Week 11

Question 1

How do you treat people already engaging in addictive behaviors? (2)

Answer 1

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)

Question 2

What is the Transtheoretical Model of Change? (3)

Answer 2

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)

Question 3

What are the 6 stages of the Transtheoretical Model of Change? When do you enter?

Answer 3

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

Question 4

What are the five principles of MI? SDARE

Answer 4

1. 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)
2. Develop discrepancy between the client’s goals/values and their current behavior (helps them connect the dots themselves)
3. Avoid argumentation and direct confrontation (adapt, have a conversation, arguing will go nowhere)
4. Roll with client resistance instead of fighting it (roll with the resistance, they will come around and fighting won’t do anything)
5. 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)

Question 5

What is the spirit of MI? (4) ER AP CE E

Answer 5

Represents an egalitarian relationship

Unconditional acceptance and positive regard

Compassionate and empathic understanding

A stance of evoking (not installing) ideas, goals and deep wisdom

Question 6

What are the 4 processes of MI? EFEP

Answer 6

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

Question 7

What is the readiness ruler?

Answer 7

Measure after MI to test confidence and importance to determine how ready they are to change

Question 8

What is relapse? What does the “relapsing nature of addictive behaviors” mean? (3)

Answer 8

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

Question 9

How did we used to define relapse? (4)

Answer 9

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

Question 10

What are the 6 components of a more complex definition of relapse? TWRPCV

Answer 10

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)

Question 11

Define: lapse, relapse, prolapse

Answer 11

Lapse: an initial setback

Relapse: a return to post-treatment use

Prolapse: recovering from a relapse by making positive behavior changes

Question 12

What is a client-centered definition of relapse? What are the three considerations? PCR

Answer 12

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

Question 13

What is Marlatt’s original Relapse Prevention Model? (4)

Answer 13

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

Question 14

What is Marlatt’s taxonomy of 8 relapse determinants (risky situations)? UE PD PE PC UT C SP PT

Answer 14

Unpleasant emotions

Physical discomfort

Pleasant emotions

Tests of personal control

Urges and temptations

Conflict with others

Social pressure to use

Pleasant times with others

Question 15

What are some limitations of Marlatt’s Relapse Prevention Model? (4)

Answer 15

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)

Question 16

What is Marlatt’s Revised Model of Relapse? (3)

Answer 16

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

Question 17

What is a Biopsychosocial+ perspective of relapse? (5)

Answer 17

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

Question 18

What are 12-step Mutual Help Organizations? (4)

Answer 18

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)

Question 19

What is Social Identity Theory? (5)

Answer 19

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

Question 20

What is the theorized role of social identity in behavior change? (5)

Answer 20

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

Question 21

What are “All or Nothing” service delivery approaches? (4)

Answer 21

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

Question 22

What are the limitations of “All or Nothing” approaches? (3) what is the response to these limitations?

Answer 22

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

Question 23

What is a Harm Reduction (HR) approach? (5)

Answer 23

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

Question 24

What is the definition (2) and principles of HR? (5) D SSU RR E R

Answer 24

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

Question 25

How did HR start? (4)

Answer 25

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

Question 26

What are the stats on injection drugs, HIV and death in Canada? (4)

Answer 26

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

Question 27

Where does Canada stand in terms of HR police and practice? (5)

Answer 27

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

Question 28

What are the limitations of needle exchange programs? (3) What is the solution to this? (3)

Answer 28

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

Question 29

What did the extensive evaluation of a SIF that opened in Vancouver in 2003 do? (2) What did it find? (5)

Answer 29

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

Question 30

What is Methadone Maintenance Treatment? (5)

Answer 30

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)

Question 31

What is Heroin Assisted Treatment (HAT)? (5)

Answer 31

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