Week 11 Flashcards
How do you treat people already engaging in addictive behaviors? (2)
Motivational interviewing can be used to help them think about and pursue behavior change
Goal is to evoke the client’s own reasons for change (and their ideas about how change should happen)
What is the Transtheoretical Model of Change? (3)
States that recovery and behavior change relating to addiction is not linear but circular
Addiction is a chronic relapsing condition and many people require multiple attempts to stop
MI employs this model as it is a way of getting them to think about stopping and, of their own volition, guiding them to change their behavior (bridges precontemplation and contemplation)
What are the 6 stages of the Transtheoretical Model of Change? When do you enter?
Precontemplation: idea of stopping fully has not even been considered but ideas have been planted (safe injection site suggestions)
Contemplation: created the intention to change behavior and think seriously about stopping stopping (taking those suggestions seriously)
Determination/preparation: working with a counselor to determine the best way to do it, come up with a plan, more determined to stop
Action: put it into action, do the plan
Relapse: very rare to reach recovery goal on the first goal, people will likely relapse many times, sometimes for the rest of their lives
Maintenance: if you don’t relapse and exit the cycle, you go into maintenance to maintain your sobriety, which is a life long struggle
You can enter and exit at any stage, which is why it’s a circle
What are the five principles of MI? SDARE
- Express sympathy for the client (instead of judgement, feel for and with them, builds rapport/therapeutic alliance/trust which is an active ingredient in successful treatments)
- Develop discrepancy between the client’s goals/values and their current behavior (helps them connect the dots themselves)
- Avoid argumentation and direct confrontation (adapt, have a conversation, arguing will go nowhere)
- Roll with client resistance instead of fighting it (roll with the resistance, they will come around and fighting won’t do anything)
- Support the client’s self-efficacy or their belief that they can change (mind over matter, if they don’t think they can do it they won’t, need to boost their confidence that they can)
What is the spirit of MI? (4) ER AP CE E
Represents an egalitarian relationship
Unconditional acceptance and positive regard
Compassionate and empathic understanding
A stance of evoking (not installing) ideas, goals and deep wisdom
What are the 4 processes of MI? EFEP
Basis of engaging and getting them invested/to buy in that treatment and behavior change is good and possible
Then focusing (with the client as an equal partner) on developing a plan of action and seeing what works
Evoking ideas about what is good for them, goals for short-term and long-term
Planning
What is the readiness ruler?
Measure after MI to test confidence and importance to determine how ready they are to change
What is relapse? What does the “relapsing nature of addictive behaviors” mean? (3)
Relapse means failure to maintain behavior change
Although changing addictive behavior is difficult, maintain change is even harder
Relapse is common in the recovery process, during and post treatment
Addiction is a chronic relapsing disorder
How did we used to define relapse? (4)
Once thought to be binary, in terms of you either are abstinent or non-abstinent, did or didn’t, with no in between
This is overly simplistic as addiction is a complex problem (different substances have different relapse/slip levels like a puff of a smoke versus a snort of coke)
Implies failure, weakness and shame, which is unhelpful to treatment as it is a barrier to change
Doesn’t consider that everyone is different and every case is different
What are the 6 components of a more complex definition of relapse? TWRPCV
Threshold (the amount of substance used)
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 SU required before a person can be considered to have relapsed)
Verification (self-report or collateral reports)
Define: lapse, relapse, prolapse
Lapse: an initial setback
Relapse: a return to post-treatment use
Prolapse: recovering from a relapse by making positive behavior changes
What is a client-centered definition of relapse? What are the three considerations? PCR
Looks at the severity of problem, not the quantity of consumption
The person’s progress toward treatment goals, including SU, psychosocial or other goals
The personal and social consequences related to alcohol or other drug use
Person’s return to the addictive behavior
What is Marlatt’s original Relapse Prevention Model? (4)
Cognitive behavioral model of relapse and their triggers
