior so counseling wont end -creating new problems so counseling wont end
Why antidepressants and antipsychotics help without psychoactive effects
they can produce mild relaxing or energizing effects without Euphoria. They CAN be abused so they still need to be monitored.
How does the enabler feel?
tired, resentful, worried, suffering from low self-esteem, obsessed with alcohol, feeling helpless, grat risk of developing physical illness, greater risk of depression, greater risk of being chemically dependent, greater risk of having problems with co-workers. They hold the key to family recovery although they may not feel so. . Once the enabler stops protecting the user and forces them to face the negative consequences of drinking, the pain may be intense enough to cause the alcoholic to seek recovery.
Goals of Counseling
to help clients accept and admit that alcohol/drugs are a problem and that they need help to stop using Acceptance is the most important issue in early trx -if the client maintains his her denial that chemicals are not the problem then it is difficult to make progress in counseling -To determine the necessity for medical trx A. alcohol and drug dependence can be both psychological and physical B. the counselor must accurately assess whether the client has reached the stage of physical dependence -important for unsupervised withdrawal is dangerous. It is necessary to refer to inpatient trx if physical dependence is determined. -if no physical dependence is determined The client is maintained in outpatient trx. 4. to help client accept that they cannot use alcohol and drugs-in order to prevent the reactivation of the dependence cycle. Help client reorganize their life without alcohol and drugs -client must accept responsibility for putting his or her life back together without alcohol and drugs.
Tolerance and withdrawal in opioids
tolerance and withdrawal are common evident criteria. Babies born to mothers who have opioid during their pregnancy can be born physiological dependent. Severity of negative health effects underscores the need for early and effective interventions for opioid users.
What is the goal of intervention?
treatment
aversion therapy
treatment that uses punishment to decrease the frequency of undesirable behaviors
psychotherapeutic drugs for Monopolar depression
tricyclic antideppresents-(Tofranil, Elavil) MAO inhibitors (Nardil, parnate) SSRI's ( Prozac, Luvox, Paxil, Celexa, Lexapro) Trazadone (Desyrel) Bupropian (Wellbutrin)
Recent use of ECT therapy
use as an aversive stimulus has generally diminished in recent years. because of the ethical image problesm involved in its use and because the new behaviors do not generalize to other settings. . Less dangerous and more effective procedures have been found. Method of choice today is probably differential reinforcement of other responses.
Systematic use of reinforcement
use of reinforcement to elicit and maintian effective behavior have acheived notable success, especially in institutional settings.
Lithium (Eskalith, Lithobid)
used as a mood stabilizer in patients with bipolar manic depressive disorder. mechanism of action is not understood but influence on electrical conductivity can result in adverse effects and toxicity. has a low therapeutic index. adverse effects include tremor, ataxia, confusion, convulsions, nausea, vomiting, diarrhea, arrhythmias, poly-uria/dipsia, edema, goiter, and hypothyroidism. Does not work immediately. It is NOT psychoactive or mood altering. But MOOD stabilizers.
Claudia black-responsible one
usually the oldest child. , take responsibility for making the family ruan as smoothly as possible. Takes over household chores, directs the activity of younger children, Learns to set realistic short term goals, Joins only structured activities. As an adult, very responsible, frequently a leader. has learned not to trust others or depend on them feels it is betterto do it themselves. Does not know how to trust, become intimate, and have fun. often is tense, anxious, fearful, lonely and depressed.
When do you cease the therapy session of systematic desensitization?
where the client reports extreme anxiety. It picks up next session at a stage before it left off. It is finished when the moment of stress is approached and feels comfortable with and can cope with these emotions.
Secular Organization for Sobriety
(SOS): a 12-step self-help group for agnostics and atheists. It uses the scientific method to understand alcoholism.
What does universality do
Helps eliminate isolation and perhaps demoralization the individual is feeling
Yalom's writings suggest that the most successful group leaders show what/
High caring level, high meaning attribution level, moderate emotional stimulation level, moderate executie function level.
Who is the highest prevalence of alcohol use disorders and the lowest
Highest prevalence is Native Americans and Alaska natives at 12.1% hello is among Asian Americans and Pacific Islanders and 4.5%. Age of onset peaks in late teens and most individuals will develop use disorders do so by their late 30s
Recent FDA regulation states that methadone can be used for detoxification for up to how many days
Hundred and 80
What is the purpose of communication
inform, persuade, entertain
What section of the DSM-V's pathological gambling listed under
now under addictions
How effective is motivational interviewing?
of 11 studies, 9 have shown that MI is more effective then no trx, standard care, extended trx, or being in a waiting list before receiving an intervention.
When a crisis naturally occurs
offers an opportunity as an indirect cry for help that will eventually focus on alcoholism.
What does the ego do?
mediates between the impulses of the id and the demands of the superego. If this becomes too great for the ego to handle; defense mechanisms are used.
false alarm- flooding
modified form of flooding that involves repeated exposure to the somatic cues that in fact trigger full blown anxiety attacks. It is part of treatment for panic disorders. It teaches clients to self induce their false alarms repeatedly. It was shown to be better than Xanax.
Drugs that immediately reinforce a feeling of well being
more likely to lead to psychiatric or substance use problems.
Additives, have knives or anxiolytics are prescribed for specific medical practices and medication is taken as prescribed individual meet the criteria for the use disorder
no
Systematic desensitization involves
pairing a feared stimulus with a state of deep relaxation by being exposed to feared situations in a gradual hierarchical fashion
What does the ID seek?
pleasure
Negatively reinforced behaviors
reinforced by the successful avoidance of a painful situation. Individuals with negatively reinforced maladaptive behavior becomes anxious and withdraws at the first sign of the painful situation they never get the chance to find out whether the expected aversion consequences do in fact come about. The avoidance is anxiety reducing so it is reinforced.
Tolerance
the diminishing effect with regular use of the same dose of a drug, requiring the user to take larger and larger doses before experiencing the drug's effect. It prompts larger use.
ego
the largely conscious, "executive" part of personality that, according to Freud, mediates among the demands of the id, superego, and reality. The ego operates on the reality principle, satisfying the id's desires in ways that will realistically bring pleasure rather than pain.
democratic leadership style
the leader is viewed as a facilitator. Communication flows both ways. Takes a humanistic approach. Leader shares responsibility with members for the direction of the group and success of the group.
Using medications during SUD trx
striking a balance between therapeutic and detrimental effects. For example, diazepam is helpful for coming off the effects of alcohol. However, sedation and physical dependency is a real problem. Just as Disulfiram(Antabuse) is therapeutic for Alcohol dependence it also is harsh on the liver.
How to reveal discrepency
talking, a video that is discussed and compare their life with the video. Developing the awareness of consequences helps clients examine their behavior. A discrepancy between present behavior and important goals motivates change The clients should present the arguments for change Ethnic views can shape what is viewed as a discrepancy to what is valued. e.g. African-American may view addiction as "chemical slavery" which may conflict with their ethnic pride and improve desire to overcome
The goal of REBT is to:
teach a client to analyze their belief system and correct the irrational distortions.
positive punishment
the administration of a stimulus to decrease the probability of a behavior's recurring
How an intervention might go.
the alcoholic may accept without argument They may decide that they want to do it their way. It is almost impossible to stop drinking without professional help (according to this book), Before the family members agree to "my way" they clearly state that if the alcoholic takes just one drink then he will go the trx facility the family is requesting.
What is self-efficacy?
the belief that one can master a situation and produce favorable outcomes. It is not a global measure. It is behavior specific. It is the clients optimism that they can take action to change substance use behaviors.
