Week 10 - Treatment and Ethics Flashcards
Principles of effective
treatment
- No single treatment is appropriate for all individuals
- Treatment needs to be readily available
- Effective treatment attends to multiple needs of the individual, not just his or her drug use
- An individuals treatment plan must be assessed continually & modified as necessary to ensure the
plan meets the person’s changing needs
Principles of effective
treatment (ii)
- Remaining in treatment for an adequate period of time is crucial for treatment effectiveness
- Counselling (individual or group) & other behavioural therapies are critical components of effective treatment for addiction
- Medications are an important element of
treatment, especially when combined with counselling & other behavioural therapies
Principles of effective
treatment (iii)
- Clients presenting with coexisting mental health & substance abuse should have both disorders treated in an integrated way.
- Medical detoxification is only the first stage of treatment & by itself does little to change long-term drug use
- Treatment does not need to be voluntary to be effective
- Possible drug use during treatment must be monitored continuously
Principles of effective
treatment (iv)
- Treatment programs should provide assessment for blood borne viruses & other infectious diseases, & counselling to help modify or change behaviours that place the person or others at risk of infection.
- Recovery can be a long term process & frequently requires multiple episodes of treatment
Miller & Hester Informed Eclecticism
4 assumptions:
There is no single superior approach to Treatment for all individuals
Treatment programs/systems should be constructed with a variety of approaches that have been shown to be effective
Different individuals respond best to different treatment approaches
It is possible to match clients to optimal treatment, therefore increasing Rx effectiveness and efficiency
Australian Treatment Outcomes Study (ATOS)
overview
Heroin users
Replacement; withdrawal; residential rehabilitation; non-Treatment control
3 and 12 month post entry follow-up
Treatment sample differed from general population
More PTSD, Depression, Borderline PD, and disability.
High suicide and overdose rate; criminality
ATOS Outcomes
General functioning improved
Majority of participants abstinent for the 1 month prior to 12 month follow-up
65% Replacement
63% residential rehabilitation
52% withdrawal
25% non-Treatment control
Noticeable reduction in criminal behaviours, improved injection related health, decline in depression
Effective Treatment
- Many people recover from harmful substance use without psychological therapy.
- There is no single superior approach to treatment for all individuals: different individuals respond best to different treatment approaches at different times and it is important to match clients to their stage of change to maximise treatment effectiveness and efficiency.
- Comprehensive assessment, including mental health assessment, is essential as substance use and mental health problems often occur together.
- Treatment approaches should consider the needs and engagement of other family members, including children, to improve outcomes for all those affected by an individual’s problematic alcohol or other drug use.
- There are effective withdrawal and replacement pharmacotherapies for some
substances, which can be important adjuncts to psychological treatments. - Current evidence-based psychological interventions include contingency management (but not so much for tobacco), CBT, and motivational interviewing
approaches. Other intervention approaches await evaluation. - Relapse is an expected part of the treatment process and relapse prevention should be routinely incorporated. Relapse prevention needs to focus on enabling clients to
identify and cope with risky situations for relapse. - It is important to recognise that alcohol and other drug problems occur in social and cultural contexts.
- This is best done through the adoption of a biopsychosocial approach
What does future treatment needs to improve on?
- Improve understanding of dependence & withdrawal
- Greater attention to the use of psychosocial interventions as primary & adjunct treatment
- Consider significance of lifetime treatment history & how individual treatment episodes fit together to achieve recovery
- Assess effectiveness & efficiency under typical circumstances
- Assess effectiveness of treatment interventions with subgroups
What are the unique moral, ethical and legal issues
- Unique risks to user and community balanced with therapeutic goals
- Potential impact on the therapeutic relationship, clinician and client’s reactions, and services offered
- Who should have access to treatment? (esp. public)
- Consent (intoxication, third party pressures)
- Illegal behaviours and confidentiality limits
- Minors
- Harm reduction vs No Tolerance/Abstinence approaches
- Different beliefs associated with different drugs –> Based on personal experiences?
- Stigma is a barrier to accessing treatment ( Stigmatisation of drug use often means clients have often experienced judgemental approaches and rejection in the past)
What are the three general ethical principles of the APS code of ethics
- Respect for the rights and dignity of people and peoples, including the right to autonomy and justice.
- Propriety, incorporates the principles of beneficience, non-maleficience (including competence) and responsibility to clients, the profession and society.
- Integrity, reflects the need for good character & acknowledges the high level of trust intrinsic to professional relationships, and the impact of conduct on the reputation of the profession
Psychologists only provide psychological services within the
boundaries of their professional competence. This includes,
but is not restricted to:
A) working within the limits of their education, training,
supervised experience & appropriate professional experience
B) basing their service on established knowledge of the discipline and profession of psychology
C) adhering to the APS Code and Ethical Guidelines
D) complying with the law of the jurisdiction in which they provide psychological services; &
E) ensuring their emotional, mental, & physical state does not impair their ability to provide a competent psychological service
Clinical vs Ethical decisions
Clinical decision making is based on evidence
Ethical decision making is based on respect, propriety, & integrity.
What are Forester-Miller & Davis five (5) Moral
Principles as the “cornerstone” of a healthy therapeutic relationship.
Autonomy
Justice
Beneficence
Non-maleficience
Fidelity
What is autonomy?
The principle that addresses respect for independence, and self-determination.
This principle allows an individual the freedom of choice and action.
It addresses the responsibility of the counsellor to encourage clients, when appropriate, to make their own decisions and to act on their own values.
There are two important considerations in encouraging clients to be autonomous.
First, helping clients to understand how their decisions and their values may be received within the context of the society in which they live, and how they may impinge on the rights of others. The second consideration is related to the client’s ability to make sound and rational decisions. People not capable of making competent choices, such as children and some individuals with mental disabilities, should not be allowed to act on decisions that could harm themselves or others.
What is justice?
Justice does not mean treating all individuals the same. If
an individual is to be treated differently, the counsellor needs to be able to offer a rationale that explains the necessity and appropriateness of treating the individual differently. An example of justice is that a counsellor would give a person who is blind a form that is in braille, or would go through the form with that individual orally, instead of giving him or her a standard written form to fill out. But the counsellor would treat him or her the same as any other client in all other regards
What is benefice
reflects the counsellor’s responsibility to contribute to the welfare of the client. Simply stated, it means to do good, to be proactive, and also to prevent harm when possible. Beneficence can come in many forms, such as prevention and early intervention actions that contribute to the betterment of clients
What is non-maleficence
Non-maleficence is the concept of not causing harm to
others. Often explained as “above all, do no harm,” this principle is considered by some to be the most critical of all
the principles, even though theoretically they are all of equal
weight. This principle reflects both the idea of not inflicting
intentional harm, and not engaging in actions that risk
harming others. Weighing potential harm against potential
benefits is important in a counsellor’s efforts toward ensuring “no harm.
What is fidelity
Fidelity involves the notions of loyalty, faithfulness, and
honouring commitments. Clients must be able to trust the
counsellor and have faith in the therapeutic relationship if
growth is to occur. Therefore, the counsellor must take care
not to threaten the therapeutic relationship or to leave
obligations unfulfilled.
