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PYB159 - No.2 > 11. Principles of Effective Treatment & Ethical Considerations > Flashcards

11. Principles of Effective Treatment & Ethical Considerations Flashcards

1
Q

What are the principles of effective treatment?

A
  1. No single treatment is appropriate for all individuals
  2. Treatment needs to be readily available
  3. Effective treatment attends to multiple needs of the individual, not just his or her drug use
  4. An individuals treatment plan must be assessed continually & modified as necessary to ensure the plan meets the person’s changing needs
  5. Remaining in treatment for an adequate period of time is crucial for treatment effectiveness
  6. Counselling (individual or group) & other behavioural therapies are critical components of effective treatment for addiction
  7. Medications are an important element of treatment, especially when combined with counselling & other behavioural therapies
  8. Clients presenting with coexisting mental health & substance abuse should have both disorders treated in an integrated way.
  9. Medical detoxification is only the first stage of treatment & by itself does little to change long-term drug use
  10. Treatment does not need to be voluntary to be effective
  11. Possible drug use during treatment must be monitored continuously
  12. Treatment programs should provide assessment for blood borne viruses & other infectious diseases, & counselling to help modify or change behaviours that place the person or others at risk of infection.
  13. Recovery can be a long term process & frequently requires multiple episodes of treatment
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2
Q

What are the most important principles of effective treatment?

A
  1. No single treatment is appropriate for all individuals
  2. Effective treatment attends to multiple needs of the individual, not just his or her drug use
  3. Remaining in treatment for an adequate period of time is crucial for treatment effectiveness
  4. Treatment does not need to be voluntary to be effective
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3
Q

what percentage of patients who relapse have type 1 diabetes?

A

30-50%

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4
Q

what percentage of patients who relapse have drug addiction?

A

40-60%

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5
Q

what percentage of patients who relapse have hypertension?

A

50-70%

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6
Q

what percentage of patients who relapse have asthma?

A

50-70%

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7
Q

what are the services involved in the components comprehensive drug abuse treatment?

A 
child care services
vocational services
mental health services
medical services
educational services
AIDS/HIV services
Legal services
financial services
housing/transportation services
family services
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8
Q

what are the therapies in the components comprehensive drug abuse treatment?

A 
intake/process assessment
behavioural therapy and counselling
treatment plan
substance use monitoring
clinical and case management
pharmacotherapy
self-help / peer support groups
continuing care
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9
Q

what do the best treatment programs provide?

A

a combination of therapies and other services to meet the needs of the individual patient

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10
Q

how long, where and how many clinical professionals are in project match?

A

runs for a 8 year period
in 30 locations
with 130 clinical professionals

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11
Q

what therapeutic programs does project match incorporate?

A

12 step programs
CBT
MET (motivational interviewing)

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12
Q

what are the outcome differences of project match?

A

there are few apart from the effect of psychiatric severity

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13
Q

what are the criticisms of project match?

A

eligibility criteria
too much focus on assessment and follow-up research - which interrupted usual therapy
all participants attend AA groups
abstinence was the determinant of success
no control group

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14
Q

What is the issue of the eligibility criteria for project match?

A

poly drug users are excluded (except THC)

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15
Q

what are the major conclusions from project match?

A

o No superior treatment model exists - Therapist and therapeutic relationship (Bambling & King 2001)
o No single treatment intervention is effective for all people
o Matching treatments to clients is a complex but important process

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16
Q

what did Glasser suggest that project match was?

A

the Titanic of treatment outcome studies.
Like Project MATCH, the great ship was large, the largest man-made object to that point in history. It was complex; it generated enormous enthusiasm and it sank like a stone on its maiden voyage with great loss of life

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17
Q

what did Miller & Hester provide about informed eclecticism?

A

“…future progress and practice should be directed to an informed eclecticism, an openness to a variety of approaches that is guided by scientific evidence.”

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18
Q

what are Miller & Hester’s 4 assumptions of informed eclecticism?

A

o There is no single superior approach to Treatment (Rx) for all individuals
o Rx programs/systems should be constructed with a variety of approaches that have been shown to be effective
o Different individuals respond best to different Rx approaches, and
o It is possible to match clients to optimal Rx, therefore increasing Rx effectiveness and efficiency

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19
Q

Who did the australian treatment outcome study (ATOS) examine?

A

heroin users

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20
Q

What did the australian treatment outcome study (ATOS) examine?

A

Replacement
withdrawal
residential rehabilitation
non-Treatment control

21
Q

What was the structure of the australian treatment outcome study?

A

3 and 12 month post entry follow-up

22
Q

How did the ATOS treatment sample differ from the general population?

A

o More PTSD, Depression, Borderline PD, and disability.

o High suicide and overdose rate; criminality (Holt, Ritter, Swan and Pahoki, 2002)

23
Q

What were the outcomes of the ATOS?

A

o General functioning improved (Ross et al 2004)
o Majority of participants abstinent for the 1 month prior to 12 month follow-up
o Noticeable reduction in criminal behaviours, improved injection related health, decline in Depression

24
Q

What percentage of participants were abstient for the 1 month prior to 12 month follow up in the ATOS for each category examined?

A
  • 65% Replacement
  • 63% residential rehabilitation
  • 52% withdrawal
  • 25% non-Treatment control
25
Q

What does research indicate a need to do in the future?

A

o Improve understanding of dependence & withdrawal
o Greater attention to the use of psychosocial interventions as primary & adjunct treatment
o Consider significance of lifetime treatment history & how individual treatment episodes fit together to achieve recovery
o Assess effectiveness & efficiency under typical circumstances
o Assess effectiveness of treatment interventions with subgroups

26
Q

What does it mean to be utilitarian according to Peter singer? (ethics)

A

To be a utilitarian means that you judge actions as right or wrong in accordance with whether they have good consequences. So you try to do what will have the best consequences for all of those affected.

