specialist interventions Flashcards
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
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
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
what is a major aspect of interventions targeting the drug?
withdrawal management (detoxification)
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
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
what is a trend seen between withdrawal management and relapse
rates of relapse post withdrawal management are usually high
what is delirium tremens
condition caused by alcohol withdrawal
characterised by tremor , visual hallucinations and autonomic instability
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
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
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
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
compare burprenorphine to methadone maintenance treatment
similar/slightly less retention in treatment
reduced illicite drug use to an equivilant or greater extent
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
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
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
