Week 6 SOWK 655

1. SPECIFIC APPROACHES TO OPIOID
TREATMENT SEMINAR
Group 5
Emily Bailiff, Verenis Gasca, Ali Shilleh, Madison Wilmeth
Department of Social Work University of Massachusetts
Global
SOWK 655 Substance Abuse
Dr. Yoshioka, DSW

2. Specific Approaches To Opioid Treatment Seminar
(TED-Ed. ,2020)

3. Specific Approaches To Opioid Treatment
Seminar Component Overview
● An introduction to Opioid, behavior and rural populations
○ Define opioids/behaviors
○ Identify short and long-term effects of opioid use/behavior
○ Current topics/issues in society with Opioids or behavior
● Differentiation between “normal” use/behavior and when it becomes an
addiction
● The MI approach for opioid addiction
● Intervention from the MI treatment approach and client in process note
format
● Resources for the therapist to use with the client and why helpful
● Resources for the client and how to use them with the client
(Yoshioka Mora, n.d.)

4. What are Opioids ?
Opioids are defined as a class of drugs that derive from, or mimic, natural
substances found in the opium poppy plant. Opioids is classified as drug
that is used to manage Severe and Chronic Pain. Commonly prescribed
opioids include oxycodone, fentanyl, buprenorphine, methadone,
oxymorphone, hydrocodone, codeine, and morphine.
Proper use of Opioids should alleviate pain and provided relaxation of
Pain. Short term Opioid abuse can lead to Sleepiness , Relaxation,
Euphoria, Nausea, Vomiting, Constipation.
Long Term Opioid Abuse can lead to insomnia, muscle pain, heart
infections, pneumonia, addiction and possibly death.
Behaviors of Some signs of Opioid use are Avoiding time with family and
friends, preferring to be in isolation, Showing signs of depression,
Irritability, nervousness, lack of Hygiene, change in appetite, mood swings
And lack of motivation.
Cdc.gov ( 2023)

5. Current topics/issues in society with Opioids or behavior
Opioid Addiction Epidemic: Increased prescription of opioid medications like
oxycodone and hydrocodone led to widespread misuse of both prescription and
non- prescription opioids.
Current increase in Fentanyl Abuse: It is a prescription drug that is also made
and used illegally. Fentanyl is a powerful synthetic opioid that is similar to
morphine but is 50 to 100 times more potent.
Current Abuse of Synthetic opioids: In 2020, more than 56,000 deaths
involving synthetic opioids occurred in the United States, which is more deaths
than from any other type of opioid. Synthetic opioid-involved death rates
increased by over 56% from 2019 to 2020 and accounted for over 82% of all
opioid-involved deaths in 2020. The rate of overdose deaths involving synthetic
opioids was more than 18 times higher in 2020 than in 2013.
nida.nih.gov(2023), Image Courtesy CDC

6. Differentiation Between “Normal” Opioid Use/Behavior and
Addiction
Normal Use
● Tanken as prescribed per doctors recommendations
● Adheres to the outlined risks and benefits
● Acknowledges acceptable and unacceptable drug-taking behaviors
Normal Behavior
● Agreement, discussed and signed by the patient before opioid therapy
begins
● Safeguarding these medications against diversion by friends, family,
or visitors
● Discusses use
● Appropriate and deliberate use of Opioid
Photo: (“Nurse Uses Digital Tablet While Talking With Patient Stock Photo,” n.d.) (Passik, 2009)

7. Differentiation Between “Normal” Opioid Use/Behavior and
Addiction
Addiction Use
● Misuse and addiction may include taking someone else's medicine,
taking it in a different way than you are supposed to, or taking the
medicine to get high.
● Larger quantities than intended
● Powerful, compulsive urge to use opioids, even when they are no longer
required medically.
● Risky behaviors obtaining or administering use (i.e. combined with other
substances or IV use
● Physical and psychological symptoms of withdrawal (such as muscle
cramping, diarrhea, and anxiety)
● Continued use during pregnancy
● Overdose
○ The person's face is extremely pale and/or feels clammy to the
touch
○ Their body goes limp
○ Their fingernails or lips have a purple or blue color
○ They start vomiting or making gurgling noises
○ They cannot be awakened or are unable to speak
○ Their breathing or heartbeat slows or stops
Video: (Psych Hub, 2020)
(National Library of Medicine, n.d.)

8. Differentiation Between “Normal” Opioid Use/Behavior and
Addiction
Addiction Behavior
Video: (Fairfax County Government, 2017)
(Community Service Board, 2018)

9. Treatment Approach
for Opioid Addiction
Motivational Interviewing
Purpose: explore readiness to change and resolve hesitation
● Stage 1: Precontemplation- Not yet interested in change or do
not see need to change. May not think they have a problem.
● Stage 2: Contemplation- When pros and cons are weighed.
Notices long-term benefits of change versus short term
satisfaction of use.
● Stage 3: Preparation- Commitment to change is made.
Information gathering about making the change begins.
● Stage 4: Action- Actively making steps to change. Motivation to
change negative behaviors to positive ones.
● Stage 5: Maintenance- Ability to maintain new behaviors and
stay away from the behaviors that were changed.
Relapse: Reverting to previous behaviors. Part of recovery process.
Photo: (ACTion Psychotherapy, 2022)
(Stages of change model, n.d.)

