Prevention

Question 1

What do prevention programs involve?

Answer 1

one or more intervention to reduce or deter specific or predictable problems, protect the current state of well-being, or promote desired outcomes or behaviours

Question 2

What can be influential in helping to prevent addiction and reduce substance abuse?

Answer 2

Messages that parents, doctors, teachers, the media and others in the community send to children and teens about the dangers of tobacco/nicotine, alcohol and other drug abuse

Question 3

What is the preventure program?

Answer 3

Examined how children’s temperament drives their risk for drug use, indicating different pathways to addiction. Since most teenagers who try addictive substances (e.g., alcohol, opioids or methamphetamine) dont become addicted, the program focuses on what’s different about the minority who do. Personality testing can help identify most of the highest risk children before their risky traits cause problems

Question 4

What 4 personality traits may lead to or foster the development of addiction?

Answer 4

impulsivity, sensation seeking, hopelessness, anxiety sensitivity

Question 5

How does the preventure program work?

Answer 5

1. An intensive two- to three-day training is given for teachers—a crash course in therapy techniques proven to fight psychological problems.
2. When the school year starts, middle schoolers take a personality test to identify the outliers. Months later, two 90-minute workshops—framed as a way to channel students’ personalities toward success—are offered to the whole school, with only a limited number of slots.
3. The workshops teach students cognitive behavioral techniques to address specific emotional and behavioral problems.

Question 6

What components of the preventurre programme intervention are incorporated using manuals?

Answer 6

psycho-educational
motivational enhancement therapy (MET)
cognitive–behavioural therapy (CBT)
and include real-life ‘scenarios’ shared by local youth with similar personality profiles.

Question 7

What is the goal of the preventure programme?

Answer 7

Goal is to provide participants with the tools to moderate the cognitive and behavioural tendencies stemming form their personality that contribute to their difficulties in life

Question 8

Is the preventure programme effective?

Answer 8

The evidence is promising

Two RCT’s show reduced alcohol consumption and initiation among at risk adolescents

Question 9

What is the goal of prevention in general?

Answer 9

The goal of prevention is to identify and help those at high risk to not develop behavioural addictions

Question 10

What Is motivational interviewing?

Answer 10

Among people engaging in addictive behaviours, motivational interviewing (MI) can be used to help them think about and pursue behaviour change
The goal of MI is to evoke the client’s own reasons for change (and his/her ideas bout how change should happen)

Question 11

What are the five principles of MI?

Answer 11

1. Express empathy for the client
2. Develop discrepancy between the client’s goals and values and their current behaviour (i.e., behavioural addiction)
3. Avoid argumentation and direct confrontation
4. Roll with client resistance, instead of fighting it
5. Support the client’s self efficacy, or their belief that they can change

Question 12

What is an understudied element of MI?

Answer 12

People become more ready to change and actually attempt to change through nostalgia (gambling, alcohol and cannabis)
Longing for the past is an understudied aspect of MI
Finding that it actually has utility in trying to motivate change

Question 13

What is the spirit of MI?

Answer 13

The MI spirit represents an egalitarian relationship characterized by:

• Unconditional acceptance and positive regard
• Compassionate and empathetic understanding (no confronting)
• A stance of evoking (versus installing) ideas, goals and deep wisdom

Question 14

What are the Do’s of MI?

Answer 14

MI Do’s: Emphasize and respect client’s autonomy, actively collaborate with them, elicit their perspective, ideas, concerns, and demonstrate non-judgmental acceptance while conveying empathy

Question 15

What are the Dont’s of MI?

Answer 15

Asserts authority about what is best for the client, pursues own agenda in the session, mandates specific goals, provides unsolicited feedback, confronts or threatens client with negative consequences if change does not occur

Question 16

What are the four processes of MI?

Answer 16

Engaging, focusing, evoking, planning

Question 17

What is the nature of addictive behaviours and changing them?

Answer 17

Addiction has been conceptualized as a chronic relapsing disorder or chronic disease. Although changing an addictive behavior is difficult, maintaining change is even more challenging. Relapse means failure to maintain behavioral change

Question 18

What was treatment outcome once believed to be?