Common side effects for medication for COD meds
1. Tardive dyskinesia 2. Neuroleptic malignant syndrome 3. Diabetes mellitus
When was Narcotics Anonymous developed
1970s
Focus on early counseling
becoming clean and sober and staying clean and sober and tell them that urges to use are normal
What is aversive conditioning
Aversive conditioning is an example providing negative rewards to extinguish, to behaviors. Unpleasant stimuli such as chemically or hypnotically induced nausea or paralysis, electric shock or noxious imagery are paired with the site smell and taste of the abuse drugs. Programs using this approach and claimed high rates of success. However research studies often have been flawed about studies have found inconsistent results.
When does treatment began
After detox
What are the two dynamics of communication?
Intrapersonal and interpersonal
Transactional Analysis Adult
Our ability to think and determine action for ourselves, based on received data. Processed without distortion. Rationally and reality oriented. Similar to Freud's ego. Not influenced by the past. *Thought* concept of life
What is the execution function of leaders and group therapy
Sets time limits, time management, and interceding
What is attentive listening
The purpose is to truly hear and understand the speaker and help the speaker feel valued open up more involves no commenting from the listener and eye contact appropriate facial expression
What does the Superego seek?
What it has been taught is right
Medications for panic attack
Xanax-alprazolam
Is caffeine withdrawn the DSM-V
Yes
classical conditioning (Pavlovian conditioning)
a learning process that occurs when two stimuli are repeatedly paired; a response that is at first elicited by the second stimulus is eventually elicited by the first stimulus alone.
Unspecified Disorder
allows SW option to forgo specification
Six or more criteria indicate what severity index
severe
Three Stages of Drug/Alcohol Counseling
1) Medical/Physical Intervention 2) Psychosocial Rehabilitation 3) Aftercare
Three types of arguing
Challenging, discounting hostility
Closed AA meetings
For AA members and prospective members only
Speaker meetings in aa
Members who describe their experiences with alcohol in recovery
Is polysubstance dependence in the DSM-V
No
Psychoanalytic stages
Oral Stage Anal Stage Phallic Latency Puberty
Who is the Founder of Reality Therapy?
William Glasser
What is the "transaction" in transactional analysis?
ego states that interact with the ego states of another person.
3 parts of arguing
1. Challenging. -the accuracy of what counselor says 2. Discounting--the clinicians personal authority and expertise 3. Hostility-the client expresses direct hostility toward the clinician
naltrexone
use for reducing withrawal and relapse
Best way to approach resistance
with non resistance
Client centered therapy techniques
if the therapist provides the right environment the client will achieve congruence between self and experience the right environment is provided by furnishing three facilitative conditions • unconditional positive regard (the therapist genuinely cares about the client and affirms the client's worth as a person) • accurate empathetic understanding (the therapist has the ability to see the world as the client does and conveys that understanding to the client) • congruence ( the therapist must be genuine in therapy) therapy is non-directive and client-centered clients are the experts of their own inner processes Nonjudgemental, does not interpret but reflects thoughts back.
"Five types of problematic client defense mechanism
1- client does nt believe she can relate to other members 2-the quick thinker is valued in society but if they refused to from thoughts to feelings he will not grow 3. Client enjoys irritating others 4. Client brings confusion to the group 5. At times the client will arrive at an alcoholic and drug group intoxicated
Three main categories of abuse substances the often require detoxification
1. Alcohol and other central nervous system depressants 2. Opiates 3. Cocaine
Motivational interviewing is accounting style based on what following assumptions
1. Ambivalence about substance use and change is normal and constitutes an important motivation obstacle in recovery Ambivilance can be resolved by working with your clients intrinsic motivations and values the alliance between you and your client is a collaborative partnership to which you bring important expertise and aesthetics supported yet directed counseling style provides conditions under which change can occur. Direct argument and aggressive compensation may tend to increase clients defensiveness and reduce the likelihood of behavioral change.
There are seven features of an empathic style in MI
1. Communicate respect for and acceptance of claims of clients and feelings 2. Encourages a nonjudgmental, collaborative relationship 3. Allows you to be supportive and knowledgeable consultant 4. Sincerely complements rather than denigrates 5. Gently persuades the understanding that the decision to change clients 6. Provide support through the recovery process Empathic motivational interviewing establishes a safe and open environment that is conducive to designing issues and eliciting personal reasons and methods for change. Component of motivational interviewing is understanding each client's unique perspective, hearings, and values. Your attitude should be one of acceptance but not necessarily approval or agreement recognizing the ambivalence that change is to be expected. Motivational interviewing is most successful when a trusting relationship is established to me and your clients
5 principles of motivational interviewing
1. Express empathy 2. Develop discrepancy 3. Avoid argumentation 4. Roll with resistance 5. Support self-efficacy
4 parts of rolling with resistance
1. Momentum can be used to good advantage 2. Perceptions can be shifted 3. New perspectives are invited but not imposed 4. The client is valuable resources in finding solutions to problems.
negative punishment
A response behavior is followed immediately by the removal of a stimulus (or a decrease in the intensity of the stimulus), that decreases the future frequency of similar responses under similar conditions. Taking tv away
Transactional Analysis
Eric Berne believes that people operate in three ego states and that awareness is an important first step in changing our ways of thinking, feeling, and behaving. Three basic needs are stimulus, recognition, and structure.
The following can signal a clients readiness to change;
1. clients resistance changes 2. client asks fewer questions about the problem 3. client shows a certain amount of resolve and may be more peaceful ,calm, relaxed, unburdened, or settled. 4. clt makes direct self motivational statements reflecting openness to change an optimism. 5. client asks more questions about change 6. Clt talks about how life would be after the change 7. clt may have begun experimenting with possible change approaches such as going to AA meetings or stopping substance use for a few days.
4 types of Motivational statements
1. cognitive recognition of the problem 2. affective expression of concern about the perceived problem (Im really worried about.....) 3. A direct or implicit intention to change behavior (Ive got to do something about this) 4. Optimism about one's ability to change. Making affirming gestures is helpful by reflecting, nodding, making approved facial expressions. You can explore by asking to elaborate, give explicit examples, more details about remaining concerns.
Parts of an intervention
1. discuss the cause of the intervention, list of important people In the alcoholics life who have seen the effects of the substance of abuse, it is decided who would be willing to participate in a confrontation. Meeting is arranged with the counselor and those who are willing to participate. The counselor provides more information on chemical dependency and the intervention process. The counselor can assess the family's damage.
Things to watch out for when clients are taking medication for COD's.
1.medication compliance, 2. abuse and addiction potential, 3. Substance use disorder relapse 4. Psychiatric disorder relapse.
Detoxification cocaine
Cocaine dependence results in a period of physical and mental instability con discontinuation of use. Usual powder cocaine use involves binges or runs that last 12-36 hours. Usually lasting several days which no cocaine is used in detoxification occurs after a person consumes all the cocaine available.
Specifiers for depressive and bipolar disorders
Added features include catatonia, with anxious distress, mixed features. They are intended to account for experience is often comorbid comorbid with mood disorders yet not part of standard criteria
section for internet gaming dsm 5
As listed in section 3 of the DSM-V under the chapter conditions for further study may be added as an addictive disorder to subsequent generations of the manual. Other types of behavior of action such as exercise, shopping or sex addiction have not yet been shown to identify a diagnostic profile or similar development course.
Example combined setting treatment
2 x 4 programs, day or partial hospitalization, halfway houses, sober living houses
How is cocaine use and what are the signs and symptoms
Cocaine is often taken a powdery substance which is snorted to the nose. This can result in frequent nosebleeds, sores in the nose and even erosion in eating away at the nasal septum what instruction it separates to nostrils overdosing
Contemplation stage of change
2nd stage - aware of problem, thinking about making a change
How long does systematic desensitization last?
30 minute intervals. May be 2-3 times per week. It may take a couple of weeks to a couple of months
AXIS 4 psychosocial and environmental stressors
Code or ICD 10 CMC codes using a V code with special notations for psychosocial and contextual factors. An expanded list of the codes has been provided in the DSM-V. In rare cases where psychosocial and contextual factors are not listed, counselors can include a specific factor as it relates to the client diagnosis
Smart recovery is based on what theory
Cognitive behavioral psychotherapy especially rationally emotive behavioral therapy
tool for developing discrepancy in MI?
