final Flashcards
what does trauma represent
experience that overwhelms an individuals ability to cope
three e’s of trauma
events (circumstances causing trauma)
experiences (personal response to event)
effects (physical, emotional, behavioural, cognitive, spiritual)
4 r’s of trauma informed care
realize, recognize, respond, resist re-traumatization
addiction service providers should assume that all service users…
have experienced some level of trauma & should be inquiring, in a respectful and safe manner about the nature of the trauma service users experiences
5 key practice provisions when offering trauma informed care
safety (provide protected physical and emotional environment where they feel welcome)
trust (a feeling b/w rpn & user, no judgemental, empathetic, and compassionate listening)
choice (sense of control and autonomy)
collaboration (belief that many have experienced power imbalances; work along side user)
empowerment (focus on resilience rather than deficits, understanding that drugs are coping mechanism)
reasons for grounding substance misuse in trauma informed practice
- given how prevalent trauma is, TIP always be used
- substance misuse only one negative consequence of trauma = assess trauma to determine other negative behaviours
- trauma affects perceptions of self & environment = users become trapped and unable to move forward
- experienced trauma = more likely to perpetuate violence making TIP ethical imperative
- marginalized populations (race, sexual orientation) who struggle with addiction - greater risk of experiencing ongoing trauma, perpetuating substance misuse
- trauma barrier to seeking help = TIP can alleviate stressors in accessing services
- trauma often occurs within institutions, making less likely to seek institutional services
- trauma affects staff, can experience secondary trauma from stories
road map to TIP
trauma awareness, trauma sensitive, trauma responsive (gather info & prioritize & create plan), trauma informed (implement & monitor)
6 stages of trans theoretical model of change
pre-contemplation: no intention to change, unaware there is problem
contemplation: aware problem exists, not committed to take action
preparation: intends to take action & makes small changes; needs to set goals and priorities
action: dedicates considerable time & energy; make overt changes; develops strategies to deal with barriers
adaption/maintenance: works to adapt and adjust to facilitate maintenance of change
evaluation: assessment and feedback to continue dynamic change process
describe the pre-contemplation stage
not ready
resist change & no intention of altering behaviour/doesn’t recognize any problem exists
unaware of impact of behaviour on those around
counsellors assist users in the pre-contemplation stage in…
distinguishing b/w how they see their circumstances and the reality of their situation
describe the contemplation stage
getting ready
users become aware that they stuck in situation & must decide whether they wish to change or remain where they are
counsellors help the user in the contemplation stage by
help equilibrium b/w desire to change and fear of changing & associated unknown consequences
assist in weighing pros and cons of change, whole working to tip the scales towards change
describe the preparation stage
ready
consider changing drug-using behaviour and anticipate what this future action will entail
identify and resolve barriers to success, including friends and family who may still benefit from users drug use
develop realistic plans that can be easily implemented with min risk of failure
describe the action stage
doing
work and behavioural change begins; heavy emphasis on problem solving skills
entails changing awareness, emotions, self-image, and thinking
support of positive decisions and reinforcement
identifying and exploring times that may lead to use
describe maintenance / adaption stage
focus on supporting and consolidating the gains made during the action stage and avoiding brief or longer drug user reoccurrences
focus on social skills training
describe the evaluation/termination stage
sees service user move beyond problem solving, with a focus on preventing reoccurrence and dealing with the reality of sobriety
service users assess their strengths and areas that may be problematic in the future as they develop a reoccurrence-prevention plan
counsellors strategies for the different stages
pre-contemplation: build rapport and trust; increase problem awareness
contemplation: acknowledge ambivalence towards change; discuss pros and cons
preparation: build confidence; talk about timing of change; provide information, options, advice; work at their pace
action: offer planning assistance, provide support, develop attainable goals
