Session 8 -approaches to treatment

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This powerpoint is part of AllCEU's Addiction Counselor Training Series. In this session we examined different approaches to treatment ranging from medication assisted to cognitive behavioral, community rewards and more. We also discuss where to look to find current best practices. Each week we provide 8 hours of face-to-face continuing education and precertification training to LPCs, LADCs, and those wishing to become addiction counselors. Many states allow precertification to be done via online learning as well. We are approved education providers by NAADAC #599 and NBCC #6261

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Session 8 -approaches to treatment

  1. 1. Common Treatment Models
  2. 2.  Identify five common approaches to treatment  Identify the main components of each approach  Compare and contrast each approach for ◦ Practical utilization ◦ Research Support/Efficacy
  3. 3.  Addiction is a complex but treatable condition that affects brain, body and behavior  No single treatment is appropriate for everyone.  Treatment needs to be available  Effective treatment attends to multiple needs of the individual  Duration in treatment for at least 3 months is critical  Treatment plans must be assessed continually and modified to ensure that it meets his or her changing needs  Treatment does not need to be voluntary to be effective
  4. 4.  Behavioral Self Control Training  Psychotherapeutic ◦ Seeking Safety/Trauma Informed ◦ Dialectical Behavior Therapy ◦ Motivational Interviewing  Multidisciplinary/Biopsychosocial Approach  Medication Assisted  Harm Reduction
  5. 5.  Self-monitoring of drinking and urges to drink  Specific goal setting  Rate control of alcohol consumption and drink refusal  Behavioral contracting in which reward and consequences for goal adherence are specified  Identification and management of triggers for excessive drinking  Functional analysis of drinking behavior  Relapse prevention training
  6. 6.  BSCT is by far the most intensely studied controlled- drinking treatment approach  BSCT was superior, relative to alternative non- abstinence interventions, no intervention, and abstinence interventions on measures of alcohol consumption and drinking-related problems.  Walters GD. Behavioral self-control training for problem drinkers: A meta-analysis of randomized control studies. Behav Ther 2000; 31:135-149.
  7. 7.  Dialectical Behavior Therapy ◦ Why  Clients found the focus on change inherent to CBT invalidating  Clients unintentionally rewarded ineffective treatment while punishing their therapists for effective therapy.  The sheer volume and severity of problems presented by clients made it impossible to use the standard CBT format. ◦ Over Riding Themes  Mindfulness (wise mind) Distress tolerance Emotion regulation Interpersonal effectiveness
  8. 8.  Matrix Model ◦ A 45 session treatment program ◦ Effective with stimulant users ◦ Patients will  Learn about issues critical to addiction and relapse  Receive direction and support from a trained therapist  Become familiar with self-help programs. ◦ The therapist functions simultaneously as teacher and coach, fostering a positive, encouraging relationship
  9. 9.  Motivational Enhancement Therapy ◦ Helps resolve ambivalence about treatment & abstinence ◦ This therapy consists of:  Initial assessment battery  Followed by 2-4 individual sessions with a therapist  First treatment session  The therapist provides feedback to the initial assessment  Elicits self-motivational statements  Strengthen motivation and build a plan for change  Coping strategies for high-risk situations are suggested  Subsequent sessions, therapist monitors change, reviews cessation strategies being used, encourages change
  10. 10.  Family Behavior Therapy (FBT) ◦ Demonstrated positive results in both adults and adolescents, ◦ Addresses not only substance use problems but other co- occurring problems (i.e. conduct disorders, child mistreatment, depression, family conflict, and unemployment) ◦ FBT combines behavioral contracting with contingency management. ◦ FBT involves the patient along with at least one significant other such as a cohabiting partner or a parent ◦ Therapists seek to engage families in applying the behavioral strategies taught in sessions and in acquiring new skills to improve the home environment.
  11. 11.  Community Reinforcement Approach Plus Vouchers (Alcohol, Cocaine, Opioids) ◦ Intensive 24-week outpatient therapy addiction ◦ It uses a range of recreational, familial, social, and vocational reinforcers, to make a non-drug-using lifestyle more rewarding than substance use. ◦ The treatment goals are twofold:  To maintain abstinence long enough for patients to learn new life skills to help sustain it; and  To reduce alcohol consumption for patients whose drinking is associated with cocaine use
  12. 12.  Contingency Management Interventions/Motivational Incentives ◦ Voucher-Based Reinforcement (VBR) augments other community- based treatments ◦ In VBR, the patient receives a voucher for every drug-free urine sample provided. ◦ The voucher values are low at first, but increase as the number of consecutive drug-free urine samples increases ◦ Positive urine samples reset the value of the vouchers ◦ VBR has been shown to be effective in promoting abstinence in patients undergoing methadone detoxification
  13. 13.  Seeking Safety ◦ Consists of 25 topics that can be conducted in any order:  Introduction/Case Management, Safety, PTSD: Taking Back Your Power, When Substances Control You, Honesty, Asking for Help, Setting Boundaries in Relationships, Getting Others to Support Your Recovery, Healthy Relationships, Community Resources, Compassion, Creating Meaning, Discovery, Integrating the Split Self, Recovery Thinking, Taking Good Care of Yourself, Commitment, Respecting Your Time, Coping with Triggers, Self-Nurturing, Red and Green Flags, Detaching from Emotional Pain (Grounding). Life Choices, and Termination. ◦ Present-focused therapy for trauma/PTSD and addiction. ◦ Available as a book, with guidance for clients and clinicians ◦ Can be done in individual or group
  14. 14.  Psychotherapeutic co-occurring  Medication Assisted  Wrap Around Services  Family
  15. 15.  Methadone  Suboxone  Vivitrol  Antabuse
  16. 16.  Acceptance that drug use is a reality  Preventing the harm caused by drug abuse  4 Ls: Liver, Lover, Livelihood, Law  Low-threshold pharmacological interventions  Needle exchange programs  Emphasis on non-injection routes  Involvement of those with a history of use in program development
  17. 17.  Many approaches  Considerations ◦ Method of delivery ◦ Accessibility ◦ Cost ◦ Patient preferences (abstinence vs. controlled use) ◦ Co-Occurring Issues

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