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Enabling and intervention_final


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Education Track, National Rx Drug Abuse Summit, April 2-4, 2013. Enabling and Intervention presentation by Karen Perry and Dominique Simon-Levin

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Enabling and intervention_final

  1. 1. Enabling  and  Interven/on   Karen  Perry    Co-­‐Founder,  Execu/ve  Director,  NOPE   Task  Force   Dominique  Simon-­‐Levine   Director,  Allies  in  Recovery    
  2. 2. Learning  Objec/ves    1.  Analyze  two  effec/ve  advocacy  programs  and   the  current  trends  of  Rx  drug  abuse.  2.   Describe  CRAFT  procedures  to  increase  the   chance  of  a  loved  one  entering  treatment.  3.  Describe  the  methods  for  engaging  a  loved   one  to  seek  help.  
  3. 3. Disclosure  Statement  •  Karen  Perry  has  no  financial  rela/onships  with   proprietary  en//es  that  produce  health  care   goods  and  services.    •  Dominique  Simon-­‐Levine  has  no  financial   rela/onships  with  proprietary  en//es  that   produce  health  care  goods  and  services.    
  4. 4. Enabling  and  Interven/on   Karen  H.  Perry   Co-­‐Founder   Execu;ve  Director  
  5. 5. Richard  Perry   Age  21  
  6. 6. Richard  Perry   Age  21  
  7. 7. Na/onal  Overdose  Sta/s/cs    •  28,578  uninten/onal  fatal  drug  poisonings  (2009)  •  In  2009,  approximately  1.2  Million  Emergency  Room   visits  for  non  medical  use  of  pharmaceu/cals.    •  Research  indicates  an  es/mated  6  people  will  be   directly  affected  by  each  sudden  loss,  which  equates   to  171,468  people  annually  
  8. 8. Current  Trends      •  Every  day,  2,000  teens  in  the   United  States  try  prescrip/on   drugs  to  get  high  for  the  first   /me  •  60%  of  teens  who  have  abused   prescrip/on  painkillers,  did  so   before  the  age  of  15  •  45%  of  those  who  use  prior  to   the  age  of  15,  will  later  develop   an  addic/on  which  also   increases  the  chance  for   overdose.    
  9. 9. Successful  Community  Partnerships  •  Assess  the  Local  Community  •  Forming  Partnerships  •  Plan  and  Set  Goals  •  Implement    
  10. 10. Community  Partnerships    •  Law  Enforcement  •  Medical  Examiner  •  Community  Government  •  Medical  Professionals  •  Treatment  Providers  •  Educa/onal  Ins/tu/ons  •  Legislators  •  Family  Members  
  11. 11. Assess  Local  Community   Partnership  with  Palm  Beach  County  Sheriff  Office  •  Majority  died  from  a   •  Highest  spikes  occur   combina/on  of  drugs   between  ages  of  18-­‐30  an  •  Prescrip/on  drugs  were   50-­‐60   found  in  majority  of   •  At  least  one  third  of   deaths   vic/ms  has  suffered  a  •  Majority  of  deaths   previous  non-­‐fatal   someone  was  with  in   overdose   earshot  of  vic/m  •  Majority  of  vic/ms  were   Caucasian  male  
  12. 12. NOPE  Task  Force™  a  501c-­‐3  non-­‐profit   Mission  To  reduce  the  frequency  and  impact  of  drug  overdose  death  through:    • Community  Educa/on    • Family  Support    •   Purposeful  Advocacy  
  13. 13. Plan  and  Set  Goals    •  Reduce  early  onset  of  substance  use.  •  Empower  youth  to  become  peer    advocates  Increase  knowledge  of  parents  and  community  members.  •  Reduce  the  number  of  drug  overdose  deaths.    
