Enabling and Interven/on Karen Perry Co-‐Founder, Execu/ve Director, NOPE Task Force Dominique Simon-‐Levine Director, Allies in Recovery
Learning Objec/ves 1. Analyze two eﬀec/ve advocacy programs and the current trends of Rx drug abuse. 2. Describe CRAFT procedures to increase the chance of a loved one entering treatment. 3. Describe the methods for engaging a loved one to seek help.
Disclosure Statement • Karen Perry has no ﬁnancial rela/onships with proprietary en//es that produce health care goods and services. • Dominique Simon-‐Levine has no ﬁnancial rela/onships with proprietary en//es that produce health care goods and services.
Enabling and Interven/on Karen H. Perry Co-‐Founder Execu;ve Director
Na/onal Overdose Sta/s/cs • 28,578 uninten/onal fatal drug poisonings (2009) • In 2009, approximately 1.2 Million Emergency Room visits for non medical use of pharmaceu/cals. • Research indicates an es/mated 6 people will be directly aﬀected by each sudden loss, which equates to 171,468 people annually
Current Trends • Every day, 2,000 teens in the United States try prescrip/on drugs to get high for the ﬁrst /me • 60% of teens who have abused prescrip/on painkillers, did so before the age of 15 • 45% of those who use prior to the age of 15, will later develop an addic/on which also increases the chance for overdose.
Successful Community Partnerships • Assess the Local Community • Forming Partnerships • Plan and Set Goals • Implement
Community Partnerships • Law Enforcement • Medical Examiner • Community Government • Medical Professionals • Treatment Providers • Educa/onal Ins/tu/ons • Legislators • Family Members
Assess Local Community Partnership with Palm Beach County Sheriﬀ Oﬃce • Majority died from a • Highest spikes occur combina/on of drugs between ages of 18-‐30 an • Prescrip/on drugs were 50-‐60 found in majority of • At least one third of deaths vic/ms has suﬀered a • Majority of deaths previous non-‐fatal someone was with in overdose earshot of vic/m • Majority of vic/ms were Caucasian male
NOPE Task Force™ a 501c-‐3 non-‐proﬁt Mission To reduce the frequency and impact of drug overdose death through: • Community Educa/on • Family Support • Purposeful Advocacy
Plan and Set Goals • Reduce early onset of substance use. • Empower youth to become peer advocates Increase knowledge of parents and community members. • Reduce the number of drug overdose deaths.
Preven/on & Educa/on Presenta/ons • Middle & High Schools • Universi/es • Parents & Communi/es • Treatment and Correc/onal ins/tu/ons • Health Care Professionals
Student Presenta/ons TOPICS OF DISCUSSION RELATED NOPE TAG LINES 1. Addic/on • Be the Hero-‐Tell Someone ® 2. Combining Drugs = Overdose • One Time Can Kill ® 3. Make the Call! Dial 911 • Make the Call! Dial 911 ® 4. Passed out= Medical • Some/mes You Never Sleep It Emergency Oﬀ ®
Parent Presenta/on 4 Components: • Impact on family • Underage drinking • Current trends • Paren/ng strategies
Follow Up • ASK ADAM & AMY • Interac/ve Website • Publica/ons • Student Cer/ﬁca/on and Life Choices Scholarship
Eﬃcacy Empirical support indicates par/cipants show: • Change in knowledge • Change in aktudes towards drug Lynn University Research Boca Raton, FL
Awareness • Na/onal Candle Light Vigil • Interac/ve Website • Social media • Prescrip/on Drug Take Back • Advocates for legisla/ve change
Advocate for Legisla/on • Be informed of local issues and poten/al bills • Create tool kit for community partners • Inform partners of upcoming bills
Family Support • Treatment Support • ASK ADAM • Support Groups • Interac/ve Website • Publica/ons
NOPE Task Force’s Accomplishments • 11 Chapters across Florida • Florida Prescrip/on Drug • Over 120,000 students Monitoring Program passed receiving our evidence and ac/ve based message annually • Good Samaritan 911 Law • Over 50 loca/ons hos/ng passed Candle Light Vigils Annually
Partners • Oﬃce of Na/onal Drug Control Policy • Mar/n County Sheriﬀ’s Oﬃce • Florida Oﬃce of the Anorney General • Okeechobee County Sheriﬀ’s Oﬃce • The Florida Sheriﬀ’s Associa/on • Palm Beach County Sheriﬀ’s Oﬃce • The Florida Police Chiefs Associa/on • Palm Beach County State Anorney • Florida Coali/on Alliance • Pinellas County Sheriﬀ’s Oﬃce • Safe and Drug Free Schools • St. Lucie County Sheriﬀ’s Oﬃce • Caron Center • Sarasota County Sheriﬀ’s Oﬃce • Hanley Center • Seminole County Sheriﬀ’s and • Lynn University municipal law enforcement agencies • Flagler County Sheriﬀ’s Oﬃce • Volusia County Sheriﬀ’s Oﬃce • Hillsborough County Sheriﬀ’s Oﬃce • Indian River County Sheriﬀ’s Oﬃce
NOPE Task Force 866-‐612-‐NOPE www.nopetaskforce.org Karen Perry KPerry@NOPETaskForce.org
Enabling and Interven;on When Love Isn’t Enough… CRAFT (Community Reinforcement and Family Training) Dominique Simon-‐Levine, PhD April 2 – 4, 2013 Omni Orlando Resort at ChampionsGate
Learning Objec;ves 1. Understand speciﬁc CRAFT procedures (eg. reinforcement strategies, allowing natural consequences) to increase the chance that the Loved One will enter treatment. 2. Understand the methods for engaging a Loved One to seek help. 3. Review the science behind CRAFT.