Columbo approach
How do we send effective messages?
: Speaker first person I. Send complete and specific messages. Verbal and nonverbal messages congruent our matching because the nonverbal will be believed over the verbal if they are not congruent. Ask for feedback and questions. Tailor the message to the receiver. Describe feelings to reduce ambiguity. describe other people's behaviors that judging or interpreting
flooding therapy
A behavioral treatment for phobias that involves prolonged exposure to a feared stimulus, thereby providing maximal opportunity for the conditioned fear response to be extinguished. It is repeated exposure to real life anxiety arousing situations. (behavioral therapy)
humanistic psychology
A clinical viewpoint emphasizing human ability, growth, potential, and free will.
Medicare
A federal program of health insurance for persons 65 years of age and older, Part of social security. it is also to persons with long term disabilities. It consists of 2 parts: Part A is hospital insurance that covers hospital care, skilled nursing facilities, home health and hospice. Financed through SS payroll taxes. Part B- voluntary supplemental insurance obtained partly through premium payments and partly through govt financing. it covers outpatient and inpatient physician svs, hospital outpatient, laboratory svs, durable medical equipment, trx for end-stage renal disease, medical supplies.
What is the transtheoretical model of change?
A model used to determine a patient's willingness to change: pre-contemplation, contemplation, preparation, action, maintenance, termination. It is supported by the biopsychosocial models of care. It reflects how change occurs outside the therapeutic interventions.
I'm Not OK--You're Ok
A person who relies mostly on others for assistance. Does not feel that they are competent to take care of themselves.
What are the critics of the new DSM-V say
A say is cumbersome ambiguous and thus providing for clinical utility. Many clinicians will agree that although the multiaxial system was well-intentioned, client reports typically stop at Axis I. In cases where Axis two was listed some clients would feel stigmatized by their diagnosis labels such as bipolar disorder. Enhanced attention to the codes with a nonaxial system may also help counselors emphasize a client entire worldview into thematic context in a way that informs the therapeutic process. If you intentionally a movement to a nonaxial system may help increase client understanding, remind counselors that medical and psychosocial issues are not are just as important as mental health and reduce stigma
According to the APA what is the definition of a substance use disorder
A substance use disorder is a cluster of cognitive, behavioral, ideological symptoms indicating that an individual continues using the substance despite significant substance -related problems. These changes may be observed through underlying changes in the brain circuits. The first four criteria for substance use disorder encompasses impaired control, social impairment, risky use and pharmacological criteria
plan for the intervention day is made
A time is chosen when the alcoholic is sober, but feeling the effects of a hanover or drunk driving charges, so they will be more vulnerable and unable to deny the problem. Each member lists concrete examples of the alcoholics behavior that caused pain, danger, and humiliation. wording is checked for directness, honesty, caring, and lack of hostility. . Each member practices reading their part, their own list to be delivered calmly during the intervention. Prior to the intervention, the family decides on a course of action and makes arrangements with a trx facility. A date is set for the intervention, so all family members will be there So the counselor can attend as the neutral party The place can be the home or the counselor's office
systematic desensitization
A type of exposure therapy that associates a pleasant relaxed state with gradually increasing anxiety-triggering stimuli. Commonly used to treat phobias. Based upon the idea that assumption that a person cannot be anxious and relaxed at the same time. 1. Client relaxes 2. client visualizes or imagines the first anxiety producing stimulus until they start to feel anxious 3. the client stops visualizing and relaxes 4. the client repeats visualization and relaxes until they are able to visualize the stimuuls without becoming anxious. 5. then the client repeats the process with the ext more anxiety producing stimulus, through the entire list, at this point the stimulus should not cause any anxiety.
shifting focus
A way of responding to discord by redirecting attention and discussion to a less contentious topic or perspective. Such as focusing on goals and allowing the client to see how there could be a problem with how this fits in with goals on their own.
For parts for stimulating alternative frame of reference
A. Advanced accurate empathy be. Self-disclosure C. Confrontation D. Immediacy
What six parts are found in counseling skills of stage III the helping act
A. Role-playing B. Values clarification C. Goalsetting D. Problem-solving E. Homework F. Advice giving
What are the stages of counseling
A. Information gathering B. Evaluation C. Be back D. Counseling agreement E. Changing behavior /////f. Termination
Yalom's Therapeutic Factors of Groups
A. Installation of hope-the person must be over there is hope to solve their problems B. Universality-person must feel that they have a problem common to others. C. Imparting information-informed person is better able to cope and paying for new problems D. altruism- caring about others decreases in unhealthy self absorption E. corrective recapitulation of one's family- members behave the way they did while growing up in our families through group processes they learn healthier ways to behave F. development of socializing techniques- a person learns how to interact with people. G. Imitative behavior-leaders and senior group members act as role models of helping behavior for new members H. interpersonal learning I. noticed new interpersonal skills J. group cohesiveness- when members feel a sense of togetherness they are more willing to attend, participate and help other members and defend group roles K. catharsis-after person is release of intense emotions they may feel freer to use information and new experiences to grow L. existential factors are self responsibility- a person owns responsibility for their own thoughts, feelings and behaviors
Sober living houses
Combined treatment setting. Play an important role in supporting and treatment and recovery from drug and alcohol addiction. Sobering living helps individuals in a recovery to maintain an alcohol and drug free lifestyle by establishing a living environment that supports a writing recovery. Living in a sober environment recovering addicts are surrounded by others who share a common experience will support one another in their sobriety
Techniques of Behavior Therapy
A. counselor discusses with the client what specific behavior the clients wants to change. -new behavior is clearly defined B. Behavioral modification- When desired behavior is performed the client gets rewarded. Repeating this makes the behavior automatic. May also include punishment C. Contracting-behavioral contract can be written in a contract.details carefully written out and both parties sign the contract. Contracting prevents misunderstanding and can be used as a tool in confrontation with the client has broken the contract. Contracting is often used with alcohol and drug dependent clients. D. Systematic Desensitization- the client is taught a method to relax the mind and body. List of anxiety producing stimuli and is rated from least anxiety producing to most. E. Modeling-the client observes and mimics the counselor or another expert in the desired behavior.
Samples of counseling skills and action
A. feelings B. Sensitive Issues C. Treatment Issues D. CUltural Issues
Continuing Education
ADC is quickly changing. Substance abuse counselors must stay on top of new info. Read journals, books etc. Conferences, workshops, classes. Licensure and certification requires Ceu's and many professionals, through no fault of their own often, wait until the last minute to do so.
Methadone (Dolophine)
Abstinence maintenance med. Binds with opiate receptors in CNS to produce analgesic and euphoric effects. Prevents withdrawal symptoms in clients who were addicted to opiate drugs. Precautions/interactions: do not use in clients who have severe asthma, chronic respiratory disease, or history of head injury. Side/adverse effects: sedation, respiratory depression, paradoxical CNS excitation.Basically it is a synthetic narcotic analgesic compound. It is the most commonly used form of pharmacotherapy for opiate drugs! Is medically safe and has few side effects. It produces a stable drug level and is not behaviorally or subjectively intoxicating. It blocks the cravings for opiate drugs and does not produce euphoria as heroin and other drugs do. There's a lot of changes because of different types of patients coming and that addicted to other drugs, IV drug users and have HIV. Problem usually lies in that we need bigger facilities. especially with the new epidemics. We better trained staff more funding. Among the various therapies. Methadone maintenance has been studied most thoroughly. Methadone maintenance is generally successful in meeting treatment goals. When the appropriate doses of methadone are administered heroin use decreases markedly however in some cases other drugs such as cocaine and alcohol continue to be used. A substantial reduction in criminal behavior has documented by several studies this reduction increases the length of time and methadone treatment. Socially productive behavior such as employment, education or homemaking has been shown to improve the length of time in treatment
What is critical to group participant outcome
Commitment to participation, commitment to sobriety if appropriate, regular and timely attendance, and completion of group.
