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Intervention Presentation

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

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