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Intervention Motivating Substance Abusers To Enter Treatment

Intervention Motivating Substance Abusers To Enter Treatment






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    Intervention Motivating Substance Abusers To Enter Treatment Intervention Motivating Substance Abusers To Enter Treatment Presentation Transcript

    • Michael Provines, MD Chief Operating Officer 1-800-673-1847
      • We are not law enforcement, we provide treatment to the patient and family system
      • We do not judge our patients for having the disease
      • We base our decisions on the facts of the case we are treating
      • We are not involved in the morality (concern with the distinction
      • between good and evil or right and wrong) of addiction
      • The “disease model” of addiction describes addiction as a lifelong DISEASE involving biologic and environmental sources of origin.
      • Justice Department involvement is a symptom of the disease and may not be avoidable
    • Disease Model of Addiction
      • A disease causes an interruption, cessation, or disorder of bodily function, systems, or organs
      • And is characterized by:
        • A recognized etiologic agent (or agents)
        • An identifiable group of signs and symptoms
        • Consistent anatomical alterations of known body systems
      • Treatable with medications and cognitive, behavioral interventions.
    • Alcoholics Anonymous
      • Alcoholics Anonymous is a fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem and help others to recover from alcoholism.
      • Described as an “allergy” to alcohol.
      • First edition of “big book” published in 1939.
    • Primary Illness
      • Addiction is a primary illness
      • Must be treated before other “problems” can be managed (legal, social, financial).
      • Oftentimes treated concurrently with other mental health and medical issues
      • Chronic mental health and medical issues are unlikely to improve unless addiction is treated simultaneously
    • Chronic and Progressive
      • Addiction is a chronic and progressive disease.
        • Can be arrested but not eliminated
        • Tends to worsen over time
          • Increase use of the substance
          • Worsening of consequences (symptoms)
    • Fatal
      • Fatal from direct or indirect actions of the substance
        • Production of organ system disease
          • i.e. alcoholic hepatitis leading to chirrosis, cocaine induce cardiomyopathy
        • Behaviors
          • Accidents
          • Trauma
          • Neglect of body (eating, sleeping, hygiene, sexual health)
          • Suicide
          • Violence
          • Overdosage
    • 12-Steps (AA, NA, CA, MA)
      • State that chronic addiction ends in, “jails, institutions, and death.”
      • Self-help groups that offer support and encouragement to its fellows
      • Offer practical, real-life advice on coping skills
      • Spiritually based, not religious
      • Do not treatment medical ailments, psychological or psychiatric problems, and do not offer clinical advice
    • Treatable
      • Successful treatment is available
        • Medical interventions
        • Cognitive and behavioral interventions
        • Social interventions
        • Support groups
      • But the disease is characterized by……
    • Denial
      • Denial is a state of being that places the person out of touch with reality
      • The most difficult aspect of treatment for addiction
      • The support network and the patient can be in denial
      • Caused by multiple factors
        • Distortions of memory (blackouts and euphoric recall)
        • Psychological defense mechanisms (projection, repression, etc.)
        • Social factors (enabling, environment of origin, normalizing the lifestyle)
        • And……..
    • Enabling
      • AA
        • doing something for someone that they should or could be doing for themselves
      • CODA
        • putting someone elses needs above your own
      • Clinical
        • doing something for someone that prevents them from experiencing consequences
    • Enabling
      • Often misunderstood
        • Not as simple as buying drugs or alcohol for a patient, or supporting the addict financially
        • Can be as simple as accepting the behavior without addressing it
        • The reduction of enabling DOES NOT mean that the goal is to give additional consequences to the addict, the consequences will come naturally
          • Reduction of enabling leads to the cessation of the prevention of consequences
          • Is not meant to induce “tattle-telling” in family members
        • AA and AL-ANON slogan “live and let live”
    • Enabling
      • Examples
        • Making excuses for the addict
        • Paying bills
        • Bailing them out of jail
        • Making rationalizations
        • Ignoring problems cause by use (financial, employment, legal)
        • Cleaning up messes
        • Not discussing the problem of chemical use
        • Not getting help for “yourself”
    • Consequences
      • The severity of consequences for addict and for family will determine the willingness to intervene
      • Consequences can be completely internal (emotional collapse, depression, anxiety, sleeplessness, guilt, fear, etc.)
      • External consequences (financial, legal, employment, medical) are more likely to lead to intervention, but not necessarily.
        • Dependent on the stage of the disease
    • Intervention
      • A formal or informal process to aid in motivating a person to seek treatment
      • Many different styles of intervention