Founder of REBT
Albert Ellis
What a similar to all substance use disorders in the DSM-V
Although drug of abuse is related separately all substance use disorders are based on the same criteria. Substance use criteria are also separate from something specific intoxication and withdraw criteria. For example there is alcohol use disorder, alcohol application, alcohol withdrawal, which are coded separately. The only exception is loosely generated and inhalant related disorders because symptoms of withdrawal have not been sufficiently documented abuse substances to the withdrawal criterion has been eliminated
Medications that prevent relapse
Are able to reduce prolonged withdrawal symptoms, decreased drug craving, also the drugs reinforcing effects entry underlying psychopathology and treat drug-induced psychopathology. Included in this category are antidepressants, desipramine, bromocriptine, naltrexone and disulfiram.
Family roles of Sharon when Schneider was adapted from the work of Virginia Satir and others about the roles of families in the alcoholic family
As shows the rigid, and inhumane rules of each member becomes more isolated, more out of touch with feelings, more desperate and more disturbed. More survival each person learns to play a role consisting of a set of years, attitudes and feeling. Person believes that playing this fall and cannot act any other way and this reduces stress and linking the fragile family balance. Role will be are forced to family members based upon
Screening tasks for the counselor
Assemble screening forms, collect and analyze information from referral sources, interview prospective client questions about; general client data client date, sent problems, previous treatment efforts, outside were available, level change. Analyze Imation determine client program, client appropriate intake, and appropriate as as. Begin arrangements for intake. Clients inappropriate in this heat referral options discussed client
.Counseling skills of stage I: responding to the clients frame of reference
Attending skills, concreteness, distinguishing content from feelings, probing, primary level accurate empathy, genuineness, respect
What is a ladder of active listening skills
Attentive listening, minimal encouragers, parroting, paraphrasing, reflecting without interpretation, confrontation.
Autism, Asperger's disorder, childhood disintegrative disorder and pervasive developmental disorder have been replaced with one umbrella diagnosis
Autism s spectrum disorder
Axis I and Axis II o of the DSM
Axis I was clinical disorders and other conditions that are focus of treatment where Axis two used to be personality disorders and intellectual disabilities such as mental retardation Axis III was Gen. medical conditions. It is now combined in DSM-V as attention to clinical disorders including personality disorders and intellectual disability such as mental retardation and other conditions that are focus of treatment; and medical conditions continue to be listed as part of the diagnosis
What are supportive groups
Help addictive members tolerate abstinence and assist them in remaining drug or alcohol free by enabling them to draw on their own resources
What are the two categories of therapeutic medications
Help patients stop abusing drugs, and drugs that help prevent relapse
Reality therapy goal of therapy
To help people become more effective in meeting their needs. To enable clients to get reconnected with the people they have chosen to put into their quality worlds and teach clients choice theory. Being RESPONSIBLE
Is it hallucinogen use disorder or ecstasy use disorder?
Be specific. Ecstasy
who are therapeutic communities not appropriate for
Because these programs use confrontation and prohibition of psychotropic drugs, use of therapeutic communities is not appropriate for individuals with psychopathology or substance use related neurological damage. For some persons, especially those with low levels of self-esteem and impaired neurological functioning the confrontational approach of the modality may be too intense
what is genuineness in counseling
Being myself in the role of counselor, the counselor does not become a different person counseling but retained their own personal personality counselor can truly understand what the client is feeling or experiencing.By conducting a professional manner. Counselor is not excessive professional jargon but uses every terms for the client eased facility location. Counselor spontaneously tactful not rigid. Counselors able to express thoughts and ideas appropriate time
What is the meaning attribution or explanation of the world the function of the leader is supposed to provide in group therapy?
Concepts or thought frameworks, explanations and interpretations
What is motivational interviewing?
a client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence
Tools used for assessment should consider what components
Biopsychosocial and behavioral. Tools can be self administered surveys at the Michigan alcohol screening test or mast. A verbal drug abuse history client which includes, age of first use of drug or alcohol, heaviest time, a pattern of use of time, when it harms belt, weather dependent developed, and history of convulsions or hallucinations, current drug being used, you should include both illicit drugs are drugs, current dose amounts, currently, use, (i.e., oral, nasal, intravenous etc.) Wide client seeking help now. History of family members and significant others that you family dynamics and family members
Boring client In group therapy
Boring client is frequently a frightened, inhibited individual who barely takes risks and feels badly about themselves. They crave attention but by demanding, timidly treating or droning your she drives people away. Did the client want to be accepted by the group, a rarely actively disrupt their rarely disrupted and says safe and predictable things and is rarely spontaneous. The client and other members can be encouraging to the client by reinforcing small risky displays of spontaneity. During the members on as they work towards release of inhibition by physical activity such as screaming or hitting a punching bag-is let the client know that spontaneity and inhibition release was very inhibited person is good and others will still accept them
Criterion E also known as grief exclusion
Can now be diagnosed with depression using the other criteria for major depressive episode. It is eliminated from DSM-V
Clonidine
Can partially suppress many withdrawal symptoms and opiates alcohol and tobacco. Is most effective for persons who are motivated and involved in the treatment program. Is not useful in assets after withdrawal from opiate drugs and has been achieved. So it most useful during withdrawal period
Challenges of moving to a nonaxial system
Conceptual lack of clarity regarding how clinicians are going to implement a nonaxial system. If clinicians struggle to use holistic assessment within a multiaxial system that essentially requires some attention to psychosocial and environmental issues and overall distress and stability, where they actually take the time to incorporate these elements is more in this format? We anticipate problems and interpretation, specifically regarding the combinations of these axes went in the counseling profession and among interdisciplinary teams. Counselors can include subjective descriptors next to the client diagnosis there is no telling whether these will carry over to the next clinician or if it will make sense to a different party. Other challenges include delays as insurance companies and government agencies update the claim forms and reporting procedures to accommodate new DSM-V changes. Major challenges for both counselors and clients are to be expected as helpful as helping professionals, insurance and service providers and public or private institutions towards nonaxial documentation of diagnoses
Distinguishing content and feelings
Content is what the client talks about in session. Maybe what is implied or what is that in session. Feelings are body mind reactions client experiences that may not be able to express because he or she does not have feelings vocabulary, denies feelings, or is unaware of their own feelings. Feelings coloring waivers the content are shown nonverbal behavior and manner of delivery. Feelings enhance content. Feelings may contradict the content.
What are interactional groups.(trust groups)
Create an environment of safety, cohesion and trust where members engage in in-depth self-disclosure and affective expression
psychoactive pharmacotherapy
significant and acute alterations in psychomotor, emotional, and mental actitivity at therapeutic doses. at high doses euphoria. opioids, stimulants, benzodiazepines, barbiturates, and sedative-hypnotics
How to extinguish negatively reinforced behaviors?
since it involves avoidance it involves exposure to these feelings and situations.