  14. 14. Preven/on  &  Educa/on   Presenta/ons  •  Middle  &  High  Schools  •  Universi/es  •  Parents  &  Communi/es  •  Treatment  and  Correc/onal   ins/tu/ons  •  Health  Care  Professionals  
  15. 15. Student  Presenta/ons   TOPICS  OF  DISCUSSION   RELATED  NOPE  TAG  LINES  1.  Addic/on   •  Be  the  Hero-­‐Tell  Someone  ®  2.  Combining  Drugs  =  Overdose   •  One  Time  Can  Kill  ®  3.  Make  the  Call!  Dial  911   •  Make  the  Call!  Dial  911  ®  4.    Passed  out=  Medical   •  Some/mes  You  Never  Sleep  It   Emergency   Off  ®  
  16. 16. Parent  Presenta/on  4  Components:  •  Impact  on  family  •  Underage  drinking  •  Current  trends  •  Paren/ng  strategies  
  17. 17. Follow  Up    •  ASK  ADAM  &  AMY  •  Interac/ve  Website  •  Publica/ons    •  Student  Cer/fica/on   and  Life  Choices   Scholarship    
  18. 18. Efficacy    Empirical  support  indicates  par/cipants  show:    •  Change  in  knowledge  •  Change  in  aktudes   towards  drug    Lynn  University  Research   Boca  Raton,  FL    
  19. 19. Awareness  •  Na/onal  Candle  Light   Vigil  •  Interac/ve  Website  •  Social  media  •  Prescrip/on  Drug  Take   Back  •  Advocates  for  legisla/ve   change  
  20. 20. Advocate  for  Legisla/on  •  Be  informed  of  local   issues  and  poten/al   bills    •  Create  tool  kit  for   community  partners  •  Inform  partners  of   upcoming  bills    
  21. 21. Family  Support  •  Treatment  Support  •  ASK  ADAM  •  Support  Groups  •  Interac/ve  Website  •  Publica/ons    
  22. 22. NOPE  Task  Force’s  Accomplishments  •  11  Chapters  across  Florida     •  Florida  Prescrip/on  Drug  •  Over  120,000  students   Monitoring  Program  passed   receiving  our  evidence   and  ac/ve   based  message  annually   •  Good  Samaritan  911  Law  •  Over  50  loca/ons  hos/ng   passed     Candle  Light  Vigils  Annually  
  23. 23. Partners    •  Office  of  Na/onal  Drug  Control  Policy   •  Mar/n  County  Sheriff’s  Office  •  Florida  Office  of  the  Anorney  General     •  Okeechobee  County  Sheriff’s  Office  •  The  Florida  Sheriff’s  Associa/on   •  Palm  Beach  County  Sheriff’s  Office  •  The  Florida  Police  Chiefs  Associa/on   •  Palm  Beach  County  State  Anorney    •  Florida  Coali/on  Alliance   •  Pinellas  County  Sheriff’s  Office  •  Safe  and  Drug  Free  Schools   •  St.  Lucie  County  Sheriff’s  Office  •  Caron  Center   •  Sarasota  County  Sheriff’s  Office  •  Hanley  Center   •  Seminole  County  Sheriff’s  and    •  Lynn  University   municipal  law  enforcement  agencies  •  Flagler  County  Sheriff’s  Office   •  Volusia  County  Sheriff’s  Office  •  Hillsborough  County  Sheriff’s  Office  •  Indian  River  County  Sheriff’s  Office  
  24. 24. NOPE  Task  Force   866-­‐612-­‐NOPE   Karen  Perry  
  25. 25.  Enabling  and  Interven;on   When  Love  Isn’t  Enough…  CRAFT  (Community  Reinforcement  and  Family  Training)   Dominique  Simon-­‐Levine,  PhD   April  2  –  4,  2013   Omni  Orlando  Resort     at  ChampionsGate  
  26. 26. Learning  Objec;ves  1.  Understand  specific  CRAFT  procedures  (eg.  reinforcement  strategies,  allowing  natural  consequences)  to  increase  the  chance  that  the  Loved  One  will  enter  treatment.  2.  Understand  the  methods  for  engaging  a  Loved  One  to  seek  help.  3.    Review  the  science  behind  CRAFT.  
  27. 27. Disclosure  Statement  Dominique  Simon-­‐Levine  has  no  financial  rela/onships  with  proprietary  en//es  that  produce  health  care  goods  and  services.  
  28. 28. CRAFT  is  driven  by  the  principles  of  classical  behavioralism.  Dolphins  do  it,  dogs  do  it,  people  do  it…  
  29. 29. Control vs Influence: !Control   Influence  •  Demand,  dominate,   •  Request,  provide  resources,  you   manipulate   are  a  mirror  “what  do  you  want  to   do?”  •  “No”  leads  to  guil/ng,   •  “No”  leads  to  disappointment  and   anger,  shaming,   provides  informa/on   resentment  •  Power  over     •  Power  with,  it’s  a  partnership  “Use  and  you’re  out  of   “Please  do  not  come  home  if  you’ve  here.”     been  using.    You’re  welcome  back   when  you  straighten  up.”  
  30. 30. The  Essen/al  Skill  Set:  CRAFT  1.    Safety,  de-­‐escala/on  2.  Posi/ve  communica/on  3.  What  to  do  when  your  LO  is  not  using,  right  now  4.  What  to  do  when  your  LO  is  using,  right  now  5.  How  to  handle  the  hard  emo/ons  6.  How  to  get  your  LO  into  treatment  
  31. 31. CRAFT  happens  in  the  moment  …  the  world  divides  in  two.      •    How  you  respond  when  you  see  use  •    How  you  respond  when  you  don’t  see  use  
  32. 32. When  you  see  use,  disable  the  enabling  …  1)  Remove  the  rewards.  2)  Remove  yourself  in  a  quiet  neutral  way.    3)  Allow  natural  consequences,  if  safe  to  do  so.      .    