      • Older styles relied more upon threatening the addict with consequences
      • Newer styles rely on treating the family system and prevention of enabling behaviors
    • Intervention Models
      • Major categories are direct and indirect
        • Direct is a direct confrontation with the addict
          • First direct model was the Johnson Model, originating in the 1960s
        • Indirect is working with a co-dependent person in the addict’s support network
          • Allows co-dependent person to be more effective in working with the addict (AL-ANON)
    • Johnson Model
      • Originated in 1960s with Dr. Vernon Johnson
      • Taught at the Johnson Institute
      • Very effective in treatment entry rates
      • Method
        • Family meets with a counselor (or interventionist)
        • Family prepares letters to addict
        • Intervention rehearsal meeting takes place
        • List of consequences if addict does not enter treatment is developed
        • Intervention takes place and is usually a rapid process
        • Addict agrees to treatment or accepts consequences
    • Confrontational vs. Motivational Approaches
      • Confrontational approaches may work more quickly
      • Confrontational approaches tend to address the addict, rather than the entire family unit
      • Confrontational approaches may lead to higher treatment drop-out
      • Confrontational approaches are more stressful for the family unit and addict
    • Forcible Intervention
      • Civil liberty issues arise with forcible interventions
      • Interventions that use physical force to capture or even confine the addict
      • Addict has not been allowed to attend court nor have they been served with legal action
      • Deprives the person of liberty without due process
    • Underlying Themes of Modern Interventions
      • Utilize motivation rather than confrontation
      • Are invitational in nature, rather than by surprise
      • Decreases the focus on the addicted individual
      • Focuses on need of entire family system to grow towards increased health
      • Focus on dignity and respect for the addict and the family
      • May be effective in helping the addict decrease use without their direct participation
    • Modern models
        • Motivational Interviewing
        • Systemic
        • A.R.I.S.E. (A Relational Intervention Sequence of Engagement)
        • CRAFT (Community Reinforcement and Family Training)
    • Motivational Interviewing
      • Open-ended questions
      • Utilizes mirroring
      • Reflective listening
      • Affirmations
      • Summaries
      • Reframing
      • Takes the burden of motivation away from the family
      • Patient eventually accepts the consequences of their actions
    • Systemic Approaches
      • Can help the family return to a state of health, even if the addict continues to use
      • Rewards sober activities
      • Discourages activities that include drugs or alcohol
      • Eventually reasons not to use outweigh the reasons to use, the addict seeks treatment
      • Avoids nagging, pleading, and threatening
      • Addict gradually develops insight into the consequences of their actions
    • A.R.I.S.E. ( A Relational Intervention Sequence of Engagement )
      • Divided into phases
        • Phase A
          • Level 1—first call and first meeting of intervention team
          • Level 2—Continue intervention meetings
          • Level 3—Formal ARISE intervention takes place and consequences are given if patient has not entered treatment
        • Phase B
          • Individual and family healing, individual and family get treatment
        • Phase C
          • Relapse prevention and long-term recovery
    • CRAFT
      • Designed for others who need assistance in getting help for their loved one
      • Utilizes positive communication
      • Rewards sober activities
      • Discourages using activities
      • Could lead to a lower rate of relapse b/c entire family unit is motivated
      • Goals:
        • Increase happiness of family members
        • Decrease addict’s use
        • Motivate addict to seek treatment
    • CRAFT
      • Uses positive communication styles to encourage the family and addict
        • Brief sessions to describe problem
        • Positive and hopeful
        • Use I statements and stick to fact
        • Indicate hopes for future outcome
    • Treatment of the Family
      • Help is available for the family, even if the addict is unable to gain motivation for change
      • Self help groups such as AL-ANON and CODA are helpful tools and offer support at no cost
      • Individual and family therapy
      • Help from an interventionist
      • Help from a treatment facility to guide family through process
    • Choosing a technique
      • A “one size fits all” approach does not work
      • You must match the technique with the family and patient’s needs
      • The urgency of the situation may dictate your approach
      • If one approach is unsuccessful, try another
      • Reminder that working with the family or employer who initiated the intervention is of utmost importance
    • Interventions are initiated by
      • Family
      • Friends
      • Employers
      • EAPs
      • Professional licensing agencies
      • Law enforcement and legal means
      • Child protective services
      • Physicians
      • Therapists or counselors
    • Recovery Connection
      • If you are looking for assistance, please call our 24 hour helpline, free of charge
      • 800-673-1847, Recovery Connection
      • Guidance is available in looking at options
      • Staff here receive 30,000 calls per month and are experts at interventions