Signs and symptoms of users of inhalants
Dizziness, staff the, lack of coordination, slurred speech, slow reflexes. Associated behaviors may include belligerence, predisposition to violence,, impaired judgment
Interpersonal relationships/learning in group dynamics
In group therapy another important factor that occurs in groups of chemically dependent person involves interpersonal learning alcoholics and drug dependent individuals commonly share difficulties in interpersonal relationships. The group setting provides a safe environment to learn new ways of communication of their needs and feelings. Members tend to be accepting of one's expression of feelings group and are free to give feedback to each other
Behaviorism Theorists
Ivan Pavlov, John B. Watson, B.F. Skinner
2 to 3 criterion indicate what severity of index
Mild
DSM-V with feeding eating disorders
New diagnosis for binge eating disorders
Are legal difficulties criterion
Nor
Naltrexone
Opioid Antagonist at Mu, Delta, and Kappa receptors USES: opioid addiction, decrease alcohol craving in chronic alcoholics. So is also used for alcohol. Reviva, is for treatment of alcohol. Does not produce euphoria as opiate drugs
Why are groups for adolescence good
Peer associations are particularly important during adolescence. The development of tasks include separating family forming their own identities. Peer groups have a significant effect on attitudes and behaviors. This influence can either be positive or negative. Peer groups may be located in schools, community agencies, residential programs, churches, and of on street such as gangs. Four categories of peer groups
Signs and symptoms of cannabis use
Red eyes were dilated pupils, increased appetite, dry mouth, and rapid pulse; may be sluggish and slow to react
Psychodynamic theorists
Sigumund Freud
What the biggest change with regards to the DSM-V and use
The removal of this distinction between abuse and dependence
What is an action example of maintenance stage client conflict
These recent months of absence had made me feel that I'm progressing towards recovery. I still wonder whether Abstinence is really necessary
What is the definition of communication
Transmission of ideas, feelings and attitudes by verbal and nonverbal methods. The reception of these ideas and attitudes which creates a response
Client-centered therapy view of the client
a person is essentially good, a person is capable of living a good meaningful life, an individual integrates experiences into a consistent picture of themselves. The self continually changes with the environment! A person gets out of touch with themselves when they place unrealistic demands on self and deny their feelings. Each person has a natural healing ability so that in a safe environment, they can explore without fear of criticism.As they learn more about themselves they will reorganize themselves in a healthier more fulfilling one.
Values clarification
a process of self-exploration by which people identify and rank their own personal values. It is helpful to access the clients internal frame of reference to understand the importance of the clients values. Allows the client to modify values.
Gestalt Psychology
a psychological approach that emphasizes that we often perceive the whole rather than the sum of the parts. GESTALT MEANS WHOLE!
Id
a reservoir of unconscious psychic energy that, according to Freud, strives to satisfy basic sexual and aggressive drives. The id operates on the pleasure principle, demanding immediate gratification.
Recovering Addict as a counselor
a significant number of alcohol and drug abuse counselors are themselves recovering addicts. They act as role models. They offer hope. Life can be rich and fulfilling as well. How long should a would be counselor maintain sobriety before he or she is hired. Suggested AA guidelines is 3-5 years. The field is plagued by individuals with weeks of sobriety trying to be counselors, They are often hired because their eagerness is high and salaries low. It poses risks to relapse to the counselor and a low quality of service to the clients. There is always a risk for relapse. If a counselor relapses, what does it do to the encouragement of the client if a counselor relapses. Policies should be put into place as to what would occur if a relapse occurs. . =this keeps distress at a minimum.
flooding/implosion
a sudden and large-scale exposure under controlled conditions. May escalate symptoms under severe trauma.
punishment
an event that decreases the behavior that it follows
self efficacy 3 parts
belief in the possibility of change is an important motivator' The client is responsible for choosing and carrying out personal change There is hope in the range of alternative approaches available
anxiety medications
benzodiazapines, (valium, Librium, xaanax, Buspar (Buspirone)
What is an intervention?
creation or use of a crisis involving the alcoholic that is so emotionally painful that they will stop denying that there is a substance abuse problem before they lost everything.
Extinction (operant conditioning)
decreases in the frequency of a behavior when the behavior is no longer reinforced
Purpose of ECT
often an effective way of stopping maladaptive responses for a period of time This interruption of behavior is an opportunity to start a good behavior. This is because, if new behaviors are not started, the maladaptive ones may be repeated in areas where there is little to no threat of punishment or shock. Other forms of gratification are created. It is not realistic to view that an old behavior will be replaced with NOTHING!
Behaviors for maintenance
plan for stabilization, identify risky situations, practice new coping skills, find support systems, build a new lifestyle with sufficient satisfaction. Life changes must be made. Therapists can help by finding competing reinforcers.
Projection
psychoanalytic defense mechanism by which people disguise their own threatening impulses by attributing them to others
respect as a counselor
treat clt w/ dignity. Client with warmth but without intimacy that is reserved for friends and avoid artificial warmth. It is nonjudgmental and non exploitive
13 guidelines for ethical practice
1. Counselors must be aware of what their needs are, what they are getting from their work, how their needs influence their clients. The therapists needs are not to be met at the xpense of the clients. 2. Counselors must have enough training to make proper assessments and Rx the most therapeutic interventions. . New skills must be studied. 3. Counselors must always be aware of the boundaries of their professional compentence and either seek qualified supervision or refer clients to other practitioners when they recognize that they have reached their limit. Be familiar with community resources for referrals. 4. Beyond just ethical and moral rules, you must know how to apply them. . The counselor needs to realize that many problems which occur may not have clear cut answers or solutions, they accept the responsibility of findint appropriate answers. 5. counselors have theoretical framework to guide them in their practice. 6. Counselors must update information, kno wledge 7. avoid relationships that are clearly a threat to the therapeutic relationship. If the relationship could cause potential problems to the client. 8. Counselors must inform clients of situations where confidentiality may not be able to maintained. Do not impose personal views on client. 9. Counselor must be aware of their own values and attitudes , role that their personal belief system plays in the relationships with their clients. 10. COUNSELORS MUST AVOID IMPOSING PERSONAL BELIEFS ON THEIR CLIENTS IN EITHER A SUBTLE OR A DIRECT MANNER> 10. Counselors must inform clients of such things as goals, techniques and procedures that will be used and possible risks that will effect therapy. 11. Teach through modeling. They need to practice In their life what they want the clients to practice 12. Be culturally sensitive and aware that we bring our own culture with us . The clients values are working within and operating in the cultural process. 13. Counselor must learn to apply a process for thinking about and dealing with ethical dilemmas, realizing that most ethical issues are complex and defy simple easy definition. A counselor seeking therapy is a sign of maturity.
What are the five general principles of motivational interviewing
1. Express empathy through reflective listening 2. Develop discrepancy between clients goals or values and their current behavior. 3. Avoid arguments and direct confrontation 4. Adjusted clients resistance rather than imposing it directly 5. Support self-efficacy and optimism
Ignoring (resistance) 4 parts
1. Inattention-indicates that the client has not been paying attention 2. Nonanswer-In answering a clinicians query..gives an answer that is not related to the question 3. No Response-Client gives no audible verbal answer, or clear nonverbal replay to the clinicians answer. 4. Sidetracking-the client changes the direction of the conversation that the clinician has been pursuing.
4 types of operant conditioning
1. Positive Reinforcement 2. Negative Reinforcement 3. Positive Punishment 4. Negative Punishment
The family roles of Claudia Black
1. Responsible one (oldest) 2.adjuster (adapts to the situation) 3. Placater - sensitive - makes others feel better 4. Acting out - draws negative attention
How do we recognize resistance?
1. arguing 2. Interrupting 3. Denying 4. Ignoring
How many standard enumerated criteria are there for substance use disorders
11
Treatment found in inpatient hospitals/rehabs
12 step model, individual, group, family counseling, drug education, medical management. Long-term aftercare and transitional services especially for opiate addicts are important part of treatment. Programs do not devote significant resources to them however. These programs may be especially appropriate for persons with co-commitment psychiatric disorders, persons assessed to be suicidal, is addicted to more than one chemical, people with serious medical complications Tthe most inpatient programs have multidisciplinary staff teams mor represent a range of training and experience and people offering a variety of services. More than one chemical, persons with serious medical complications. Inpatient treatment provides comprehensive treatment services and constant support during the early stages of sobriety, and close supervision to prevent relapse and respond to medical emergencies.