Two-stage process, where the precipitants of SU 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 engaging in addictive behavior in certain challenging situations
Solution is to provide coping skills training for the risky situations that are particular to each client
What is Marlatt’s taxonomy of 8 relapse determinants (risky situations)? UE PD PE PC UT C SP PT
Unpleasant emotions
Physical discomfort
Pleasant emotions
Tests of personal control
Urges and temptations
Conflict with others
Social pressure to use
Pleasant times with others
What are some limitations of Marlatt’s Relapse Prevention Model? (4)
Relapse determinants are multidimensional and can interact in complex ways (fine on their own but makes the perfect storm)
Does not account for structural factors (social part of biopsychosocial like housing and healthcare)
Relapse may solidify the motivation to change for some people (could also create ambivalence)
Does not take into account the powerful role of neurobiology and craving (makes it harder to resist, brain has literally changed to a new normal)
What is Marlatt’s Revised Model of Relapse? (3)
Revised to capture the complex and dynamic interplay of factors that may predict vulnerability to relapse
Slight or seemingly insignificant changes/events may trigger a downward spiral towards relapse based on an intersection of high risk situations (taxonomy), tonic processes (stable factors like family history and number of addiction symptoms), and phasic responses (fluctuating factors like coping behavior and affect)
Acknowledges relapse is dynamic and varies depending on person and circumstances, and how it all overlaps and intersects to make the perfect storm for relapse for a certain individuals
What is a Biopsychosocial+ perspective of relapse? (5)
Bio: vulnerable biological systems due to neuroadaptations from long-term drug use
Psycho: personality, beliefs, motivation, emotions (i.e., impulsivity, hopelessness, ineffective coping)
Social: number of people in social support network and those who engage in addictive behavior, living alone, chronic life stressors
Socio-structural: neighborhood factors (crime rate), level of education, access to safe stable housing, access to meaningful and stable opportunities
Spiritual: spiritual growth through treatment, prayer, relying on a high power, finding deeper meaning in life
What are 12-step Mutual Help Organizations? (4)
Somewhere to go, people to turn to, when you have nothing left and all your bridges have been burned
Idea of connection, being part of a group, a collective, social identity, belonging, support, etc.
AA supports recovery by helping members cultivate spirituality and related practices as a new way of living
AA facilitates helpful social network changes (drop other drinkers from their friend group, replace them with sober friends)
What is Social Identity Theory? (5)
Part of people’s self-concept is derived from their membership in social groups
You identify with your group and therefore you act in line with how those within the group act, which is encouraged by the group
MHO’s like AA applies social identity theory to behavior change
Being a member of a group of people in recovery can have important benefits (social support, learn knowledge and coping resources, belongingness to reduce need to cope)
People who use MHO’s value the identity, belongingness and hope they developed from others
What is the theorized role of social identity in behavior change? (5)
The groups to which recovering individuals formerly belonged to during active addiction facilitated and perpetuated SU and other risky behaviors (seen as positive outcomes because it’s fun and exciting)
Over time, the addictive individual experiences more substance related negative consequences whereby continued use becomes more punitive than pleasurable
The person, who may now be motivated to change, look for new social groups that can offer hope of change and recovery to stop substance use
By observing and interacting with others at MHOs, membership would become associated with positive outcomes like content and happiness
This identifying with MHOs enhance their own unstable self-concept and fills a void that facilitates recovery
What are “All or Nothing” service delivery approaches? (4)
Require abstinence from all substances prior to receiving treatment
Rooted in the belief that change is motivated by the experience of negative consequences from SU
Continued use is a sign that the person is unmotivated to change (based on assumption of choice)
Providing service to persons who have not abstained would delay their commitment to abstinence and thus change
What are the limitations of “All or Nothing” approaches? (3) what is the response to these limitations?
