Addiction or recovery? Enabling change. Dr Clare Fleming GP, Compass Health
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1 Addiction or recovery? Enabling change Dr Clare Fleming GP, Compass Health
2 What would you like to know about?
3 How do you feel when you are dealing with an alcoholic who doesn t want to change? How do you approach this issue? In small groups
4 How do you approach this issue?
5 How do you approach this issue? Patient change Yourself
6 Why do people? Smoke Take drugs Drink alcohol Eat too much Have promiscuous sex Gamble machines or money markets
7 Why do people? Work excessive hours Go on spending sprees Take compulsive exercise Have co-dependent relationships (rescuer)
8 Reasons to drink
9 Reasons to drink 1. I like it; it makes me feel good
10 Reasons to drink 1. I like it; it makes me feel good 2. It helps me stop feeling bad
11 Reasons to drink 1. I like it; it makes me feel good 2. It helps me stop feeling bad 3. If I don t drink I feel ill
12 Reasons to drink 1. I like it; it makes me feel good 2. It helps me stop feeling bad 3. If I don t drink I feel ill 4. Dependence is the shift from: I want it I need it
13
14 Consequences?
15
16 ROUGH guide
17 ROUGH guide LONELY planet
18 B M S
19 B M S
20 Where do I start?
21 Relationship Don t jump in Listen Build relationship Develop trust
22 Barriers to relationship? Whose eyes are you looking through?
23 Attitude: Pete s story + - Authentic Kind Hopeful Expecting the best Consequence: Empowers the best Positive feedback loop Critical, hypocritical Rejecting Stigmatising Expecting the worst Outcome: Empowers the worst Negative feedback loop
24 Communication skills Education Illiteracy Reading glasses Memory poor
25 Drug & alcohol Malnutrition Biochemical
26 Mental health Personality disorders Attention Deficit and Hyperactivity Disorder Aspergers, autism Psychosis eg foot washing Depression & anxiety Examination issues (h/o abuse?)
27 Dual Diagnosis
28 Past experience - tinted spectacles Trauma: 80% homeless people had childhood trauma
29 Past experience Prejudice or abuse from people in authority (eg Pete s story) Medical experiences (eg A&E)
30 Self worth Rejection eg ball in park story Hygiene - waiting room / examination Prioritising own needs
31 Self worth
32 Environment - stability
33 Isolation & loneliness Lack of family / friend / support / advocate
34 Coping strategies Disconnection / emotional numbness
35 Coping strategies Anger / aggression Short fuse Fear /avoidance / denial eg PR bleeding story upload.wikimedia.org/wikipedia/commons/thumb/0/0e/anger_controlls_him.jpg/640px-anger_controlls_him.jpg
36 Coping strategies?
37 What do you do to mood alter? Have you ever thought about changing this habit? Have you ever tried to change it? How did you get on?
38 Model of change Prochaska & DiClemente
39 Cycle of Change
40 Stages of change Not ready (pre-contemplation) Change in awareness Unsure (contemplation) Relapse Changed (maintenance) Ready (preparation) Changing (action)
41 Stages of change Not ready (pre-contemplation) Unsure (contemplation) Ready (preparation) Change in awareness Change in attitude Relapse Changed (maintenance) Changing (action)
42 Stages of change Not ready (pre-contemplation) Unsure (contemplation) Ready (preparation) Change in awareness Change in attitude Change in behaviour Relapse Changed (maintenance) Changing (action)
43 PC Pre-contemplation Not even thinking about it
44
45 Denial The truth will set you free How do you find the truth that pierces through denial?
46
47 Consequences: Benefits and Costs What good things happen when drink? What bad things can I avoid by drinking? What bad things happen when I drink? What good things do I miss out on if I drink?
48 Reality check No. 1 feature of alcohol dependence is denial The underlying emotions are guilt & shame Is there a safe person with whom to look at the truth?
49 Take home key It s not what you do but who you are AUTHENTICITY
50 Motivational Style Empathy Am I different to you? Avoiding arguments I want a detox NO Rolling with resistance Pick your battle Highlighting ambivalence: where behaviour contradicts their ambition / self-image eg family contact Bolstering confidence that they can change for the better You have already
51 Contemplation The thinking about it stage C
52 I m sick and tired of feeling sick and tired I feel guilty and ashamed. I don t know how to stop drinking It s your fault Help me. Leave me alone Help me I m afraid I m going to die and I m scared I ll never get better I m hurting. Something is wrong No one is helping me
53 Frustration of the drinker I don t like this I think there is a problem I try to stop I can t What next?
54 Where do I start? Creating a safe space
55 Martin Arber
56
57 Step 1: We admitted that we were powerless over alcohol, that our lives had become unmanageable
58
59 Step 2: We came to believe that a Power greater than ourselves could restore us to sanity.
60 Is there any hope? Able to accept help?
61
62 Increasing motivation for change + Drinking Stop drinking -
63 Tipping point for change Pain of the status quo > pain of change
64 Ready for change? Is drink a friend or foe? What have you lost? Which is harder to carry on as you are or to change? What are the barriers to change?
65 What makes change harder? H ungry? A ngry? L onely? T ired?
66 What makes change harder? M alnourished? A nxious? D epressed?
67 Preparation I know I want to, but I m not ready yet P
68 Think wider Housing? Support? Food / fluids? Vitamins? What first? start simple make plans
69 Bristol Specialist Drug & Alcohol Service Refer to ROADS Colston Fort Stokes Croft 6 Hub practices Acer Unit = in-patient DHI (Blackberry Centre) = South Glos DHI = BANES ARA = NS
70 Build on success What have you done before that went well? What skills enabled you to do that?
71 Action Doing it A
72 Detox Plan & prepare Do it Maintain
73 Relapse Going backwards R
74 Relapse Relapse is part of recovery What went well? Reinforce the positives What went wrong? Be specific What did you learn? What will you do differently next time? When will you try again?
75 Additional resources 12 step fellowship: AA 94 per week CBT model: SMART recovery 7 per week 12 step Dual diagnosis
76 Carer support Alcohol famanon.org.uk Drugs National Association for Children of Alcoholics Bristol S Bristol
77 Information resources Services throughout the region BME, crack use Sexual violence Bristol Against Violence & Abuse
78 Take home key It s not what you do but who you are
79 Take home key It s not what you do but who you are Relentless kindness Authentic truth
80 Take home keys Authenticity - Respect Relentless kindness Hope Firm boundaries Listen for the story Think whole person/family Be realistic
81 Pro / con chart Body/mind/spirit Pictures Take home tools Drinking Stop drinking + -
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