Cultural inclusion
An attitude or behavior pattern based on the belief that those who think or act differently from oneself deserve respect; a commitment to acknowledge, respect, and when possible, adapt to those different from oneself. This is based on section 3 of DSM by and include special attention to diverse ways in which individuals in different cultural groups can experience in scrap describe distress. The manual provides a cultural formulation interview to help clinicians gather relevant cultural information. The cultural formulation interview calls for clinicians to outline systematically assess cultural identity, cultural conceptualization of distress, psychosocial stressors related to cultural features of vulnerability and risk resilience, cultural differences between the counselor and client, and cultural factors relevant to seeking help. It also includes descriptions regarding how different cultures groups encounter identify with and convey feelings of distress by breaking out both formally at known as culture bound syndromes into three different concepts. The first contest concept is cultural syndromes, I cluster of co-occurring symptomology with a specific cultural group. Second is culture idioms of distress, linguistic terms that specific cultural groups or phrases you to convey suffering within a specific cultural group. There concept concept is cultural explanation are perceived cause mental disorders you need to certain cultures that serve as the meeting for symptoms elements are distressed. It improves clinical utility by helping clinicians offer accurately communicate with clients and are able to differentiate disorders from non-disorders and working with clients from varying background.
principal psychotherapeutic drugs used today (conditions)
Anxiety, panic attack, Depression (Monopolar and Bipolar), Pychosis
Open meetings for AA
Are for nonalcoholics as well
What happens if a person detoxes without being engaged in treatment
Are no more likely to succeed in reducing future drug use person achieving unassisted withdrawal
Methods of probing
Are the number one reason probing is asking open-ended questions and are useful means of gathering information they don't limit his answers and less directive
Relief of the symptoms
Are the possible solutions to the problem which will relieve the symptoms
Four types of Client Resistance
Arguing, interrupting, denying, ignoring
Why do we avoid argumts?
Arguments are counterproductive! Defending breeds Defensiveness Resistance is a signal to change strategies Labeling is unnecessary
What is confrontation?
Definitions-the point of noted discrepancies in three areas; between client ideal and real self, to client clients verbal and nonverbal expressions, to the client view of the counselor's view of the client. Though the congregation something comfortable to the client and the counselor growth often gets blocked unless the client is confronted face-to-face deals with an issue. It forces the client to talk about deeper underlying emotions that lead to the resolution of the issue rather than focusing on shallow experiences. Confrontation is a way for counselor to act as a role model for direct, honest. It may involve giving honest feedback was real versus imagined.
Outlook of therapeutic communities compared to prisons.
Demonstrate that they are cost-effective when compared with prisons. But persons are in the program, criminal activity is significantly reduced compared to pre-or post treatment productivity. Those who complete the program illicit drug use and criminal activities are diminished, while training status improves. Approximately 15% of therapeutic community graduates qualified and trained for staff counsel positions. Of those approximately half continue their planet for More than one year some studies have reported that less severe activity is correlated with longer retention therapeutic community programs while lower lifetime. Criminality is correlated with better treatment outcomes. More positive treatment outcomes and loss of higher levels of education and the drug and alcohol use
. goal of assessment
Does the client have a chemical dependency problem? Identify other conditions associated with addiction or other problems in these areas: psychological, physiological, behavioral, family, economic, environmental, interpersonal, other drug use or multiple addictions. Increase the client likelihood of entering remaining in treatment by the berries of barriers to treatment, using the client anxiety about treatment and sat satisfied and insurance companies determining diagnosis and prognosis
Other specified disorder
Doesn't fit a standard diagnosis with an explanation why not.
Moderate Management
For people who want to cut back or quit drinking. Moderation management is a new national support network for people who have made how the decision to reduce the consumption of alcohol. The main purpose of an and is to help problem drinkers reducer drinking to a level which no longer causes like problems. Research indicates that many nondependent problem drinkers can be successful in recovery goal of moderation it encourages people to recognize and do something about a drinking problem as early as possible before a series health problem in person problems develop. Unfortunately many problem drinkers today actively and purposely avoid traditional treatment approaches. Because they know most traditional programs label them as alcoholic permanently strongly suggest reports AA attendance and prescribe lifetime abstinence and the only acceptable recovery goal. You even have real concerns about how their participation in these programs will affect their jobs and ability to maintain future medical and life insurance. It is seen as a less threatening option and one that beginning problem drinkers are more likely to attempt before their problems become nearly intractable. It is when the likelihood of attaining for recovery Q absence or moderation is still comparatively high. More people seek help when they are given real options.. Is probably not necessary to mention that the great majority of problem drinkers and other drinking problems are mild or severe will try to moderate reducer consumption before the attempt utility abstain. When a problem drinker tries to moderate and is not successful even after attending the program like an animal where they receive support to cut back more likely to accept that most workable solutions for them is to quit drinking entirely. With their dignity in tact and intelligence respected they are empowered to commit to recovery goal they have chosen for themselves. The implant or assessment as part of the relational intervention. Client advised of his or her chances of success and the risks and benefits involved with both recovery goals are discussed and information about free community self-help programs for follow-up and support is provided. In this client centered approach therapist does not force compliance with a predetermined recovery goal because this would rob a client of choice, raise resistance, and very likely create a great deal of denial. It offers mutual support and self-help settings and a nine step professionally reviewed program that provides information about alcohol, moderate drinking guidelines and limits, drink monitoring exercises, goalsetting techniques and self-management strategies. In addition members work actively to achieve balance and moderation and many other areas of their lives
Women for Sobriety
Found by Dr. Jean Kirkpatrick. Focused on self-esteem as magic building block for recovery
Listen Reflectively
Fundamental component of MI. demonstrate that you have accurately heard and understood a clients communication by restating its meaning. It is a way of checking rather than assuming that you know what is meant.
the following fact supports the use of AVRT or rational recovery;
Large majority of those who actually recover from serious substance abuse do so on their own without the aid of recovery groups for professional consultation. They get fed up with the outcome of drinking quick for life. Recovery is not an outcome of the process of self-improvement but personal growth is usually an outcome of commitment to lifetime abstinence. Following a personal commitment to permanent absence complete recovery is typically accomplished within a matter of weeks or months or what drugs have persistent withdrawal syndrome within months. Addiction recovery, regardless of substance involved in the age of onset and duration of addiction or whatever other problems may coexist is much easier and simpler than currently imagined are made out to be a global "emotional closeness and close individuals they are capable of soft globally and make available accurate information on planned abstinence. Group format is inappropriate to purpose of an individual's prompt recovery. The notion of addictive diseases discouraging to addictive people. Something probably is based on the understanding that addiction is an expression of survival drives associated with intense physical pleasure, self-restraint is of these drives is well within human capacity. The act of self intoxication is in an individual moral issue once a pattern of self-destruction or antisocial is established. Persons who commitment to permanent abstinence required to abstain you will rise up's parent. These feelings are predictable, authentic and vital to the regeneration of life following an episode of addiction. Also probably is self identification as a normal, healthy person who simply never drinks or uses for reasons that are nobody's business but one's own rational recovery. Rational recovery is nt a professional tool and may not lawfully be provided by an professional personal as a service to clientelle. , ,
Commonality in group therapy
Leaders can take on a members problem and asked if others have a similar experience generalizing about other so we can related to themselves as includes other members and discussion. Just the focus from one to one back to the group. Of the members know connect them not alone.
What are the assumptions about the leader in group therapy
Leaders in a trained expert who is not a group member-the leader is a trained professional you must make it clear that he is she is still human and still has normal problems they will be seen as godlike or some of your members cannot relate to.
assertiveness therapy
Learning the open and appropriate expression of thoughts and feelings, with due regard to the rights of others. It had been used as an alternative to relaxation patient procedure and as a means of developing more effective coping techniques. It is more effective in persons with difficulties in interpersonal interactions of anxiety responses that may prevent them from speaking, claiming their rights, or even from showing appropriate affection. Such inhibition may lead to continual in our town while, particularly if an individual feel strongly about the situation. Assertiveness therapy may be useful especially in cases where individuals allow others to take advantage of them and maneuver them into uncomfortable situations
One study found early dropouts from long-term therapeutic communities had common psychosocial characteristics including the following;
Low self-esteem and low self value, for concept divides self-identity, most self acceptance, low evaluation of self behaviors, low valuation of physical attributes, health and sexuality, low assessment of self worth and self adequacy, low valuation of self in relation to family/friends in primary group, high levels of self-criticism and lack of adequate defenses, and in tendency to overemphasize negative features. Yet they still put children in these facilities because they get kickbacks and ruin their lives. They use them as babysitters in dysfunctional families!!!
