Chapter 4 Flashcards
Michigan Alcohol Screening Test (MAST):
consists of 24 items and takes 10-15 minutes to complete. Items are scored with a 0 for non-drinking, or a 1, 2, or 5 for an affirmative response to drinking.
- Scores: 0-4 (nonalcoholic), 5-6 (alcohol problem), 7-9 (alcoholic), 10-20 (moderate alcoholic), 20+ (severe alcoholic)
- Relatively easy to fake
Substance Abuse Subtle Screening Inventory-3 (SASSI-3)
SASSI-2 added a correction scale to measure recidivism in the criminal justice system and the random-answering scale was added to identify random responses. Takes 10-15 minutes to administer; consists of 67 true-false items on the adult version and 55 items on the adolescent version; good job identifying individuals with dependency on alcohol and drugs. Does not diagnose abuse.
Co-occurring disorders
suggests that a client has met the criteria for two disorders on Axis I, one being a substance abuse/dependency disorder and the other a mental illness.
- Funding for mental illness and substance abuse treatment typically is separate
- Treatment of co-occurring disorders occurs simultaneously
Motivational interviewing
helps reduce defenses and at the same time help the client and clinician with referral and treatment options. Is directive, client centered, and elicits behavior change by helping clients explore and resolve ambivalence.
Motivational Interviewing Tasks
- Initial task is to develop rapport with the client and listen to the presenting issues.
- Second task is to help enhance client motivation
- Third task is to work with the resistance the client may bring to the session
Motivational Interviewing: Not Helpful
-Arguing for change: attempts to persuade clients to make changes from their stated position. Can be covert or overt.
-Assuming the expert role: counselor presents as “knowing it all”
-Criticizing, shaming, and/or blaming:
Labeling: attempt to focus on diagnostic labels as opposed to exploring the feelings related to the client’s trauma or addiction to alcohol and drugs
-Being in a hurry
-Chaiming preeminence: counselors believe they understand what their clients need better than the clients
Motivational Interviewing: Four Basic Principles
- expressing empathy
- developing a discrepancy
- rolling with resistance
- support self-efficacy
expressing empathy
genuine acceptance allows change and reflective listening. Clients who genuinely feel understood are less resistant and more opening to therapy
Developing a discrepency
- Accurate reflection of the awareness of consequences builds rapport and helps the client envision how actions and behaviors do result in outcomes
- Pointing out discrepancies between goals and behaviors encourages client growth
- Explore with clients their values and goals and how the use of drugs/alcohol impact them
rolling with resistance
- Dont argue
- Process your reactions
- Use empathy
- Practice being in the moment
- Encourage new perspectives
- Embrace their story while supporting alternatives
- Determine how the client feels about recommendations
- Work with the client on new directions
support self-efficacy
- Express hopeful and optimistic attitude for change
- Make affirmation statements
- Notice and comment on strengths and positive movement
- Understand that change is inevitable
Managing resistance
Use Motivational Interviewing
CAGE
brief screening instrument; provides initial information on client’s alcohol use. A ‘yes’ to 2+ items = likely alcohol problem
C–Have you ever felt the need to cut down on your drinking?
A–Have you ever felt annoyed by someone criticizing your drinking?
G–Have you ever felt guilty about your drinking?
E–Have you ever had an eye opener or drank in the morning to steady your nerves?
