Assessment of Chemical Dependency Final Flashcards
Assumptions of CBT
- Behavior is learned.
- Same processes that create bad behavior can change them.
- Behavior is contextual.
- Can learn to change thoughts/feelings (covert behaviors).
More assumptions of CBT
- Engaging in new behaviors is critical.
- Each client is unique.
- Thorough behavioral assessment is key.
Critical Tasks in CBT
- Assess individuals behavior and environment.
- Motivation
- Teach coping/reinforcement skills.
Coping Skills
- Craving management
- Interpersonal functioning.
- Communication skills.
- Enhancing social supports.
Advantages of CBT
- Short-term.
- Goal oriented
- Flexible
- Empirically supported
Community Reinforcement Approach (CRA)
- Behavioral treatment for substance abuse.
- Social and recreational reinforcers to aid recovery.
- Reinforce(positive) sober behavior.
- Avoid confrontation.
Basic Tasks of CRA
- Eliminate positive reinforcement for substance abuse.
- Enhance positive reinforcement for non-use behavior.
CRA Clinical Components
- Assessment
- Sobriety Sampling
- Medication
- Treatment Plan
- Behavioral Skills Training
Functional Analysis
Identifying patterns of use and triggers.
Cost Benefit Analysis
- Identify areas to address and validates client experience.
- Can help lower defenses.
High Risk/High Safety
- Used when motivated to abstain.
- People, places, things.
Sobriety Sampling
- Let’s client experience sobriety for a set period (90 days) to reflect on it later.
- Builds trust, attainable, motivator, etc.
Medications
- Disulfiram/Antabuse (inhibitor): Treats alcohol by making hangover effects immediate after drinking.
- Suboxone/Naltrexone (antagonist): blocks positive effects of alcohol.
- Reduce worry Increase opportunities for positive reinforcement
Behavior Skills Training
- Communication Skills (brief, specific)
- Problem Solving Skills (define problem, generate alternatives)
- Drinking Refusal Skills (social support, assertive, restructure negative thoughts)
Social and Recreational Counseling
- Develop a healthy social life through areas of interest and community access.
- Reinforcer sampling Reinforcer access
CRA Marital Therapy
Time limited Focus on present-day problems
Address expectations, communication, problem solving.
Common Mistakes with CRA
- Losing sight of client’s reinforcers.
- Inadequate monitoring.
Problems with old approaches.
- 12-step saturated.
- Focus on inpatient treatment.
Best Practices
- Psychiatrically sophisticated
- Individualized
- Medication-supported
- Outpatient
- CBT/CRA/DBT
- Evidence Based
MI Spirit
- Honors Autonomy. (Client choice, roll with resistance, build discrepancy)
- Collaborative. (Supports self-efficacy and express empathy)
- Evocative. (Strategic, clear goal)
Motivational Interviewing (MI)
- A collaborative conversation style to strengthen a person’s motivation and commitment to change.
- Person-centered
- Addresses ambivalence
- Goal-oriented
Motivation facts
- It’s a state not a trait.
- Negatively affected by confrontation.
- Needs interpersonal interaction.
- Can occur when cost/benefit balance shifts in favor of change.
Self Determination Theory
- Competence and autonomy are needed to change.
- Autonomous reasons are better than controlled reasons.
Overlap of MI and SDT
- Autonomy oriented
- Resolves ambivalence
- Avoid coercion/unsolicited advice/imposing beliefs
- Clarify goals for change/non-change
Sustain Talk
Reinforce status quo.
“There no way I can do this…”
Change Talk
DARN
Desire. Ability. Reason. Need.
Therapist reinforces this.
“I can change, I want to change…”
MI Skill Focus Areas
- Engaging (building relationship, understanding problem)
- Focusing (set agenda, switch and repeat, feedback/tone/empathy)
- Evoking (strategic, use OARS)
- Planning (More CBT than MI, collaborate on goals, SMART)
OARS
- Open ended questions
- Affirmations
- Reflections
- Summary statements
Harm Reduction
- Reducing the harm associated with drug use without reducing drug use.
- Yellow Light alternative to abstinence.
- Humanistic, rooted in acceptance.
- More acceptable outside the US/outpatient treatment programs.
Morbidity vs Mortality
- Morbidity = living with sickness
- Mortality = leading to death
Harm Reduction Public Policy examples
Needle exchanges, safe injection facilities, Naloxone, etc
Suboxone
- Buprenorphine
- Partial agnonist to mu opioid receptor which protects against withdrawal.
- Antagonist for kappa and delta opioid receptors. (reduces drug reward)
Vivitrol
- Naltrexone
- Opioid antagonist that blocks opioid receptors.
Neuron System
HIPAA
- Health Insurance Portability and Accountability Act 1996
- PHI: protected health information
- Need conset to disclose PHI
DBT Prioritization
- Suicidality
- Behavior that interferes with treatment
- Quality of life
- Increasing other skills
- Trauma related symptoms
- Increasing self respect
- Other
Setting Frame of Treatment
- Establish routine early
- Attend to high risk behaviors
