Intervention Presentation


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Intervention Presentation

  1. 1. Invitational Intervention:The ARISE ModelGetting Resistant Substance Abusers into Treatment<br />Char Scott Maloney<br />Passages Counseling Center, Inc. <br /><br /><br />Office: 630.848.0445<br /><br />
  2. 2. Today’s Agenda<br />Scope of addiction and current challenges<br />Psychosocial Aspects<br />The role of families and support systems in treatment engagement<br />Impact of stressors<br />Treatment engagement, treatment and long-term recovery<br />How families can bring about healing<br />
  4. 4. ADDICTION STEREOTYPES & MYTHS<br />Myth 1: “You are powerless to help until the substance abuser is ready”<br />Myth 2: “Putting pressure on the substance abuser will push him/her over the edge”<br />Myth 3: Secrets are really secret<br />Myth 4: “The substance abuser must ‘hit bottom’ before getting help”<br />Myth 5: Substance Abusers are disconnected from their families<br />Myth 6: “Tough consequences will chase the substance abuser away forever”<br />
  5. 5. TREATMENT ENGAGEMENT<br />A very small proportion of people with drug dependency or abuse are engaged in treatment or self-help<br />NATHAN (1990) ESTIMATED 5%<br />FRANCES ET AL. (1989) ESTIMATED 10%<br />KESSLER ET AL. (1994) ESTIMATED 8%<br />
  6. 6. Psychosocial Aspects of Addiction<br />
  7. 7. Loss and Addiction<br />Onset of addiction is almost always connected to:<br /><ul><li>death of a parent, grandparent, spouse or significant friend,
  8. 8. natural or human-made disaster, immigration/refugee experience, or war</li></ul>Substance use:<br /><ul><li>numbs the sadness, loss, anger, guilt and loneliness
  9. 9. distracts from grief in other members of the family</li></li></ul><li>More Vietnam veterans have died from addiction and/or suicide than were lost during the Vietnam conflict<br />Deaths of Vietnam veterans: <br /><ul><li>during Vietnam conflict: 58,000
  10. 10. since Vietnam conflict from addiction/suicide: 62,000</li></li></ul><li>Trauma and Addiction:Individual Trauma<br /><ul><li> 60% of the women in AA report a history of sexual abuse
  11. 11. 30% of the men in AA report a history of sexual abuse</li></li></ul><li>Despite prevailing beliefs, Addicted Individuals do not need to hit bottom to receive help or be motivated to get treatment. Families can help.Substance abusers and others suffering from addiction are closely connected to their families<br />
  12. 12. 70%<br />64%<br />60%<br />51%<br />50%<br />40%<br />30%<br />20%<br />9%<br />10%<br />0%<br />Non-Addicts<br />Heroin<br />Polydrug<br />Percentage of Subjects in Daily Telephone Contact With One or More Parent<br />Addicts<br />Heroin<br />Addicts<br />Polydrug<br />Non-<br />addictss<br />(Purzel and Lamon, 79)<br />
  13. 13. IS THERE A STRANGER LIVING IN YOUR HOME?<br />Nature of calls that come in from family regarding getting a resistant loved one started in treatment<br />
  14. 14. Prefrontal Cortex -- Functions<br />(Executive Functions)<br /><ul><li>judgment
  15. 15. impulse control
  16. 16. self-monitoring</li></li></ul><li>Prefrontal Cortex -- Functions<br />(Coping Functions)<br /><ul><li>attention span
  17. 17. organization
  18. 18. learning from experience
  19. 19. empathy
  20. 20. problem solving</li></li></ul><li>Prefrontal Cortex – Malfunctions<br /><ul><li>inability to objectively assess oneself
  21. 21. poor judgment
  22. 22. inability to learn from experience
  23. 23. decreased attention span
  24. 24. becoming easily bored
  25. 25. argumentative
  26. 26. thin skinned
  27. 27. Self-centered
  28. 28. disorganized</li></li></ul><li>Prefrontal Cortex related– Recovery Slogans<br /><ul><li>Think, Think, Think
  29. 29. Easy Does It (But Do It)
  30. 30. Insanity: Doing the Same Thing Over and Over Again and Expecting a Different Outcome
  31. 31. I cannot control my first thought---but I am responsible for my second thought.</li></li></ul><li>TRANSITIONALFAMILY THERAPY<br />
  32. 32. PHILOSOPHY OF TRANSITIONAL FAMILY THERAPY<br /><ul><li>Families are intrinsically healthy and competent
  33. 33. People and environments are constantly in transition
  34. 34. Individuals, families and communities will find and utilize their competence
  35. 35. Competence is unavailable when individuals and families are cut off from their extended families and natural support systems
  36. 36. To access competence, mobilize and extend natural support system
  37. 37. Eliminate the we/they dichotomy and maintain connection to family and culture of origin</li></li></ul><li>Impact of Stressors/Change on Family Functioningand Getting Off-Track<br />
  38. 38.