  33. 33. When  you  don’t  see  use….*!+REWARD+!*  4  Characteris/cs    pleasurable  to  your  LO    free  or  affordable      can  be  given  immediately      something  you  are  willing  to  give  4  Types  Stuff:  like  a  video  game  or  /x  to  a  ball  game  or  a  favorite  food.  Verbal  comments:  “It  really  saves  me  /me  when  you  take  out  the  trash.  Non  verbal  behaviors:  eye  contact  or  a  pat  on  the  back.    Ac;vi;es:  a  back  rub,  a  walk  to  the  corner  for  ice  cream.  
  34. 34. How  do  I  get  my  Loved  One  into  treatment?  •  You  create  that  bridge  between  the  two  of  you.    •  You  empathize  and  show  respect.      •  You  stop  the  nega/ve  talk,  add  in  posi/ve  talk,  and  listen    to  what  your  LO  is  saying.      •  You  make  requests.    You  don’t  dominate.      •  You  take  care  of  yourself,  which  helps  you  stay  calm    and  pa/ent.      •  You  understand  that  gekng  sober  and  clean  is  a  process.      
  35. 35.  You  have  treatment  in  your  back  pocket.     Treatment  defined  broadly:  public,  private,  self-­‐help,    faith-­‐based..  Windows  of  Opportunity  1)  A  wish  or  a  dip…Change  Talk,  there’s  mo/va/on  in  this.  2)  The  planned  conversa/on.    A  serious  moment  around  the  table.  3)  When  LO  talks  of  gekng  help.   Script  it  out.  Avoid  jargon  and  words  like  alcoholic,  drug  addict,    treatment…     Rehearse  it.   Prepare  for  refusal.  
  36. 36. Sandy’s  Tea  Party  I  hate  that  I  don’t  want  to  have  sex  with  you.    Only  recently  has  there  been  any  closeness  at  all.    I  don’t  want  any  more  weekends  like  the  last  one.    We  aren’t  enjoying  each  other.    I  think  we’re  both  isolated  and  lonely.    I  want  us  connected  again.    I  want  you.    That  isn’t  possible  with  your  drinking.    Come  see  me.  I  have  a  list  of  places  that  help  professionals  who  have  problems  with  drinking.    Will  you  take  a  look  at  it  with  me?  
  37. 37. Controlled  Trial   130  family  members  assigned  to  1  of  3  interven/ons  "   Al-­‐Anon  Facilita/on  therapy  "   Johnson  Ins/tute  Interven/on  "   CRAFT      "   Loved  Ones  are  all  alcoholic  
  38. 38. Family  Member  Depression  (Becks)  
  39. 39. Sisson & Miller, CRAFT  STUDIES   Kirby, et al., Meyers, Meyers, Waldron, Dutcher, et Manual, etAzrin Meyers, et 1999 Miller, et al., Miller, et al., et. al., 2007 al., 1999 al., 20111986 al., 1999 1999 2002 adolescent Group vs Self- Directed14 CSOs 130 CSOs 32 CSOs 62 CSOs 90 CSOs 42 CSOs 99 CSOs 40 CSOs 75% Anglo 80% 49% 48% 59% 60% Anglo 23% AA Hispanic Hispanic Hispanic HispanicAlcohol Alcohol 55% 37% Coca MJ MJ Alcohol Drugs/ Cocaine 35% MJ Cocaine Alcohol 90% Alcohol 22% 16% Stim Stimulants Cocaine opiates 8% opiate 7%Randomized Randomized Randomized Non- Randomized Non- Non- Craft in(CRAFT vs (CRAFT/JI (CRAFT vs Randomized Randomized Randomized Group vs12 Step) /12-step 12-step) Self- Directed86% vs 64% 74% vs 74% 65.5% vs 71% 55%-65% 70%0% vs23% 17% CSOs 29% CSOs CSOs vs 40%CSOs vs13% CSOs Better CSOs Better Better BetterBetter CSOs Better Better Better
  40. 40. Other  Outcomes  from  Clinical  Trials  "  CRAFT-­‐engaged  Loved  Ones  most  owen   anend  6  sessions  of  outpa/ent  treatment  as   compared  to  NM  state  modal  of  1.  "  Loved  Ones  reduce  their  use  by  50%  while   family  member  is  in  CRAFT  
  41. 41. CRAFT  Resources  Dr.  Robert  Meyers,  William  Miller,  Jane  Ellen  Smith,  University  of  New  Mexico,  Center  on  Alcoholism,  Substance  Abuse,  and  Addic/ons    HBO  film  on  CRAFT  hnp://  Dominique  Simon-­‐Levine