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My final project

My final project

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  • 1. The Methadone and Family Therapy Clinic for Adolescents
  • 2.  Providemethadone maintenance treatment (MMT) and concurrent family oriented psychotherapy services and psychoeducation to adolescents with DSM-IV-TR diagnosed heroin abuse/dependence Yes, you read correctly…adolescents.
  • 3. Provide early, comprehensive treatment toheroin dependent/abusing adolescents in aneffort to cease future heroin usage as well asreduce the likelihood of complicationsassociated with heroin use. Focus is placedupon the family unit.
  • 4.  Stanton, et al. (1978), proposed that the heroin’s chronic relapse nature is explainable from the viewpoint of family system’s theory Estimated yearly cost of untreated addiction of opiates – 20 billion (2) Estimated 1 million persons for opiate addiction (including heroin) (2) Provide early methadone treatment for adolescents with heroin abuse/dependence to aid these persons in ceasing heroin usage Provide psychotherapy services to adolescents “…families of young adult heroin addicts tend to differ from normal families or other dysfunctional families in a number of ways” (10) There is a relationship between family functioning and drug abuse (11) Research indicates family dysfunction after substance abuse treatment completion can lead to relapse (11)
  • 5.  Methadone treatment is beneficial, however, many individuals do not remain in active methadone treatment for the minimum period of one year – most of these individuals will replapse (2) It is not uncommon for individuals to continue using upon treatment admission to methadone maintenance programs (2) Financially, untreated opiate addicts rack up about $20 billion (2) Methadone maintenance is a valid treatment approach (2) Estimated cost of methadone treatment per day is $13 (5) Single doses of methadone can last up to 36 hours depending on dose of course – significantly longer time period than heroin (7) There is also possibility for addiction to methadone, which psychotherapy will help to address this potential issue Methadone is low cost compared to other potential drug treatments (8) Methadone considered to be choice treatment for opiate addiction (9) Detoxification from methadone relapse rates are quite high ranging anywhere from 50-90% one year after treatment – hence inclusion of mandatory psychotherapy (9) OVERALL: methadone will stabilize the client for psychotherapy
  • 6.  Minimum duration of treatment as indicated by studies is 12 months continuous use (2) Average daily dosage range 60 to 120 mg (2) Noteworthy potential benefits are not just beneficial to society but also the individual (2)  Reduction/ceasation of injectable drug use  Common diseases acquired through injected drugs include: HIV, STDs, hepatitis C/B, bacterial infections, etc (2)  Reduction in overdose risk  Reduction in mortality risk  Family stability improvements  Possible reduction in criminal activity
  • 7.  Outpatient Treatment Program 1 Year minimum treatment duration Treatment must be concurrent: psychotherapy in conjunction with methadone maintenance Services provided by substance abuse experts as well as family therapy trained psychotherapists Weekly drug test screenings
  • 8.  The treatment program will be broken down into 3 phases (adapted in part from source 3)  Phase 1: Stabilization  Consists of recognition of need for drug abstinence, initial administration of methadone, struggles with continued heroin use, psychotherapy to address struggles, etc.  Minimum duration of 8 weeks  Phase 2: Transition  Targeted at learning about and the management of addiction process (including withdrawal), motivation development, increased focus on family infrastructure and client’s role in family  Phase 3: Community  Focus upon development of prosocial community and family connections
  • 9.  Methadone Maintenance treatment  Mandatory weekly physician appointment  Methadone to be administered on a daily in- person basis by a licensed medical professional with the proper credentials  Substance abuse/dependence group therapy, minimum of 1 hour per week Therapy Services  Individual therapy, minimum of 1 hour per week  Family therapy, minimum of 1 hour per week  Psychoeducation, minimum of 1 hour per week
  • 10.  Topicsinclude, but are not limited to methadone treatment, substance abuse, role of the family, etc. Specific topic examples can be (partially adapted from source 3):  Treatment regulations for methadone  Problem solving  Relapse prevention  The addiction cycle  Owning one’s addiction  Blood born pathogens  Stress management  Relationship boundaries
  • 11.  Potential clients can be referred via parent(s), physician, agency, or self-referred providing parental consent is acquired Potential clients will complete a diagnostic evaluation Family involvement/caregiver involvement, at least one family member/caregiver must be actively engaged in the treatment process with the adolescent
  • 12.  Family therapy model  Focus primarily – Brief Strategic Family Therapy  Robbins, et al. (2011), found when compared to treatment as usual community based programs that this brief approach yields higher retainment of adolescents and improved family functioning according to parents  Is an effective model for adolescent substance abuse (12)  Primary aim is to “reduce adolescent behavior problems by improving within-family relationships between family members and other important systems that influence the youth’s behavior…” (12)  Support exists for effectiveness in minority families as well (12)
  • 13.  Parental consent/child assent Adolescents ages 14 to 19 Failure to attend 2 consecutive psychotherapy sessions (whether family, individual, or psychoeducational) will result in temporary cessation of methadone administration, after one week of continuous attendance for psychotherapy, methadone treatment will resume.
  • 14.  Automatic termination upon age of 19 (referred/transferred to another program) Failure to sufficiently attend psychotherapy Misuse of methadone (sharing, selling, etc) Complete lack of caregiver/family involvement – treatment process targets family involvement, therefore, at least one member must be actively engaged in the treatment process with the adolescent
  • 15.  Methadone maintenance is effective to a degree, however, it is not a comprehensive treatment approach by itself. It may help wean the person off of heroin, however, there is the potential for long term use. Methadone maintenance is a temporary bridge to psychotherapeutic treatment. Family based therapy will aid in repairing dysfunctions in the family with emphasis on the client.
  • 16.  (2) Center for Disease Control. (2002). Methadone maintenance treatment. http://www.cdc.gov/idu/facts/MethadoneFin.pdf (9) Craig, R.J. & Olson, R.E. (2004). Predicting methadone maintenance treatment outcomes using the addiction severity index and the mmpi-2 content scales (negative treatment indicators and cynism scales). The American Journal of Drug and Alcohol Abuse, 30, 823-839. (8) Eder, H., & et al. (2005). Comparative study of the effectiveness of slow-release morphine and methadone for opioid maintenance therapy. Society for the Study of Addiction, 100, 1101-1109. (5) Methadoneclinic.com. (unknown). Methadone treatment approaches. http://www.methadone- clinic.com/treatments.php (3) New Brunswick Addiction Services. (2009). Methadone maintenance treatment policies and procedures. http://www.gnb.ca/0378/pdf/methadone_policies-e.pdf (12) Robbins, M.S., & et al., 2011). Brief strategic family therapy versus treatment as usual: results of a multisite randomized trial for substance using adolescents. Journal of Consulting and Clinical Psychology, 6, 713-727. (11) Rowe, C.L. (2012). Family therapy for drug abuse: review and updates 2003-2010. Journal of Marital and Family Therapy, 38, 59-81. (1) Stanton, M.D., et al. (1978). Heroin addiction as a family phenomenon: a new conceptual model. American Journal of Drug and Alcohol Abuse, 5, 125-150. (7) University of Maryland. (2005). Methadone. http://www.cesar.umd.edu/cesar/drugs/methadone.asp (10) Volk, R.J., Edwards, D.W., Lewis, R.A., & Sprenkle, D.H. (1989). Family systems of adolescent substance abusers. Family Relations, 38, 266-272.