maintenance: support & encourage new behaviour; talk about possible trouble areas; talk about stressors or triggers
evaluation: reinforce new skills; review triggers; develop strategies on how to return to the new behaviour if lapse occurs rather than drugs
consciousness raising
increasing information to service users about themselves and their problems
dramatic relief
experiencing and expressing feelings about one’s problems and solutions grieving losses, partaking in role play to appreciate impact of changed behaviour
environmental re-evaluation
assesses habits that affect one’s social and physical environment; increase awareness that one can be a positive or negative role model for others
self re-evaluation
users assess how they think and feel about themselves with respect to their substance use; value clarification, healthy role models,
self-liberation
choose and commit to change beliefs and actions
reinforcement management
providing consequences, punishments or rewards
helping relationships
combining caring, trust, openness, and acceptance and support for healthy behaviour
counter-conditioning
sub healthier alternatives for problems drug using behaviours; focus on sub alternatives for problem behaviours with an emphasis on self care
stimulus control
removing cues for drug use and replacing them with prompts for healthier alternatives
social liberation
increasing engagement in non-drug-related behaviours, considering the needs of others, becoming involved in broader issues; increase in social opportunities or alternatives
motivational interviewing
interpersonal and interactional process where there’s the probability of turning negative behaviours into positive ones
why people resist change
nature of change is misunderstood, change is forced, hard work required, new skills & knowledge required, threatens one’s competence, too many changes are asked at once, goal is not achievable
change talk
talking about the possibility of changing
sustain talk
talking about remaining in the same situation
MI
brief, person-centred method; uses intrinsic motivation to change
explores and resolves client ambivalence
uses the ideas of attribution, cognitive dissonance, self-efficacy and empathy
interpersonal process that de-emphasizes labelling
emphasizes internal attribution for change and individual responsibility
strength-based approach, works with user instead of doing things for them
MI focuses on
locating natural motivating issues within a person’s life
MI is non-confrontational in nature, acknowledges that creating conflict is counterproductive
TRUE
cognitions include
thoughts and beliefs; our opinions about the environment, ourselves, our actions and behaviours
when cognitions align, its called
consistency
if balance doesn’t occur b/w cognitions, the individual will experience…
state of tension or inconsistency b/w their opinions, attitudes, beliefs, and action
dissonance occurs when
tension motivates individuals to alter their thoughts, bringing their beliefs and perceptions closer
principles of MI: RULE
R = resist providing suggestions
U = understand the person’s motivation to change
L = listen intently, provide feedback
E = empowerment through encouragement and support
components of MI: PACE
P = partnership (collaborative work)
A = acceptance (absolute worth; autonomy & support; affirmation; accurate empathy)
C = compassion (non-judgemental, non-blaming, non-shaming)
E = evocation (draw knowledge and options from service users rather than imparting information or opinions)
attributes of MI
express empathy: sets the stage for acceptance of efforts to facilitate change
develop discrepancies: perceived values vs actual behaviours and outcomes, user must be able to perceive discrepancy b/w present behaviour and personal goals
roll with resistance: resist arguing against resistance, have user voice arguments for change
support self-efficacy: users must believe change can happen
counselling approach: OARS
O = open-ended qts (allows user to guide convo)
A = affirmations (compliment user on behaviours, strengths, and efforts
R = reflections (2-3 after open ended qts)
S = summarizing (ensure mutual understanding of discussion)
MI processes
engaging = establish mutually trusting relationship
focusing = “what stage” entails clarifying particular goal or direction for change and exploring ambivalence to change
evoking = “why stage” counsellors assist user to find, nurture, and implement their own reasons
planning = “how stage” counsellors helps user develop specific change plan that user is willing to implement
prevention
the promotion of constructive lifestyles and norms that discourage drug use. The development of social and physical environments that facilitate drug-free lifestyles.
