Effective Treatment: Doing the Right Thing, In the Right Way. Terrence D Walton, MSW, ICADC

Transcription

1 Effective Treatment: Doing the Right Thing, In the Right Way Terrence D Walton, MSW, ICADC

2 Monitor Manage Impact

3 1. Understand the Treatment Field, including Evidenced Based Practices 2. Understand Your Provider 3. Build Relationships & Partnerships 4. Understand Organization s Functioning, including limitations

4 Philosophy Policy Process Practice

5 Values addiction treatment science Values court-involved treatment Values the therapeutic alliance

6 Facilitates vigorous participation on the drug court team Mandates clinical credentialing/ advanced education Operationalizes the utilization of evidencebased practices

7 Scope Duration Intensity Dosage

8 Full Continuum of Care Adequate Duration (cost benefit analysis) Aftercare Peer Support Fellowships Stage of Recovery-based Design Session Frequency Guidelines

9 Culturally-appropriate evidenced based treatment practices Practitioners trained and coached in manual-guided delivery Services dominated by those that have been rigorously tested

10 1. Look for a Good Match 2. Understand the Condition, Culture, & Climate Profession, Institution (modality), Provider Resources (leadership, finances) Motivation, Resources, Staff Attributes Language & Lingo 3. Express Empathy Appreciate Difficulty of Work & Limitations Respect Expertise and Perspective

11 4. Find Common Ground Recognize Strengths Appreciate and Re-Frame Differences 5. Communicate: Realistically, Regularly, and Reciprocally 6. Agree if There is Need for Change Desired Outcome Drug Court Bottom Lines Treatment Provider Bottom Lines Can Change Happen?

12 National Registry of Evidencedbased Programs and Practices:

13 1. Generic Counseling 2. AOD Education 3. Confrontational Interventions 4. Psychodynamic Therapy 5. Solution-focused Therapy 6. Mindfulness-based Stress Reduction 7. Acupuncture

14 1. Cognitive Behavioral Approaches 2. Relapse Prevention 3. Motivational Interviewing & Motivational Enhancement Therapy (MET) 4. Medication-Assisted Treatment 5. Co-occurring Services 6. Recovery Oriented Services

15 1. Analyzes thoughts, feelings, and actions (behavior) 2. Thoughts drive emotions 3. Emotions drive behavior 4. Identify thinking patterns and stop thinking errors from leading to emotional reactions that produce problem behaviors.

16 1) Matrix Model 2) Moral Reconation Therapy (MRT ). 3) Thinking for a Change (

17 Nearly every evidenced based intervention is manual-based. However not every intervention that is manual-based is evidenced based.

18 1. So tell me, what are some of the thinking errors that you ve been hearing about in group? 2. What kind of thinking has gotten you in trouble in the past? 3. What have you been told you should do when you start thinking in ways that usually get you in trouble?

19 Understand relapse as a process Identify and cope effectively with high-risk situations such as negative emotional states, interpersonal conflict, and social pressure Cope with urges and craving Implement damage control procedures during a lapse to minimize negative consequences Stay engaged in treatment even after a relapse Learn how to create a more balanced lifestyle

20 1. I may want to see your relapse prevention plan. Can you bring it with you next time? 2. What are your high risk situations? 3. If that happens, who are the people that you plan to call on? What are their numbers?

21 1. To increase and maintain the person s motivation to change his or her life 2. Motivate those who don t want to change 3. Help increase the motivation of the people who aren t sure 4. Help the motivated maintain their readiness to change

22 1. Motivational Interviewing: Preparing People for Change William Miller & Stephen Rollnick (2002) 2. Addiction and Change: How Addictions Develop and Addicted People Recover Carlo C. DiClemente (2003)

23 Pre-Contemplation Contemplation Preparation Action Maintenance

24 1. To provide relief from withdrawal symptoms 2. To prevent drugs from working (antagonist) 3. To reduce craving 4. To provide replacement (agonist) 5. To provide aversive reactions

25 Naltrexone Interrupts actions of alcohol and opiates; reduces cravings (Vivitrol) Acamprosate reduction of alcohol cravings Disulfiram/Antabuse produces adverse reaction with alcohol use

26 Methadone Opiate addiction reduces craving, mediates withdrawal symptoms, helps restore normal functioning (agonist) Buprenorphine (Subuxone) similar to methadone, may be prescribed by an MD with special training (partial agonist)

27 1. May I see the schedule of psychosocial treatment sessions for patients on methadone maintenance? 2. How many consecutive treatment sessions is a patient allowed to miss before their dosing is suspended? 3. How do you monitor if patients are taking their medication as prescribed and if they are using illicit drugs?

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29 1. Blended Screening and Assessment Approaches? 2. Education on Co-Occurring Disorders? 3. Medication Monitoring and Management Sessions? 4. Heavy Utilization of Positive Reinforcement and Flexible Application of Graduated Sanctions? 5. Mental Health Specialists? 6. Agreements with Community Mental Health Services Agencies?

30 The 12 Step Facilitation Therapy Manual Offer choice (types, spiritual & secular) Be selective regarding approved groups Try to match demographics, lifestyles, and level of substance involvement

31 A choice More than sobriety A personal condition, not a specified method or program Voluntarily maintained, balanced lifestyle

32 Stable Sobriety Sustained Sobriety Early Sobriety Active Abuse or Addiction

33 Stable 5+ Years Sustained 1 to 5 years Early 1 to 11 months Active Abuse or Addiction

34 Effective Treatment