10. Motivational Interviewing in
Opioid Treatment
● Creates sense of autonomy
● Motivation comes from the individual
● Includes the client in goal setting
● Client becomes aware of negative
consequences of substance misuse
Motivational Interviewing was more successful in
treating substance use disorders than other
counseling strategies by 75% (Thomas, 2023).
Photo: (IDEA Health & Fitness Association, 2022)
(Generes, 2022)

11. Motivational Interviewing in Opioid Treatment
S.O.A.P. Notes
S (subjective)
● Describe your symptoms in detail. When did they start and how long have
they been going on?
● What is the severity of the symptoms and what makes them better or worse?
● What is their medical and mental health history?
● What other health-related issues are they experiencing?
● What medications are they taking?
O(objective)
● Relevant medical records or information from other specialists
● The client’s appearance, behavior, and mood in session
A(assessment)
● What you think is going on with the patient; impressions and your
interpretation of subjective and objective information and draw from any
clinical professional knowledge or DSM criteria/therapeutic models to arrive at
a diagnosis (or list of possible diagnoses).
P (plan)
● Outline the plan for next steps to treat the patient; may include short and long
term goals and specific plan to work on during the next session or general
expectations for the duration of treatment.
MI Session Link Start 2:14
Photo: (IDEA Health & Fitness Association, 2022)
(PsychotherapyNet, 2019)(Simple Practice, 2023)

12. Motivational Interviewing in Opioid Treatment
S (subjective) Client began using Oxycontin when her boyfriend encouraged her to take the non prescribed medication for
pain. Client further stated that her use helped take the pain away. Pain was described as the feeling of loneliness following
the death of her grandmother 12 months ago; “I feel alone.” Client stated that the medication helps with emotional
discomfort. “I don’t want to rely on having to take that.” When client does not take the non prescribed OxyContin she
experiences depression, pain in her joints, diarrhea, general body pain and aches. To relieve the symptoms, Client takes
the non prescribed medication. Client has no prior history of medical or mental health. She is not prescribed any
medications. She reported that she took 2 OxyContin at 2:00 PM, prior to this appointment.
O (objective) During the session the client was fidgety, wringing her hands. Her speech was normal. She appeared fully
oriented, mood depressed, and answers to open ended questions were formed in a questions-oriented fashion. Client did
not have difficulty concentrating. Client described a fear of becoming dependent on the non-prescribed medication and is
in the preparation stage of change. Client tested positive for opiates via urinary analysis; the sample was sent to the
laboratory for further analysis.
A (assessment) Based on the client’s reports and in-session observations, meets the DSM-5-TR criteria for:
F11.220 Opioid use disorder Moderate, opioid intoxication, without perceptual disturbances as evident by recent use of the
substance, a persistent desire or unsuccessful efforts to cut down or control opioid use; Craving, or a strong desire to use
opioids; withdrawal symptoms.
F43.8 Prolonged Grief Disorder as evident by “The death, at least 12 months ago, of a person who was close to the
bereaved individual;Intense yearning/longing for the deceased person; Preoccupation with thoughts or memories of the
deceased person; Identity disruption since the death; Intense emotional pain related to the death; “Intense loneliness as a
result of the death. “The disturbance causes clinically significant distress or impairment in social, occupational, or other
important areas of functioning. The duration and severity of the bereavement reaction clearly exceed expected social,
cultural, or religious norms for the individual’s culture and context.
P (plan) Client will enter the Medical Detoxification Program, as to be determined by the establishment. Client desires long
term sobriety and grief counseling. Further plan discussion will continue throughout the detoxification process and ASAM
level 2.5, Intensive Outpatient Care, group entry.
Photo: (IDEA Health & Fitness Association, 2022)
(American Psychiatric Association, 2013) (Association, 2022)

13. Resources for the therapist to use with the client and the benefits
● Evidence based practice centers
● SAMHSA’s National Helpline at 1-800-662-HELP.
● SAMHSA's Behavioral Health Treatment Services
Locator.
● Medical App that helps opioid users stay in their
recovery programs.
● 988 Sucide & Crisis Lifeline
● Technology integrations such as telehealth and
web-based tools
● This can help extend resources for the client and
would be beneficial for those who would not want
to engage in informal care.
● Structural and Financing Models
● Health care setting and which provide counseling.
Facing addiction in america - NCBI bookshelf.(n.d)
● The benefits from these
resources are that it will help
the client get the support that
they need with their opioid
addiction.
● Each resource is different and
beneficial for the clients to use
with this addiction.