Disclosure Statement Dominique Simon-‐Levine has no ﬁnancial rela/onships with proprietary en//es that produce health care goods and services.
CRAFT is driven by the principles of classical behavioralism. Dolphins do it, dogs do it, people do it…
Control vs Inﬂuence: !Control Inﬂuence • Demand, dominate, • Request, provide resources, you manipulate are a mirror “what do you want to do?” • “No” leads to guil/ng, • “No” leads to disappointment and anger, shaming, provides informa/on resentment • Power over • Power with, it’s a partnership “Use and you’re out of “Please do not come home if you’ve here.” been using. You’re welcome back when you straighten up.”
The Essen/al Skill Set: CRAFT 1. Safety, de-‐escala/on 2. Posi/ve communica/on 3. What to do when your LO is not using, right now 4. What to do when your LO is using, right now 5. How to handle the hard emo/ons 6. How to get your LO into treatment
CRAFT happens in the moment … the world divides in two. • How you respond when you see use • How you respond when you don’t see use
When you see use, disable the enabling … 1) Remove the rewards. 2) Remove yourself in a quiet neutral way. 3) Allow natural consequences, if safe to do so. .
When you don’t see use….*!+REWARD+!* 4 Characteris/cs pleasurable to your LO free or aﬀordable can be given immediately something you are willing to give 4 Types Stuﬀ: like a video game or /x to a ball game or a favorite food. Verbal comments: “It really saves me /me when you take out the trash. Non verbal behaviors: eye contact or a pat on the back. Ac;vi;es: a back rub, a walk to the corner for ice cream.
How do I get my Loved One into treatment? • You create that bridge between the two of you. • You empathize and show respect. • You stop the nega/ve talk, add in posi/ve talk, and listen to what your LO is saying. • You make requests. You don’t dominate. • You take care of yourself, which helps you stay calm and pa/ent. • You understand that gekng sober and clean is a process.
You have treatment in your back pocket. Treatment deﬁned broadly: public, private, self-‐help, faith-‐based.. Windows of Opportunity 1) A wish or a dip…Change Talk, there’s mo/va/on in this. 2) The planned conversa/on. A serious moment around the table. 3) When LO talks of gekng help. Script it out. Avoid jargon and words like alcoholic, drug addict, treatment… Rehearse it. Prepare for refusal.
Sandy’s Tea Party I hate that I don’t want to have sex with you. Only recently has there been any closeness at all. I don’t want any more weekends like the last one. We aren’t enjoying each other. I think we’re both isolated and lonely. I want us connected again. I want you. That isn’t possible with your drinking. Come see me. I have a list of places that help professionals who have problems with drinking. Will you take a look at it with me?
Controlled Trial 130 family members assigned to 1 of 3 interven/ons " Al-‐Anon Facilita/on therapy " Johnson Ins/tute Interven/on " CRAFT " Loved Ones are all alcoholic
Sisson & Miller, CRAFT STUDIES Kirby, et al., Meyers, Meyers, Waldron, Dutcher, et Manual, etAzrin Meyers, et 1999 Miller, et al., Miller, et al., et. al., 2007 al., 1999 al., 20111986 al., 1999 1999 2002 adolescent Group vs Self- Directed14 CSOs 130 CSOs 32 CSOs 62 CSOs 90 CSOs 42 CSOs 99 CSOs 40 CSOs 75% Anglo 80% 49% 48% 59% 60% Anglo 23% AA Hispanic Hispanic Hispanic HispanicAlcohol Alcohol 55% 37% Coca MJ MJ Alcohol Drugs/ Cocaine 35% MJ Cocaine Alcohol 90% Alcohol 22% 16% Stim Stimulants Cocaine opiates 8% opiate 7%Randomized Randomized Randomized Non- Randomized Non- Non- Craft in(CRAFT vs (CRAFT/JI (CRAFT vs Randomized Randomized Randomized Group vs12 Step) /12-step 12-step) Self- Directed86% vs 64% 74% vs 74% 65.5% vs 71% 55%-65% 70%0% vs23% 17% CSOs 29% CSOs CSOs vs 40%CSOs vs13% CSOs Better CSOs Better Better BetterBetter CSOs Better Better Better
Other Outcomes from Clinical Trials " CRAFT-‐engaged Loved Ones most owen anend 6 sessions of outpa/ent treatment as compared to NM state modal of 1. " Loved Ones reduce their use by 50% while family member is in CRAFT
CRAFT Resources Dr. Robert Meyers, William Miller, Jane Ellen Smith, University of New Mexico, Center on Alcoholism, Substance Abuse, and Addic/ons HBO ﬁlm on CRAFT hnp://www.hbo.com/addic/on/theﬁlm/supplemental/628_addict_into_treatment.html Dominique Simon-‐Levine firstname.lastname@example.org Simonlevine.com