Answer 18

once thought to be binary: “Either you have it or you don’t, and there is nothing in between”. Categorizes treatment outcomes as either abstinent or non-abstinent. Then means that relapse Implies failure, weakens, and shame, which are unhelpful value judgments and barriers to change

Question 19

What are some factors that should be considered when assessing relapse?

Answer 19

Threshold (the amount of substance use)
Window (the period of time judged)
Reset (the period of abstinence required before a person can be considered to have relapsed)
Polydrugs (the types of substance use that constitute a relapse)
Consequences (behaviors and consequences associated with substance use required before a person can be considered to have relapsed)
Verification (self-report or collateral reports).

Question 20

What is a relapse versus a prolapse?

Answer 20

Lapse – an initial setback (a slip)/Relapse – a return to pre-treatment use
Prolapse – recovering from a relapse by making positive behavior changes
Others use quantitative cut-offs to distinguish between lapse and relapse. These terms may not equally apply to all addictive behaviors (e.g., having 1 beer vs. injecting heroin)

Question 21

What is the client centered definition of relapse?

Answer 21

Severity of problem not quantity of consumption

1. the person’s progress toward treatment goals, including substance use, psychosocial or other goals
2. The personal and social consequences related to alcohol or other drug use (e.g., fight with partner)
3. The person’s return to the addictive behaviour

Question 22

What is Marlatt’s relapse prevention model?

Answer 22

Cognitive-behavioral model of relapse
Two-stage process, where the precipitants of substance use are distinct from the factors that prolong or sustain such use over time. Relapse occurs as a result of a person’s lack of coping skills to successfully avoid drinking or using drugs in certain challenging situations

Question 23

What 8 risk situations or relapse determinants did Marlatt propose?

Answer 23

Unpleasant emotions
Physical discomfort
Pleasant emotions
tests of personal control
Urges and temptations
Conflict with others
Social pressure to use
Pleasant times with others

Marlatt’s approach focuses on Providing coping skills training for the risk situations that are particular to each client

Question 24

What are some limitations of Marlett’s prevention model?

Answer 24

Relapse determinants are multidimensional and can interact in complex ways. Does not account for structural factors (e.g., living n substandard housing, poor access to health care) which can affect behaviour change. As can motivation and ambivalence. The negative experience of relapse may solidify the motivation to change for some people
Does not take into account the powerful role of neurobiology and craving on relapse risk.

Question 25

What are the revisions to Marlett's model?

Answer 25

Revised to capture the complex and dynamic interplay of factors that may predict vulnerability to relapse. Includes high-risk situations which have been called tonic processes (primarily stable) and phasic processes (primarily fluctuating) that are somewhat overlapping. Tonic: underlying level of risk (e.g., family history, craving, self-efficacy, social support) and physical withdrawal (the individual differences that put people at risk). Phasic: represent dynamic precipitants to relapse and can also include cognition and withdrawals as well as coping behavior, substance use and perceived effects (factors that change and develop in individuals environment).

Question 26

What is the biological perspective of relapse?

Answer 26

vulnerable biological systems due to neuroadaptations from long-term drug use (changes in brain structure particularly in brain's executive functioning and reward system) and genetics

Question 27

What are the psychological perspectives of relapse?

Answer 27

personality factors (e.g., impulsivity, anxiety sensitivity, hopelessness), ineffective coping

Question 28

What are the social factors of relapse?

Answer 28

of people in social support network (protective) and attachment to circle of support. Those who engage in addictive behavior (risk), living alone, and chronic life stressors

Question 29

What are the socio-cultural factors of relapse?

Answer 29

neighborhood factors (e.g., crime rate), level of education, access to safe stable housing, access to meaningful and stable opportunities, substance availability,

Question 30

What are the spiritual factors of relapse?

Answer 30

Spiritual growth through treatment, prayer, relying on a higher power, findings deeper meaning in life

Question 31

How does AA support recovery?

Answer 31

Alcoholics Anonymous (AA) supports recovery through helping members cultivate spirituality and related practices as a new way of living and it helps facilitate social network changes (e.g., by helping people drop heavy drinkers from their social networks and adopt abstainers and recovering people into their social network). AA boosts peoples confidence in their ability to stay sober when faced with high risk situation or negative emotions. Finally AA reduces craving and impulsivity.

Question 32

What is the social identity theory?