14. Three recovery resources for the client
● Counseling and behavioral therapies with the client. It is more effective when
counseling and other services are available to provide patients with a whole-person
approach and to support their recovery.
● Opioid treatment programs
● Inpatient treatment centers
● Detox Centers
● Medications would be a resource for the client and the therapist to support the client
when taking medication. Support the client and monitor their behavior and changes
while they take this step. Medication such as Buprenorphine- controlling withdrawal
symptoms and blocking cravings. Methadone- is a long-acting medication that reduces
cravings and withdrawal symptoms. It can block the euphoric effects of short-acting
opioids, such as heroin. Naltrexone- blocks the ability of opioids to eliminate pain and
induce euphoria. Medications, counseling, and related conditions. SAMHSA.(n.d)

15. References
American Psychiatric Association. (2013). DSM-5 Criteria for Diagnosis of Opioid Use Disorder. IT MATTTRs Colorado. Retrieved
April 13, 2023, from https://www.asam.org/docs/default-source/education-docs/dsm-5-dx-oud-8-28-2017.pdf
Association, A. P. (2022). DSM-5-TR(tm) Classification (5th-TR ed.). American Psychiatric Publishing.
Community Service Board. (2018, April). Signs of opioid use | Community Services Board. fairfaxcounty.gov. Retrieved April 9, 2023,
from https://www.fairfaxcounty.gov/community-services-board/heroin-opioids/signs-of-opioid-use
Facing addiction in america - NCBI bookshelf. (n.d.). Retrieved April 13, 2023, from
https://www.ncbi.nlm.nih.gov/books/NBK424857/
Fairfax County Government. (2017, July 27). Know the Signs of Heroin & Opioid Use [Video]. YouTube. Retrieved April 10, 2023,
from https://www.youtube.com/watch?v=NN_ZsXydqMA
Generes, W. M. (2022, October 21). Motivational interviewing in addiction treatment. American Addiction Centers. Retrieved April 13,
2023, from https://americanaddictioncenters.org/therapy-treatment/motivational-interviewing

16. References
Gladden RM, Martinez P, Seth P. Fentanyl law enforcement submissions and increases in synthetic opioid-Involved overdose deaths –
27 states, 2013-2014. Morb Mortal Wkly Rep. 2016;65(33):837-43.
Medications, counseling, and related conditions. SAMHSA. (n.d.). Retrieved April 13, 2023, from
https://www.samhsa.gov/medications-substance-use-disorders/medications-counseling-related-conditions
National Library of Medicine. (n.d.). Opioid Misuse and Addiction. medlineplus.gov. Retrieved April 12, 2023, from
https://medlineplus.gov/opioidmisuseandaddiction.html
Nurse uses digital tablet while talking with patient stock photo. (n.d.). In iStick.
https://www.istockphoto.com/photo/nurse-uses-digital-tablet-while-talking-with-patient-gm1189419527-336786929 Photo
Stock ID: 1189419527
Passik, S. D. (2009). Issues in Long-term Opioid Therapy: Unmet Needs, Risks, and Solutions. Mayo Clinic Proceedings, 84(7),
593–601. https://doi.org/10.1016/s0025-6196(11)60748-9

17. References
Psych Hub. (2020, January 7). Opioid Withdrawal [Video]. YouTube. Retrieved April 10, 2023, from
https://www.youtube.com/watch?v=2M6jkWutyh0
PsychotherapyNet. (2019, February 13). Motivational Interviewing for Adolescent Substance Use [Video]. YouTube.
https://www.youtube.com/watch?v=K-zJme3RTzM
Simple Practice. (2023, January 23). How to Write a SOAP Note. simplepractice.com. Retrieved April 13, 2023, from
https://www.simplepractice.com/resource/how-to-write-soap-notes/?utm_source=google&utm_medium=cpc&network=x&utm_
campaign=PMAX_Features_Client_Portal&utm_term=&device=c&matchtype=&gclid=EAIaIQobChMI-Y-uxu6n_gIVVSs4Ch
3Owg3VEAAYASAAEgKiZvD_BwE
Stages of change model. School of Medicine. (n.d.). Retrieved April 12, 2023, from
https://medicine.llu.edu/academics/resources/stages-change-model#:~:text=The%20Stages%20of%20Change&text=Contemplat
ion%20(Acknowledging%20that%20there%20is,Maintenance%20(Maintaining%20the%20behavior%20change)

18. References
Thomas, S. (2023, February 2). Motivational interviewing for substance abuse. Drug Rehab Options. Retrieved April 13, 2023, from
https://rehabs.com/motivational-interviewing-whats-the-process/
TED-Ed. (2020, May 7). What causes opioid addiction, and why is it so tough to combat? - Mike Davis [Video]. YouTube. Retrieved
April 9, 2023, from https://www.youtube.com/watch?v=V0CdS128-q4
Yoshioka Mora, G. (n.d.). SOWK 655 Week 6 Treatment Team Presentation on Specific Approaches to Treatment by Addiction. In
umassglobal.blackboard.com/. University Of Massachusetts Global. Retrieved April 8, 2023, from
https://umassglobal.blackboard.com/webapps/blackboard/content/listContent.jsp?course_id=_296915_1&content_id=_1317405
1_1&mode=reset
Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2021.
Available at http://wonder.cdc.gov.