Chapter 7 - Treatment Flashcards
What types of skills training are included in treatment for addiction?
- relaxation skills
- stress management
- assertiveness skills
- affect regulation skills
- coping skills
- relapse prevention strategies
also important to seek support!
- strengthen existing support
- build new supports
- scaffolding (self reg. and control)
definition of motivational interviewing
a collaborative communication used to strengthen a person’s desire to change. Goal-oriented - commit to a specific goal by exploring the person’s reasons for change
4 processes of motivational interviewing
even foxes eat pepperoni
Engaging - helping them see what’s in it for them
Focusing - finding targets for change, respecting autonomy, don’t force change
Evoking - evoke ambivalence about change, reasons and strategies for it. evoke change talk
Planning - when client is ready to commit to change. evoke commitment talk and client’s ideas for change
motivational learning - spirit
apples attack cars everywhere
Acceptance
Autonomy
Compassion
Empathy
stages of change definition
- also called the transtheoretical model of behavior change
- used for recovery from chronic beh patterns. Stages are integrated w/ diff processes of change
- people can rapidly change between stages, even in span of a day
what are the stages of change? (just name)
precontemplation
contemplation
preparation
action
maintenance
precontemplation
does not recognize the need for change or is not actively considering change
this stage can be weaponized by healthcare providers - say they don’t want help, but don’t even give people resources
contemplation
recognizes problem and is considering change but not quite ready yet
- ex: I’m thinking about quitting smoking, it’s bad for my health
preparation/action
has initiated the change
- go to pharmacy for resources like nicotine patch
maintenance
is adjusting to change and practicing new skills and behaviors to sustain change
- some stay here, others leave treatment, relapse, etc
self-efficacy
the belief an individual has about their own capability to succeed in achieving their aims despite challenges
- beliefs can change as progression through stage occurs
meeting people where they’re at
assessment: how often/heavy is use, consequences, medical problems, previous quit attempts, social support, personal resources, motivation, etc
- give clients treatment options
- match intervention to stage of change
possible treatment goals
- changing pattern of use
- cut down on use in more controlled manner (harm reduction)
- stop using for a period of time before making decision (abstinence sampling)
- stop using regularly but can when have strong urge
- quit using altogether, but understand there may be some slip-ups
- quit using substance altogether and never use again
how to meet people where they’re at in each stage of change
- precontemplation: increase awareness for change
- contemplation: look at pros/cons of current beh
- preparation: inc commitment
- action: implement strategies for change
- maintenance: sustaining change across range of diff siutations
criticisms of stages of change
used in various healthcare fields but has criticisms because of arbitrary nature of time periods used to define each stage and that it doesn’t see complexity of human functioning
motivational interviewing: skills
OARS:
asking Open ended questions
Affirming - express genuine appreciation, positive regard for client
Reflective listening - consider ethnic/cultural diffs, best way to show empathy
Summarizing - reinforce their statements about change
4 types of behavior therapies
aversion therapy
cue exposure therapy
cognitive bias modification
contingency management
12 step programs
- most widely known (AA)
- founded in 1935, influenced by Christian movement at the time
- has been criticized on religious overtones, however it is non-dogmatic, can be interpreted differently - has helped atheists
SMART recovery
Self Management Recovery Training
- online and in person, volunteers “give back” to community by helping those who enroll
- can attend meetings as long as they find it useful
techniques used in CBT
- assessment/engagement: treatment rationale, motivational enhancement, goal setting/contracting, functional analysis
- coping skills training: self-monitoring, coping w/ cravings/urges, substance refusal skills, mood management, positive lifestyle enhancement
- planning and maintenance: relapse prevention, social supports
CBT - situation
a central part of the model because it triggers thoughts, feelings, behs associated w/ substance use. Situations involve external and internal components
2 types of addictive beliefs
1) permissive beliefs: justify or minimize consequences of substance use - “one more time won’t hurt”, “I deserve this”
2) anticipatory beliefs: expectations of the benefits or pleasure from substance use - “this will make me feel better”, “I’ll be more social”
CBT - core beliefs
deep-seated, often negative beliefs about self, others, and the world
- “I am unlovable”, “you can’t count on other people”, “the world is a cruel place”
- beliefs make addictive beh feel like an escape
behavioral activation
helping individuals schedule more positive, goal-oriented activities
- focuses on pleasure and mastery activities (gives sense of accomplishment)
mechanism: interrupts cycle of low motivation and inactivity that worsens depression, anxiety
list types of worksheets used for treatment
- behavior activation
- thought record
- exposure hierarchy
- relapse prevention plan
relapse and recovery rates
first attempt - less than half finish treatment initially, relapse is common
relapse rates - 40-60% relapse within 1st year of treatment
multiple attempts: recovery often involves multiple treatment attempts
long term recovery: after 5 years of being sober, relapse risk drops to 15%
2 elements of treatment effectiveness
- greater client readiness to change associated w/ greater success
- greater severity of addiction is associated w/ poorer response to treatment
harm reduction definition
- humanitarian stance that accepts the dignity of life and gives empathy
- assumes people will make more health positive choices if they have access to support
- compassionate and pragmatic approaches including public health policy, prevention, intervention, education, peer support, advocacy
harm reduction strategies
- psychoeducation and correcting misinformation
- provide info on safe use (low risk drinking guidelines, safer smoking and injecting)
- brief interventions (MI, expectancy challenge
- CBT
- public policies (laws, needle distribution, safe injection sites, Narcan kits)
2 types of prevention
Universal prevention - everyone gets the intervention (also called primary intervention)
- early intervention to disrupt initial stages of initiation
Selective prevention - participants selected based on known risk factors (also called secondary/indicated prevention)
- once risky engagement has begun, disrupt initiation process
safe injection site
supervised site for substances to be injected, individuals bring their own supplies
safe supply site
environment where substances are given, they are safe, as they are regulated, it’s not coming from drug dealer where it could be laced with other substances