Fervor to change
MAY be a sign of wanting change...but be careful! It can also be to convince the clinician and the others in group.
What is the prevalence of alcohol use disorders between men and women in the United States
Man is 12.4% and women are 4.9%
What is family therapy
Many cases addictive disorders are multigenerational and families. The full assessment of the identified substance abuser and his or her family's important to determine the range of biopsychosocial factors influencing the person's addiction. Then a family system drug use behavior has a purpose and it is important to assess this. Family therapy is usually not sufficient as the sole treatment for substance abuse. Rather is valuable and often essential adjunct to other treatment modalities. The opportunity to observe until families always valuable to your diagnostic process. Three parts of the family system include family of origin, styles and children. It is helpful to offer a broad definition to include significant others and employers.
So drug treatment, how we decide what kind of drug treatments someone needs
Many factors must be considered, including personality, background, mental condition and drug use experience. Have they been in therapy before. How is their home life? Is it dangerous?
Tobacco and quitting
Many tobacco users attempt to quit with most making multiple times before successfully stopping use. Tobacco is linked to a plethora of physical health problems and accounts for approximately one out of every five deaths in the United States. Tobacco smokers are lifespan projection is about 10 years shorter than non-smokers
What drug is used more than any other illegal drug
Marijuana
Develop discrepancy for motivational interviewing
Motivation for change enhance the client's perceived discrepancies between the client situation and hopes for the future. The task is to help focus your clients attention on how current behavior differs from ideal or desired behavior. Discrepancy is initially highlighted by raising your clients awareness of the negative personal, familial or community consequences of problems behaviors and helping them confront the substance use and contributed to the consequences. Although helping a client received discrepancy can be difficult, carefully chosen strategic reflecting can_underscore incongruities. Separate the behavior from the person help your client explore how important personal goals are. This requires you to listen carefully to your client statements about values and connections to community, family and church. The client shows concern about the effects of personal behavior, highlight this concern to heighten the client's perception and acknowledgment of the discrepancy. Once a client begin to understand how the consequences or potential consequences of current behavior conflict with significant personal values, amplify and focus on his discordance until the client can articulate consistent concerning commitment to change. One useful tactic for helping a client perceived discrepancies sometimes called the Colombo approach. His approach is particularly useful when a client prefers to be in control. Essentially the clinician expresses understanding and continuously seeks clarification of the clients problems but appears unable to perceive a solution. Extent of uncertainty or confusion can motivate clients take control of the situation by offering a solution to the clinician.
How does motivational interviewing work
Motivational interviewing has been practical focus. Strategy is of motivational interviewing are more persuasive than coercive more supportive and argumentative. The motivational interviewer must perceive a strong sense of purpose, clear strategies and skills for pursuing the purpose is the time to intervene in particular ways at incisive moments.
triggers of change
Multidimensional nature of motivation is captured in the popular phrase that a person is ready, willing and able to change. His expression highlights three critical elements of motivation-but in reverse order from that which motivation typically evolves. Ability-refers to the extent to which the person has necessary skills, resources and confidence or self efficacy to carry out a change. One can be able to change but not willing. The willing component involves the importance of a person place on changing, teaching is involved wanted or desired. It is possible to feel willing yet not able to change. Even willingness and ability are not always enough. You probably can think of examples of people who are willing and able to change but not yet ready to change. The ready component represents the final step the person decides to change a particular behavior. So to instill motivation for change is help the client become ready willing and able
What are the disadvantages of group therapy?
Need to share the therapist's time with others in the group. Lack of a private setting in which to reveal concerns. Possibility that shy people will not be able to speak up within a group setting. Inability of people with severe disorders to tolerate being in a group. Peer pressures can move individuals towards more negative behaviors. Members may challenge leaders for leadership. The counselor may feel excluded and have less power.
How prominent is tobacco use United States and adolescence
One in five adolescents in the United States will use tobacco on a regular basis and most individuals will develop tobacco use disorder prior to the age of 21
Reasons to support hospital-based drug detoxification
Only if medical complications occur and when appropriate residential or outpatient facilities are not available. The conditions for which hospital-based drug detoxification is recommended include: serious concurrent medical illnesses such as tuberculosis, pneumonia or acute hepatitis, and history of medical complications such as seizures and previous detoxification episodes, evidence of suicidal ideation, dependence on fetid and hypnotic drugs, history of failure to complete earlier ambulatory or residential detoxification
Third party payment and Substance abuse counseling
Only recently has 3rd party payers have begun on a widespread basis, to reimburse patients for trx for SUD's. In the past, insurance fraud occurred in the form of using a medical diagnosis to provide care for the chemically dependent client. A physician might list the dx of the patient being treated for substance abuse as having cirrhoisis of the liver, or something similar on the forms. Today, the potential for INS fraud exists in fitting the dx of a client to fit the type of coverage. The coverage may cover alcohol but not illicit drugs. Or, many ins companies will not reimburse family members of a chemically dependent individuals for family therapy unless the family members have received a psychiatric diagnosis. . Sometimes, the therapist may have the clients best interest in mind and be tempted to assign an unwarranted dx.
When does opioid use disorder typically develop
Opioid use disorder typically develops in early adulthood and stands many years. Patent opioid use is higher in males and females. Problem first occurs in adolescence and early doll had. Opioid use disorder is seen across ethnicities,i
Specific learning disorders have been expanded and represent distinct disorders that involve problems in the acquisition and/or use of one of the following skills
Oral language, reading, written, and or mathematical operations. Now referred to as specific learning disorder in this diagnosis is intended to combine reading disorder, mathematics disorder written expression and not otherwise specified
When and how do you orientation to place
Oration orientation may take place before during or after screening and intake. It can be by an individual, group or family context. May include other personnel such as physicians or nurses that may be present for medication
What are 12 examples of non-empathetic responses have been identified
Ordering and directing 2. Warning or threatening 3. Giving advice and making suggestions or providing solutions prematurely or when unsolicited 4. Persuading the logic, arguing or lecturing 5. Moralizing, preaching part-time client their Duty 6. Judging, criticizing, disagreement or blaming 7. agreeing, approving or praising 8. Shaming, little children, labeling, or name-calling 9. Interpreting or analyzing 10. Reassuring, sympathizing with consoling 11. Questioning or probing 12. Withdrawing, distracting humoring or changing the subject
What information uses screening information was used what information is used
Patient data age, sex present, referral source, presenting problems, insurance availability, whether to accept program work to refer elsewhere
Biofeedback Treatment
Person is taught to influence his or her own physiological processes, Especially in regard to anxiety. It is to help control the autonomic nervous system. A person is taught to influence their own physiological processes and is known as biofeedback. A monitor physiological response that is to be modified such as blood pressure or skin temperature. Convert the information to a visual or auditory signal and providing of prompt feedback indicating to a subject as rapidly as possible when the desired changes taking place. The speed that subject may then seek to reduce his or her emotionality as by lowering the skin temperature. For the most part biofeedback is oriented by reducing reactivity to some organ systems that are innervated by autonomic nervous system especially a physiological component of anxiety response
What is a client counselor match
Personality should not clash unreasonably, counselor style therapy is appropriate, difficulty with client issues and lifestyle, if the counselor is inappropriate for the client we need to refer the client account was more appropriate
Section 3 of DSM-5
Pertaining to cultural inclusion; cultural syndromes, cultural idioms of distress, cultural explanation of perceived cause
recurrance
People most people do not immediately sustain most people do not immediately sustain the changes they are attempting to make. There is a return to substance abuse usually after a period of absence this is the rule rather than the exception. His contribute information that can facilitate or hinder subsequent progress in through the stages of change. These experiences contribute information to facilitate or hinder subsequent progression through the stages of change. Recurrence often referred to as relapse, in the event that triggers the individuals return to earlier stages of change and the recycling through the process. Individuals may learn that certain goals are unrealistic, certain strategies are ineffective, or certain environments are not conducive to strategic unsuccessful change. Though substance abusers will require several revolutions page the change to achieve successful recovery. After he returned to substance use, clients usually revert to earlier exchange stage not always to maintenance or action but more often some level of contemplation. They may even go back to precontemplation again, temporarily unwilling or unable to try to change soon. It should not be considered a failure and he not become disastrous or prolonged recurrence. Recurrence of symptoms is not necessarily mean that the client has abandoned a commitment to change
Diagnostic criteria example of alcohol use disorder
Problematic pattern of alcohol use leading to clinically significant distress is manifested by two of the following occurring within a 12 month period; alcohol is often taken in large amounts or over longer. Then was intended there is a persistent desire or unsuccessful efforts to cut down or control alcohol use -a great deal time is spent in activities necessary to obtain alcohol, use alcohol, recover from its effects -craving, our strong desire to use alcohol -the current alcohol use resulting in a failure to fulfill major role obligations at work, school or home -continued use despite having persistent or recurrent social or interpersonal problems caused by or exacerbated by the effects of alcohol -important social, occupational, or recreational activities are given up or reduced because of alcohol use -the current alcohol use in situations in which is physically hazardous -alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem is likely to have been caused by or exacerbated by alcohol -tolerance as defined by either the following: a need for markedly increased amount of alcohol to achieve intoxication or desired effect, and markedly diminished effect with continued use of the same amount of alcohol -withdrawal, as manifested by either of the following: the characteristic withdrawal symptoms for alcohol or alcohol or close related substances such as benzodiazepines taken to relieve or avoid withdrawal symptoms.