27
Q

What is the issue of utilitarianism in A&D studies according to peter singer?

A

In the real world, 90% of the money spent on medical research is focused on conditions that are responsible for just 10% of the deaths and disability caused by diseases globally.

28
Q

What are things to consider in ethics in A&D practice?

A
  • Consider the many difficult decisions you may be faced with when working in the alcohol and drug field…
  • How might the illegality of drug use impact on your work?
  • What about working with drug using parents?
  • Or clients under 18?
  • When do you terminate treatment?
29
Q

How does West (1997) suggest that addiction affects the lives of all human kind?

A

“Addiction affects the lives of all human kind, either directly or indirectly. The cost to individuals and societies is immense and tackling the problem is as much one for policy makers as clinicians, counsellors and scientists. Ethical issues permeate much of the work of all these groups.”

30
Q

what are the levels of ethics?

A 
macro ethics (theory)
Meso ethics (applied)
Micro ethics (applied)
31
Q

What are macro ethics?

A

the framework or theory

32
Q

Was are meso ethics?

A

applied in procedures or guidelines

33
Q

What are micro ethics?

A

applied in practice

34
Q

What are unique moral, ethical and legal issues?

A

o Unique risks to user and community balanced with therapeutic goals
o Potential impact on the therapeutic relationship, clinician and clients reactions, and services offered
o Who should have access to treatment? (esp. public)
o Consent (intoxication, third party pressures)
o Illegal behaviours and confidentiality limits
o Minors
o Harm reduction vs No Tolerance/Abstinence approaches

35
Q

What are value and belief issues with regards to the impact of ethics?

A

o Different beliefs associated with different drugs
o Differences between personal beliefs and evidence of harm - Based on personal experiences?
o Stigmatisation of drug use often means clients have often experienced judgemental approaches and rejection in the past -
Stigma is a barrier to accessing treatment

36
Q

what are the barriers for mental health professionals in ethics?

A
  • Lack of familiarity with AOD issues - belief that referral is the most appropriate way to change
  • Stereotyped beliefs of clients
  • Views on how to manage relapse vary greatly - from supportive to judgemental
  • Concerns about lack of skills / providing ill informed service
37
Q

what is the issue of stereotyped beliefs of clients?

A

o difficult and chaotic (media influence)

o focus on intoxication, non-compliance, likelihood of relapse, potential violence, and criminality

38
Q

What are the codes or ethical guidelines in the AOD field?

A

o ADCA Code of ethics
o APS Code of Ethics and Substance Use Position Paper (2009)
o Individual services Code of Conduct, policy and procedures
o Legislation – eg Child Protection Act, Health Services Act, Drug Misuse Act

39
Q

What is the issue with the ADCA Code of ethics?

A

Only a discussion paper… and appears to be unavailable now that ADCA has been “defunded”

40
Q

What is the issue with the APS Code of Ethics and Substance use Position Paper?

A

is it unique to psychology?

41
Q

What is the issue with legislation as an ethical guideline in AOD?

A

Is legislation always based on ethical principles?

42
Q

What are the guiding principles in the ADCA code of ethics?

A
  • Equity and access
  • The client/worker relationship
  • Privacy and confidentiality
  • Training & professional development
  • Responsive services
  • Effective and efficient services
  • Reducing stress and workload issues
  • Community consultation and involvement
  • Ethics committee approval for research
  • Advocacy in public policy and public health outcomes
43
Q

When are breaches in professional practice most likely to occur?

A

o When workloads are high
o When staff are under significant stress
o When client and clinician’s values are in conflict
o Lack of defined policies, procedures and guidelines
o Lack of supervision / support
o Lack of professional development opportunities

44
Q

what did Duncan, Williams and Knowles (2013) explore?

A

o Explored views of 264 Australian Psychologists
o Case of a fifteen year old client using drugs and alcohol, and a number of other concerns
o Asked when they would breach confidentiality for different drug types and use frequencies

45
Q

what is the goal of the applied ethics process proposed by Benaroya?

A

the goal of which is to reach consensus decisions on ethical challenges, through structured open discussion in a series of step

46
Q

what are the steps in the applied ethics process as proposed by Benaroya?

A

o 1) identify the practical ethical problem
o 2) identify the client’s individual context
o 3) identify the duty of care responsibilities of each staff member
o 4) identify the values staff consider essential to responding to the problem
o 5) identify any conflicting values
o 6) identify alternative solutions to the ethical conflicts identified
o 7) choose the consensus option best suited to the program objectives; and
o 8) provide justification for the choice.

47
Q

what are the APS Guidelines of confidentiality?

A
  1. Understand the legal context and the organisational requirements associated with confidentiality and limitations
  2. Informed Consent
  3. Only breach confidentiality when:
  4. When disclosing information, only disclose what is needed to achieve the purpose of the disclosure and only to individuals who require the information
  5. Where safety permits, psychologists inform clients:
    o if their information is to be disclosed;
    o about what information is to be disclosed;
    o of the circumstances and the reasons for the intended disclosure of information; and
    o to whom and when the disclosure is to be made.
48
Q

How does one conform to the APS guideline on confidentialy with regards to informed consent?

A

o Prior to treatment, ensure clients are aware of the limitations of confidentiality
o Consider the capacity of the person to provide consent (e.g. minors, intoxication, mandated clients etc…)

49
Q

When can a psychologist breach confidentiality according to the APS guideline on confidentiality?

A

o Consent exists to do so
o There is a legal obligation to do so
o There is an immediate and specified risk to an identified person that can be averted by the disclosure of confidential information

PYB159 - No.2 (5 decks)

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