specialist interventions Flashcards by Alecia Yu

interventions usually target one of three different areas,

it is important to consider all three in a wholistic treatment plan

what are the three different areas of interventions

The drug

The Individual

The environment

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intervention targeting the drug

it is important to provide accurate drug informaiton

why?

particularly useful for those in pre-contemplation stage

avoids confrontation and argument
raises awareness

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when providing drug information what should be portrayed and what shoudl be discussed

through brochures and psychoeducation

effects and side effects, dosage, methods, and potential harms

correct inaccurate or dangerous information

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what is a major aspect of interventions targeting the drug?

withdrawal management (detoxification)

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in interventions targeting the drug

what are the different settings in which withdrawal management is implemented

variety of settings:
general hospital 
specialist inpatient units
outpatient clinics
home based

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what levels of severity and service are provided and attended to at different settings of withdrawal management

inpatient - physical dependence requiring medical assistance

outpatient - less severe or complicated

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what is a trend seen between withdrawal management and relapse

rates of relapse post withdrawal management are usually high

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what is delirium tremens

condition caused by alcohol withdrawal

characterised by tremor , visual hallucinations and autonomic instability

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what is naltrexone rapid detoxification

an intervention targeting the drug

naltrexone is an opiate antagonist - blocks the effects of opioids

causes a rapid withdrawal from opiates

risks associated - overdose

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what is naltrexone maintenance treatement

reduced cravings, blocks effects of opiates

need to completely detox from opioids to minimise withdrawal reaction

tablet or implant avaliable

best outcome when highly motivated, employed with good support, older and with prior treatment experience

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what is methadone maintenance treatment

methadone is a full opiate agonist

for those unable to cease opiate use manage withdrawal

maintenance over abstinence
preferred choice for high levels of opiate dependence

highly regulated

reduces HIV risk behaviour, criminal behaviour and risk of overdose

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what is buprenorphine

parcial agonist/antagonist

maintanence treatment

can be a detoxification aid

higher doses improve retention in treatment and reduce heroin use

can be taken in 1, 2, or 3 day doses

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compare burprenorphine to methadone maintenance treatment

similar/slightly less retention in treatment

reduced illicite drug use to an equivilant or greater extent

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what pharmacotherapy anti-craving medications are there for alcohol abuse

campral (acamproste)
- 3 times daily dosing

Naltrexone

daily dosing
expensive

both sometimes prescribes taken together

mixed effectiveness

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what is antabuse maintenance therapy

a pharmotherapy for alcohol abuse

blocks enzymes that metabolise alcohol

reacts with alcohol to make client feel very ill

more effective i used in conjunction with ongoign support

indications: alcohol use disorder with tolerance/withdrawal symptoms and abstinance goal

some risk include hepatitis

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what forms of nicotine replacement is there

patches - one daily application, socailly acceptable, easy to use, steady and reliable dose

gum - best for smokers heavily dependent on nicotine - poor compliance

inhalers - plastic tube wiht inhalable nicotine

all are more effective with counselling

what is varenicline (Champix)

12 week Tx for smoking

antagonist and partical agonist on receptors

reduces cravings
lowers effecs

dopamine levels

successful longer term quit rates 1-3x

best with counselling and support

not recommended for young people

what is urine drug screening used fo r

screenign to identify drugs used recently - random or intermittent testing

may aid in relapse prevention - best if participating voluntarily

danger of shifting to less detectable drugs
- focus can become beating the test than on the treatment goal

how does controlled drinking/drug use training work as a intervention for the individual

harm minimisation approach - used if abstinence is not the goal

requires high motivation

difficult for long-standing addiction

environmental factors = key to success (social support)

process involves

self-minitoring
develop limits and rules around consumption
devise strategies for high risk situation s
use reward s to maintain changes to behaviour

describt self- help groups as an intervention for the individual

widely available
easy to set up and run
low/no cost

non-drug using social support - usually run by peers in recovery

most common = 12 step programs

strong spiritual based philosophy
require abstinence as a goal

what are the 12 steps of the 12 step program

admission 
recognition 
submision 
confession 
readiness
humility 
reparation 
apology 
integrity 
meditation 
awakening

what is different about BT and MI based group programs compared to 12 step?

lead by trained facilitators

in CBT and MI based group program

each group session teaches usefull skills to help with what 4 points

building and maintaining motivation
cope with urges
learning problem solving techniques
achieving lifestyle balance

what are some tools and techniques used in 4 point programs to assist in the management of adictive behaviour

identifying pros and cons of problematic behaviour

recognising triggers, beliefs and consequences

coping with cravings and urges

setting acheivable goals

evaluating areas of importance

what does the SMART acronym in SMART recovery Australia stand for?

``` Self Management And Recovery Training ```

breif interventions are another means of intervention targeting the individual

1-5 sessions with follow up an dself help material very focused interventins - decision making, problem solving, goal setting, relapse prevention useful for pre-contemplators, less severe/complicated SUD and primary care settings results often as good or better than longer therapies in these contexts

according to Upton and Thirlaway (2014) key features of brief intervention include

focuses on reduced substance use adress motivation remain individualised have features of - give feedback of risk - encourage responsibility for change - give options - demonstrate empathy - enhance self efficacy

miller and sanches (1994) identified 6 key aspects of key intervention using the acrynom FRAMES what does FRAMES stand for

F- feedback of personal risk or impairment R- responsibility for change A- advice to change M- menue of alternative change options S- self-efficacy or optimism in client facilitated by practitioner

another intervention targetign the individual is social skills training what is the premise surrounding social skills training

deficient social skills leads to poor adjustment and dysfunction > substance use is tehn used as a coping strategy

what is the focus of social skills training

training in areas of deficiency - teach new social skills - goup therapy can be good setting for this assertiveness training, anger management, relaxation training, modelling, role playing etc.

community development is a means of intervention targeting the environment what are the prospects of community developmet

generates and disseminates drug related recources to the community prevention and intervention strategies can raise awareness of drug issues useful if linked to development of more comprehensive stategies for the community - liquor licensing interventions, support groups, school based interventions

what can employment, education and recriational opportunities do in terms of interventions targeting the environmetn

recognises role of social disadvantages in substance abuse problems if successful, are strong a and protective factors agains drug misuse opportunities to develop skills and social networks outside the drug using lifestyle can improve sel-worth and self-esteem introduces alternative and health lifestyle

what are the aims of family therapy in targeting the environment

focus on treating and including the whole family better treatment outcomes - improve complience with treatment and earlier engagement - can alleviate distress of significant others members need to agree to be involved confidentiality issues multiple needs need to be managed - as with individual counselling

case management is an intergention targeting the environment what does it entitle

single point of contact with health and social services client driven advocacy community based felexible and culturally sensitive link clients with appropriate services monitor clients progress in treatment

define rehabilitation centres as a enironmental intervention

meduim to long term residential programs public and private options generally require absinence as a goal facilitate access to medial services, education, employment, skills training and community support promote participation in daily running of program - therapeutic community tend to be group based staged reintegration programs - 1/2 way and 3/4 way houses with less structure

what is the common factor of predicting a therapeutic otucome

the quality and strength of the collaborative relationships between client and therapist

why is matchign clients to treatments so important

each person is different each intervention will work differently with individual factors influencing the suitability of different therapies different problems require different types or combinations of interventions at different levels

what is a clincians goal when matching a client to a treatment

goal is to place client into the lest intensive treatment that will most likely facilitate treatment goals