Answer 32

Part of people’s self-concept is derived from their membership in social groups

Question 33

What benefits can being a member of a group have?

Answer 33

The nature of MHOs like AA fits well with the major themes of the social identity approach to behavior change (e.g., social support from similar others, knowledge-base of coping resources) People who used MHOs indicate that they valued the identification and belongingness they developed with others and feelings of hope.

Question 34

What is the theorized role of social identity in behaviour change?

Answer 34

Look for new social role models and social groups that can offer hope of change and recovery. When someone stopping substance use it is unachievable without outside support and help (MHOs).By observing and interacting with others at MHOs, membership becomes associated with positive outcomes (contented sobriety and happiness) because people are motivated to reduce subjective uncertainty in their lives, those new to MHOs may identify with their MHO and MHO members to reduce this uncertainty and to enhance their own self-concept

Question 35

What is the "all or nothing" service delivery approach?

Answer 35

Require abstinence prior to receiving treatment. Rooted in belief that change is motivated by the experience of negative consequences from substance use.Continued substance use is a sign that that the person is unmotivated to change. Providing service to persons who have no abstained would delay their commitment to abstinence and thus change

Question 36

What are the limitations of the all or nothing approach?

Answer 36

Deprives people who are not interested in cessation, but want to remain healthy Deprives people who have problems controlling one addictive behavior, but not other addictive behaviors Limits the right to self-determination Harm reduction policies, programs, and approaches deal with these limitations

Question 37

What is the Harm reduction approach?

Answer 37

Harm reduction approaches involve policies, programmes and practices that aim primarily to reduce the adverse health, social and economic consequences of engagement in addictive behaviors without necessarily reducing engagement in the addictive behavior.

Question 38

Who does harm reduction benefit?

Answer 38

Harm reduction benefits people who engage in addictive behavior, their families, and their community and · Helps people who have not benefited form the traditional treatment system

Question 39

How did harm reduction star?t

Answer 39

with injection drug use (injection practices continuum)

Question 40

What is the prevalence of injecting drugs, HIV and death?

Answer 40

In 2014, 0.3% of the Canadian population inject drugs. People who inject drugs are 59 times more likely to get HIV . 14.3% of all new HIV infections in Canada may have been acquired through injection drug use (incidence). Unsupervised drug injection can lead to overdose death

Question 41

What country is a leader in HR policy and practice?

Answer 41

Canada, · One of the first needle exchange programs to open in North America was initiated in Vancouver in 1988. HR is part of the federal government’s response to illicit drug use

Question 42

What are some limitations of the needle exchange program?

Answer 42

People may continue to inject in public spaces thus increasing their risk of overdose death Injecting in public may also cause users to inject as quickly as possible, thus increasing the risk for local tissue damage and infection Supervised injecting facilities (SIF) overcome these limitations

Question 43

What did they find at an extensive evalutation of a SIF that opened in Vancouver

Answer 43

Attracted drug users at higher risk of acquiring HIV and having an overdose After the facility opened, public injecting in the neighborhood around the facility decreased. Less risk of acquiring HIV, such as less syringe sharing and increased use of sterile water Lower drug use: refer users to withdrawal management services and subsequent addiction treatment and Lower risk of death from overdose

Question 44

What is the methadone Maintenance treatment?

Answer 44

Most widely studied and most effective treatment for opioid addiction. Helps deal with problems related to withdrawal and intoxication MMT has a long history in Canada. The first Canadian methadone program started in Vancouver in 1959

Question 45

When prescribed within the context of appropriate services, What benefits does MMT leads to for patients and the community?

Answer 45

``` reduced use of other opioids reduced use of other drugs improved mental and physical health reduced illegal activity and incarceration reduced risk of acquiring HIV infection improved outcomes of pregnancy improved quality of life ```

Question 46

What is heroin assisted treatment?

Answer 46

Prescribing individualized doses of pharmaceutically pure heroin, which the patient self-administers under nursing supervision up to three times daily Reserved for people who have injected opioids long term, and not benefited from other treatment options

Question 47

Many of the harms associated with heroin injection arise not because of the drug itself, but the context of drug use, what are they?

Answer 47

an illicit source resulting in unknown purity; an illegal market driving costs, and resulting in criminal activity for obtaining drugs unsafe injection practices