Definition of assessment.
Procedures by which a counselor a program to evaluate individual strengths,, programs problems and needs for the development of the treatment plan. Although assessment is a continuing process in general reemphasized early in treatment. It usually results from a combination of focus interviews, testing and/or records reviews. Many counselors use a general systems perspective what is analytical and historic simultaneously. Using this approach the counter would separately evaluate major life areas health location about, social adaptation, legal environment and psychological functioning. At the same time Assessing the extent to which alcohol or drug use has interfered with the client functioning in the area. As an attempt to turn the relationship of functional areas
What are educational groups
Provide information on issues related to specific addictions, such as a natural course of medical consequences, implications of intravenous drug use, and availability of community resource. Methods use may include material such as videotapes, audio cassettes, or lectures following by this discussion
activity groups
Provide occupational recreational means for socialization and self expression
Halfway house
Provides an intermediate step between inpatient treatment and independent living. Is a good alternative for persons who do not have a stable social support system. Halfway house program generally have a small patient population, emphasize twelve-step programs and have a minimum of rules and few professional staff members. Usually residents must find employment within these houses
What are minimal encouragers?
Purpose is to encourage the speaker to continue by indicating that the listener is understanding the message. Understanding is communicated via small verbal such as yes, I see, okay
Seven ways to respond to resistance
Simple reflection, amplified reflection, double-sided reflection, shifting focus, agreement with a twist, reframing rolling with resistance, siding with the negative
What is a here and now focus
Since the dynamics of the group reflect the members interpersonal skills and issues at using the real world is often helpful to direct the groups attention to presently current situation to learn from it; gaining the skills to resolve the situation within the quote group will allow carry over into the real world
Signs and symptoms of opioid drug use
Slurred speech, drowsiness, impaired memory, constricted pupils. They appear slow in their physical movements
Signs and symptoms of alcohol intoxication
Slurred speech, lack of coordination, unsteady gait, memory impairment, student work, behavioral changes manifesting himself shortly after ingestion, inappropriate aggressive behavior, volatility, and impaired functioning.
Signs and symptoms of sedative hypnotic or anxiolytic drugs
Slurred speech, unsteady gait, inattentiveness, impaired memory. It may display appropriate behavior, mood volatility and impaired functioning.
Using the Lord's prayer's in alcoholics anonymous
So common in many areas. Usually asked to join them for only if they want to. What American groups today about a variety of ways close the meetings elsewhere in Spanish groups the US and groups outside the United States. Some groups recite serenity prayer others you smother them for a paraphrasing or simply moment of silence.
Is there a link between cannabis use and mood disorders
So far it looks like it
type 2 client-quick thinker
Some intellectualization plays the role of assistant. Once let others know of their vast knowledge of psychology. Clarifies and summarizes for the group but does not share personal material. This type of client needs to be helped to turn off thinking and get into feelings. This may be a defense mechanism to avoid really painful thoughts and feelings and it usually is. Sometimes they need to be taught the difference between thought and feeling. Use of nonverbal exercises designed to bring out feelings.
What are comorbid settings
Some treatment programs have been developed to attempt to capitalize on the advantages of inpatient and outpatient treatment approaches. They provide elements from which each type of setting attempting to maximize benefits while reducing costs
What is the first step to prepare for an intervention?
Someone must reach out for help
Tolerance of anxiolytics
Sometimes individuals who receive a prescription will build a tolerance and seek additional access or use of multiple conditions and counselors should be careful to assess her patterns of use clients report accessing substances through medical providers. Sedatives, hypnotics and anxiolytic related disorders are often comorbid with alcohol and tobacco use disorders personality disorders and depressive disorders anxiety disorders and bipolar disorders
Phonological disorders now to refer to is what
Speech sound disorder
Alcoholic in the family
The alcoholic's behavior creates a disturbed environment for those who live with the alcoholic. As the disease progresses the becomes more preoccupied with alcohol; maintaining a supply, covering it up, despairing about getting drunk again and although the family is love they take a backseat to the alcohol. Alcohol feels good alcohol which is an object not about people. The alcohol wears off you feel lonely and isolated because they no longer have relationships with people. These feelings are compounded by additional feelings of shame, fear, and guilt. To survive alcoholic denies guys in place the blame on others including family friends and coworkers. Eventually alcoholic becomes a bundle of unresolved feelings always leave them feeling continuously aching
Why is it appropriate to have the spouse in an intervention?
The alcoholics police record indicates a history of spousal abuse, the client appears to be heavily into denial but admits his wife has complained about his drinking and that there are some problems in the marriage. or if the potential client's wife has called him on several occasions complaining about the husbands behavior.
What is one of the downfalls of Alcoholics Anonymous
The best outcomes are usually those who spend years in AA and a lot of weekly time with sponsors groups therapists. It often doesn't cover activities that can be done to learn to enjoy life but can focus just on the disease and not life afterwords.
Trauma DSM-V
The chapter on trauma and stressors related disorders related to trauma and/or situational stress factors such as reactive attachment disorder, adjustment disorder, social engagement disorder, PTSD and acute stress disorder
Why was there a difference DSM-IV between abuse and dependence
The classification of abuse and dependence was based on the notion that there is a biaxial difference between the two and the abuse was less severe form of dependence. The bimodal theory did not hold true in research and practice classification was revised to address substance use disorders as existing on a fluid continuing spectrum is resulted in a new substance use disorder section
During the last session a long-term client talks with downcast eyes about the father's death 16 years ago and how difficult it was to run the family without him. The counselor can guess what about the client
The counselor can guess that they are expressing their concern about ability to get along without counselors help
First meeting of an intervention
The counselor discusses with the individual what important issues are facing the alcoholic e.g. drunk driving, marital problems, job performance etc.
What are diagnostic criteria for screening
The counselor must utilize objective criteria to determine whether or not the substance abuse is present, client level dysfunction, he issues and problem areas, and degree of denial