prevention levels
primary, secondary, tertiary
primary prevention
occurring before a person begins to use substances, goal is to prevent or delay onset of first use
secondary prevention
occurring once a person has begun to experiment with drug use. the goal is to prevent more frequent, reg use
tertiary prevention
occurring after substance use has become problematic, goal is to reduce the harm associated with use or if possible abstinence
prevention programs focus on
those who chose to abstain from drugs, postpone drug use, already using, experiencing difficulties with current drugs, experiencing difficulties with the use of drugs by family/friends, larger family system
3 prevention focuses that can be adopted within the risk continuum
universal, selective, indicated or targeted
indicated prevention
- designed to prevent the onset of substance misuse in individuals who are showing early danger
- those who are already using or involved with psychoactive drugs
- programming is individual and can include a formal counselling component
- targets injection drug users and teaches them harm reduction techniques with or without a goal of abstinence
selective prevention
targets subsets of the total population that are deemed to be at risk for substance misuse (academic struggles, family issues, poverty, problematic social environments, family history)
universal prevention
addressing the whole population
selective prevention programs have
smaller # of participants
longer and more intensive structure
more intrusive intervention, with a goal of changing existing behaviours
higher degree of skill among leaders and staff
greater cost
greater likelihood of demonstrating change
prevention program components
knowledge, attitudes & values, skills
knowledge components of prevention
- concept of abstinence and alternative behaviours to drug use
- how different drugs can affect a person’s ability to perform tasks
- how different contexts and situations influence personal values, attitudes, beliefs, and behaviour
- importance of self-esteem, positive self-concept, and identity
- rights and responsibilities of interpersonal relationships
attitude and values prevention components
- a value stance regarding drug use and the confidence to act on those values
- significance of social and cultural influences on beliefs
- empathy and acceptance of a diverse range of people
- individual responsibility for health and universal health protection
- personal beliefs about drugs and their effects on decisions
skills components of prevention
- ability to communicate constructively with parents, teachers, and peers
- giving and receiving care in a variety of health-related situations
- setting short and long term health goals
- demonstrating conflict, aggression, stress, and time management skills
- identifying and assessing personal risk and practicing universal protection
- developing assertiveness and dealing with influences from others; working effectively with others; and coping with change, loss, and grief
prevention strategies
information strategies, normative education, perceived harm education, social influence education, advertising pressures education, protective factors, resistance skills, competence enhancement skills training, persuasion strategies, counselling strategies, tutoring/teaching strategies, peer group strategies, family strategies, recreational activities, harm minimization/harm reduction, affective education, resilience development
effective programming components
bonding
cognitive competence
clear and positive identity
resilience
self-determination
the goal of family skills programs is
not only to decrease substance misuse, but to positively affect parent-child family relations by increasing family cohesion, decreasing family conflict, and decreasing family health and social problems overall
family programming options
information sharing (harm reduction)
parental skills training
parent support (counselling for parents)
family interaction (family counselling)
competencies are
essential skills, knowledge, attitudes, values, specific, measureable
technical competencies (considered “hard skills” of counselling)
understanding substance use
understanding concurrent conditions
case management
referral
community development
counselling
crisis intervention
family and social support
group facilitation
medication
outreach
prevention and health promotion
program development, implementation and evaluation
record keeping and documentation
screening and assessment
individual counselling
psychotherapy, brief solution-focused therapies, feminist approach, narrative therapy, confrontation
psychotherapy overview
- broad title for a host of talk therapies
- belief that substance abuse is a function of some underlying psychopathology
- attempts to facilitate a major personality change through personal insights, relying on historic events, major life developmental stages, and traumas as a guide
contemporary psychotherapy
strengths-based approach
six principles of psychotherapy
- clients with addiction issues can recover, reclaim, and transform their lives
- focus is on individual strengths, not deficits
- community is viewed as an oasis of resources
- client is the director of the helping process
- worker client relationship is primary and essential
- primary setting for work is the community, not a residential facility
brief solution-focused therapies
- brief sessions directed by counsellors
- uses client’s strengths to build a solution; goals are typically practical and concrete