  39. 39. Despite prevailing beliefs, a well-guided Intervention with no secrecy or ambush will not chase a resistant substance abuser away, but can motivate him/her to enter and maintain treatment and long-term recovery<br />
  40. 40. Intergenerational Transitional Checkerboard I<br />MGF<br />MGM<br />PGF<br />PGM<br />Wife<br />Husband<br />Mother<br />Father<br />Sibling 1<br />Sibling 2<br />Sibling 3<br />
  41. 41. Intergenerational Transitional Checkerboard I<br />MGF<br />MGM<br />PGF<br />PGM<br />Wife<br /> Husband<br />Husband<br />Husband<br />Mother<br />Father<br />Father<br />Sibling 3<br />Sibling 1<br />Sibling 2<br />
  42. 42. Intergenerational Transitional Checkerboard II<br />MGF<br />MGM<br />PGF<br />PGM<br />Wife<br /> Husband<br />Husband<br />Husband<br />Mother<br />Father<br />Father<br />Sibling 3<br />Sibling 2<br />Sibling 1<br />
  43. 43. Family Resilience<br />
  44. 44. Family Motivation to Change is the combined forces operating within a family guiding it toward maintaining survival and healthy functioning in the face of serious threat, and toward healing when that threat is removed.<br />
  45. 45. FAMILY MOTIVATION TO CHANGE: THE PROCESS IN ACTION<br />First Protecting and then Healing the Family<br />Completing the Transitional Task for “Peace of Mind.”<br />Getting a Loved One Back<br />Preventing Further Loss<br />
  46. 46. Invitational Intervention: A Relational Intervention Sequence for Engagement: (ARISE)<br />A Three-Level, Graduated <br />Continuum of Intervention To <br />Engage and Maintain Substance Abusers <br />in Treatment<br /><ul><li>Goal: Getting the substance abuser into treatment
  47. 47. Principle: Stop at the first level that works
  48. 48. Process: Starts with Treatment Engagement, continues through </li></ul>Treatment Support into Long-term individual & Family Recovery<br /><ul><li>Applies the least amount of time and effort
  49. 49. Responds to the love, fear, worry, and guilt of those living with the addiction
  50. 50. Is designed to be cost and time effective</li></li></ul><li>ARISE CONTINUUM OF CARE<br />PHASE A:<br />Intervention: escalating levels of effort as needed to ensure treatment entry and engage family as Intervention Network<br />PHASE B:<br />Treatment Support: facilitate interface among treatment team, addicted individual and Intervention Network<br />Relapse Prevention: Develop and implement relapse prevention plan; provide psycho-education; promote family healing & long-term individual & family recovery<br />
  51. 51. ARISE Levels<br /><ul><li>Level I: The First Call
  52. 52. Someone calls or contacts an agency concerned about a substance abuser
  53. 53. The call is used to “coach” the caller on getting the substance abuser into treatment
  54. 54. The First Caller (Concerned Other) is coached to mobilize members of the support system to get the substance abuser into treatment
  55. 55. Level II: Strength in Numbers
  56. 56. Family, friends, and Concerned Others meet to plan bringing the substance abuser into treatment if substance abuser is not engaged after Level I
  57. 57. Level III: The Formal ARISE Intervention
  58. 58. If needed – Network proceeds to a supportive, formal Intervention meeting</li></li></ul><li>ARISE OUTCOME DATA NATIONAL INSTITUTE ON DRUG ABUSE (NIDA) STUDY<br />Landau, J., Stanton, M.D., Brinkman-Sull, D., Ikle, D., McCormick, D., Garrett, J., Baciewicz, G., Shea, R., Wamboldt, F. (2004). Outcomes with the ARISE approach to engaging reluctant drug- and alcohol-dependent individuals in treatment. American Journal of Drug & Alcohol Abuse,30(4).<br />
  59. 59. PRIMARY CONCLUSIONS<br /><ul><li>Included all consecutive cases with no exclusion criteria (i.e., all Concerned Others who called the agencies)
  60. 60. Of 110 cases, 82.7% (n = 91) became engaged in treatment (n = 86) or self-help (n = 5)
  61. 61. Over half (55%) became engaged during Level I (First Call and First Meeting)
  62. 62. Mean amount of time required (telephone and face-to-face) per case was 88 minutes (median = 75 minutes)
  63. 63. 50% were engaged within 1 week; 76% within 2 weeks; 83% within 3 weeks</li></li></ul><li>PRIMARY CONCLUSIONS cont.<br /><ul><li>Greater number of network members involved predicted greater success of engagement and less time and effort by clinician
  64. 64. Less time spent by clinician on phone, or fewer calls, predicted better outcome
  65. 65. Parental involvement significantly enhanced rate of success, regardless of age of parent or substance abuser
  66. 66. Preferred substance of abuse did not predict success, neither did severity of abuse nor psychiatric problems</li></li></ul><li>MOST SIGNIFICANT PREDICTOR VARIABLE<br />The greater the number of significant others involved in the network, the more likely was the substance abuser to get engaged in treatment or self-help (p&lt;.0001)<br />
  67. 67. RELATIONSHIP OF CONCERNED OTHERTO THE Addicted Individual<br />94.7% OF ALL CONCERNED OTHERS WERE FAMILY MEMBERS<br />PARENTS 38 40.3%<br />SPOUSES/PARTNERS 29 30.9%<br />OFFSPRING 4 4.3%<br />OTHER RELATIVES 18 19.2%<br />NON-RELATIVES 5 5.3%<br />The majority was female: 68.8%<br />Their mean age was 46.6 (range 15-78)<br />
  68. 68. Outcome By <br />Level Of Care<br />60.00%<br />52.70%<br />50.00%<br />Inpatient<br />Intensive OPD<br />40.00%<br />27.50%<br />SA OPD <br />30.00%<br />Self-Help<br />20.00%<br />13.20%<br />10.00%<br />5.50%<br />0.00%<br />
  69. 69. Invitational Intervention: The ARISE Model(Relational Intervention Sequence for Engagement)<br />Results of Real World Replication of ARISE at SSTAR (Stanley Street Treatment & Resources)<br />
  70. 70. Real World Data from SSTAR cont.<br />17%<br />