Deprives people who are not interested in cessation but healthy use
Deprives people who have problems controlling one addictive behavior but not others
Limits the right to self-determination
Harm reduction polices, programs and approaches deal with these limitations
What is a Harm Reduction (HR) approach? (5)
Grounded in evidence-based research and draws on the collective wisdom and knowledge from the lived experiences of people who engage in addictive behavior
Many people want to be abstinent and addiction-free in the way that many of us have long-term goals that are currently out of reach
Whether or not we get there, we can take actions to reduce risk to health and well-being and minimize harm as much as possible by meeting people where they are at
HR happens when we realize that there are other problems happening that are far worse than addiction and substance use that we can address and help them not have to experience
Been around since the 80s and 90s to address the AIDS crisis and is even more popular now
What is the definition (2) and principles of HR? (5) D SSU RR E R
Involves policies, programs and practices that aim primarily to reduce the adverse health, social and economic consequences of engaging an addictive behavior without necessarily reducing engagement in said behavior
Benefits people who engage in addictive behavior, their families and their community
Principles are dignity, safer substance use, risk reduction of other problems, empowerment, and respect
How did HR start? (4)
It all started with safe injection sites and exchanges in response to the aids and HIV epidemic in the 80s, which was spreading by IV substances as they were sharing needles and drugs
Public health recognize this as a source of the epidemic and decided to give people safe equipment to reduce HIV transition through needle exchange programs, where people could turn in their old equipment for new sterile equipment
Also used as a hub for HIV testing while they were there and to give people more info on their own health (possibly creating motivation to change) and info sharing on drug use (how to do it safely)
Has now developed into more elaborate approaches like safe injection sites
What are the stats on injection drugs, HIV and death in Canada? (4)
In 2014, 0.3% of the Canadian population injected drugs
People who inject drugs are 59 times more likely to get HIV than people who do not inject drugs
14.3% of all new HIV infections in Canada may have been acquired through injection drug use
Unsupervised drug injection can lead to overdose death
Where does Canada stand in terms of HR police and practice? (5)
Canada is a leader in HR police and practice
One of the first needle exchange programs to open in North America was initiated in Vancouver in 198
HR is part of the federal governments response to illicit drug use
Many countries endorse needle exchange programs as a mechanism to reduce the spread of HIV
It has been studied very well with lots of literature on these programs to prove their effectiveness for HR
What are the limitations of needle exchange programs? (3) What is the solution to this? (3)
People may continue to inject in public spaces that 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
Public/community health risk due to public drug use (needles in parks)
Supervised injecting facilities, overcome these limitations
People get new equipment, get the substances tested, use while being watched over to make sure they don’t OD and dispose of them properly
Also have a window of opportunity to talk to someone about whether they are ready to change or not, and what options are available to them
What did the extensive evaluation of a SIF that opened in Vancouver in 2003 do? (2) What did it find? (5)
This was a research study to examine who the client were, their outcomes, etc.
There are several studies all over the world replicating these findings
They attracted drug users at higher risk of acquiring HIV and having an overdose
After the facility opened, injecting in the neighborhood around the facility decreased
Less risk of acquiring HIV (less syringe sharing and increased use of sterile water)
Drug use (refer users to withdrawal management services and subsequent addiction treatment)
Lower risk of death from overdose
What is Methadone Maintenance Treatment? (5)
Most widely studied and most effective treatment for severe opioid addiction
Helps deal with problems related to withdrawal and intoxication
Methadone is a substitution with smaller effects than heroin and takes away the physical withdrawal effects to allow them to re-integrate into the community, find a job, access other forms of healthcare, etc. because they can function again and are more stabilized
Usually oral and not a standalone treatment, but often one part embedded within a wider treatment framework
When prescribed within the context of appropriate services, MMT leads to a range of benefits, not only for patients, but ultimately for the community (improved quality of life, less OD, less illegal activity, less use of other drugs)
What is Heroin Assisted Treatment (HAT)? (5)
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 (last resort)
Many of the harms associated with heroin injection rise not from the drug itself, but the context of drug use
Some people think this is crazy but it is not widely available and it has shown to have some benefits
Once again, part of a more comprehensive treatment plan
