Treatment and the Recovery Process. Treatment Options. Treatment Options. Hagedorn MHS

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1 Treatment and the Recovery Process W. Bryce Hagedorn, PhD, LMHC, NCC, MAC Treatment Options Settings Inpatient Hospitalization Short term ( days) used for detox, stabilization, & safety Inpatient Residential days, expensive, yet artificial environment Partial Hospitalization/_ More cost effective, allows practice of skills in real world yet many clients continue to use without detection Treatment Options Settings Continued and Intensive Outpatient Allows for continued work and school Therapeutic Communities Long term (12-18 m),, structured Choice of Treatment Settings Should be Based on ASAM PPC criteria American Society of Addiction Medicine Patient Placement Criteria Uniform criteria to guide proper placement often determines level of care without consideration of best practice MHS

2 Treatment Models Minnesota Model most common Behavioral Models Biomedical Approaches Brief Therapies Cognitive Behavioral Approaches Developmental Approaches Existential Approaches Experiential Approaches Motivational Interviewing Narrative Approaches Pharmacological Approaches Psychodynamic Approaches System Approaches The Sequential Treatment Model Juhnke & Hagedorn (family and addiction counseling) Basic premise : begin with the model (shortterm Tx), and given more time, move on to -term Tx models Find what combination works for you/setting It is silly to think that one treatment model will work for every client The Sequential Treatment Model (Juhnke & Hagedorn, 2006) 8 Sessions Short Term Tx 24 Sessions Long Term Tx MHS

3 The Sequential Treatment Model Motivational Interviewing ( sessions) An assessment tool and intervention strategy Main Premise successful behavior change depends on the client s This directive strategy helps to explore & resolve The 1 st interview can make/break success Involves six active processes (FRAMES) and strategic questioning (see additional handout) The Sequential Treatment Model Solution Focused ( sessions) (Capitalize on success) What will life be like when the addiction is over? Techniques The, the Crystal Ball, Circular questioning, the Movie Director, the Mapping technique Cognitive/Behavioral ( sessions) Recognizing self-talk, feelings, behaviors, and communication patterns Evaluating (positive/negative consequences) Identifying high risk situations (trigger list/non-use list) Explore new, The Sequential Treatment Model Family Systems Approach ( sessions) Learned & supported roles Power hierarchies/relationship dynamics ( ) Multi-Generational Family of Origin ( ) Involvement of the Is the client s behavior the result of family pathology? Object Relations ( sessions) What deficits exist? Defenses used? Focuses on the past and the unconscious Insight is Getting rid of the pathology gained from parents MHS

successful change: Knowing the client s stage & Moving from Resolving ambivalence

4 The Stages of Change Model Basic Premises Prochaska, DiClemente, & Norcross (1992) Before implementing interventions know your client s Six staged Model of Change Keys to successful change: Knowing the client s stage & Moving from Resolving ambivalence (Motivational Interviewing) Relapse is an expected part of change The key to un-successful change: MHS

5 Precontemplation ( ) Characteristics Lack and avoid information Ignorant bliss Resistance Don t want to change themselves, but the people around them Interventions Experiential and insight oriented therapies Psycho-education Drug effects Drug dangers _ Identify barriers Increase Self-esteem Contemplation ( ) Characteristics Interventions Acknowledgement Emotional arousal and Waiting for the Experiential and insight Struggle to understand oriented therapies Enhance motivation to Not ready for change/ change action Awaken a desire for Substitute thinking for action Help client see the impact of and AOD Chronic contemplators Preparation/Determination ( ) Characteristics Making adjustments Heighten awareness Confidence builds May be public disclosures High anticipation Not necessarily Detailed plan Interventions Behavioral and Family Systems therapies Develop a firm, Nurture the change process Encouragement Support Feedback Validation Gentle confrontation MHS

6 Action ( ) Characteristics Interventions Overt modifications Apply rewards Make environment more Requires time, effort, change-friendly energy and support Support Systems Change is visible Helping relationships Parent/mentor/cheering squad/guide therapies Relapse triggers Maintenance ( ) Characteristics Concern of relapse Change never ends Gains are consolidated Interventions Same strategies as those in the action stage Confront personal issues that led to use Learning a Termination Characteristics No more temptation Behavior never returns No fears of No more continuing effort Interventions to others Apply learning to other MHS

7 Preventing Relapse sobriety is the most difficult aspect of recovery Meaning of relapse has changed over time A is a brief return to use after a period of abstinence A is a return to uncontrolled use after a period of abstinence Must start recovery from the beginning of recovery process a learning experience success rate (maintained sobriety) after 12 months Preventing Relapse Determinants of relapse (Chiauzzi, 1990) Personality traits that interfere with sobriety (e.g., ) Tendency towards addictions Having a narrow view of recovery Ignoring _ Preventing Relapse 4 reasons a relapse occurs comfortable with short term progress or with reduced pain forgetting how bad it was, begin to rationalize returning to risky situations the return to old using patterns MHS

8 The Environment High risk situations Social pressure Helping clients with their environmental inventory What people do/not? What situations are most risky for you? Behavioral poor or no Helping clients with their behavioral inventory What behaviors? What new things need to be learned? What behaviors need? Cognitive: Person s Perceptions of their ability to cope (self-efficacy) Irrational beliefs ( ) interpretation of cues Helping clients with their cognitive inventory What things do you say to yourself about your recovery? What can become a part of your recovery program? MHS

9 Affective: Negative or positive emotional states Correlation with depression and anxiety (hungry, angry, lonely, and tired) Shame and guilt Helping clients with their emotional inventory Let s do a HEART check today. Are you feeling: Relational: Lack of (co-abuser, distrust, violence, etc) Work and leisure acquaintances Helping clients with their relational inventory Are you at peace with those around you? If not, _ about it? Who s living upstairs? Preventing Relapse How the addict contributes to the relapse Reverting to willpower ignoring Ignoring one of the Steps to recovery Trying to recover Getting full of pride MHS

The Stages of Change Stage One: Precontemplation Stage Two: Contemplation

The Stages of Change Stage One: Precontemplation Stage Two: Contemplation The Stages of Change The stages of change are: Precontemplation (Not yet acknowledging that there is a problem behavior that needs to be changed) Contemplation (Acknowledging that there is a problem but